Linkage of clinical trial and administrative data: a survey of cancer patient preferences

BACKGROUND

Personal health information, including diagnoses and hospital admissions, is routinely collected in administrative databases. Patients enrolling on clinical trials consent to separate collection and storage of their personal health information. We evaluated patient preferences for linking long-term data from administrative databases with clinical trials.

METHODS

Adults with cancer attending outpatient clinics at 3 Ontario hospitals were surveyed about their willingness, when faced with the hypothetical scenario of participating in a clinical trial, to provide potentially identifying information such as initials and date of birth to facilitate long-term research access to normally deidentified publicly collected databases.

RESULTS

Of 569 patients surveyed, 335 (59%) were women, 452 (79%) were white, 385 (68%) had a post-secondary education, and 386 (68%) had never participated in a clinical trial. Median age in the group was 59 years. Most participants (93%, cohort 1) would allow long-term access to their information and allow personal information to be used to match clinical trial with administrative data. At the time of clinical trial closure, two thirds of participants (68%, cohort 2) preferred to make additional clinical information available through linkage with administrative databases, and 8 (9%) preferred to have no further information made available to researchers. No significant differences were found in the subset of patients who were part of a clinical trial and those who had never participated (p = 0.65).

INTERPRETATION

Almost all patients would allow a clinical trial research team to access their confidential information, providing a more comprehensive assessment of an intervention's long-term risks and benefits.

[Imaging diagnosis of 95 cases of moderate and severe acute carbon monoxide poisoning]

Objective: To explore the difference of radiological imaging features of delayed encephalopathy after carbon monoxide poisoning (DECMP) and acute carbon monoxide poisoning (ACMP) , and the correlation between the imaging findings and clinical prognosis of the disease. Methods: The correlation between imaging findings and clinical manifestations and prognosis of 95 patients with moderate and severe acute carbon monoxide poisoning were retrospectively analyzed. In the above 95 cases, there were 62 cases of ACMP and 33 cases of DEACMP. All patients underwent conventional CT, MRI and magnetic resonance diffusion tensor imaging (DTI) . Circular regions of interest (ROI) measurement was used for analysis of average diffusion coefficient (ADC) value and fractional anisotropy (FA) value of the MRI and DTI imaging manifestations in different brain regions. Results: The main clinical manifestation of moderate acute carbon monoxide poisoning was consciousness disorder and fatigue; Severe poisoning patients showed deep coma as the main clinical manifestations; The most prominent clinical manifestations of DEACMP were mental disorders and neurological impairment in the extrapyramidal system. A total of 95 cases with moderate or severe CO poisoning showed unilateral or bilateral cerebral cortex, bilateral basal ganglia (white ball) , cerebral white matter around bilateral ventricles or bilateral centrum semiovale, around bilateral ventricles cerebral white matter around bilateral ventricles and bilateral centrum semiovale, cerebral cortex and subcortical involvement. CT showed normal or low density shadow.MRI showed that the lesion T(1)WI presented slightly low or equal signal, T(2)WI and FLAIR sequences showed equal, a slightly higher or high signal; DWI sequence showed slightly higher or high signal. ADC value and FA value in different brain white matter regions of DEACMP group was significantly lower than those of ACMP group (P<0.05) , especially for those around semi oval center and lateral ventricles of the brain white matter (P<0.01) ; The ADC values increased significantly, FA value decreased significantly in the nerve nucleus (P<0.05) , especially for ADC values in globus pallidus (P<0.01) . Conclusion: DTI can evaluate the brain tissue damage in patients with DEACMP more early and more accurately.

Culprit-only versus staged complete revascularization for patients with ST-segment elevation myocardial infarction and Multivessel disease: a retrospective cohort study

BACKGROUND

Multivessel disease (MVD) is common in patients with ST-segment elevation myocardial infarction (STEMI), but optimal treatment management remains undetermined.

METHODS

In this retrospective cohort study, 602 consecutive STEMI patients with MVD were enrolled between January 1, 2010 and October 1, 2014. Three hundred and eighty-two patients underwent culprit-only revascularization and 220 underwent staged complete revascularization. Primary end points were a composite of cardiac mortality or nonfatal reinfarction.

RESULTS

The mean duration of follow-up was 35 months (12-71 months). Following multivariate analysis, staged complete revascularization was associated with a lower rate of the composite of cardiac mortality or nonfatal reinfarction [HR: 0.430, 95 % CI: 0.197-0.940, P = 0.034] and unplanned repeat revascularization [HR: 0.343, 95 % CI: 0.166-0.708, P = 0.004] compared with culprit-only revascularization.

