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Fearon IM, Cordery SF, Fitzpatrick M, Weaver S, Stevenson M, Grandolfo E, Malt L, Thompson K, Nahde T. A Scoping Review of Behavioural Studies on Heated Tobacco Products. Cureus 2024; 16:e65773. [PMID: 39211653 PMCID: PMC11361622 DOI: 10.7759/cureus.65773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2024] [Indexed: 09/04/2024] Open
Abstract
Heated tobacco products (HTPs) are electronic devices that heat tobacco sticks to temperatures much lower than those which cause pyrolysis and combustion in cigarettes. While this electrical heating causes the formation of an inhalable aerosol which contains nicotine, the aerosol from HTPs contains significantly fewer and lower levels of the harmful and potentially harmful chemicals found in cigarette smoke. As a result, HTP use potentially conveys reduced risks to health compared to cigarette smoking. While this relative reduction in individual health risk is becoming clearer, what is less certain is the impact of HTPs on overall population‑level health, taking into account both the potential positive impact on adult smokers who completely switch to using HTPs and any unintended impacts such as use by tobacco non‑users and particularly by youth. The aim of this scoping review was to collate and evaluate the published scientific evidence to date, with a cut‑off of 1 January 2024, investigating the impact of HTPs on population‑level health. This evaluation suggests that HTP use is almost exclusively observed among those with a history of cigarette smoking, and there is a growing body of evidence for the ability of HTPs to provide support for adult smokers to transition away from cigarette smoking, in the absence of any significant "gateway" into tobacco use initiation. Many studies have reported a significant degree of dual use of cigarettes and HTPs, and efforts to assess the reasons for such patterns of use, whether these provide overall exposure reductions, and whether dual use acts as a bridge towards a complete transition away from cigarette smoking, requires further investigation. In addition, correction of the widespread and increasing misperceptions of HTPs among adult smokers is recommended to promote HTP uptake as a potentially less harmful alternative to smoking in this population.
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Affiliation(s)
- Ian M Fearon
- Scientific Research, whatIF? Consulting Ltd., Harwell, GBR
| | - Sarah F Cordery
- Group Science and Regulatory Affairs, Imperial Brands PLC, Bristol, GBR
| | | | - Sarah Weaver
- Group Science and Regulatory Affairs, Imperial Brands PLC, Bristol, GBR
| | - Matthew Stevenson
- Group Science and Regulatory Affairs, Imperial Brands PLC, Bristol, GBR
| | - Erika Grandolfo
- Group Science and Regulatory Affairs, Imperial Brands PLC, Bristol, GBR
| | - Layla Malt
- Group Science and Regulatory Affairs, Imperial Brands PLC, Bristol, GBR
| | - Keith Thompson
- Scientific Consultant, Elucid8 Holdings Ltd., Newtownabbey, GBR
| | - Thomas Nahde
- Group Science and Regulatory Affairs, Imperial Brands Reemtsma, Hamburg, DEU
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Cordery S, Thompson K, Stevenson M, Simms L, Chapman F, Grandolfo E, Malt L, Weaver S, Fearon IM, Nahde T. The Product Science of Electrically Heated Tobacco Products: An Updated Narrative Review of the Scientific Literature. Cureus 2024; 16:e61223. [PMID: 38939262 PMCID: PMC11209752 DOI: 10.7759/cureus.61223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/28/2024] [Indexed: 06/29/2024] Open
Abstract
Heated tobacco products represent a novel category of tobacco products in which a tobacco consumable is heated to a temperature that releases nicotine from the tobacco leaf but not to a temperature sufficient to cause combustion. Heated tobacco products may therefore have the potential to be a less harmful alternative for adult smokers who would otherwise continue to smoke cigarettes, as their use should result in exposure to substantially fewer and lower levels of toxicants. This update represents a two-year extension to our previous narrative review, which covered peer-reviewed journal articles published up to August 31, 2021. The scientific evidence published between 2021 and 2023 continues to indicate that aerosols produced from heated tobacco products contain fewer and substantially lower levels of harmful and potentially harmful constituents and that these observed reductions consistently translate to reduced biological effects in both in vitro and in vivo toxicological studies. Biomarker and clinical data from studies in which product use is controlled within a clinical setting continue to suggest changes in levels of biomarkers of exposure, biomarkers of potential harm, and clinical endpoints indicating the potential for reduced harm with switching to exclusive use of heated tobacco products in adult smokers. Overall, the available peer-reviewed scientific evidence continues to indicate that heated tobacco products offer promise as a potentially less harmful alternative to cigarettes, and as such, the conclusions of our original narrative review remain valid.
