Medication Use and Adherence in Patients with Hypertension: A Prospective Study in Vietnam

Objective: to document patients’ antihypertensive agents, determine their medication adherence, and identify factors associated with the adherence.  Material and Methods: A prospective study was performed on a group of hypertensive outpatients, with social health insurance, in Can Tho, Vietnam. The study included 330 patients over 18 years old, who agreed to participate and could listen, speak and answer questions in Vietnamese. The data collection method was based on prescriptions and patient interviews. Data were analyzed using descriptive statistics, and Generalized Estimating Equations with Poisson-log linear distribution.  Results: Among the drug use characteristics, 76.1% were prescribed beta-blockers, 91.5% polytherapy, and 63.0% changed drugs at the third follow-up visit. The percentage of patients who adhered to medication ranged from 70.0% to 91.2%. Factors that improved drug adherence included: the academic level at high school or higher (39.0% increase), living in urban areas (15.0% increase), having a job related to social interaction (11.2%), and having a family history of hypertension (9.0% increase). Factors that reduced adherence included: advanced age (22.0% decrease), prolonged disease duration (16.0% decrease), prolonged treatment duration (11.0% decrease), and changes in at least one type of antihypertensive drug (8.0% decrease).  Conclusion: The highlight of this study is the demonstration of an inverse relationship between the adherence rate and the number of follow-up visits: the higher the number of visits, the lower the adherence rate. The 3rd follow-up adherence rate was 70.0%, and the decreased adherence rate is related to older age, higher education levels, and a longer duration of treatment

A SOCIAL SURVEY ON COMMUNITY RESPONSE TO ROAD TRAFFIC NOISE IN HANOI

Joint Research on Environmental Science and Technology for the Eart

Effectiveness of cervical pessary compared to cervical cerclage with or without vaginal progesterone for the prevention of preterm birth in women with twin pregnancies and a short cervix : Study protocol for a two-by-two factorial randomised clinical trial

Peer reviewedPublisher PD

Intensified Antituberculosis Therapy in Adults with Tuberculous Meningitis

BACKGROUND Tuberculous meningitis is often lethal. Early antituberculosis treatment and adjunctive treatment with glucocorticoids improve survival, but nearly one third of patients with the condition still die. We hypothesized that intensified antituberculosis treatment would enhance the killing of intracerebral Mycobacterium tuberculosis organisms and decrease the rate of death among patients. METHODS We performed a randomized, double-blind, placebo-controlled trial involving human immunodeficiency virus (HIV)-infected adults and HIV-uninfected adults with a clinical diagnosis of tuberculous meningitis who were admitted to one of two Vietnamese hospitals. We compared a standard, 9-month antituberculosis regimen (which included 10 mg of rifampin per kilogram of body weight per day) with an intensified regimen that included higher-dose rifampin (15 mg per kilogram per day) and levofloxacin (20 mg per kilogram per day) for the first 8 weeks of treatment. The primary outcome was death by 9 months after randomization. RESULTS A total of 817 patients (349 of whom were HIV-infected) were enrolled; 409 were randomly assigned to receive the standard regimen, and 408 were assigned to receive intensified treatment. During the 9 months of follow-up, 113 patients in the intensified-treatment group and 114 patients in the standard-treatment group died (hazard ratio, 0.94; 95% confidence interval, 0.73 to 1.22; P=0.66). There was no evidence of a significant differential effect of intensified treatment in the overall population or in any of the subgroups, with the possible exception of patients infected with isoniazid-resistant M. tuberculosis. There were also no significant differences in secondary outcomes between the treatment groups. The overall number of adverse events leading to treatment interruption did not differ significantly between the treatment groups (64 events in the standard-treatment group and 95 events in the intensified-treatment group, P=0.08). CONCLUSIONS Intensified antituberculosis treatment was not associated with a higher rate of survival among patients with tuberculous meningitis than standard treatment. (Funded by the Wellcome Trust and the Li Ka Shing Foundation; Current Controlled Trials number, ISRCTN61649292.)

