Successful Chemotherapy Treatment for a Tricuspid Valvular Stenosis Patient due to Right Ventricular Lymphoma.

Background: This study presents a patient diagnosed with tricuspid valvular stenosis due to right ventricular lymphoma, who was treated successfully. Case presentation: A 66-year-old man with a history of worsening shortness of breath during activity for the last three weeks sought medical attention. The patient later experienced swelling in the extremities, fluid build-up around the lungs and abdominal fluid accumulation, with no reported chest pain, fever, or weight loss. An echocardiogram found a mass in the lateral wall near the tricuspid valve of the right ventricle, leading to moderate tricuspid stenosis. The cardiac magnetic resonance imaging (MRI) revealed a lumpy, poorly defined mass that invaded the heart muscle and displayed varied enhancement after contrast administration. Suspicion arose for a malignant tumour or metastatic lesion due to its features and contrast uptake capability. A percutaneous biopsy was carried out on the mass in the right ventricle to confirm the diagnosis. The pathology report indicated a diagnosis of non-Hodgkin's lymphoma. After being diagnosed, the patient underwent chemotherapy using the R-CHOP regimen. Over time the symptoms improved, and echocardiograms revealed a decrease in the size of the tumour. After undergoing six rounds of chemotherapy, a cardiac MRI four months later showed no signs of a tumour. After that, the patient resumed their regular activities. Conclusion: Right ventricular tumours are mostly malignant lesions and often have an inferior prognosis. Early diagnosis with imaging techniques and myocardial biopsy is necessary to deliver life-saving treatment quickly. LEARNING POINTS: Right ventricular tumours are mostly malignant lesions and often have an inferior prognosis.Early diagnosis with imaging techniques and myocardial biopsy is necessary to deliver life-saving treatment quickly.Right ventricular lymphoma is a sporadic tumour, but the prognosis is favourable if detected in time.

Synchronous tumors of gastric carcinoma combined gallbladder cancer and pseudotumor chronic pancreatitis.

INTRODUCTION AND IMPORTANCE: Synchronous primary cancers in the stomach and gallbladder were not previously reported in the medical literature. Pseudotumor pancreatitis was also described many years ago. It was misdiagnosed and required surgery for pancreatic head neoplasms. PRESENTATION OF CASE: A 57-year-old male patient went to our hospital for abdominal pain. He was indicated for gastroduodenal endoscopy, and the result was adenocarcinoma. Abdominal ultrasound and Ctscan detected the gallbladder fundus's localized thickening structure and the pancreatic head's hyperechoic structure. The endoscopic ultrasound and MRI showed a gallbladder + pancreatic head tumor with chronic pancreatitis with pancreatic stones. The patient underwent distal gastrectomy, cholecystectomy, and pancreaticoduodenectomy. CLINICAL DISCUSSION: The detection of gastric cancer is often based on upper gastrointestinal endoscopy and biopsy results. Gallbladder cancer is often diagnosed at an advanced stage, and only very few patients are diagnosed early. Pancreatic cancer often occurs in the head of the pancreas. Symptoms may include obstruction of the common bile and Wirsung duct, often in advanced stages. Surgery for the gallbladder, distal stomach, and head of pancreatic tumors are related to each other located in a neighboring location in the anatomy, so surgery to remove all three tumors is relatively similar to a pancreaticoduodenectomy procedure. CONCLUSION: Synchronous tumors of gastric carcinoma combined with gallbladder cancer and pseudotumor chronic pancreatitis are rare. The attitude of treating these three diseases at the same time requires a tumor board. Simultaneous surgery for gallbladder, stomach, and pancreatic head tumors can be performed if the tumors are still in the resectable stage.

Endoscopic and Histopathological Characteristics of Gastrointestinal Lymphoma: A Multicentric Study.

