ABSTRACT
The COVID-19 pandemic underscored the promise of monoclonal antibody-based prophylactic and therapeutic drugs1-3 and revealed how quickly viral escape can curtail effective options4,5. When the SARS-CoV-2 Omicron variant emerged in 2021, many antibody drug products lost potency, including Evusheld and its constituent, cilgavimab4-6. Cilgavimab, like its progenitor COV2-2130, is a class 3 antibody that is compatible with other antibodies in combination4 and is challenging to replace with existing approaches. Rapidly modifying such high-value antibodies to restore efficacy against emerging variants is a compelling mitigation strategy. We sought to redesign and renew the efficacy of COV2-2130 against Omicron BA.1 and BA.1.1 strains while maintaining efficacy against the dominant Delta variant. Here we show that our computationally redesigned antibody, 2130-1-0114-112, achieves this objective, simultaneously increases neutralization potency against Delta and subsequent variants of concern, and provides protection in vivo against the strains tested: WA1/2020, BA.1.1 and BA.5. Deep mutational scanning of tens of thousands of pseudovirus variants reveals that 2130-1-0114-112 improves broad potency without increasing escape liabilities. Our results suggest that computational approaches can optimize an antibody to target multiple escape variants, while simultaneously enriching potency. Our computational approach does not require experimental iterations or pre-existing binding data, thus enabling rapid response strategies to address escape variants or lessen escape vulnerabilities.
Subject(s)
Antibodies, Monoclonal , Antibodies, Neutralizing , Antibodies, Viral , Computer Simulation , Drug Design , SARS-CoV-2 , Animals , Female , Humans , Mice , Antibodies, Monoclonal/chemistry , Antibodies, Monoclonal/immunology , Antibodies, Neutralizing/chemistry , Antibodies, Neutralizing/immunology , Antibodies, Viral/chemistry , Antibodies, Viral/immunology , COVID-19/immunology , COVID-19/virology , Mutation , Neutralization Tests , SARS-CoV-2/classification , SARS-CoV-2/genetics , SARS-CoV-2/immunology , Spike Glycoprotein, Coronavirus/chemistry , Spike Glycoprotein, Coronavirus/genetics , Spike Glycoprotein, Coronavirus/immunology , DNA Mutational Analysis , Antigenic Drift and Shift/genetics , Antigenic Drift and Shift/immunology , Drug Design/methodsABSTRACT
High-density polyethylene (HDPE) is a widely used commercial plastic due to its excellent mechanical properties, chemical resistance, and water vapor barrier properties. However, less than 10% of HDPE is mechanically recycled, and the chemical recycling of HDPE is challenging due to the inherent strength of the carbon-carbon backbone bonds. Here, we report chemically recyclable linear and branched HDPE with sparse backbone ester groups synthesized from the transesterification of telechelic polyethylene macromonomers. Stoichiometrically self-balanced telechelic polyethylenes underwent transesterification polymerization to produce the PE-ester samples with high number-average molar masses of up to 111 kg/mol. Moreover, the transesterification polymerization of the telechelic polyethylenes and the multifunctional diethyl 5-(hydroxymethyl)isophthalate generated branched PE-esters. Thermal and mechanical properties of the PE-esters were comparable to those of commercial HDPE and tunable through control of the ester content in the backbone. In addition, branched PE-esters showed higher levels of melt strain hardening compared with linear versions. The PE-ester was depolymerized into telechelic macromonomers through straightforward methanolysis, and the resulting macromonomers could be effectively repolymerized to generate a high molar mass recycled PE-ester sample. This is a new and promising method for synthesizing and recycling high-molar-mass linear and branched PE-esters, which are competitive with HDPE and have easily tailorable properties.
ABSTRACT
Little information is available on the epidemiology of Giardia duodenalis in beef cattle from Vietnam. This study was performed to determine the prevalence and genotypes/assemblages of G. duodenalis in native beef calves younger than 6 months in the region. A total of 412 calf fecal samples, randomly selected from 99 small-scale farms located in DacLac and KhanhHoa provinces, central Vietnam, were screened for the presence of G. duodenalis cysts using the zinc-sulfate flotation method followed by iodine staining. The overall prevalence on the sample and herd levels were 13.8% (57/412) and 42.4% (42/99), respectively. Molecular analysis in the ß-giardin and triosephosphate isomerase genes demonstrated the presence of only G. duodenalis assemblage E in the animals. Since assemblage E has been rarely reported in humans, the zoonotic risk in beef calves in the region appears to be minimal.
