Cardio-Oncology: a medical specialty in constant growth and evolution. the 10-year experience of the first cardio-oncology service in the United Kingdom

Introduction

Survivorship has increased significantly in cancer patients with the advent of novel therapies. However, this improvement has been at the cost of higher rates of cardiotoxicity. Cardiovascular disease has become the main cause of death or cancer therapy interruption in many of these patients. The need for specialist services to deal with these emerging problems has led to global development of many Cardio-Oncology services.

Objectives

To describe how a Cardio-Oncology service has grown and evolved over a 10 year period in response to the constantly changing oncological landscape.

Methods and results

Prospective, single center, study of cancer patients referred to our service from February 2011 to December 2021. 1499 patients were referred to the service. Mean age was 60 years (SD: 15) and 60% were female. CV risk factors including hypertension (32%), dyslipidaemia (12%) and diabetes (6%) were common.

The most frequent primary tumour location was breast (427 patients, 28%), followed by haematological (151, 10%) and gastrointestinal tract (114, 8%). The average number of referrals per month increased 6 fold from 2011, from 3.3 patients per month to 21 patients in 2021. In the last 5 years there was a 10 fold increase in the number of outpatient consultations from 189 consultations in 2016 to 1988 consultations in 2021.

The most frequent reason for referral was pre-treatment assessment (39%), followed by cancer therapy related cardiac dysfunction (CTRCD) (33%) and other acute cancer therapy related CV diseases (CTR-CVDs) (22%). From 2011 to 2017 CTRCD was the main CTR-CVD due to anthracycline and trastuzumab. This ratio changed in 2018 when other CTR-CVDs became the most frequent referral reason following pre-treatment assessment. Patients referred to our service were or had been, mostly under medical therapy alone or in combination with surgery or radiotherapy (1058 patients, 70%), anthracyclines being the predominant treatment (435 patients, 40%). Targeted therapies and immune check point inhibitors became more popular in the last two years (2020–2021). A multivariable logistic regression model was built to assess the relation between the medical treatment and the prevalence of CTRCD vs other CTR-CVDs. Anthracyclines and HER2 therapy are independently associated with a higher prevalence of CTRCD while tyrosine kinase inhibitors and immune checkpoint inhibitors increase the risk of other CTR-CVDs e.g. hypertension, arrhythmias and myocarditis.

Conclusions

Cardio-Oncology has rapidly evolved from its origin as a subspecialty of heart failure medicine, to a diverse medical specialty that encompasses many different domains of cardiology. Future cardio-oncology services should reflect this and be dynamic, collaborating with cardiac sub-specialities as necessary. Provision of cardio-oncology services requires a considerable knowledge and understanding of the ever growing and changing oncology therapies.

Funding Acknowledgement

Type of funding sources: None.

Geriatric Assessment Reveals Actionable Impairments in Hematopoietic Stem Cell Transplantation Candidates Age 18 to 80 Years

Allogeneic hematopoietic stem cell transplantation (HCT) is a potentially curative treatment for both malignant and nonmalignant hematologic diseases; however, reported rates of treatment-related mortality approach 30%. Outcomes are worse in patients who begin HCT with functional impairments. To detect such impairments, a geriatric assessment (GA) is recommended in adults age ≥65 years. Younger HCT candidates also may be impaired because of chemotherapy regimens pre-HCT. Therefore, we hypothesized that GA can be beneficial for adult patients of all ages and subsequently created a clinical pretransplantation optimization program to assess all HCT candidates using a modified GA. One-hundred fifty-seven patients were evaluated in 4 functional domains- physical, cognitive, nutritional, and psychological-at 2 time points prior to HCT-new patient evaluation (NPE) and sign-off (SO)-between October 2017 and January 2020. At NPE, 80.9% of the patients had at least 1 domain with a functional impairment, and physical (P = .006), cognitive (P = .04), and psychological (P = .04) impairments were associated with an increased likelihood of not proceeding to HCT. In addition, patients age 18 to 39 years were more likely than older patients to have a physical function impairment (P = .001). Between NPE and SO, 51.9% of the patients had resolution of 1 or more impairments, and nutritional impairment at SO was predictive of worse overall survival (P = .01). Our study shows that GA can identify functional impairments in patients of all ages. Early identification of impairments could facilitate referrals to supportive care and resolution of impairments prior to HCT, suggesting that GA could be recommended for HCT candidates of all ages.