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Affiliation(s)
- Sarah Cordery
- Group Science and Regulatory Affairs, Imperial Brands Plc., Bristol, GBR
| | - Keith Thompson
- Independent Scientific Consultant, Elucid8 Holdings Ltd., Coleraine, GBR
| | - Matthew Stevenson
- Group Science and Regulatory Affairs, Imperial Brands Plc., Bristol, GBR
| | - Liam Simms
- Group Science and Regulatory Affairs, Imperial Brands Plc., Bristol, GBR
| | - Fiona Chapman
- Group Science and Regulatory Affairs, Imperial Brands Plc., Bristol, GBR
| | - Erika Grandolfo
- Group Science and Regulatory Affairs, Imperial Brands Plc., Bristol, GBR
| | - Layla Malt
- Group Science and Regulatory Affairs, Imperial Brands Plc., Bristol, GBR
| | - Sarah Weaver
- Group Science and Regulatory Affairs, Imperial Brands Plc., Bristol, GBR
| | - Ian M Fearon
- Scientific Research, whatIF? Consulting Ltd., Harwell, GBR
| | - Thomas Nahde
- Group Science and Regulatory Affairs, Imperial Brands Reemtsma, Hamburg, DEU
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Zamora Goicoechea J, Boughner A, Cirion Lee JJ, Mahajan A, Yeo K, Sproga M, Patel T, Saitta C, Russell C, Coughlan M, Caponnetto P, Polosa R. A Global Health Survey of People Who Vape but Never Smoked: Protocol for the VERITAS (Vaping Effects: Real-World International Surveillance) Study. JMIR Res Protoc 2024; 13:e54236. [PMID: 38546715 PMCID: PMC11009848 DOI: 10.2196/54236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 12/19/2023] [Accepted: 01/31/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND There is only limited information about the health effects of regular vaping. Research on the health status of people who used to smoke faces the challenge that previous smoking may have caused unknown health effects. Only studies of people who vape but have never smoked combustible cigarettes can enable the detection of harms attributable to vaping. Large prospective studies of well-characterized electronic cigarette users with and without a history of combustible cigarette smoking are warranted to establish the long-term effects of regular vaping on respiratory health. OBJECTIVE We will conduct a global cross-sectional survey of individuals from 6 world regions. Respiratory symptoms will be assessed using a validated questionnaire-the Respiratory Symptom Experience Scale (RSES). Current vapers who are nonusers of other tobacco or nicotine products will be compared with matched controls who are nonusers of vapes and other tobacco or nicotine products. METHODS This will be a multicountry, cross-sectional internet-based survey of 750 adults aged ≥18 years who satisfy the criteria for inclusion in either a cohort of people who exclusively vape and who are nonusers of other tobacco or nicotine products ("vapers cohort"; target N=500) or a cohort of nonvapers who are also nonusers of other tobacco or nicotine products ("controls cohort"; target N=250). The primary end point of the study is the RSES score. RSES scores of people in the "vapers cohort" will be compared with those of people in the "controls cohort." Additionally, the study will collect data to characterize patterns of vaping product use among the vapers cohort. Data collection will include information about the age initiation of using vape products, reasons for starting and continuing the use of vape products, specific types of products used, flavors and nicotine strengths of recently used products, as well as the frequency and intensity of product use in the past 30 days. RESULTS Participant recruitment started in April 2023, and enrollment was completed by November 2023 with 748 participants. Results will be reported in 2024. CONCLUSIONS This will be the first study providing key insights into respiratory health effects associated with using electronic cigarettes in people who vape with no established use of combustible cigarettes or other tobacco or nicotine products. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/54236.
