Objectives: The purpose of this study was to examine the influence of the local Vietnamese government initiative, the ‘invisible healthcare system’, on the activities of Organization A, which focuses on oral health projects. Methods: Since 2000, Organization A has conducted preventive care and oral health-focused activities in central Vietnam, with formal and informal interventions from local Vietnamese governments. This study conducts an in-depth analysis of the relationship between local Vietnamese governments and oversea non-government organizations (NGOs) from the perspective of the recipient country. Results: First, the initial step involves aligning intentions with the local Vietnamese government through negotiations, such as reaching agreements on the operation of oral health programs. Second, efforts should be made to understand the implicit aspects of Vietnamese policies regarding oversea NGO activities. For instance, it can be the People’s Aid Coordination Committee (PACCOM), which has a policy to manage oversea NGOs. The policies of PACCOM inherently reflect an ‘invisible healthcare system’ and a ‘nationalist-oriented character’. Conclusions Finally, oversea NGO activities in Vietnam increasingly require a focus on ‘localization’and ‘Vietnamization’ to effectively achieve the desired outcomes.

Objectives: The purpose of this study was to examine the influence of the local Vietnamese government initiative, the ‘invisible healthcare system’, on the activities of Organization A, which focuses on oral health projects. Methods: Since 2000, Organization A has conducted preventive care and oral health-focused activities in central Vietnam, with formal and informal interventions from local Vietnamese governments. This study conducts an in-depth analysis of the relationship between local Vietnamese governments and oversea non-government organizations (NGOs) from the perspective of the recipient country. Results: First, the initial step involves aligning intentions with the local Vietnamese government through negotiations, such as reaching agreements on the operation of oral health programs. Second, efforts should be made to understand the implicit aspects of Vietnamese policies regarding oversea NGO activities. For instance, it can be the People’s Aid Coordination Committee (PACCOM), which has a policy to manage oversea NGOs. The policies of PACCOM inherently reflect an ‘invisible healthcare system’ and a ‘nationalist-oriented character’. Conclusions Finally, oversea NGO activities in Vietnam increasingly require a focus on ‘localization’and ‘Vietnamization’ to effectively achieve the desired outcomes.

Objectives: The purpose of this study was to examine the influence of the local Vietnamese government initiative, the ‘invisible healthcare system’, on the activities of Organization A, which focuses on oral health projects. Methods: Since 2000, Organization A has conducted preventive care and oral health-focused activities in central Vietnam, with formal and informal interventions from local Vietnamese governments. This study conducts an in-depth analysis of the relationship between local Vietnamese governments and oversea non-government organizations (NGOs) from the perspective of the recipient country. Results: First, the initial step involves aligning intentions with the local Vietnamese government through negotiations, such as reaching agreements on the operation of oral health programs. Second, efforts should be made to understand the implicit aspects of Vietnamese policies regarding oversea NGO activities. For instance, it can be the People’s Aid Coordination Committee (PACCOM), which has a policy to manage oversea NGOs. The policies of PACCOM inherently reflect an ‘invisible healthcare system’ and a ‘nationalist-oriented character’. Conclusions Finally, oversea NGO activities in Vietnam increasingly require a focus on ‘localization’and ‘Vietnamization’ to effectively achieve the desired outcomes.

Objectives: The purpose of this study was to examine the influence of the local Vietnamese government initiative, the ‘invisible healthcare system’, on the activities of Organization A, which focuses on oral health projects. Methods: Since 2000, Organization A has conducted preventive care and oral health-focused activities in central Vietnam, with formal and informal interventions from local Vietnamese governments. This study conducts an in-depth analysis of the relationship between local Vietnamese governments and oversea non-government organizations (NGOs) from the perspective of the recipient country. Results: First, the initial step involves aligning intentions with the local Vietnamese government through negotiations, such as reaching agreements on the operation of oral health programs. Second, efforts should be made to understand the implicit aspects of Vietnamese policies regarding oversea NGO activities. For instance, it can be the People’s Aid Coordination Committee (PACCOM), which has a policy to manage oversea NGOs. The policies of PACCOM inherently reflect an ‘invisible healthcare system’ and a ‘nationalist-oriented character’. Conclusions Finally, oversea NGO activities in Vietnam increasingly require a focus on ‘localization’and ‘Vietnamization’ to effectively achieve the desired outcomes.

