APPaRENT 3: Asthma Patients' and Physicians' Perspectives on the Burden and Management of Asthma in Seven Countries.

INTRODUCTION: Asthma management is strongly dependent on physician and patient beliefs and perceptions about the disease and its long-term treatment. The APPaRENT 3 study was conducted to explore factors influencing treatment choice and to understand patients' and physicians' attitudes and perspectives on the use of controller inhalers in regular versus flexible dosing for asthma management. METHODS: This cross-sectional survey of patients with asthma and treating physicians was conducted in seven countries: Indonesia, Malaysia, Philippines, Thailand, Vietnam (patient survey only), Saudi Arabia, and the United Arab Emirates. Assessment was carried out through an online/face-to-face questionnaire, where patients' viewpoints were focused on their attitudes and beliefs about asthma and treatment adherence, whereas physicians' viewpoints were gathered on their attitudes and beliefs about asthma management, knowledge of and adherence to asthma treatment guidelines, and asthma treatment regimens. RESULTS: Overall, 1400 patients (mean age, 34 years) and 599 physicians (mean age, 43 years) were included in the survey. Physicians similarly prioritised symptom control (39%) and exacerbation reduction (40%) in moderate asthma, whereas patients prioritised symptom control (41%) over exacerbation reduction (22%). Although both groups (physicians, 86%; patients, 84%) perceived asthma as well-controlled, poor management was evident based on Asthma Control Test (ACT) scores (mean, 15.7; standard deviation, 4.14; 82% had an ACT score < 20) and high symptom burden (39% reported nighttime awakenings or early mornings ≥ 2 nights/week). Most patients (76%) with moderate asthma were prescribed regular dosing, with the most common treatment being inhaled corticosteroid (ICS)/long-acting ß2-agonist (LABA) with as-needed inhaled short-acting ß2-agonist (SABA; 20%). Among patients on maintenance and reliever therapy, 93% of patients received a separate inhaled reliever. CONCLUSIONS: Despite high symptom burden, patients overestimated their level of asthma control. Physicians prioritised controlling symptoms and reducing exacerbations as treatment goals for moderate asthma, often prescribing regular dosing with ICS/LABA with as-needed inhaled SABA.

Managing asthma depends a lot on what doctors and patients think about the illness and its long-term treatment. This study looked into what influences treatment decisions and what patients and doctors think about using inhalers regularly or on an as-needed basis to manage asthma across seven countries (Indonesia, Malaysia, Philippines, Thailand, Vietnam [patient survey only], Saudi Arabia, and the United Arab Emirates). In this study, patients with asthma and doctors managing asthma completed an online/face-to-face questionnaire. The study aimed to understand what patients think about asthma and their treatment plan. Meanwhile, the doctors were asked what they think about managing asthma and how much they apply clinical guidelines for treating patients with asthma. Doctors believed it is equally important to control symptoms and prevent worsening of symptoms in patients with moderate asthma, while patients cared more about controlling symptoms than preventing worsening of symptoms. While doctors and patients both regarded asthma as well-controlled, many patients had low Asthma Control Test scores and experienced a lot of symptoms, suggesting that they are poor perceivers of asthma control. Most patients with moderate asthma were given regular treatment, usually with inhaled corticosteroid combined with long-acting ß₂-agonist along with as-needed short-acting ß₂-agonist as a reliever. Most patients who were prescribed the same inhaler for regular use and as a reliever also had a separate inhaler for quick relief of symptoms. This study shows the need for patients and doctors to have better conversations about asthma, its treatments, and what to expect from them.

Reversible Coupling of Germylone with Isocyanates.

The germylone dimNHCGe (5, dimNHC=diimino N-heterocyclic carbene) undergoes a [2+2] cycloaddition with isocyanates RNCO (R=4-tolyl or 3,5-xylyl) to furnish novel alkyl carboxamido germylenes 7 (R=4-tolyl) and 8 (R=3,5-xylyl), featuring a C-C bond between the former carbene carbon and the isocyanate moiety. Heating a mixture of 8 with 4-tolyl isocyanate to 100 °C results in isocyanate metathesis, demonstrating reversible C-C bond formation on the reduced germanium compound. DFT calculations suggest that this process occurs via the reductive dissociation of isocyanate from 8 that regenerates the parent Ge(0) compound 5.

Risk Factors Related to the Death of Admitted COVID-19 Patients: A Buffalo Study.

