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J. G. Mill, D. Malta, Í. Machado et al.
Revista Brasileira de Epidemiologia · 2019
OBJECTIVE To estimate the salt intake in the Brazilian population according to their urinary sodium excretion. METHODS The National Health Survey (2013) aimed to gather data on the health of adults (≥ 18 years) through a random selection of households. In each household, one adult was selected to have their biological data collected (anthropometry, blood pressure, and blood and urine tests). The urine sample was sent to a central laboratory to determine sodium (ion-selective electrode) and creatinine (Jaffé method) concentrations. Sodium excretion was estimated with the Tanaka equation. RESULTS Urinary sodium and creatinine concentrations were measured in 8,083individuals (58% women). The mean salt intake was estimated at 9.34 g/day (95% confidence interval - 95%CI 9.27 - 9.41) and was higher in males (9.63 g/day; 95%CI 9.52 - 9.74) than in females (9.08 g/day; 95%CI 8.99 - 9.17). Wefound no significant differences regarding age group, ethnicity, or schooling. Salt intake was higher in the Southeast and South regions and lower in the Northeast and North. Only 2.4% (95%CI 2.0 - 2.8) of the sample consumed less than 5 g/day, and 58.2% (95%CI 56.7 - 59.6) of participants had an estimated intake of 8 to 12 g/day. CONCLUSION The mean salt intake in the Brazilian population is approximately twice the recommended by the World Health Organization (5g/day).Given the association of high salt intake with hypertension and decreased renal function, these data indicate the need to adopt comprehensive public policies to reduce the consumption in the Brazilian population.
Tae Hang Yoon, Hak Jin Song, Woo Young Jung et al.
Bulletin of the Korean Chemical Society · 2018
A plant health monitoring method based on a plant microbial fuel cell (PMFC) technique was investigated. The reducing action of plant exudates on electrochemically active bacteria (EAB) in the rhizosphere was used as the basis of the method. Ardisia pusilla was used as an experimental plant. The results indicated that the open circuit potential (OCP) development from the PMFC is closely related to plant health and affected by the cultivation environment. Distinctive OCP developments were observed using the PMFC with live, dead (heat shocked), or no plant. Cultivation conditions such as watering, fertilizing, temperature variation, and lighting affected OCP development from the PMFC. Plant root viability analysis indicated that OCP development from the PMFC is closely related to plant health. These results suggest that this method based on the PMFC technique is a facile, cost‐effective, and rapid tool for monitoring plant health.
H. Akaza, S. Naito, N. Ueno et al.
Japanese Journal of Clinical Oncology · 2015
Objective This prospective, post-marketing study collected sunitinib safety and efficacy data in Japanese patients with unresectable/metastatic renal cell carcinoma. Retrospective analysis investigated adverse events as potential sunitinib efficacy biomarkers. Methods Patients administered sunitinib, after its release, were registered until reaching a pre-specified number of cases. Primary starting dose was 50 mg/day orally on a 4-weeks-on and 2-weeks-off schedule. Physicians completed investigation forms at 6-week intervals for 24 weeks. Associations between baseline characteristics and adverse events were analyzed by Cox proportional hazards model and compared by χ2 test. The log-rank test compared survival in subpopulations based on selected factors. Results Of note, 1689 patients receiving sunitinib were registered between June 2008 and November 2009. Most of them were males (75%), aged <65 years (56%), and had Eastern Cooperative Oncology Group performance status 0/1 (90%), metastatic disease (88%) and previous systemic therapy (66%). Grade ≥3 adverse events occurred in 70%, with reduced platelet count the most common (34%). Characteristics significantly associated with Grade ≥3 adverse events were female sex, age ≥55 years, Eastern Cooperative Oncology Group performance status ≥2, history of several medical conditions and prior treatment. Objective response rate was 22%. Median progression-free survival was 22.7 weeks. Median overall survival was not reached; however, 24-week overall survival rate was 84%. Improved overall survival was associated with higher relative dose intensity during the first 6 weeks and specific adverse events: hypertension, hand–foot syndrome, hypothyroidism, leukopenia and thrombocytopenia. Conclusions Sunitinib demonstrated acceptable safety and useful efficacy in Japanese patients with unresectable/metastatic renal cell carcinoma. Potential biomarkers associated with greater efficacy were relative dose intensity and specific adverse events.
G. Kaneko, A. Miyajima, Kazuyuki Yuge et al.
Japanese Journal of Clinical Oncology · 2015
OBJECTIVE To investigate the prognostic significance of visceral obesity to predict recurrence after curative surgery for Japanese patients with localized renal cell carcinoma. METHODS The data of 285 patients who underwent curative surgery for localized renal cell carcinoma were retrospectively reviewed. Median follow-up was 36.7 months. The association between visceral obesity and recurrence-free survival rate was evaluated using the Kaplan-Meier method and Cox regression models. Visceral fat area at the level of the umbilicus measured using pre-operative computed tomography was used as an index of visceral obesity. RESULTS Twenty-nine patients (10.2%) experienced recurrence. Five-year recurrence-free survival rates were 91.3% in high visceral fat area group (≥ 120 cm(2)) and 76.9% in low visceral fat area group (<120 cm(2)) (P = 0.037); however, visceral fat area was not an independent predictor of recurrence-free survival in multivariate analysis. In the patients with clear cell renal cell carcinoma, 28 patients (11.6%) experienced recurrence. Five-year recurrence-free survival rates were 88.7% in high visceral fat area group and 71.0% in low visceral fat area group (P = 0.043), and visceral fat area was an independent predictor of recurrence-free survival (hazard ratio: 1.974, P = 0.042) as well as C-reactive protein, Fuhrman nuclear grade, tumor size and microvascular invasion. In patients with organ confined clear cell renal cell carcinoma in particular, visceral fat area was also a useful and independent predictor of recurrence-free survival (hazard ratio: 2.807, P = 0.038). Body mass index was not useful in either cohort. CONCLUSIONS High visceral fat area was a positive predictive biomarker for better recurrence-free survival after curative surgeries for localized clear cell renal cell carcinomas; however, body mass index was not a predictor.
