Abstract Background Viet Nam has one of the world’s most diverse hepatitis C virus (HCV) epidemics, dominated by genotype 6. Understanding pre-treatment resistance-associated substitutions (RASs) particularly in under-studied genotype 6 is essential to protect cure rates and guide national elimination strategies. We aimed to evaluate the landscape of viral diversity and baseline drug resistance in Vietnam. Methods We utilized whole-genome sequencing to analyze HCV isolates from a cohort of 1,649 patients enrolled in six clinical studies in Viet Nam between 2013 and 2023. The study assessed genotype and subtype distribution, associations with demographic and clinical variables, and prevalence of known and putative RASs in NS3, NS5A, and NS5B relevant to DAAs used in Viet Nam. Findings Phylogenetic analysis revealed that genotype 6 was dominant (50.3%, 829/1,649). We observed distinct geographical and demographic partitioning: genotype 2 was concentrated in the south and associated with older age and HIV co-infection, while genotype 3 was clustered in the north among younger males. Clinically relevant RASs were detected in 37.9% (617/1,630) of patients, with the highest burden in NS5A region. Genotypes 2 and 3 displayed near-universal intrinsic resistance. Among genotype 6 infections, subtype 6a frequently carried L28F mutation (43.3%, 181/418), whereas subtype 6e remained largely susceptible. Interpretation Viet Nam is characterized by a complex, genotype 6-predominant HCV epidemic with significant reservoirs of natural resistance. The high-level resistance mutations in genotypes 2 and 3 suggests that “pan-genotypic” regimens may face efficacy gaps, highlighting the need for subtype-level molecular surveillance to guide national treatment policies.

Background Hepatitis C remains a leading cause of liver disease worldwide, and access to Direct-Acting Antiviral (DAA) treatment remains limited in many settings. Alternative treatment strategies that require fewer tablets and clinical visits could help improve equitable access, and new approaches have recently been found to be non-inferior in producing sustained viral suppression. Methods We did a cost-minimization analysis of alternative treatment options for non-cirrhotic patients evaluated in the VIETNARMS trial (ISRCTN61522291), conducted between 19/06/2020 and 10/05/2023 in Vietnam. These were: (i) ‘response guided’ (which adjusts treatment duration based on 1-week viral load); (ii) ‘induction maintenance’ (which reduces the dosing frequency in later weeks of treatment); and (iii) ‘Peg-IFN + DAA’ (4 weeks of DAAs combined with four weekly doses of PEGylated interferon (Peg-IFN)). The primary outcome was the cost per cure. A disaggregated societal perspective was adopted, including stratification for the healthcare provider and patient costs. Findings The three alternative treatment strategies were projected to have lower costs per cure than standard 12-week DAA treatment in the base-case scenario: US$202 (15%) less for ‘response guided’, US$234 (18%) less for ‘induction maintenance’, and US$163 (12%) less for ‘Peg-IFN + DAA’. However, the potential for cost savings, and which strategy had the lowest cost per cure, depended on the assumed cost of DAA drugs: the strategy with the lowest cost per cure was generally ‘induction maintenance’ when DAA drug costs for a standard treatment course were under US$1000, but Peg-IFN + DAA when DAA costs exceeded US$1500. In some scenarios, lower costs per cure were achieved through reduced health system expenditures, despite increased costs to patients. Interpretation Alternative strategies for Hepatitis C treatment could reduce costs for providers and patients. As this is highly dependent on the variable costs of DAAs, approaches should be fit carefully to the prevailing context. Funding Wellcome Trust, Medical Research Council.