ESMO expert consensus statements on the management of EGFR mutant non-small-cell lung cancer

The European Society for Medical Oncology (ESMO) held a virtual consensus-building process on epidermal growth factor receptor (EGFR)-mutant non-small-cell lung cancer in 2021. The consensus included a multidisciplinary panel of 34 leading experts in the management of lung cancer. The aim of the consensus was to develop recommendations on topics that are not covered in detail in the current ESMO Clinical Practice Guideline and where the available evidence is either limited or conflicting. The main topics identified for discussion were: (i) tissue and biomarkers analyses; (ii) early and locally advanced disease; (iii) metastatic disease and (iv) clinical trial design, patient's perspective and miscellaneous. The expert panel was divided into four working groups to address questions relating to one of the four topics outlined above. Relevant scientific literature was reviewed in advance. Recommendations were developed by the working groups and then presented to the entire panel for further discussion and amendment before voting. This manuscript presents the recommendations developed, including findings from the expert panel discussions, consensus recommendations and a summary of evidence supporting each recommendation.

Cognitive impairment in candidates for allogeneic hematopoietic stem cell transplantation

Hematopoietic cell transplant (HCT) is an increasingly common and curative treatment strategy to improve survival among individuals with malignant and nonmalignant diseases, with over one million HCTs having been performed worldwide. Neurocognitive dysfunction is a common and untoward consequence of HCT for many recipients, although few studies have examined the profile of neurocognitive impairments in HCT or their association with clinical features, such as frailty, or the incidence of pre-HCT neurocognitive impairments across all ages, which may influence post-HCT neurocognitive impairments. We examined the pattern and correlates of pre-transplant neurocognitive dysfunction in a prospective sample of adults undergoing HCT. Neurocognition was assessed using the Montreal Cognitive Assessment Battery. Frailty was assessed using the Short Physical Performance Battery. Linear regression analysis was used to examine the associations between neurocognitive performance and frailty. Neurocognitive screening profiles were also examined by partitioning MoCA into domain scores, including Executive Function and Memory. We also examined the associations between neurocognition, frailty, and clinical outcomes, including length of transplant hospitalization and survival. One hundred and ten adults were evaluated across a wide age range (range: 19-75; mean age = 54.7 [SD = 14.1]). Neurocognitive performance tended to fall below published normative levels (mean MoCA = 25.5 [SD = 4.1]), with 17% of participants demonstrating impaired performance compared with medical normative data (MoCA ≤ 22) and 34% exhibiting impaired performance relative to healthy samples (MoCA ≤ 25). Mild impairments (MoCA ≤ 25) were common across age ranges, including middle-aged patients (23% for age < 50; 35% for age 50-60, 41% for age ≥ 60), particularly for items assessing Executive Function. Greater levels of frailty associated with lower neurocognitive screening scores (r = -0.29, P < 0.01) and Executive Functioning (r = -0.24, P < 0.01), whereas greater age was associated with poorer Memory performance only (r = -0.33, P < 0.01). Greater levels of frailty prior to transplant associated with longer length of stay (β = 0.10, P = 0.046), but were not associated with survival. Neurocognitive impairments are common among adults undergoing HCT and the pattern of performance varies by age. Pre-transplant frailty is associated with neurocognitive functioning and may portend worse post-transplant early clinical outcomes.

Mature tertiary lymphoid structures in lung adenocarcinoma are associated with better progression free survival

Introduction/Objective

The presence of inducible lymphoid structures known as tertiary lymphoid structures in the tumor microenvironment has been shown to correlate with positive clinical outcome. However, the maturation states of lymphoid aggregates in lung adenocarcinoma are not completely understood.

