Safety and efficacy of fluoxetine on functional outcome after acute stroke (AFFINITY): a randomised, double-blind, placebo-controlled trial

Background Trials of fluoxetine for recovery after stroke report conflicting results. The Assessment oF FluoxetINe In sTroke recoverY (AFFINITY) trial aimed to show if daily oral fluoxetine for 6 months after stroke improves functional outcome in an ethnically diverse population. Methods AFFINITY was a randomised, parallel-group, double-blind, placebo-controlled trial done in 43 hospital stroke units in Australia (n=29), New Zealand (four), and Vietnam (ten). Eligible patients were adults (aged ≥18 years) with a clinical diagnosis of acute stroke in the previous 2–15 days, brain imaging consistent with ischaemic or haemorrhagic stroke, and a persisting neurological deficit that produced a modified Rankin Scale (mRS) score of 1 or more. Patients were randomly assigned 1:1 via a web-based system using a minimisation algorithm to once daily, oral fluoxetine 20 mg capsules or matching placebo for 6 months. Patients, carers, investigators, and outcome assessors were masked to the treatment allocation. The primary outcome was functional status, measured by the mRS, at 6 months. The primary analysis was an ordinal logistic regression of the mRS at 6 months, adjusted for minimisation variables. Primary and safety analyses were done according to the patient's treatment allocation. The trial is registered with the Australian New Zealand Clinical Trials Registry, ACTRN12611000774921. Findings Between Jan 11, 2013, and June 30, 2019, 1280 patients were recruited in Australia (n=532), New Zealand (n=42), and Vietnam (n=706), of whom 642 were randomly assigned to fluoxetine and 638 were randomly assigned to placebo. Mean duration of trial treatment was 167 days (SD 48·1). At 6 months, mRS data were available in 624 (97%) patients in the fluoxetine group and 632 (99%) in the placebo group. The distribution of mRS categories was similar in the fluoxetine and placebo groups (adjusted common odds ratio 0·94, 95% CI 0·76–1·15; p=0·53). Compared with patients in the placebo group, patients in the fluoxetine group had more falls (20 [3%] vs seven [1%]; p=0·018), bone fractures (19 [3%] vs six [1%]; p=0·014), and epileptic seizures (ten [2%] vs two [<1%]; p=0·038) at 6 months. Interpretation Oral fluoxetine 20 mg daily for 6 months after acute stroke did not improve functional outcome and increased the risk of falls, bone fractures, and epileptic seizures. These results do not support the use of fluoxetine to improve functional outcome after stroke

NĂNG LỰC TRÍ TUỆ CỦA HỌC SINH LỨA TUỔI TIỂU HỌC TẠI TỈNH BÌNH ĐỊNH

A research on 6.514 primary-school pupils including 3.298 schoolboys and 3.216 schoolgirls from the age of 6 to 10 in three ecological areas: urban, rural and mountainous areas in Binh Dinh Province revealed that the intelligence quotation and memory of the children increase gradually with age. The intelligence quotation of children from 6 to 10 years of age is 87.46; 96.77; 102.95; 107.54; and 110,81 points, respectively. On average, it increases by 5.86 points or 6,67 % per year. Short-term memory by sight and hearing increases with age. Children from the age of 6 to 10 can memorize visually better than aurally, therefore, visual teaching method should be strengthened in primary education. The development of intellectual abilities of children is different when the pupils live in various ecological areas with the urban pupils having the best values. This shows that the environment has an influence on the development of children’s thinking.Kết quả nghiên cứu 6.514 học sinh tiểu học, trong đó có 3.298 nam và 3.216 nữ độ tuổi 6–10 thuộc ba khu vực thành thị, nông thôn và miền núi tại tỉnh Bình Định cho thấy chỉ số thông minh và trí nhớ của trẻ tăng dần theo tuổi. Chỉ số thông minh của trẻ từ 6 đến 10 tuổi lần lượt là 87,46; 96,77; 102,95; 107,54 và 110,81 điểm; trung bình mỗi năm tăng 5,86 điểm hay 6,67 %. Trí nhớ ngắn hạn thị giác và thính giác tăng dần theo tuổi. Trẻ 6 đến 10 tuổi có khả năng ghi nhớ bằng mắt tốt hơn bằng tai nên cần tăng cường phương pháp trực quan trong dạy học ở bậc tiểu học. Ở các khu vực sinh thái khác nhau, sự phát triển trí tuệ của trẻ khác nhau, học sinh vùng thành thị có sự phát triển năng lực trí tuệ tốt nhất trong ba khu vực. Điều này cho thấy sự ảnh hưởng của môi trường sống đối với sự phát triển tư duy của trẻ

Current status of Helicobacter pylori resistance to clarithromycin and levofloxacin in Vietnam: Results from molecular analysis of gastric biopsy specimens

