Continuous influenza virus production in a tubular bioreactor system provides stable titers and avoids the “von Magnus effect”
Authors:
Felipe Tapia aff001; Daniel Wohlfarth aff001; Volker Sandig aff002; Ingo Jordan aff002; Yvonne Genzel aff001; Udo Reichl aff001
Authors place of work:
Max Planck Institute for Dynamics of Complex Technical Systems, Magdeburg, Germany
aff001; ProBioGen AG, Berlin, Germany
aff002; Chair for Bioprocess Engineering, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany
aff003
Published in the journal:
PLoS ONE 14(11)
Category:
Research Article
doi:
https://doi.org/10.1371/journal.pone.0224317
Summary
Continuous cell culture-based influenza vaccine production could significantly reduce footprint and manufacturing costs compared to current batch processing. However, yields of influenza virus in continuous mode can be affected by oscillations in virus titers caused by periodic accumulation of defective interfering particles. The generation of such particles has also been observed previously in cascades of continuous stirred tank reactors (CSTRs) and is known as the “von Magnus effect”. To improve virus yields and to avoid these oscillations, we have developed a novel continuous tubular bioreactor system for influenza A virus production. It was built using a 500 mL CSTR for cell growth linked to a 105 m long tubular plug-flow bioreactor (PFBR). Virus propagation took place only in the PFBR with a nominal residence time of 20 h and a production capacity of 0.2 mL/min. The bioreactor was first tested with suspension MDCK cells at different multiplicities of infection (MOI), and then with suspension avian AGE1.CR.pIX cells at a fixed nominal MOI of 0.02. Maximum hemagglutinin (HA) titers of 2.4 and 1.6 log10(HA units/100 μL) for suspension MDCK cells and AGE1.CR.pIX cells, respectively, were obtained. Flow cytometric analysis demonstrated that 100% infected cells with batch-like HA titers can be obtained at a MOI of at least 0.1. Stable HA and TCID50 titers over 18 days of production were confirmed using the AGE1.CR.pIX cell line, and PCR analysis demonstrated stable production of full-length genome. The contamination level of segments with deletions (potentially defective interfering particles), already present in the virus seed, was low and did not increase. Control experiments using batch and semi-continuous cultures confirmed these findings. A comparison showed that influenza virus production can be achieved with the tubular bioreactor system in about half the time with a space-time-yield up to two times higher than for typical batch cultures. In summary, a novel continuous tubular bioreactor system for cell culture-based influenza virus production was developed. One main advantage, an essentially single-passage amplification of viruses, should enable efficient production of vaccines as well as vectors for gene and cancer therapy.
Keywords:
Influenza viruses – Influenza A virus – Viral replication – Stainless steel – influenza – Flow rate – Genetic oscillators – Batch culture
Introduction
Influenza viruses are a major threat for human and animal health. Influenza viruses have an approximate size of 100 nm and are characterized by an enveloped structure with a negative-sense RNA genome. The genome is divided in 7–8 separated segments coding for more than 10 proteins depending on strains [1]. Hemagglutinin (HA) and neuraminidase (NA), the two main viral glycoprotein antigens, are located in the virus membrane. Infectious units are transmitted via air droplets and cause sudden fever and severe morbidity, sometimes leading to the death of the patients either directly or via bacterial sequelae. The most effective approach to control the disease is by vaccination [2]. Although influenza vaccine production capacity increased to 6.4 billion doses in 2015, providing enough vaccines remains challenging especially in a pandemic situation [3].
The main technology platform for influenza virus production is based on the infection and harvest of embryonated-chicken eggs. Despite the annual need for millions of eggs and dependence on a complex logistic, this technology is still considered efficient for production of seasonal influenza vaccines [4]. However, limitations regarding response time and scalability in case of a pandemic is a main public concern [3]. To alleviate these limitations, animal cell culture and bioreactor technology has been introduced for influenza vaccine production in Europe and the United States in the past two decades [5]. Typically, cells are grown to high concentrations (2–6×106 cells/mL) and, once the desired cell concentration is reached, the culture is infected and harvested after about 2–3 days. More recently, a recombinant influenza vaccine using the baculovirus expression system has also been approved for commercialization [5]. Despite small differences in process operation and parameters among these platforms, all processes are basically operated in batch mode. Moving from batch to continuous production could significantly improve volumetric productivity (virus produced/[(time)×(volume of cultured media used)]) and reduce the manufacturing footprint [6]. Continuous production is currently not only promoted by various manufacturers of recombinant CHO cell-based biologicals, but also by regulatory agencies [7].
Cascades of stirred tank bioreactors have been used since the 1960’s for production of viruses in continuous mode [8]. This included adenovirus, poliovirus, baculovirus, picornavirus [9], influenza virus [10], and Modified Vaccinia Ankara virus [6]. The cascades are characterized by one continuous stirred tank reactor (CSTR) for cell growth and at least one CSTR in series for virus infection and propagation. The use of a cascade of CSTRs is a good option for production of genetically stable viruses such as MVA, but suffers from low productivity levels when less stable viruses such as influenza virus and baculovirus are propagated [10] [11]. In particular, these viruses show oscillations in virus concentration over cultivation time that can be explained by the accumulation of defective interfering particles (DIPs) in the virus population. DIPs have deletions in genes required for replication so that they depend on co-infections with standard viruses (STV) with full-length (FL) genome for successful propagation [12]. At high DIP concentrations, the replication of the STV is reduced, and the infectious units are washed out of the CSTR. This generates oscillations in the virus titers, which is known as “von Magnus effect”, in honor to Preben von Magnus, who discovered these “incomplete forms of influenza virus” in 1950’s [13].
An alternative continuous production system could be a tubular plug-flow bioreactor (PFBR) [14]. Tubular bioreactors have been used, for example, for waste water treatment [15], for production of bioethanol [16], and for production of algae [17]. Tubular bioreactors have unique properties such as a reduced back-mixing and a large surface-to-volume ratio that are useful for a variety of biotechnological applications. In contrast to CSTRs, reagents and products do not accumulate in the tubular bioreactor volume over process time [18]. The reduced back-mixing within the PFBR volume and the possible compartmentalization of the fluid via air bubbles ensure that DIPs produced within a compartment do not interact with recently infected cells at neighboring compartments. This combination can in theory reduce co-infection of cells compared to a normal batch or two-stage CSTR infection, and therefore significantly minimize the amount of DIPs produced. Therefore, if enough time for virus replication inside the PFBR is provided, the von Magnus effect is avoided, and stable titers can be expected in the harvest.
In this work, a continuous tubular bioreactor system for influenza A/PR/8/34 (H1N1) virus production is presented. The system consisted of a CSTR operated in chemostat mode for cell growth linked to a PFBR for virus propagation. Units operations such as point of infection (POI), virus stock (VS), air injection and medium stock are introduced. Nominal values of residence time (RT) and multiplicities of infection (MOI) were set for each cultivation. Because flow rates and cell concentrations were adjusted during some experiments, the actual value of RT and MOI are also reported. First, results from cultivations with suspension MDCK cells infected at different MOI are shown to complement previous findings [19] and to discuss options for process optimization. In addition, results for influenza virus production at defined MOIs in an avian suspension cell (AGE1.CR.pIX) are presented. The results obtained demonstrate that DIP-induced oscillations in virus titers, which have been observed previously using avian suspension cells in cascades of CSTRs [10], can be avoided with the described system.
Materials and methods
Cell lines and influenza virus strain
Suspension MDCK.SUS2 cells (collaboration with Prof. Klaus Scharfenberg, University of Applied Sciences Emden-Leer, Germany) were used and inoculated at 0.5×106 cells/mL into the CSTR. Cells were grown in the chemically defined medium Smif8 (also obtained from Prof. K. Scharfenberg) and supplemented with 4 mM L-glutamine and 4 mM pyruvate immediately before the cultivation. MDCK.SUS cells with passage number 40 and 58 were used for the experiments described in sections 3.1 and 3.2.
The avian suspension cell line AGE1.CR.pIX (ProBioGen AG, Germany) was grown in a chemically defined medium CD-U3 (Biochrom-Merck, Germany) supplemented with 2 mM of L-glutamine (Sigma-Aldrich, Germany), 2 mM L-alanine (Fluka Analytical, Sigma-Aldrich, Germany) and 10 ng/mL Long®R3IGF-I (SAFC Biosciences, USA). AGE1.CR.pIX cells were inoculated at a concentration of 0.8×106 cells/mL, and passaged in shaker flasks at 37°C, 5% CO2 in air, and 185 rpm.
The virus strain used to infect MDCK.SUS2 cells was influenza A/PR/8/34 (RKI) virus adapted to adherent MDCK cells (1.28×108 TCID50/mL). For infection of AGE1.CR.pIX cells, this virus was adapted over four passages to propagation in AGE1.CR.pIX cells (1.48×107 TCID50/mL) as reported previously [10].
Continuous tubular bioreactor system: Set-up and operation
A continuous tubular bioreactor system consisting of a 500 mL CSTR followed by a 211 mL PFBR with a nominal production capacity of 12 mL/h was established as shown in Fig 1, and the system was operated in a cultivation room at a controlled and stable temperature of 37°C. The first bioreactor unit (CSTR; pitch-blade stirrer; Dasgip, Germany) was inoculated with either MDCK or AGE1.CR.pIX cells and operated at 37°C, 150 rpm, pH 7.0–7.3, and 350 mL working volume (WV). Aeration of the CSTR was provided with a tube connected to two 0.2 μm air filters (Sartorius, Switzerland) that injected bubbles into the CSTR. The feed medium (Smif8 or CD-U3) bottle was stored in a styrofoam box with ice (which was replaced twice a day).