Background: Extranodal non-Hodgkin lymphoma (NHL) is more prevalent in the gastrointestinal (GI) tract than in other sites. This study aimed to determine the endoscopic characteristics of primary gastrointestinal non-Hodgkin lymphomas. Methods: We investigated 140 patients from three tertiary referral hospitals with primary malignant lymphoma of the gastrointestinal tract. Characteristics of the lesions were evaluated and analyzed using image-enhanced endoscopy, endoscopic ultrasound, and histopathology. Results: The median age was 60.5 (range: 11-99), and 59 (42.1%) were female. The most frequent complaint was abdominal pain (74.3%), followed by bloody feces (10%) and diarrhea (2.9%). B symptoms were observed in 15 (10.7%) patients. GI obstruction was the most common complication (10.0%), followed by hemorrhage (7.9%) and perforation (1.5%). Regarding endoscopic findings, the identified sites were the following: the stomach (61.4%), colon (10%), small intestine (10%), ileocecum (8.6%), rectum (6.4%), and duodenum (3.6%). Diffuse large B-cell lymphoma (DLBCL) and mucosa-associated lymphoid tissue (MALT) lymphoma are most prevalent in the stomach. Helicobacter pylori was identified in 46 cases (39.0%), with MALT lymphoma being the most infected subtype. Nearly all gastrointestinal non-Hodgkin lymphomas manifested as superficial type (25-59.6%) and ulcer type (15.6-50%) under endoscopy. We found that fungating type and protruding with ulcer type were more frequent types of aggressive lymphomas (diffuse large B-cell lymphoma, mantle cell lymphoma, and T-cell lymphoma) compared to the indolent types (MALT lymphoma, follicular lymphoma, duodenal-type follicular lymphoma, and small lymphocytic lymphoma) (p < 0.05). Conclusions: This study showed that most subtypes of gastrointestinal non-Hodgkin lymphomas exhibited same endoscopic features (superficial type and ulcer type). Aggressive gastrointestinal non-Hodgkin lymphomas (diffuse large B-cell lymphoma, mantle cell lymphoma, and T-cell lymphoma) were highly suspected when fungating lesions and protruding with ulcer lesions were encountered under endoscopy. Endoscopists should be aware of the connection between enhanced endoscopic characteristics and histological varieties of gastrointestinal lymphoma to improve diagnosis.

Isolation and purification of potential weed inhibitors from Mimosa pigra L.

The diversity in structure and herbicidal properties detected in natural phytotoxic compounds could bring about advantages for development bio-herbicides. The present study was carried out search for potential weed inhibitors from the parts of Mimosa pigra L. The ethyl acetate (EtOAc) extract of leaf of M. pigra showed inhibitory activity during the time that Echinochloa crus-galli (barnyardgrass) germinates and grows, which is greater than that of other extracts. From this active extract, potent growth inhibitors were isolated and identified by column chromatography (CC), gas chromatography-mass spectrometry (GC-MS) and nuclear magnetic resonance (1H and 13C NMR). The six compounds were purified in this study namely: lupeol (C1, 13.2 mg), stigmastane-3,6-dione (C2, 14.7 mg), quercetin (C3, 20.2 mg), chrysoeriol (C4, 28 mg), methyl gallate (C5, 21.5 mg) and daucosterol (C6, 16.0 mg). The C2 (quercetin) compound completely inhibited the emergency, shoot height and root length of E. crus-galli at 1 mg/mL concentration (IC50 shoot height = 0.56 mg/mL). This was also the first study to report the isolation and allelopathic activity of lupeol, chrysoeriol and daucosterol from M. pigra leaf. Findings of this study highlighted that quercetin from M. pigra may become bio-herbicide to control barnyard grass and other grass weeds for the development of safe agriculture.

Radiological risk assessment of outdoor222Rn and220Rn around rare earth element and uranium mines from northern Vietnam.