Methods/Case Report

Seventy tumor samples from 69 patients diagnosed with lung adenocarcinoma (Stages I to III) between 2013 and 2015 were included in the study. The presence and maturation states of the lymphoid structures within the tumors were evaluated by conventional and 26 samples were further analyzed by multiplexed immunohistochemistry of formalin fixed paraffin embedded tissues and then quantified. Mature lymphoid follicles containing germinal centers were identified by the presence of CD21+ and BCL-6+ cells in an organized configuration within tight clusters of T and B cells.

Results (if a Case Study enter NA)

Samples with fully mature lymphoid structures (germinal centers) had larger tumors and higher disease stage. The number of mature lymphoid structures correlated with the total number of lymphoid aggregates present in the tumor microenvironment. Additionally, tumor samples with ≥10 mature lymphoid structures had more primary follicles. While there was no difference in overall survival, progression free survival was significantly longer in patients who had ≥10 mature lymphoid structures in comparison with patients who had &lt;10 mature structures.

Conclusion

In conclusion, a spectrum of lymphoid aggregates in different stages of maturation are present in lung adenocarcinoma. An increase in the number of mature lymphoid structures may be associated with progression free survival in patients with lung adenocarcinoma.

The burden of COVID-19 infection in a rural Tamil Nadu community

Background

There have been over 30 million cases of COVID-19 in India and over 430,000 deaths. Transmission rates vary from region to region, and are influenced by many factors including population susceptibility, travel and uptake of preventive measures. To date there have been relatively few studies examining the impact of the pandemic in lower income, rural regions of India. We report on a study examining COVID-19 burden in a rural community in Tamil Nadu.

Methods

The study was undertaken in a population of approximately 130,000 people, served by the Rural Unit of Health and Social Affairs (RUHSA), a community health center of CMC, Vellore. We established and evaluated a COVID-19 PCR-testing programme for symptomatic patients—testing was offered to 350 individuals, and household members of test-positive cases were offered antibody testing. We also undertook two COVID-19 seroprevalence surveys in the same community, amongst 701 randomly-selected individuals.

Results

There were 182 positive tests in the symptomatic population (52.0%). Factors associated with test-positivity were older age, male gender, higher socioeconomic status (SES, as determined by occupation, education and housing), a history of diabetes, contact with a confirmed/suspected case and attending a gathering (such as a religious ceremony, festival or extended family gathering). Amongst test-positive cases, 3 (1.6%) died and 16 (8.8%) suffered a severe illness. Amongst 129 household contacts 40 (31.0%) tested positive. The two seroprevalence surveys showed positivity rates of 2.2% (July/Aug 2020) and 22.0% (Nov 2020). 40 tested positive (31.0%, 95% CI: 23.02 − 38.98). Our estimated infection-to-case ratio was 31.7.

Conclusions

A simple approach using community health workers and a community-based testing clinic can readily identify significant numbers of COVID-19 infections in Indian rural population. There appear, however, to be low rates of death and severe illness, although vulnerable groups may be under-represented in our sample. It’s vital these lower income, rural populations aren’t overlooked in ongoing pandemic monitoring and vaccine roll-out in India.

LWBA: Lévy-walk bat algorithm based data prediction for precision agriculture in wireless sensor networks

Smart farming is one of the immense applications of Wireless Sensor Networks (WSN). Still, most of the researches have been focusing on precision agriculture using WSNs. In general, the nodes within the wireless sensor systems are self-configured. Based on the application requirement, gadgets within the region of interest collect data, prepare it, and send it to the recipient. The biggest impediments to these sensor systems are collision, restricted battery, and transmission capacity. Due to these characteristics, the node battery depletes earlier, when it starts working. Currently, agriculture depends on rain due to the lack of water resources and irrigation services. The crop development depends totally on the factors of water, the climatic conditions of the soil, etc. In large-scale agriculture, it is exceptionally problematic to analyze all the parameters accurately throughout the growing field. In this article, high-precision architecture for large-scale agriculture has been proposed. An IoT (Internet of Things) enabled WSN has been built and installed in the respective areas to measure the physical quantities regularly. In addition, Lévy-Walk Bat (LWBA) algorithm has been proposed to optimize the collected data. The prediction accuracy of the collected data is evaluated by LWBA and then, it is compared with the existing optimization algorithms with different error solvers. It has provided the exact information regarding the whole landscape and it will help the farmers to irrigate precisely.

