BackgroundMinimally invasive mitral valve surgery is becoming a gold standard and provides many advantages for patients. A learning curve is required for a surgeon to become proficient, and the exact number to overcome this curve is controversial. Our study aimed to define this number for mitral valve surgery in general, for replacement and repair separately.MethodsA total of 204 mitral valve surgeries were performed via the right minithoracotomy approach from October 2014 to January 2019 by a single surgeon who isexperienced in conventional mitral valve surgery. Learning curves were analysed based on the trend of important variables (cross-clamp time, CPB time, ventilation time, ICU time, composite technical failure) over time, and the number of operations required was calculated by CUSUM method.ResultsMIMVS provided an excellent outcome in the carefully selected patients, with low mortality of 0.5% and low rate of complications. The decreasing trend of the important variables were observed over the years and as the cumulative number of procedures increased. The number of operations required to overcome the learning curve was 75 to 100 cases. When considered separately, the quantity for mitral valve replacement was 60 cases, whereas valve repair necessitated at least 90 cases to have an acceptable technical complication rate.ConclusionMIMVS is an excellent choice for mitral valve surgery. However, this approach required a long learning curve for a surgeon who is experienced in conventional mitral valve surgery.Trial registrationThe research was registered and approved by the ethical board of the University of Medicine and Pharmacy at Ho Chi Minh City, number 141/DHYD-HDDD, on April 11th 2018.

''Twinning'' refers to a constructive partnership between hospitals in developed and developing nations. Such an effort may contribute immensely to capacity building for the developing nation, but one of the reasons given for the lack of sustainability is cost. We share a detailed operating cost analysis of our recent experience with an institution in Vietnam. We were awarded a 1-year $54,000 grant from the Vietnam Education Foundation (VEF) to conduct a live tele-video conferencing course on the ''Fundamentals of Clinical Surgery'' with Thai Binh Medical University (TBMU). In-country lectures as well as an assessment of the needs at TBMU were performed. Total financial assistance and expenditures were tabulated to assess up-front infrastructure investment and annual cost required to sustain the program. The total amount of direct money ($66,686) and in-kind services ($70,276) was $136,962. The initial infrastructure cost was $41,085, which represented 62% of the direct money received. The annual cost to sustain the program was approximately $11,948. We concluded that the annual cost to maintain a ''twinning'' program was relatively low, and the efforts to sustain a ''twinning'' program were financially feasible and worthwhile endeavors. ''Twinning'' should be a critical part of the surgical humanitarian volunteerism effort.

Nowadays, Vietnam is known as a developing country with a fast-growing economy. Agriculture is the main traditional sector which plays an important role in Vietnamese economic growth and development. Improving the efficiency of agricultural production towards sustainable development is one of the country’s national economic development goals. This study aims to measure the efficiency of the orange farms which have created jobs and improved living standards for people in Tuyen Quang province, Vietnam. A comprehensive literature review, key informant interviews, and a structured questionnaire were applied in this research for data collection. The data envelopment analysis (DEA) model was applied to evaluate the technical, allocative, cost, and scale efficiencies. The main results of this analysis show that the orange farms have high scores for technical and scale efficiencies. On the other hand, the research reveals low levels of cost and allocative efficiencies. This is in line with the fact that though the farms’ owners have extensive experience in orange cultivation and receive periodic technical training, they still have low levels of education and a lack of economic management expertise. The study results also propose optimal input allocation for the orange farmers. The research could provide crucial information to farms’ owners, the local government, and agricultural planners for formulating effective strategies to improve agricultural sustainability.