bluuebunny/crossref_metadata_2025 huggingface dataset:
Current Status of Intranasal COVID-19 Vaccine, its Usage and Efficacy: A Narrative Review
Authors: Tandon Ratan , Joshi Abhishek
Published: May 2023

The creation of a vaccine against Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) has received top focus worldwide. The majority of the COVID-19 vaccine candidates created is given Intramuscularly (IM). Intranasal (IN) vaccines offer a great benefit due to the first involvement of mucosa of the nasal cavity in the due course of disease, also SARS-CoV-2 is spread through respiratory secretions which are infectious, and mucosal immunity due to IN vaccination could contribute significantly to controlling this disease. IN vaccination has been shown in preclinical and clinical investigations to produce significant levels of neutralising antibodies, mucosal IgA, and T-cell responses that protect against SARS-CoV-2 infection in the respiratory pathway. Blocking Coronavirus Disease-2019 (COVID-19) infection and transmission requires the immune system response at the initial infection site of the virus. Many IN vaccines are currently under trial for their safety and efficacy, while some are recently approved for use in specific conditions in India and are proven to be protective against the virus and safe also. In this context, this review will provide knowledge of the IN vaccines for their effectiveness and application.
Students’ Adoption of ICT Tools for Learning English Based on Unified Theory of Acceptance and Use of Technology
Authors: He Limin , Li Chunming
Published: May 2023

Information and communication technology (ICT) has advanced significantly over the past few decades, and students now frequently use ICT tools that enable them to learn anywhere and at any time. This study explored the influencing factors of the adoption of ICT tools among Chinese college students to learn English based on the unified theory of acceptance and use of technology (UTAUT). Structural equation modelling was applied to analyse sample data collected from 223 students in Zhaoqing University and Guangdong University of Finance in China. The results revealed that effort expectancy, performance expectancy and social influence exerted significant effect on behavioural intention. In addition, facilitating conditions and behavioural intention are positively and significantly related to use behaviour. The five variables, namely, effort expectancy, performance expectancy, social influence, facilitating conditions and behavioural intention explained 93.4% of the total variance in the ICT tools use behaviour to learn English by Chinese college students, confirming the validity of UTAUT in Chinese higher education context. Finally, some implications were provided to boost the adoption of ICT tools for promoting students’ learning performance.
Bio-Accumulation of Heavy Metals in Aquatic Organism in Otamiri River in Owerri, Imo State, Nigeria
Authors: V. Ekweogu Chinonye , Bridget Diagi E. , Okorondu Justin N. , Ikedi Chidinma Acholonu Obayi Victor , Nmecha M. I.
Published: May 2023

Depending on a number of variables, heavy metals from both natural and anthropogenic sources may accumulate in fish bodies and heads in aquatic environments. This study intends to evaluate the degree of heavy metal bioaccumulation in Tilipia fish from the Otamiri river. A sample of dry tissue weighing around one gram was weighed, placed into polyethylene tubes, and treated with 8 ML of nitric acid and 4 ML of perchloric acid. An atomic absorption spectrophotometer was used to determine the presence of heavy metals in the fish tissues. The amount of heavy metals present in fish sections was listed as follows: Lead varies from 32.00-7.23mg/kg, and the greatest value was found in the fish head that was caught in the Otammiri River. Zinc ranges from 16.75 mg/kg to 17.13 mg/kg, with the highest value recorded in the fish head. Copper concentrations range from 1.50 to 5.43 mg/kg, and iron concentrations range from 67.25 to 90.58 mg/kg, with the greatest value found in fish heads. Nickel ranges from 5.78 to 13.90mg/kg and cadmium ranges from 1.38 to 3.68mg/kg; the fish head has the highest concentration of these elements. The region of the fish's head was discovered to have the highest concentration of all the heavy metals. This is due to the fact that the fish's gills are the first organs to be exposed to heavy metal exposure and are a significant site for heavy metal intake. However, when the levels of heavy metals in the fish from this Rivers was compared to the WHO's tolerable standard, the concentrations were significantly higher, raising serious concerns because, by all accounts, the Otammiri River is highly contaminated and these fish could have a negative impact on human health if consumed. Therefore, steps should be done to prevent additional River contamination.
Airway-Occluding Mucus Plugs and Mortality in Patients With Chronic Obstructive Pulmonary Disease
Authors: Diaz Alejandro A. , Orejas José L. , Grumley Scott , Nath Hrudaya P. , Wang Wei , Dolliver Wojciech R. , Yen Andrew , Kligerman Seth J. , Jacobs Kathleen , Manapragada Padma P. , Abozeed Mostafa , Aziz Muhammad Usman , Zahid Mohd , Ahmed Asmaa N. , Terry Nina L. , San José Estépar Ruben , Kim Victor , Make Barry J. , Han MeiLan K. , Sonavane Sushilkumar , Washko George R. , Cho Michael , San José Estépar Raúl
Published: May 2023

Importance

Airway mucus plugs are common in patients with chronic obstructive pulmonary disease (COPD); however, the association of airway mucus plugging and mortality in patients with COPD is unknown.

Objective

To determine whether airway mucus plugs identified on chest computed tomography (CT) were associated with increased all-cause mortality.

Design, Setting, and Participants

Observational retrospective analysis of prospectively collected data of patients with a diagnosis of COPD in the Genetic Epidemiology of COPD cohort. Participants were non-Hispanic Black or White individuals, aged 45 to 80 years, who smoked at least 10 pack-years. Participants were enrolled at 21 centers across the US between November 2007 and April 2011 and were followed up through August 31, 2022.