Background: Coronavirus disease 2019 (COVID-19) may result in a severe acute respiratory syndrome that leads to a worldwide pandemic. Despite the increasing understanding of COVID-19 disease, the mortality rate of hospitalized COVID-19 patients remains high. Objective: To investigate the risk factors related to the mortality of admitted COVID-19 patients during the peak of the epidemic from August 2021 to October 2021 in Vietnam. Methods: This is a prospective cohort study performed at the Hospital for Rehabilitation-Professional diseases. The baseline and demographic data, medical history, clinical examination, the laboratory results were recorded for patients admitted to the hospital with confirmed COVID-19. A radiologist and a pulmonologist will read the chest radiographs on admission and calculate the Brixia scores to classify the severity of lung abnormalities. Patients were followed up until beingrecovered or their death. Comparison of clinical and subclinical characteristics between recovery and death groups to find out risk factors related to the death of COVID-19 patients. Results: Among 104 admitted COVID-19 patients, men accounted for 42.3%, average age of 61.7 ± 13.7. The most common symptoms were fever 76.9%, breathlessness 74%, and fatigue 53.8%. The majority (84.6%) of the study population had at least one co-morbidity, including hypertension (53.8%), diabetes (25.9%), gastritis (19.2%), ischemic heart disease (15.4) %), stroke (9.6%) and osteoarthritis (9.6%). The rate of mild and moderate COVID-19 is 13.4%, severe 32.7%, and critical 40.4%. There are 88 inpatients (84.6%) who needed respiratory support. The median hospital stay was 13 days (IQR 10-17.75 days). The rate of intubated patients with mechanical ventilation was 31.7%. The overall mortality rate was 29.8%. Risk factors related to death included Brixia scores > 9, Urea > 7 mmol/L, Ferrtin > 578 ng/ml, Failure to get vaccinated, Age > 60 years, and Low Oxygen SpO2 < 87% (BUFFALO). Conclusion: The main result of the study is the independent risk factors related to the death of admitted COVID-19 patients including Brixia scores > 9, Urea > 7 mmol/L, Ferrtin > 578 ng/ml, Failure to get vaccinated, Age > 60 years, and Low Oxygen SpO2 < 87% ((BUFFALO) which suggests that these COVID-19 patients should be closely followed up.

A Guanidine-Supported π-Complex of Germanium Amenable to Intramolecular C-C Cleavage in Arene and Ge Atom Transfer.

The germylone dimNHCGe (dimNHC=diimino N-heterocyclic carbene) reacts with azides N3 R (R=SiMe3 or p-tolyl) to furnish the first examples of germanium π-complexes, i. e. guanidine-ligated compounds (dimNHI-SiMe3 )Ge (NHI=N-heterocyclic imine, R=SiMe3 ) and (dimNHI-Tol)Ge (R=p-tolyl). DFT calculations suggest that these species are formed by a Staudinger type replacement of dinitrogen in the azide by a nucleophilic germylone, leading to a transient carbene adduct of iminogermylidene. Heating a solution of compound (dimNHI-SiMe3 )Ge to 70 °C results in extrusion of the iminogermylidene that further aggregates to produce the known [Me3 SiNGe]4 tetramer, whereas the imidazolylidene fragment transforms into an unusual heptatriene species that can be considered as a product of carbene insertion into the C-C bond of a pendant Ar substituent at the imidazolylidene nitrogen of the dimNHC. Reaction of (dimNHI-SiMe3 )Ge with tetrachloro-o-benzoquinone results in the net transfer of a germanium atom and formation of the free diimino-guanidine ligand. This ligand also forms when (dimNHI-SiMe3 )Ge is treated with azide N3 (p-Tol), with the germanium product being [(p-Tol)NGe]n.

Physical therapy for sleep apnea: a smartphone application for home-based physical therapy for patients with obstructive sleep apnea.

Purpose: In this study, we described "PT for Sleep Apnea", a smartphone application for home-based physical therapy of patients with Obstructive Sleep Apnea (OSA). Methods: The application was created in a joint program between the University of Medicine and Pharmacy at Ho Chi Minh City (UMP), Vietnam, and National Cheng Kung University (NCKU), Taiwan. Exercises maneuvers were derived from the exercise program previously published by the partner group at National Cheng Kung University. They included exercises for upper airway and respiratory muscle training and general endurance training. Results: The application provides video and in-text tutorials for users to follow at home and a schedule function to assist the user in organizing the training program, which may improve the efficacy of home-based physical therapy in patients with Obstructive Sleep Apnea. Conclusion: In the future, our group plans to conduct a user study and randomized-controlled trials to investigate whether our application can benefit patients with OSA.

