Cervical pessary vs vaginal progesterone for prevention of preterm birth in women with twin pregnancy and short cervix: economic analysis following randomized controlled trial

OBJECTIVE:To compare the cost-effectiveness of cervical pessary vs vaginal progesterone to prevent preterm birth and neonatal morbidity in women with twin pregnancy and a short cervix. METHODS:Between 4 March 2016 and 3 June 2017, we performed this economic analysis following a randomized controlled trial (RCT), performed at My Duc Hospital, Ho Chi Minh City, Vietnam, that compared cervical pessary to vaginal progesterone in women with twin pregnancy and cervical length < 38 mm between 16 and 22 weeks of gestation. We used morbidity-free neonatal survival as a measure of effectiveness. Data on pregnancy outcome, maternal morbidity and neonatal complications were collected prospectively from medical files; additional information was obtained via telephone interviews with the patients. The incremental cost-effectiveness ratio was calculated as the incremental cost required to achieve one extra surviving morbidity-free neonate in the pessary group compared with in the progesterone group. Probabilistic and one-way sensitivity analyses were also performed. RESULTS:During the study period, we screened 1113 women with twin pregnancy, of whom 300 fulfilled the inclusion criteria of the RCT and gave informed consent to participate. These women were assigned randomly to receive cervical pessary (n = 150) or vaginal progesterone (n = 150), with two women and one woman, respectively, being lost to follow-up. The rate of morbidity-free neonatal survival was significantly higher in the pessary group compared with the progesterone group (n = 241/296 (81.4%) vs 219/298 (73.5%); relative risk, 1.11 (95% CI, 1.02-1.21), P = 0.02). The mean total cost per woman was 3146 € in the pessary group vs 3570 € in the progesterone group (absolute difference, -424 € (95% CI, -842 to -3 €), P = 0.048). The cost per morbidity-free neonate was significantly lower in the pessary group compared with that in the progesterone group (2492 vs 2639 €; absolute difference, -147 € (95% CI, -284 to 10 €), P = 0.035). CONCLUSION:In women with twin pregnancy and a short cervix, cervical pessary improves significantly the rate of morbidity-free neonatal survival while reducing costs, as compared with vaginal progesterone. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.K. D. Le, L. K. Nguyen, L. T. M. Nguyen, B. W. J. Mol, V. Q. Dan

Phytophthora stem rot of purple passionfruit in Vietnam

In August 2012 a severe stem rot (stem canker) disease was observed in a purple-fruit variety of passionfruit, Passiflora edulis, in Nghe An province, Vietnam. The stem rot progressed rapidly along the stem affecting branches and fruit, leading to chlorosis, wilting and death of the distal part of the stem. It did not progress below the graft junction into the stem or roots of the rootstock, Passiflora edulis var. flavicarpa. The disease spread within and between plantings causing 100 % loss of some plantings. Phytophthora nicotianae was consistently isolated from diseased tissue and the morphological identification was confirmed by sequencing, and two cultures were deposited in the Murdoch University Culture Collection as MUCC707 and MUCC708. The former culture proved pathogenic in stem inoculations and P. nicotianae was reisolated fulfilling Koch’s postulates. This report represents a new record of Phytophthora stem rot of purple passionfruit in Vietnam

Long-Term Heavy Metal Retention by Mangroves and Effect on Its Growth: A Field Inventory and Scenario Simulation

The ability of mangroves in taking up and storing heavy metal (HM) helps in reducing HM pollution. However, HMs likewise adversely affect the growth of mangroves. We assess the effects of the long-term soil HMs enrichment on the growth of Rhizophora apiculata forest in the Can Gio Mangrove Forest (Southern Vietnam) in different environmental conditions of soil salinity, ground elevation, and tree density based on a novel set of measured data. These data were analyzed and were used to calibrate and validate for a tree growth model with influencing factors salinity, elevation, tree density, and heavy metals content. Three scenario simulations were performed to predict the mangrove dynamics under different levels of heavy metal pollution in combined environmental conditions of salinity and elevation. Simulation results show the decline of total forest biomass from 1,750,000 tons (baseline scenario with no HM pollution) down to 850,000 tons and 350,000 tons for the current HM pollution and double HM pollution scenarios, respectively. Both data analysis and simulations have shown that although mangroves can assist in reducing HM pollution, the quality and health of this ecosystem will be severely affected if the environment is excessively polluted. In addition, a data-and-model driven management tool is devised for the sustainable management of the mangrove environmental resources