Subject(s)
Cattle Diseases/epidemiology , Giardia lamblia/isolation & purification , Giardiasis/veterinary , Animals , Cattle , Cattle Diseases/parasitology , Feces/parasitology , Genotype , Giardia lamblia/genetics , Giardiasis/epidemiology , Prevalence , Red Meat , Vietnam/epidemiologyABSTRACT
This study was performed to investigate the prevalence and to characterize the genetic diversity of Histomonas meleagridis isolates in chickens in southern Vietnam. A total of 194 chickens, randomly selected from 18 backyard and 18 commercial flocks, were screened for H. meleagridis infection using both macroscopic diagnosis and an 18S rRNA gene-based PCR method. Overall, 12.9% of birds, representing 19 flocks, showed gross lesions typical for histomonosis whereas 25.3% of the birds from 29 flocks were positive by PCR assay. Following initial diagnostic approaches, H. meleagridis-positive samples were further analyzed by sequencing three different genomic loci; the 18S rRNA, alpha-actinin1, and rpb1. Thirteen samples from 12 flocks were genetically identified as H. meleagridis, demonstrating a flock and sample prevalence of 33.3% and 6.7%, respectively. There was no significant difference in prevalence between different farm types, age groups, and seasonality. Genetic analysis demonstrated minor heterogeneity of Vietnamese isolates with 99% homology to H. meleagridis sequences from the database. This is the first survey of the prevalence and genetic characterization of H. meleagridis in chickens in Vietnam.
Subject(s)
Chickens , Poultry Diseases/parasitology , Protozoan Infections, Animal/parasitology , Trichomonadida/genetics , Animals , Cross-Sectional Studies , Polymerase Chain Reaction , Poultry Diseases/epidemiology , Prevalence , Protozoan Infections, Animal/epidemiology , Vietnam/epidemiologyABSTRACT
Background: In Vietnam, there is limited research on the role of nerve conduction in myasthenia gravis and its association with clinical features. Objective: This study aims to describe the electrophysiological features in patients with myasthenia gravis. Methods: This descriptive study was conducted from September 2019 to December 2021. The study included 33 myasthenia gravis patients who sought medical consultation or received inpatient treatment during this period. The Myasthenia Gravis Foundation of America classifies myasthenia gravis into five groups: I, IIa, IIb, IIIa, IIIb, IVa, IVb, and V. Notably, Group I involves pure ocular weakness, whereas Group a primarily impacts limb and axial muscles, and Group b mainly affects bulbar and respiratory muscles. Results: The study revealed that motor and sensory nerve conduction in the upper and lower limbs were within normal limits for the patient group under evaluation. Repetitive nerve stimulation testing at a frequency of 3 Hz showed positive results in 66.7% of myasthenia gravis patients. Myasthenia gravis patients displayed distinct clinical symptoms, with ptosis being the most common (87.9%). Myasthenia Gravis Foundation of America classification indicated the highest proportion in subgroup IIa (24.2%), with myasthenia gravis predominating in limb and axial muscles (Group a) observed in 51.5% of cases. Needle electromyography showed no abnormalities in myasthenia gravis patients. There was an association between acetylcholine receptor antibody titers and the results of the 3 Hz repetitive nerve stimulation test in myasthenia gravis patients, with a significance of p = 0.002. Conclusion: Nerve conduction studies should be performed in patients with suspected neuromuscular disorders to aid in differential diagnosis and definitive diagnosis of myasthenia gravis.
ABSTRACT
This study was performed to determine the prevalence and molecular characterization of Cryptosporidium in ostriches on a farm in Khanh Hoa province, central Vietnam. A total of 464 ostrich fecal samples were examined Cryptosporidium oocysts using the modified Ziehl-Neelsen staining method, and 110 (overall prevalence 23.7%) were identified as positive by microscopy. Prevalence of Cryptosporidium in animals of <45 days, 45-60 days, 61-90 days, 91 days-12 months and >12 months was 23.5% (16/68), 33.3% (22/66), 35.2% (68/193), 0 and 5.8% (4/69), respectively (p<0.05). The majority of positive samples scored as the 3+ level of intensity of infection were from 61 to 90 days ostriches. Molecular analysis in the 18S ribosomal RNA, 70 kDa heat shock protein and actin genes demonstrated the presence of only Cryptosporidium avian genotype II in ostriches in central Vietnam.