Adjunctive corticosteroids such as dexamethasone are recommended in tuberculous meningitis treatment, despite modest and heterogeneous survival benefit. Leukotriene A4 hydrolase (LTA4H) genotypes associate with distinct intracerebral inflammatory phenotypes and may determine corticosteroid response in tuberculous meningitis, with benefit observed in hyperinflammatory TT genotype but uncertain benefit in lower inflammation CC and CT genotypes. Here, in a phase 3, placebo-controlled trial of human immunodeficiency virus-negative Vietnamese adults with tuberculous meningitis, we randomized 613 LTA4H CC- and CT-genotype participants to 6–8 weeks of dexamethasone or placebo, aiming to show noninferiority of placebo (hazard ratio margin of 0.75) or its superiority. Given the significant survival benefit of dexamethasone previously seen in LTA4H TT-genotype individuals, TT-genotype participants all received open-label dexamethasone and were not randomized. A total of 89 TT-genotype participants received open-label dexamethasone. In CC- and CT-genotype participants, the primary endpoint of all-cause death or new neurological event over 12 months from randomization occurred in 108/305 (35.4 NCT03100786 ). In this phase 3 trial, human immunodeficiency virus-negative Vietnamese adults with tuberculous meningitis were stratified by LTA4H genotype to assess whether this influences corticosteroid response. However, outcomes were not significantly better according to genotype.

Novel clade 2.3.2.1e A(H5N1) virus was detected in cerebrospinal fluid but not in respiratory, rectal swab, or blood samples of an 8-year-old boy presenting with meningoencephalitis without respiratory symptoms. Cerebrospinal fluid A(H5N1) hemagglutinin-specific antibody levels were higher than those of sera. Clinicians should be aware of emerging clade 2.3.2.1e A(H5N1)-associated meningoencephalitis.

Background Viet Nam has one of the world's most diverse hepatitis C virus (HCV) epidemics, dominated by genotype 6. Understanding pre-treatment resistance-associated substitutions (RASs) particularly in under-studied genotype 6 is important for informing resistance surveillance and supporting national HCV elimination strategies. We aimed to evaluate the landscape of viral diversity and baseline RASs relevant to currently used direct-acting antivirals (DAAs) in Viet Nam. Methods We utilised whole-genome sequencing to analyse HCV isolates from a cohort of 1649 treatment-naïve patients enrolled in six clinical studies in Viet Nam between 2013 and 2023. The study assessed genotype and subtype distribution, associations with demographic and clinical variables, and prevalence of known and putative RASs in NS3, NS5A, and NS5B relevant to DAAs used in Viet Nam. Findings Phylogenetic analysis revealed that genotype 6 was dominant (50.3%, 829/1649). We observed distinct geographical and demographic partitioning: genotype 2 was concentrated in the south and associated with older age and HIV co-infection, while genotype 3 was clustered in the north among younger males. Clinically relevant RASs were detected in 37.9% (617/1630) of patients, with the highest burden in NS5A region. Genotypes 2 and subtype 3b demonstrated a high prevalence of subtype-specific polymorphisms occurring at previously reported resistance-associated positions. Among genotype 6 infections, subtype 6a frequently carried L28F mutation (43.3%, 181/418), whereas subtype 6e demonstrated a low prevalence of previously reported clinical RASs. Interpretation Viet Nam is characterised by a complex, genotype 6-predominant HCV epidemic with substantial subtype-specific baseline resistance diversity. The high prevalence of subtype-defining polymorphisms observed in several genotype 2 and subtype 3b lineages highlights the importance of continued molecular surveillance and may have implications for optimisation of DAA regimen selection and resistance monitoring strategies within highly diverse HCV populations. Funding Wellcome Trust.

