RESUMO
KEY MESSAGE: A molecular analysis using informative SNP markers in 1570 clones of cassava from Vietnam reveals varietal composition from farmers' field and genebank collections Cassava is the most important smallholder cash crops in Southeast Asia and is especially used in industrial products. Yet, systematic genetic studies on molecular markers from Vietnamese germplasm have not been considered for breeding and conservation programs. We conducted a molecular analysis of 1570 clones of cassava germplasm from farms across six agro-ecological zones using informative SNP markers. We unraveled the genetic diversity and population structure and provided insights into the value of breeding and conservation programs. Duplicated genotypes comprised 98% of the total sample of the Central Highlands region. Ninety-six SNPs were amplified Central Highlands and South East provinces had the highest allelic richness, covering up to 83% of alleles. The average observed heterozygosity (Ho = 0.43) was slightly higher than expected (He = 0.40) across SNP markers, suggesting an excess of heterozygotes plants. Diversity indexes indicated that cassava populations from North West and Eastern Vietnam are genetically diverse (mean He = 0.40). Genetic parentage tests identified 85 unique genetic groups within the varieties KM94, KM419, BRA1305, KM101, KM140, PER262, KM60, KM57 and two unidentified varieties, which accounted for 82% of the frequency distribution. KM94 is the most dominant variety in Vietnamese farms surveyed (38%), reflecting its superior quality and productivity. Discriminant analysis of principal components (DAPC) revealed four main subgroups, which were partially corroborated by neighbor joining (NJ) analyses. After removing duplicates, 31 unique genotypes were distributed across five of the agro-ecological zones. These were well distributed in the subgroups revealed via DAPC and NJ analyses. The genetic groups identified herein could be used to select unique accessions that should ideally conform with ex situ germplasm collections and identify areas where on-farm conservation programs should be targeted. Newly identified genotypes may also contribute as genetic breeding resources that could be used to adapt cassava to future changes and farmers' needs.
Assuntos
Impressões Digitais de DNA , Manihot , Melhoramento Vegetal , Manihot/genética , VietnãRESUMO
INTRODUCTION: Student-run free clinics (SRFCs) have become important primary care homes during the COVID-19 pandemic. With students pulled from clinical sites, funding deficits, SRFCs' voluntary nature, and no best practices for telehealth SRFCs, many have been forced to close. This report shares a systematic approach for implementing a telehealth clinic along with initial outcomes from the Dedicated to Aurora's Wellness and Needs (DAWN) SRFC. METHODS: We utilized pilots with students, community volunteers, and patients to identify a telehealth platform. We implemented weekly plan-do-study-act (PDSA) cycles to develop a feasible interprofessional telehealth model. Key PDSA cycle goals included seamless utilization of platform, identification of necessary team members, appropriate scheduling of patients and volunteers, integration of interprofessional learners, positive patient and volunteer experience, and process for identifying and addressing patient social needs. Measured outcomes included total visits, no-show rates, and chief complaints addressed. RESULTS: Outcomes from PDSA cycles included a resultant telehealth clinic team and model, workflow for outreach for social needs screening and navigation, and team training guides. Visit data and no-show rates from January 2020 through July 2020 demonstrated total visits returned to 60% of pre-COVID numbers while no-show rates decreased significantly below pre-COVID rates. A range of acute and chronic concerns were successfully managed via telehealth. CONCLUSION: SRFCs are poised to continue serving an important role in caring for the country's most vulnerable populations. The DAWN telehealth implementation process, outcomes, and resultant protocols may help inform other SRFCs seeking to establish telehealth services.
RESUMO
OBJECTIVES: At diagnosis, 30% of patients with pancreatic cancer are unresectable stage 3 locally advanced. The standard treatment for locally advanced pancreatic cancer (LAPC) is not defined. The current study was conducted to assess the roles of chemotherapy and chemoradiation for LAPC treatment. MATERIALS AND METHODS: Between June 2006 and March 2011, 100 patients with LAPC were treated at the Johns Hopkins Hospital. Retrospective analysis was performed to compare cumulative incidence of progression (CIP) and overall survival (OS) among different subgroups. RESULTS: For the 100 patients, the median OS was 15.8 months and the median CIP was 8.4 months. The combination of chemotherapy and chemoradiation before disease progression was significantly associated with improved CIP (P=0.001) and improved OS when compared with chemoradiation alone (median OS: 16.4 vs. 11.1 mo, P=0.03). Among patients receiving combination treatment, patients who received chemotherapy first followed by chemoradiation had a trend toward lower CIP (P=0.09) and improved OS (median OS: 18.1 vs. 11.0 mo, P=0.09). Patients who received >2 cycles of chemotherapy before chemoradiation had a significantly decreased CIP (P=0.008) and a trend toward better OS (median OS: 19.4 vs. 15.7 mo, P=0.10). On multivariate analysis, receiving >2 cycles of chemotherapy before chemoradiation was associated with improved CIP. CONCLUSIONS: Although combination chemotherapy and chemoradiation is favored in the treatment of LAPC, longer induction chemotherapy may play a more important role in sensitization of tumors to subsequent chemoradiation. Our results support treating patients with induction chemotherapy for at least 3 cycles followed by consolidative chemoradiation. These results merit further validation by a prospective study.