Exposures

Mucus plugs that completely occluded airways on chest CT scans, identified in medium- to large-sized airways (ie, approximately 2- to 10-mm lumen diameter) and categorized as affecting 0, 1 to 2, or 3 or more lung segments.

Main Outcomes and Measures

The primary outcome was all-cause mortality, assessed with proportional hazard regression analysis. Models were adjusted for age, sex, race and ethnicity, body mass index, pack-years smoked, current smoking status, forced expiratory volume in the first second of expiration, and CT measures of emphysema and airway disease.

Results

Among the 4483 participants with COPD, 4363 were included in the primary analysis (median age, 63 years [IQR, 57-70 years]; 44% were women). A total of 2585 (59.3%), 953 (21.8%), and 825 (18.9%) participants had mucus plugs in 0, 1 to 2, and 3 or more lung segments, respectively. During a median 9.5-year follow-up, 1769 participants (40.6%) died. The mortality rates were 34.0% (95% CI, 32.2%-35.8%), 46.7% (95% CI, 43.5%-49.9%), and 54.1% (95% CI, 50.7%-57.4%) in participants who had mucus plugs in 0, 1 to 2, and 3 or more lung segments, respectively. The presence of mucus plugs in 1 to 2 vs 0 and 3 or more vs 0 lung segments was associated with an adjusted hazard ratio of death of 1.15 (95% CI, 1.02-1.29) and 1.24 (95% CI, 1.10-1.41), respectively.

Conclusions and Relevance

In participants with COPD, the presence of mucus plugs that obstructed medium- to large-sized airways was associated with higher all-cause mortality compared with patients without mucus plugging on chest CT scans.
When strength is a weakness
Authors: Felson Richard B.
Published: May 2023

In general, individuals with low levels of coercive power are at greater risk of victimization than those who are more powerful. However, in some circumstances, superior coercive power increases an individual's vulnerability. In this paper, I show how coercive power can increase vulnerability (offsetting its protective effect) by its effects on targeting and tactics. Individuals with greater coercive power can increase their risk of getting targeted because they tend to be less vigilant and more likely to behave in ways that provoke others. They generate more grievances and have more enemies because they are less compliant and more verbally aggressive and confrontational. Powerful parties are also at greater risk of being targeted by adversaries seeking to gain status. An attack on a strong adversary is more likely to enhance status than an attack on a weaker adversary since it is a greater achievement. Individuals with coercive power are also at greater risk because of the tactics used by their weaker adversaries. Weaker parties are more likely to engage in pre‐emptive attack and use weapons. They are better able to attract and rely on allies because of the norm of social responsibility, that is, the tendency to protect those in need. Finally, they are more likely to attempt to kill more power adversaries in order to incapacitate them and, thereby, avoid retaliation.
Trade‐off between dispersal traits in a heterocarpic plant across its invasion route
Authors: Robinson Dafna , Bogdanova Tatiana , Cohen Oded , Gruntman Michal
Published: May 2023

Premise

Dispersal ability (i.e., investment in dispersing structures) can vary across plant species or populations, such as between core compared to leading populations of invasive plants. However, in heterocarpic plants, which produce propagules with varying dispersal abilities, dispersal potential can also vary via investment in the proportion of dispersing morphs (termed dispersal rate). Nevertheless, very little is known about the interplay between investment in dispersal ability vs. dispersal rate or how each is affected by varying environmental pressures.

Methods

This study examined the interplay between dispersal ability and dispersal rate across the invasion route of the heterocarpic plant Heterotheca subaxillaris. Capitula of H. subaxillaris were collected from eight populations along its invasion route in the Eastern Mediterranean coastal plain. The dispersal ability of the dispersing pappus‐bearing achenes was measured as the ratio between pappus width and biomass. Dispersal rate was calculated as the ratio between the number of dispersing achenes and total achenes per capitulum.

Results

Dispersal ability and dispersal rate were found to be negatively correlated across populations of H. subaxillaris, with a greater investment in pappus width in populations at the leading edge of the invasion compared to a greater proportion of dispersing achenes in core populations.

Conclusions

Our results suggest a trade‐off might exist between dispersal ability and dispersal rate, which could change along the invasion route of heterocarpic plants such as H. subaxillaris and contribute to their invasive success. This study highlights the importance of examining both dispersal traits when studying the dispersal potential of heterocarpic species.
Developmental and genetic basis of the androgynophore in Gynandropsis gynandra
Authors: Zenchyzen Brandi , Carey Shane , Antochi‐Crihan Georgiana , Hall Jocelyn C.
Published: May 2023

Premise

Flowering plants have evolved a vast array of floral features involved in plant–pollinator interactions. A feature that seemingly increases the chance of pollen transfer is the androgynophore, a stalk‐like structure that raises the reproductive organs of the flower. However, little is known about the developmental and genetic basis of this structure despite its presence in multiple, distantly related taxa. Here, we address this gap by investigating Gynandropsis gynandra (Cleomaceae), a species with a prominent androgynophore.

Methods

We combined morphological and anatomical analyses with a comparative transcriptomic study to provide a detailed description of the androgynophore throughout development, examine global gene expression patterns, and identify candidate genes putatively involved in androgynophore elongation.

Results

The radially symmetric androgynophore of G. gynandra rapidly lengthens primarily via cell elongation. Despite its structural uniformity, androgynophore development is characterized by complex gene expression patterns including differential expression of floral organ identity genes and genes associated with organ development and growth in Arabidopsis thaliana.