Sốt xuất huyết Dengue (SXH-D) là bệnh truyền nhiễm gây dịch do virus Dengue gây nên. Virus Dengue có 4 týp huyết thanh là DEN-1, DEN-2, DEN-3 và DEN-4. Virus truyền từ người bệnh sang người lành do muỗi đốt. Muỗi Aedes aegypti là côn trùng trung gian truyền bệnh chủ yếu. Tại Việt Nam, bệnh xảy ra quanhnăm, thường gia tăng vào mùa mưa, gặp ở cả trẻ em và người lớn. SXH-D có thể diễn tiến cấp tính, dẫn đến sốc giảm thể tích tuần hoàn, rối loạn đông máu, suy tạng, đe dọa tính mạng và tử vong.Trong thời gian gần đây, dịch bệnh có xu hướng diễn biến phức tạp trên thế giới và Việt Nam, số ca ghi nhận hàng năm đều rất cao và có xu hướng tăng, trong đó có một số lượng lớn ca mắc không được báo cáo đầy đủ. Tính chất chu kỳ dịch SXH-D thay đổi do nhiều yếu tố: Tác động của biến đổi khí hậu, đô thị hóa, nềnnhiệt độ trung bình tăng dần, gia tăng di chuyển trong nước và quốc tế.Vắc xin TAK-003 phòng sốt xuất huyết Dengue đã được chứng minh về hiệu lực bảo vệ và tính an toàn thông qua nghiên cứu đáp ứng các tiêu chuẩn của Tổ chức Y tế Thế giới. Tại Việt Nam, vắc xin TAK-003 đã được cấp phép và chỉ định sử dụng cho người từ 4 tuổi trở lên.Các chuyên gia Hội Truyền nhiễm Việt Nam đồng thuận về gánh nặng bệnh tật của SXH-D tại Việt Nam, dịch tễ bệnh phức tạp và có xu hướng gia tăng. Hội Truyền nhiễm Việt Nam khuyến cáo dự phòng chủ động bằng vắc xin ngừa sốt xuất huyết Dengue (TAK-003) cho người từ 4 tuổi trở lên, không yêu cầu xét nghiệm đánh giá tình trạng phơi nhiễm trước đó, nhấn mạnh việc triển khai cần đảm bảo an toàn, tiếp tục cập nhật và bổ sung dữ liệu về hiệu lực, hiệu quả và an toàn của vắc xin TAK-003 trên thế giới.

The retrieval of entailing legal article sets aims to identify a concise set of legal articles that holds an entailment relationship with a legal query or its negation. Unlike traditional information retrieval that focuses on relevance ranking, this task demands conciseness. However, prior research has inadequately addressed this need by employing traditional methods. To bridge this gap, we propose a three-stage Retrieve-Revise-Refine framework which explicitly addresses the need for conciseness by utilizing both small and large language models (LMs) in distinct yet complementary roles. Empirical evaluations on the COLIEE 2022 and 2023 datasets demonstrate that our framework significantly enhances performance, achieving absolute increases in the macro F2 score by 3.17% and 4.24% over previous state-of-the-art methods, respectively. Specifically, our Retrieve stage, employing various tailored fine-tuning strategies for small LMs, achieved a recall rate exceeding 0.90 in the top-5 results alone-ensuring comprehensive coverage of entailing articles. In the subsequent Revise stage, large LMs narrow this set, improving precision while sacrificing minimal coverage. The Refine stage further enhances precision by leveraging specialized insights from small LMs, resulting in a relative improvement of up to 19.15% in the number of concise article sets retrieved compared to previous methods. Our framework offers a promising direction for further research on specialized methods for retrieving concise sets of entailing legal articles, thereby more effectively meeting the task's demands.

