The Naturally Occurring YMDD Mutation among Patients Chronically Infected HBV and Untreated with Lamivudine: A Systematic Review and Meta-Analysis

Background: Several recent reports have demonstrated that tyrosine (Y)-methionine (M)-aspartic acid (D)-aspartic acid (D) (YMDD) motif mutations can naturally occur in chronic HBV patients without antiviral treatment such as lamivudine therapy. This paper aims to assess the overall spontaneous incidence and related risk factors of YMDD-motif mutations among lamivudine-naïve chronic HBV carriers, so as to provide some clue for clinical treatment of hepatitis B. Methodology/Principal Findings: Chinese and English literatures were searched for studies reporting natural YMDD mutations among untreated chronic HBV patients from 2001 to 2010. The incidence estimates were summarized and analyzed by meta-analyses. Forty-seven eligible articles from eight countries were selected in this review (13 in English and 34 in Chinese). The pooled incidence of YMDD-motif mutation among untreated chronic HBV patients from eight countries was 12.21 % (95 % CI: 9.69%–14.95%). China had an incidence of 13.38 % (95 % CI: 10.90%–16.07%) and seven other countries had an incidence of 9.90 % (95 % CI: 3.28%–19.55%), respectively. Lamivudine therapy would increase the risk of mutations 5.23 times higher than the untreated patients. A higher HBV DNA copy number was associated with increased incidence of natural YMDD mutation. No significant difference was found in YMDD mutation incidence between groups of different gender, age, HBeAg status, patients ’ ALT (alanine aminotransferase) level, and between the groups of HBV genotype B and C. Conclusions: The YMDD-motif mutations can occur spontaneously with a relatively high incidence in CHB patient

Identification of drought-responsive microRNAs in Medicago truncatula by genome-wide high-throughput sequencing

<p>Abstract</p> <p>Background</p> <p>MicroRNAs (miRNAs) are small, endogenous RNAs that play important regulatory roles in development and stress response in plants by negatively affecting gene expression post-transcriptionally. Identification of miRNAs at the global genome-level by high-throughout sequencing is essential to functionally characterize miRNAs in plants. Drought is one of the common environmental stresses limiting plant growth and development. To understand the role of miRNAs in response of plants to drought stress, drought-responsive miRNAs were identified by high-throughput sequencing in a legume model plant, <it>Medicago truncatula</it>.</p> <p>Results</p> <p>Two hundreds eighty three and 293 known miRNAs were identified from the control and drought stress libraries, respectively. In addition, 238 potential candidate miRNAs were identified, and among them 14 new miRNAs and 15 new members of known miRNA families whose complementary miRNA*s were also detected. Both high-throughput sequencing and RT-qPCR confirmed that 22 members of 4 miRNA families were up-regulated and 10 members of 6 miRNA families were down-regulated in response to drought stress. Among the 29 new miRNAs/new members of known miRNA families, 8 miRNAs were responsive to drought stress with both 4 miRNAs being up- and down-regulated, respectively. The known and predicted targets of the drought-responsive miRNAs were found to be involved in diverse cellular processes in plants, including development, transcription, protein degradation, detoxification, nutrient status and cross adaptation.</p> <p>Conclusions</p> <p>We identified 32 known members of 10 miRNA families and 8 new miRNAs/new members of known miRNA families that were responsive to drought stress by high-throughput sequencing of small RNAs from <it>M. truncatula</it>. These findings are of importance for our understanding of the roles played by miRNAs in response of plants to abiotic stress in general and drought stress in particular.</p