CONCLUSIONS

Compared with culprit-only revascularization, staged complete revascularization significantly reduced the rate of the composite of cardiac mortality or nonfatal reinfarction, and the need for unplanned repeat revascularization.

Mutation-based selection and analysis of Komagataeibacter hansenii HDM1-3 for improvement in bacterial cellulose production

AIMS

A low yield of bacterial cellulose (BC) always results from an excessive accumulation of organic acids. Screening and the selection of bacterial mutants with a low accumulation of organic acids is an efficient approach for improving BC production.

METHODS AND RESULTS

In combination with the proton suicide method (medium containing NaBr-NaBrO₃ ), diethyl sulphate chemical mutagenesis coupled with ⁶⁰ Co-γ irradiation treatment were performed for the screening and selection of desired mutant lines with a high yield of BC. Two high-yield strains, Br-3 and Co-5, as well as a low-yield strain, Br-12, were obtained. Amplified fragment length polymorphism (AFLP) was applied to explore the differences between the mutant lines and the wild type. For the Br-12 line, three specific fragments were verified, corresponding to TonB-dependent transport (TBDT), exopolysaccharides output protein (PePr) and an unknown gene. For Co-5, two specific fragments were matched, acsD and UDP-galactose-4-epimerase. In addition, metabolic analysis for the mutant lines indicated that BC production may be limited by excessive accumulation of organic acids in the fermentation. The limitation would be resolved by the cross-talk of genes involved in BC biosynthesis.

CONCLUSIONS

Reduced organic acid by-products from glucose in bypasses were found to be responsible for the high-yield BC synthesis in Komagataeibacter hansenii mutant strains.

SIGNIFICANCE AND IMPACT OF THE STUDY

The metabolic process was varied by mutagenesis-induced gene disruption of the metabolic products. A new idea was provided for the targeted screening and characterization of mutants in the future.

Genetic structure and diversity in natural and stocked populations of the mandarin fish (Siniperca chuatsi) in China

The Chinese perch, or mandarin fish (Siniperca chuatsi), is a freshwater fish that is endemic to East Asia. In this study, we investigated the genetic diversity and structure of nine natural mandarin fish populations (from the Yangtze River and Amur River basins) and six hatchery stocks (from central and south China) using microsatellite markers. The results show that the genetic diversity of the Yangtze River populations was high and stable, and genetic differences between them were not significant. In contrast, a low level of genetic diversity and strong genetic structure were detected in the Amur River population. These results suggest that the Yangtze River region and the Amur River region should be treated as two separate units in conservation programs. The hatchery stocks exhibited low genetic diversity and significant genetic differentiation compared to natural populations; this may result in a significant impact on the species if escape events occur. Therefore, a scientific aquaculture management strategy is necessary for the long-term development of hatcheries.

[Brain function network analysis and recognition for psychogenic non-epileptic seizures based on resting state electroencephalogram]

Studies have shown that the clinical manifestation of patients with neuropsychiatric disorders might be related to the abnormal connectivity of brain functions. Psychogenic non-epileptic seizures (PNES) are different from the conventional epileptic seizures due to the lack of the expected electroencephalographically epileptic changes in central nervous system, but are related to the presence of significant psychological factors. Diagnosis of PNES remains challenging. We found in the present work that the connectivity between the frontal and parieto-occipital in PNES was weaker than that of the controls by using network analysis based on electroencephalogram (EEG) signals. In addition, PNES were recognized by using the network properties as linear discriminant nalysis (LDA) input and classification accuracy was 85%. This study may provide a feasible tool for clinical diagnosis of PNES.

Design and implementation of a new autonomous sensor fish to support advanced hydropower development

Acceleration in development of additional conventional hydropower requires tools and methods to perform laboratory and in-field validation of turbine performance and fish passage claims. The new-generation Sensor Fish has been developed with more capabilities to accommodate a wider range of users over a broader range of turbine designs and operating environments. It provides in situ measurements of three-dimensional (3D) linear accelerations, 3D rotational velocities, 3D orientation, pressure, and temperature at a sampling frequency of 2048 Hz. It also has an automatic floatation system and built-in radio-frequency transmitter for recovery. The relative errors of the pressure, acceleration, and rotational velocity were within ±2%, ±5%, and ±5%, respectively. The accuracy of orientation was within ±4° and accuracy of temperature was ±2 °C. The new-generation Sensor Fish is becoming a major technology and being deployed for evaluating the conditions for fish passage of turbines or other hydraulic structures in both the United States and several other countries.