BACKGROUND:WHO recommends treating hepatitis C infection with one of three antiviral combinations for 8-12 weeks. No randomised trials have compared these regimens, and high cure rates might be achievable with shorter durations of therapy. We aimed to compare sofosbuvir-daclatasvir with sofosbuvir-velpatasvir, and to evaluate potential novel treatment strategies. METHODS:We conducted a multi-arm, open-label, randomised controlled non-inferiority trial in two public hospitals in Viet Nam. Adults (aged ≥18 years) with chronic hepatitis C infection and mild-to-moderate liver fibrosis were eligible. Recruitment was stratified by centre and viral genotype (1-5 vs 6) with 1:1 random allocation to an oral fixed-dose combination of sofosbuvir 400 mg plus daclatasvir 60 mg (sofosbuvir-daclatasvir) or sofosbuvir 400 mg plus velpatasvir 100 mg (sofosbuvir-velpatasvir). Participants were simultaneously factorially randomly assigned to one of four treatment strategies: 12 weeks' standard of care (SOC); 4 weeks' therapy with four weekly PEGylated interferon alfa-2a subcutaneous injections; induction and maintenance therapy with 2 weeks' standard therapy followed by 10 weeks' therapy 5 days a week; and response-guided therapy (RGT) for 4, 8, or 12 weeks determined by viral load on day 7. The primary outcome was sustained virological response (SVR) 12 weeks after treatment completion, analysed in all evaluable participants regardless of actual treatment received. We chose a 5% non-inferiority margin for the drug comparison, and a 10% non-inferiority margin for the treatment strategy comparisons. Safety was assessed in all randomised participants. This trial is registered with ISRCTN, 61522291, and is completed. FINDINGS:Between June 19, 2020, and May 10, 2023, 624 participants were randomised (470 [75%] were male and 154 [25%] were female). 296 (47%) had genotype 6 and 328 (53%) had genotypes 1-5. The primary outcome was assessable in 609 (98%) participants. SVR occurred in 294 (97%) of 302 participants in the sofosbuvir-daclatasvir group and 292 (95%) of 307 participants in the sofosbuvir-velpatasvir group (risk difference 2·2%, 90% credible interval [CrI] -0·2 to 4·8, within the 5% non-inferiority margin; 93% probability that sofosbuvir-daclatasvir is superior to sofosbuvir-velpatasvir). SVR occurred in 148 (99%) of 150 in the SOC group, 143 (94%) of 152 in the 4-week antiviral plus interferon group (-4·5%, 90% CrI -8·3 to -1·3), 151 (99%) of 152 in the induction-maintenance group (0·6%, -1·1 to 2·7), and 144 (93%) of 155 in the RGT group (-5·7%, -9·6 to -2·3); all risk differences were within the 10% non-inferiority margin. Serious adverse events were rare (11 [4%] of 313 participants in the sofosbuvir-velpatasvir group vs six [2%] of 311 in the sofosbuvir-daclatasvir group; risk difference -1·6% [95% CrI -4·2 to 0·8]) with no evidence of differences between regimens or strategies, but adverse reactions were very common in the 4-week antiviral plus interferon group compared with the other treatment strategies (risk difference vs SOC group, 66·8% [59·2 to 74·0]; p<0·0001). INTERPRETATION:Sofosbuvir-daclatasvir was non-inferior to sofosbuvir-velpatasvir. High efficacy was seen with novel strategies, which might help to inform approaches to treatment for harder-to-reach populations. FUNDING:Wellcome Trust.

NMDAR-antibody encephalitis can arise as a post-infectious 'relapse' following HSV encephalitis. We asked whether a similar condition might occur after Japanese Encephalitis (JE). Cell-based assays for antigen-specific antibodies and IgG binding to the surface of live hippocampal neurons were performed on 13 CSFs and 65 sera, many sampled longitudinally, from 34 Vietnamese children with JE. Three month outcomes were scored according to a pediatric post-encephalitis scale; clinical features focussed on new onset symptoms during the follow-up, blinded to antibody results. Ten/34 children (29 %) had serum antibodies against known neuronal-surface antigens, 4 NMDAR, 4 CASPR2, 1 GABAAR and 1 LGI1, detected from day 23 after onset. In addition, 8/10 (80 %) of these children and 13/24 (54 %) others had antibodies that bound in a distinctive pattern to live hippocampal neurons (HN-Abs), four detected on days 9-12. A relapse was only considered possible in 5 patients, two with specific neuronal surface antibodies (NSAbs). Neither specific NSAbs (p = 1.00) nor HN-Abs (p = 1.00).were more common in patients with possible relapse than in those with unlikely relapse. There was a modest trend towards worse outcome scores in patients with known NSAbs than in the remaining patients (p = 0.089). Antibodies to neuronal surface proteins, known and unknown, are common in children after JE. Caution is urged in defining post-infectious autoimmune encephalitis on the basis of a positive neuronal antibody and new onset symptoms or deterioration following recovery from JE, or in initiating immunotherapy without confirmatory evidence of a time-dependent encephalitic illness defined by published guidelines.