S. Akter, I. Kashino, T. Mizoue et al.
Japanese Journal of Clinical Oncology · 2016
OBJECTIVE It remains unclear whether coffee drinking is associated with colorectal cancer risk. We performed a systematic review and meta-analysis of epidemiologic studies on this issue among the Japanese population. METHODS Original data were obtained from MEDLINE searches using PubMed or from searches of the 'Ichushi' database, complemented with manual searches. Meta-analysis was performed by using the random effects model to estimate the summary relative risk with 95% confidence interval according to the study design. The final judgment was made based on a consensus of the research group members with consideration for both epidemiological evidence and biological plausibility. RESULTS We identified five cohort studies and nine case-control studies. Of these, one cohort study reported a strong inverse association (in women only), whereas three case-control studies reported a strong inverse association with colon or rectal cancer. In meta-analysis, high consumption of coffee was not appreciably associated with colorectal cancer risk among cohort studies, whereas it was associated with significantly lower risk of colorectal or colon cancer among case-control studies. The summary relative risk/odds ratio (95% confidence interval) for the highest versus lowest categories of coffee consumption was 0.95 (0.77-1.17) and 0.78 (0.65-0.95) for cohort and case-control studies, respectively. CONCLUSIONS The evidence is insufficient to support that coffee drinking increases or decreases the risk of colorectal cancer among the Japanese population.
C. Hamashima, A. Fukao
Japanese Journal of Clinical Oncology · 2016
The Japanese government introduced endoscopic screening for gastric cancer in 2015 as a public policy based on the Japanese guidelines on gastric cancer screening. To provide appropriate endoscopic screening for gastric cancer in Japanese communities, we developed a quality assurance manual of endoscopic screening and recommend 10 strategies with their brief descriptions as follows: (i) Formulation of a committee responsible for implementing and managing endoscopic screening, and for deciding the suitable implementation methods in consideration of the local context; (ii) Development of an interpretation system that leads to a final judgement to standardize endoscopic examination and improve its accuracy; (iii) Preparation of management and reporting systems for adverse effects by the committee for safety management; (iv) Obtaining informed consent before operation following adequate explanations regarding the benefits and harms of endoscopic screening; (v) Avoidance of frequent screenings to reduce false-positive results and overdiagnosis. As a reference, the target age group is ≥50 years, and the screening interval is 2 years; (vi) Keeping the biopsy rate within 10% as post-biopsy bleeding may occur. Before endoscopic screening, any history of antithrombotic drug usage should be checked; (vii) Nonadministration of sedation in endoscopic screening for safety management; (viii) Adherence to proper endoscopic cleaning and disinfection to reduce infection; (ix) Use of a checklist to achieve optimal program preparation when municipal governments introduce endoscopic screening; (x) Identification of the aims and roles by referring to a checklist if primary care physicians decide to participate in endoscopic screening.
A. Kawai, N. Araki, H. Hiraga et al.
Japanese Journal of Clinical Oncology · 2016
Abstract Objective This analysis of the Japanese subpopulation of the PALETTE Phase III, randomized, placebo-controlled study investigated efficacy and safety of pazopanib in patients with metastatic soft tissue sarcoma after failure of standard chemotherapy. Methods Patients were randomly assigned in a 2:1 ratio to receive either pazopanib 800 mg once daily or placebo, with no subsequent cross-over. Primary endpoint was progression-free survival. Secondary endpoints included overall survival and overall response rate. Efficacy analysis was by intent-to-treat. Safety was also investigated. Results Forty-seven patients received either pazopanib (n = 31) or placebo (n = 16). Median progression-free survival was 7.0 weeks (95% confidence interval: 4.0–11.7) for placebo and 24.7 weeks (95% confidence interval: 8.6–28.1) for pazopanib (hazard ratio = 0.41 [95% confidence interval: 0.19–0.90]; P = 0.002). Median overall survival was 14.9 months (95% confidence interval: 6.8—not calculable) for placebo and 15.4 months (95% confidence interval: 7.9–28.8) for pazopanib (hazard ratio = 0.87 [95% confidence interval: 0.41–1.83]; P = 0.687). More patients receiving pazopanib experienced best response of stable disease versus placebo. Adverse events were similar to the global population; those leading to dose reduction were more common and mean daily dose was lower in the Japanese population versus the global population (45 vs. 32% and 624.4 vs. 700.4 mg, respectively). Conclusions The efficacy and safety of pazopanib observed in the Japanese subpopulation of PALETTE were similar to those in the global population. Pazopanib is a new treatment option for Japanese patients with metastatic non-adipocytic soft tissue sarcoma after chemotherapy. Clinical trial Registration number NCT00753688; GSK study ID: VEG110727; http://www.gsk-clinicalstudyregister.com/study/VEG110727#ps.
Yuriko N. Koyanagi, K. Matsuo, Hidemi Ito et al.
Japanese Journal of Clinical Oncology · 2016
OBJECTIVE Although cigarette smoking is a well-established risk factor for head and neck cancer, the impact of smoking on head and neck cancer might vary among geographic areas. To date, however, no systematic review of cigarette smoking and head and neck cancer in the Japanese population has yet appeared. METHODS We conducted a systematic review of previous epidemiological studies for cigarette smoking and head and neck cancer among Japanese. Evaluation of associations was based on the strength of evidence ('convincing', 'probable', 'possible' or 'insufficient') and the magnitude of association ('strong', 'moderate', 'weak' or 'no association'), together with biological plausibility as previously evaluated by the International Agency for Research on Cancer. A meta-analysis was conducted to obtain summary estimates for the overall magnitude of association. RESULTS We identified five cohort studies and 12 case-control studies. Four of five cohort studies and 11 of 12 case-control studies showed a strong positive association between cigarette smoking and head and neck cancer. Nine of 12 studies indicated a dose-response relationship between cigarette smoking and the risk of head and neck cancer. Meta-analysis of 12 studies indicated that the summary relative risk for ever smokers relative to never smokers was 2.43 (95% confidence interval: 2.09-2.83). Summary relative risks for current and former smokers relative to never smokers were 2.68 (2.08-3.44) and 1.49 (1.05-2.11), respectively. CONCLUSIONS Cigarette smoking is a convincing risk factor for head and neck cancer in the Japanese population.
Hiroyoshi Suzuki, T. Shin, S. Fukasawa et al.