Subject(s)
Bird Diseases/epidemiology , Bird Diseases/parasitology , Cryptosporidiosis/veterinary , Cryptosporidium/genetics , Struthioniformes/parasitology , Actins/genetics , Age Factors , Animals , Animals, Domestic , Cross-Sectional Studies , Cryptosporidiosis/epidemiology , Cryptosporidiosis/parasitology , Cryptosporidium/classification , Cryptosporidium/isolation & purification , DNA, Protozoan/chemistry , DNA, Protozoan/isolation & purification , Feces/parasitology , Genotype , HSP70 Heat-Shock Proteins/genetics , Molecular Sequence Data , Phylogeny , Prevalence , RNA, Ribosomal, 18S/genetics , Vietnam/epidemiologyABSTRACT
Little information is available on the epidemiology of Cryptosporidium in pigs in central Vietnam. The aims of this study were to investigate the prevalence and to characterize the genotype distribution of Cryptosporidium isolates in pigs in this region. A total of 193 pig fecal samples were screened for the presence of Cryptosporidium oocysts using the modified Ziehl-Neelsen staining method, and 28 (overall prevalence 14.5 %) were identified as positive by microscopic observation. Positive samples were further analyzed by polymerase chain reaction amplification and sequencing. Genetic identification based on the 18S ribosomal RNA and 70 kDa heat shock protein genes revealed that pigs in Vietnam are infected with two species/genotypes (Cryptosporidium suis and Cryptosporidium pig genotype II). This study is the first molecular characterization of Cryptosporidium in pigs in Vietnam. The presence of these host-adapted species/genotypes suggests that pigs may not pose a significant public health risk in this area. More extensive studies are necessary to ascertain the zoonotic potential of Cryptosporidium in porcine hosts in Vietnam.
Subject(s)
Cryptosporidiosis/veterinary , Cryptosporidium/classification , Cryptosporidium/genetics , Genetic Variation , Swine Diseases/epidemiology , Swine Diseases/parasitology , Animals , Cryptosporidiosis/epidemiology , Cryptosporidiosis/parasitology , Cryptosporidium/isolation & purification , DNA, Protozoan/chemistry , DNA, Protozoan/genetics , DNA, Ribosomal/chemistry , DNA, Ribosomal/genetics , Feces/parasitology , Genes, rRNA , Genotype , Heat-Shock Proteins/genetics , Molecular Epidemiology , Molecular Sequence Data , Polymerase Chain Reaction , Prevalence , RNA, Protozoan/genetics , RNA, Ribosomal, 18S/genetics , Sequence Analysis, DNA , Swine , VietnamABSTRACT
In the present study, we attempted to improve the developmental competence of vitrified immature porcine oocytes by the preservation of mitochondrial properties using Cyclosporin A (CsA, inhibitor of mitochondrial membrane permeability transition) and Docetaxel (stabilizer of microtubules, hence mitochondrial distribution). In Experiment 1, Mitotracker red staining revealed reduced mitochondrial activity (MA) in vitrified/warmed oocytes at 0 and 22 h of in vitro maturation (IVM) compared with fresh ones. However, by at 46 h of IVM, MA levels in vitrified oocytes were similar to those in fresh control. Treatment of oocytes with CsA or Docetaxel improved MA at 0 h and 22 h of IVM compared with non-treated vitrified oocytes. However, there were no significant differences among groups in percentages of survival, maturation and embryo development after subsequent IVM and parthenogenetic activation. Nevertheless, a pretreatment with a combination of 10 µg/mL CsA and 0.05 µM Docetaxel improved the blastocyst formation of vitrified oocytes compared with non-treatment counterparts (11.2 ± 1.6% vs 5.9 ± 1.6%, P < 0.05). In conclusion, vitrification reduced mitochondrial activity in GV-stage oocytes during 0-22 h of IVM; however, it was normalized by 46 h IVM. Docetaxel or CsA pretreatment alone did not improve development competence of vitrified oocytes. However, pretreatment with a combination of CsA and Docetaxel could improve blastocyst formation rates.