In 2022, we established a residual sample serosurveillance program in Ho Chi Minh City, Vietnam. During September 2022-April 2024, we found low measles antibody seroprevalence in children in the city's western region, where a measles outbreak began in May 2024. Serosurveillance could be a useful tool for outbreak prediction and prevention.

INTRODUCTION:The pathognomonic feature of dengue shock syndrome (DSS) is a transient capillary leak syndrome resulting in profound intravascular volume depletion. WHO management guidelines recommend particular parenteral fluid regimens during the critical leakage phase, including synthetic colloid solutions in certain circumstances. We set out to describe the actual fluid management strategies employed in different settings and to investigate relationships with clinical outcomes. METHODS:We performed a retrospective review of paediatric DSS cases managed at seven hospitals across Malaysia, Myanmar and Vietnam. We explored the effects of both initial resuscitation (crystalloid alone or mixed crystalloid/colloid in the first 2 hours) and general management: group 1 (conservative-colloid, crystalloid only), group 2 (intermediate-colloid, colloid for 1-4 hours) or group 3 (liberal-colloid, continuous colloid for more than 4 hours) categorised according to the fluid given over the first 6 hours in clinically stable patients. We incorporated an inverse probability weighting score to adjust for potential differences in baseline severity. RESULTS:Among all 691 patients, respiratory compromise (HR 2.08, p=0.022), requirement for nasal continuous positive airway pressure (NCPAP)/ventilation (OR 2.34, p<0.045) and days in hospital after DSS onset (risk ratio, RR 1.33, p=0.032) were significantly worse for mixed crystalloid/colloid versus crystalloid-only initial resuscitation regimens, after adjusting for baseline severity. Among the 547/691 children who stabilised within 2 hours, although a liberal-colloid general management strategy (group 3) was associated with a reduction in recurrent shock episodes (RR 0.13, p=0.043) when compared with a conservative-colloid strategy (group 1), the risks for respiratory compromise (OR 8.84, p<0.001) and requirement for NCPAP/ventilation (OR 8.16, p<0.001) were markedly increased. Additionally, the respective costs for group 3 vs group 1 were significantly higher. CONCLUSIONS:The study highlights the potential benefits and risks of using colloid solutions in children with DSS. Formal randomised trials could help determine the most effective and safe parenteral fluid regimens for paediatric DSS. In the meantime, prolonged use of colloid solutions may be inappropriate, especially in settings without access to respiratory support.

Abstract Background Diagnosis of tuberculous meningitis (TBM) is hampered by the lack of a gold standard. Current microbiological tests lack sensitivity and clinical diagnostic approaches are subjective. We therefore built a diagnostic model that can be used before microbiological test results are known. Methods We included 659 individuals aged $$\ge 16$$ ≥ 16 years with suspected brain infections from a prospective observational study conducted in Vietnam. We fitted a logistic regression diagnostic model for TBM status, with unknown values estimated via a latent class model on three mycobacterial tests: Ziehl–Neelsen smear, Mycobacterial culture, and GeneXpert. We additionally re-evaluated mycobacterial test performance, estimated individual mycobacillary burden, and quantified the reduction in TBM risk after confirmatory tests were negative. We also fitted a simplified model and developed a scoring table for early screening. All models were compared and validated internally. Results Participants with HIV, miliary TB, long symptom duration, and high cerebrospinal fluid (CSF) lymphocyte count were more likely to have TBM. HIV and higher CSF protein were associated with higher mycobacillary burden. In the simplified model, HIV infection, clinical symptoms with long duration, and clinical or radiological evidence of extra-neural TB were associated with TBM At the cutpoints based on Youden’s Index, the sensitivity and specificity in diagnosing TBM for our full and simplified models were 86.0% and 79.0%, and 88.0% and 75.0% respectively. Conclusion Our diagnostic model shows reliable performance and can be developed as a decision assistant for clinicians to detect patients at high risk of TBM. Summary Diagnosis of tuberculous meningitis is hampered by the lack of gold standard. We developed a diagnostic model using latent class analysis, combining confirmatory test results and risk factors. Models were accurate, well-calibrated, and can support both clinical practice and research.