A novel n-p heterojunction Bi2S3/ZnCo2O4 photocatalyst for boosting visible-light-driven photocatalytic performance toward indigo carmine.

An innovative p-n heterojunction Bi2S3/ZnCo2O4 composite was first fabricated via a two-step co-precipitation and hydrothermal method. By controlling the weight amount of Na2S and Bi(NO3)3 precursor, different heterogeneous xBi2S3/ZnCo2O4 were synthesized (x = 0, 2, 6, 12, and 20). The p-n heterojunction Bi2S3/ZnCo2O4 was characterized by structural, optical, and photochemical properties and the photocatalyst decoloration of indigo carmine. Mott-Schottky plots proved a heterojunction formed between n-Bi2S3 and p-ZnCo2O4. Furthermore, the investigation of the photocurrent response indicated that the Bi2S3/ZnCo2O4 composite displayed an enhanced response, which was respectively 4.6 and 7.3 times (4.76 µA cm-2) greater than that of the pure Bi2S3 (1.02 µA cm-2) and ZnCo2O4 (0.65 µA cm-2). Especially the optimized p-n Bi2S3/ZnCo2O4 heterojunction with 12 wt% Bi2S3 showed the highest photocatalyst efficacy of 92.1% at 40 mg L-1 solutions, a loading of 1.0 g L-1, and a pH of 6 within 90 min of visible light illumination. These studies prove that p-n Bi2S3/ZnCo2O4 heterojunction photocatalysts can greatly boost their photocatalytic performance because the inner electric field enhances the process of separating photogenerated electron-hole pairs. Furthermore, this composite catalyst showed good stability and recyclability for environmental remediation.

COPD Patients with Asthma Features in Vietnam: Prevalence and Suitability for Personalized Medicine.

COPD patients with asthma features usually benefit from inhaled corticosteroids (ICS)-containing regimens, but their burden and diagnostic criteria remain to be established. The aims of this study were to estimate the proportion of patients with asthma features among patients with physician-diagnosed COPD and to investigate differences in clinical characteristics and current medications between COPD patients with asthma features and patients with COPD alone. A cross-sectional study was conducted at two respiratory out-patient clinics at the University Medical Center in Ho Chi Minh City and Bach Mai Hospital in Ha Noi, Vietnam. COPD patients with asthma features were identified by attending physicians following the approach recommended by the GINA/GOLD joint committee. Of the 332 patients screened, 300 were enrolled in the study. The proportion of COPD patients with asthma features was 27.3% (95% confidence interval (95% CI) 22.6-32.6%). COPD patients with asthma features were younger, with higher FEV1 values, a greater proportion of positive bronchodilator reversibility tests, higher blood eosinophil count, and were more often treated with ICS/LABA (ICS/long-acting bronchodilator beta-2 agonist) than patients with COPD alone. The prevalence of COPD patients with asthma features is particularly high in Vietnam thus requiring appropriate action plans in clinical practice.

GINA Implementation Improves Asthma Symptoms Control and Lung Function: A Five-Year Real-World Follow-Up Study.

Symptoms control remains challenging for most patients with asthma. This study was conducted to evaluate the level of asthma symptoms control and lung function over 5 years of GINA (Global INitiative for Asthma) implementation. We included all patients with asthma who had been managed following GINA recommendations at the Asthma and COPD Outpatient Care Unit (ACOCU) of the University Medical Center in Ho Chi Minh City, Vietnam from October 2006 to October 2016. Of 1388 patients with asthma managed following GINA recommendations, the proportion of patients with well-controlled asthma significantly improved from 2.6% at baseline to 66.8% at month 3, 64.8% at year 1, 59.6% at year 2, 58.6% at year 3, 57.7% at year 4, and 59.5% at year 5 (p < 0.0001 for all comparisons). The proportion of patients with persistent airflow limitation significantly decreased from 26.7% at baseline to 12.6% at year 1 (p < 0.0001), 14.4% at year 2 (p < 0.0001), 15.9% at year 3 (p = 0.0006), 12.7% at year 4 (p = 0.0047), and 12.2% at year 5 (p = 0.0011). In patients with asthma managed according to GINA recommendations, asthma symptoms control and lung function improved after 3 months and the improvement was sustained over 5 years.