The outdoor222Rn and220Rn concentrations at 320 sampling points at 1 m above the ground in different sites surrounding rare earth element (REE) and uranium mines from northern Vietnam were measured using the RAD7. Results showed that222Rn concentrations were always higher than220Rn concentrations with large variation ranges from 25.7 to 573 Bq m-3and from 18.5 to 385 Bq m-3, respectively. The high correlation between220Rn and228Ra concentrations in surface soil of the studied sites were observed. The highest220Rn and222Rn concentrations are found at the sampling points of the REE NX-Lai Chau site. The220Rn and222Rn activities surrounding the REE mines were found to be higher than those surrounding the uranium mines. The average annual committed effective doses originated from the inhalation of220Rn and222Rn outdoor concentrations is about five times higher than the worldwide average value.

Stable Isotopes (δ13C and δ15N) and Trace Elements of Invertebrates and Fish from the Coastal Waters of Ha Tinh Province, Central Vietnam.

Stable isotope signatures (δ13C, δ15N) and trace elements (TEs) were analyzed from invertebrates and fish to assess food web structure and the biomagnification or biodilution of Cu, Pb, Cd, Zn, Mn, Cr, Hg and As in coastal waters of Ha Tinh Province, Central Vietnam. δ13C and δ15N values of purported food sources (sediments, phytoplankton, macroalgae, and zooplankton) ranged from -21.24 ± 0.39‰ to -16.72 ± 1.02‰ and from 3.02 ± 0.70‰ to 7.30 ± 0.42‰, respectively. The δ13C and δ15N values in invertebrates and fish ranged from -19.75 ± 0.10‰ to -18.68 ± 0.40‰, and from 7.02 ± 1.21‰ to 9.10 ± 0.29‰. The δ15N values showed that the food web structure could be divided into four trophic levels. The benthic invertebrates had significantly higher concentrations of Cu, Pb, Zn, Cd and As. Hg concentrations tended to accumulate higher in the crabs and fish. The biodilution of Pb, Cd, Zn, Cr was observed throughout the food web, whereas biomagnification was observed for Cr, Mn, and As in bivalves; Cd and Zn in gastropods; Pb, Cd, Zn, and As in crabs; Cd in prawns and Hg in fish.

Synchronous esophageal squamous cell carcinoma and hepatocellular carcinoma: A rare case report.

Multiple primary malignancies in general and synchronous cancers, in particular, are relatively rare but have increased in recent decades. We report a case of a 62-year-old Vietnamese male who visited our hospital with the chief symptom was mild dysphagia. An irregular lesion causing the total luminal obstruction was detected at the low third part of the esophagus via endoscopy and two suspicious nodules in the segment V of the liver were incidentally encountered through the Computed tomography (CT). Multiple biopsies from the lesions were then performed. Histopathology and immunohistochemistry results demonstrated Squamous cell carcinoma of the esophagus and Hepatocellular carcinoma of the liver, which verified the existence of synchronous cancers in the patient.

Metabolic Toxification of 1,2-Unsaturated Pyrrolizidine Alkaloids Causes Human Hepatic Sinusoidal Obstruction Syndrome: The Update.

Saturated and unsaturated pyrrolizidine alkaloids (PAs) are present in more than 6000 plant species growing in countries all over the world. They have a typical heterocyclic structure in common, but differ in their potential toxicity, depending on the presence or absence of a double bond between C1 and C2. Fortunately, most plants contain saturated PAs without this double bond and are therefore not toxic for consumption by humans or animals. In a minority of plants, however, PAs with this double bond between C1 and C2 exhibit strong hepatotoxic, genotoxic, cytotoxic, neurotoxic, and tumorigenic potentials. If consumed in error and in large emouns, plants with 1,2-unsaturated PAs induce metabolic breaking-off of the double bonds of the unsaturated PAs, generating PA radicals that may trigger severe liver injury through a process involving microsomal P450 (CYP), with preference of its isoforms CYP 2A6, CYP 3A4, and CYP 3A5. This toxifying CYP-dependent conversion occurs primarily in the endoplasmic reticulum of the hepatocytes equivalent to the microsomal fraction. Toxified PAs injure the protein membranes of hepatocytes, and after passing their plasma membranes, more so the liver sinusoidal endothelial cells (LSECs), leading to life-threatening hepatic sinusoidal obstruction syndrome (HSOS). This injury is easily diagnosed by blood pyrrolizidine protein adducts, which are perfect diagnostic biomarkers, supporting causality evaluation using the updated RUCAM (Roussel Uclaf Causality Assessment Method). HSOS is clinically characterized by weight gain due to fluid accumulation (ascites, pleural effusion, and edema), and may lead to acute liver failure, liver transplantation, or death. In conclusion, plant-derived PAs with a double bond between C1 and C2 are potentially hepatotoxic after metabolic removal of the double bond, and may cause PA-HSOS with a potential lethal outcome, even if PA consumption is stopped.