Japanese Journal of Clinical Oncology · 2018
Abstract Background LATITUDE was a randomized, double-blind, international and phase 3 study of abiraterone acetate plus prednisone in patients with high-risk metastatic hormone-naïve prostate cancer. In the first interim analysis of LATITUDE (clinical cutoff date: 31 October 2016), significant prolongation in overall survival and radiographic progression-free survival (co-primary endpoints) was observed when compared with placebo. The results of the Japanese subgroup analysis of LATITUDE first interim analysis were consistent with those of the overall population. In this study, overall survival and safety results from the final analysis of the Japanese subgroup of the LATITUDE study are presented (clinical cutoff date: 15 August 2018). Methods Abiraterone acetate (1000 mg/day) and prednisone (5 mg/day) were administered orally in the abiraterone acetate plus prednisone group, and matching placebos in the placebo group. Results Of the 1199 patients included in LATITUDE, 70 constituted the Japanese subgroup (abiraterone acetate plus prednisone: n = 35, placebo: n = 35). Following a median (range) follow-up of 56.6 (2.5, 64.2) months, the median overall survival was not reached in both the treatment arms of the Japanese subgroup (hazard ratio: 0.61; 95% confidence interval: 0.27–1.42; nominal P = 0.2502). A total of 23 deaths (abiraterone acetate plus prednisone: 9 [25.7%], placebo group: 14 [40.0%]) were reported in Japanese subgroup. Grade 3/4 adverse events were reported in 24 (68.6%) and 9 (25.7%) patients in the abiraterone acetate plus prednisone and placebo groups, respectively. Conclusions In this Japanese subgroup analysis, addition of abiraterone acetate plus prednisone to androgen-deprivation therapy demonstrated favorable efficacy and safety outcomes in patients with newly diagnosed, high-risk metastatic hormone-naïve prostate cancer. Survival benefits observed in the Japanese subgroup first interim analysis were sustained long-term and were consistent with the overall population.
H. Iwata, Kenichi Inoue, K. Kaneko et al.
Japanese Journal of Clinical Oncology · 2019
Abstract Background In the randomised Phase 3 IMpassion130 trial, atezolizumab combined with nab-paclitaxel (atezo + nab-P) in 902 patients with triple-negative breast cancer (TNBC) showed prolonged progression-free survival (PFS) in both the intention-to-treat (ITT) population and programmed death-ligand 1 (PD-L1)–positive subgroup compared with placebo plus nab-P (plac + nab-P). This study assessed the efficacy and safety of atezo + nab-P in the IMpassion130 Japanese subpopulation. Methods Eligible patients had unresectable locally advanced or metastatic TNBC previously untreated with chemotherapy for metastatic disease. Patients were randomised 1:1 to receive either atezo + nab-P or plac + nab-P. Co-primary endpoints were investigator-assessed PFS and overall survival (ITT population and PD-L1–positive subgroup). These were also assessed in the Japanese subpopulation. Results There were 65 Japanese patients (34 atezo + nab-P; 31 plac + nab-P). The PD-L1–positive subgroup included 25 patients (12 atezo + nab-P; 13 plac + nab-P). Median PFS was 7.4 months (atezo + nab-P) versus 4.6 months (plac + nab-P; hazard ratio [HR], 0.47; 95% CI, 0.25–0.90). In the PD-L1–positive subgroup, median PFS was 10.8 months (atezo + nab-P) versus 3.8 months (plac + nab-P; HR, 0.04; 95% CI, <0.01–0.35). Safety results in the Japanese subgroup were consistent with those in the overall population. The Japanese subgroup had a lower incidence of adverse events leading to treatment withdrawal than the overall population. More patients in the atezo + nab-P arm had neutrophil count decreases and stomatitis than patients in the plac + nab-P arm. Conclusions Atezo + nab-P efficacy in Japanese patients was consistent with the overall IMpassion130 population. No new safety signals were observed, and tolerability was consistent with that of the overall population.
Y. Tomita, T. Kondo, G. Kimura et al.
Japanese Journal of Clinical Oncology · 2019
Abstract Background Nivolumab plus ipilimumab (NIVO+IPI) demonstrated superior efficacy over sunitinib (SUN) for previously untreated advanced renal cell carcinoma (aRCC) in CheckMate 214, with a manageable safety profile. We report efficacy and safety with extended follow-up amongst Japanese patients. Methods CheckMate 214 patients received NIVO (3 mg/kg) plus IPI (1 mg/kg) every 3 weeks for four doses, then NIVO (3 mg/kg) every 2 weeks; or SUN (50 mg) once daily for 4 weeks (6-week cycle). This subgroup analysis assessed overall survival (OS), objective response rate (ORR) and progression-free survival (PFS) per investigator in International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) intermediate/poor-risk and intent-to-treat (ITT) patients and safety (ITT patients). Results Of 550 and 546 patients randomized to NIVO+IPI and SUN, 38 and 34, respectively, were Japanese. Of these, 31 (NIVO+IPI) and 29 (SUN) patients were IMDC intermediate/poor-risk. In IMDC intermediate/poor-risk patients with 30 months’ minimum follow-up, there was a delayed trend in OS benefit with NIVO+IPI (hazard ratio [HR] 0.56; 95% confidence interval [CI]: 0.19–1.59; P = 0.2670), and 24-month OS probability favoured NIVO+IPI (84%) versus SUN (76%). The ORR was 39% with NIVO+IPI and 31% with SUN (P = 0.6968). PFS was similar in both treatment arms (HR 1.17; 95% CI: 0.62–2.20; P = 0.6220). Efficacy in ITT patients was similar to IMDC intermediate/poor-risk patients. Grade 3–4 treatment-related adverse event incidence was lower with NIVO+IPI versus SUN (58 versus 91%). Conclusions Japanese patients with untreated aRCC in the NIVO+IPI arm had a numerically higher ORR and improved safety profile versus patients in the SUN arm. A delayed OS benefit appears to be emerging with NIVO+IPI. Longer follow-up is needed. https://clinicaltrials.gov/ct2/show/NCT02231749?term=NCT02231749&rank=1 identifier: NCT02231749.
K. Shitara, K. Yamazaki, T. Tsushima et al.
Japanese Journal of Clinical Oncology · 2020
Abstract Objectives Tepotinib (MSC2156119J) is an oral, potent and highly selective small molecule mesenchymal-epithelial transition factor (MET) inhibitor for which the recommended Phase II dose of 500 mg once daily has been defined, based on the first-in-man trial conducted in the USA and Europe. We carried out a multicenter Phase I trial with a classic `3 + 3' design to determine the recommended Phase II dose in Japanese patients with solid tumors (NCT01832506). Methods Patients aged ≥20 years with advanced solid tumors (refractory to standard therapy or for whom no effective standard therapy was available) received tepotinib at 215, 300 or 500 mg once daily in a 21-day cycle. Occurrence of dose-limiting toxicities during cycle 1 was used to determine the maximum tolerated dose. Efficacy, safety and pharmacokinetics were also evaluated to support the dose assessment. Results Twelve patients were treated. Tepotinib was generally well tolerated with no observed dose-limiting toxicities; treatment-related adverse events were mainly grades 1–2. The tolerability profile of tepotinib was similar to that observed in non-Japanese populations. Pharmacokinetics in Japanese and Western patients was comparable. One patient with gastric cancer and one patient with urachal cancer had stable disease of ≥12 weeks in duration. The observed safety profile and pharmacokinetics are comparable with those in patients from the USA and Europe, and the recommended Phase II dose of tepotinib in Japanese patients was confirmed as 500 mg once daily. Conclusions These results, including initial signals of antitumor activity, support further development of tepotinib in Japanese patients with cancer.