Conclusions

Our morphological characterizations and high‐quality transcriptome for G. gynandra suggest that the androgynophore is a novel structure formed via elaboration of both the receptacle and base of reproductive organs because it is structurally like an elongated internode but expresses the genetic repertoire typically associated with the reproductive organs. The drastic increase in cell length and uniform structure elevates the androgynophore as a potentially powerful model for cell elongation.
What do we mean by complex percutaneous coronary intervention? An assessment of agreement amongst interventional cardiologists for defining complexity
Authors: Rjoob Khaled , McGilligan Victoria , McAllister Roisin , Bond Raymond , Doolub Gemina , Leslie Stephen J. , Manktelow Matthew , Knoery Charles , Shand James , Iftikhar Aleeha , McShane Anne , Mamas Mamas A. , Peace Aaron ,   EAPCI Innovation and Digital Cardiology Committee
Published: May 2023

Background

In the last decade, percutaneous coronary intervention (PCI) has evolved toward the treatment of complex disease in patients with multiple comorbidities. Whilst there are several definitions of complexity, it is unclear whether there is agreement between cardiologists in classifying complexity of cases. Inconsistent identification of complex PCI can lead to significant variation in clinical decision‐making.

Aim

This study aimed to determine the inter‐rater agreement in rating the complexity and risk of PCI procedures.

Method

An online survey was designed and disseminated amongst interventional cardiologists by the European Association of Percutaneous Cardiovascular Intervention (EAPCI) board. The survey presented four patient vignettes, with study participants assessing these cases to classify their complexity.

Results

From 215 respondents, there was poor inter‐rater agreement in classifying the complexity level (k = 0.1) and a fair agreement (k = 0.31) in classifying the risk level. The experience level of participants did not show any significant impact on the inter‐rater agreement of rating the complexity level and the risk level. There was good level of agreement between participants in terms of rating 26 factors for classifying complex PCI. The top five factors were (1) impaired left ventricular function, (2) concomitant severe aortic stenosis, (3) last remaining vessel PCI, (4) requirement fort calcium modification and (5) significant renal impairment.

Conclusion

Agreement among cardiologists in classifying complexity of PCI is poor, which may lead to suboptimal clinical decision‐making, procedural planning as well as long‐term management. Consensus is needed to define complex PCI, and this requires clear criteria incorporating both lesion and patient characteristics.
Optical coherence tomography‐derived predictors of stent expansion in calcified lesions
Authors: Ziedses des Plantes Annemieke C. , Scoccia Alessandra , Neleman Tara , Groenland Frederik T. W. , van Zandvoort Laurens J. C. , Ligthart Jurgen M. R. , Witberg Karen T. , Liu Shengnan , Boersma Eric , Nuis Rutger‐Jan , den Dekker Wijnand K. , Wilschut Jeroen , Diletti Roberto , Zijlstra Felix , Van Mieghem Nicolas M. , Daemen Joost
Published: May 2023

Background

Severe coronary artery calcification is associated with stent underexpansion and subsequent stent failure.

Aims

We aimed to identify optical coherence tomography (OCT)‐derived predictors of absolute (minimal stent area [MSA]) and relative stent expansion in calcified lesions.

Methods

This retrospective cohort study included patients who underwent percutaneous coronary intervention (PCI) with OCT assessment before and after stent implantation between May 2008 and April 2022. Pre‐PCI OCT was used to assess calcium burden and post‐PCI OCT was used to assess absolute and relative stent expansion.

Results

A total of 361 lesions in 336 patients were analyzed. Target lesion calcification (defined as OCT‐detected maximum calcium angle ≥ 30°) was present in 242 (67.0%) lesions. Following PCI, median MSA was 5.37 mm2 in calcified lesions and 6.24 mm2 in noncalcified lesions (p < 0.001). Median stent expansion was 78% in calcified lesions and 83% in noncalcified lesions (p = 0.325). In the subset of calcified lesions, average stent diameter, preprocedural minimal lumen area, and total calcium length were independent predictors of MSA in multivariable analysis (mean difference 2.69 mm2/mm2, 0.52 mm2/mm, and −0.28 mm2/5 mm, respectively, all p < 0.001). Total stent length was the only independent predictor of relative stent expansion (mean difference −0.465% per mm, p < 0.001). Calcium angle, thickness, and the presence of nodular calcification were not significantly associated with MSA or stent expansion in multivariable analyses.

Conclusion

Calcium length appeared to be the most important OCT‐derived predictor of MSA, whereas stent expansion was mainly determined by total stent length.
Drug‐coated balloon strategy following orbital atherectomy for calcified coronary artery compared with drug‐eluting stent: One‐year outcomes and optical coherence tomography assessment
Authors: Mitsui Kentaro , Lee Tetsumin , Miyazaki Ryoichi , Hara Nobuhiro , Nagamine Sho , Nakamura Tomofumi , Terui Mao , Okata Shinichiro , Nagase Masashi , Nitta Giichi , Watanabe Keita , Kaneko Masakazu , Nagata Yasutoshi , Nozato Toshihiro , Ashikaga Takashi
Published: May 2023

Background

Percutaneous coronary intervention (PCI) for calcified coronary artery remains challenging in the drug‐eluting stent (DES) era. While recent studies reported the efficacy of orbital atherectomy (OA) combined with DES for calcified lesion, the effectiveness of drug‐coated balloon (DCB) following OA has not been fully elucidated.

Methods

Between June 2018 and June 2021, 135 patients who received PCI for calcified de novo coronary lesions with OA were enrolled and divided into two groups; OA followed by DCB (n = 43) if the target lesion achieved acceptable preparation, or second‐ or third‐generation DESs (n = 92) if the target lesion showed suboptimal preparation between June 2018 and June 2021. All patients underwent PCI with optical coherence tomography (OCT) imaging. The primary endpoint was 1‐year major adverse cardiac event (MACE), that was a composite of cardiac death, nonfatal myocardial infarction, or target lesion revascularization.