Soil and sediment contamination by unsubstituted and methylated polycyclic aromatic hydrocarbons in an informal e-waste recycling area, northern Vietnam: Occurrence, source apportionment, and risk assessment.

Improper processing activities of e-waste are potential sources of polycylic aromatic hydrocarbons (PAHs) and their derivatives, however, information about the environmental occurrence and adverse impacts of these toxic substances is still limited for informal e-waste recycling areas in Vietnam and Southeast Asia. In this study, unsubstituted and methylated PAHs were determined in surface soil and river sediment samples collected from a rural village with informal e-waste recycling activities in northern Vietnam. Total levels of PAHs and MePAHs decreased in the order: workshop soil (median 2900; range 870-42,000 ng g-1) > open burning soil (2400; 840-4200 ng g-1) > paddy field soil (1200; range 530-6700 ng g-1) > river sediment samples (750; 370-2500 ng g-1). About 60% of the soil samples examined in this study were heavily contaminated with PAHs. Fingerprint profiles of PAHs and MePAHs in the soil and sediment samples indicated that these pollutants were mainly released from pyrogenic sources rather than petrogenic sources. The emissions of PAHs and MePAHs in this area were probably attributed to uncontrolled burning of e-waste and agricultural by-products, domestic coal and biomass combustion, and traffic activities. Carcinogenicity and mutagenicity of PAHs in the e-waste workshop soils were significantly higher than those of the field soils; however, the incremental lifetime cancer risk of PAH-contaminated soils in this study ranged from 5.5 × 10-9 to 4.6 × 10-6, implying acceptable levels of human health risk. Meanwhile, concentrations of some compounds such as phenanthrene, anthracene, fluoranthene, benz[a]anthracene, and benzo[a]pyrene in several soil samples exceeded the maximum permissible concentrations, indicating the risk of ecotoxicological effects.

Monitoring fine root growth to identify optimal fertilization timing in a forest plantation: A case study in Northeast Vietnam.

Fertilizer is applied widely to improve the productivity of plantations. Traditionally, fertilization is conducted in spring and/or in the early rainy season, and it is believed to support the growth of planted trees in the growing season. Little attention to date has been paid on identification of the optimal timing of fertilization and fertilizer dose. In this study, application of the fine root monitoring technique in identifying optimal fertilization timing for an Acacia plantation in Vietnam is described. The study used two fertilizer doses (100 and 200 g NPK/tree) and three fertilization timings (in spring; in the early rainy season; and based on the fine root monitoring technique to identify when the fine roots reach their growth peak). As expected fertilization timings significantly affected growth and above-ground biomass (AGB) of the plantation. Fertilization based on the fine root monitoring technique resulted in the highest growths and AGB, followed by fertilization in the early rainy season and then in spring. Applying fertilizer at 200 g NPK/tree based on the fine root monitoring technique increased diameter at breast height (DBH) by 16%, stem height by 8%, crown diameter (Dc) by 16%, and AGB by 40% as compared to early rainy season fertilization. Increases of 32% DBH, 23% stem height, 44% Dc, and 87% AGB were found in fertilization based on fine root monitoring technique compared to spring fertilization. This study concluded that forest growers should use the fine root monitoring technique to identify optimal fertilization timing for higher productivity.