The start-up phase was initiated by priming the system with phosphate-buffered saline (PBS) for up to 72 h to check for leakage and to control correct operation of pumps. Once the system reached a stable flow pattern, the PBS was removed, and the CSTR was seeded with cells and fresh medium. The continuous cultivation was initiated either immediately after cell seeding or after some hours, but only PBS was pumped initially from the VS bottle to prime the PFBR. To start the infection, the PBS in the VS bottle was replaced by fresh medium containing 42.8 trypsin units/mL (Gibco, UK) and between 104−105 TCID50/mL (based on desired MOI). 15 min after the virus was added to the stock bottle, the infection was initiated (this corresponds to the time it takes for the transfer of the virus solution from the stock bottle to the POI). First drops of virus-containing culture medium can be collected at the tube outlet about 20 h after the VS addition (corresponding to the RT of the tubular bioreactor, Eq 2).
The MOI at the POI was determined with the following equation:
The average RT in the tubular bioreactor was determined with the following equation:
Finally, the Reynolds number (Re) in the tubular bioreactor was calculated with the following equation:
Continuous influenza virus production in MDCK.SUS2 cells in the tubular bioreactor system
To test the feasibility of influenza virus production in the tubular bioreactor system, the first experiment was performed using the suspension MDCK.SUS2 cell line. Cells were seeded at 1×106 cells/mL in the CSTR and the continuous culture was immediately initiated with a dilution rate (D) of 0.9×μmax (D = F2/WVCSTR, Fig 1) . The PFBR was fed with cell culture from the CSTR and virus from the VS immediately after starting the continuous mode. The experiment was maintained for 23 days. In addition to the cell concentration, HA and TCID50 titers were determined. The VS used in this experiment had an infectious titer of 7×104 TCID50/mL. This resulted in a nominal MOI of 0.025 at the POI. The nominal RT in the tubular reactor was 20 h.
Impact of MOI on virus production in suspension MDCK cells
To test the impact of different MOI on virus titers of the PFBR harvest, one additional experiment of 240 h (10 days) with MDCK.SUS2 cells was carried out. The experiment was started using a CSTR that was already running with MDCK cells at 1.2×106 cells/mL and with a dilution rate of 0.9×μmax. More MDCK cells, taken from a shake flask, were added to the CSTR to reach a concentration of 5×106 cells/mL, similar to the cell concentration observed in a previous successful experiment [19]. The RT of the PFBR was adjusted to 18 h by increasing the rotational speed of Pump 2. The MOI was changed at different time points of cultivation by increasing the VS concentration in four phases from 0.2×106 TCID50/mL (phase I), to 0.7×106 TCID50/mL (phase II), to 6.2×106 TCID50/mL (phase III), and back to 0.2×106 TCID50/mL (phase IV). Samples from the PFBR harvest for HA and flow cytometry analysis were taken in all phases. A control experiment to cover the whole MOI range was performed infecting MDCK.SUS2 cells in shake flasks with MOI similar to phase I, II and III.
Continuous influenza virus production in AGE1.CR.pIX cells in the tubular bioreactor system
Frensing et al. [10] showed that continuous influenza A virus production with the avian cell line AGE1.CR in cascades of CSTRs leads to oscillations in the virus titers known as “von Magnus effect”. To challenge these results, the avian cell line AGE1.CR.pIX was used for continuous influenza A virus production in the continuous tubular bioreactor system. The tubular bioreactor was operated as indicated in section 2.2 and continuous virus production was maintained over three weeks. In addition, control experiments using batch and semi-continuous cultures were carried out and compared to the tubular bioreactor system (see below). Cell concentration, cell viability, HA and TCID50 titers, and segment-specific PCR for identification of defective segments were determined from 4–5 mL samples. Two selected cultivation runs named tubular cultivation A and B are here presented. Tubular cultivation A was started from a newly established bioreactor setup. Tubular cultivation B was started after a different experiment was finished by flushing out the complete bioreactor with PBS, and then seeding fresh cells in the CSTR and preparing a new virus stock.
Control experiments in AGE1.CR.pIX cells: Batch and semi-continuous cultures
For batch control experiments, a volume of 30 mL and 50 mL of AGE1.CR.pIX cells were taken from the CSTR of the tubular bioreactor system and infected in batch mode in shaker flasks (150 mL shakers with baffles, Corning, USA). With cell concentrations of about 5–6×106 cells/mL, a 100 : 58 dilution (culture volume: fresh CD-U3 medium) was performed with VS, identically prepared as in the PFBR experiments, to mimic the infection conditions at the POI in the PFBR. The infection was carried out with an MOI of 0.025 using the influenza virus strain A/PR/8/34 in fresh medium before adjusting to the final 100 : 58 dilution. HA and TCID50 titers, and segment-specific PCR were analyzed.
A semi-continuous two-stage cultivation system (SSC) using two shaker flasks in series was used for reproducing the results of the two-stage continuous cultivations described previously [10]. The SSC system had a nominal production capacity of 3 mL/h and was operated for two weeks. It consisted of a 120 mL WV shaker flask for cell production (Small Cell Bioreactor, SCB; without baffles, 5% CO2 and 185 rpm; Corning, USA), and a 65 mL WV shaker flask for influenza virus propagation (Small Virus Bioreactor, SVB). An MOI of 0.025 was used. The methodology for sampling, medium exchanges and harvesting, as well as the equations required for operating this semi-continuous cultivation system is described in detail in [6]. HA titers, TCID50 titers, and segment-specific PCR were analyzed.
Sampling and analytics
Cell concentration and viability
Concentration and viability of AGE1.CR.pIX and MDCK.SUS2 cells were determined using a ViCellTM XR cell viability analyzer (Beckman Coulter GmbH, Germany) with a standard deviation of 5% for concentration measurements [20]. Samples containing MDCK.SUS2 cells were treated with trypsin to reduce aggregation before cell counting as described previously [21].
Influenza virus titers
The total number of viral particles was determined from viral HA titration as described previously and is expressed in units of log10 (HA units/100 μL). [22]. The titer of infectious virus particles was measured using a TCID50 assay and is expressed in units of [TCID50/mL] [23]. In addition, PCR was performed for influenza A virus genome segments 1, 2, and 3 as described previously [10].
Flow cytometric analysis
The percentage of infected MDCK.SUS2 cells at the outlet of the tubular bioreactor was measured using flow cytometry (ImageStream®, Merck). A total of 0.5–1.0×106 cells were fixed with a final concentration of 2% paraformaldehyde. Cells were trypsinized for 10 min after fixing. For viral nuclear protein (NP)-staining, a protocol using two antibodies was used [24]; the wavelengths for FITC excitation/emission were 488 and 642 nm, respectively.
Productivity indicators of the cultivation systems
The productivity of the tubular system can be described with the two parameters time yield (TY) and space-time yield (STY):
Where tn is the total operational time, VirionsH,tn is the concentration of virions (estimated from HA titer assuming that 1 virus particle binds to 1 cell) of a harvest at time tn (if no harvest is taken at time tn its value is zero), and VH,tn is the harvest volume collected at time tn. Here, tubular and batch modes are compared with the assumption that the HA titer of the PFBR harvest is stable at 2.5 log10 (HA units/100 μL). This value is based on the best result obtained with suspension MDCK cells (Fig 2A, 384–432 h) and corresponds to 6.4×109 virions/mL if 1 virion binds to 1 cell. Eqs 4 and 5 were also used for the estimation of the productivity of two hypothetical batch processes in single-use or stainless steel bioreactors with the same 711 mL WV as the tubular bioreactor system. The (maximum) productivity of these hypothetical batch cultivations was estimated using the same HA titer of 2.5 log10 (HA units/100 μL). Time zero (t0) of the tubular bioreactor system was the time in which the first virus-containing PFBR harvest drop was observed (approx. 20 h after the start of the infection at the “point of infection”). Time zero of the batch processes was the time of the first virus harvest.
The total number of virus particles produced over time was derived by multiplication of the STY with the accumulated volume and culture time (corresponding to the numerator of Eq 5).
Results and discussion
Continuous influenza A virus production in suspension MDCK.SUS2 cells in the tubular bioreactor system
The first functional cultivation with the tubular bioreactor system was operated for a total of 552 h (23 days). A stable cell concentration of 5–6×106 cells/mL in the CSTR was achieved after one week of culture. The nominal RT of the PFBR was set to 20 h, however, the actual RT, determined by measuring the volume of harvest collected twice a day, was 21 h. Results for HA and TCID50 titers are depicted in Fig 2A and 2B, respectively. During the first 144 h of culture (phase 1), HA titers in the tubular bioreactor harvest were below the detection limit, and the TCID50 titers corresponded to the VS. This indicated that the virus did not replicate. Once the right conditions for virus propagation were reached, i.e. cell concentration, mixing, and pH (phase 2), an average HA titer of 1.6 log10(HA units/100 μL) and an average of 4×105 TCID50/mL were obtained from harvest bottle samples, which indicated successful virus replication. Bioreactor system operation was stable until 288 h of culture, when MDCK.SUS2 cells started to grow in agglomerates resulting in cell sedimentation and clogging at some points of the tube. Accordingly, in phase 3, the flow rates (F3, Fig 1) were increased to washout the cell clumps. This led to a change in the actual RT from 21 to 18 h in the PFBR. To keep the nominal MOI of 0.025, the VS concentration was increased to 2×105 TCID50/mL. For this phase, HA titers of approximately 2.5 log10(HA units/100 μL) and infectious virus titers up to 1×106 TCID50/mL were obtained. From 504 h of culture (phase 4), the pH value of the manually-operated CSTR bioreactor decreased from 7.2 to 6.6 (due to overnight failure of the aeration pump). This resulted in a drop in the HA titers of the system to about 0.5 log10(HA units/100 μL), and the experiment was stopped.