Y. Sugawara, I. Tsuji, T. Mizoue et al.
Japanese Journal of Clinical Oncology · 2018
Background There is a body of evidence to suggest that cigarette smoking increases the risk of cervical cancer in women, but no study has examined the magnitude of the association in Japanese women. Here, we evaluated the association between cigarette smoking and the risk of cervical cancer in Japanese women based on a systematic review of epidemiological evidence. Methods Original data were obtained from a MEDLINE search using PubMed or from a search of the 'Ichushi' database, as well as by a manual search. Evaluation of associations was based on the strength of evidence and the magnitude of association, together with biological plausibility as evaluated previously by the International Agency for Research on Cancer. Meta-analysis of associations was also conducted to obtain a summarized overview of the data. Results We identified two cohort studies and three case-control studies. All five studies had indicated strong positive associations between cigarette smoking and the risk of cervical cancer. Our summary estimate indicated that the relative risk (RR) for individuals who had ever-smoked relative to never-smokers was 2.03 (95% confidence interval: 1.49-2.57). Four studies had also demonstrated dose-response relationships between cigarette smoking and the risk of cervical cancer. Conclusion We conclude that there is convincing evidence that cigarette smoking increases the risk of cervical cancer among Japanese women.
Y. Ohe, F. Imamura, N. Nogami et al.
Japanese Journal of Clinical Oncology · 2018
In the FLAURA trial Japanese subset, osimertinib significantly improved median PFS versus standard-of-care (gefitinib) in patients with previously untreated EGFR (exon 19 deletion or L858R) mutation-positive advanced or metastatic NSCLC.
Hiroki Sakurai, M. Miyashita, Kengo Imai et al.
Japanese Journal of Clinical Oncology · 2019
Background To improve palliative care practice, the need for patients-reported outcome measures is increasing globally. The Integrated Palliative care Outcome Scale (IPOS) is a streamlined outcome scale developed to comprehensively evaluate patients' distress. The goal of this study is to assess the reliability and validity of IPOS-Japanese version in cancer patients. Methods This is a multicenter, cross-sectional observational study. We assessed the missing values, prevalence, test-retest reliability, criterion validity and known-group validity in Japanese adult cancer patients. Patients provided responses to IPOS, European Organization for Research and Treatment for Cancer Quality of Life Questionnaire-Core 30 (EORTC QLQ-C30), and Functional Assessment of Chronic Illness Therapy- Spiritual 12 (FACIT-Sp12). Our medical staff provided responses to Support Team Assessment Schedule (STAS). Results One hundred forty-two patients were enrolled at six palliative care facilities. Missing values accounted for less than 1% of most items, with a maximum of 2.8%. The prevalence of symptoms was 17.7-88.7%. The intra-class correlation coefficient ranged from 0.522 to 0.951. The range of correlation coefficients with EORTC-QLQ-C30, FACIT-Sp12 and STAS as gold standards was 0.013 to 0.864 (absolute values). Total IPOS scores were positively correlated with Eastern Corporative Oncology Group Performance Status (P < 0.001). Conclusion IPOS-Japanese version is a valid and reliable tool. The scale is useful in assessing physical, psychological, social and spiritual symptoms and in measuring outcomes of adult cancer patients in Japan.
G. Jain
South Asian Journal of Food Technology and Environment · 2016
Hotel industry, in recent years, has been a major consistent force behind the tremendous growth in Indian GDP. It has also fueled the increase in number of hotels around the country. Hotels are the major consumers of resources and contribute heavily toward the waste generation, as compared to others. The study aims to know the current status of use of energy resources; the amount and type of waste generated; the waste management practices followed by hotels. Kitchen waste is defined as left-over organic matter from restaurants, hotels and households. Tons of kitchen wastes are produced daily in highly populated areas. Kitchen wastes entering the mixed-municipal waste system are difficult to process by standard means, such as incineration, due to the high moisture content. Furthermore, organic matter can be transformed into useful fertilizer and bio-fuel. New disposal methods that are both environmentally and economically efficient are being developed which rely on various forms of microbial decomposition.
J. Maninder, Umesh Bhawan
Global NEST Journal · 2015
The technology transfer for rural livelihood development had greater impact to protect microclimatic conditions which further affects the microflora and microbial activities to larger extent in the Indian Himalayan Region (IHR). The technological interventions were made by the Himalayan Research Group organization which helped in economic upliftment of rural poor, women empowerment and in environment protection in hill region. The major activities are Passive Solar Retrofitting (namely, Thermosyphoning Air heat Panel (TAP), Trombe Wall (TW), and Sun Spaces (SS)) fodder development, vermicompost biotechnology, button mushroom cultivation and protected cultivation for climate change mitigation and adaptations. The solar retrofits reduced estimated 4.97 tones carbon emission per household during six winter months which helped in reducing the fuel wood consumption. Improved varieties of different fodder spp. were introduced for year round green fodder availability and reduce soil erosion and reduction in tree lopping. Fodder choppers and silage preparation was popularized to contain the fodder wastage. Vermicompost biotechnology was popularized among farmers to reduce the use of chemical fertilizers for improving the quality of soil. The button mushroom cultivation was used for conversion of agriculture residue into compost making by reducing crop residue burning which increases carbon emission. Protected cultivation in local made polyhouse was popularized to generate maximum returns from small piece of land through cut flower and vegetable cultivation and by raising plant nurseries.