Cordycepin Isolated from Cordyceps militaris: Its Newly Discovered Herbicidal Property and Potential Plant-Based Novel Alternative to Glyphosate.

There is currently much interest in finding new phytochemicals among plants and fungi as nature-based alternatives to replace problematic herbicides such as glyphosate, which are preferentially used in agricultural production n. We discovered striking herbicidal potency in Cordyceps militaris (L.) and identified cordycepin as its principal plant growth inhibitor. Cordycepin obtained as an ethyl acetate extract was subjected to column chromatography and evaluated for its bioassay-guided phytotoxic capacity against Raphanus sativus (radish), showing a maximum inhibition on germination and growth of radish (IC50 = 0.052-0.078 mg/mL). Gas chromatography-mass spectrometry (GC-MS) (m/z: 251.2) and liquid chromatography-electrospray ionization-mass spectrometry (LC-ESI-MS) ([M + Na]+ m/z: 274.1; [M + H]+ m/z: 252.1) analyses confirmed cordycepin as the major component of the tested column fraction (55.38%). At 0.04 mg/mL, cordycepin showed 3.8-5.9- and 3.3-3.7-fold greater inhibition of the germination and growth of radish than benzoic acid (BA) and glyphosate, respectively. Compared with BA, isolated cordycepin reduced plant chlorophyll and carotenoid contents (2.0-9.5 -fold), while proline, total phenolic and total flavonoid contents were increased 1.2-1.8-fold. Finally, cordycepin promoted electrolyte leakage and malondialdehyde accumulation in radish aerial parts. Thus, cordycepin successfully isolated from Cordyceps militaris is a highly potent plant growth inhibitor with pending worldwide patent and may become a potential plant-based novel alternative to the disputed glyphosate.

Biological Activities and Chemical Constituents of Essential Oils from Piper cubeba Bojer and Piper nigrum L.

In this study, we evaluated antioxidant, antihyperuricemic, and herbicidal activities of essential oils (EOs) from Piper cubeba Bojer and Piper nigrum L.; two pepper species widely distributed in tropics, and examined their chemical compositions. Dried berries of P. cubeba and P. nigrum were hydro-distilled to yield essential oil (EO) of 1.23 and 1.11% dry weight, respectively. In the antioxidant assay, the radical scavenging capacities of P. cubeba EO against DPPH and ABTS free radicals were 28.69 and 24.13% greater than P. nigrum, respectively. In the antihyperuricemic activity, P. cubeba EO also exhibited stronger inhibitory effects on xanthine oxidase (IC50 = 54.87 µg/mL) than P. nigrum EO (IC50 = 77.11 µg/mL). In the herbicidal activity, P. cubeba EO showed greater inhibition on germination and growth of Bidens pilosa and Echinochloa crus-galli than P. nigrum EO. Besides, P. cubeba EO decreased 15.98-73.00% of photosynthesis pigments of B. pilosa and E. crus-galli, while electrolyte leakages, lipid peroxidations, prolines, phenolics, and flavonoids contents were increased 10.82-80.82% at 1.93 mg/mL dose. Gas chromatography-mass spectrometry (GC-MS) and liquid chromatography-electrospray ionization-mass spectrometry (LC-ESI-MS) analyses revealed that P. nigrum and P. cubeba EOs principally possessed complex mixtures of monoterpenes and sesquiterpenes. Terpinen-4-ol (42.41%), α-copaene (20.04%), and γ-elemene (17.68%) were the major components of P. cubeba EO, whereas ß-caryophyllene (51.12%) and ß-thujene (20.58%) were the dominant components of P. nigrum EO. Findings of this study suggest both P. cubeba and P. nigrum EOs were potential to treat antioxidative stress and antihyperuricemic related diseases. In addition, the EOs of the two plants may be useful to control B. pilosa and E. crus-galli, the two invasive and problematic weeds in agriculture practice.