Subject(s)
Cyclosporine , Vitrification , Swine , Animals , Cyclosporine/pharmacology , Docetaxel/pharmacology , Cryopreservation/veterinary , Oocytes , Embryonic DevelopmentABSTRACT
BACKGROUND: Although men have a higher rate of stroke than women, it is not clear whether women have a worse outcome after adjusting for confounders such as vascular risk factors, age, stroke severity, and reperfusion therapy. We evaluated sex differences on 90-day functional outcomes after stroke in a multicenter study in Vietnam. METHODS: We recruited patients presenting with ischemic or hemorrhagic stroke at 10 stroke centers in Vietnam for a period of 1 month from 1 August 2022 to 31 August 2022. We reviewed the patient's clinical demographics, time from symptom onset to hospital admission, stroke classification, stroke subtype, stroke severity, characteristics of reperfusion therapy, and 90-day clinical outcome. We compared functional outcomes and predisposing factors at day 90 between men and women after an ischemic and hemorrhagic stroke. Poor outcome was defined as modified Rankin Scale 3-6. RESULTS: There were 2300 stroke patients included. Men accounted for 61.3% (1410) of participants. Compared to men, women were older (67.7 ± 13.9 vs 63.7 ± 13.3, P < 0.001), had a higher rate of diabetes mellitus (21.1% vs 15.3%, P < 0.001), a lower rate of tobacco use (1.0 % vs 23.6%, P < 0.001), and a lower body mass index (21.4 ± 2.70 vs 22.0 ± 2.72, P < 0.001). There was a higher rate of intracranial hemorrhage (ICH) in men (21.3% vs 15.6%, P = 0.001), whereas the rate of subarachnoid hemorrhage was higher in women (6.2% vs 3.0%, P < 0.001). For ischemic stroke, door-to-needle time (36.9 ± 17.6 vs 47.8 ± 35.2 min, P = 0.04) and door-to-recanalization time (113.6 ± 51.1 vs 134.2 ± 48.2, P = 0.03) were shorter in women. There was no difference in 90-day functional outcomes between sexes. Factors associated with poor outcomes included age ⩾50 years (adjusted odds ratio (aOR): 1.75; 95% confidence interval (CI): 1.16-2.66), history of stroke (aOR: 1.50; 95% CI: 1.15-1.96), large artery atherosclerosis (aOR: 5.19; 95% CI: 3.90-6.90), and cardioembolism (aOR: 3.21; 95% CI: 1.68-6.16). Factors associated with mortality in patients with acute ischemic stroke included a history of coronary artery disease (aOR: 3.04; 95% CI: 1.03-8.92), large artery atherosclerosis (aOR: 3.37; 95% CI: 2.11-5.37), and cardioembolism (aOR: 3.15; 95% CI: 1.20-8.27). CONCLUSION: There were no sex differences in the clinical outcome of stroke and ischemic stroke in this prospective cohort of hospitalized Vietnamese patients.
Subject(s)
Atherosclerosis , Brain Ischemia , Hemorrhagic Stroke , Ischemic Stroke , Stroke , Humans , Female , Male , Middle Aged , Stroke/epidemiology , Stroke/therapy , Stroke/complications , Ischemic Stroke/complications , Hemorrhagic Stroke/complications , Vietnam/epidemiology , Brain Ischemia/epidemiology , Brain Ischemia/therapy , Brain Ischemia/complications , Treatment Outcome , Registries , Multicenter Studies as TopicABSTRACT
The COVID-19 pandemic underscored the promise of monoclonal antibody-based prophylactic and therapeutic drugs1-3, but also revealed how quickly viral escape can curtail effective options4,5. With the emergence of the SARS-CoV-2 Omicron variant in late 2021, many clinically used antibody drug products lost potency, including Evusheld™ and its constituent, cilgavimab4,6. Cilgavimab, like its progenitor COV2-2130, is a class 3 antibody that is compatible with other antibodies in combination4 and is challenging to replace with existing approaches. Rapidly modifying such high-value antibodies with a known clinical profile to restore efficacy against emerging variants is a compelling mitigation strategy. We sought to redesign COV2-2130 to rescue in vivo efficacy against Omicron BA.1 and BA.1.1 strains while maintaining efficacy against the contemporaneously dominant Delta variant. Here we show that our computationally redesigned antibody, 2130-1-0114-112, achieves this objective, simultaneously increases neutralization potency against Delta and many variants of concern that subsequently emerged, and provides protection in vivo against the strains tested, WA1/2020, BA.1.1, and BA.5. Deep mutational scanning of tens of thousands pseudovirus variants reveals 2130-1-0114-112 improves broad potency without incurring additional escape liabilities. Our results suggest that computational approaches can optimize an antibody to target multiple escape variants, while simultaneously enriching potency. Because our approach is computationally driven, not requiring experimental iterations or pre-existing binding data, it could enable rapid response strategies to address escape variants or pre-emptively mitigate escape vulnerabilities.
