HIV-related stigma, symptoms of depression and their association with suicidal ideation among people living with HIV in Ho Chi Minh City, Vietnam.

To date, little are known about HIV-related stigma, symptoms of depression (SOD) and suicidal ideation among people living with HIV (PLHIV) in Vietnam. This study aimed to estimate the level of stigma, SOD and suicidal ideation and to explore the direction and magnitude of the relationship between stigma, SOD and suicidal ideation among Vietnamese PLHIV. A cross-sectional study was conducted in four outpatient clinics providing healthcare services including antiretroviral therapy (ART) for PLHIV in Ho Chi Minh City. At each clinic, patients were chosen using the systematic sampling technique. Participants underwent face-to-face interviews through a pre-defined structural questionnaire that included validated scales. Among 777 PLHIV in the analysis, most were male (81.1%) and the average age was 34.3 (SD = 8.8) years. Two-thirds of PLHIV had a moderate-to-high level of HIV stigma. Symptoms of depression were identified in 41.4% of PLHIV. Suicidal ideation was reported by 26.3% of PLHIV. Based on univariate and multivariate logistic regression, higher levels of SOD and HIV stigma were positively associated with suicidal ideation. For PLHIV with extreme stigma and SOD, the probability of having suicidal ideation was up to 80%. The prevalence and association found in this study indicates that interventions for SOD and stigma not only help reduce these two problems but also help address and minimize suicidal ideation in this vulnerable population. In Vietnam, to optimize such interventions, the involvement of families and communities is crucial.

Development of downflow hanging sponge (DHS) reactor as post treatment of existing combined anaerobic tank treating natural rubber processing wastewater.

Conventional aerated tank technology is widely applied for post treatment of natural rubber processing wastewater in Southeast Asia; however, a long hydraulic retention time (HRT) is required and the effluent standards are exceeded. In this study, a downflow hanging sponge (DHS) reactor was installed as post treatment of anaerobic tank effluent in a natural rubber factory in South Vietnam and the process performance was evaluated. The DHS reactor demonstrated removal efficiencies of 64.2 ± 7.5% and 55.3 ± 19.2% for total chemical oxygen demand (COD) and total nitrogen, respectively, with an organic loading rate of 0.97 ± 0.03 kg-COD m-3 day-1 and a nitrogen loading rate of 0.57 ± 0.21 kg-N m-3 day-1. 16S rRNA gene sequencing analysis of the sludge retained in the DHS also corresponded to the result of reactor performance, and both nitrifying and denitrifying bacteria were detected in the sponge carrier. In addition, anammox bacteria was found in the retained sludge. The DHS reactor reduced the HRT of 30 days to 4.8 h compared with the existing algal tank. This result indicates that the DHS reactor could be an appropriate post treatment for the existing anaerobic tank for natural rubber processing wastewater treatment.

Evolutionary analysis and expression profiling of the HSP70 gene family in response to abiotic stresses in tomato (Solanum lycopersicum).

Heat shock protein 70 (HSP70) genes play essential roles in guarding plants against abiotic stresses, including heat, drought, and salt. In this study, the SlHSP70 gene family in tomatoes has been characterized using bioinformatic tools. 25 putative SlHSP70 genes in the tomato genome were found and classified into five subfamilies, with multi-subcellular localizations. Twelve pairs of gene duplications were identified, and segmental events were determined as the main factor for the gene family expansion. Based on public RNA-seq data, gene expression analysis identified the majority of genes expressed in the examined organelles. Further RNA-seq analysis and then quantitative RT-PCR validation showed that many SlHSP70 members are responsible for cellular feedback to heat, drought, and salt treatments, in which, at least five genes might be potential key players in the stress response. Our results provided a thorough overview of the SlHSP70 gene family in the tomato, which may be useful for the evolutionary and functional analysis of SlHSP70 under abiotic stress conditions.

Laparoscopic caudate lobectomy for large hepatoblastoma in children: A case report.

Hepatoblastoma originating in the caudate lobe (segment 1) is extremely rare. Complete resection of the caudate lobe, without sacrificing other parts of the liver, remains a surgical challenge. We present our experience with laparoscopic complete resection of caudate lobe hepatoblastoma for a 7-years-old girl, with a history of hepatitis B.

Cystic pulmonary tuberculosis: A rare form of an ancient disease.