Impact of MOI on virus production in suspension MDCK cells
To investigate the impact of MOI on the virus titers of the PFBR harvest, different MOI were adjusted over the cultivation time. This was done by changing the VS concentration resulting in four MOI phases, as depicted in Fig 3 A (I, II, III and IV). A running CSTR with 1.2×106 MDCK.SUS2 cells/mL was fed with more cells to obtain a concentration of 5.5×106 cells/mL (0 h of culture, Fig 3A), similar to the steady-state concentration of the experiment described in 3.1. The cell concentration decreased the first 120 h of culture, possibly because the cells were of a different passage number, and a stable concentration of about 1.7×106 cells/mL was reached only after 120 h. However, the main goal of this experiment, comparison of different MOI values, was not affected by this decrease in cell concentration. The MOI shown in Fig 3A was calculated for the cell concentration, flow rates and virus concentrations at the respective time points using Eq 1. The resulting MOI of phase I, II, III and IV were 0.03, 0.1, 3 and 0.1, respectively.
In phase I (MOI = 0.03, 0–70 h), the HA titer in the harvest (closed circles) was similar to the HA titer in the VS (open circles) with values around 0.9 log10(HA units/100 μL) (Fig 3B). In phase II (MOI = 0.3, 70–150 h), the HA increased up to 1.4 log10(HA units/100 μL) in the harvest, while the HA titer in the VS was near 0.7 log10(HA units/100 μL). Phase III (MOI = 3, 150–180 h) resulted in HA titers of 2.0 log10(HA units/100 μL), while the VS had titers near 1.2 log10(HA units/100 μL). Later, in phase IV (MOI = 0.1, 180–240 h), an HA titer as high as 2.4 log10(HA units/100 μL) was obtained (216 h) before dropping to 1.6 log10(HA units/100 μL).
The results obtained with these MOI variations showed that the HA titers obtained in the PFBR harvest increase with increasing MOI at the POI. Despite having been seeded at 5.5×106 cells/mL, the concentration of MDCK.SUS2 cells in the CSTR after 120 h of culture was close to 1.7×106 cells/mL, which was at least 2-fold lower compared to the MDCK.SUS2 concentrations obtained in previous batch cultivations [21] [25]. While a maximum HA titer of 2.4 log10(HA units/100 μL) was obtained at the outlet of the PFBR at 216 h of culture, previous batch experiments have shown HA titers up to 2.9 log10(HA units/100 μL) for cell concentrations in the range of 1.9–2.3×106 cells/mL in STR and wave bioreactors [21]. However, increasing the viral titers of the continuous tubular bioreactor system is feasible with further optimization. A more specific comparison between a batch and continuous tubular bioreactor was made for AGE1.CR.pIX cells and will be presented in the following chapters. Finally, experiments with suspension MDCK cells showed that cell sedimentation in the tube can be an issue when cell agglomerates are present. Nevertheless, using high flow rates, tubular bioreactors can be operated over weeks without interruption.
For the lower MOI condition (0.03) obtained in phase I, only 16% of the cells collected at the PFBR harvest were infected (Fig 3C). In contrast, in phases II, III and IV (MOI of 0.3, 3, and 0.1, respectively) the percentage of infected cells was almost 100%. While phase I (lowest MOI condition) resulted only in an HA titer of 0.9 log10(HA units/100 μL) in the harvest, phase II, III and IV led to 1.5, 2.0 and 2.4 log10(HA units/100 μL), respectively. The HA titers obtained for high MOI conditions were similar to titers obtained in batch culture (Fig 3D). Control experiments indicated that a batch culture at 18 h post infection has about 100% of infected cells and an average HA titer of 2.2 log10(HA units/100 μL). Interestingly, despite the fact that 100% infected cells were found in the PFBR Harvest, a MOI of 3 resulted in a lower HA titer. Phase IV resulted in a HA peak titer of 2.4 log10(HA units/100 μL) at 216 h, however, the subsequent drop to 1.6 log10(HA units/100 μL) suggests that the peak might have been caused by cells infected in phase III that remained inside the tube (possible due to flow perturbation when changing the VS from phase III to IV). This result suggests that progress of infection under this condition is slower than in batch cultivations and a longer tube might be required to achieve higher titers. Hence, while operation of the tubular reactor under the actual laminar regime (Reynolds number about 30–60) allows to infect all cells at a MOI near 0.1, the RT should be increased to allow for an extension of virus spread and intracellular virus propagation to achieve batch-like titers. To use MOI below 0.1, the mixing conditions inside the tubular bioreactor have to be improved, e.g., by introducing static-mixers or mechanical mixing.
Production of influenza virus in AGE1.CR.pIX cells in batch and semi-continuous reference experiments
To determine the maximum virus titers under perfect mixing conditions, and to confirm the presence of “von Magnus effect” in serial passage, influenza virus was propagated in AGE1.CR.pIX cells in batch and semi-continuous mode. Batch cultures were infected with an MOI of 0.025. Maximum infectious virus titers were observed 18 h post infection with a value of 1.0×109 TCID50/mL. HA titers started to increase at 7 h post infection and maximum values of approximately 2.1 log10 (HA units/100 μL) were obtained at 20 h post infection (Fig 4A). Such high TCID50 titers with rather low HA values seem typical for AGE1.CR.pIX cells [26].
Influenza virus was also propagated in semi-continuous mode using the same MOI (Fig 4B). Virus levels oscillated over 450 h of culture. As in batch cultures, maximum HA titers of 2.1 log10 (HA units/100 μL) were observed at 24 h post infection, followed by a drop in the HA titers to values below the detection limit of the assay. Similarly, infectious virus titers oscillated between 1.0×109 TCID50/mL in the upper range, and 1.0×105 TCID50/mL in the lower range. Overall, the titers observed did not differ much from results obtained previously with AGE1.CR cells (the parental cell line for AGE1.CR.pIX) using an AGE1.CR-adapted influenza A/PR/8/34 virus [10].This observation suggests that maximum infectious titers are largely independent of the cultivation mode and that oscillations in the virus titers might also arise in cascades of stirred tank systems [10]. Finally, it is to be expected that in a perfectly mixed tubular bioreactor without diffusion limitations the virus concentration over the tube length should reflect that of a batch culture at different time points post infection. Hence, an ideal tubular bioreactor with perfect mixing and 20 h of nominal RT should show HA and TCID50 titers of approximately 2.1 log10(HA units/100 μL) and 1×109 TCID50/mL at the tube outlet, corresponding to results obtained at 20 h post infection for batch cultivation.
Production of influenza virus in AGE1.CR.pIX cells in the continuous tubular bioreactor system
Cell propagation
Continuous cultivations in the CSTR were started immediately after seeding AGE1.CR.pIX cells at a concentration of 1.0×106 cells/mL, named tubular cultivation A and B (Fig 5A and 5B). Maximum cell concentrations were achieved at 150 h and 200 h for cultivation A and B, respectively. In the PFBR harvest, first cells were visible after 20 h of culture for both cultivations, as expected for the selected RT. A lower cell concentration in the PFBR harvest compared to the CSTR was observed. This can be explained, in part, because of the dilution of F2 by F3 at the POI (see Fig 1).
Cell viability in the CSTR was always above 90% for both cultivations. In contrast to MDCK.SUS2 cells, no agglomerates were observed for AGE1.CR.pIX cells. In the PFBR harvest, viabilities between 40 and 90% were obtained at the beginning of tubular cultivation A and stabilized between 80–90% after 110 h of culture (Fig 5A). In tubular cultivation B, cell viabilities between 80–90% were measured in the PFBR harvest throughout the experiment (Fig 5B). Lower cell viabilities compared to the CSTR were expected in the PFBR harvest due to the cytopathic effect of an actively propagating virus in the suspension culture inside the tube. However, a less than optimal air supply (F5, Fig 1) may explain the low viabilities in the harvest of tubular cultivation A during the first 100 h (Fig 5A), where long liquid segments with lower air-to-liquid ratios were observed.
Residence time in the PFBR
With the start of cultivations, the nominal RT of the PFBR was set to 20 h and calculated for each time point (Eq 2). Tubular cultivation A, however, showed a RT of 27 h for the first 24 h of culture, which later stabilized in the range of 20–21 h (Fig 5C). Tubular cultivation B showed an oscillatory pattern of the RT that (after about 20 h) increased to 26 h RT and decreased again to 16 h RT at 225 h of culture (Fig 5D). Afterwards, these oscillations in the RT decreased and approached the nominal RT of 20 h. Visual inspection of the velocity of liquid compartments in the transparent silicone tubes confirmed differences during these RT oscillations. Additional experiments are needed to better understand the origin and impact of these oscillations in process performance. As explained in Materials and Methods, cultivation B was started with a running bioreactor that was flushed with PBS after finishing a previous experiment. The transient stop of pump 1 and 2 for addition of fresh cells in the CSTR and preparation of a fresh VS may have introduced perturbations that significantly affected the pressure inside the already running PFBR. A smooth RT profile like in cultivation A is possible when bioreactor operation is maintained without changes during process operation.
MOI in the PFBR
The nominal MOI of the tubular bioreactor system was set to 0.025 as chosen by Frensing et al. [10]. The actual MOI of tubular cultivation A (Fig 5C), was, however, 0.0068 for the first 24 h of culture; later it increased to 0.062 at 50 h of culture, and only then stabilized near 0.025. Obtaining the nominal MOI at the POI was possible, because cells in the CSTR grew to the expected concentration. Thus, no re-adjustment of the infectious titer of the VS was required.
