3,732 research outputs found
Supermassive Black-hole Demographics & Environments With Pulsar Timing Arrays
Precision timing of large arrays (>50) of millisecond pulsars will detect the
nanohertz gravitational-wave emission from supermassive binary black holes
within the next ~3-7 years. We review the scientific opportunities of these
detections, the requirements for success, and the synergies with
electromagnetic instruments operating in the 2020s.Comment: Submitted to the Astro2020 Decadal Survey. One of 5 core white-papers
authored by members of the NANOGrav Collaboration. 9 pages, 2 figure
Pyronaridineâartesunate for treating uncomplicated Plasmodium falciparum malaria
Background
The World Health Organization (WHO) recommends artemisininâbased combination therapies (ACTs) to treat uncomplicated Plasmodium falciparum malaria. Concerns about artemisinin resistance have led to global initiatives to develop new partner drugs to protect artemisinin derivatives in ACT. Pyronaridineâartesunate is a novel ACT.
Objectives
To evaluate the efficacy of pyronaridineâartesunate compared to alternative ACTs for treating people with uncomplicated P falciparum malaria, and to evaluate the safety of pyronaridineâartesunate and other pyronaridine treatments compared to alternative treatments.
Search methods
We searched the Cochrane Infectious Diseases Group Specialized Register; Cochrane Central Register of Controlled Trials (CENTRAL), published in the Cochrane Library; MEDLINE; Embase; and LILACS. We also searched ClinicalTrials.gov, the WHO International Clinical Trials Registry Platform, and the ISRCTN registry for ongoing or recently completed trials. The date of the last search was 27 October 2021.
Selection criteria
For the efficacy analysis, we included randomized controlled trials (RCTs) of pyronaridineâartesunate for treating uncomplicated P falciparum malaria. For the safety analysis, we included RCTs that used pyronaridine alone or in combination with any other antimalarials. In addition to these analyses, we conducted a separate systematic review summarizing data on safety from nonârandomized studies (NRS) of any patient receiving pyronaridine (NRS safety review).
Data collection and analysis
Two review authors independently extracted all data and assessed the certainty of the evidence. We metaâanalysed data to calculate risk ratios (RRs) for treatment failures between comparisons, and for safety outcomes between and across comparisons.
Main results
We included 10 relevant RCTs. Seven RCTs were coâfunded by Shin Poong Pharmaceuticals, and three were funded by government agencies.
Efficacy analysis (RCTs)
For the efficacy analysis, we identified five RCTs comprising 5711 participants. This included 4465 participants from 13 sites in Africa, and 1246 participants from five sites in Asia. The analysis included 541 children aged less than five years. Overall, pyronaridineâartesunate had a polymerase chain reaction (PCR)âadjusted treatment failure rate of less than 5%. We evaluated pyronaridineâartesunate versus the following.
⢠Artemetherâlumefantrine. Pyronaridine artesunate may perform better for PCRâadjusted failures at day 28 (RR 0.59, 95% confidence interval (CI) 0.26 to 1.31; 4 RCTs, 3068 participants, lowâcertainty evidence); for unadjusted failures at day 28 (RR 0.27, 95% CI 0.13 to 0.58; 4 RCTs, 3149 participants, lowâcertainty evidence); and for unadjusted failures at day 42 (RR 0.61, 95% CI 0.46 to 0.82; 4 RCTs, 3080 participants, lowâcertainty evidence). For PCRâadjusted failures at day 42, there may be little or no difference between groups (RR 0.86, 95% CI 0.49 to 1.51; 4 RCTs, 2575 participants, lowâcertainty evidence).
⢠Artesunateâamodiaquine. Pyronaridine artesunate may perform better for PCRâadjusted failures at day 28 (RR 0.55, 95% CI 0.11 to 2.77; 1 RCT, 1245 participants, lowâcertainty evidence); probably performs better for unadjusted failures at day 28 (RR 0.49, 95% CI 0.30 to 0.81; 1 RCT, 1257 participants, moderateâcertainty evidence); may make little or no difference for PCRâadjusted failures at day 42 (RR 0.98, 95% CI 0.20 to 4.83; 1 RCT, 1091 participants, lowâcertainty evidence); and probably makes little or no difference for unadjusted failures at day 42 (RR 0.98, 95% CI 0.78 to 1.23; 1 RCT, 1235 participants, moderateâcertainty evidence).