Results

Mean age was 73 years and 82% was male. In OCT analysis, maximum calcium plaque was thicker (median: 1050 µm [interquartile range (IQR): 945–1175 µm] vs. 960 µm [808–1100 µm], p = 0.017), calcification arc tended to larger (median: 265° [IQR: 209–360°] vs. 222° [162–305°], p = 0.058) in patients with DCB than in DES, and the postprocedure minimum lumen area was smaller in DCB compared with minimum stent area in DES (median: 3.83 mm2 [IQR: 3.30–4.52 mm2] vs. 4.86 mm2 [4.05–5.82 mm2], p < 0.001). However, 1 year MACE free rate was not significantly different between 2 groups (90.3% in DCB vs. 96.6% in DES, log‐rank p = 0.136). In the subgroup analysis of 14 patients who underwent follow‐up OCT imaging, late lumen area loss was lower in patients with DCB than DES, despite lower lesion expansion rate in DCB than DES.

Conclusions

In calcified coronary artery disease, DCB alone strategy (if acceptable lesion preparation was performed with OA) was feasible compared with DES following OA with respect to 1‐year clinical outcomes. Our finding indicated using DCB with OA might be reduce late lumen area loss for severe calcified lesion.
Intracardiac echocardiogram to diagnose infective endocarditis after transcatheter aortic valve‐in‐valve implantation
Authors: Ho Cheuk Bong , Vejlstrup Niels G. , De Backer Ole , Søndergaard Lars
Published: May 2023

A 70‐year‐old man with history of transcatheter aortic valve‐in‐valve implantation was admitted because of suspected infective endocarditis (IE). Transesophageal echocardiogram did not reveal any vegetations, as the metallic stent frames caused significant artifacts. Position emission tomography was also negative. Intracardiac echocardiogram (ICE) was performed retrogradely through the ascending aorta, which showed clear vegetations over the stent frame of the transcatheter heart valve. Endocarditis after transcatheter aortic valve implantation was not uncommon. With increasing use of valve‐in‐valve procedures, echocardiographic diagnosis of IE would be more challenging. This case demonstrated the advantage of ICE over conventional echocardiography in visualizing the neo‐aortic valve complex for diagnosing IE.
Entamoeba histolytica‐associated proctitis and ileitis mimicking Crohn's disease—A case report
Authors: Griemert Thomas , Siegel Ekkehard , Brandstetter Moritz , Straub Beate K. , Kreft Andreas , Galle Peter R. , Sprinzl Martin F.
Published: May 2023

We report about a proctitis and ileitis terminalis, leading to the misdiagnosis of Chron's disease, in a male patient who has sex with men. Molecular multiplex analysis identified Entamoeba histolytica as the underlying cause. We provide diagnostic images, clues and pitfalls for diagnosis of E. histolytica associated proctitis.
Paraneoplastic acute eosinophilic pneumonia due to carotid angiosarcoma: A rare case
Authors: Paraandavaji Elham , Hadidi Homa , Norouzi Mahtab , Azaddehghan Maryam , Khodaparasti Mohadeseh , Shafiei Sasan , Ghadirzadeh Erfan , Nekooghadam Seyyed Mojtaba , Karimi Hanie
Published: May 2023

Key Clinical Message

This case report emphasizes that we should analyze a patient's signs and symptoms as a whole rather than relying exclusively on a common pattern to diagnose the condition and indicates that thorough histological investigation and sample collection are needed to accurately diagnose this malignancy.

Angiosarcoma is a rare, fatal, and poorly understood malignant tumor of vascular endothelial cells which is a challenging disease to diagnose in the clinical settings and requires early diagnosis to achieve a favorable prognosis. Paraneoplastic syndromes associated with angiosarcoma can include hypercoagulability, thrombocytopenia, anemia, fever, weight loss, and night sweats. In some cases, the paraneoplastic syndrome can be the first sign of the underlying malignancy. Here, we present a 47‐year‐old individual with angiosarcoma over the right scapula accompanied by hemoptysis and other pulmonary complaints whom at first was thought to be metastatic polmunary involvement. However, the patient's dramatic response to corticosteroids, in addition to further imaging and paraclinical studies, led us to an acute eosinophilic pneumonia (AEP) diagnosis which is an eosinophilic infiltrations of alveolar spaces. The patient received chemotherapy for angiosarcoma and radiation, since the brachial nerve network was disrupted, leaving the tumor unresectable. After 3 years of continuous follow‐up, the patient is now completely cured.
An unusual cause of chronic diarrhea in a Middle‐Aged adult: A diagnostic challenge
Authors: Reddy Aswanth , Nwankwo Nkolika , Sekar Arjun , Kumar Aswini
Published: May 2023

Key Clinical Message

Diarrhea is a common symptom in medical practice that often gets overlooked. This article is intended to increase the awareness of physicians and other providers on a subtle but important cause of chronic diarrhea.
Fahr's disease presenting as Parkinson's disease along with dysphagia and dysarthria: A case report
Authors: Sapkota Dilip , Neupane Srijana , Pant Prashant , Shrestha Oshan , Singh Pragyat , Sapkota Diwas
Published: May 2023

Key Clinical Message

Fahr's disease, a rare motor and neurocognitive condition, is characterized by idiopathic calcification of basal ganglia. This article presents such case of 61‐year‐old female, exhibiting movement, speech, and swallowing difficulties with multiple calcifications in brain in NCCT. Early and supportive management can lead to improved outcomes and prevent unnecessary interventions.
Popeye's sign: A diagnostic clue
Authors: Yamada Takayuki
Published: May 2023

Key Clinical Message

Sudden onset bulging of the upper arm may indicate biceps tendon rupture.