A different situation was obtained in tubular cultivation B, where the actual MOI oscillated between 0.021 and 0.120 during the first 200 h of culture. Afterwards (200–450 h), the MOI was reduced with values between 0.032 and 0.079. This oscillation in the MOI was a result of changes in the cell concentration in the CSTR (Fig 5B at 225 h of culture), which were due to manual corrections (removal of cells from the reactor and dilution with culture medium) in an attempt to maintain the cell concentration near 6×106 cells/mL. Note that the MOI oscillation is not linked to the oscillations in the RT since Eqs 1 and 2 show that MOI and RT are independent parameters. These oscillations in the MOI should be easy to avoid if the cell growth in CSTR can be maintained at steady-state.
Virus titers in the PFBR harvest
HA and TCID50 virus titers were measured in the PFBR harvest twice a day (Fig 6A). In tubular cultivation A, HA titers were below the detection limit for the first 60 h and gradually increased after 100 h of culture to values near 1.9 log10(HA units/100 μL) to finally stabilize at around 1.6 log10(HA units/100 μL) for the rest of the experiment. In the tubular cultivation B (Fig 6B), virus production was observed earlier and an HA value of 1.8 log10(HA units/100 μL) was measured at 50 h of culture. Afterwards, HA titers fluctuated between 0.9 and 1.5 log10(HA units/100 μL) and reached a steady-state after 200 h of culture at values near 1.1 log10(HA units/ 100 μL). This correlated with a decrease of oscillations in MOI and RT.
Infectious virus titers were measured in the PFBR harvest and in the VS bottle. The VS of tubular cultivation A was maintained at values between 0.9×104 and 1.8×105 TCID50/mL during the whole cultivation (Fig 6C). The first infectious titer measured in the PFBR harvest was 1.8×104 TCID50/mL and increased to a maximum of 5×107 TCID50/mL at 150 h of culture. The infectious titer at the PFBR harvest dropped at 150 h and finally stabilized near a value of 1.0×107 TCID50/mL. In tubular cultivation B, the VS was adjusted initially to an infectious titer of 5×104 TCID50/mL (Fig 6D) and maintained afterwards at 1×104 TCID50/mL. Surprisingly, the TCID50 in the PFBR harvest was initially below the limit of quantification (1x103 TCID50/mL) for the first 48 h. Then, the infectious titer increased to 1.0×107 TCID50/mL to finally stabilize near 1.0×106 TCID50/mL.
Overall, the HA titers in the PFBR harvest reached an average value of 1.6 log10(HA units/ 100 μL) and 1.1 log10(HA units/100 μL) in tubular cultivations A and B, respectively. Compared to virus titer values observed in batch mode (20 h post infection), the HA of the PFBR harvests was clearly reduced (Fig 4B) and corresponded to batch titers expected between 10 and 15 h post infection (Fig 4A). Results indicate that virus propagation in the PFBR was not optimal. Besides virus diffusion limitations, resulting in poor cell-to-cell spreading, other parameters such as the pH inside the tubes and drop in oxygen partial pressure in cell-containing compartments might be relevant. Hence, installing monitoring and controlling ports of dissolved oxygen, pH and metabolite concentration along the PFBR may be useful in future designs, particularly for longer residence times, to ensure oxygen and nutrient supply to the cells. With a Reynolds number in the range 30–60, which corresponds to a laminar regime, and the absence of mechanical mixing, mass transfer is expected to be diffusion limited. Therefore, improving the PFBR harvest titers will require a further optimization of the infection conditions and the tube length. In addition, measures to improve mixing at the POI and along the tube, e.g., passive or static mixing, and incorporation of a vibration or agitation platform should be investigated [27].
The dynamics of the infectious titer in the PFBR harvest was characterized by an initial drop, followed by an increase to values near 1.0×107 and 1.0×106 TCID50/mL for tubular cultivation A and B, respectively. At the beginning of cultivations, a similar infectious titer in the harvest and in the VS was measured for up to 60 h. This was an indication of reduced virus replication inside the tube following the bioreactor start-up phase. Afterwards, a TCID50 increase of up to three orders of magnitude was achieved compared to the TCID50 in the VS.
Dynamics of replication of influenza virus gene segments 1, 2 and 3
Non-quantitative PCR was used to analyze the dynamics of replication of gene segments 1, 2 and 3 of influenza virus propagated in batch and semi-continuous cultures and the continuous tubular bioreactor system (Fig 7). The PCR assay shows bands of FL segments, and defective segments (segments with deletions, DS) near 2000 bp and 500 bp, respectively.
In batch cultures (Fig 7A), FL segments near 2000 bp were observed for all three genes between 0 and 24 h post infection. Interestingly, a defective segment (less than 2000 bp) was observed at 0 h post infection for segment 2. Later, at 7 h post infection, two bands were observed in the gel, and finally a FL segment with 2000 bp size only (20 h post infection). In general, deletions near 500 bp were generated in all three segments in batch mode, with segment 2 most prone for deletions in the range of 500–2000 bp.
Semi-continuous cultures were maintained for a period of 450 h (Fig 7B). This cultivation mode was selected as a small-scale approach mimicking a true continuous cascade of CSTRs [6]. A more pronounced periodic change in the ratios of FL to respective defective segment was observed when compared to the PCR measurements performed in batch cultures. The PCR signals for all three studied segments appear to oscillate in parallel, most likely due to the interference of FL genome replication by DIPs, and dependence of DIP replication on the presence of the FL segments. A similar replication dynamic was described previously [10] also for cascades of CSTR.
For segment 2, additional copies with a short deletion only (near 2000 bp) were observed at 0, 130, 220, and 320 h post infection that coincides with the results obtained for batch cultures (0 and 7 h post infection, Fig 7A). Whether the parallel oscillations of the various DS segments are due to co-packaging of minor deletions with one dominant genotype, or whether all segments with deletions each can interfere with standard virus replication is not clear yet.
All combined, the control experiments strongly suggest again that a drop in virus titers due to the “von Magnus effect” is a frequent observation in cascades of CSTR for the cell and influenza A virus system analyzed here.
Segment-specific PCR analysis of the virus produced in the continuous tubular bioreactor system (PFBR harvest of tubular cultivation A) is depicted in Fig 7C for a production time of almost 500 h. For this cultivation regime, a surprisingly constant pattern of FL bands was observed for all three segments over the whole duration of the experiment. This pattern differed substantially from the one observed for batch or semi-continuous cultures and suggests the absence of periodic DS dynamics.
Nevertheless, two bands were observed for segment 2 over the whole cultivation period, which was in line with the results observed at early time points post infection in batch culture, as well as for various time points in semi-continuous cultures with infectious titers lower than 1×107 TCID50/mL. Assuming that a biological reaction in an ideal well-mixed PFBR follows a batch-like dynamic over the tube length [28], this result indicates that virus spreading and/or intracellular virus replication cycles were not fully completed in the PFBR. Such an effect would suggest that the PFBR is diffusion-limited and, therefore, optimization of MOI and RT (tube length) may be beneficial.
Nevertheless, the continuous tubular bioreactor system provides a virus harvest with a defined virus passage number (in this case, passage number of VS plus one if defined as culture-to-culture transfer) avoiding the accumulation of large numbers of virus segments with deletions, and possible interference with standard virus replication compared to cascades of CSTRs.
Productivity of the tubular bioreactor system versus batch
The productivity of the tubular bioreactor system can be compared against two hypothetical batch processes, one single-use batch (96 h total production time without cleaning step) and one stainless steel batch process (120 h total production time including 1 day for cleaning and maintenance), in three different scenarios:
First scenario: The tubular bioreactor system and the batch processes have the same working volume and are started at the same time
The total number of influenza virus particles produced (STY multiplied by the accumulated volume and the culture time) is shown in Fig 8. For all cultivation systems a 711 mL WV was considered. For the first batch cycle (normalized to 0 h of culture), both batch processes resulted in a higher number of virus particles than the tubular system. In the second batch cycle, the single-use batch process provided more viruses than the tubular system, and the stainless steel batch provided the same number of virus particles as the tubular system. In the third batch cycle, the tubular system provided a similar number of viruses than the single-use batch process and more viruses than the stainless steel batch bioreactor. This estimation suggests that the batch process can be as efficient as the tubular system for up to two or three batch cycles, depending on whether cleaning and maintenance procedures can be avoided or not. If production exceeds three batch cycles, a tubular system can be more efficient than batch cultures, regardless of the type of batch bioreactors. Note that the concentration of the product in the harvest was assumed to be the same for both production platforms. Hence, the major advantage of the tubular system is the lower time requirement to achieve the same total amount of virus particles.
Second scenario: Production of ten times the bioreactor working volume
The production yields of ten times the bioreactor WV with the tubular system and a batch of identical WV (711 mL) was compared. The TY and the STY are shown in Table 1. The TY and the STY of the tubular system were estimated as 7.7×1010 virions/h and 1.4×1010 virions/(L×h), respectively. The TY and the STY of the single-use batch process were 4.7×1010 virions/h and 8.2×109 virions/(L×h), respectively. The TY and the STY of the stainless steel batch process were 3.8×1010 virions/h and 6.6×109 virions/(L×h), respectively. As addressed before, while the tubular system needs only 592 h to reach the target volume, the single-use and the stainless steel batch processes require 959 and 1198 h, respectively. Hence, the TY and the STY values of the tubular bioreactor system are approx. two-fold higher.