Saket Kumar, R. Gautam
Journal of Engineering Research · 2022
The need for alternative and viable energy sources for the automotive industry is increasing due to the fast depletion of fossil fuel reserves. In the present scenario fluctuating petroleum prices. Inconsistent supply, global politics, conflicts of oil-producing countries sky-rocketing energy demands, lacking oil reserves make an energy-intensive country like India, vulnerable to energy security. For a few years, researchers across the world found Biodiesel as a favourable potential energy source to fulfil its energy needs due to its availability, renewable nature, low toxicity and lesser polluting nature. There are various sources of biofuel identified by the scientist s and researchers so far, which include edible oil, non-edible oil, animal fats, microbial feedstocks, waste cooking oil, etc. making biodiesel viable for use and economical for production is the very next challenge for researchers. The present work, emphasises on various selection criteria e.g. physicochemical properties, structural composition, environmental aspects, economic aspects etc. to choose better alternative out of the available biofuel resources. This paper will extensively contribute to identifying the most appropriate and cost-effective feedstocks for biodiesel selection for greater use.
Tong Hao, Zhisong Cui, Xiao Luan et al.
Frontiers in Marine Science · 2023
Hydrocarbons are ubiquitous in marine environments and might fuel hydrocarbon-metabolizing microbes in the ocean. Numerous studies have documented microbial hydrocarbon degradation in water columns and deep-sea surface sediment. However, the degradation potential and biogeochemical cycling of hydrocarbons in subsurface sediments remain largely unknown. In this study, we used two different hydrocarbons, n-hexadecane (HEX) and methylcyclohexane (MCH), to investigate the distribution and diversity of hydrocarbon-consuming bacteria in a core sediment sample from the Central Indian Ridge (CIR), which is adjacent to mid-ridge hydrothermal vents in the Indian Ocean. We observed different vertical profiles of HEX- and MCH-degrading bacteria in the core sediments. Specifically, HEX-degrading bacteria were universally distributed, while MCH-degrading bacteria were found only in the intermediate layers of the core sediments. Changing factors including dissolved oxygen might affect the natural distribution of different hydrocarbon consumers. We found that a novel species of the genus C1-B045 might play a pivotal role in metabolizing MCH in the CIR deep biosphere. Through amino acid identity comparison with published sequences, we determined that C1-B045 harbors two novel classes of cyclohexanone monooxygenases involved in MCH metabolism. This study sheds light on the structure and function of hydrocarbon-consuming microbes in deep biospheres. Graphical abstract
Rubina Basheer, M. Suma, B. R. Sreelekshmy et al.
Asian Journal of Chemistry · 2018
There are frequent fluctuations in oil prices and decline in conventional fossil fuel reserves today. This scenario prompts serious deliberations on the need to target on non-conventional sources of energy. Currently, fossil fuels fulfill majority of the world energy needs and their share in the primary energy mix is on an ever increase. However, its extraction, which is uneconomical as of now-might cause grave damage to the environment [1]. These facts accentuate the prevalent impression that future energy requirements of the human race cannot be met entirely by fossil fuels. The consensus for alternate energy sources and sustainable development was strongly felt among the scientific community a few decades ago. Extraction of energy from renewable sources is one pragmatic step that can alleviate the crisis to a great extent. It seems most appropriate to discuss current strategies of fuel production from renewable sourcesthe non-conventional sources such as biomass and biowaste in particular. Biomass as alternate source of energy: Global and Indian scenario: Biomass and agricultural wastes have historically been used as the solid fuel since ancient times. Even today, around 2.6 million people in Asia and Africa rely solely on solid fuels such as agricultural wastes and cow dung for their energy requirements [2]. However, the combustion systems Microbial Fuel Cells as Alternate Source of Energy: Research, Advancements and Future Prospects in Indian Scenario
Ligen Yu
Indian Journal of Microbiology · 2021
COVID-19 continues to be an ongoing global threat. The elderly with underlying health conditions like cardiovascular and lung diseases, diabetes, obesity, are the most vulnerable to this disease. Curing the pre-existing health conditions will greatly increase a person’s resilience to COVID-19 and lower the death rate of the old people. Digestion and immunity form an integrated nutrition acquisition process, especially in obtaining essential amino acids and essential fatty acids from living microbial cells. A mature strong immunity coupled with gut dysbiosis in adults is the main cause of nutritional disorders like morbid obesity, diabetes mellitus, cardiovascular and pulmonary diseases. Nutrition disorders in return worsen dysbiosis. Human microbiome has an intrinsic duality. While a diverse microbiome provides a full spectrum of essential nutrients to our body, nutrition disorders fuel overgrowth of microbiota (dysbiosis) at many sites on or inside our body, and are the main causes of chronic inflammation at these sites. In the case of COVID-19, nutritional disorder impairs the immunity, causes hyperinflammation, and leads to the protracted overload of cytokines by the immune system, i.e., the cytokine storm. Autophagy induced by restrictive eating is an ideal inhibitor of microbiota overgrowth, as autophagy deprives microbiota of excessive nutrition for replication. Autophagy also attenuates inflammation. Therefore, as a precaution, the author suggests restoring good health in the elderly with the support from a diverse gut microbiome and daily regular food intake restriction, so as to lower the risk of developing into severe case even if they are infected by COVID-19.
Bharat Chandra Nath, Swagata Saikia, PRANABA NANDA BHATTACHARYYA et al.
Indian Journal of Horticulture · 2025
The current investigation is designed to illustrate the beneficial effect of different microbial bioformulations on nutrient availability, microbial biomass carbon and key enzymatic activities in a citrus orchard soil. Three different microbial bioformulations namely Biogreen-5, Bioveer and Biosona were arranged in seven different treatments including T1: Biogreen (soil + foliar application); T2: Biogreen (foliar application); T3: Bioveer (soil + foliar application); T4: Bioveer (foliar application); T5: Biosona (soil + foliar application); T6: Biosona (foliar application); T7: Control (water spray). Biogreen when applied as soil and foliar application increased the soil pH by 6.18%, organic carbon by 27.27%, and cationic exchange capacity by 6.24% over control. Like-wise, Biogreen applied both as soil and foliar application increased the availability of N, P, K, Mn, Zn, Fe and B content by 20.17%, 22.19%, 31.74%, 52.81%, 40.76%, 33.60% and 51.47%, respectively over control. Furthermore, the application of Biogreen (soil + foliar application), demonstrated noteworthy enhanced in microbial biomass carbon, and key enzyme activities including dehydrogenase, phosphomonoesterase, and fluorescein diacetate hydrolysis, with significant improvements up to 39.58%, 23.39%, 30.21%, and 36.15%, respectively as compared to control. The findings of the current investigation indicated that Biogreen followed by bioveer serves as an effective biological formulation, for sustaining microbial biomass carbon, cationic exchange capacity, essential plant nutrients and key enzymatic activities.