Cystic pulmonary tuberculosis is a unique form of pulmonary tuberculosis (PTB) presenting with multiple reversible cysts of the lung. Unlike the other forms, this cystic lung disease can improve with prompt tuberculosis treatments. Here we report the case of a 15-year-old girl who presented with respiratory failure and severe lung damage at hospital admission. We diagnosed her with PTB based on her positive GeneXpert result test. The patient was treated with a standard tuberculosis regimen for 6 months and recovered completely.

Environmental sampling for SARS-CoV-2 at a reference laboratory and provincial hospital in central Viet Nam, 2020.

OBJECTIVE: To determine whether environmental surface contamination with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) occurred at a provincial hospital in Viet Nam that admitted patients with novel coronavirus disease 2019 (COVID-19) and at the regional reference laboratory responsible for confirmatory testing for SARS-CoV-2 in 2020. METHODS: Environmental samples were collected from patient and staff areas at the hospital and various operational and staff areas at the laboratory. Specimens from frequently touched surfaces in all rooms were collected using a moistened swab rubbed over a 25 cm2 area for each surface. The swabs were immediately transported to the laboratory for testing by real-time reverse transcription polymerase chain reaction (RT-PCR). Throat specimens were collected from staff at both locations and were also tested for SARS-CoV-2 using real-time RT-PCR. RESULTS: During the sampling period, the laboratory tested 6607 respiratory specimens for SARS-CoV-2 from patients within the region, and the hospital admitted 9 COVID-19 cases. Regular cleaning was conducted at both sites in accordance with infection prevention and control (IPC) practices. All 750 environmental samples (300 laboratory and 450 hospital) and 30 staff specimens were negative for SARS-CoV-2. DISCUSSION: IPC measures at the facilities may have contributed to the negative results from the environmental samples. Other possible explanations include sampling late in a patient's hospital stay when virus load was lower, having insufficient contact time with a surface or using insufficiently moist collection swabs. Further environmental sampling studies of SARS-CoV-2 should consider including testing for the environmental presence of viruses within laboratory settings, targeting the collection of samples to early in the course of a patient's illness and including sampling of confirmed positive control surfaces, while maintaining appropriate biosafety measures.

Deficiency in the divalent metal transporter 1 increases bleomycin-induced lung injury.

Exposure to bleomycin can result in an inflammatory lung injury. The biological effect of this anti-neoplastic agent is dependent on its coordination of iron with subsequent oxidant generation. In lung cells, divalent metal transporter 1 (DMT1) can participate in metal transport resulting in control of an oxidative stress and tissue damage. We tested the postulate that metal import by DMT1 would participate in preventing lung injury after exposure to bleomycin. Microcytic anemia (mk/mk) mice defective in DMT1 and wild-type mice were exposed to either bleomycin or saline via intratracheal instillation and the resultant lung injury was compared. Twenty-four h after instillation, the number of neutrophils and protein concentrations after bleomycin exposure were significantly elevated in the mk/mk mice relative to the wild-type mice. Similarly, levels of a pro-inflammatory mediator were significantly increased in the mk/mk mice relative to wild-type mice following bleomycin instillation. Relative to wild-type mice, mk/mk mice demonstrated lower non-heme iron concentrations in the lung, liver, spleen, and splenic, peritoneal, and liver macrophages. In contrast, levels of this metal were elevated in alveolar macrophages from mk/mk mice. We conclude that DMT1 participates in the inflammatory lung injury after bleomycin with mk/mk mice having increased inflammation and damage following exposure. This finding supports the hypothesis that DMT1 takes part in iron detoxification and homeostasis in the lung.

Change in Compliance of Staff at 4 Vietnam Universities after the Enactment of Smoke-free Environment Decree.

BACKGROUND: The Tobacco Control Law in Vietnam was adopted in 2012 and came into force from May 2013, followed by a number of guiding sub-law legal documents. Smoke-free campus policy in university is considered an important measure to protect people from secondhand smoking as well as staffs and students will be in favour of the policy. Furthermore, there has been evidence suggested that smoke-free policy had positive impact on active smoking as well as anti-smoking attitude. METHODS: A cross-sectional self-administered study of staff at 4 universities were conducted in 2 phases, Phase 1 as early introduction of the Law (n = 900) and Phase 2 as 1-year post (n = 885). Demographics, tobacco consumption, compliance status and compliance with awareness towards the campus smoking regulations were assessed in both phases. RESULTS: Daily smoking prevalence decreased significantly (P < .05) 1 year after implementing the smoke-free policy, while a significant increase in occasional smoking (P < .01). Compliance of staff to the regulation the campus should be indoor smoke-free was significantly increase at Phase 2 compared to Phase 1, however participants reported there would be places on campus that smokers frequently violated the smoke-free regulations. CONCLUSIONS: The study indicated a significant positive change in compliance of staff at the 4 universities after the implementation of the Tobacco Control Law, included the smoke-free policy. Although the prevalence of tobacco smoking in this study was low, the proportion of respondents who reported to reduce infringement the smoke-free policy suggests support for staff smokers would be beneficial. Raising awareness and enforcement is likely to enhance the long-term outcomes of the implementation of smoke-free environment.