Third scenario: Scale-up for production of 1000 liters or more
The continuous tubular bioreactor system developed in this work can be scaled-up while keeping three parameters constant: dilution rate in the CSTR, ratio of F3/F2 (Fig 1), and linear flow velocity in the PFBR (approx. 10 cm/min). Operated at a dilution rate of 0.018 h-1 and with a ratio of F3/F2 = 0.333, a 50 L CSTR would produce cells at a rate of F2 = 0.9 L/h (Fig 1) which will be infected with F3 = 0.3 L/h. This would result in a total production rate of F7 = 1.3 L/h. Regarding the scale-up of the PFBR, the linear velocity inside the tube (volumetric flow rate = velocity × cross-sectional area) can be maintained constant if a 105 m long PFBR with an internal diameter of 2.0–2.5 cm is used. Such 50 L scale tubular bioreactor system would produce 1000 L in 32 days. Alternatively, a tubular bioreactor system built with a 100 L CSTR could produce 1000 L in about 17 days (F7 = 2.4 L/h).
Conclusions
A continuous tubular bioreactor system for production of influenza A virus using the suspension cell lines MDCK.SUS2 and AGE1.CR.pIX was established successfully. The culture format resembles successive bursts of defined single-passage batch processes, where each “batch unit” is compartmentalized by air bubbles. The bioreactor system has a total working volume of 711 mL, requires 1 m2 of surface area, and was built using a 105 m long tubular bioreactor. Reynolds numbers between 30 and 60 suggest a laminar regime inside the tube. The bioreactor showed a robust operation over at least three weeks at a nominal flow rate of 0.2 mL/min. As a result, production of 12-times the bioreactor working volume would be possible within one month.
Influenza A/PR/8/34 (RKI) virus was produced successfully with AGE1.CR.pIX cells in two tubular cultivations with 18 days of operation at a nominal MOI of 0.025. Stable HA titers of up to 1.6 log10(HA units/100 μL) and infectious titers of up to 1×107 TCID50/mL were obtained. PCR analysis of influenza segments 1, 2 and 3 showed that accumulation of defective particles was not significant, and that the “von Magnus effect” can be avoided in such a tubular bioreactor system.
Flow cytometric studies using the suspension cell line MDCK.SUS2 showed that only 16% of the cell population was infected at an MOI of 0.03. At MOI above 0.1 almost all cells were infected and batch-like HA titers were obtained, suggesting that determination of optimal residence time and diffusion within the compartments may be limiting factors. Future designs may improve diffusion by via passive mixing, incorporation of static-mixers or mechanical agitation.
A productivity comparison showed that a continuous tubular bioreactor system can achieve a time-yield and a space-time-yield about two-fold higher than a batch process. Hence, this continuous bioreactor technology can help to increase the volumetric productivity of manufacturing facilities and reduce the footprint of cell culture-based influenza vaccine manufacturing. The evaluation of additional influenza strains in terms of bioreactor infection parameters (infection time, infection cell density, MOI, trypsin amount and temperature), and viral aggregation performance can be considered in future developments. Also, comparing PFBR yields against batch bioreactors across different strains, especially for those flu strains with low production yields, would be an interesting next step to examine. The design presented here prevents the accumulation of defective particles that often accompany the production of an inherently unstable RNA virus. Hence, this continuous and yet single-passage reactor design may also be applicable for production of other cell-based viral vaccines, as well as viral vectors for gene and cancer therapy, provided that the respective viruses can be propagated in suspension cells.
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2019 Číslo 11
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- The impact of hepatic steatosis on portal hypertension
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- School-based obesity prevention for busy low-income families—Organisational and personal barriers and facilitators to implementation
- Neighborhood crime, disorder and substance use in the Caribbean context: Jamaica National Drug Use Prevalence Survey 2016
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- Questioning the lasting effect of galvanic vestibular stimulation on postural control
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- The mutational landscape of quinolone resistance in Escherichia coli
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- Study on the damage characteristics of gas-bearing shale under different unloading stress paths
- EPILAT-IRA Study: A contribution to the understanding of the epidemiology of acute kidney injury in Latin America
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- Development of a novel automatable fabrication method based on electrospinning co electrospraying for rotator cuff augmentation patches
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- Cyclosporine A eyedrops with self-nanoemulsifying drug delivery systems have improved physicochemical properties and efficacy against dry eye disease in a murine dry eye model
- LFastqC: A lossless non-reference-based FASTQ compressor
- Highly accurate prediction of flammability limits of chemical compounds using novel integrated hybrid models
- Nonsteroidal anti-inflammatory drugs and acetaminophen ameliorate muscular mechanical hyperalgesia developed after lengthening contractions via cyclooxygenase-2 independent mechanisms in rats
- A popular Indian clove-based mosquito repellent is less effective against Culex quinquefasciatus and Aedes aegypti than DEET
- Yeasts affect tolerance of Drosophila melanogaster to food substrate with high NaCl concentration
- The effect of climate change on cholera disease: The road ahead using artificial neural network
- Grit (effortful persistence) can be measured with a short scale, shows little variation across socio-demographic subgroups, and is associated with career success and career engagement
- Micro-dislodgement during transcatheter aortic valve implantation with a contemporary self-expandable prosthesis
- Improving the antimicrobial efficacy against resistant Staphylococcus aureus by a combined use of conjugated oligoelectrolytes
- Kin discrimination and outer membrane exchange in Myxococcus xanthus: Experimental analysis of a natural population
- Inflammatory cell infiltrates, hypoxia, vascularization, pentraxin 3 and osteoprotegerin in abdominal aortic aneurysms – A quantitative histological study
- Effects of virtual reality rehabilitation training on gait and balance in patients with Parkinson's disease: A systematic review
- Serum miR-33a is associated with steatosis and inflammation in patients with non-alcoholic fatty liver disease after liver transplantation
- Association between housing tenure and self-rated health in Japan: Findings from a nationwide cross-sectional survey
- Investigation of biochemical and physiological parameters of the newborn Saiga antelope (Saiga tatarica) in Gansu Province, China
- One-year follow-up of changes in refraction and aberrations induced by corneal incision
- Evaluation of upper limb superficial venous percussion as a sign of anatomical location and venous permeability. A comparative study of superficial venous percussion to ultrasound findings on non-renal patients and on chronic kidney disease patients
- An assessment of the Dutch experience with health insurers acting as healthcare advisors
- Perception of potential harm and benefits of HIV vaccine trial participation: A qualitative study from urban Tanzania
- Veterans with Gulf War Illness exhibit distinct respiratory patterns during maximal cardiopulmonary exercise
- Deep brain stimulation restores the glutamatergic and GABAergic synaptic transmission and plasticity to normal levels in kindled rats
- Metformin strongly affects transcriptome of peripheral blood cells in healthy individuals
- Cranberry extracts promote growth of Bacteroidaceae and decrease abundance of Enterobacteriaceae in a human gut simulator model
- Long-term retention on antiretroviral therapy among infants, children, adolescents and adults in Malawi: A cohort study
- Histochemical quantification of collagen content in articular cartilage
- Optogenetically transduced human ES cell-derived neural progenitors and their neuronal progenies: Phenotypic characterization and responses to optical stimulation
- Ion torrent high throughput mitochondrial genome sequencing (HTMGS)
- Outpatient antibiotic prescription rate and pattern in the private sector in India: Evidence from medical audit data
- Acute Influenza A virus outbreak in an enzootic infected sow herd: Impact on viral dynamics, genetic and antigenic variability and effect of maternally derived antibodies and vaccination
- Prevalence and correlates of low serum calcium in late pregnancy: A cross sectional study in the Nkongsamba Regional Hospital; Littoral Region of Cameroon
- Home-cage monitoring ascertains signatures of ictal and interictal behavior in mouse models of generalized seizures
- CRISPR/Cas9 gene editing in the West Nile Virus vector, Culex quinquefasciatus Say
- Genetic susceptibility to angiotensin-converting enzyme-inhibitor induced angioedema: A systematic review and evaluation of methodological approaches
- Proton pump inhibitor use increases the risk of peritonitis in peritoneal dialysis patients
- Comparative distribution of extended-spectrum beta-lactamase–producing Escherichia coli from urine infections and environmental waters
- Sex differences in thigh muscle volumes, sprint performance and mechanical properties in national-level sprinters
- Maternal serum and cord blood leptin concentrations at delivery
- Winter nitrification in ice-covered lakes
- Intolerance of uncertainty fuels depressive symptoms through rumination: Cross-sectional and longitudinal studies
- Monitoring exercise-induced muscle damage indicators and myoelectric activity during two weeks of knee extensor exercise training in young and old men
- Can adoption of pollution prevention techniques reduce pollution substitution?