A phase 2 trial of the somatostatin analog pasireotide to prevent GI toxicity and acute GVHD in allogeneic hematopoietic stem cell transplant

Background

Allogeneic hematopoietic stem cell transplantation (HCT) is an often curative intent treatment, however it is associated with significant gastrointestinal (GI) toxicity and treatment related mortality. Graft-versus-host disease is a significant contributor to transplant-related mortality. We performed a phase 2 trial of the somatostatin analog pasireotide to prevent gastrointestinal toxicity and GVHD after myeloablative allogeneic HCT.

Methods

Patients received 0.9mg pasireotide every 12 hours from the day prior to conditioning through day +4 after HCT (or a maximum of 14 days). The primary outcomes were grade 3–4 gastrointestinal toxicity through day 30 and acute GVHD. Secondary outcomes were chronic GVHD, overall survival and relapse free survival at one year. Stool and blood samples were collected from before and after HCT for analyses of stool microbiome, local inflammatory markers, and systemic inflammatory and metabolic markers. Results were compared with matched controls.

Results

Twenty-six patients received pasireotide and were compared to 52 matched contemporaneous controls using a 1–2 match. Grade 3–4 GI toxicity occurred in 21 (81%) patients who received pasireotide and 35 (67%) controls (p = 0.33). Acute GVHD occurred in 15 (58%) patients in the pasireotide group and 28 (54%) controls (p = 0.94). Chronic GVHD occurred in 16 patients in the pasireotide group (64%) versus 22 patients in the control group (42%) (p = 0.12). Overall survival at 1 year in the pasireotide group was 63% (95% CI: 47%,86%) versus 82% (95% CI: 72%, 93%) in controls (log-rank p = 0.006). Relapse-free survival rate at one year was 40% (95% CI: 25%, 65%) in the pasireotide group versus 78% (95% CI: 68%, 91%) in controls (log-rank p = 0.002). After controlling for the effect of relevant covariates, patients in the pasireotide group had attenuated post-HCT loss of microbial diversity. Analysis of systemic inflammatory markers and metabolomics demonstrated feasibility of such analyses in patients undergoing allogeneic HCT. Baseline level and pre-to-post transplant changes in several inflammatory markers (including MIP1a, MIP1b, TNFa, IL8Pro, and IL6) correlated with likelihood of survival.

Conclusions

Pasireotide did not prevent gastrointestinal toxicity or acute GVHD compared to contemporaneous controls. Pasireotide was associated with numerically higher chronic GVHD and significantly decreased OS and RFS compared to contemporaneous controls. Pasireotide may provide a locally protective effect in the stool microbiome and in local inflammation as measured by stool calprotectin, stool beta-defensin, and stool diversity index.

Molecular structure analysis and biological properties investigation on antiseptic drug; 2-amino-1-phenyl-1-propanol using spectroscopic and computational research analysis