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Affiliation(s)
- Jeffrey Zamora Goicoechea
- International Network of Nicotine Consumer Organisations, Vejle, Denmark
- Asociación de Reducción de Daños del Tabaquismo, Bogota, Colombia
- Asociación de usuarios de vaporizadores y métodos de reducción de daños por tabaquismo de Costa Rica, San José, Costa Rica
| | - Allison Boughner
- American Vapor Manufacturers, Prescott, AZ, United States
- South Carolina Vapor Association, Charleston, SC, United States
| | | | | | - Kurt Yeo
- Vaping Saved My Life, Benoni, Gauteng, South Africa
- World Vapers Alliance, Miami, FL, United States
| | | | - Tasmin Patel
- Confidosoft Ltd, Leatherhead, London, United Kingdom
| | | | | | | | - Pasquale Caponnetto
- Section of Psychology, Department of Science of Education, University of Catania, Catania, Italy
- Center of Excellence for the Acceleration of Harm Reduction, University of Catania, Catana, Italy
| | - Riccardo Polosa
- Center of Excellence for the Acceleration of Harm Reduction, University of Catania, Catana, Italy
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
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Tao X, Zhang J, Meng Q, Chu J, Zhao R, Liu Y, Dong Y, Xu H, Tian T, Cui J, Zhang L, Chu M. The potential health effects associated with electronic-cigarette. ENVIRONMENTAL RESEARCH 2024; 245:118056. [PMID: 38157958 DOI: 10.1016/j.envres.2023.118056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 12/17/2023] [Accepted: 12/25/2023] [Indexed: 01/03/2024]
Abstract
A good old gateway theory that electronic-cigarettes (e-cigarettes) are widely recognized as safer tobacco substitutes. In actuality, demographics also show that vaping cannibalizes smoking, the best explanation of the data is the "common liability". However, the utilization of e-cigarette products remains a controversial topic at present. Currently, there has been a widespread and substantial growth in e-cigarette use worldwide owing to their endless new flavors and customizable characteristics. Furthermore, e-cigarette has grown widespread among smokers as well as non-smokers, including adolescents and young adults. And some studies have shown that e-cigarette users are at greater risk to start using combustible cigarettes while e-cigarettes use was also observed the potential benefits to people who want to quit smoking or not. Although it is true that e-cigarettes generally contain fewer toxic substances than combustible cigarettes, this does not mean that the chemical composition in e-cigarettes aerosols poses absolutely no risks. While concerns about toxic substances in e-cigarettes and their widespread use in the population are reasonable, it is also crucial to consider that e-cigarettes have been associated with the potential for promoting smoking cessation and the clinically relevant improvements in users with smoking-related pathologies. Meanwhile, there is still short of understanding of the health impacts associated with e-cigarette use. Therefore, in this review, we discussed the health impacts of e-cigarette exposure on oral, nasal, pulmonary, cardiovascular systems and brain. We aspire for this review to change people's previous perceptions of e-cigarettes and provide them with a more balanced perspective. Additionally, we suggest appropriate adjustments on regulation and policy for e-cigarette to gain greater public health benefits.