ABSTRACT
The aims of this study were to investigate the prevalence of Cryptosporidium and to characterize the genotype distribution of Cryptosporidium isolates in native beef calves 2-6 months old in Dac Lac province, central Vietnam. The presence of Cryptosporidium oocysts was determined using the modified Ziehl-Neelsen staining method. The overall prevalence on the sample and herd levels were 18.9% (44/232) and 50% (20/40), respectively. Genotyping based on PCR and sequence analysis of the 18 S rRNA gene revealed occurrence of the two nonzoonotic species Cryptosporidium ryanae and Cryptosporidium bovis, with the former as a dominant species in the animals. The absence of the zoonotic species Cryptosporidium parvum in calves examined suggests that the native beef calves 2-6 months old in the study area are unlikely to contribute to human cryptosporidiosis transmission.
Subject(s)
Cattle Diseases/epidemiology , Cattle Diseases/parasitology , Cryptosporidiosis/veterinary , Cryptosporidium/classification , Cryptosporidium/genetics , Animals , Cattle , Cryptosporidiosis/epidemiology , Cryptosporidiosis/parasitology , Cryptosporidium/isolation & purification , DNA, Protozoan/chemistry , DNA, Protozoan/genetics , DNA, Ribosomal/chemistry , DNA, Ribosomal/genetics , Genes, rRNA , Genotype , Polymerase Chain Reaction , Prevalence , RNA, Protozoan/genetics , RNA, Ribosomal, 18S/genetics , Sequence Analysis, DNA , Vietnam/epidemiologyABSTRACT
The aims of this study were to investigate the prevalence of natural Fasciola infections in both the definitive hosts (cattle) and the intermediate hosts (Lymnaea snails) in central Vietnam. A total of 1,075 fecal samples, randomly collected from cattle in Binh Dinh, Khanh Hoa, and Phu Yen provinces, were examined for Fasciola eggs by a sedimentation method. The overall prevalence of Fasciola was 45.3 %. A subset of the animals (235) was also screened for antibodies against Fasciola by an enzyme-linked immunosorbent assay. Overall, 46.3 % of these animals were shedding Fasciola eggs while 87.2 % were Fasciola seropositive. A lower prevalence of Fasciola was observed in calves ≤ 2 years of age (37.6 %) compared to that in cattle >2 years of age (53.7 %) (p < 0.05). The prevalence in the rainy season (50.8 %) was significantly different to that in the dry season (38.1 %) (p < 0.05). Of the 3.269 Lymnaea viridis and 1.128 Lymnaea swinhoei examined, 31 (0.95 %) and seven (0.62 %), respectively, were found to be infected with Fasciola. This appears to be the first epidemiological survey of the prevalence of Fasciola in cattle and snails in these three provinces in central Vietnam.
Subject(s)
Cattle Diseases/epidemiology , Fasciola/physiology , Fascioliasis/veterinary , Lymnaea/parasitology , Age Factors , Animals , Antibodies, Helminth/blood , Cattle , Cattle Diseases/parasitology , Cross-Sectional Studies , Enzyme-Linked Immunosorbent Assay/veterinary , Fasciola/classification , Fasciola/isolation & purification , Fascioliasis/epidemiology , Fascioliasis/parasitology , Feces/parasitology , Ovum/physiology , Parasite Egg Count/veterinary , Prevalence , Seasons , Species Specificity , Vietnam/epidemiologyABSTRACT
BACKGROUND: The interaction between cancer diagnoses and COVID-19 infection and outcomes is unclear. We leveraged a state-wide, multi-institutional database to assess cancer-related risk factors for poor COVID-19 outcomes. METHODS: We conducted a retrospective cohort study using the University of California Health COVID Research Dataset, which includes electronic health data of patients tested for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) at 17 California medical centers. We identified adults tested for SARS-CoV-2 from 2/1/2020-12/31/2020 and selected a cohort of patients with cancer. We obtained demographic, clinical, cancer type, and antineoplastic therapy data. The primary outcome was hospitalization within 30d after the first positive SARS-CoV-2 test. Secondary outcomes were SARS-CoV-2 positivity and severe COVID-19 (intensive care, mechanical ventilation, or death within 30d after the first positive test). We used multivariable logistic regression to identify cancer-related factors associated with outcomes. RESULTS: We identified 409,462 patients undergoing SARS-CoV-2 testing. Of 49,918 patients with cancer, 1781 (3.6%) tested positive. Patients with cancer were less likely to test positive (RR 0.70, 95% CI: 0.67-0.74, p < 0.001). Among the 1781 SARS-CoV-2-positive patients with cancer, BCR/ABL-negative myeloproliferative neoplasms (RR 2.15, 95% CI: 1.25-3.41, p = 0.007), venetoclax (RR 2.96, 95% CI: 1.14-5.66, p = 0.028), and methotrexate (RR 2.72, 95% CI: 1.10-5.19, p = 0.032) were associated with greater hospitalization risk. Cancer and therapy types were not associated with severe COVID-19. CONCLUSIONS: In this large, diverse cohort, cancer was associated with a decreased risk of SARS-CoV-2 positivity. Patients with BCR/ABL-negative myeloproliferative neoplasm or receiving methotrexate or venetoclax may be at increased risk of hospitalization following SARS-CoV-2 infection. Mechanistic and comparative studies are needed to validate findings.