Antioxidant and Antimicrobial Properties of Fruiting Body and Submerged Mycelium of Medicinal Mushroom Phellinus robiniae (Agaricomycetes).

This study was conducted to evaluate extraction yield, antioxidant content, antioxidant capacity and antibacterial activity of extracts obtained from submerged mycelium (ME) and fruiting body (FBE) of Phellinus robiniae NTH-PR1. The results showed that yields of ME and FBE reached 14.84 ± 0.63 and 18.89 ± 0.86%, respectively. TPSC, TPC, and TFC were present in both mycelium and fruiting body, and the more contents of them were found in fruiting body. The concentrations of TPSC, TPC and TFC in ME and FBE were 17.61 ± 0.67 and 21.56 ± 0.89 mg GE g-1, 9.31 ± 0.45 and 12.14 ± 0.56 mg QAE g-1, and 8.91 ± 0.53 and 9.04 ± 0.74 mg QE g-1, respectively. EC50 values for DPPH radical scavenging revealed FBE (260.62 ± 3.33 µg mL-1) was more effective than ME (298.21 ± 3.61 µg mL-1). EC50 values for ferrous ion chelating in ME and FBE were 411.87 ± 7.27 and 432.39 ± 2.23 µg mL-1, respectively. Thus, both extracts were able to inhibit Gram-positive and Gram-negative pathogenic bacterial strains, at concentrations ranging in 25-100 mg mL-1 of ME and 18.75-75 mg mL-1 of FBE for Gram-positive bacteria; ranging in 75-100 mg mL-1 of ME and 50-75 of FBE for Gram-negative bacteria. Overall submerged mycelial biomass and fruiting bodies of Ph. robiniae NTH-PR1 can be considered as useful natural sources for development of functional food, pharmaceuticals and cosmetic products or cosmeceuticals.

Novel Projection Schemes for Graph-Based Light Field Coding.

In light field compression, graph-based coding is powerful to exploit signal redundancy along irregular shapes and obtains good energy compaction. However, apart from high time complexity to process high dimensional graphs, their graph construction method is highly sensitive to the accuracy of disparity information between viewpoints. In real-world light field or synthetic light field generated by computer software, the use of disparity information for super-rays projection might suffer from inaccuracy due to vignetting effect and large disparity between views in the two types of light fields, respectively. This paper introduces two novel projection schemes resulting in less error in disparity information, in which one projection scheme can also significantly reduce computation time for both encoder and decoder. Experimental results show projection quality of super-pixels across views can be considerably enhanced using the proposals, along with rate-distortion performance when compared against original projection scheme and HEVC-based or JPEG Pleno-based coding approaches.

Design of novel p-n heterojunction ZnBi2O4-ZnS photocatalysts with impressive photocatalytic and antibacterial activities under visible light.

Heterojunction structures have attracted considerable attention for enhancing electron migration across interfaces. In this report, ZnBi2O4-ZnS(12%) heterojunction photocatalysts was found to be capable of degrading over 94% of indigo carmine in a 15 mg/L solution within 90 min of visible light irradiation at a catalytic dose of 1.0 g/L and pH 4. Furthermore, more than 82% of the total organic carbon (TOC) was removed, confirming the almost complete mineralization of the indigo carmine by ZnBi2O4-ZnS(12%). Moreover, the photocatalyst exhibited high stability and retained its photocatalytic activity up to the 5th cycle of operation without photocorrosion. The dramatic enhancement in the visible-light photocatalytic performance of the ZnBi2O4-ZnS heterojunctions over pristine ZnBi2O4 and ZnS was due to the formation of a superior heterojunction between the n-type semiconductor, ZnS, and the p-type semiconductor, ZnBi2O4. This heterojunction facilitated the separation and transfer of the photoinduced electron at the interfaces of the two semiconductors. Furthermore, the ZnBi2O4-ZnS(12%) exhibited an inhibition zone of 15 mm against fecal Escherichia coli (ATCC 8739), with a minimum inhibitory concentration (MIC) of 150 µg/mL. These results demonstrated that the novel ZnBi2O4-ZnS p-n-type heterojunction is a promising visible-light active photo-catalyst for the degradation of organic pollutants and inhibition of fecal E. coli.