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Affiliation(s)
- Xiaobo Tao
- Department of Epidemiology, School of Public Health, Nantong University, Nantong, Jiangsu, China
| | - Jiale Zhang
- The Second People's Hospital of Nantong, Nantong, Jiangsu, China
| | - Qianyao Meng
- Department of Global Health and Population, School of Public Health, Harvard University, Boston, USA
| | - Junfeng Chu
- Department of Oncology, Jiangdu People's Hospital of Yangzhou, Yangzhou, Jiangsu, China
| | - Rongrong Zhao
- Department of Oncology, Jiangdu People's Hospital of Yangzhou, Yangzhou, Jiangsu, China
| | - Yiran Liu
- Department of Epidemiology, School of Public Health, Nantong University, Nantong, Jiangsu, China
| | - Yang Dong
- Department of Epidemiology, School of Public Health, Nantong University, Nantong, Jiangsu, China
| | - Huiwen Xu
- Department of Epidemiology, School of Public Health, Nantong University, Nantong, Jiangsu, China
| | - Tian Tian
- Department of Epidemiology, School of Public Health, Nantong University, Nantong, Jiangsu, China
| | - Jiahua Cui
- Department of Epidemiology, School of Public Health, Nantong University, Nantong, Jiangsu, China
| | - Lei Zhang
- Department of Epidemiology, School of Public Health, Nantong University, Nantong, Jiangsu, China.
| | - Minjie Chu
- Department of Epidemiology, School of Public Health, Nantong University, Nantong, Jiangsu, China.
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Krysiński A, Russo C, Campagna D, Di Pino A, John S, Belsey J, Caponnetto P, Vudu L, Lim CW, Di Ciaula A, Veronese N, Barbagallo M, Iqbal F, Fluck D, Franek E, Polosa R, Sharma P. A multicenter prospective randomized controlled trial investigating the effects of combustion-free nicotine alternatives on cardiovascular risk factors and metabolic parameters in individuals with type 2 diabetes who smoke: the DiaSmokeFree study protocol. Intern Emerg Med 2024; 19:321-332. [PMID: 37999870 PMCID: PMC10954907 DOI: 10.1007/s11739-023-03467-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 10/16/2023] [Indexed: 11/25/2023]
Abstract
Stopping smoking is crucial for public health and especially for individuals with diabetes. Combustion-free nicotine alternatives like e-cigarettes and heated tobacco products are increasingly being used as substitutes for conventional cigarettes, contributing to the decline in smoking prevalence. However, there is limited information about the long-term health impact of those products in patients with diabetes. This randomized controlled trial aims to investigate whether switching from conventional cigarettes to combustion-free nicotine alternatives will lead to a measurable improvement in cardiovascular risk factors and metabolic parameters over a period of 2 years in smokers with type 2 diabetes. The multicenter study will be conducted in seven sites across four countries. A total of 576 smokers with type 2 diabetes will be randomly assigned (1:2 ratio) to either standard of care with brief cessation advice (Control Arm) or combustion-free nicotine alternatives use (Intervention Arm). The primary end point is the change in the proportion of patients with metabolic syndrome between baseline and the 2-year follow-up. Additionally, the study will analyze the absolute change in the sum of the individual factors of metabolic syndrome at each study time point. Patient recruitment has started in September 2021 and enrollment is expected to be completed by December 2023. Results will be reported in 2026. This study may provide valuable insights into cardiovascular and metabolic health benefits or risks associated with using combustion-free nicotine alternatives for individuals with type 2 diabetes who are seeking alternatives to tobacco cigarette smoking. The study protocol, informed consent forms, and relevant documents were approved by seven ethical review boards. Study results will be disseminated through articles published in high-quality, peer-reviewed journals and presentations at conferences.
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Affiliation(s)
- Arkadiusz Krysiński
- Polish Academy of Sciences, Mossakowski Medical Research Centre Polish-Academy of Sciences, Warsaw, Poland.