Digital Health Policy and Programs for Hospital Care in Vietnam: Scoping Review

The members of the Vietnam ICU Translational Applications Laboratory (VITAL) group are as follows: Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam: An Phuoc Luu, Chanh Quang Ho, Duc Hong Du, Duc Minh Tran, Dung Thi Phuong Nguyen, Giang Thi Nguyen, Hai Bich Ho, Hien Van Ho, Hung Manh Trinh, Huy Quang Nguyen, Khanh Nguyen Quoc Phan, Khoa Dinh Van Le, Kien Trung Dang, Lam Khanh Phung, Lieu Thi Pham, Ngoc Thanh Nguyen, Nhat Tran Huy Phung, Phuong Thanh Le, Quyen Than Ha Nguyen, Thanh Thi Le Nguyen, Thy Bui Xuan Doan, Trieu Trung Huynh, Trinh Huu Khanh Dong, Van Minh Tu Hoang, Van Thi Thanh Ninh, Vuong Lam Nguyen, Yen Minh Lam, Sayem Ahmed, Joseph Donovan, Ronald Geskus, Evelyne Kestelyn, Angela Mcbride, Guy Thwaites, Louise Thwaites, Hugo Turner, Jennifer Ilo Van Nuil, and Sophie Yacoub. Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam: Tam Thi Cao, Thuy Bich Duong, Duong Thi Hai Ha, Nghia Dang Trung Ha, Chau Buu Le, Thu Ngoc Minh Le, Thao Thi Mai Le, Tai Thi Hue Luong, Phu Hoan Nguyen, Viet Quoc Nguyen, Nguyen Thanh Nguyen, Phong Thanh Nguyen, Anh Thi Kim Nguyen, Hao Van Nguyen, Duoc Van Thanh Nguyen, Chau Van Vinh Nguyen, Oanh Kieu Nguyet Pham, Van Thi Hong Phan, Qui Tu Phan, Tho Vinh Phan, and Thao Thi Phuong Truong. University of Oxford, Oxford, United Kingdom: David Clifton, Mike English, Shadi Ghiasi, Heloise Greeff, Jannis Hagenah, Ping Lu, Jacob McKnight, Chris Paton, and Tingting Zhu. Imperial College London, London, United Kingdom: Pantellis Georgiou, Bernard Hernandez Perez, Kerri Hill-Cawthorne, Alison Holmes, Stefan Karolcik, Damien Ming, Nicolas Moser, and Jesus Rodriguez Manzano. King's College London, London, United Kingdom: Alberto Gomez, Hamideh Kerdegari, Marc Modat, and Reza Razavi. ETH Zurich, Zurich, Switzerland: Abhilash Guru Dutt, Walter Karlen, Michaela Verling, and Elias Wicki. The University of Melbourne, Melbourne, Australia: Linda Denehy and Thomas Rollinson.Background: There are a host of emergent technologies with the potential to improve hospital care in low- and middle-income countries such as Vietnam. Wearable monitors and artificial intelligence–based decision support systems could be integrated with hospital-based digital health systems such as electronic health records (EHRs) to provide higher level care at a relatively low cost. However, the appropriate and sustainable application of these innovations in low- and middle-income countries requires an understanding of the local government’s requirements and regulations such as technology specifications, cybersecurity, data-sharing protocols, and interoperability. Objective: This scoping review aims to explore the current state of digital health research and the policies that govern the adoption of digital health systems in Vietnamese hospitals. Methods: We conducted a scoping review using a modification of the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines. PubMed and Web of Science were searched for academic publications, and Thư Viện Pháp Luật, a proprietary database of Vietnamese government documents, and the Vietnam Electronic Health Administration website were searched for government documents. Google Scholar and Google Search were used for snowballing searches. The sources were assessed against predefined eligibility criteria through title, abstract, and full-text screening. Relevant information from the included sources was charted and summarized. The review process was primarily undertaken by one researcher and reviewed by another researcher during each step. Results: In total, 11 academic publications and 20 government documents were included in this review. Among the academic studies, 5 reported engineering solutions for information systems in hospitals, 2 assessed readiness for EHR implementation, 1 tested physicians’ performance before and after using clinical decision support software, 1 reported a national laboratory information management system, and 2 reviewed the health system’s capability to implement eHealth and artificial intelligence. Of the 20 government documents, 19 were promulgated from 2013 to 2020. These regulations and guidance cover a wide range of digital health domains, including hospital information management systems, general and interoperability standards, cybersecurity in health organizations, conditions for the provision of health information technology (HIT), electronic health insurance claims, laboratory information systems, HIT maturity, digital health strategies, electronic medical records, EHRs, and eHealth architectural frameworks. Conclusions: Research about hospital-based digital health systems in Vietnam is very limited, particularly implementation studies. Government regulations and guidance for HIT in health care organizations have been released with increasing frequency since 2013, targeting a variety of information systems such as electronic medical records, EHRs, and laboratory information systems. In general, these policies were focused on the basic specifications and standards that digital health systems need to meet. More research is needed in the future to guide the implementation of digital health care systems in the Vietnam hospital setting.This study was supported by the Wellcome Trust United Kingdom WT217650/Z/19/Z

Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: a pooled analysis of 1201 population-representative studies with 104 million participants