The inducement of physical, chemical, structural and biological properties to entice of pharmaceutical property was analyzed by Vibrational spectroscopic, biological and theoretical tools. The structural arrangement for describing structure activity was investigated by injecting ligand groups in internal coordinate system by molecular tools (FT adopted IR, Raman, and NMR). Bond length and bond angle strain was pronounced much due to the chemical equivalent forces extension due to the injection of substitutional groups on base compound and thus non-Centro symmetry was processed. The molecular charge depletion profile was thoroughly studied to persuade protonic and electronic delocalization setup for arranging the drug potential. The chemi-equivalent potential exchange was monitored among different parts of the molecule for obtaining drug mechanism. The biological profile was keenly observed to look at the biological ambiance of the present molecule to fabricate advanced drug. The Lipinski five rule parameters; MV = 137.18, LogP = 0.27, HBD = 2, HBA = 2 and TPSA = 46.2 A2 showed the enhancement of additive drug quality. The exchange of oscillating chemical energy in the core and allied carbons of the base skeleton was keenly noted to find the prearranged chemical environment for successful drug mechanism. The non bonded transitions between Lewis acid and base of bonded molecular system were observed to determine the restoring potential to customize drug potential. The drug assistance for enantiomer characteristics of chirality sequence was displayed to expose the toxicity effect of the molecule. The active molecular bondings on different sites of molecule were measured by estimating polarizability and associated biological inhibition was validated.

Stem Cell Therapy as a Treatment for Autoimmune Disease-Updates in Lupus, Scleroderma, and Multiple Sclerosis

PURPOSE OF REVIEW

Evidence for hematopoietic stem cell transplantation (HCT) in autoimmune disease has been building since the 1990s; however, many clinicians may not yet be aware of its applications to autoimmune disease. We review the basic tenets of HCT and evidence for autologous HCT in multiple sclerosis (MS), systemic sclerosis (SSc), and lupus with an emphasis on recent advanced phase trials.

RECENT FINDINGS

In MS, the phase 3 randomized MIST trial and the phase 2 randomized ASTIMS trial demonstrated the efficacy of autologous HCT in refractory MS over disease-modifying therapies and mitoxantrone, respectively. In SSc, the phase 3 randomized ASTIS trial and the phase 2 randomized SCOT trial demonstrated the efficacy of autologous HCT in advanced SSc compared to cyclophosphamide. The evidence for HCT in autoimmune diseases continues to grow, particularly in MS and SSc. In lupus, large, comparative trials are still needed. Across autoimmune diseases, questions that still remain to be answered include optimizing patient selection to limit TRM, the appropriate use of MAC, and the necessity for graft manipulation. Furthermore, collaboration between disease-specific and transplant physicians is imperative to expand the appropriate use of HCT in routine clinical practice.

Fecal microbiota diversity disruption and clinical outcomes after auto-HCT: a multicenter observational study

We previously described clinically relevant reductions in fecal microbiota diversity in patients undergoing allogeneic hematopoietic cell transplantation (allo-HCT). Recipients of high-dose chemotherapy and autologous HCT (auto-HCT) incur similar antibiotic exposures and nutritional alterations. To characterize the fecal microbiota in the auto-HCT population, we analyzed 1161 fecal samples collected from 534 adult recipients of auto-HCT for lymphoma, myeloma, and amyloidosis in an observational study conducted at 2 transplantation centers in the United States. By using 16S ribosomal gene sequencing, we assessed fecal microbiota composition and diversity, as measured by the inverse Simpson index. At both centers, the diversity of early pretransplant fecal microbiota was lower in patients than in healthy controls and decreased further during the course of transplantation. Loss of diversity and domination by specific bacterial taxa occurred during auto-HCT in patterns similar to those with allo-HCT. Above-median fecal intestinal diversity in the periengraftment period was associated with decreased risk of death or progression (progression-free survival hazard ratio, 0.46; 95% confidence interval, 0.26-0.82; P = .008), adjusting for disease and disease status. This suggests that further investigation into the health of the intestinal microbiota in auto-HCT patients and posttransplant outcomes should be undertaken.

An efficient data prediction model using hybrid Harris Hawk Optimization with random forest algorithm in wireless sensor network