Treatment of complex complications after choledochal cyst resection by multiple minimal invasive therapies: A case report.

INTRODUCTION: Choledochal cyst is a rare benign congenital dilation of the bile duct, which causes recurring disturbing symptoms without totally resection. Nonetheless, postoperative complications are still a common issue. A step up management for patients with complex complications is required to address the problem. CASE PRESENTATION: We report a 10-year-old child who suffered complex postoperative complications after choledochal cyst resection at the age of 5, including cholangitis, bilioenteric stenosis and cystolithiasis in remnant intrapancreatic duct cyst. She occasionally endured episodes of epigastric pain, fever and jaundice afterwards. As the symptoms and recurrent rate were worsen over time, the patient was admitted multiple times and various approaches (balloon dilation, percutaneous transhepatic biliary drainage, endoscopic retrograde cholangiopancreatography and laparoscopic surgery) were applied. Afterwards, patient recovered and discharged without any complications. CONCLUSION: Our case presented sophisticated complications relating to choledochal cyst that were successfully treated by a combination of modern minimal invasive techniques. Despite operated by experienced surgeons, the post-op complications are still a concerned problem due to difficult laparoscopic techniques, injuries of hepatic artery, infection and risk of malignancy. We suggested that minimal-invasive procedures should be considered first with the aim of relieving symptoms, biliary drainage and preparing for the reoperation.

Advancing family dementia caregiver interventions in low- and middle-income countries: A pilot cluster randomized controlled trial of Resources for Advancing Alzheimer's Caregiver Health in Vietnam (REACH VN).

INTRODUCTION: Low- and middle-income countries have rapidly increasing numbers of people with dementia, yet little evidence on family caregiving interventions. We tested the preliminary efficacy and feasibility of a family caregiving intervention in northern Vietnam. METHODS: Nine clusters comprising 60 family caregivers were randomized to a culturally adapted version of a four- to six-session, multicomponent intervention delivered in-home over 2 to 3 months, or enhanced control. Eligible caregivers were ≥18 years of age and scored ≥6 on the Zarit Burden Inventory (ZBI). RESULTS: Fifty-one caregivers (85%) completed the study. Using analysis of covariance with 3-month assessment as the outcome and baseline assessment as a covariate, intervention group caregivers had an average ZBI (primary outcome) score 1.2 standard deviation (SD) lower (P = .02) and Patient Health Questionnaire-4 (psychological distress) score 0.7 SD lower (P = .03) than controls. DISCUSSION: In the first study of its kind in Vietnam, a culturally adapted, manualized, family caregiver intervention was both efficacious and feasible.

Characteristics of greenhouse gas emissions from an anaerobic wastewater treatment system in a natural rubber processing factory.

Greenhouse gas (GHG) emissions from both open-type and closed anaerobic wastewater treatment systems in a natural rubber processing factory in Vietnam were surveyed. In this factory, wastewater was treated by an open-type anaerobic baffled reactor (OABR) that comprised 60 compartments. A part of the wastewater was fed to a pilot-scale up-flow anaerobic sludge blanket (UASB) reactor to enable a comparison of the process performance and GHG emission characteristics with those of the OABR. In the OABR, 94.4% of the total chemical oxygen demand (COD) and 18.1% of ammonia nitrogen was removed. GHGs emitted from the OABR included both methane and nitrous oxide. The total GHGs emitted from the OABR was 0.153 t-CO2eq/m3-wastewater. Nitrous oxide accounted for approximately 65% of the total GHGs emitted from the OABR. By contrast, 99.6% of the methane emission and 99.9% of nitrous oxide emission were reduced by application of the UASB. However, the ammonia removal efficiency of the UASB was only 2.2%. Furthermore, Acinetobacter johnsonii, which is known as a heterotrophic ammonia remover, was detected only in the OABR. These results indicated that high nitrous oxide emissions were caused by denitrification in the OABR and that application of the closed anaerobic system could drastically reduce the emissions of both methane and nitrous oxide.