Background: Hypertension can be detected at the primary health-care level and low-cost treatments can effectively control hypertension. We aimed to measure the prevalence of hypertension and progress in its detection, treatment, and control from 1990 to 2019 for 200 countries and territories.Methods: We used data from 1990 to 2019 on people aged 30-79 years from population-representative studies with measurement of blood pressure and data on blood pressure treatment. We defined hypertension as having systolic blood pressure 140 mm Hg or greater, diastolic blood pressure 90 mm Hg or greater, or taking medication for hypertension. We applied a Bayesian hierarchical model to estimate the prevalence of hypertension and the proportion of people with hypertension who had a previous diagnosis (detection), who were taking medication for hypertension (treatment), and whose hypertension was controlled to below 140/90 mm Hg (control). The model allowed for trends over time to be non-linear and to vary by age.Findings: The number of people aged 30-79 years with hypertension doubled from 1990 to 2019, from 331 (95% credible interval 306-359) million women and 317 (292-344) million men in 1990 to 626 (584-668) million women and 652 (604-698) million men in 2019, despite stable global age-standardised prevalence. In 2019, age-standardised hypertension prevalence was lowest in Canada and Peru for both men and women; in Taiwan, South Korea, Japan, and some countries in western Europe including Switzerland, Spain, and the UK for women; and in several low-income and middle-income countries such as Eritrea, Bangladesh, Ethiopia, and Solomon Islands for men. Hypertension prevalence surpassed 50% for women in two countries and men in nine countries, in central and eastern Europe, central Asia, Oceania, and Latin America. Globally, 59% (55-62) of women and 49% (46-52) of men with hypertension reported a previous diagnosis of hypertension in 2019, and 47% (43-51) of women and 38% (35-41) of men were treated. Control rates among people with hypertension in 2019 were 23% (20-27) for women and 18% (16-21) for men. In 2019, treatment and control rates were highest in South Korea, Canada, and Iceland (treatment >70%; control >50%), followed by the USA, Costa Rica, Germany, Portugal, and Taiwan. Treatment rates were less than 25% for women and less than 20% for men in Nepal, Indonesia, and some countries in sub-Saharan Africa and Oceania. Control rates were below 10% for women and men in these countries and for men in some countries in north Africa, central and south Asia, and eastern Europe. Treatment and control rates have improved in most countries since 1990, but we found little change in most countries in sub-Saharan Africa and Oceania. Improvements were largest in high-income countries, central Europe, and some upper-middle-income and recently high-income countries including Costa Rica, Taiwan, Kazakhstan, South Africa, Brazil, Chile, Turkey, and Iran.Interpretation: Improvements in the detection, treatment, and control of hypertension have varied substantially across countries, with some middle-income countries now outperforming most high-income nations. The dual approach of reducing hypertension prevalence through primary prevention and enhancing its treatment and control is achievable not only in high-income countries but also in low-income and middle-income settings.Copyright (C) 2021 World Health Organization; licensee Elsevier.</p

An integrated approach for improved management of an island's scarce water resources under climate change and tourism development

The Modelling and Simulation Society of Australia and New Zealand Inc. All rights reserved. The management of island water systems in highly developed tourism destinations of developing countries presents many challenges in the face of climate change. Such systems are high levels of uncertainty and complexity driven by dynamic interactions amongst multiple climatic and non-climatic drivers with many feedbacks. Understanding complex interactions and feedbacks in the systems is, therefore, critical to develop a long-term strategy for safeguarding a growing water demand from socio-economic development. In this study, an integrated approach was applied to improved management of scarce water resources in Cat Ba Island under high levels of climate change and socio-economic stressors. Specifically, a range of relevant historical data was collected and examined to identify interrelations among climatic and non-climatic drivers on the island water resources. In addition, 961 households in six communes and one town in the Cat Ba Island were interviewed to understand respondents' perspectives on threats and adaptation options for the management of the island's scarce water system. Results of relevant historical data analysis and respondents' perspectives were used together with focus group discussions to develop a causal loop diagram (CLD) for the Cat Ba Island's scarce water resource system under high levels of climate change and tourism development. The CLD provides a comprehensive representation of the island's scarce water resources driven by multiple relationships and interactions amongst climatic and non-climatic drivers as well as adaptation options, represented by two reinforcing loops (R1 and R2), and ten balancing loops (B1 to B10). These loops provide further information on the potential water scarcity in the island in both current and future conditions. Specifically, water demand has been observed to be significantly increased over time due to high levels of population growth and tourism development, depicted by two reinforcing loops (R1 and R2). However, water supply has been decreasing over time due to sea level rise and precipitation decline. These observations are represented by ten balancing loops (B1 to B10) in which seven balancing loops (B4 to B10) represent a "Drifting goals" system archetype to seek the stability in water availability in the system. The next stage of this study is to apply a system dynamics model (SDM) to assess the vulnerability of the island water system in 47 years, from 2014 to 2050 under climatic and non-climatic changes. Simulations targets the year 2050 because it provides a long-term perspective from which the long-term dynamic behaviour of the island water system and the consequences of the plausible future scenarios could be assessed to inform adaptation decision-making. The key climatic and non-climatic drivers and adaptation options from the CLD will be incorporated into the SDM to assess the vulnerability of the island water system and effectiveness of adaptation options under climate change and socio-economic stressors over time. The SDM will be calibrated using relevant historical data, and validated by local stakeholders for decision-making supports. A contingent evaluation method is also applied to examine the determinant factors influencing respondents' willingness to pay (WTP) for building reservoirs and increasing water price for improved management of scarce water resources in a highly developed tourism island under climate change. The logistic regression models and Bayesian networks will be used to identify determinants of the respondents' WTP for the management of the island's scarce water system. The results of this study will assist decision-makers and water managers to understand dynamics behaviour of the system over time, and respondents' perceptions, thereby applying more effective practices to the management of scarce water resources under high levels of climate change and tourism development in the Cat Ba Island, Vietnam.Full Tex