Wireless Sensor Networks (WSNs) are consistently gathering environmental weather data from sensor nodes on a random basis. The wireless sensor node sends the data via the base station to the cloud server, which frequently consumes immoderate power consumption during transmission. In distribution mode, WSN typically produces imprecise measurable or missing data and redundant data that influence the whole network of WSN. To overcome this complexity, an effective data prediction model was developed for decentralized photovoltaic plants using hybrid Harris Hawk Optimization with Random Forest algorithm (HHO-RF) primarily based on the ensemble learning approach. This work is proposed to predict the precise data and minimization of error in WSN Node. An efficient model for data reduction is proposed based on the Principal Component Analysis (PCA) for processing data from the sensor network. The datasets were gathered from the Tamil Nadu photovoltaic power plant, India. A low cost portable wireless sensor node was developed for collecting PV plant weather data using Internet of Things (IoT). The experimental outcomes of the proposed hybrid HHO-RF approach were compared with the other four algorithms, namely: Linear Regression (LR), Support Vector Machine (SVM), Random Forest (RF) and Long Short Term Memory (LSTM) algorithm. Results show that the determination coefficient (R2), Mean Square Error (MSE), Root Mean Square Error (RMSE) and Mean Absolute Error (MAE) values of the HHO-RF model are 0.9987, 0.0693, 0.2336 and 0.15881, respectively. For the prediction of air temperature, the RMSE of the proposed model is 3.82 %, 3.84% and 6.92% model in the lowest, average and highest weather days. The experimental outcomes of the proposed hybrid HHO-RF model have better performance compared to the existing algorithms.

Precision treatment for metastatic non-small cell lung cancer: A conceptual overview

Recent developments in precision oncology have increased the complexity of diagnostic and therapeutic decisions. Here, we broadly review the field of precision oncology and discuss common mutational drivers in non-small cell lung cancer (NSCLC) that directly relate to the diagnosis, evaluation, and treatment of patients with metastatic disease.

Assessing the Feasibility of a Novel mHealth App in Hematopoietic Stem Cell Transplant Patients

Hematopoietic stem cell transplantation (HCT) is a curative treatment option for patients with hematologic conditions but presents many complications that must be managed as a complex, chronic condition. Mobile health applications (mHealth apps) may permit tracking of symptoms in HCT. In seeking strategies to manage the complexities of HCT, our team collaborated with Sicklesoft, Inc., to develop an mHealth app specifically for HCT patients to allow for daily evaluation of patient health, Technology Recordings to better Understand Bone Marrow Transplantation (TRU-BMT). The primary value of this application is that of potentially enhancing the monitoring of symptoms and general health of patients undergoing HCT, with the ultimate goal of allowing earlier detection of adverse events, earlier intervention, and improving outcomes. To first evaluate patient interest in mHealth apps, we designed and administered an interest survey to patients at the 2017 BMT-InfoNet reunion. As a follow-up to the positive feedback received, we began testing the TRU-BMT app in a Phase 1 pilot study. Thirty patients were enrolled in this single-arm study and were given the TRU-BMT mHealth app on a smartphone device in addition to a wearable activity tracker. Patients were followed for up to 180 days, all the while receiving daily app monitoring. Adherence to TRU-BMT was approximately 30% daily and 44% weekly, and greater adherence was associated with increased meal completion, decreased heart rate, and shorter hospital stay. TRU-BMT assessments of symptom severity were significantly associated with duration of hospital stay and development of chronic graft-versus-host disease. Our findings suggest that using TRU-BMT throughout HCT is feasible for patients and established a proof-of-concept for a future randomized control trial of the TRU-BMT application in HCT. © 2021 American Society for Blood and Marrow Transplantation. Published by Elsevier Inc. All rights reserved.

Treatment at Integrated Centers Might Bridge the Academic-Community Survival Gap in Patients With Metastatic Non-Small Cell Carcinoma of the Lung

BACKGROUND

Non-small cell lung cancer (NSCLC) is responsible for the most cancer-related deaths in the United States. A better understanding of treatment-related disparities and ways to address them are important to improving survival for patients with metastatic NSCLC.

MATERIALS AND METHODS

We performed a retrospective analysis using the National Cancer Database. Included in this analysis were 107,116 patients with metastatic NSCLC who were treated at academic centers (AC), community-based centers (CC), and integrated centers (IC) between 2004 and 2015. The primary end point was overall survival, with comparisons of AC, CC, and IC.