Subject(s)
COVID-19 , Neoplasms , Adult , COVID-19/epidemiology , COVID-19 Testing , Hospitalization , Humans , Methotrexate , Neoplasms/epidemiology , Retrospective Studies , SARS-CoV-2ABSTRACT
OBJECTIVE: The study sought to investigate the disease state-dependent risk profiles of patient demographics and medical comorbidities associated with adverse outcomes of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections. MATERIALS AND METHODS: A covariate-dependent, continuous-time hidden Markov model with 4 states (moderate, severe, discharged, and deceased) was used to model the dynamic progression of COVID-19 during the course of hospitalization. All model parameters were estimated using the electronic health records of 1362 patients from ProMedica Health System admitted between March 20, 2020 and December 29, 2020 with a positive nasopharyngeal PCR test for SARS-CoV-2. Demographic characteristics, comorbidities, vital signs, and laboratory test results were retrospectively evaluated to infer a patient's clinical progression. RESULTS: The association between patient-level covariates and risk of progression was found to be disease state dependent. Specifically, while being male, being Black or having a medical comorbidity were all associated with an increased risk of progressing from the moderate disease state to the severe disease state, these same factors were associated with a decreased risk of progressing from the severe disease state to the deceased state. DISCUSSION: Recent studies have not included analyses of the temporal progression of COVID-19, making the current study a unique modeling-based approach to understand the dynamics of COVID-19 in hospitalized patients. CONCLUSION: Dynamic risk stratification models have the potential to improve clinical outcomes not only in COVID-19, but also in a myriad of other acute and chronic diseases that, to date, have largely been assessed only by static modeling techniques.
Subject(s)
COVID-19 , Comorbidity , Female , Hospitalization , Humans , Male , Retrospective Studies , Risk Factors , SARS-CoV-2ABSTRACT
AIMS: To investigate the efficacy and safety of Cerebrolysin and Cerebrolysin plus nootropics in the routine treatment of patients with acute ischemic stroke (AIS). BACKGROUND: Acute ischemic stroke (AIS) is a leading cause of disability with unmet treatment needs lacking effective drug therapy. Multimodal drugs modulating stroke pathophysiology as Cerebrolysin constitute a good therapeutic option. OBJECTIVE: In this study, we assessed the effects of Cerebrolysin and Cerebrolysin plus nootropics, in comparison with other nootropic drugs alone, on functional, neurological and cognitive recovery of patients with AIS in Vietnam. METHODS: This non-interventional, controlled, open-label, prospective and multicenter study included 398 AIS patients (234 males) treated with Cerebrolysin (n=190; 20 i.v. infusions of 10 ml), other nootropics (comparator group; n=86), or a combination of both (n=122). The study primary endpoint was the modified Ranking Scale (mRS) score on day 90. Secondary endpoints included study-period change in NIHSS score; percentage of well-recovered (mRS 0-2) patients, the proportion of good NIHSS response (≥6 points) cases, and MoCA scores at day 90; and safety indicators. RESULTS: Compared with other nootropics, both Cerebrolysin and combined therapy induced significant improvements (p<0.001) in: Functional recovery (mRS scores); percentage of well-recovered patients (Cerebrolysin: 81.6%; combination: 93.4%; comparator: 43.0%); neurological recovery (study- period NIHSS change); proportion of good NIHSS responders (Cerebrolysin: 77.5%; combination: 92.5%; comparator: 47.6%); and MoCA scores (Cerebrolysin: 23.3±4.8; combination: 23.7±4.1; comparator: 15.9±7.7). Compared to Cerebrolysin, combined therapy improved (p<0.01) mRS outcomes and NIHSS change, but not MoCA scores, in moderate-severe stroke (NIHSS>11) cases only. No drug-related adverse events were reported. CONCLUSION: Cerebrolysin alone or combined with other nootropics was effective and safe in routine AIS treatment, during both acute and recovery phases, which supports its use in daily clinical practice. Others: According to the results of this multicenter study, the importance of reducing differences in the treatment regimens of AIS in Vietnam should be further emphasized.