⢠Mefloquine plus artesunate. Pyronaridine artesunate may perform better for PCRâadjusted failures at day 28 (RR 0.37, 95% CI 0.13 to 1.05; 1 RCT, 1117 participants, lowâcertainty evidence); probably performs better for unadjusted failures at day 28 (RR 0.36, 95% CI 0.17 to 0.78; 1 RCT, 1120 participants, moderateâcertainty evidence); may make little or no difference for unadjusted failures at day 42 (RR 0.84, 95% CI 0.54 to 1.31; 1 RCT, 1059 participants, lowâcertainty evidence); but may lead to higher PCRâadjusted failures at day 42 (RR 1.80, 95% CI 0.90 to 3.57; 1 RCT, 1037 participants, lowâcertainty evidence).
Safety analysis (RCTs)
For the RCT safety analysis, we identified eight RCTs, one of which was delineated by study site, comparing pyronaridineâartesunate to other antimalarials. Pyronaridineâartesunate was associated with raised liver enzymes compared to other antimalarials: alanine aminotransferase (ALT) (RR 3.59, 95% CI 1.76 to 7.33; 8 RCTS, 6669 participants, highâcertainty evidence) and aspartate transaminase (AST) (RR 2.22, 95% CI 1.12 to 4.41; 8 RCTs, 6669 participants, moderateâcertainty evidence). No such effect was demonstrated with bilirubin (RR 1.03, 95% CI 0.49 to 2.18; 7 RCTs, 6384 participants, moderateâcertainty evidence). There was one reported case in which raised ALT occurred with raised bilirubin. No study reported severe drugâinduced liver injury. Electrocardiograph (ECG) abnormalities were less common with pyronaridineâartesunate compared to other antimalarials. We identified no other safety concerns.
NRS safety review
A review on safety in NRS allowed us to increase the population within which safety was assessed. We included seven studies with 9546 participants: five singleâarm observational studies, one cohort event monitoring study, and one doseâescalation study. All studies provided data on adverse event frequency, with a small number of participants experiencing serious adverse events and adverse effects related to pyronaridine: serious adverse events average 0.37%; drugârelated 9.0%. In two studies reporting elevations in liver enzymes, small percentages of participants (2.4% and 14.1% respectively) experienced increases in either ALT, AST, or bilirubin on day 7; however, these were small increases that returned to normal by day 42.
Authors' conclusions
Pyronaridineâartesunate was efficacious against uncomplicated P falciparum malaria; achieved a PCRâadjusted treatment failure rate of less than 5% at days 28 and 42; and may be at least as good as, or better than, other marketed ACTs.
Pyronaridineâartesunate increases the risk of episodes of abnormally raised ALT. The observational data did not signal an excess of clinically important adverse effects
Gut microbial communities of hybridising pygmy angelfishes reflect species boundaries
Hybridisation and introgression of eukaryotic genomes can generate new species or subsume existing ones, with direct and indirect consequences for biodiversity. An understudied component of these evolutionary forces is their potentially rapid effect on host gut microbiomes, and whether these pliable microcosms may serve as early biological indicators of speciation. We address this hypothesis in a field study of angelfishes (genus Centropyge), which have one of the highest prevalence of hybridisation within coral reef fish. In our study region of the Eastern Indian Ocean, the parent fish species and their hybrids cohabit and display no differences in their diet, behaviour, and reproduction, often interbreeding in mixed harems. Despite this ecological overlap, we show that microbiomes of the parent species are significantly different from each other in form and function based on total community composition, supporting the division of parents into distinct species, despite the confounding effects of introgression acting to homogenize parent species identity at other molecular markers. The microbiome of hybrid individuals, on the other hand, are not significantly different to each of the parents, instead harbouring an intermediate community composition. These findings suggest that shifts in gut microbiomes may be an early indicator of speciation in hybridising species
Nanoparticles of Cu2ZnSnS4 as performance enhancing additives for organic field-effect transistors
The addition of oleylamine coated Cu2ZnSnS4 (CZTS) nanoparticles to solutions of an organic semiconductor used to fabricate organic field-effect transistors (OFETs) has been investigated. The oligothiophene-based small molecule 5T-TTF and the polymer poly(3-hexylthiophene) (P3HT) were each applied in the transistors with various concentrations of CZTS (5-20%). Atomic force microscopy (AFM) was applied to characterise the surface morphology of the OFETs. The use of 5 and 10 wt% of the CZTS nanoparticles in 5T-TTF and P3HT solutions, respectively, appears to be a simple and effective way of improving OFET performance
Correction: Nanoparticles of Cu2ZnSnS4 as performance enhancing additives for organic field-effect transistors
Correction for 'Nanoparticles of Cu2ZnSnS4 as performance enhancing additives for organic field-effect transistors' by Punarja Kevin et al., J. Mater. Chem. C, 2016, DOI: 10.1039/c6tc01650b
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