- Department of Internal Diseases, Endocrinology and Diabetology, Central Clinical Hospital, PIM MSWiA, Warsaw, Poland.
| | - Cristina Russo
- Ashford and Saint Peter's Hospitals NHS Trust, Chertsey, UK
| | - Davide Campagna
- Emergency Department, Teaching Hospital Policlinico "G. Rodolico-San Marco" of Catania, University of Catania, Catania, Italy
- Center of Excellence for the Acceleration of HArm Reduction (CoEHAR), University of Catania, Catania, Italy
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Antonino Di Pino
- Center of Excellence for the Acceleration of HArm Reduction (CoEHAR), University of Catania, Catania, Italy
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Sarah John
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | | | - Pasquale Caponnetto
- Center of Excellence for the Acceleration of HArm Reduction (CoEHAR), University of Catania, Catania, Italy
- Department of Educational Sciences, Section of Psychology, University of Catania, Catania, Italy
| | - Lorina Vudu
- Nicolae Testemitanu State Medical and Pharmaceutical University, Chisinau, Republic of Moldova
| | - Chong Wei Lim
- Ashford and Saint Peter's Hospitals NHS Trust, Chertsey, UK
| | - Agostino Di Ciaula
- Division of Internal Medicine, Department of Preventive and Regenerative Medicine and Ionian Area (DiMePrev-J), Clinica Medica "A. Murri", University of Bari Aldo Moro, Bari, Italy
| | - Nicola Veronese
- Geriatrics Section, Department of Medicine, University of Palermo, Palermo, Italy
| | - Mario Barbagallo
- Geriatrics Section, Department of Medicine, University of Palermo, Palermo, Italy
| | - Farrukh Iqbal
- The University of Lahore University College of Medicine and Dentistry, Lahore, Pakistan
| | - David Fluck
- Ashford and Saint Peter's Hospitals NHS Trust, Chertsey, UK
| | - Edward Franek
- Polish Academy of Sciences, Mossakowski Medical Research Centre Polish-Academy of Sciences, Warsaw, Poland
- Department of Internal Diseases, Endocrinology and Diabetology, Central Clinical Hospital, PIM MSWiA, Warsaw, Poland
| | - Riccardo Polosa
- Center of Excellence for the Acceleration of HArm Reduction (CoEHAR), University of Catania, Catania, Italy
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Pankaj Sharma
- Ashford and Saint Peter's Hospitals NHS Trust, Chertsey, UK
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Caponnetto P, Spicuzza L, Campagna D, Ahluwalia JS, Russell C, Maglia M, Riela PM, Longo CF, Caci G, Quattropani MC, Signorelli MS, Polosa R. Varenicline for smoking cessation in individuals who smoke cigarettes and use electronic cigarettes: a double-blind, randomised, placebo-controlled phase 3 trial. EClinicalMedicine 2023; 66:102316. [PMID: 38192585 PMCID: PMC10772233 DOI: 10.1016/j.eclinm.2023.102316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Revised: 10/24/2023] [Accepted: 10/30/2023] [Indexed: 01/10/2024] Open
Abstract
Background The efficacy and safety of varenicline for smoking cessation among individuals who smoke tobacco cigarettes and also use electronic cigarettes (known e-cigarettes or vapes) have not been studied. We aimed to address this knowledge gap and examine predictors for smoking abstinence. Methods In this double-blind, placebo-controlled, single-centre randomised trial in Italy, we enrolled adults who had used an e-cigarette daily for at least 12 months and who also smoked at least one tobacco cigarette per day and had a willingness to quit smoking. 155 participants were randomly assigned to receive either varenicline (n = 78) or matched placebo (n = 77). Varenicline (1 mg, administered twice daily for 12 weeks) was given in combination with smoking cessation counseling in dual users with an intention to quit smoking. Participants in both treatment groups received the same smoking cessation counselling throughout the whole duration of the study. The trial consisted of a 12-week treatment phase followed by a 12-week follow-up. The primary efficacy endpoint was continuous abstinence rate (CAR) in weeks 4-12. Secondary efficacy endpoints were the CAR in weeks 4-24 and 7-day point prevalence of smoking abstinence at weeks 12 and 24. This study is registered in EUDRACT, 2016-000339-42. Findings Between November 2018, and February 2020, 114 participants (61 in the varenicline group and 53 in the placebo group) completed the intervention phase at week 12 and 88 participants (52 in the varenicline group and 36 in the placebo group) completed the follow-up phase at week 24. CARs were significantly higher for the varenicline vs placebo at each time-point: 50.0% vs 16.9% (OR = 4.9; 95% CI, 2.3-10.4; P < 0.0001) between weeks 4 and 12; and 48.7% vs 14.3% (OR = 5.7; 95% CI, 2.6-12.3; P < 0.0001) between weeks 4 and 24. The 7-day point prevalence of smoking abstinence was also higher for the varenicline than placebo at each time point. Adverse events were rated as mild or moderate and rarely led to treatment discontinuation. Interpretation Our findings indicate that inclusion of varenicline in a cessation programme for adults who smoke and use e-cigarettes with an intention to quit smoking could result in smoking abstinence without serious adverse events. In the absence of evidence from other smoking cessation methods, it could be useful to suggest the use of varenicline in cessation programmes specifically designed to help dual users stop smoking. Further research in larger and more generalisable populations is required to strengthen such a suggestion. Funding Global Research Award for Nicotine Dependence, an independently reviewed competitive grants programmeme funded by Pfizer.