Subject(s)
Brain Ischemia , Ischemic Stroke , Neuroprotective Agents , Nootropic Agents , Stroke , Amino Acids , Brain Ischemia/complications , Brain Ischemia/drug therapy , Female , Humans , Male , Neuroprotective Agents/therapeutic use , Nootropic Agents/therapeutic use , Pregnancy , Prospective Studies , Stroke/complications , Stroke/drug therapy , Treatment Outcome , VietnamABSTRACT
The combination of machine learning (ML) and electronic health records (EHR) data may be able to improve outcomes of hospitalized COVID-19 patients through improved risk stratification and patient outcome prediction. However, in resource constrained environments the clinical utility of such data-driven predictive tools may be limited by the cost or unavailability of certain laboratory tests. We leveraged EHR data to develop an ML-based tool for predicting adverse outcomes that optimizes clinical utility under a given cost structure. We further gained insights into the decision-making process of the ML models through an explainable AI tool. This cohort study was performed using deidentified EHR data from COVID-19 patients from ProMedica Health System in northwest Ohio and southeastern Michigan. We tested the performance of various ML approaches for predicting either increasing ventilatory support or mortality. We performed post hoc analysis to obtain optimal feature sets under various budget constraints. We demonstrate that it is possible to achieve a significant reduction in cost at the expense of a small reduction in predictive performance. For example, when predicting ventilation, it is possible to achieve a 43% reduction in cost with only a 3% reduction in performance. Similarly, when predicting mortality, it is possible to achieve a 50% reduction in cost with only a 1% reduction in performance. This study presents a quick, accurate, and cost-effective method to evaluate risk of deterioration for patients with SARS-CoV-2 infection at the time of clinical evaluation.
Subject(s)
Budgets , COVID-19/pathology , COVID-19/virology , Machine Learning , Outcome Assessment, Health Care , SARS-CoV-2/isolation & purification , HumansABSTRACT
This research studied 31 volatile compounds for indoor control of the medically important mosquitoes Aedes aegypti L. and Culex quinquefasciatus Say. Only adult female mosquitoes were tested. The test compounds were from six families that included five heterobicyclics, eight formate esters, formic acid (a hydrolyzed metabolite of formate esters), eight acetate esters, four propionate esters, three butyrate esters, and two valerate esters. Also, the organophosphate compound dichlorvos (DDVP) was tested as a positive control. Cx. quinquefasciatus was generally more susceptible than Ae. aegypti. Cx. quinquefasciatus was most susceptible to a subset of heterobicyclics and formate esters (rank: n-butyl formate > hexyl formate = dihydrobenzofuran = menthofuran = heptyl formate = ethyl formate). Ae. aegypti was most susceptible to a subset of formate esters (rank: methyl > n-butyl > propyl = ethyl = hexyl). The most active materials against both species had LC50s of 0.4-1 mg active ingredient per 0.5 liter of air volume (0.8-2 mg/liter), which is 50- to 60-fold less toxic than dichlorvos (an organophosphate insecticide that is being phased out from indoor use). In relation to Drosophila melanogaster Meigen, both mosquito species were generally more susceptible to formate esters but more tolerant of heterobicyclics. Generally, the most toxic compound against all dipterans tested to date is n-butyl formate, whereas menthofuran is additionally toxic against Cx. quinquefasciatus and D. melanogaster. Finally, the toxicity differences between species point to the potential for differential toxicity among mosquito general/species, suggesting that further studies of a number of mosquito species might be warranted.