Deep learning models for forecasting dengue fever based on climate data in Vietnam.

BACKGROUND: Dengue fever (DF) represents a significant health burden in Vietnam, which is forecast to worsen under climate change. The development of an early-warning system for DF has been selected as a prioritised health adaptation measure to climate change in Vietnam. OBJECTIVE: This study aimed to develop an accurate DF prediction model in Vietnam using a wide range of meteorological factors as inputs to inform public health responses for outbreak prevention in the context of future climate change. METHODS: Convolutional neural network (CNN), Transformer, long short-term memory (LSTM), and attention-enhanced LSTM (LSTM-ATT) models were compared with traditional machine learning models on weather-based DF forecasting. Models were developed using lagged DF incidence and meteorological variables (measures of temperature, humidity, rainfall, evaporation, and sunshine hours) as inputs for 20 provinces throughout Vietnam. Data from 1997-2013 were used to train models, which were then evaluated using data from 2014-2016 by Root Mean Square Error (RMSE) and Mean Absolute Error (MAE). RESULTS AND DISCUSSION: LSTM-ATT displayed the highest performance, scoring average places of 1.60 for RMSE-based ranking and 1.95 for MAE-based ranking. Notably, it was able to forecast DF incidence better than LSTM in 13 or 14 out of 20 provinces for MAE or RMSE, respectively. Moreover, LSTM-ATT was able to accurately predict DF incidence and outbreak months up to 3 months ahead, though performance dropped slightly compared to short-term forecasts. To the best of our knowledge, this is the first time deep learning methods have been employed for the prediction of both long- and short-term DF incidence and outbreaks in Vietnam using unique, rich meteorological features. CONCLUSION: This study demonstrates the usefulness of deep learning models for meteorological factor-based DF forecasting. LSTM-ATT should be further explored for mitigation strategies against DF and other climate-sensitive diseases in the coming years.

Structural characteristics and chemical reactivity of gold-based clusters Aun (n = 16, 17) toward lone pairs.

Gold and gold-based clusters are still receiving special attention owing to their diverse applicability. Density functional theory (DFT) calculations were employed to investigate the structures, the lone-pair affinity of some small Aun clusters (n = 16, 17, and the effects of chromium dopant on their properties. Regarding Au16, the boat-like Cs conformation and the hollow Td form are found to be energetically quasi-degenerate and strongly competing as the ground state. In terms of Au17, a star-like cage is computed to be more stable than the putative global minimum reported in preceding studies. Given Au16Cr isomer, a novel structure for the lowest energy is proposed. Binding energies of these species with CO, NH3, and PH3 ligands are also provided as an in-depth reference to the literature. Present results altogether encourage further theoretical implementations, e.g., CCSD(T) and experimental probes, e.g., the infrared, to validate the findings, thus harnessing the potentiality of the complexes.

Geographical Distribution and Genetic Diversity of the Banana Fusarium Wilt Fungus in Laos and Vietnam.

Fusarium wilt, caused by the fungus Fusarium oxysporum f. sp. cubense (Foc), poses a major threat to global banana production. The tropical race 4 (TR4) variant of Foc is a highly virulent form with a large host range, and severely affects Cavendish bananas. Foc TR4 was recently observed within the Greater Mekong Subregion, after Chinese private companies expanded Cavendish production to the region. In this study, extensive surveys conducted across Laos and Vietnam show that Foc TR4 is still mainly constricted to the northern regions of these countries and is limited to Cavendish cultivation settings. In Laos, Foc TR4 is associated with large-scale Cavendish plantations owned by or involved with Chinese companies through which infected planting material could have been imported. In Vietnam, mostly small-holder Cavendish farmers and backyard gardens were affected by Foc TR4. In Vietnam, no direct link is found with Chinese growers, and it is expected the pathogen mainly spreads through local and regional movement of infected planting materials. Foc TR4 was not recorded on banana cultivars other than Cavendish. The extensively cultivated 'Pisang Awak' cultivar was solely infected by VCGs belonging to Foc race 1 and 2, with a high occurrence of VCG 0123 across Laos, and of VCG 0124/5 in Vietnam. Substantial diversity of Foc VCGs was recorded (VCGs 0123, 0124/5, 01218 and 01221) from northern to southern regions in both countries, suggesting that Fusarium wilt is well established in the region. Interviews with farmers indicated that the local knowledge of Fusarium wilt epidemiology and options for disease management was limited. Clear communication efforts on disease epidemiology and management with emphasis on biosecurity practices need to be improved in order to prevent further spread of Foc TR4 to mixed variety smallholder settings.