Liver injury with marked elevation of aspartate aminotransferase enzyme (AST) is commonly observed in dengue infection. To understand the pathogenesis of this liver damage, we compared the plasma levels of hepatic specific, centrilobular predominant enzymes (glutamate dehydrogenase, GLDH; glutathione S transferase-α, αGST), periportal enriched 4-hydroxyphenylpyruvate dioxygenase (HPPD), periportal predominant arginase-1 (ARG-1), and other non-specific biomarkers (paraoxonase-1, PON-1) in patients with different outcomes of dengue infection. This hospital-based study enrolled 87 adult dengue patients, stratified into three groups based on plasma AST levels (< 80, 80-400, > 400 U/L) in a 1:1:1 ratio (n = 40, n = 40, n = 40, respectively. The new liver enzymes in the blood samples from the 4th to 6th days of their illness were measured by commercial enzyme-linked immunosorbent assay (ELISA) or colorimetric kits. Based on the diagnosis at discharge days, our patients were classified as 40 (46%) dengue without warning signs (D), 35 (40.2%) dengue with warning signs (DWS), and 11 (12.6%) severe dengue (SD) with either shock (two patients) or AST level over 1000 U/L (nine patients), using the 2009 WHO classification. The group of high AST (> 400 U/L) also had higher ALT, GLDH, ARG-1, and HPPD than the other groups, while the high (> 400 U/L) and moderate (80-400 U/L) AST groups had higher ALT, αGST, ARG-1, and HPPD than the low AST group (< 80 U/L). There was a good correlation between AST, alanine aminotransferase enzyme (ALT), and the new liver biomarkers such as GLDH, αGST, ARG-1, and HPPD. Our findings suggest that dengue-induced liver damage initiates predominantly in the centrilobular area toward the portal area during the dengue progression. Moreover, these new biomarkers should be investigated further to explain the pathogenesis of dengue and to validate their prognostic utility.

We studied post-pandemic T-cell responses to five distantly related sarbecoviruses, possessing human ACE2 binding properties (SAR-CoV-1 and 2, pangolin coronavirus GX-P4L, and bat coronaviruses RSYN04 and Khosta2), and MERS-CoV. We used peripheral blood mononuclear cells samples collected before and after vaccination from health care workers in the UK and Vietnam. Strong T-cell responses to all the tested sarbecoviruses were observed in samples collected post vaccination only, with a mixture of CD4+ and CD8+ T-cells responses. There was a strong correlation between the level of T-cell responses and the degree of sequence homology. Very limited cross reactivity was observed for MERS-CoV. Collectively, we showed that post-pandemic T-cell responses cross-recognise human ACE2-dependent sarbecoviruses. The data thus suggest there may be partial protection from the post-pandemic T-cell response landscape against sarbecoviruses that have the potential to cause spillover. Our findings should be used to inform the developments and deployment of countermeasures against sarbecoviruses.

Nghiên cứu cắt ngang mô tả đánh giá kích thước trung bình răng hàm sữa thứ hai (RHSII) bên trái hàm trên và dưới của nhóm trẻ từ 4 đến 6 tuổi tại Hà Nội, sử dụng máy quét 3D. Từ đó so sánh độ tương đồng giữa kích thước RHSII đo được của nhóm trẻ trên với kích thước của chụp thép tiền chế GNI và Shinhung nhằm ứng dụng trên lâm sàng giúp bác sĩ có thể lựa chọn kích thước chụp phù hợp và bảo tồn răng sữa. Kết quả nghiên cứu cho thấy: Kích thước trung bình của RHSII trên trẻ nam lớn hơn trẻ nữ, đặc biệt ở là kích thước chiều gần-xa của RHSII hàm dưới (nam: 10,57 ± 0,44mm, nữ: 10,13 ± 0,56mm) và chiều cao của RHSII hàm trên (nam: 4,78 ± 0,46mm; nữ: 4,32 ± 0,55mm) (p<0,05). Dựa theo kích thước trung bình của RHSII, đối với trẻ nam bác sĩ lâm sàng có thể ưu tiên chọn cỡ chụp thép GNI tương ứng là cỡ 4 cho hàm trên và cỡ 5 cho hàm dưới. Đối với trẻ nữ, cỡ chụp thép GNI ưu tiên· với RHSII là cỡ 4 cho cả hàm trên và dưới. Đối với hệ chụp Shinhung, cỡ chụp ưu tiên cho RHSII ở hai hàm trên - dưới lần lượt là 3 và 4 ở giới nữ, 4 và 5 ở giới nam.