We describe a 72‐year‐old man with Popeye's sign. The patient experienced a sudden shock in his right humerus while mowing grass with his right arm using wide sweeps of a scythe. His right upper arm had an obvious bulging appearance after 3 days, indicating a rupture of the biceps tendon.
Transfusion‐related acute lung injury under general anesthesia successfully treated with extracorporeal membrane oxygenation: A case report
Authors: Ishida Yusuke , Nakazawa Koichi , Itabashi Toshio , Tomino Mikiko
Published: May 2023

Transfusion‐related acute lung injury (TRALI) is a serious complication of blood transfusion and can also develop severe hypoxemia. In TRALI cases with difficult blood oxygenation on mechanical ventilation support, temporary veno‐venous extracorporeal membrane oxygenation support appears to maintain oxygen levels.
A rare pancreatic neoplasm in a 40‐year‐old male patient
Authors: Limaiem Faten , Hajri Mohamed
Published: May 2023

Key Clinical Message

The differential diagnoses of solid pseudopapillary neoplasm of the pancreas include cystic pancreatic neuroendocrine tumor, acinar cell carcinoma, and pancreatoblastoma.

Solid pseudopapillary neoplasm (SPN) is a low‐grade malignant pancreatic tumor which accounts for 0.9%–2.7% of all exocrine pancreatic neoplasms. It predominantly affects young females (90%) and less frequently occurs in male patients. Its prognosis after surgical resection remains excellent. Herein, we report a case of SPN in a male patient.
Analysis of choroidal thickness on optical coherence tomography in a patient with sudden‐onset bilateral myopia, macular striae, and shallow anterior chamber after topiramate use
Authors: Vatwani Kishore Kumar , Tripathy Koushik , Agarwal Rohit , Bandyopadhyay Gopal
Published: May 2023

Key Clinical Message

This patient presented with sudden onset myopia, shallow anterior chamber, and radial macular folds in both eyes after using topiramate. Ocular parameters including increased choroidal thickness normalized after cessation of topiramate.
Delineation of the right ventricular septal activation during a right bundle branch origin accelerated idioventricular rhythm
Authors: Nishimura Takuro , Goya Masahiko , Negishi Miho , Ikenouchi Takashi , Yamamoto Tasuku , Goto Kentaro , Shigeta Takatoshi , Tao Susumu , Takigawa Masateru , Miyazaki Shinsuke , Sasano Tetsuo
Published: May 2023

Accelerated idioventricular rhythm (AIVR) originating from the right bundle branch (RBB) (RBB‐AIVR) is a rare ventricular arrhythmia. We delineated RBB and myocardial activation separately during RBB‐AIVR, which revealed the spatial relationship of the AIVR origin, preferential pathway, and breakout site. Radiofrequency ablation to the preferential pathway successfully eliminated this arrhythmia.
Crystal‐storing histiocytosis and associated marginal zone lymphoma with extensive plasmacytic differentiation
Authors: Al‐Qaderi Ayah , Sakhdari Ali
Published: May 2023

Key Clinical Message

Crystal‐storing histiocytosis (CSH) is a non‐neoplastic histiocytic proliferation that results from the intra‐lysosomal accumulation of immunoglobulins as crystals. CSH is frequently associated with various B‐cell lymphomas or plasma cell neoplasms. CSH can potentially obscure underlying lymphoproliferative neoplasms. This association should always be considered and the tissue should be carefully evaluated.
Previous crop and herbicide timing application effects on weed population growth rate
Authors: Oreja Fernando H. , Hare Andrew T. , Jordan David L. , Leon Ramon G.
Published: May 2023

A well‐designed crop rotation can create an unstable environment that disrupts weed population growth rates. In combination with effective herbicide programs, growers may maintain weed populations at levels below competitive and economic thresholds. The objectives of the present study were to evaluate how the preceding rotational crop determines the response of weed populations to in‐season postemergence herbicide programs and the weed population density of the following crop season. The first‐year crop treatments were corn (Zea mays L.), cotton (Gossypium hirsutum L.), peanut (Arachis hypogaea L.), grain sorghum [Sorghum bicolor (L.) Moench.], and soybean [Glycine max (L.) Merr.]. In the second year, all plots were planted with cotton, and herbicide treatments were single applications 2 or 6 weeks after planting (WAP), two sequential applications 2 and 4 or 4 and 6 WAP, three sequential applications 2, 4, and 6 WAP, and a weedy control without herbicides was included. In the absence of herbicides, corn had the lowest population growth rates for broadleaf weeds (λ = 0.8) while peanut and grain sorghum had the highest (λ = 1.7 and 1.3, respectively). The results indicated that herbicide applications focused exclusively on preventing yield loss may not be sufficient to ensure weed population reductions. Thus, the observed population growth rates (λ = 2 for grassy weeds and λ = 1.26 for broadleaved weeds) indicated that weed issues would continue increasing, despite meeting yield goals. Considering population growth rates when assessing weed management strategies is key to determining the sustainability of the crop production operation.
Characterization of industry relationships in oncology
Authors: Harrison Rebecca A. , Majd Nazanin K. , Johnson Margaret O. , Urbauer Diana L. , Puduvalli Vinay , Khasraw Mustafa
Published: May 2023

Background

Collaborative relationships between academic oncology and industry (pharmaceutical, biotechnology, “omic,” and medical device companies) are essential for therapeutic development in oncology; however, limited research on engagement in and perceptions of these relationships has been done.