RESULTS

The survival disparity between AC and CC continued to grow over the study period, from a 5.7% difference in 2-year survival to a 7.5% difference. Treatment at IC was initially associated with survival similar to CC (hazard ratio [HR], 0.93), however, later in the study period treatment at IC improved (HR, 0.74) outpacing the improvement in survival in CC (HR, 0.82) but not to the same degree as the improvement in AC (HR, 0.64). The improvement in survival at IC was noted predominantly in patients with adenocarcinoma (HR, 0.72; P < .001) but not in squamous-cell carcinoma (HR, 0.89; P value not significant).

CONCLUSION

Treatment of metastatic NSCLC at IC was associated with improved survival during our study period compared with treatment at CC. This appeared to be histology-dependent, suggesting a treatment-related improvement in survival because over this period newer therapies were preferentially available for adenocarcinoma. Integrating care across treatment facilities might be one way to bridge the growing gap in survival between AC and CC.

Sequential Targeted Treatment for a Geriatric Patient with Acute Myeloid Leukemia with Concurrent FLT3-TKD and IDH1 Mutations

Targeting and monitoring several acute myeloid leukemia mutations sequentially provides insights into optimal treatment plans.

Synthesis opto-electronic characterization and NLO evaluation of 6-methyl 5-nitro Uracil crystal using XRD, spectroscopic and theoretical tools

The organic composite crystal for 6-methyl 5-nitro Uracil was grown using slow-evaporation method and the crystal quality was checked by observing the peaks in XRD pattern. The molecular structure of 6-methyl 5-nitro Uracil was used to find crystal parameters for determining NLO activity. The appropriate electronic geometrical structure was keenly noted and the transitional energy exchange was studied and thereby fine-tuning of crystal performance was made by adopting suitable electron-accepting and with-drawing substitutional groups. The crystal parameters; a≠b≠c confirmed the orthorhombic lattice pattern. The space group was found as P21/a and Transparency range was observed as 409-1256 nm. The laser measurements were made and laser Damage threshold was estimated at 10 ns[1.08-3 GW/cm2]. The scattering characteristics of bond networks over the molecule were observed by studying vibrational characteristics of elemental bonds. The hybrid calculations on DFT methods were made using B3LYP/6-311++(D,P) basis set. The chemical shift was observed and retracing chemical potential was identified from the parametric oscillation. The frontier molecular interactions between ground and excited orbital lobe overlapping segments were noted and type of interaction system was identified. The electronic and protonic transfer energy was measured and the origination point of equivalent chemical potential was acknowledged. The NBMO profile was keenly grafted and the transitional energy was measured at every consumed electronic energy band. The vibrational circular dichroic image for all vibrational regions was sketched and the rate of transmission and absorption ratio was verified from peak intensity.

Pre-transplant hepatic steatosis (fatty liver) is associated with chronic graft-vs-host disease but not mortality

Allogeneic-HCT (allo-HCT), while potentially curative, can result in significant complications including graft versus host disease (GVHD). Prior studies suggest that metabolic syndrome may be one risk factor for GVHD. We hypothesized that hepatic steatosis on pre-HCT computed tomography (CT) scans may be a marker for development of GVHD and poor outcomes in allo-HCT. In this retrospective study, we reviewed the pre-HCT CT scans and transplant outcome data of patients who underwent allo-HCT at Duke University Medical Center from 2009 to 2017. The presence of steatosis was confirmed using CT attenuation measurements. We then assessed the association between pre-HCT hepatic steatosis and HCT-related outcomes including GVHD. 80 patients who had pre-HCT CT scans were included in the study. Pre-transplant hepatic steatosis was associated with the development of chronic GVHD (OR 4.2, p = 0.02), but was not associated with acute GVHD (OR 1.3, p = 0.7), non-relapse mortality (p = 0.81) or overall survival (p = 0.74). Based on this single center retrospective study, pre-transplant hepatic steatosis is associated with development of chronic GVHD. Further, prospective study with other imaging modalities including non-contrasted CT scans is needed to determine if this association is reproducible.