Fuel Cells Bulletin · 2018
Several research institutes and industrial companies in India have signed a Memorandum of Understanding to jointly develop a fuel cell-based train prototype. SRM Institute of Science and Technology (SRMIST) in Chennai and SRM University in Amaravati are partnering with the Integral Coach Factory (ICF) of Indian Railways on the project.
P. Lu, Yong-Hua Zhao
Chinese Medicine · 2020
Nuclear factor-kappa B (NF-κB) is a kind of multi-functional nuclear transcription factor involved in regulating gene transcription to influence pathological evolution of inflammatory and immune diseases. Numerous literature evidence that NF-κB pathway plays an essential role in pathogenic development of ulcerative colitis (UC). UC is a chronic non-specific inflammatory bowel disease, and until now, therapeutic agents for UC including aminosalicylates, corticosteroids and immune inhibitors still cannot exert satisfied effects on patients. In recent years, Chinese medicines suggest the advantages of alleviating symptoms and signs, decreasing side-effects and recurrence, whose one of mechanisms is related to regulation of NF-κB pathway. In this review, we categorize Chinese medicines according to their traditional therapeutic functions, and summarize the characteristics of Chinese medicines targeting NF-κB pathway in UC treatment. It indicates that 85 kinds of Chinese medicines’ compounds and formulae can directly act on NF-κBp65; while 58 Chinese medicines’ ingredients and formulae indirectly suppress NF-κBp65 by regulation of its upstream or other related pathways. Moreover, by the analysis of Chinese medicines’ category based on their traditional functions, we conclude the category of dampness-drying and detoxificating medicine targeting NF-κB pathway accounts for primary status for amelioration of UC. Simultaneously, this review also contributes to the choices of Chinese medicine category and provides curative potential of Chinese medicines for clinical UC treatment.
Jing-ming Ye, Bao-Liang Guo, Qian Liu et al.
Chinese Medical Journal · 2021
Axillary lymph node assessment is one of the important indicators in the clinical pathological staging of breast cancer. Studies have shown that sentinel lymph node biopsy (SLNB) has the advantages of fewer complications and less trauma than conventional axillary lymph node dissection (ALND). Common mapping methods for SLNB include blue dye, radioisotopes, a combination of blue dye and radioisotopes, and fluorescence imaging. To standardize the SLNB techniques for breast cancer, the Chinese Society of Breast Surgery (CSBrS) re-evaluated the quality of evidence for clinical studies of SLNB for breast cancer, referring to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE), and developed the Clinical Practice Guidelines for Sentinel Lymph Node Biopsy in Patients with Early-Stage Breast Cancer: CSBrS Practice Guidelines 2021, in accordance with the Expert Consensus and Technical Operational Guidelines for Sentinel LymphNode Biopsy guided by blue dye alone in Early Breast Cancer (2018) combined with data from clinical practice in breast surgery in China, providing a reference for breast surgeons in clinical practice in China.
X. Dai, Jiayi Feng, Yi Chen et al.
Chinese Medicine · 2021
Nonalcoholic fatty liver disease (NAFLD) has become the world's largest chronic liver disease, while there is still no specific drug to treat NAFLD. Traditional Chinese Medicine (TCM) have been widely used in hepatic diseases for centuries in Asia, and TCM’s holistic concept and differentiation treatment of NAFLD show their advantages in the treatment of this complex metabolic disease. However, the multi-compounds and multi-targets are big obstacle for the study of TCM. Here, we summarize the pharmacological actions of active ingredients from frequently used single herbs in TCM compounds. The combined mechanism of herbs in TCM compounds are further discussed to explore their comprehensive effects on NAFLD. This article aims to summarize multiple functions and find the common ground for TCM treatment on NAFLD, thus providing enrichment to the scientific connotation of TCM theories and promotes the exploration of TCM therapies on NAFLD.
A. Zakari, Irfan Khan
Journal of Chinese Economic and Business Studies · 2021
ABSTRACT In 2019, Chinese investment rose to $110 billion across all sectors in Africa. However, there are many criticisms that the Chinese presence is a curse to the development of Africa. Hence, we direct our attention to unravel the truth about these allegations by examining the underlying effect of institutional quality and Chinese investment in Africa on energy consumption (EC) and its impact on economic growth. We applied a panel corrected standard error (PCSE) econometric procedure for a selected 21 sub-Saharan African countries. Our results show that energy consumption promotes economic growth. Similarly, the study revealed that the institutional quality and Chinese investment in Africa were the underlying factors for the positive effect of energy consumption and economic growth. Therefore, our results expand the economic growth literature and inform policymakers of the need to pay attention to bilateral trade and investment with China.
Mei Wang, Pei-Fen Yao, Pengjun Sun et al.
Chinese Medicine · 2022
Chinese herbal medicines (CHMs) have unique advantages in the prevention and treatment of diseases, which are widely recognized in the world. More and more CHMs are becoming increasingly popular in the international markets. However, the quality control of CHMs is a significant issue for their acceptance and recognition in the international market. This review mainly focuses on the quality requirements for CHMs to enter the European Union (EU) market. Both Chinese and European regulations and quality controls are compared. Firstly, the EU medicinal regulatory system and relevant regulations were reviewed. Secondly, the key factors of the quality control of CHMs, including Chinese herbal drugs, extracts and products were compared with those of European herbal medicines in the EU market. Subsequently, three main registration routes for herbal medicinal products including Chinese herbal medicinal products entering the EU were introduced. Furthermore, the legal status of traditional Chinese medicine granules in the EU was also discussed. Through the comparison of the key quality factors for CHMs in China and the EU, the similarities and differences in terms of quality requirements and regulations are addressed, which provides a reference for the development of CHMs into the EU market.
Lai Wei, Zeyu Wang, Nian-cai Jing et al.