Xanthine Oxidase Inhibitory Potential, Antioxidant and Antibacterial Activities of Cordyceps militaris (L.) Link Fruiting Body.

Background: Cordyceps militaris is a medicinal mushroom and has been extensively used as a folk medicine in East Asia. In this study, the separation of constituents involved in xanthine oxidase (XO) inhibitory, antioxidant and antibacterial properties of C. militaris was conducted. Methods: The aqueous residue of this fungus was extracted by methanol and then subsequently fractionated by hexane, chloroform, ethyl acetate and water. The ethyl acetate extract possessed the highest XO inhibitory and antioxidant activities was separated to different fractions by column chromatography. Each fraction was then subjected to anti-hyperuricemia, antioxidant and antibacterial assays. Results: The results showed that the CM8 fraction exhibited the strongest XO inhibitory activity (the lowest IC50: 62.82 µg/mL), followed by the CM10 (IC50: 68.04 µg/mL) and the CM7 (IC50: 86.78 µg/mL). The level of XO inhibition was proportional to antioxidant activity. In antibacterial assay, the CM9 and CM11 fractions showed effective antibacterial activity (MIC values: 15⁻25 mg/mL and 10⁻25 mg/mL, respectively). Results from gas chromatography-mass spectrometry (GC-MS) analyses indicated that cordycepin was the major constituent in the CM8 and CM10 fractions. Conclusions: This study revealed that C. militaris was beneficial for treatment hyperuricemia although in vivo trials on compounds purified from this medicinal fungus are needed.

Antihyperuricemia, Antioxidant, and Antibacterial Activities of Tridax procumbens L.

Tridax procumbens L. is a medicinal plant and used as a drink to treat bronchial catarrh, diarrhea, dysentery and liver diseases. In this study, we evaluated the potential use of T. procumbens to treat hyperuricemia, oxidative stress, and bacterial infection. Ethyl acetate extract of this plant was separated to different fractions by column chromatography (CC) using chloroform and methanol as eluents and subjected to xanthine oxidase (XO) inhibitory, antioxidant, and antibacterial assays. The results showed that the F45⁻47 fraction exhibited the strongest XO inhibitory activity (IC50 = 133.17 µg/mL), while the F48⁻50 fraction possessed maximum antioxidant activity assessed by DPPH (2,2-diphenyl-2-picrylhydrazyl) and ABTS (2,2'-azinobis (3-ethylbenzothiazoline-6-sulfonic acid) assays (IC50 = 0.51 and 1.04 mg/mL, respectively). In addition, the F4⁻5 fraction presented the most effective inhibition on the growth of Escherichia coli, Staphylococcus aureus, Bacillus subtilis, and Proteus mirabilis. Gas chromatography-mass spectrophotometry (GS-MS) and liquid chromatography-electrospray ionization-mass spectrophotometry (LC-ESI-MS) results revealed that fatty acids, glycerides, and flavonoids were the major compounds of the F45⁻47 fraction. Glycerides, triose sugar alcohols, and fatty acids were dominant compounds of the F48⁻50 fraction, while sterols were principal components of the F4⁻5 fraction. This study indicated that T. procumbens had potent inhibitory effects on XO inhibitory, antioxidant, and antibacterial activities. These biological activities may be attributed to the presence of fatty acids, flavonoids, and sterols in this plant. It is suggested that T. procumbens can be utilized as a healthy source to develop beverages and foods to treat antihyperuricemia, oxidative stress, and bacterial infection.

An Overview of Chemical Profiles, Antioxidant and Antimicrobial Activities of Commercial Vegetable Edible Oils Marketed in Japan.