Whole transcriptome analysis identifies differentially regulated networks between osteosarcoma and normal bone samples

We performed whole transcriptome analysis of osteosarcoma bone samples. Initially, we sequenced total RNA from 36 fresh-frozen samples (18 tumoral bone samples and 18 non-tumoral paired samples) matching in pairs for each osteosarcoma patient. We also performed independent gene expression analysis of formalin-fixed paraffin-embedded samples to verify the RNAseq results. Formalin-fixed paraffin-embedded samples allowed us to analyze the effect of chemotherapy. Data were analyzed with DESeq2, edgeR and Reactome packages of R. We found 5365 genes expressed differentially between the normal bone and osteosarcoma tissues with an FDR below 0.05, of which 3399 genes were upregulated and 1966 were downregulated. Among those genes, BTNL9, MMP14, ABCA10, ACACB, COL11A1, and PKM2 were expressed differentially with the highest significance between tumor and normal bone. Functional annotation with the reactome identified significant changes in the pathways related to the extracellular matrix degradation and collagen biosynthesis. It was suggested that chemotherapy may induce the modification of ECM with important collagen biosynthesis. Taken together, our results indicate that changes in the degradation of extracellular matrix seem to be an important mechanism of osteosarcoma and efficient chemotherapy induces the genes related to bone formation

Micronized progesterone plus dydrogesterone versus micronized progesterone alone for luteal phase support in frozen-thawed cycles (MIDRONE): a prospective cohort study

Study Question: Does the addition of oral dydrogesterone to vaginal progesterone as luteal phase support improve pregnancy outcomes during frozen embryo transfer (FET) cycles compared with vaginal progesterone alone? Summary Answer: Luteal phase support with oral dydrogesterone added to vaginal progesterone had a higher live birth rate and lower miscarriage rate compared with vaginal progesterone alone. What is Known Already: Progesterone is an important hormone that triggers secretory transformation of the endometrium to allow implantation of the embryo. During IVF, exogenous progesterone is administered for luteal phase support. However, there is wide inter-individual variation in absorption of progesterone via the vaginal wall. Oral dydrogesterone is effective and well tolerated when used to provide luteal phase support after fresh embryo transfer. However, there are currently no data on the effectiveness of luteal phase support with the combination of dydrogesterone with vaginal micronized progesterone compared with vaginal micronized progesterone after FET. Study Design Size, Duration: Prospective cohort study conducted at an academic infertility center in Vietnam from 26 June 2019 to 30 March 2020. Participants/Materials, Settings, Methods: We studied 1364 women undergoing IVF with FET. Luteal support was started when endometrial thickness reached 8 mm. The luteal support regimen was either vaginal micronized progesterone 400 mg twice daily plus oral dydrogesterone 10 mg twice daily (second part of the study) or vaginal micronized progesterone 400 mg twice daily (first 4 months of the study). In women with a positive pregnancy test, the appropriate luteal phase support regimen was continued until 7 weeks’ gestation. The primary endpoint was live birth after the first FET of the started cycle, with miscarriage <12 weeks as one of the secondary endpoints. Main Results and the Role of Chance: The vaginal progesterone + dydrogesterone group and vaginal progesterone groups included 732 and 632 participants, respectively. Live birth rates were 46.3% versus 41.3%, respectively (rate ratio [RR] 1.12, 95% CI 0.99–1.27, P¼0.06; multivariate analysis RR 1.30 (95% CI 1.01–1.68), P¼0.042), with a statistically significant lower rate of miscarriage at <12 weeks in the progesterone + dydrogesterone versus progesterone group (3.4% versus 6.6%; RR 0.51, 95% CI 0.32–0.83; P¼0.009). Birth weight of both singletons (2971.0§628.4 versus 3118.8§559.2 g; P¼0.004) and twins (2175.5§494.8 versus 2494.2§584.7; P¼0.002) was significantly lower in the progesterone plus dydrogesterone versus progesterone group. Limitations, Reasons for Caution: The main limitations of the study were the open-label design and the non-randomized nature of the sequential administration of study treatments. However, our systematic comparison of the two strategies was able to be performed much more rapidly than a conventional randomized controlled trial. In addition, the single ethnicity population limits external generalizability. Wider Implications of the Findings: Our findings study suggest a role for oral dydrogesterone in addition to vaginal progesterone as luteal phase support in FET cycles to reduce the miscarriage rate and improve the live birth rate. Carefully planned prospective cohort studies with limited bias could be used as an alternative to randomized controlled clinical trials to inform clinical practice.Lan N. Vuong, Toan D. Pham, Khanh T.Q. Le, Trung T. Ly, Ho L. Le, Diem T.N. Nguyen, Vu N.A. Ho, Vinh Q. Dang, Tuan H. Phung, Robert J. Norman, Ben W. Mol, and Tuong M. H