Consensus on the Southeast Asian management of hypotension using vasopressors and adjunct modalities during cesarean section under spinal anesthesia.

BACKGROUND AND AIMS: This consensus statement presents a comprehensive and evidence-based set of guidelines that modify the general European or US guidelines for hypotension management with vasopressors during cesarean delivery. It is tailored to the Southeast Asian context in terms of local human and medical resources, health system capacity, and local values and preferences. METHODS AND RESULTS: These guidelines were prepared using a methodological approach. Two principal sources were used to obtain the evidence: scientific evidence and opinion-based evidence. A team of five anesthesia experts from Vietnam, the Philippines, and Thailand came together to define relevant clinical questions; search for literature-based evidence using the MEDLINE, Scopus, Google Scholar, and Cochrane libraries; evaluate existing guidelines; and contextualize recommendations for the Southeast Asian region. Furthermore, a survey was developed and distributed among 183 practitioners in the captioned countries to gather representative opinions of the medical community and identify best practices for the management of hypotension with vasopressors during cesarean section under spinal anesthesia. CONCLUSIONS: This consensus statement advocates proactive management of maternal hypotension during cesarean section after spinal anesthesia, which can be detrimental for both the mother and fetus, supports the choice of phenylephrine as a first-line vasopressor and offers a perspective on the use of prefilled syringes in the Southeast Asian region, where factors such as healthcare features, availability, patient safety, and cost should be considered.

Portable Rabies Virus Sequencing in Canine Rabies Endemic Countries Using the Oxford Nanopore MinION.

As countries with endemic canine rabies progress towards elimination by 2030, it will become necessary to employ techniques to help plan, monitor, and confirm canine rabies elimination. Sequencing can provide critical information to inform control and vaccination strategies by identifying genetically distinct virus variants that may have different host reservoir species or geographic distributions. However, many rabies testing laboratories lack the resources or expertise for sequencing, especially in remote or rural areas where human rabies deaths are highest. We developed a low-cost, high throughput rabies virus sequencing method using the Oxford Nanopore MinION portable sequencer. A total of 259 sequences were generated from diverse rabies virus isolates in public health laboratories lacking rabies virus sequencing capacity in Guatemala, India, Kenya, and Vietnam. Phylogenetic analysis provided valuable insight into rabies virus diversity and distribution in these countries and identified a new rabies virus lineage in Kenya, the first published canine rabies virus sequence from Guatemala, evidence of rabies spread across an international border in Vietnam, and importation of a rabid dog into a state working to become rabies-free in India. Taken together, our evaluation highlights the MinION's potential for low-cost, high volume sequencing of pathogens in locations with limited resources.

Vietnam Climate Change and Health Vulnerability and Adaptation Assessment, 2018.

BACKGROUND: The Global Climate Risk Index 2020 ranked Vietnam as the sixth country in the world most affected by climate variability and extreme weather events over the period 1999-2018. Sea level rise and extreme weather events are projected to be more severe in coming decades, which, without additional action, will increase the number of people at risk of climate-sensitive diseases, challenging the health system. This article summaries the results of a health vulnerability and adaptation (V&A) assessment conducted in Vietnam as evidences for development of the National Climate Change Health Adaptation Plan to 2030. METHODS: The assessment followed the first 4 steps outlined in the World Health Organization's Guidelines in conducting "Vulnerability and Adaptation Assessments." A framework and list of indicators were developed for semi-quantitative assessment for the period 2013 to 2017. Three sets of indicators were selected to assess the level of (1) exposure to climate change and extreme weather events, (2) health sensitivity, and (3) adaptation capacity. The indicators were rated and analyzed using a scoring system from 1 to 5. RESULTS: The results showed that climate-sensitive diseases were common, including dengue fever, diarrheal, influenza, etc, with large burdens of disease that are projected to increase. From 2013 to 2017, the level of "exposure" to climate change-related hazards of the health sector was "high" to "very high," with an average score from 3.5 to 4.4 (out of 5.0). For "health sensitivity," the scores decreased from 3.8 in 2013 to 3.5 in 2017, making the overall rating as "high." For "adaptive capacity," the scores were from 4.0 to 4.1, which meant adaptive capacity was "very low." The overall V&A rating in 2013 was "very high risk" (score 4.1) and "high risk" with scores of 3.8 in 2014 and 3.7 in 2015 to 2017. CONCLUSIONS: Adaptation actions of the health sector are urgently needed to reduce the vulnerability to climate change in coming decades. Eight adaptation solutions, among recommendations of V&A assessment, were adopted in the National Health Climate Change Adaptation Plan.

