Pragmatic economic valuation of adaptation risk and responses across scales Case study in Vietnam

Vietnam is one of the countries particularly vulnerable to climate change. Increased temperatures, increased salinity intrusion due to sea-level rise and altering precipitation patterns significantly affect livelihood options of smallholder farmers, resulting in losses in agricultural production. These impacts are projected to become increasingly severe, hence, adaptation to climate change and sensitivity needs to be assessed and adaptation measures taken. This study provides a vulnerability assessment based on the results for exposure, sensitivity and adaptive capacity. This includes present and projected future climatic conditions and hazards, crop suitability analyses and socioeconomic assessments on a district scale. In addition, a case study is presented focusing on the two provinces of Tra Vinh and Ben Tre, identified as highly vulnerable in the Mekong Delta area. The case study shows opportunities, economic trade-offs and barriers of adoption of climate-smart agriculture (CSA) practices to adapt to progressive climate change

Efficacy and safety of zero‐fluoroscopy ablation of ventricular arrhythmias originating from the right ventricular outflow tract: Comparison with fluoroscopy‐guided ablation without a three‐dimensional electroanatomic mapping system

Abstract Background Radiofrequency catheter ablation is the preferred treatment choice for ventricular arrhythmias (VAs) originating from right ventricular outflow tract (RVOT) in symptomatic patients and is usually performed under fluoroscopy guidance. Zero‐fluoroscopy (ZF) ablations using 3D mapping system applied for treatment of various types of arrhythmias are trending and practiced in many centers around the world, but rarely done in Vietnam. The objective of this study was to evaluate the efficacy and safety of zero‐fluoroscopy ablation of RVOT VAs, compared with fluoroscopy‐guided ablation without a 3D electroanatomic mapping (EAM) system. Methods and Results We conducted a nonrandomized, prospective single‐center study including 114 patients with RVOT VAs that had electrocardiographic features of typical left bundle branch block, inferior axis QRS morphology, and a precordial transition ≥ V3, from May 2020 to July 2022. The patients were assigned (without randomization) to two different approaches of either zero‐fluoroscopy ablation under the guidance of the Ensite system (ZF group) or fluoroscopy‐guided ablation without a 3D EAM (fluoroscopy group) in a 1:1 ratio. After a follow‐up time of 5.0 ± 4.9 months and 6.9 ± 9.3 months in the ZF and fluoroscopy groups, respectively, the results showed a higher success rate in the fluoroscopy group than in the complete ZF group (87.3% vs 86.8%), although the difference was not statistically significant. No major complication was noted in both the groups. Conclusion ZF ablation for RVOT VAs can be done safely and effectively using the 3D electroanatomic mapping system. The results of ZF approach are comparable to that of the fluoroscopy‐guided approach without a 3D EAM system

Relationship between serum TNF-α, IL-6, and IL- 10 levels and disease severity, and changes in the cytokines after treatment in patients with bacterial community-acquired pneumonia

Introduction The role of some cytokines, such as interleukin (IL) and tumor necrosis factor-α (TNF-α), in serum in community-acquired pneumonia (CAP) has been mentioned. There are few results on changes in serum cytokines in patients with bacterial CAP. This study aimed at the relationship between serum TNF-α, IL-6, and IL-10 levels, disease severity, and changes in serum cytokines in patients with bacterial CAP. Methods A descriptive follow-up study was conducted on 78 hospitalized patients with CAP. Serum IL-6, IL-10, and TNF-α levels were measured by fluorescence covalent microbead immunosorbent assay technique. Changes in serum cytokine levels were measured on admission’s first and seventh day. Results TNF-α, IL-6, and IL-10 medians were 0.76, 2.15, and 1.18 pg/ mL, respectively. There was no difference in interleukin levels between the two groups, namely those aged 0.05). The levels of IL-10 in patients with Gram-positive bacteria pneumonia were significantly higher than those with Gram-negative bacteria (2.23 pg/mL vs 1.15 pg/mL, respectively, p=0.03). Logistic regression analysis revealed that IL-10 (OR=0.92; 95% CI: 0.86–0.99, p=0.03) was associated with the prognosis of disease severity. IL-6 levels decreased statistically on day 7 after treatment (1.12 pg/mL vs 2.15 pg/mL, p=0.003). The change in TNF-α and IL-10 after treatment was not significant (p>0.05). Conclusions Serum IL-10 levels during hospitalization time are related to the prognosis of disease severity. After 7 days of treatment, IL-6 levels decreased statistically; however, TNF-α and IL-10 levels did not change