Chinese Medicine · 2022
Hepatocellular carcinoma (HCC, accounting for 90% of primary liver cancer) was the sixth most common cancer in the world and the third leading cause of cancer death in 2020. The number of new HCC patients in China accounted for nearly half of that in the world. HCC was of occult and complex onset, with poor prognosis. Clinically, at least 15% of patients with HCC had strong side effects of interventional therapy (IT) and have poor sensitivity to chemotherapy and targeted therapy. Traditional Chinese medicine (TCM), as a multi-target adjuvant therapy, had been shown to play an active anti-tumor role in many previous studies. This review systematically summarized the role of TCM combined with clinically commonly used drugs for the treatment of HCC (including mitomycin C, cyclophosphamide, doxorubicin, 5-fluorouracil, sorafenib, etc.) in the past basic research, and summarized the efficacy of TCM combined with surgery, IT and conventional therapy (CT) in clinical research. It was found that TCM, as an adjuvant treatment, played many roles in the treatment of HCC, including enhancing the tumor inhibition, reducing toxic and side effects, improving chemosensitivity and prolonging survival time of patients. This review summarized the advantages of integrated traditional Chinese and modern medicine in the treatment of HCC and provides a theoretical basis for clinical research.
K. W. Chan, V. Wong, S. Tang
The American Journal of Chinese Medicine · 2020
As of 22 February 2020, more than 77662 cases of confirmed COVID-19 have been documented globally with over 2360 deaths. Common presentations of confirmed cases include fever, fatigue, dry cough, upper airway congestion, sputum production, shortness of breath, myalgia/arthralgia with lymphopenia, prolonged prothrombin time, elevated C-reactive protein, and elevated lactate dehydrogenase. The reported severe/critical case ratio is approximately 7-10% and median time to intensive care admission is 9.5-10.5 days with mortality of around 1-2% varied geographically. Similar to outbreaks of other newly identified virus, there is no proven regimen from conventional medicine and most reports managed the patients with lopinavir/ritonavir, ribavirin, beta-interferon, glucocorticoid and supportive treatment with remdesivir undergoing clinical trial. In China, Chinese medicine is proposed as a treatment option by national and provincial guidelines with substantial utilization. We reviewed the latest national and provincial clinical guidelines, retrospective cohort studies, and case series regarding the treatment of COVID-19 by add-on Chinese medicine. We have also reviewed the clinical evidence generated from SARS and H1N1 management with hypothesized mechanisms and latest in silico findings to identify candidate Chinese medicines for the consideration of possible trials and management. Given the paucity of strongly evidence-based regimens, the available data suggest that Chinese medicine could be considered as an adjunctive therapeutic option in the management of COVID-19.
Junning Fan, Zhijia Sun, Canqing Yu et al.
Chinese Medical Journal · 2022
Abstract Background: Few studies have assessed the relationship between multimorbidity patterns and mortality risk in the Chinese population. We aimed to identify multimorbidity patterns and examined the associations of multimorbidity patterns and the number of chronic diseases with the risk of mortality among Chinese middle-aged and older adults. Methods: We used data from the China Kadoorie Biobank and included 512,723 participants aged 30 to 79 years. Multimorbidity was defined as the presence of two or more of the 15 chronic diseases collected by self-report or physical examination at baseline. Multimorbidity patterns were identified using hierarchical cluster analysis. Cox regression was used to estimate the associations of multimorbidity patterns and the number of chronic diseases with all-cause and cause-specific mortality. Results: Overall, 15.8% of participants had multimorbidity. The prevalence of multimorbidity increased with age and was higher in urban than rural participants. Four multimorbidity patterns were identified, including cardiometabolic multimorbidity (diabetes, coronary heart disease, stroke, and hypertension), respiratory multimorbidity (tuberculosis, asthma, and chronic obstructive pulmonary disease), gastrointestinal and hepatorenal multimorbidity (gallstone disease, chronic kidney disease, cirrhosis, peptic ulcer, and cancer), and mental and arthritis multimorbidity (neurasthenia, psychiatric disorder, and rheumatoid arthritis). During a median of 10.8 years of follow-up, 49,371 deaths occurred. Compared with participants without multimorbidity, cardiometabolic multimorbidity (hazard ratios [HR] = 2.20, 95% confidence intervals [CI]: 2.14 − 2.26) and respiratory multimorbidity (HR = 2.13, 95% CI:1.97 − 2.31) demonstrated relatively higher risks of mortality, followed by gastrointestinal and hepatorenal multimorbidity (HR = 1.33, 95% CI:1.22 − 1.46). The mortality risk increased by 36% (HR = 1.36, 95% CI: 1.35 − 1.37) with every additional disease. Conclusion: Cardiometabolic multimorbidity and respiratory multimorbidity posed the highest threat on mortality risk and deserved particular attention in Chinese adults.
W. U. Jiashuo, Fangqing Zhang, L. Zhuangzhuang et al.
PubMed · 2022
Traditional Chinese Medicine (TCM) has been extensively used as a mainstay for treating various pathologies. Combing the pharmacology and systems biology approaches, the network pharmacology (NP) approach was developed to predict the probable mechanism underlying the therapeutic effect of TCM. However, approaches solely based on NP cannot effectively elucidate the curative mechanism in a holistic and reliable manner due to limitations in NP-based methods and complexity of TCM components. Thus, integration strategies combining NP with other approaches are increasingly being used. Since the interdisciplinary research in TCM has received much attention in the advent of the big data era of which the NP-based integration strategy is broadly used, the strategy is clearly elaborated in the present review. We summarized several NP-based integration strategies and their applications in TCM studies, including multi-omics approach, gut microbiota study, chemical information analysis, data-mining, and network toxicology study.
Yi-xuan Yu, Shuo Wang, Zhe-Ning Liu et al.
Chinese Medicine · 2023
Immune checkpoint inhibitors (ICIs) have revolutionized cancer management and have been widely applied; however, they still have some limitations in terms of efficacy and toxicity. There are multiple treatment regimens in Traditional Chinese Medicine (TCM) that play active roles in combination with Western medicine in the field of oncology treatment. TCM with ICIs works by regulating the tumor microenvironment and modulating gut microbiota. Through multiple targets and multiple means, TCM enhances the efficacy of ICIs, reverses resistance, and effectively prevents and treats ICI-related adverse events based on basic and clinical studies. However, there have been few conclusions on this topic. This review summarizes the development of TCM in cancer treatment, the mechanisms underlying the combination of TCM and ICIs, existing studies, ongoing trials, and prospects for future development.
Jin-Fang Chen, Shiheng Wu, Zi-Man Shi et al.