Stress, anxiety and depression in clinical nurses in Vietnam: a cross-sectional survey and cluster analysis.

BACKGROUND: Hospital nurses are exposed to various work-related factors that may be associated with increased risk of developing different mental disorders. Empirical evidence on the prevalence and correlates of individual mental health problems such as stress, anxiety and depression is widely reported, while a combined pattern of these conditions is unknown. This study aims to examine the co-occurrence of stress, anxiety and depression among clinical nurses, and to explore socio-demographic characteristics of, and working conditions experienced by, nurses that may be associated with these three mental health conditions. METHODS: A cross-sectional study was implemented in one tertiary hospital in Hanoi city, Vietnam, from May to September 2015. A self-reported questionnaire including a short version of the Depression, Anxiety and Stress scale 21 items and questions on demographic and work-related characteristics was delivered to 787 registered nurses. 600 completed questionnaires was used in the final analysis (76.2% response rate). The two-step clustering analysis was performed to identify sub groups. Chi square test and post hoc ANOVA analysis with Bonferroni correction were used to examine differences in psychological status, demographic characteristics and working conditions among the clusters (two-tailed p < 0.05). RESULTS: The prevalence of self-reported stress, anxiety and depression were 18.5%, 39.8% and 13.2%, respectively. 45.3% participants reported symptoms of at least one mental disorder, 7.3% had all three. Nurses in the first cluster (high prevalence of mental disorders), had high task demand and conflict at work with low job control and reward. The second cluster nurses (moderate percentage of mental strain) were significantly older and in marital relationship, high task demand and job control, and presence of chronic diseases. The lowest proportion of self-perceived mental disorders were observed in the cluster three who were younger and had fewer years of services, moderate task demand and low job control and better physical health in comparison with those in the other two clusters (p < 0.05). CONCLUSIONS: Stress, anxiety and depression were prevalent among clinical nurses. Heterogeneity in demographic characteristics and working conditions were observed across clusters with different patterns of mental disorders. Institutional effort should be emphasized to support nurses in their career development to reduce psychological strains.

Performance evaluation of the pilot scale upflow anaerobic sludge blanket - Downflow hanging sponge system for natural rubber processing wastewater treatment in South Vietnam.

A pilot-scale upflow anaerobic sludge blanket (UASB)-downflow hanging sponge system (DHS) combined with an anaerobic baffled reactor (ABR) and a settling tank (ST) was installed in a natural rubber processing factory in South Vietnam and its process performance was evaluated for 267days. The UASB reactor achieved a total removal efficiency of 55.6±16.6% for chemical oxygen demand (COD) and 77.8±10.3% for biochemical oxygen demand (BOD) with an organic loading rate of 1.7±0.6kg-COD·m-3·day-1. The final effluent of the proposed system had 140±64mg·L-1 of total COD, 31±12mg·L-1 of total BOD, and 58±24mg-N·L-1 of total nitrogen. The system could significantly reduce 92% of greenhouse gas emissions and 80% of hydraulic retention times compared with current treatment systems.

The inflammatory and normal transcriptome of mouse bladder detrusor and mucosa.

BACKGROUND: An organ such as the bladder consists of complex, interacting set of tissues and cells. Inflammation has been implicated in every major disease of the bladder, including cancer, interstitial cystitis, and infection. However, scanty is the information about individual detrusor and urothelium transcriptomes in response to inflammation. Here, we used suppression subtractive hybridizations (SSH) to determine bladder tissue- and disease-specific genes and transcriptional regulatory elements (TRE)s. Unique TREs and genes were assembled into putative networks. RESULTS: It was found that the control bladder mucosa presented regulatory elements driving genes such as myosin light chain phosphatase and calponin 1 that influence the smooth muscle phenotype. In the control detrusor network the Pax-3 TRE was significantly over-represented. During development, the Pax-3 transcription factor (TF) maintains progenitor cells in an undifferentiated state whereas, during inflammation, Pax-3 was suppressed and genes involved in neuronal development (synapsin I) were up-regulated. Therefore, during inflammation, an increased maturation of neural progenitor cells in the muscle may underlie detrusor instability. NF-kappaB was specifically over-represented in the inflamed mucosa regulatory network. When the inflamed detrusor was compared to control, two major pathways were found, one encoding synapsin I, a neuron-specific phosphoprotein, and the other an important apoptotic protein, siva. In response to LPS-induced inflammation, the liver X receptor was over-represented in both mucosa and detrusor regulatory networks confirming a role for this nuclear receptor in LPS-induced gene expression. CONCLUSION: A new approach for understanding bladder muscle-urothelium interaction was developed by assembling SSH, real time PCR, and TRE analysis results into regulatory networks. Interestingly, some of the TREs and their downstream transcripts originally involved in organogenesis and oncogenesis were also activated during inflammation. The latter represents an additional link between inflammation and cancer. The regulatory networks represent key targets for development of novel drugs targeting bladder diseases.

