Landscape of cancer clinical trials in India - a comprehensive analysis of the Clinical Trial Registry-India.

Background: Cancer is one of the leading causes of morbidity and mortality in India. Clinical trials are critical for driving innovation in cancer therapy, diagnosis, and prevention. This study aims to depict the evolving landscape of cancer clinical trials in India by analysing the clinical trials registered in Clinical Trial Registry-India (CTRI). Methods: We identified cancer trials registered in CTRI (between 2007 and 2021) using search terms adapted from the cancer types defined by the National Cancer Institute (USA). We then collated and analysed the publicly available information from CTRI (cancer subtypes, type of trial, treatment intent, type of intervention, sponsor type, recruitment countries) and used descriptive statistics to illustrate the overall as well as year-to-year trend. Findings: In total, we identified 1988 cancer trials, the majority of which focused on treating cancer (63%) and rest of the trials aimed at optimising the operational aspects of surgery (19%), mitigating treatment-related toxicity (10.6%), or treating cancer-related symptoms (7.8%). Focusing on trials with the intent of treating cancer, we found that most were investigating solid tumours as opposed to haematological malignancies with the most prominent cancer subtypes being breast cancer (17%), head and neck cancer (9.8%), lung cancer (9.6%), and cervical cancer (6.6%). The number of trials conducted in a given cancer subtype from our analysis overall correlated to the incidence, mortality, and 5-year prevalence of the respective cancer subtype in India; however, head and neck cancer and cervical cancer were underrepresented in trials as compared with the disease burden. The most common type of intervention was investigational drugs. The most common sponsor types were global pharmaceutical industry (26%) and research institution and hospital (26%). Despite a relatively high cancer burden, the availability of cancer trials in the Northeastern states of India was limited. Interpretation: There is a pressing need for clinical cancer research in India to be better aligned with the nation's healthcare needs and disease burden, focusing on prevalent and deadly cancers while ensuring the availability of clinical trials across geographic regions and underserved populations. Funding: Pi Health USA, a fully owned subsidiary of BeiGene Ltd.

A scientometric analysis of fairness in health AI literature.

Artificial intelligence (AI) and machine learning are central components of today's medical environment. The fairness of AI, i.e. the ability of AI to be free from bias, has repeatedly come into question. This study investigates the diversity of members of academia whose scholarship poses questions about the fairness of AI. The articles that combine the topics of fairness, artificial intelligence, and medicine were selected from Pubmed, Google Scholar, and Embase using keywords. Eligibility and data extraction from the articles were done manually and cross-checked by another author for accuracy. Articles were selected for further analysis, cleaned, and organized in Microsoft Excel; spatial diagrams were generated using Public Tableau. Additional graphs were generated using Matplotlib and Seaborn. Linear and logistic regressions were conducted using Python to measure the relationship between funding status, number of citations, and the gender demographics of the authorship team. We identified 375 eligible publications, including research and review articles concerning AI and fairness in healthcare. Analysis of the bibliographic data revealed that there is an overrepresentation of authors that are white, male, and are from high-income countries, especially in the roles of first and last author. Additionally, analysis showed that papers whose authors are based in higher-income countries were more likely to be cited more often and published in higher impact journals. These findings highlight the lack of diversity among the authors in the AI fairness community whose work gains the largest readership, potentially compromising the very impartiality that the AI fairness community is working towards.

Patient diversity and author representation in clinical studies supporting the Surviving Sepsis Campaign guidelines for management of sepsis and septic shock 2021: a systematic review of citations.

BACKGROUND: The generalizability of the Surviving Sepsis Campaign (SSC) guidelines to various patient populations and hospital settings has been debated. A quantitative assessment of the diversity and representation in the clinical evidence supporting the guidelines would help evaluate the generalizability of the recommendations and identify strategic research goals and priorities. In this study, we evaluated the diversity of patients in the original studies, in terms of sex, race/ethnicity, and geographical location. We also assessed diversity in sex and geographical representation among study first and last authors. METHODS: All clinical studies cited in support of the 2021 SSC adult guideline recommendations were identified. Original clinical studies were included, while editorials, reviews, non-clinical studies, and meta-analyses were excluded. For eligible studies, we recorded the proportion of male patients, percentage of each represented racial/ethnic subgroup (when available), and countries in which they were conducted. We also recorded the sex and location of the first and last authors. The World Bank classification was used to categorize countries. RESULTS: The SSC guidelines included six sections, with 85 recommendations based on 351 clinical studies. The proportion of male patients ranged from 47 to 62%. Most studies did not report the racial/ ethnic distribution of the included patients; when they did so, most were White patients (68-77%). Most studies were conducted in high-income countries (77-99%), which included Europe/Central Asia (33-66%) and North America (36-55%). Moreover, most first/last authors were males (55-93%) and from high-income countries (77-99%). CONCLUSIONS: To enhance the generalizability of the SCC guidelines, stakeholders should define strategies to enhance the diversity and representation in clinical studies. Though there was reasonable representation in sex among patients included in clinical studies, the evidence did not reflect diversity in the race/ethnicity and geographical locations. There was also lack of diversity among the first and last authors contributing to the evidence.