Whole transcriptome analysis to reveal differentially expressed genes between paired osteosarcoma and normal bone samples

Background: In present study we performed whole transcriptome analysis of bone samples of 18 osteosarcoma patients confirmed with histology and we compared the result of tumoral to non-tumoral samples from the same patient. We sequenced total RNA from 36 samples (18 tumoral bone samples and 18 non-tumoral bone samples) matching in pairs for each osteosarcoma patient. Methods: We extracted RNA from 18 tumor normal paired osteosarcoma fresh bone samples. RNAseq data were analyzed with DESeq2 and Reactome packages of R. Results: We found 6775 genes expressed differentially between the normal bone and osteosarcoma tissues. The differential expression had FDR corrected statistical significance below 0.1. 4092 genes were up-regulated and 2683 were down-regulated. Among those genes, BTNL9, MMP14, ABCA10, ACACB, COL11A1 and PKM2 were expressed differentially with the highest significance between tumor and normal bone. Functional annotation with the Reactome identified significant changes in the pathways related to the extracellular matrix degradation and collagen biosynthesis. Activation of PKM2 indicates the Warburg effect in tumor tissues. Conclusions: We identified differential expression of 6775 genes between the normal and osteosarcoma tissues with very high confidence. The up-regulation of COL family genes (COL11A1, COL2A1, COL10A1, COL3A1, COL6A1) with interaction with some others indicates the changes in the regulation of the synthesis and degradation of collagen and extracellular matrix that seems to be an important mechanism of osteosarcoma

Two new and potentially highly threatened Megophrys Horned frogs (Amphibia: Megophryidae) from Indochina’s highest mountains

Megophrys are a group of morphologically conserved, primarily forest-dependent frogs known to harbour cryptic species diversity. In this study, we examined populations of small-sized Megophrys from mid- and high elevation locations in the Hoang Lien Range, northern Vietnam. On the basis of morphological, molecular and bioacoustic data, individuals of these populations differed from all species of Megophrys known from mainland Southeast Asia north of the Isthmus of Kra and from neighbouring provinces in China. Further, the newly collected specimens formed two distinct species-level groups. We herein describe two new species, Megophrys fansipanensis sp. nov. and Megophrys hoanglienensis sp. nov. Both new species are range restricted and likely to be highly threatened by habitat degradation. These discoveries highlight the importance of the Hoang Lien Range for Vietnam’s amphibian diversity

A metabolic model for members of the genus Tetrasphaera involved in enhanced biological phosphorus removal

Members of the genus Tetrasphaera are considered to be putative polyphosphate accumulating organisms (PAOs) in enhanced biological phosphorus removal (EBPR) from wastewater. Although abundant in Danish full-scale wastewater EBPR plants, how similar their ecophysiology is to ‘Candidatus Accumulibacter phosphatis’ is unclear, although they may occupy different ecological niches in EBPR communities. The genomes of four Tetrasphaera isolates (T. australiensis, T. japonica, T. elongata and T. jenkinsii) were sequenced and annotated, and the data used to construct metabolic models. These models incorporate central aspects of carbon and phosphorus metabolism critical to understanding their behavior under the alternating anaerobic/aerobic conditions encountered in EBPR systems. Key features of these metabolic pathways were investigated in pure cultures, although poor growth limited their analyses to T. japonica and T. elongata. Based on the models, we propose that under anaerobic conditions the Tetrasphaera-related PAOs take up glucose and ferment this to succinate and other components. They also synthesize glycogen as a storage polymer, using energy generated from the degradation of stored polyphosphate and substrate fermentation. During the aerobic phase, the stored glycogen is catabolized to provide energy for growth and to replenish the intracellular polyphosphate reserves needed for subsequent anaerobic metabolism. They are also able to denitrify. This physiology is markedly different to that displayed by ‘Candidatus Accumulibacter phosphatis’, and reveals Tetrasphaera populations to be unusual and physiologically versatile PAOs carrying out denitrification, fermentation and polyphosphate accumulation