Seroprevalence of Tissue and Luminal Helminths among Patients in Hanoi Medical University Hospital, Vietnam, 2018

A serological survey was performed using ELISA to estimate the prevalence of tissue and luminal helminthic infections among hospital patients in Hanoi region, Vietnam. An overall seroprevalence of tissue and luminal helminthiases was 64.0% (95% CI 61.2-66.8) among 1,120 patients who visited Hanoi Medical University Hospital, Vietnam in 2018. The highest seroprevalence was observed against Toxocara spp. (59.0%), followed by Strongyloides stercoralis (46.3%), Gnathostoma spp. (25.5%), cysticercus (12.8%), Angiostrongylus cantonensis (10.5%), Fasciola spp. (11.1%), and Clonorchis sinensis (8.7%). Mono-infection by one species (11.1%) was lower than multiple infections (53.0%) (P0.05). Children (<15 years) revealed lower seroprevalence (34.0%) than adults (68.4%), and the age group 51-70 years revealed the highest seroprevalence (76.0%). Among the seropositive patients, eosinophilia (≥8.0%) was noted in 80.2%. The present results suggested active transmission of various tissue and luminal helminths among people in Hanoi, Vietnam.

Two Human Cases of Echinococcus ortleppi Infection in the Lung and Heart in Vietnam

This is a report of 2 cases of human hydatidosis caused by Echinococcus ortleppi in Vietnam. The patients were a 12-year-old male (case 1) having a cyst of 10.0×9.0 cm size in the lung and a 50-year-old female with a 3.0×3.3 cm-sized cyst in the heart. Eosinophilia was 33.7% in the male and 45.8% in the female patient. C-reactive protein was increased to 16.5 mg/L in the male and 18.2 mg/L in the female. Both patients were positive for ELISA at OD=2.5 and 3.1, respectively. Echinococcus protoscolices were collected from the cysts by amniocentesis and surgery. The protoscolices were identified as E. ortleppi by morphology and analysis of mitochondrial NADH dehydrogenase 1 (nad1) gene sequence. Both patients were cured by surgical resection of the hydatid cyst combined with albendazole medication. The E. ortleppi infection in lung is the second report, and the other in the heart is the first in Vietnam.

Neurokinin 1 receptors and neprilysin modulation of mouse bladder gene regulation.

Neurokinin 1 (NK(1)) receptors play a fundamental role in neurogenic inflammation. We sought to determine the mechanisms downstream from NK(1) receptor (NK(1)R) activation using cDNA arrays and a novel statistical method to analyze gene expression. We used female NK(1)R(-/-) and wild-type (WT) mice that were sensitized actively by intraperitoneal injections of dinitrophenol 4 (DNP(4))-human serum albumin. Cystitis was induced by intravesical instillation of antigen of DNP(4)-ovalbumin, and control mice were challenged with saline. At 1, 4, and 24 h after instillation, bladders were removed for 1) RNA extraction (n = 3), 2) replicate of RNA extraction (n = 3), and 3) morphological analysis (n = 6). For cDNA array experiments, three bladders from each group were homogenized, and total RNA was obtained. DNase-treated RNA was reverse-transcribed to cDNA, labeled with [alpha-(32)P]dATP and hybridized to Atlas Mouse 1.2 Arrays (Clontech). After calculating the mean and SD for background spots, each experimental value was assigned a normalized score S using the formula S' = (S - Av)/SD, where S' is the original pixel value, and Av and SD are the mean and standard deviation of background spots, respectively. Only genes that expressed 3 SD values above background were used. Hypervariable genes were sorted by cluster analysis. Matrices of correlation coefficients were calculated and represented in a connectivity mosaic. As results, we found that in WT mice the most prominent gene cluster had neprilysin in a central position and positively correlated to a group of activator protein-1 (AP-1)-responsive genes, including laminin-alpha3, tissue plasminogen activator 11, fos-B, and TNF-beta. In WT mice, antigen-induced bladder inflammation led to a downregulation in neprilysin expression. In contrast, NK(1)R(-/-) mice failed to mount an inflammatory reaction and presented neprilysin negatively correlated with the same genes described in WT. In conclusion, this work indicates an overriding participation of NK(1)R and neprilysin in bladder inflammation, provides a working model for the involvement of AP-1 transcription factor, and evokes testable hypotheses regarding the role of NK(1)R and neprilysin in inflammation.