Objectives: The management of Helicobacter pylori in Vietnam is becoming progressively more difficult due to increasing antibiotic resistance, particularly to clarithromycin (CLR) and levofloxaxin (LVX). In Vietnam, the selection of an H. pylori eradication regimen is predominantly based on empirical evidence. However, molecular analysis aimed at identifying H. pylori antibiotic-resistant genotypes is a promising method in antibiotic susceptibility testing. In this study, we aimed to determine the rates of genotypic H. pylori resistance to CLR and LVX by using DNA strip technology in Vietnam. Methods: We performed DNA-strip technology-based testing on 112 patients with H. pylori-positive gastroduodenal diseases to detect 23S rRNA and gyrA mutations. Results: Helicobacter pylori genotypic resistance to CLR and LVX was evident in 81.3% and 53.6% of the patients, respectively, and dual resistance was observed in 48.2%. The 23S rRNA A2142G and A2143G mutations accounted for 1.8% and 79.5% of cases, respectively. The gyrA N87K, D91N, D91G, and D91Y mutations were present in 37.5%, 11.6%, 5.4%, and 5.4% of patients, respectively. All four gyrA mutations were observed in both the naïve and failure patients. We further found an association between the 23S rRNA A2143G mutation and a history of CLR use as well as between the gyrA N87K mutation and a history of LVX use. Conclusions: We found a very high prevalence of H. pylori resistance to CLR and LVX and dual resistance to these antibiotics in Vietnam. The application of molecular assays is feasible and may improve the management of H. pylori infection in Vietnam

The prevalence of malnutrition based on anthropometry among primary schoolchildren in Binh Dinh province, Vietnam in 2016

Objective: The study was conducted to determine the prevalence of malnutrition based on anthropometry among primary schoolchildren in Binh Dinh province, Vietnam. Material and Methods: This was a school-based cross-sectional survey using random sample technique with multistage process. Variables in malnutrition were classifed as thinness, stunting, underweight, overweight, and obesity based on z-scores according to the World Health Organization (WHO) (2007). Anthropometric measurements were taken according to WHO’s standard procedures. The Chi-square test was used to compare prevalences and the Chi-square test for trend was employed to assess the trend of the prevalence of malnutrition forms by age. Results: 6,514 pupils from 6 to 10 years old including 3,298 males and 3,216 females were observed. The prevalence of thinness, stunting, underweight, overweight and obesity among schoolchildren accounted for 11.19%, 6.16%, 10.79%, and 30.1%, respectively. The prevalence of underweight and that of overweight-obesity of all pupils at the age of 6 were 13.1% and 32.11%, respectively, and tended to decrease to age 10 (p &lt; 0.01). The prevalence of thin and stunted pupils had little sign of change over ages (p &gt; 0.05). There was a statistically significant difference in the prevalence of malnutrition in three areas of Binh Dinh (p &lt; 0.05), in which the highest prevalence of undernutrition was in mountainous area and midland, and the highest prevalence of overweight-obesity was in urban areas. Conclusion: The prevalence of malnutrition of primary schoolchildren in Binh Dinh was relatively high, in which the prevalence of overweight-obesity was rather high in urban areas and the prevalence of undernutrition was pretty high in mountainous area and midland. This study has characterized an important public health challenge, highlighting the need for attention to potential interventions

The description, distribution and habitat of wild banana species in northern Viet Nam.

Northern Viet Nam displays a remarkable diversity of wild bananas ( L.) including the species from which the majority of cultivated bananas derive. The taxonomy and exact distribution of these wild bananas are however not well known, limiting their conservation and use. In the present study, we describe the morphology, ecology, and phytogeography of the 6 species that were collected between 2016 and 2019 in northern Viet Nam: Colla, Colla, Cheesman, N.S.Ly &amp; Haev, R.V.Valmayor, L.D.Danh and Hakkinen and A.Z.Liu and D.Z.Li:. Of these, was the species with the most widespread distribution range, occurring as large mats in various habitats between 136 and 1331 m, whereas was found between 136 and 989 m and was between 108 and 981 m. Furthermore, and were distributed in open areas with low competition for light, between 80 and 800 m. These latter three species have the potential to become ornamental plants, being characterized by bright and colourful upright inflorescences. The data presented here will help in providing a valuable contribution to the conservation and use of the wild bananas in northern Viet Nam

Multimodal analysis of methylomics and fragmentomics in plasma cell-free DNA for multi-cancer early detection and localization

Despite their promise, circulating tumor DNA (ctDNA)-based assays for multi-cancer early detection face challenges in test performance, due mostly to the limited abundance of ctDNA and its inherent variability. To address these challenges, published assays to date demanded a very high-depth sequencing, resulting in an elevated price of test. Herein, we developed a multimodal assay called SPOT-MAS (screening for the presence of tumor by methylation and size) to simultaneously profile methylomics, fragmentomics, copy number, and end motifs in a single workflow using targeted and shallow genome-wide sequencing (~0.55×) of cell-free DNA. We applied SPOT-MAS to 738 non-metastatic patients with breast, colorectal, gastric, lung, and liver cancer, and 1550 healthy controls. We then employed machine learning to extract multiple cancer and tissue-specific signatures for detecting and locating cancer. SPOT-MAS successfully detected the five cancer types with a sensitivity of 72.4% at 97.0% specificity. The sensitivities for detecting early-stage cancers were 73.9% and 62.3% for stages I and II, respectively, increasing to 88.3% for non-metastatic stage IIIA. For tumor-of-origin, our assay achieved an accuracy of 0.7. Our study demonstrates comparable performance to other ctDNA-based assays while requiring significantly lower sequencing depth, making it economically feasible for population-wide screening

