IntroductionMultidrug-resistant tuberculosis (MDR-TB) remains a major public health problem globally. Long, complex treatment regimens coupled with frequent adverse events have resulted in poor treatment adherence and patient outcomes. Smartphone-based mobile health (mHealth) technologies offer national TB programmes an appealing platform to improve patient care and management; however, clinical trial evidence to support their use is lacking. This trial will test the hypothesis that an mHealth intervention can improve treatment success among patients with MDR-TB and is cost-effective compared with standard practice.Methods and analysisA community-based, open-label, parallel-group randomised controlled trial will be conducted among patients treated for MDR-TB in seven provinces of Vietnam. Patients commencing therapy for microbiologically confirmed rifampicin-resistant or multidrug-resistant tuberculosis within the past 30 days will be recruited to the study. Participants will be individually randomised to an intervention arm, comprising use of an mHealth application for treatment support, or a ‘standard care’ arm. In both arms, patients will be managed by the national TB programme according to current national treatment guidelines. The primary outcome measure of effectiveness will be the proportion of patients with treatment success (defined as treatment completion and/or bacteriological cure) after 24 months. A marginal Poisson regression model estimated via a generalised estimating equation will be used to test the effect of the intervention on treatment success. A prospective microcosting of the intervention and within-trial cost-effectiveness analysis will also be undertaken from a societal perspective. Cost-effectiveness will be presented as an incremental cost per patient successfully treated and an incremental cost per quality-adjusted life-year gained.EthicsEthical approval for the study was granted by The University of Sydney Human Research Ethics Committee (2019/676).DisseminationStudy findings will be disseminated to participants and published in peer-reviewed journals and conference proceedings.Trial registration numberACTRN12620000681954.

Background: The World health organization (WHO) recently recommended standardized all-oral shorter regimens for rifampicin resistant Tuberculosis (RR-TB). For highly resistant Tuberculosis patients such as pre-XDR-TB: RR-TB plus additional resistance to fluoroquinolones (FQ), the 6–9-months bedaquiline (bedaquiline)-based regimens or BDQ-based long regimens are recommended. The role of second-line injectable (SLI) drugs in the treatment of drug resistant TB is restricted because of safety concerns. Nevertheless, it is not well-known how all-oral long regimens (BDQ-long) perform compared to SLI-containing long regimens (BDQ/SLI-long) in terms of safety and effectiveness among patients with highly resistant TB.Method: A prospective observational cohort of patients with RR-TB additionally resistant to fluoroquinolones and/or second-line injectable, treated with either BDQ-long or BDQ/SLI-long regimens according to the guidance of the National Tuberculosis Program of Vietnam, enrolled between December 2015 and June 2017.Results: Of 99 patients enrolled, 42 (42%) patients were treated with BDQ-long and 57 (57%) with BDQ/SLI-long. More than 85% of patients were previously exposed to both FQ and SLI. FQ and SLI resistance were confirmed in 28 (67%) and 41 (98%) in the BDQ-long cohort and 48 (84%) and 17 (30%) in the BDQ/SLI-long cohort, respectively. Treatment success was achieved among 29 (69%) and 46 (81%) patients on the BDQ-long and BDQ/SLI-long regimen, respectively (p = 0.2). For both regimens, median time to first smear/culture sputum conversion was 2 months. All patients experienced at least one adverse event (AE) and 85% of them had at least one severe Adverse events. The median time to a first severe adverse event was 2 months. Among patients treated with BDQ-long a higher proportion of patients had three QT-prolonging drugs in the regimen (26.2% versus 7.0%; p = 0.009). The severe prolonged QTcF was observed in 22 (52.4%) and 22 (38.6%) patients on BDQ-long and BDQ/SLI-long, respectively. Overall, 30 (30%) patients had to either temporary or permanently discontinued or more TB drugs due to AEs.Conclusion: Treatment success was similar for both all-oral and SLI-containing BDQ-based long regimens in highly resistant TB patients. Both regimens had a similar high frequency of AEs. For both BDQ-long and BDQ/SLI-long regimens active AEs monitoring is essential.

Pleurotus citrinopileatus, also known in Vietnam as golden oyster mushroom, is a food rich in protein, fiber, essential amino acids, carbohydrates, water-soluble vitamins, and minerals. In particular, in the composition of yellow oyster mushrooms, there is β -1.3 - glucan with high biological activity as an active ingredient contributing to the intense stimulation of immunity. The study researched the process of extracting Pleurotus citrinopileatus mushroom by the assisted extraction of a combination of ultrasonic waves and pyrolysis in an aqueous solvent at 100°C, then evaluation of the biological activity of the extract to orient the application of functional foods to support cancer treatment. Some of the conditions of the Pleurotus citrinopileatus extraction process documented through the study are as follows: The solvent used for extraction was water, sodium chloride salt was used as a catalyst, with a ratio of 1g NaCl:100 ml of solution, the sample was ultrasonically processed for 60 min and magnetic stirred at 100°C for 2 hours, the concentration of Na2CO3 participating in the reaction was 20%, HCl concentration was 2M, the ratio of IPA treatment/mushroom residue was 1:1 (v/v). From Pleurotus citrinopileatus mushroom powder, the research team successfully obtained β- glucan.

The structure of P2O5-SiO2 and CaO-P2O5-SiO2 systems have been systematically investigated by molecular dynamics simulation. The structural characteristics were clarified with intuitive figures and images at atomic scale. Specially, we have applied the recognition and visualization methods to clarify short range order, intermediate range order, and network structure. The structural and compositional heterogeneities and mechanism of alkaline earth metals incorporation into -O-P-O-Si-O- network have been discussed in detail. This is useful information for designing bioactive systems with many potential applications.

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