Methods

Survey questions were developed to evaluate relationships between academic oncology and industry. An electronic survey was delivered to 1000 randomly selected members of the American Society of Clinical Oncology, a professional organization for oncologists, eliciting respondents' views around oncology‐industry collaborations. The responses were analyzed according to prespecified plans.

Results

There were 225 survey respondents. Most were from the United States (70.0%), worked at an academic institution (60.1%), worked in medical oncology (81.2%), and had an active relationship with industry (85.8%). One quarter (26.7%) of respondents reported difficulty establishing a relationship with industry collaborators, and most respondents (75%) did not report having had mentorship in developing these relationships. The majority (85.3%) of respondents considered these collaborations important to their careers. Respondents generally thought that scientific integrity was preserved (92%), and most respondents (95%) had little concern over the quality of the collaborative product. Many (60%) shared concerns over potential conflict of interest if an individual with a compensated relationship promoted an industry product for clinical care/research, yet most respondents (67%) stated these relationships did not shape their interactions with patients.

Conclusions

This study provides novel data characterizing the nature of collaborative relationships between clinicians, researchers, and industry in oncology. Although respondents considered these collaborations an important part of clinical and academic oncology, formal education or mentorship around these relationships was rare. Conflicting findings around conflict of interest highlight the importance of more dedicated research in this area.

Plain Language Summary

Business enterprises in health care play a central role in cancer research and care, driving the development of new medical testing, drugs, and devices. Effective working relationships among clinicians, researchers, and these industry partners can promote innovative research and enhance patient care. Study of these collaborations has been limited to date. Through distribution of a questionnaire to cancer clinicians and researchers, we found that most participants consider these relationships valuable, though they find establishing such relationships challenging partly because of gaps in educational programs in this area. Our findings also highlight the need for further policy around the potential bias these relationships can introduce.
Pharmacokinetics, Bioequivalence, and Safety Evaluation of 2 Formulations of 10‐mg Rivaroxaban Tablets: A 4‐Period Crossover Trial
Authors: Zhang Canhua , Shen Zihan , Li Jianhao , Wu Yaofen , Xu Zuoheng , Gu Wenzhao , Jian Jianqing , Wu Zixing , Liu Weixiong , Yang Hui , Su Jianfen
Published: May 2023

This study compared the safety, bioequivalence, and pharmacokinetic properties of 2 formulations of 10‐mg rivaroxaban tablets in healthy Chinese participants in fasting and fed arms. The trial was an open, randomized, 4‐period, replicated crossover scheme, and 36 volunteers were recruited separately for the fasting and fed arms. Volunteers were randomly administered a single dose of the test or reference formulation (10 mg) orally, followed by a 5‐day washout period. Rivaroxaban concentrations in the plasma were determined using liquid chromatography–tandem mass spectrometry, and pharmacokinetic parameters were obtained from the concentration‐time profiles. The mean values of the test and the reference product for the area under the plasma concentration–time curve from time 0 to the last measurable concentration, area under the plasma concentration–time curve from time 0 to infinity, and maximum plasma concentration were 996 and 1014 ng • h/mL, 1024 and 1055 ng • h/mL, and 150 and 152 ng/mL in the fasting arm, respectively; the values were 1155 and 1167 ng • h/mL, 1160 and 1172 ng • h/mL, and 202 and 193 ng/mL in the fed arm, respectively. All the parameters were within acceptable limits in terms of bioequivalence. No serious adverse events were observed. This study demonstrated that the 2 rivaroxaban tablets were bioequivalent in healthy Chinese participants under fasting and fed conditions.
Pharmacokinetics and Safety of Coadministered Atogepant and Topiramate in Healthy Participants: A Phase 1, Open‐Label, Drug–Drug Interaction Study
Authors: Boinpally Ramesh , McGeeney Danielle , Borbridge Lisa , Trugman Joel
Published: May 2023

Atogepant, an oral calcitonin gene‐related peptide receptor antagonist, and topiramate, a commonly used oral antiepileptic, are approved as preventive migraine treatments. Given the distinct mechanisms of action of these treatments, it is possible that they may be coprescribed for migraine. This open‐label, single‐center, 2‐cohort, phase 1 trial evaluated the potential pharmacokinetic (PK) 2‐way drug–drug interactions (DDIs), safety, and tolerability of atogepant and topiramate in healthy adults. Participants received atogepant 60 mg once daily and topiramate 100 mg twice daily. Cohort 1 (N = 28) evaluated the effect of topiramate on the PK of atogepant; cohort 2 (N = 25) evaluated the effect of atogepant on the PK of topiramate. Potential DDIs were assessed using geometric mean ratios and 90% confidence intervals calculated for maximum plasma drug concentration at steady state (Cmax,ss) and area under the plasma concentration–time curve during the dosing interval at steady state (AUC0−tau,ss). Additional PK parameters were assessed. Atogepant AUC0−tau,ss and Cmax,ss decreased by 25% and 24%, respectively, with topiramate coadministration. Topiramate AUC0−tau,ss and Cmax,ss decreased by 5% and 6%, respectively, with atogepant coadministration. The 25% reduction in atogepant exposure when coadministered with topiramate is not considered to be clinically relevant and would not require dose adjustments.
High‐latitude invasion and environmental adaptability of the freshwater mussel Limnopernafortunei in Beijing, China
Authors: Wang Congcong , Xu Mengzhen , Zhang Jiahao , Zhou Xiongdong
Published: May 2023