This study analyzed chemical components and investigated the antioxidant and antimicrobial activities of fourteen vegetable edible oils marketed in Japan. High-performance liquid chromatography (HPLC) was used to identify and quantify principal phenolic acids and flavonoids. In the 1,1-diphenyl-2-picrylhydrazyl (DPPH) radical scavenging assay, sunflower, safflower, canola, soybean, Inca inchi, sesame, and rice bran showed markedly greater activity, whilst the percentage of lipid peroxidation inhibition (LPI%) in sunflower, canola, cotton, grape, flax, perilla, Inca inchi, perillartine, and rice bran were significantly higher than other oils. Maximum total phenol content (TPC) was recorded in flax, followed by perillartine, rice bran, and perilla, whereas total flavonoid content (TFC) was the greatest in Inca inchi and sesame. Benzoic acid was the most common constituent, followed by vanillic acid, p-hydroxybenzoic acid, ferulic acid, and p-coumaric acid. On the other hand, luteolin was the most abundant flavonoid, followed by esculetin, myricetin, isoquercetin, and kaempferol, while fisetin was detected only in sunflower. In general, all of the edible oils showed antimicrobial activity, but the growth inhibition of Staphylococcus aureus and Escherichia coli of cotton, grape, chia, sesame, and rice bran were greater than other oils.

Distribution and depth profiles of polychlorinated dibenzo-p-dioxins, polychlorinated dibenzofurans, and polychlorinated biphenyls in sediment collected from offshore waters of Central Vietnam.

Concentrations of PCBs and OCPs were measured in 35 surface sediment samples collected from offshore waters of Central Vietnam. The mean concentrations of PCBs, HCHs, and DDTs in surface sediments were 86.5, 37.0, and 44.5pgg(-1), respectively. Additionally, nine PCDDs, eleven PCDFs, and twelve dl-PCBs were also examined in 19 sediment core samples collected from five locations. Concentration of PCDDs, PCDFs, and dl-PCBs ranged from 200 to 460, 0.39 to 2.9, and 1.6 to 22pgg(-1), respectively. OCDD was detected at the highest concentration, ranged from 100 to 300pgg(-1). Generally, the concentrations of PCDD/Fs at shallower depths were higher, meanwhile the depth profiles of dl-PCBs in sediment cores were different than the depth profiles of PCDD/Fs. The results suggest that the pollution of PCBs might be from many different sources leading to the variation between depths.

Timing of adjuvant surgical oophorectomy in the menstrual cycle and disease-free and overall survival in premenopausal women with operable breast cancer.

BACKGROUND: For women with hormone receptor-positive, operable breast cancer, surgical oophorectomy plus tamoxifen is an effective adjuvant therapy. We conducted a phase III randomized clinical trial to test the hypothesis that oophorectomy surgery performed during the luteal phase of the menstrual cycle was associated with better outcomes. METHODS: Seven hundred forty premenopausal women entered a clinical trial in which those women estimated not to be in the luteal phase of their menstrual cycle for the next one to six days (n = 509) were randomly assigned to receive treatment with surgical oophorectomy either delayed to be during a five-day window in the history-estimated midluteal phase of the menstrual cycles, or in the next one to six days. Women who were estimated to be in the luteal phase of the menstrual cycle for the next one to six days (n = 231) were excluded from random assignment and received immediate surgical treatments. All patients began tamoxifen within 6 days of surgery and continued this for 5 years. Kaplan-Meier methods, the log-rank test, and multivariable Cox regression models were used to assess differences in five-year disease-free survival (DFS) between the groups. All statistical tests were two-sided. RESULTS: The randomized midluteal phase surgery group had a five-year DFS of 64%, compared with 71% for the immediate surgery random assignment group (hazard ratio [HR] = 1.24, 95% confidence interval [CI] = 0.91 to 1.68, P = .18). Multivariable Cox regression models, which included important prognostic variables, gave similar results (aHR = 1.28, 95% CI = 0.94 to 1.76, P = .12). For overall survival, the univariate hazard ratio was 1.33 (95% CI = 0.94 to 1.89, P = .11) and the multivariable aHR was 1.43 (95% CI = 1.00 to 2.06, P = .05). Better DFS for follicular phase surgery, which was unanticipated, proved consistent across multiple exploratory analyses. CONCLUSIONS: The hypothesized benefit of adjuvant luteal phase oophorectomy was not shown in this large trial.