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Affiliation(s)
- Pasquale Caponnetto
- Department of Science of Education, Section of Psychology, University of Catania, Italy
- Centre of Excellence for the Acceleration of HArm Reduction (CoEHAR), University of Catania, Italy
- Centre for the Prevention and Treatment of Tobacco Addiction (CPCT), University Teaching Hospital “Policlinico-S.Marco”, University of Catania, Italy
| | - Lucia Spicuzza
- Centre of Excellence for the Acceleration of HArm Reduction (CoEHAR), University of Catania, Italy
- Respiratory Unit - University Teaching Hospital “Policlinico-S.Marco”, University of Catania, Italy
- Department of Clinical & Experimental Medicine, University of Catania, Italy
| | - Davide Campagna
- Centre of Excellence for the Acceleration of HArm Reduction (CoEHAR), University of Catania, Italy
- Department of Clinical & Experimental Medicine, University of Catania, Italy
- UOC MCAU, University Teaching Hospital “Policlinico-S.Marco”, University of Catania, Italy
| | - Jasjit S. Ahluwalia
- Brown University School of Public Health and Alpert School of Medicine, Providence, RI, USA
| | | | - Marilena Maglia
- Centre for the Prevention and Treatment of Tobacco Addiction (CPCT), University Teaching Hospital “Policlinico-S.Marco”, University of Catania, Italy
- ECLAT Srl, Spin-off of the University of Catania, Italy
| | - Paolo Marco Riela
- Department of Mathematics and Informatics, University of Catania, Catania, Italy
| | - Carmelo Fabio Longo
- Department of Mathematics and Informatics, University of Catania, Catania, Italy
| | - Grazia Caci
- UOC MCAU, University Teaching Hospital “Policlinico-S.Marco”, University of Catania, Italy
| | - Maria Catena Quattropani
- Department of Science of Education, Section of Psychology, University of Catania, Italy
- Centre of Excellence for the Acceleration of HArm Reduction (CoEHAR), University of Catania, Italy
| | | | - Riccardo Polosa
- Centre of Excellence for the Acceleration of HArm Reduction (CoEHAR), University of Catania, Italy
- Centre for the Prevention and Treatment of Tobacco Addiction (CPCT), University Teaching Hospital “Policlinico-S.Marco”, University of Catania, Italy
- Department of Clinical & Experimental Medicine, University of Catania, Italy
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Polosa R, Spicuzza L, Palmucci S. Molecular Imaging of Pulmonary Inflammation: Claiming That Vaping Is More Harmful Than Smoking Is Unsupported. J Nucl Med 2023; 64:994-995. [PMID: 37169536 PMCID: PMC10241007 DOI: 10.2967/jnumed.123.265533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 02/02/2023] [Accepted: 02/07/2023] [Indexed: 05/13/2023] Open
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