The invasive freshwater mussel Limnoperna fortunei (Dunker, 1857) has spread widely throughout Asia and South America, especially via interbasin water diversion and navigation. The middle route of the South‐to‐North Water Transfer Project (SNWTP), whose terminal is Beijing, has diverted more than 60 billion m3 of water from the Yangtze River Basin to Northern China since December 2014. L. fortunei has spread north to Beijing along the SNWTP, biofouling its channels and tunnels. To determine the status of L. fortunei's invasion in Beijing, we systematically inspected the water bodies receiving southern water, including all branches of the SNWTP, water treatment plants, lakes, reservoirs, and rivers. We measured the densities of adults and veligers of L. fortunei and conducted eDNA analyses of water samples. A generalized linear model and canonical correspondence analysis were adopted to investigate the correlations between environmental (e.g., water temperature, conductivity, pH, total nitrogen, and phosphorus) and biological (e.g., chlorophyll a, plankton density, and community composition) variables and the densities of adults and veligers of L. fortunei. Water temperature is the most important factor in determining the densities of D‐shaped and pediveliger veligers, with explanatory variable contributions of 56.2% and 43.9%, respectively. The pH affects the densities of D‐shaped, umbonated, and pediveliger veligers. The density of plantigrade veligers is negatively correlated with the conductivity and positively correlated with the concentration of chlorophyll a. Canonical correspondence analysis shows a weak correlation between the dominant phytoplankton taxa and the density of veligers. The densities of D‐shaped, umbonated, and pediveliger veligers are positively correlated with the density of small phytoplankton (12.54 ± 4.33 μm), and the density of plantigrade veligers is positively correlated with the density of large (16.12 ± 5.96 μm) phytoplankton. The density of planktonic veligers is well correlated with local abiotic variables, and that of plantigrade veligers is less correlated with local abiotic variables. This finding implies that controlling early‐stage veligers by altering water temperature, pH, and food size might effectively control the establishment of further L. fortunei colonies.
Patient profiles in heart failure with reduced ejection fraction: Prevalence, characteristics, treatments and outcomes in a real‐world heart failure population
Authors: Musella Francesca , Rosano Giuseppe M.C. , Hage Camilla , Benson Lina , Guidetti Federica , Moura Brenda , Sibilio Gerolamo , Boccalatte Marco , Dahlström Ulf , Coats Andrew J.S. , Lund Lars H. , Savarese Gianluigi
Published: May 2023

Aims

The Heart Failure Association of the European Society of Cardiology has recently proposed to optimize guideline‐directed medical treatments according to patient's profiles. The aim of this analysis was to investigate prevalence/characteristics/treatments/outcomes for individual profiles.

Methods and results

Patients with heart failure (HF) with reduced ejection fraction (HFrEF) enrolled in the Swedish Heart Failure Registry (SwedeHF) between 2013 and 2021 were considered. Among 108 profiles generated by combining different strata of renal function (by estimated glomerular filtration rate [eGFR]), systolic blood pressure (sBP), heart rate, atrial fibrillation (AF) status and presence of hyperkalaemia, 93 were identified in our cohort. Event rates for a composite of cardiovascular (CV) mortality or first HF hospitalization were calculated for each profile. The nine most frequent profiles accounting for 70.5% of the population had eGFR 30–60 or ≥60 ml/min/1.73 m2, sBP 90–140 mmHg and no hyperkalaemia. Heart rate and AF were evenly distributed. The highest risk of CV mortality/first HF hospitalization was observed in those with concomitant eGFR 30–60 ml/min/1.73 m2 and AF. We also identified nine profiles with the highest event rates, representing only 5% of the study population, characterized by no hyperkalaemia, even distribution among the sBP strata, predominance of eGFR <30 ml/min/1.73 m2 and AF. The three profiles with eGFR 30–60 ml/min/1.73 m2 also showed sBP <90 mmHg.

Conclusions

In a real‐world cohort, most patients fit in a few easily identifiable profiles; the nine profiles at highest risk of mortality/morbidity accounted for only 5% of the population. Our data might contribute to identifying profile‐tailored approaches to guide drug implementation and follow‐up.
Prevalence, characteristics and prognostic impact of aortic valve disease in patients with heart failure and reduced, mildly reduced, and preserved ejection fraction: An analysis of the ESC Heart Failure Long‐Term Registry
Authors: Shahim Bahira , Shahim Angiza , Adamo Marianna , Chioncel Ovidiu , Benson Lina , Crespo‐Leiro Maria G. , Anker Stefan D. , Coats Andrew J.S. , Filippatos Gerasimos , Lainscak Mitja , McDonagh Theresa , Mebazaa Alexandre , Piepoli Massimo F. , Rosano Giuseppe M.C. , Ruschitzka Frank , Savarese Gianluigi , Seferovic Petar , Volterrani Maurizio , Crespo Leiro Marisa , Segovia Cubero Javier , Amir Offer , Palic Benjamin , Maggioni Aldo P. , Metra Marco , Lund Lars H.
Published: May 2023

Aims

To assess the prevalence, clinical characteristics, and outcomes of patients with heart failure (HF) with or without moderate to severe aortic valve disease (AVD) (aortic stenosis [AS], aortic regurgitation [AR], mixed AVD [MAVD]).