Mục tiêu: Đánh giá tác động dài hạn của chương trình quản lý sử dụng kháng sinh tại Bệnh viện Bệnh Nhiệt đới TPHCM bằng mô hình giả lập. Đối tượng và phương pháp: Đối tượng nghiên cứu của đề tài là chương trình quản lý sử dụng kháng sinh tại Bệnh viện Bệnh Nhiệt đới TPHCM giai đoạn 2016 – 2018 (pASP) và 2018 – 2020 (nASP). Kết quả: Kết quả từ mô hình giả lập cho thấy, LOT/1.000 ngày nằm viện và DOT/1.000 ngày nằm viện có sự chêch lệch giữa 2 chương trình nhưng sự chêch lệch này không quá 1 đơn vị. Giai giai đoạn nASP cho hiệu quả cao hơn về số đợt nhiễm khuẩn và số lần đổi kháng sinh. Chi phí điều trị của mỗi ca bệnh nội trú trong giai đoạn nASP thấp hơn giai đoạn pASP (14.393.915 VND so với 15.954.576 VND) và tổng chi phí điều trị của các ca bệnh nếu áp dụng nASP trong 5 năm sẽ tiết kiệm 38.902.432.416 VND so với pASP. Kết luận: Nghiên cứu đã mở ra hướng ứng dụng mô hình giả lập để đối sánh, lựa chọn các phương án quản lý tối ưu trong hoạt động quản lý bệnh viện nói chung và hoạt động quản lý sử dụng kháng sinh nói riêng.

The legal domain presents unique challenges in information processing, given the complexity and specificity of legal texts. Addressing these challenges, this work leverages breakthroughs in Large Language Models (LLMs) to push the boundaries in legal information extraction and entailment. Our approaches involve the integration of LLMs in the COLIEE 2024 competition across four tasks: Legal Case Retrieval (Task 1), Legal Case Entailment (Task 2), Statute Law Retrieval (Task 3), and Legal Textual Entailment (Task 4). In Task 1, we employ a two-stage strategy that combines keyword-based retrieval using BM25 with a sophisticated MonoT5 reranker fine-tuned on legal datasets. For Task 2, we further adapt MonoT5, incorporating hard negative sampling. For Task 3, we introduce a novel strategy that utilizes LLMs to enhance the performance of high-recall predictions from smaller language models, an approach we also adapt for Task 2. To address Task 4, we employ an ensemble of LLMs’ predictions, adjudicated via majority voting and the Dawid-Skene label model. Our strategies take advantage of the strengths of each model, with prompting techniques and constraints applied to exploit ensemble advantages. Consequently, we have achieved the top-ranked performance in Task 3 and secured promising outcomes in Tasks 1, 2, and 4. This paper describes our methodologies, offering insights into how integrating LLMs into legal information systems can significantly enhance their efficacy in tackling complex legal documents.

The Competition on Legal Information Extraction/Entailment (COLIEE) is held annually to encourage advancements in the automatic processing of legal texts. Processing legal documents is challenging due to the intricate structure and meaning of legal language. In this paper, we outline our strategies for tackling Task 2, Task 3, and Task 4 in the COLIEE 2023 competition. Our approach involved utilizing appropriate state-of-the-art deep learning methods, designing methods based on domain characteristics observation, and applying meticulous engineering practices and methodologies to the competition. As a result, our performance in these tasks has been outstanding, with first places in Task 2 and Task 3, and promising results in Task 4. Our source code is available at https://github.com/Nguyen2015/CAPTAIN-COLIEE2023/tree/coliee2023.