Gene expression profiling of inflammatory bladder disorders.

Inflammation underlies all major bladder pathologies including malignancy and represents a defense reaction to injury caused by physical damage, chemical substances, micro-organisms or other agents. During acute inflammation, activation of specific molecular pathways leads to an increased expression of selected genes whose products attack the insult, but ultimately should protect the tissue from the noxious stimulus. However, once the stimulus ceases, gene-expression should return to basal levels to avoid tissue damage, fibrosis, loss of function, and chronic inflammation. If this down-regulation does not occur, tissue fibrosis occurs as a serious complication of chronic inflammation. Although sensory nerve and most cells products are known to be key parts of the inflammatory puzzle, other key molecules are constantly being described that have a role in bladder inflammation. Therefore, as the database describing the repertoire of inflammatory mediators implicated in bladder inflammation increases, the central mechanisms by which injury can induce inflammation, cell damage, and repair often becomes less rather than more clear. To make sense of the vast knowledge of the genes involved in the inflammatory response may require analysis of the patterns of change and the elucidation of gene networks far more than definition of additional members of inflammatory cascades. This review discuss the appropriate use of microarray technology, which promises to solve both of these problems as well as identifying key molecules and mechanisms involved in the transition between acute and chronic inflammation.

New strategy toward dioxin risk reduction for local residents surrounding severe dioxin hotspots in Vietnam.

BACKGROUND: A public health intervention program with active involvement of local related stakeholders was piloted in the Bien Hoa dioxin hotspot (2007-2009), and then expanded to the Da Nang dioxin hotspot in Vietnam (2009-2011). It aimed to reduce the risk of dioxin exposure of local residents through foods. This article presents the results of the intervention in Da Nang. METHODOLOGY: To assess the results of this intervention program, pre- and post-intervention knowledge, attitude, and practice (KAP) surveys were implemented in 400 households, randomly selected from four wards surrounding the Da Nang Airbase in 2009 and 2011, respectively. RESULTS: After the intervention, the knowledge on the existence of dioxin in food, dioxin exposure pathways, potential high-risk foods, and preventive measures significantly increased (P<0.05). Ninety-eight percent were willing to follow advice on preventing dioxin exposure. Practices to reduce the risk of dioxin exposure also significantly improved (P<0.05). After intervention, 60.4% of households undertook exposure preventive measures, significantly higher than that of the pre-intervention survey (39.6%; χ(2)=40.15, P<0.001). High-risk foods had quite low rates of daily consumption (from 0 to 2.5%) and were significantly reduced (P<0.05). CONCLUSIONS: This is seen as an effective intervention strategy toward reducing the risk of human exposure to dioxin at dioxin hotspots. While greater efforts are needed for remediating dioxin-polluted areas inside airbases, there is also evidence to suggest that, during the past four decades, pollution has expanded to the surrounding areas. For this reason, this model should be quickly expanded to the remaining dioxin hotspots in Vietnam to further reduce the exposure risks in other areas.

Antisense transcripts are targets for activating small RNAs.

Agents that activate expression of specific genes to probe cellular pathways or alleviate disease would go beyond existing approaches for controlling gene expression. Duplex RNAs complementary to promoter regions can repress or activate gene expression. The mechanism of these promoter-directed antigene RNAs (agRNAs) has been obscure. Other work has revealed noncoding transcripts that overlap mRNAs. The function of these noncoding transcripts is also not understood. Here we link these two sets of enigmatic results. We find that antisense transcripts are the target for agRNAs that activate or repress expression of progesterone receptor (PR). agRNAs recruit Argonaute proteins to PR antisense transcripts and shift localization of the heterogeneous nuclear ribonucleoprotein-k, RNA polymerase II and heterochromatin protein 1 gamma. Our data demonstrate that antisense transcripts have a central role in recognition of the PR promoter by both activating and inhibitory agRNAs.