Methods and results

Data from the prospective ESC HFA EORP HF Long‐Term Registry including both chronic and acute HF were analysed. Of 15 216 patients with HF (62.5% with reduced ejection fraction, HFrEF; 14.0% with mildly reduced ejection fraction, HFmrEF; 23.5% with preserved ejection fraction, HFpEF), 706 patients (4.6%) had AR, 648 (4.3%) AS and 234 (1.5%) MAVD. The prevalence of AS, AR and MAVD was 6%, 8%, and 3% in HFpEF, 6%, 3%, and 2% in HFmrEF and 4%, 3%, and 1% in HFrEF. The strongest associations were observed for age and HFpEF with AS, and for left ventricular end‐diastolic diameter with AR. AS (adjusted hazard ratio [HR] 1.43, 95% confidence interval [CI] 1.23–1.67), and MAVD (adjusted HR 1.37, 95% CI 1.07–1.74) but not AR (adjusted HR 1.13, 95% CI 0.96–1.33) were independently associated with the 12‐month composite outcome of cardiovascular death and HF hospitalization. The associations between AS and the composite outcome were observed regardless of ejection fraction category.

Conclusions

In the ESC HFA EORP HF Long‐Term Registry, one in 10 patients with HF had AVD, with AS and MAVD being especially common in HFpEF and AR being similarly distributed across all ejection fraction categories. AS and MAVD, but not AR, were independently associated with increased risk of in‐hospital mortality and 12‐month composite outcome, regardless of ejection fraction category.
Effects of dapagliflozin on heart failure hospitalizations according to severity of inpatient course: Insights from DELIVER and DAPA‐HF
Authors: Chatur Safia , Kondo Toru , Claggett Brian L. , Docherty Kieran , Miao Zi Michael , Desai Akshay S. , Jhund Pardeep S. , de Boer Rudolf A. , Hernandez Adrian F. , Inzucchi Silvio E. , Kosiborod Mikhail N. , Lam Carolyn S.P. , Martinez Felipe A. , Shah Sanjiv J. , Petersson Magnus , Langkilde Anna Maria , McMurray John J.V. , Solomon Scott D. , Vaduganathan Muthiah
Published: May 2023

Aims

Dapagliflozin resulted in significant and sustained reductions in first and recurrent heart failure (HF) hospitalizations among patients with HF across the spectrum of ejection fraction. How treatment with dapagliflozin differentially impacts hospitalization for HF of varying complexity is not well studied.

Methods and results

In the DELIVER and DAPA‐HF trials, we examined the effects of dapagliflozin on adjudicated HF hospitalizations of varying complexity and hospital length of stay (LOS). HF hospitalizations requiring intensive care unit stay, intravenous vasoactive therapies, invasive/non‐invasive ventilation, mechanical fluid removal or mechanical circulatory support were categorized as complicated. The balance was classified as uncomplicated. Of the total 1209 HF hospitalizations reported in DELIVER, 854 (71%) were uncomplicated and 355 (29%) were complicated. Of the total 799 HF hospitalizations reported in DAPA‐HF, 453 (57%) were uncomplicated and 346 (43%) were complicated. Relative to patients experiencing a first uncomplicated HF hospitalization, those with complicated HF hospitalizations had a significantly higher in‐hospital mortality both in DELIVER (16.7% vs. 2.3%, p < 0.001) and DAPA‐HF (15.1% vs. 3.8%, p < 0.001). Dapagliflozin similarly reduced total ‘uncomplicated’ (DELIVER: rate ratio [RR] 0.67, 95% confidence interval [CI] 0.55–0.82 and DAPA‐HF: RR 0.69, 95% CI 0.54–0.87) and ‘complicated’ HF hospitalizations (DELIVER: RR 0.82, 95% CI 0.63–1.06 and DAPA‐HF: RR 0.75, 95% CI 0.58–0.97). Dapagliflozin consistently reduced hospitalizations irrespective of their LOS: <5 days (DELIVER: RR 0.76, 95% CI 0.58–0.99 and DAPA‐HF: RR 0.58, 95% CI 0.42–0.80) or ≥5 days (DELIVER: RR 0.71, 95% CI 0.58–0.86 and DAPA‐HF: RR 0.77, 95% CI 0.62–0.94).

Conclusion

A substantial proportion of hospitalizations (∼30–40%) among patients with HF irrespective of ejection fraction required intensification of treatment beyond standard intravenous diuretics. Such patients experienced significantly higher in‐hospital mortality. Treatment with dapagliflozin consistently reduced HF hospitalizations regardless of severity of inpatient course or LOS.

Clinical Trial Registration: ClinicalTrials.gov, DELIVER (NCT03619213) and DAPA‐HF (NCT03036124).
The youth transformative participatory evaluator education and training approach: The EvalYouth experience
Authors: Bitar Khalil , Hoosen Fazeela , Montrosse‐Moorhead Bianca , Jahid Qudratullah
Published: May 2023

In the face of unprecedented and ever‐changing challenges at the local, national, and global levels, evaluation must change too. Our old ways no longer serve us or the field's social, economic, political, and humanitarian betterment aims. Taking these aims seriously means much must change, including how we educate and train. In this article, we lay out a vision for what must happen within evaluator education and training and examples of how a transformative frame can be successfully integrated. With the great challenges our countries and societies face, we revisit three fundamental questions: what do evaluator education and training ‘done well’ mean? What should such education and training look like? Who should lead it?
Medical cannabis: Roles, responsibilities, and challenges for clinical pharmacists
Authors: Sera Leah , Duncan Nakia
Published: May 2023

Cannabis is a plant that has been grown for centuries for it is industrial, medicinal, and recreational uses. Over the last few decades, cannabis has been increasingly used therapeutically and recreationally as states increasingly decriminalize or legalize its cultivation and sale. Pharmacists, as medication experts, can play an important role in educating patients and other healthcare professionals about cannabis, the evidence of its potential for therapeutic use, and the risks for short and long‐term adverse effects. This paper aims to broadly review the current policy landscape, describe specific issues and challenges relevant to patients and healthcare providers, and provide a framework for the clinical pharmacist's approach to the patient using cannabis.