Mossbauer mineralogy of rock, soil, and dust at Meridiani Planum, Mars: Opportunity's journey across sulfate-rich outcrop, basaltic sand and dust, and hematite lag deposits

The Mössbauer (MB) spectrometer on Opportunity measured the Fe oxidation state, identified Fe-bearing phases, and measured relative abundances of Fe among those phases at Meridiani Planum, Mars. Eight Fe-bearing phases were identified: jarosite (K,Na,H3O)(Fe,Al)(OH)6(SO4)2, hematite, olivine, pyroxene, magnetite, nanophase ferric oxides (npOx), an unassigned ferric phase, and metallic Fe (kamacite). Burns Formation outcrop rocks consist of hematite-rich spherules dispersed throughout S-rich rock that has nearly constant proportions of Fe3+ from jarosite, hematite, and npOx (29%, 36%, and 20% of total Fe). The high oxidation state of the S-rich rock (Fe3+/FeT ~ 0.9) implies that S is present as the sulfate anion. Jarosite is mineralogical evidence for aqueous processes under acid-sulfate conditions because it has structural hydroxide and sulfate and it forms at low pH. Hematite-rich spherules, eroded from the outcrop, and their fragments are concentrated as hematite-rich soils (lag deposits) on ripple crests (up to 68% of total Fe from hematite). Olivine, pyroxene, and magnetite are primarily associated with basaltic soils and are present as thin and locally discontinuous cover over outcrop rocks, commonly forming aeolian bedforms. Basaltic soils are more reduced (Fe3+/FeT ~ 0.2–0.4), with the fine-grained and bright aeolian deposits being the most oxidized. Average proportions of total Fe from olivine, pyroxene, npOx, magnetite, and hematite are 33%, 38%, 18%, 6%, and 4%, respectively. TheMB parameters of outcrop npOx and basaltic-soil npOx are different, but it is not possible to infer mineralogical information beyond octahedrally coordinated Fe3+. Basaltic soils at Meridiani Planum and Gusev crater have similar Fe-mineralogical compositions.Additonal co-authors: P Gütlich, E Kankeleit, T McCoy, DW Mittlefehldt, F Renz, ME Schmidt, B Zubkov, SW Squyres, RE Arvidso

Social Contact Patterns in Vietnam and Implications for the Control of Infectious Diseases

BACKGROUND: The spread of infectious diseases from person to person is determined by the frequency and nature of contacts between infected and susceptible members of the population. Although there is a long history of using mathematical models to understand these transmission dynamics, there are still remarkably little empirical data on contact behaviors with which to parameterize these models. Even starker is the almost complete absence of data from developing countries. We sought to address this knowledge gap by conducting a household based social contact diary in rural Vietnam. METHODS AND FINDINGS: A diary based survey of social contact patterns was conducted in a household-structured community cohort in North Vietnam in 2007. We used generalized estimating equations to model the number of contacts while taking into account the household sampling design, and used weighting to balance the household size and age distribution towards the Vietnamese population. We recorded 6675 contacts from 865 participants in 264 different households and found that mixing patterns were assortative by age but were more homogenous than observed in a recent European study. We also observed that physical contacts were more concentrated in the home setting in Vietnam than in Europe but the overall level of physical contact was lower. A model of individual versus household vaccination strategies revealed no difference between strategies in the impact on R(0). CONCLUSIONS AND SIGNIFICANCE: This work is the first to estimate contact patterns relevant to the spread of infections transmitted from person to person by non-sexual routes in a developing country setting. The results show interesting similarities and differences from European data and demonstrate the importance of context specific data

Mössbauer mineralogy of rock, soil, and dust at Gusev crater, Mars: Spirit's journey through weakly altered olivine basalt on the plains and pervasively altered basalt in the Columbia Hills

The Mössbauer spectrometer on Spirit measured the oxidation state of Fe, identified Fe-bearing phases, and measured relative abundances of Fe among those phases for surface materials on the plains and in the Columbia Hills of Gusev crater. Eight Fe-bearing phases were identified: olivine, pyroxene, ilmenite, magnetite, nanophase ferric oxide (npOx), hematite, goethite, and a Fe3+-sulfate. Adirondack basaltic rocks on the plains are nearly unaltered (Fe3+/FeT < 0.2) with Fe from olivine, pyroxene (Ol > Px), and minor npOx and magnetite. Columbia Hills basaltic rocks are nearly unaltered (Peace and Backstay), moderately altered (WoolyPatch, Wishstone, and Keystone), and pervasively altered (e.g., Clovis, Uchben, Watchtower, Keel, and Paros with Fe3+/FeT ~ 0.6–0.9). Fe from pyroxene is greater than Fe from olivine (Ol sometimes absent), and Fe2+ from Ol + Px is 40–49% and 9–24% for moderately and pervasively altered materials, respectively. Ilmenite (Fe from Ilm 3–6%) is present in Backstay, Wishstone, Keystone, and related rocks along with magnetite (Fe from Mt 10–15%). Remaining Fe is present as npOx, hematite, and goethite in variable proportions. Clovis has the highest goethite content (Fe from Gt = 40%). Goethite (α-FeOOH) is mineralogical evidence for aqueous processes because it has structural hydroxide and is formed under aqueous conditions. Relatively unaltered basaltic soils (Fe3+/FeT ~ 0.3) occur throughout Gusev crater (60–80% Fe from Ol + Px, 10–30% from npOx, and 10% from Mt). PasoRobles soil in the Columbia Hills has a unique occurrence of high concentrations of Fe3+-sulfate (65% of Fe). Magnetite is identified as a strongly magnetic phase in Martian soil and dust.Additional co-authors: E Kankeleit, P Gütlich, F Renz, SW Squyres, RE Arvidso