Molecular mechanisms in grass-Epichloë interactions: towards endophyte driven farming to improve plant fitness and immunity

All plants harbor many microbial species including bacteria and fungi in their tissues. The interactions between the plant and these microbes could be symbiotic, mutualistic, parasitic or commensalistic. Mutualistic microorganisms are endophytic in nature and are known to play a role in plant growth, development and fitness. Endophytes display complex diversity depending upon the agro-climatic conditions and this diversity could be exploited for crop improvement and sustainable agriculture. Plant-endophyte partnerships are highly specific, several genetic and molecular cascades play a key role in colonization of endophytes in host plants leading to rapid changes in host and endophyte metabolism. This results in the accumulation of secondary metabolites, which play an important role in plant defense against biotic and abiotic stress conditions. Alkaloids are one of the important class of metabolites produced by Epichloë genus and other related classes of endophytes and confer protection against insect and mammalian herbivory. In this context, this review discusses the evolutionary aspects of the Epichloë genus along with key molecular mechanisms determining the lifestyle of Epichloë endophytes in host system. Novel hypothesis is proposed to outline the initial cellular signaling events during colonization of Epichloë in cool season grasses. Complex clustering of alkaloid biosynthetic genes and molecular mechanisms involved in the production of alkaloids have been elaborated in detail. The natural defense and advantages of the endophyte derived metabolites have also been extensively discussed. Finally, this review highlights the importance of endophyte-arbitrated plant immunity to develop novel approaches for eco-friendly agriculture.

Optimizing cancer care using digital technologies requires coordinated multi-stakeholder effort

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Background: Oncology has unique characteristics that predict early benefit from digital technologies including a culture of patient involvement in trials, genetic testing, and longitudinal assessments including objective measures. However, implementation of digital tools is slow for many reasons including lack of incentives/interoperability, and high-profile cases highlighting inadequate data governance. We report results from the Digital Medicine Society’s study of the stakeholders involved in using digital technologies to optimize health, with a focus on oncology. Methods: We performed 16 interviews with diverse Key Opinion Leaders (KOLs) including physicians, executives, senior government officials, patients, payers, tech innovators, and investors. KOLs received a pre-interview list of topics. We used the Delphi method, an evidence-based approach to compile expert opinions, to iteratively refine recommendations. Results: We identified priorities for 5 stakeholder groups to facilitate digital tool implementation (Table); all groups must also act now to develop a framework for data governance. We describe 4 categories of early success in oncologic digital tools: regimen/drug choice, drug approval efficiency, digital user training, and patient generated health data. Conclusions: Data and technology have great potential to improve cancer care. Multi-stakeholder involvement and a framework for US health data governance are needed. [Table: see text]

Structural, biological and pharmaceutical importance of antibiotic agent chloramphenicol

The vibrational, magnetic resonance and electronic spectral techniques are used to evaluate structural activity associated physico-chemical properties. The biological affinity and drug importance was validated by calculating biological parameters using HyperChem. Mulliken charge assignment for restoring chemical potential for generating drug potential in the molecular site was mapped and analyzed. The vibrational spectral pattern was estimated by identifying active and inactive bands and hindrance of vibrational activity of Acetamide group was monitored and thereby drug malfunction was tested. The chemical reaction pathway around the core carbons of chain and ring was keenly noted and the cause of chemical potential for the inducement of drug mechanism was reported. The stimulation of chemical mechanism for antibiotic activity was addressed by suitable evidence and further improvement for enhancing activity was made. The electronic HOMO and LUMO interaction over different molecular entities are discussed to expose accompany of drug mechanical transitions. The CT complex was recognized to be C=N and C=C bonds and operating drug mechanism was monitored. The unwanted drug property induced by perplexes of charge depletion on α-hydroxyl group was assessed from MEP map. The hyperactive polarization energy of 266.18 X10-33 esu and 327 X10-33 esu of present compound is causing biological activity in good order. The uncontrolled breathing region of Acetamide group was clarified in VCD profile and this is main cause to produce toxicity in drug process.