Chinese Medicine · 2023
Colorectal cancer (CRC) is a disease with complex pathogenesis, it is prone to metastasis, and its development involves abnormalities in multiple signaling pathways. Surgery, chemotherapy, radiotherapy, target therapy, and immunotherapy remain the main treatments for CRC, but improvement in the overall survival rate and quality of life is urgently needed. Traditional Chinese medicine (TCM) has a long history of preventing and treating CRC. It could affect CRC cell proliferation, apoptosis, cell cycle, migration, invasion, autophagy, epithelial–mesenchymal transition, angiogenesis, and chemoresistance by regulating multiple signaling pathways, such as PI3K/Akt, NF-κB, MAPK, Wnt/β-catenin, epidermal growth factor receptors, p53, TGF-β, mTOR, Hedgehog, and immunomodulatory signaling pathways. In this paper, the main signaling pathways and potential targets of TCM and its active ingredients in the treatment of CRC were systematically summarized, providing a theoretical basis for treating CRC with TCM and new ideas for further exploring the pathogenesis of CRC and developing new anti-CRC drugs.
Jia-Hui Liao, C. Hsueh, Bor-Yann Chen
Science Discovery · 2017
For thousands of years, toxicity risk assessment on Chinese medicinal herbs showed that they are "generally regarded as safe" at appropriate dosages. Literature revealed that medical mechanism for human health could be associated with abundant compositions of antioxidants (e.g., polyphenolics and flavonoids). As a matter of fact, some studies disclosed such bioelectrochemical characteristics also strongly depended upon contents of antioxidants. That is, Chinese medicinal herbs contained significant amounts of electron transfer (ET)-associated antioxidants for myriads of uses. As prior studies revealed, decolorized intermediates owned promising ET capabilities; however, such intermediates were originally obtained from artificially synthesized chemicals and could not be considered as environmentally friendly. Thus, using edible medicinal herbs for bioenergy and/or biorefinery applications would be inevitable. This first-attempt study explored technical feasibility using microbial fuel cell-aided wastewater treatment (e.g., the association of antioxidants and dye decolorization and power generation) as evaluation platform. The findings indicated that some Chinese medicinal herbs apparently showed electrochemical capabilities not only antioxdidant activities, but also ET characteristics for sustainable development. In addition, ET capabilities were strongly affected by pH, temperature, dosage and method of extraction. Moreover, extracts of medicinal herbs owned moderate ET capabilities relatively less than tea extracts for bioenergy applications not only in bioremediation, but also functional foods.
Jiefu Wang, Hao Niu, Wenguo Wu
PubMed · 2017
Microbial fuel cells (MFCs) is a highly promising bioelectrochemical technology and uses microorganisms as catalyst to convert chemical energy directly to electrical energy. Microorganisms in the anodic chamber of MFC oxidize the substrate and generate electrons. The electrons are absorbed by the anode and transported through an external circuit to the cathode for corresponding reduction. The flow of electrons is measured as current. This current is a linear measure of the activity of microorganisms. If a toxic event occurs, microbial activity will change, most likely decrease. Hence, fewer electrons are transported and current decreases as well. In this way, a microbial fuel cell-based biosensor provides a direct measure to detect toxicity for samples. This paper introduces the detection of antibiotics, heavy metals, organic pollutants and acid in MFCs. The existing problems and future application of MFCs are also analyzed.
Lai Xie, Min Yang, Enzhe Yang et al.
PubMed · 2023
To investigate the bioelectrochemical enhanced anaerobic ammonia oxidation (anammox) nitrogen removal process, a bioelectrochemical system with coupled anammox cathode was constructed using a dual-chamber microbial electrolysis cell (MEC). Specifically, a dark incubation batch experiment was conducted at 30 ℃ with different influent total nitrogen concentrations under an applied voltage of 0.2 V, and the enhanced denitrification mechanism was investigated by combining various characterization methods such as cyclic voltammetry, electrochemical impedance spectroscopy and high-throughput sequencing methods. The results showed that the total nitrogen removal rates of 96.9%±0.3%, 97.3%±0.4% and 99.0%±0.3% were obtained when the initial total nitrogen concentration was 200, 300 and 400 mg/L, respectively. In addition, the cathode electrode biofilm showed good electrochemical activity. High-throughput sequencing results showed that the applied voltage enriched other denitrifying functional groups, including Denitratisoma, Limnobacter, and ammonia oxidizing bacteria SM1A02 and Anaerolineaceae, Nitrosomonas europaea and Nitrospira, besides the anammox bacteria. These electrochemically active microorganisms comprised of ammonium oxidizing exoelectrogens (AOE) and denitrifying electrotrophs (DNE). Together with anammox bacteria Candidatus Brocadia, they constituted the microbial community structure of denitrification system. Enhanced direct interspecies electron transfer between AOE and DNE was the fundamental reason for the further improvement of the total nitrogen removal rate of the system.
Cheng Shang
The American Journal of Chinese Medicine · 1993
Several converging points from recent research results on cellular signal transduction, pattern formation, bioelectromagnetism and acupuncture are reviewed. These converging points indicate the general importance of bioelectrochemical oscillations in morphogenesis and physiology: An organism is not only a system of molecules and cells, but also a system of oscillations. These oscillations precede the morphological changes in development or pathology. Converging discoveries and hypotheses in different fields, and a perspective on their potential application in biomedicine are also discussed in this article.
J. Zamorano, P. Lancellotti, Daniel Rodríguez Muñoz et al.
European Heart Journal · 2016
2-D : two-dimensional 3-D : three-dimensional 5-FU : 5-fluorouracil ACE : angiotensin-converting enzyme ARB : angiotensin II receptor blocker ASE : American Society of Echocardiography BNP : B-type natriuretic peptide CABG : coronary artery bypass graft CAD : coronary artery
V. Kunadian, A. Chieffo, P. Camici et al.
European Heart Journal · 2020
This consensus document, a summary of the views of an expert panel organized by the European Association of Percutaneous Cardiovascular Interventions (EAPCI), appraises the importance of ischaemia with non-obstructive coronary arteries (INOCA). Angina pectoris affects approximately 112 million people globally. Up to 70% of patients undergoing invasive angiography do not have obstructive coronary artery disease, more common in women than in men, and a large proportion have INOCA as a cause of their symptoms. INOCA patients present with a wide spectrum of symptoms and signs that are often misdiagnosed as non-cardiac leading to under-diagnosis/investigation and under-treatment. INOCA can result from heterogeneous mechanism including coronary vasospasm and microvascular dysfunction and is not a benign condition. Compared to asymptomatic individuals, INOCA is associated with increased incidence of cardiovascular events, repeated hospital admissions, as well as impaired quality of life and associated increased health care costs. This consensus document provides a definition of INOCA and guidance to the community on the diagnostic approach and management of INOCA based on existing evidence from research and best available clinical practice; noting gaps in knowledge and potential areas for further investigation.