A Novel BRCA1 Gene Mutation Detected With Breast Cancer in a Vietnamese Family by Targeted Next-Generation Sequencing: A Case Report.

Hereditary breast cancer is an inherited genetic condition, mainly caused by BRCA1 and BRCA2 gene mutations. These genetic changes can increase the risks of breast and ovarian cancers in women, while prostate and breast cancers in men. Especially, mutations in either BRCA1 or BRCA2 genes take important roles in early-onset breast cancer. The present study focused on a 47-year-old Vietnamese woman with breast cancer by applying targeted next-generation sequencing technique. A novel BRCA1 gene mutation, namely NM_007294.3 (BRCA1): c.4998insA (p. Tyr1666Terfs), was identified both in this patient and in some of the members in her family proved the fact that the mutated genes passed down through generations. This change may exponentially initiate breast cancer risks and become a valuable marker for exact clinical prognosis and treatment.

Novel reduced graphene oxide/ZnBi2O4 hybrid photocatalyst for visible light degradation of 2,4-dichlorophenoxyacetic acid.

A new highly efficient rGO/ZnBi2O4 hybrid catalyst has been successfully synthesized through oxidation-reduction and co-precipitation methods, followed by heating at 450 °C. The obtained rGO/ZnBi2O4 catalyst was characterized by X-ray diffraction (XRD), UV-vis diffuse reflectance spectroscopy (DRS), scanning electron microscopy (SEM), Fourier-transform infrared (FTIR) spectroscopy, and X-ray photoelectron spectroscopy (XPS). The catalytic activity of rGO/ZnBi2O4 under visible light irradiation was tested using 2,4-dichlorophenoxyacetic acid (2,4-D) in aqueous solution. The rGO/ZnBi2O4 hybrid catalyst containing 2% rGO (2.0rGO/ZnBi2O4) showed the best catalytic performance. More than 90% of 2,4-D in a 30 mg/L solution was degraded after 120 min of visible light irradiation using 2.0rGO/ZnBi2O4 at 1.0 g/L concentration. Moreover, the 2.0rGO/ZnBi2O4 catalyst showed excellent stability over four consecutive cycles, with no significant changes in the photocatalytic degradation rate. This study demonstrated that rGO/ZnBi2O4 may be a promising, low-cost, and green photocatalyst for environmental remediation applications.

Per cent low attenuation volume and fractal dimension of low attenuation clusters on CT predict different long-term outcomes in COPD.

BACKGROUND: Fractal dimension (D) characterises the size distribution of low attenuation clusters on CT and assesses the spatial heterogeneity of emphysema that per cent low attenuation volume (%LAV) cannot detect. This study tested the hypothesis that %LAV and D have different roles in predicting decline in FEV1, exacerbation and mortality in patients with COPD. METHODS: Chest inspiratory CT scans in the baseline and longitudinal follow-up records for FEV1, exacerbation and mortality prospectively collected over 10 years in the Hokkaido COPD Cohort Study were examined (n=96). The associations between CT measures and long-term outcomes were replicated in the Kyoto University cohort (n=130). RESULTS: In the Hokkaido COPD cohort, higher %LAV, but not D, was associated with a greater decline in FEV1 and 10-year mortality, whereas lower D, but not %LAV, was associated with shorter time to first exacerbation. Multivariable analysis for the Kyoto University cohort confirmed that lower D at baseline was independently associated with shorter time to first exacerbation and that higher LAV% was independently associated with increased mortality after adjusting for age, height, weight, FEV1 and smoking status. CONCLUSION: These well-established cohorts clarify the different prognostic roles of %LAV and D, whereby lower D is associated with a higher risk of exacerbation and higher %LAV is associated with a rapid decline in lung function and long-term mortality. Combination of %LAV and fractal D may identify COPD subgroups at high risk of a poor clinical outcome more sensitively.