Diversity of Fusarium associated banana wilt in northern Viet Nam

Fusarium is one of the most important fungal genera of plant pathogens that affect the cultivation of a wide range of crops. Agricultural losses caused by Fusarium oxysporum f. sp. cubense (Foc) directly affect the income, subsistence, and nourishment of thousands of farmers worldwide. For Viet Nam, predictions on the impact of Foc for the future are dramatic, with an estimated loss in the banana production area of 8% within the next five years and up to 71% within the next 25 years. In the current study, we applied a combined morphological-molecular approach to assess the taxonomic identity and phylogenetic position of the different Foc isolates collected in northern Viet Nam. In addition, we aimed to estimate the proportion of the different Fusarium races infecting bananas in northern Viet Nam. The morphology of the isolates was investigated by growing the collected Fusarium isolates on four distinct nutritious media (PDA, SNA, CLA, and OMA). Molecular phylogenetic relationships were inferred by sequencing partial rpb1, rpb2, and tef1a genes and adding the obtained sequences into a phylogenetic framework. Molecular characterization shows that c. 74% of the Fusarium isolates obtained from infected banana pseudostem tissue belong to F. tardichlamydosporum. Compared to F. tardichlamydosporum, F. odoratissimum accounts for c.10% of the Fusarium wilt in northern Viet Nam, demonstrating that Foc TR4 is not yet a dominant strain in the region. Fusarium cugenangense – considered to cause Race 2 infections among bananas – is only found in c. 10% of the tissue material that was obtained from infected Vietnamese bananas. Additionally, one of the isolates cultured from diseased bananas was phylogenetically not positioned within the F. oxysporum species complex (FOSC), but in contrast, fell within the Fusarium fujikuroi species complex (FFSC). As a result, a possible new pathogen for bananas may have been found. Besides being present on several ABB ‘Tay banana’, F. tardichlamydosporum was also derived from infected tissue of a wild Musa lutea, showing the importance of wild bananas as a possible sink for Foc

Twelve-Month Outcomes of the AFFINITY Trial of Fluoxetine for Functional Recovery After Acute Stroke: AFFINITY Trial Steering Committee on Behalf of the AFFINITY Trial Collaboration

Background and Purpose: The AFFINITY trial (Assessment of Fluoxetine in Stroke Recovery) reported that oral fluoxetine 20 mg daily for 6 months after acute stroke did not improve functional outcome and increased the risk of falls, bone fractures, and seizures. After trial medication was ceased at 6 months, survivors were followed to 12 months post-randomization. This preplanned secondary analysis aimed to determine any sustained or delayed effects of fluoxetine at 12 months post-randomization. Methods: AFFINITY was a randomized, parallel-group, double-blind, placebo-controlled trial in adults (n=1280) with a clinical diagnosis of stroke in the previous 2 to 15 days and persisting neurological deficit who were recruited at 43 hospital stroke units in Australia (n=29), New Zealand (4), and Vietnam (10) between 2013 and 2019. Participants were randomized to oral fluoxetine 20 mg once daily (n=642) or matching placebo (n=638) for 6 months and followed until 12 months after randomization. The primary outcome was function, measured by the modified Rankin Scale, at 6 months. Secondary outcomes for these analyses included measures of the modified Rankin Scale, mood, cognition, overall health status, fatigue, health-related quality of life, and safety at 12 months. Results: Adherence to trial medication was for a mean 167 (SD 48) days and similar between randomized groups. At 12 months, the distribution of modified Rankin Scale categories was similar in the fluoxetine and placebo groups (adjusted common odds ratio, 0.93 [95% CI, 0.76–1.14]; P =0.46). Compared with placebo, patients allocated fluoxetine had fewer recurrent ischemic strokes (14 [2.18%] versus 29 [4.55%]; P =0.02), and no longer had significantly more falls (27 [4.21%] versus 15 [2.35%]; P =0.08), bone fractures (23 [3.58%] versus 11 [1.72%]; P =0.05), or seizures (11 [1.71%] versus 8 [1.25%]; P =0.64) at 12 months. Conclusions: Fluoxetine 20 mg daily for 6 months after acute stroke had no delayed or sustained effect on functional outcome, falls, bone fractures, or seizures at 12 months poststroke. The lower rate of recurrent ischemic stroke in the fluoxetine group is most likely a chance finding. REGISTRATION: URL: http://www.anzctr.org.au/ ; Unique identifier: ACTRN12611000774921