Background/Aims: Combination immunotherapy, exemplified by atezolizumab plus bevacizumab, has become the standard of care for inoperable hepatocellular carcinoma (HCC). However, the lack of predictive biomarkers and limited understanding of response mechanisms remain a challenge. Methods: Using data from the IMbrave150plus cohort, we applied an immune signature score (ISS) predictor to stratify HCC patients treated with atezolizumab plus bevacizumab or with sorafenib alone into potential high and low response groups. By applying multiple statistical approaches including a Bayesian covariate prediction algorithm, we refined the signature to 10 key genes (ISS10) for clinical use while maintaining similar predictive power to the full model. We further validated ISS10 in an independent HCC cohort treated with nivolumab plus ipilimumab. Results: The study identified a significant association between the ISS and treatment response. Among patients classified as high responders, those treated with the atezolizumab plus bevacizumab combination exhibited improved overall and progression-free survival as well as better objective response rate compared to those treated with sorafenib. We also observed a significant correlation between ISS10 and response to nivolumab plus ipilimumab treatment. Analysis of immune cell subpopulations revealed distinct characteristics associated with ISS subtypes. In particular, the ISS10 high subtype displayed a more favorable immune environment with higher proportions of antitumor macrophages and activated T-cells, potentially explaining its better response. Conclusions Our study suggests that ISS and ISS10 are promising predictive biomarkers for enhanced therapeutic outcomes in HCC patients undergoing combination immunotherapy. These markers are crucial for refining patient stratification and personalized treatment approaches to advance the effectiveness of standard-of-care regimens.

Background: It is well known that a large number of patients with diabetes also have dyslipidemia, which significantly increases the risk of cardiovascular disease (CVD). This study aimed to evaluate the efficacy and safety of combination drugs consisting of metformin and atorvastatin, widely used as therapeutic agents for diabetes and dyslipidemia. Methods: This randomized, double-blind, placebo-controlled, parallel-group and phase III multicenter study included adults with glycosylated hemoglobin (HbA1c) levels >7.0% and <10.0%, low-density lipoprotein cholesterol (LDL-C) >100 and <250 mg/dL. One hundred eighty-five eligible subjects were randomized to the combination group (metformin+atorvastatin), metformin group (metformin+atorvastatin placebo), and atorvastatin group (atorvastatin+metformin placebo). The primary efficacy endpoints were the percent changes in HbA1c and LDL-C levels from baseline at the end of the treatment. Results: After 16 weeks of treatment compared to baseline, HbA1c showed a significant difference of 0.94% compared to the atorvastatin group in the combination group (0.35% vs. −0.58%, respectively; P<0.0001), whereas the proportion of patients with increased HbA1c was also 62% and 15%, respectively, showing a significant difference (P<0.001). The combination group also showed a significant decrease in LDL-C levels compared to the metformin group (−55.20% vs. −7.69%, P<0.001) without previously unknown adverse drug events. Conclusion The addition of atorvastatin to metformin improved HbA1c and LDL-C levels to a significant extent compared to metformin or atorvastatin alone in diabetes and dyslipidemia patients. This study also suggested metformin’s preventive effect on the glucose-elevating potential of atorvastatin in patients with type 2 diabetes mellitus and dyslipidemia, insufficiently controlled with exercise and diet. Metformin and atorvastatin combination might be an effective treatment in reducing the CVD risk in patients with both diabetes and dyslipidemia because of its lowering effect on LDL-C and glucose.

Background/Aims: A poor prognostic factor for Crohn’s disease (CD) includes perianal fistulizing disease, including perianal fistula and/or perianal abscess. Currently, a tool to assess perianal symptoms in patients with CD remains nonexistent. This study aimed to develop a perianal fistulizing disease self-screening questionnaire for patients with CD. Methods: This prospective pilot study was conducted at three tertiary referral centers between January 2019 and May 2020. We formulated questions on perianal symptoms, including tenesmus, anal discharge, bleeding, pain, and heat. A 4-point Likert scale was used to rate each question. Patients with CD completed a questionnaire and underwent pelvic magnetic resonance imaging (MRI). Results: Overall, 93 patients were enrolled, with 51 (54.8%) diagnosed with perianal fistulizing disease, as determined by pelvic MRI. The Spearman correlation findings demonstrated that anal pain (p = 0.450, p < 0.001) and anal discharge (p = 0.556, p < 0.001) were the symptoms that most significantly correlated with perianal disease. For anal pain and discharge, the area under the receiver operating characteristic curve of the scores was significantly higher than that of the combined score for all five symptoms (0.855 vs. 0.794, DeLong’s test p = 0.04). For the two symptoms combined, the sensitivity, specificity, and positive predictive and negative predictive values were 88.2, 73.8, 80.4, and 83.8%, respectively, with 81.7% accuracy for detecting perianal fistulizing disease. Conclusions This study indicates that simple questions regarding anal pain and discharge can help accurately identify the presence of perianal fistulizing disease in patients with CD.