Subject(s)
Aedes/drug effects , Culex/drug effects , Insecticides , Volatile Organic Compounds , Animals , Drosophila melanogaster , Female , Structure-Activity Relationship , Toxicity TestsABSTRACT
This study was carried out to determine the prevalence, genotypes/assemblages and possible risk factors associated with Giardia duodenalis infection in dogs in central Vietnam. A total of 209 dog fecal samples, randomly collected from private owned dogs (n=105) and dogs from stores (n=104), were examined for Giardia cysts by microscopy. Positive samples were genotyped by PCR-sequence analysis of ß-giardin and triosephosphate isomerase genes markers. Risk factors were studied using a structured questionnaire and collected data were analyzed by univariate and multivariate logistic regression analyses. Results indicated that the overall infection rate was 8.6% (18/209) with the detected parasites were belonging to the non-zoonotic assemblages C and D. Age, gender and origin of animals were the main risk factors associated with G. duodenalis infection in dogs under study. Occurrence of infection was more likely in young animals compared to old ones and in females compared to males. Dogs originated from stores were more prone to Giardia infection compared to private owned counterparts.
Subject(s)
Dog Diseases/parasitology , Giardia/isolation & purification , Giardiasis/veterinary , Age Factors , Animals , Cytoskeletal Proteins/genetics , Dog Diseases/epidemiology , Dogs , Feces/parasitology , Female , Genotype , Giardia/genetics , Giardiasis/epidemiology , Male , Prevalence , Protozoan Proteins/genetics , Risk Factors , Sequence Analysis, DNA , Sex Factors , Triose-Phosphate Isomerase/genetics , Vietnam/epidemiologyABSTRACT
We investigated the prevalence of Cryptosporidium infection in relation to age and clinical status in cattle in the central region of Viet Nam. A total of 266 fecal samples from diarrheic and non-diarrheic cattle were examined by the modified Ziehl-Neelsen staining method. Prevalence of Cryptosporidium parvum type infections, those of the Cryptosporidium andersoni type, and mixed infection of both types was 33.5% (89/266), 5.6% (15/266), and 3.4% (9/266), respectively. The infection rate of 44.3% (35/79) of C. parvum in calves less than 6 months old was significantly higher than that of 28.9% (54/187) in cattle greater than 6 months old (P<0.01). Although no C. andersoni oocysts were detected in calves less than 3 months old, no significant difference was observed between the age groups in the prevalence of C. andersoni infection and mixed infection. The percentage of diarrheic and non-diarrheic cattle identified to be shedding C. parvum oocysts was 46.5% (74/159) and 14.0% (15/107), respectively (P<0.0001). The risk of diarrhea was 1.7 times greater in C. parvum-infected calves than in their non-infected counterparts. DNA sequences of 18S rRNA genes of C. parvum type and C. andersoni type indicated that they were C. parvum bovine genotype and C. andersoni, respectively. This is the first genetic identification of C. parvum bovine genotype and C. andersoni from cattle in Viet Nam.
Subject(s)
Cattle Diseases/epidemiology , Cryptosporidiosis/veterinary , Cryptosporidium/isolation & purification , DNA, Protozoan/analysis , Age Factors , Animals , Animals, Newborn , Cattle , Cattle Diseases/parasitology , Cryptosporidiosis/epidemiology , Cryptosporidiosis/parasitology , Cryptosporidium/classification , Cryptosporidium/genetics , Feces/parasitology , Genotype , Oocysts/growth & development , Parasite Egg Count/veterinary , Prevalence , Species Specificity , Vietnam/epidemiologyABSTRACT
Naturally derived volatile insecticides from the heterobicyclic and formate ester classes were investigated using a combination of volatility and synergist bioassays. In these studies, Drosophila melanogaster (Meigen) was used as a model for other medically important dipterans. In addition to a susceptible strain (Canton-S), three mutant strains were tested that included a strain resistant by P450-based metabolism (Hikone-R) and two resistant neurological mutant strains; one voltage-gated sodium channel mutant (para(ts-1)) and one GABA-gated chloride channel mutant (Rdl). In general, the 11 tested insecticides displayed a diversity of toxicity, metabolism, and resistance characteristics that correlate with their structural diversity. Several important trends were revealed by these studies, including hydrolase- and cytochrome P450 (P450)-based activation, P450-based resistance, distinct patterns of neurological activity, and negative cross-resistance with established insecticides. These findings provide important insight into the metabolism and modes of action for the volatile insecticides. These findings also suggest potential approaches for insecticide deployment in integrated vector management and resistance management programs.