Determining PTEN Functional Status by Network Component Deduced Transcription Factor Activities

PTEN-controlled PI3K-AKT-mTOR pathway represents one of the most deregulated signaling pathways in human cancers. With many small molecule inhibitors that target PI3K-AKT-mTOR pathway being exploited clinically, sensitive and reliable ways of stratifying patients according to their PTEN functional status and determining treatment outcomes are urgently needed. Heterogeneous loss of PTEN is commonly associated with human cancers and yet PTEN can also be regulated on epigenetic, transcriptional or post-translational levels, which makes the use of simple protein or gene expression-based analyses in determining PTEN status less accurate. In this study, we used network component analysis to identify 20 transcription factors (TFs) whose activities deduced from their target gene expressions were immediately altered upon the re-expression of PTEN in a PTEN-inducible system. Interestingly, PTEN controls the activities (TFA) rather than the expression levels of majority of these TFs and these PTEN-controlled TFAs are substantially altered in prostate cancer mouse models. Importantly, the activities of these TFs can be used to predict PTEN status in human prostate, breast and brain tumor samples with enhanced reliability when compared to straightforward IHC-based or expression-based analysis. Furthermore, our analysis indicates that unique sets of PTEN-controlled TFAs significantly contribute to specific tumor types. Together, our findings reveal that TFAs may be used as “signatures” for predicting PTEN functional status and elucidate the transcriptional architectures underlying human cancers caused by PTEN loss

A study of alterations in DNA epigenetic modifications (5mC and 5hmC) and gene expression influenced by simulated microgravity in human lymphoblastoid cells

Cells alter their gene expression in response to exposure to various environmental changes. Epigenetic mechanisms such as DNA methylation are believed to regulate the alterations in gene expression patterns. In vitro and in vivo studies have documented changes in cellular proliferation, cytoskeletal remodeling, signal transduction, bone mineralization and immune deficiency under the influence of microgravity conditions experienced in space. However microgravity induced changes in the epigenome have not been well characterized. In this study we have used Next-generation Sequencing (NGS) to profile ground-based “simulated” microgravity induced changes on DNA methylation (5-methylcytosine or 5mC), hydroxymethylation (5-hydroxymethylcytosine or 5hmC), and simultaneous gene expression in cultured human lymphoblastoid cells. Our results indicate that simulated microgravity induced alterations in the methylome (~60% of the differentially methylated regions or DMRs are hypomethylated and ~92% of the differentially hydroxymethylated regions or DHMRs are hyperhydroxymethylated). Simulated microgravity also induced differential expression in 370 transcripts that were associated with crucial biological processes such as oxidative stress response, carbohydrate metabolism and regulation of transcription. While we were not able to obtain any global trend correlating the changes of methylation/ hydroxylation with gene expression, we have been able to profile the simulated microgravity induced changes of 5mC over some of the differentially expressed genes that includes five genes undergoing differential methylation over their promoters and twenty five genes undergoing differential methylation over their gene-bodies. To the best of our knowledge, this is the first NGS-based study to profile epigenomic patterns induced by short time exposure of simulated microgravity and we believe that our findings can be a valuable resource for future explorations

Cancer metabolism: current perspectives and future directions

Cellular metabolism influences life and death decisions. An emerging theme in cancer biology is that metabolic regulation is intricately linked to cancer progression. In part, this is due to the fact that proliferation is tightly regulated by availability of nutrients. Mitogenic signals promote nutrient uptake and synthesis of DNA, RNA, proteins and lipids. Therefore, it seems straight-forward that oncogenes, that often promote proliferation, also promote metabolic changes. In this review we summarize our current understanding of how ‘metabolic transformation' is linked to oncogenic transformation, and why inhibition of metabolism may prove a cancer′s ‘Achilles' heel'. On one hand, mutation of metabolic enzymes and metabolic stress sensors confers synthetic lethality with inhibitors of metabolism. On the other hand, hyperactivation of oncogenic pathways makes tumors more susceptible to metabolic inhibition. Conversely, an adequate nutrient supply and active metabolism regulates Bcl-2 family proteins and inhibits susceptibility to apoptosis. Here, we provide an overview of the metabolic pathways that represent anti-cancer targets and the cell death pathways engaged by metabolic inhibitors. Additionally, we will detail the similarities between metabolism of cancer cells and metabolism of proliferating cells