- The association between self-efficacy and self-management behaviors among Chinese patients with type 2 diabetes
- Poly-arginine-18 peptides do not exacerbate bleeding, or improve functional outcomes following collagenase-induced intracerebral hemorrhage in the rat
- Affective disorders in the elderly in different European countries: Results from the MentDis_ICF65+ study
- Evaluation of forearm vascular resistance during orthostatic stress: Velocity is proportional to flow and size doesn’t matter
- Proton pencil minibeam irradiation of an in-vivo mouse ear model spares healthy tissue dependent on beam size
- Maternal stress in Shank3ex4-9 mice increases pup-directed care and alters brain white matter in male offspring
- Aspartate aminotransferase-to-platelet ratio index (APRI): A potential marker for diagnosis in patients at risk of severe malaria caused by Plasmodium vivax
- Exploiting open source 3D printer architecture for laboratory robotics to automate high-throughput time-lapse imaging for analytical microbiology
- Long non-coding RNAs and latent HIV – A search for novel targets for latency reversal
- Clinical characteristics of neonatal fulminant necrotizing enterocolitis in a tertiary Children's hospital in the last 10 years
- Effects of neuromuscular electrical stimulation training on muscle size in collegiate track and field athletes
- Adaptive fuzzy flow rate control considering multifractal traffic modeling and 5G communications
- Evaluation of four commercial tests for detecting ceftiofur in waste milk bulk tank samples
- A smart tele-cytology point-of-care platform for oral cancer screening
- Vasopressin SNP pain factors and stress in sickle cell disease
- Carbonate production of Micronesian reefs suppressed by thermal anomalies and Acanthaster as sea-level rises
- Microbial metabolisms in an abyssal ferromanganese crust from the Takuyo-Daigo Seamount as revealed by metagenomics
- Incidence of chronic kidney disease hospitalisations and mortality in Espírito Santo between 1996 to 2017
- The impact of short-term machine perfusion on the risk of cancer recurrence after rat liver transplantation with donors after circulatory death
- Proteomic profiling of the thrombin-activated canine platelet secretome (CAPS)
- Blood metal levels and serum testosterone concentrations in male and female children and adolescents: NHANES 2011–2012
- The effects of prolonged single night session of videogaming on sleep and declarative memory
- Diversity, distribution and dynamics of large trees across an old-growth lowland tropical rain forest landscape
- Mapping developmental QTL for plant height in soybean [Glycine max (L.) Merr.] using a four-way recombinant inbred line population
- Vaginal ring acceptability and related preferences among women in low- and middle-income countries: A systematic review and narrative synthesis
- UM171 induces a homeostatic inflammatory-detoxification response supporting human HSC self-renewal
- Positive selection and precipitation effects on the mitochondrial NADH dehydrogenase subunit 6 gene in brown hares (Lepus europaeus) under a phylogeographic perspective
- Evaluation of Minimum Inhibitory Concentrations for 154 Mycoplasma synoviae isolates from Italy collected during 2012-2017
- Enhancement of antibiotics antimicrobial activity due to the silver nanoparticles impact on the cell membrane
- Correction: Smoking, alcohol use disorder and tuberculosis treatment outcomes: A dual co-morbidity burden that cannot be ignored
- Correction: Effect of corruption on perceived difficulties in healthcare access in sub-Saharan Africa
- Knowledge-based best of breed approach for automated detection of clinical events based on German free text digital hospital discharge letters
- Importance of thorough tissue and cellular level characterization of targeted drugs in the evaluation of pharmacodynamic effects
- Integrated value-chain and risk assessment of Pig-Related Zoonoses in Ghana
- Failed sperm retrieval from severely oligospermic or non-obstructive azoospermic patients on oocyte retrieval day: Emergent oocyte cryopreservation is a feasible strategy
- Cassava yield traits predicted by genomic selection methods
- Verification of hub genes in the expression profile of aortic dissection
- Pig farmers’ willingness to pay for management strategies to reduce aggression between pigs
- Metabolomic response of Euglena gracilis and its bleached mutant strain to light
- Diagnostic value of ASVS for insulinoma localization: A systematic review and meta-analysis
- Newly educated care managers’ experiences of providing care for persons with stress-related mental disorders in the clinical primary care context
- Real-time telemetry monitoring of oxygen in the central complex of freely-walking Gromphadorhina portentosa
- Qualification programmes for immigrant health professionals: A systematic review
- An analytical model to minimize the latency in healthcare internet-of-things in fog computing environment
- Grain filling of early-season rice cultivars grown under mechanical transplanting
- Intercalation of small molecules into DNA in chromatin is primarily controlled by superhelical constraint
- Correlative evidence for co-regulation of phosphorus and carbon exchanges with symbiotic fungus in the arbuscular mycorrhizal Medicago truncatula
- How to design a dose-finding study on combined agents: Choice of design and development of R functions
- Altered expression of Notch1 in Alzheimer's disease
- The ZJU index is a powerful surrogate marker for NAFLD in severely obese North American women
- Trunk velocity-dependent Light Touch reduces postural sway during standing
- Evaluation of cytological diagnostic accuracy for canine splenic neoplasms: An investigation in 78 cases using STARD guidelines
- Trade-offs in motivating volunteer effort: Experimental evidence on voluntary contributions to science
- Does caching strategy vary with microclimate in endangered Mt. Graham red squirrels?
- Assessment of energy expenditure during high intensity cycling and running using a heart rate and activity monitor in young active adults
- Evaluating rectal swab collection method for gut microbiome analysis in the common marmoset (Callithrix jacchus)
- Implementation of a screening, brief intervention and referral to treatment programme for risky substance use in South African emergency centres: A mixed methods evaluation study
- Can the CalproQuest predict a positive Calprotectin test? A prospective diagnostic study
- The calcium sensor OsCBL1 modulates nitrate signaling to regulate seedling growth in rice
- Acceptability of and treatment preferences for recurrent bacterial vaginosis—Topical lactic acid gel or oral metronidazole antibiotic: Qualitative findings from the VITA trial
- Mathematical determination of the HIV-1 matrix shell structure and its impact on the biology of HIV-1
- Contingent negative variation during a modified cueing task in simulated driving
- CAMDI interacts with the human memory-associated protein KIBRA and regulates AMPAR cell surface expression and cognition
- Effect of feeding patterns on growth and nutritional status of children aged 0-24 months: A Chinese cohort study
- A fecal sequel: Testing the limits of a genetic assay for bat species identification
- Measuring the impact of chronic conditions and associated multimorbidity on health-related quality of life in the general population in Hong Kong SAR, China: A cross-sectional study
- Short and long-term clinical effectiveness and cost-effectiveness of a late-phase community-based balance and gait exercise program following hip fracture. The EVA-Hip Randomised Controlled Trial
- Vaccine cold chain in general practices: A prospective study in 75 refrigerators (Keep Cool study)
- Brazilian norms for the Bank of Standardized Stimuli (BOSS)
- Distinct varieties of aesthetic chills in response to multimedia
- Interaction between apolipoprotein E genotype and hypertension on cognitive function in older women in the Nurses’ Health Study
- Correction: Resistance profile of the HIV-1 maturation inhibitor GSK3532795 in vitro and in a clinical study
- New formulation of the Gompertz equation to describe the kinetics of untreated tumors
- Development of visual perception of others’ actions: Children’s judgment of lifted weight
- Retrospective comparative analysis of intraocular lens calculation formulas after hyperopic refractive surgery
- Human vitreous concentrations of citicoline following topical application of citicoline 2% ophthalmic solution
- Development and validation of exhaled breath condensate microRNAs to identify and endotype asthma in children
- Arthroscopic release for frozen shoulder: Does the timing of intervention and diabetes affect outcome?
- Risk factors affecting dairy cattle protective grouping behavior, commonly known as bunching, against Stomoxys calcitrans (L.) on California dairies
- Acceleration of chemical shift encoding-based water fat MRI for liver proton density fat fraction and T2* mapping using compressed sensing
- Characterisation and microbial community analysis of lipid utilising microorganisms for biogas formation
- Sexuality in male partners of women with fibromyalgia syndrome: A qualitative study
- Exploring optimization strategies for improving explicit water models: Rigid n-point model and polarizable model based on Drude oscillator
- Artificial insemination with fresh, liquid stored and frozen thawed semen in dromedary camels
- Moving into an urban drug scene among people who use drugs in Vancouver, Canada: Latent class growth analysis
- Numerical study on the start and unstart phenomena in a scramjet inlet-isolator model
- Effects of dietary supplementation with apple peel powder on the growth, blood and liver parameters, and transcriptome of genetically improved farmed tilapia (GIFT, Oreochromis niloticus)
- Urban growth simulation in different scenarios using the SLEUTH model: A case study of Hefei, East China
- Chronic bronchitis without airflow obstruction, asthma and rhinitis are differently associated with cardiovascular risk factors and diseases
- Factors associated with medication adherence among people with diabetes mellitus in poor urban areas of Cambodia: A cross-sectional study
- Mammary microbiome of lactating organic dairy cows varies by time, tissue site, and infection status
- Force field generalization and the internal representation of motor learning
- Polyphenism of visual and chemical secondary sexually-selected wing traits in the butterfly Bicyclus anynana: How different is the intermediate phenotype?
- Minimal genetic differentiation of the malaria vector Nyssorhynchus darlingi associated with forest cover level in Amazonian Brazil
- The impact of leisure activities on older adults’ cognitive function, physical function, and mental health
- scafSLICR: A MATLAB-based slicing algorithm to enable 3D-printing of tissue engineering scaffolds with heterogeneous porous microarchitecture
- Association of serum leptin and adiponectin concentrations with echocardiographic parameters and pathophysiological states in patients with cardiovascular disease receiving cardiovascular surgery
- Operation of cognitive memory inhibition in adults with Down syndrome: Effects of maintenance load and material
- Influences on surgical antimicrobial prophylaxis decision making by surgical craft groups, anaesthetists, pharmacists and nurses in public and private hospitals
- Post-treatment Lyme disease symptoms score: Developing a new tool for research
- Expression of Concern: The Role of the RACK1 Ortholog Cpc2p in Modulating Pheromone-Induced Cell Cycle Arrest in Fission Yeast
- Equine bronchial fibroblasts enhance proliferation and differentiation of primary equine bronchial epithelial cells co-cultured under air-liquid interface
- Investigating cooperation with robotic peers
- Synthesis, purification and crystallization of a putative critical bulge of HAR1 RNA
- Prosthetic push-off power in trans-tibial amputee level ground walking: A systematic review
- A case study of the use of verbal reports for talent identification purposes in soccer: A Messi affair!