Sustainability and cost of a community-based strategy against Aedes aegypti in northern and central Vietnam.

We previously reported a new community-based mosquito control that resulted in the elimination of Aedes aegypti in 40 of 46 communes in northern and central Vietnam. During 2007 and 2008, we revisited Nam Dinh and Khanh Hoa provinces in northern and central Vietnam, respectively, to evaluate whether or not these programs were still being maintained 7 years and 4.5 years after formal project activities had ceased, respectively. Using a previously published sustainability framework, we compared 13 criteria from Tho Nghiep commune in Nam Dinh where the local community had adopted our community-based project model using Mesocyclops from 2001. These data were compared against a formal project commune, Xuan Phong, where our successful intervention activities had ceased in 2000 and four communes operating under the National Dengue Control Program with data available. In Khanh Hoa province, we compared 2008 data at Ninh Xuan commune with data at project completion in 2003 and benchmarked these, where possible, against an untreated control commune, Ninh Binh, where few control activities had been undertaken. The three communes where the above community-based strategy had been adopted were rated as well-sustained with annual recurrent total costs (direct and indirect) of $0.28-0.89 international dollars per person.

A description of the management of itinerant grazing ducks in the Mekong river delta of Vietnam.

A cross-sectional survey of management practices of itinerant grazing ducks (known as field running ducks) was conducted during March 2008 in four districts of Can Tho and Bac Lieu provinces in the Mekong River Delta, Vietnam. The objective was to characterize the demographic structure of the itinerant grazing duck population and the management practices which might be related to the continuing outbreaks of H5N1 avian influenza in this region. Broiler duck flocks were owned by 55% of survey respondents, and layer flocks by 53%. Greater than 80% of ducks within 93% of villages and 99% of duck flocks were reported to have been vaccinated against H5N1 avian influenza, whereas only 19% of villages and 60% of chicken flocks had greater than 80% of chickens vaccinated. Fifty-nine percent of duck owners moved their ducks outside their home communes, whilst 37% and 28% of owners moved their ducks outside their home district and province, respectively. Larger flocks were more likely to be run outside their home district compared with smaller flocks. After adjusting for the effect of flock production type and district, the odds of an out-of-district field running duck flock movement was increased by a factor of 7.24 (95% CI 2.89-19.24) for households with flocks of more than 800 ducks, compared with flocks of less than 250. Most households sold ducks to traders (72%) or to neighbours (33%), whereas less than 20% sold their birds through markets. The findings of this study suggest that surveillance strategies for field running duck flocks should focus on layer flocks as well as larger flocks as they are more likely to be moved outside of their home district, facilitating long-distance disease spread.

Association of human leukocyte antigen class II alleles with severe acute respiratory syndrome in the Vietnamese population.

Excessive immune response is believed to play a role in the development of severe acute respiratory syndrome (SARS). Inhomogeneous spread of SARS led one to think of an Asian genetic predisposition and contribution of human leukocyte antigen (HLA) to the disease susceptibility. However, past case-control studies showed inconsistent results. In Viet Nam, of 62 patients with SARS, 44 participated in the present study together with 103 individuals who had contact with SARS patients and 50 without contact history. HLA-DRB1*12 was more frequently shown in SARS patients than in controls (corrected p = 0.042). HLA-DRB1*1202, the predominant allele in the Vietnamese population showed the strongest association with SARS in a dominant model (corrected p = 0.0065 and 0.0052, depending on the controls to be compared). Our results and accumulated data on HLA in the Asian populations would help in the understanding of associations with emerging infectious diseases.