Adsorption and Photochemical Properties of a Molecular CO2 Reduction Catalyst in Hierarchical Mesoporous ZSM-5: An In Situ FTIR Study.

As part of our recent effort to attach well-defined molecular photocatalysts to solid-state surfaces, this present study investigates adsorption and photochemical properties of a tricarbonyl rhenium(I) compound, Re(bpy)(CO)3Cl (bpy = 2,2'-bipyridine), in hierarchical mesoporous ZSM-5. The molecular Re(I) catalyst, a Ru(bpy)3(2+) photosensitizer, and an amine-based electron donor were coadsorbed in the mesopores of the hierarchical ZSM-5 through simple liquid-phase adsorption. The functionalized ZSM-5 was then characterized with infrared and UV-visible spectroscopies and was tested in CO2 reduction photocatalysis at the gas-surface interface. In the mesoporous ZSM-5, CO2 molecules were adsorbed on the amine electron-donor molecules as bicarbonate, which would release CO2 upon light irradiation to react with the Re(I) catalyst. The formation of important reaction intermediates, particularly a Re-carboxylato species, was revealed with in situ Fourier transform infrared spectroscopy in combination with isotopic labeling. The experimental results indicate that hierarchical mesoporous zeolites are promising host materials for molecular photocatalysts and that zeolite mesopores are potential "reaction vessels" for CO2 reduction photocatalysis at the gas-solid interface.

Framework stability of nanocrystalline NaY in aqueous solution at varying pH.

Nanocrystalline zeolites are emerging as important materials for a variety of potential applications in industry and medicine. Reducing the particle size to less than 100 nm results in advantages for nanocrystalline zeolites relative to micrometer-sized zeolite crystals, such as very large total and external specific surface areas and reduced diffusion path lengths. Understanding the physical and chemical properties of zeolite nanocrystals is imperative for further development and application of nanocrystalline zeolites. In this study, the framework stability of nanocrystalline NaY zeolite with a crystal size of 66 nm and Si/Al = 1.74 was investigated at pH 7.4, 4, 2, and 1. The solids and solutions were analyzed using several different analytical techniques. The relative crystallinity and crystal size and morphology of the solids were examined by powder X-ray diffraction (XRD) and transmission electron microscopy (TEM), respectively. The aluminum content, Si/Al, and coordination were monitored by inductively coupled plasma/optical emission spectroscopy (ICP/OES), X-ray photoelectron spectroscopy (XPS), and aluminum-27 solid-state magic-angle spinning NMR. As the acidity of the medium increased, the framework stability of nanocrystalline NaY decreased. Treatment of the zeolite samples at pH 1 resulted in complete degradation of the zeolite framework after 1 h. An increase in Si/Al was also observed, suggesting the selective removal of aluminum at low pH.

Effect of crystal size and surface functionalization on the cytotoxicity of silicalite-1 nanoparticles.

In this report, we describe the synthesis and characterization of nanocrystalline silicalite (the purely siliceous form of the zeolite, ZSM-5) of defined crystal size and surface functionalization and determine the effect on the type and degree of cytotoxicity induced in two distinct model cell lines. The silicalite materials were characterized by powder X-ray diffraction, dynamic light scattering and zeta potential, solid state NMR, thermal gravimetric analysis, and nitrogen adsorption using the BET method to determine specific surface area. The silicalite samples were functionalized with amino, thiol, and carboxy groups and had crystal sizes of approximately 30, 150, and 500 nm. The cytotoxicities of the silicalite samples with different crystal sizes and different surface functional groups were investigated using human embryonic kidney 293 (HEK-293) cells and RAW264.7 macrophage cell lines. We used the lactic dehydrogenase release assay to measure damage to the cell membrane, the caspase 3/7 activity assay to measure key molecules involved in apoptosis, and the Annexin V-propidium iodide staining method to provide visual confirmation of the types of cell death induced. We have shown that the impact of size and surface functionalization of silicalite nanoparticles on cell toxicity and mechanism of cell death is cell type-dependent. Thirty nanometer silicalite nanoparticles were nontoxic in RAW264.7 cells relative to untreated controls but caused necrosis in HEK293 cells. Carboxy-functionalized 500 nm silicalite nanoparticles resulted in apoptosis and necrosis in RAW264.7 cells and predominantly activated apoptosis in HEK293 cells.