Evaluation of a chemoresponse assay as a predictive marker in the treatment of recurrent ovarian cancer: further analysis of a prospective study

BACKGROUND

Recently, a prospective study reported improved clinical outcomes for recurrent ovarian cancer patients treated with chemotherapies indicated to be sensitive by a chemoresponse assay, compared with those patients treated with non-sensitive therapies, thereby demonstrating the assay's prognostic properties. Due to cross-drug response over different treatments and possible association of in vitro chemosensitivity of a tumour with its inherent biology, further analysis is required to ascertain whether the assay performs as a predictive marker as well.

METHODS

Women with persistent or recurrent epithelial ovarian cancer (n=262) were empirically treated with one of 15 therapies, blinded to assay results. Each patient's tumour was assayed for responsiveness to the 15 therapies. The assay's ability to predict progression-free survival (PFS) was assessed by comparing the association when the assayed therapy matches the administered therapy (match) with the association when the assayed therapy is randomly selected, not necessarily matching the administered therapy (mismatch).

RESULTS

Patients treated with assay-sensitive therapies had improved PFS vs patients treated with non-sensitive therapies, with the assay result for match significantly associated with PFS (hazard ratio (HR)=0.67, 95% confidence interval (CI)=0.50-0.91, P=0.009). On the basis of 3000 simulations, the mean HR for mismatch was 0.81 (95% range=0.66-0.99), with 3.4% of HRs less than 0.67, indicating that HR for match is lower than for mismatch. While 47% of tumours were non-sensitive to all assayed therapies and 9% were sensitive to all, 44% displayed heterogeneity in assay results. Improved outcome was associated with the administration of an assay-sensitive therapy, regardless of homogeneous or heterogeneous assay responses across all of the assayed therapies.

CONCLUSIONS

These analyses provide supportive evidence that this chemoresponse assay is a predictive marker, demonstrating its ability to discern specific therapies that are likely to be more effective among multiple alternatives.

Overview of a chemoresponse assay in ovarian cancer

The objective of this review is to summarize recent scientific and medical literature regarding chemoresponse assays or chemotherapy sensitivity and resistance assays (CSRAs), specifically as applied to epithelial ovarian cancer. A total of sixty-seven articles, identified through PubMed using the key words “in vitro chemoresponse assay,” “chemo sensitivity resistance assay,” “ATP,” “HDRA,” “EDR,” “MiCK,” and “ChemoFx,” were reviewed. Recent publications on marker validation, including relevant clinical trial designs, were also included. Recent CSRA research and clinical studies are outlined in this review. Published findings demonstrate benefits regarding patient outcome with respect to recent CSRAs. Specifically, analytical and clinical validations, as well as clinical utility and economic benefit, of the most common clinically used CSRA in the United States support its use to aid in making effective, individualized clinical treatment selections for patients with ovarian cancer.

Analytical criterion for amplitude death in nonautonomous systems with piecewise nonlinear coupling

We investigate the amplitude death phenomenon in a nonautonomous chained network with complicated piecewise nonlinear coupling functions. An analytical criterion for the boundary of the amplitude death region is derived by using the average method. The mechanism of the amplitude death in the nonautonomous networks is very different from that of autonomous systems and rapid dynamic transitions could halt the amplitude death. Numerical verifications are carried out to check jump transitions among different solution branches and further confirm the correctness of the theoretical results.

Cortical network properties revealed by SSVEP in anesthetized rats

Steady state visual evoked potentials (SSVEP) are assumed to be regulated by multiple brain areas, yet the underlying mechanisms are not well understood. In this study, we utilized multi-channel intracranial recordings together with network analysis to investigate the underlying relationships between SSVEP and brain networks in anesthetized rat. We examined the relationship between SSVEP amplitude and the network topological properties for different stimulation frequencies, the synergetic dynamic changes of the amplitude and topological properties in each rat, the network properties of the control state, and the individual difference of SSVEP network attributes existing among rats. All these aspects consistently indicate that SSVEP response is closely correlated with network properties, the reorganization of the background network plays a crucial role in SSVEP production, and the background network may provide a physiological marker for evaluating the potential of SSVEP generation.