- Transgenerational deep sequencing revealed hypermethylation of hippocampal mGluR1 gene with altered mRNA expression of mGluR5 and mGluR3 associated with behavioral changes in Sprague Dawley rats with history of prolonged febrile seizure
- Obesity is associated with an impaired survival in lymphoma patients undergoing autologous stem cell transplantation
- Periodontal disease: Repercussions in pregnant woman and newborn health—A cohort study
- Origins of Chinese reindeer (Rangifer tarandus) based on mitochondrial DNA analyses
- Regional, racial, gender, and tumor biology disparities in breast cancer survival rates in Africa: A systematic review and meta-analysis
- How effective are films in inducing positive and negative emotional states? A meta-analysis
- 3D nanostructural characterisation of grain boundaries in atom probe data utilising machine learning methods
- An outbreak of tuberculosis in a middle school in Henan, China: Epidemiology and risk factors
- Initial clinical radiological findings and staging to predict prognosis of primary hepatic angiosarcoma: A retrospective analysis
- A new early Eocene deperetellid tapiroid illuminates the origin of Deperetellidae and the pattern of premolar molarization in Perissodactyla
- Longevity and marginal bone loss of narrow-diameter implants supporting single crowns: A systematic review
- Impact of UVC-sustained recirculating air filtration on airborne bacteria and dust in a pig facility
- Cold-related Florida manatee mortality in relation to air and water temperatures
- Conceptual fluency in inductive reasoning
- Clinical outcomes and treatment patterns among Medicare patients with nonvalvular atrial fibrillation (NVAF) and chronic kidney disease
- Improvements in the learnability of smartphone haptic interfaces for visually impaired users
- Role of the malic enzyme in metabolism of the halotolerant methanotroph Methylotuvimicrobium alcaliphilum 20Z
- Cyclic loading test study on a new cast-in-situ insulated sandwich concrete wall
- Natural compounds as angiogenic enzyme thymidine phosphorylase inhibitors: In vitro biochemical inhibition, mechanistic, and in silico modeling studies
- Analysis of virulence potential of Escherichia coli O145 isolated from cattle feces and hide samples based on whole genome sequencing
- Pre-clinical medical student reflections on implicit bias: Implications for learning and teaching
- Prognostic significance of non-sustained ventricular tachycardia on stored electrograms in pacemaker recipients
- Determinants of preterm birth among mothers who gave birth at public hospitals in the Amhara region, Ethiopia: A case-control study
- Real-world evidence of the effectiveness of ombitasvir-paritaprevir/r ± dasabuvir ± ribavirin in patients monoinfected with chronic hepatitis C or coinfected with human immunodeficiency virus-1 in Spain
- Unique transcriptomic landscapes identified in idiopathic spontaneous and infection related preterm births compared to normal term births
- Restrained expansion of the recall germinal center response as biomarker of protection for influenza vaccination in mice
- Arabidopsis TRM5 encodes a nuclear-localised bifunctional tRNA guanine and inosine-N1-methyltransferase that is important for growth
- Achievement of weight loss in patients with overweight during dietetic treatment in primary health care
- Autophagy deficiency exacerbates colitis through excessive oxidative stress and MAPK signaling pathway activation
- The impacts of parity on lung function data (LFD) of healthy females aged 40 years and more issued from an upper middle income country (Algeria): A comparative study
- Reorganization of spatial configurations in visual working memory: A matter of set size?
- Unravelling travellers’ route choice behaviour at full-scale urban network by focusing on representative OD pairs in computer experiments
- Evaluating the higher-order structure of the Profile of Emotional Competence (PEC): Confirmatory factor analysis and Bayesian structural equation modeling
- HIV prevalence and correlated factors among male clients of female sex workers in a border region of China
- Next generation sequencing and RNA-seq characterization of adipose tissue in the Nile crocodile (Crocodylus niloticus) in South Africa: Possible mechanism(s) of pathogenesis and pathophysiology of pansteatitis
- Association between advanced maternal age and maternal and neonatal morbidity: A cross-sectional study on a Spanish population
- Ethnic differences in the prevalence, socioeconomic and health related risk factors of knee pain and osteoarthritis symptoms in older Malaysians
- Increasing knowledge of HIV status in a country with high HIV testing coverage: Results from the Botswana Combination Prevention Project
- Friends with benefits: The effects of vegetative shading on plant survival in a green roof environment
- Comparison of the fecal, cecal, and mucus microbiome in male and female mice after TNBS-induced colitis
- Identifying candidate diagnostic markers for early stage of non-small cell lung cancer
- Complex alternative splicing of human Endonuclease V mRNA, but evidence for only a single protein isoform
- Correction: KML001 Induces Apoptosis and Autophagic Cell Death in Prostate Cancer Cells via Oxidative Stress Pathway
- Unique developmental trajectories of risk behaviors in adolescence and associated outcomes in young adulthood
- Enhanced fibrinolysis detection in a natural occurring canine model with intracavitary effusions: Comparison and degree of agreement between thromboelastometry and FDPs, D-dimer and fibrinogen concentrations
- Overexpression of Saussurea involucrata dehydrin gene SiDHN promotes cold and drought tolerance in transgenic tomato plants
- Foxtail millet (Setaria italica (L.) P. Beauv) CIPKs are responsive to ABA and abiotic stresses
- Autonomous drone hunter operating by deep learning and all-onboard computations in GPS-denied environments
- Heterogeneity Diffusion Imaging of gliomas: Initial experience and validation
- Frequency cluster formation and slow oscillations in neural populations with plasticity
- DHP23002 as a next generation oral paclitaxel formulation for pancreatic cancer therapy
- Diagnostic accuracy of SOX11 immunohistochemistry in mantle cell lymphoma: A meta-analysis
- Analytical solution to swing equations in power grids
- Pathways to conspiracy: The social and linguistic precursors of involvement in Reddit’s conspiracy theory forum
- Spatiotemporally random and diverse grid cell spike patterns contribute to the transformation of grid cell to place cell in a neural network model
- Empathic concern and personal distress depend on situational but not dispositional factors
- Who is more susceptible to job stressors and resources? Sensory-processing sensitivity as a personal resource and vulnerability factor
- Cost-effectiveness of integrating postpartum antiretroviral therapy and infant care into maternal & child health services in South Africa
- A substitution mutation in a conserved domain of mammalian acetate-dependent acetyl CoA synthetase 2 results in destabilized protein and impaired HIF-2 signaling
- One step at a time: Physical activity is linked to positive interpretations of ambiguity
- Calreticulin regulates vascular endothelial growth factor-A mRNA stability in gastric cancer cells
- Evaluation of various methods of selection of B. subtilis strains capable of secreting surface-active compounds
- Association between US Pharmacopeia (USP) monograph standards, generic entry and prescription drug costs
- Molecular characterisation of the synovial fluid microbiome in rheumatoid arthritis patients and healthy control subjects
- On sorption hysteresis in wood: Separating hysteresis in cell wall water and capillary water in the full moisture range
- Inbreeding, Allee effects and stochasticity might be sufficient to account for Neanderthal extinction
- Reliability and construct validity of the stepping-forward affordance perception test for fall risk assessment in community-dwelling older adults
- Socioeconomic determinants of nutritional status among ‘Baiga’ tribal children In Balaghat district of Madhya Pradesh: A qualitative study
- Study on characteristics of fire plume in building facade window under lateral blow
- ‘When you talk to someone in a bad way or always put her under pressure, it is actually worse than beating her’: Conceptions and experiences of emotional intimate partner violence in Rwanda and South Africa
- Effects of 6-mercaptopurine in pressure overload induced right heart failure
- The association between haemoglobin levels in the first 20 weeks of pregnancy and pregnancy outcomes
- Implementation and evaluation of an antimicrobial stewardship programme in companion animal clinics: A stepped-wedge design intervention study
- Factors associated with persistently high-cost health care utilization for musculoskeletal pain
- Nitrogen and chlorophyll status determination in durum wheat as influenced by fertilization and soil management: Preliminary results
- Effect of repeated in vivo microCT imaging on the properties of the mouse tibia
- Coupling environment and physiology to predict effects of climate change on the taxonomic and functional diversity of fish assemblages in the Murray-Darling Basin, Australia
- Hematology and plasma biochemistries in the Blanding’s turtle (Emydoidea blandingii) in Lake County, Illinois
- CRISPR-Cas influences the acquisition of antibiotic resistance in Klebsiella pneumoniae
- Phosphorylation-dependent activity-based conformational changes in P21-activated kinase family members and screening of novel ATP competitive inhibitors
- Antidepressant prescriptions, discontinuation, depression and perinatal outcomes, including breastfeeding: A population cohort analysis
- Why men with a low-risk prostate cancer select and stay on active surveillance: A qualitative study
- Imported severe malaria and risk factors for intensive care: A single-centre retrospective analysis
- Combined treatment (image-guided thrombectomy and endovascular therapy with open femoral access) for acute lower limb ischemia: Clinical efficacy and outcomes
- Low-latency single channel real-time neural spike sorting system based on template matching
- Quantifying the scale effect in geospatial big data using semi-variograms
- Paper-and-pencil versus computerized administration mode: Comparison of data quality and risk behavior prevalence estimates in the European school Survey Project on Alcohol and other Drugs (ESPAD)
- Regression adjusted colocalisation colour mapping (RACC): A novel biological visual analysis method for qualitative colocalisation analysis of 3D fluorescence micrographs
- Ostrich eggshell bead diameter in the Holocene: Regional variation with the spread of herding in eastern and southern Africa
- Spatial and temporal variations in female size at maturity of a Southern Rock Lobster (Jasus edwardsii) population: A likely response to climate change
- Inactive USP14 and inactive UCHL5 cause accumulation of distinct ubiquitinated proteins in mammalian cells
- Training rhesus macaques to take daily oral antiretroviral therapy for preclinical evaluation of HIV prevention and treatment strategies
- Left ventricular structural and functional changes in Friedreich ataxia – Relationship with body size, sex, age and genetic severity
- Magnitude and factors associated with anemia among pregnant women attending antenatal care in Bench Maji, Keffa and Sheka zones of public hospitals, Southwest, Ethiopia, 2018: A cross -sectional study
- Effectiveness of telerehabilitation in the management of adults with stroke: A systematic review
- Hydrogen sulphide-induced hypometabolism in human-sized porcine kidneys
- Correction: Comparison of the molecular properties of retinitis pigmentosa P23H and N15S amino acid replacements in rhodopsin
- Retraction: Regulation of gastric smooth muscle contraction via Ca2+-dependent and Ca2+-independent actin polymerization
- Evaluation of neutral oral contrast agents for assessment of the small bowel at abdominal staging CT
- Blood type and breed-associated differences in cell marker expression on equine bone marrow-derived mesenchymal stem cells including major histocompatibility complex class II antigen expression
- Induced abortion and future use of IVF treatment; A nationwide register study
- Psychosocial determinants of sustained maternal functional impairment: Longitudinal findings from a pregnancy-birth cohort study in rural Pakistan
- Measurement of finger joint angle using stretchable carbon nanotube strain sensor
- Determinants of mortality among patients with drug-resistant tuberculosis in northern Nigeria
- Drugs modulating stochastic gene expression affect the erythroid differentiation process
- Efficacy of UB0316, a multi-strain probiotic formulation in patients with type 2 diabetes mellitus: A double blind, randomized, placebo controlled study
- Prognostic value of des-γ-carboxy prothrombin in patients with hepatocellular carcinoma treated with transarterial chemotherapy: A systematic review and meta-analysis
- Avermectin induces the oxidative stress, genotoxicity, and immunological responses in the Chinese Mitten Crab, Eriocheir sinensis
- Antibiotic use in mandarin production (Citrus reticulata Blanco) in major mandarin-producing areas in Thailand: A survey assessment
- Application of CPI cutoff value based on parentage testing of duos and trios typed by four autosomal kits
- Correction: Good and Bad in the Hands of Politicians: Spontaneous Gestures during Positive and Negative Speech
- Adolescents with worse levels of oral health literacy have more cavitated carious lesions
- Effective methods for the inactivation of Francisella tularensis
- Detection of early-stage Alzheimer’s pathology using blood-based autoantibody biomarkers in elderly hip fracture repair patients
- Correlation between internal pudendal artery stenosis and erectile dysfunction in patients with suspected coronary artery disease
- Analysis of HER2 genomic binding in breast cancer cells identifies a global role in direct gene regulation
- Population productivity of shovelnose rays: Inferring the potential for recovery
- Correction: Long-term clinical outcomes in a cohort of patients with solitary plasmacytoma treated in the modern era
- Effects of tetracycline on myocardial infarct size in obese rats with chemically-induced colitis
- Mineral absorption is an enriched pathway in a brain region of restless legs syndrome patients with reduced MEIS1 expression
- Changes in weight and body composition across five years at university: A prospective observational study
- Adeno-associated virus-mediated expression of human butyrylcholinesterase to treat organophosphate poisoning
- Effects of insulin signaling on mouse taste cell proliferation
- Patient-level cost of home- and facility-based child pneumonia treatment in Suba Sub County, Kenya
- TAP: A static analysis model for PHP vulnerabilities based on token and deep learning technology
- Cost-effectiveness of QuantiFERON-TB Gold In-Tube versus tuberculin skin test for diagnosis and treatment of Latent Tuberculosis Infection in primary health care workers in Brazil
- Multifaceted intervention for the prevention and management of musculoskeletal pain in nursing staff: Results of a cluster randomized controlled trial
- Changes over time in creatinine clearance and comparison of emergent adverse events for HIV-positive adults receiving standard doses (300 mg/day) of lamivudine-containing antiretroviral therapy with baseline creatinine clearance of 30–49 vs ≥50 mL/min
- Population dynamics of foxes during restricted-area culling in Britain: Advancing understanding through state-space modelling of culling records
- Impacts of experimental advisory exit speed sign on traffic speeds for freeway exit ramp
- In-hospital outcomes and 30-day readmission rates among ischemic and hemorrhagic stroke patients with delirium
- Monitoring quality indicators for the Xpert MTB/RIF molecular assay in Ethiopia
- Delivering genes across the blood-brain barrier: LY6A, a novel cellular receptor for AAV-PHP.B capsids
- Correction: Using remote sensing to detect whale strandings in remote areas: The case of sei whales mass mortality in Chilean Patagonia
- Comparison of the inoculum size effects of antibiotics on IMP-6 β-lactamase-producing Enterobacteriaceae co-harboring plasmid-mediated quinolone resistance genes
- Contrast-enhanced computed tomography findings of canine primary renal tumors including renal cell carcinoma, lymphoma, and hemangiosarcoma
- Non-invasive in vivo imaging of UCP1 expression in live mice via near-infrared fluorescent protein iRFP720
- Overexpression of pink1 or parkin in indirect flight muscles promotes mitochondrial proteostasis and extends lifespan in Drosophila melanogaster
- Fiber stiffness, pore size and adhesion control migratory phenotype of MDA-MB-231 cells in collagen gels
- Comparison of two experimental ARDS models in pigs using electrical impedance tomography
- Are primary school children attending full-day school still engaged in sports clubs?
- Stroke risks in women with dysmenorrhea by age and stroke subtype
- Changes in patterns of mortality rates and years of life lost due to firearms in the United States, 1999 to 2016: A joinpoint analysis
- In vitro modeling of Batrachochytrium dendrobatidis infection of the amphibian skin
- Development and validation of LC-MS/MS method for imatinib and norimatinib monitoring by finger-prick DBS in gastrointestinal stromal tumor patients
- Correction: Habitat disturbance and the organization of bacterial communities in Neotropical hematophagous arthropods
- Characterisation of early metazoan secretion through associated signal peptidase complex subunits, prohormone convertases and carboxypeptidases of the marine sponge (Amphimedon queenslandica)
- Time trends between 2002 and 2017 in correlates of self-reported sitting time in European adults
- Performance of patient acuity rating by rapid response team nurses for predicting short-term prognosis
- Changes in HbA1c during the first six years after the diagnosis of Type 2 diabetes mellitus predict long-term microvascular outcomes
- Correction: Antimicrobial resistance genotypes and phenotypes of Campylobacter jejuni isolated in Italy from humans, birds from wild and urban habitats, and poultry
- Correction: Mental health and quality of life outcomes in family members of patients with chronic critical illness admitted to the intensive care units of two Brazilian hospitals serving the extremes of the socioeconomic spectrum
- Correction: Establishing an infrastructure for collaboration in primate cognition research
- Correction: The impact of public health insurance on health care utilisation, financial protection and health status in low- and middle-income countries: A systematic review
- Health provider and service-user experiences of sensory modulation rooms in an acute inpatient psychiatry setting
- Comparison of potential drug-drug interactions with metabolic syndrome medications detected by two databases
- The Polish version of the Cultural Intelligence Scale: Assessment of its reliability and validity among healthcare professionals and medical faculty students
- Selection of optimal reference genes for qRT-PCR analysis of shoot development and graviresponse in prostrate and erect chrysanthemums
- Metastasis risk prediction model in osteosarcoma using metabolic imaging phenotypes: A multivariable radiomics model
- Defining hospital community benefit activities using Delphi technique: A comparison between China and the United States
- Establishment of the experimental procedure for prediction of conjugation capacity in mutant UGT1A1
- A robust multi-objective optimization framework to capture both cellular and intercellular properties in cardiac cellular model tuning: Analyzing different regions of membrane resistance profile in parameter fitting
- Sea star wasting disease demography and etiology in the brooding sea star Leptasterias spp.
- Diagnostic plasma miRNA-profiles for ovarian cancer in patients with pelvic mass
- Genetic diversity and drug resistance of HIV-1 among infected pregnant women newly diagnosed in Luanda, Angola
- I’ve been robbed! – Can changes in floral traits discourage bee pollination?
- Visualising statistical models using dynamic nomograms
- Assessing the capacity of Malawi’s district and central hospitals to manage traumatic diaphyseal femoral fractures in adults
- Diagnostic performance of basal cortisol level at 0900-1300h in adrenal insufficiency
- The Mastery Rubric for Bioinformatics: A tool to support design and evaluation of career-spanning education and training
- Microdissection and whole chromosome painting confirm karyotype transformation in cryptic species of the Lariophagus distinguendus (Förster, 1841) complex (Hymenoptera: Pteromalidae)
- Quality of Kangaroo Mother Care services in Ethiopia: Implications for policy and practice
- Gemcitabine potentiates the anti-tumour effect of radiation on medullary thyroid cancer
- iTRAQ-based high-throughput proteomics analysis reveals alterations of plasma proteins in patients infected with human bocavirus
- The detection of a non-anemophilous plant species using airborne eDNA
- Perception and control of low cable operation forces in voluntary closing body-powered upper-limb prostheses
- Neoadjuvant chemotherapy plus surgery versus concurrent chemoradiotherapy in stage IB2-IIB cervical cancer: A systematic review and meta-analysis
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- Retraction: Placental expression of CD100, CD72 and CD45 is dysregulated in human miscarriage
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- Correction: The modulation of facial mimicry by attachment tendencies and their underlying affiliation motives in 3-year-olds: An EMG study
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