Better tools for better estimates: improving approaches to handling missing data in Swiss cancer registries

OBJECTIVE

Various approaches have been used in the literature to handle missing vital status data in cancer registries. We aimed to compare these approaches to determine which led to the least biased estimates in typical analytic tasks of cancer registries.

METHODS

A simulation study was performed using data from the Swiss National Agency for Cancer Registration for six tumor types. First, 5%, 10% and 15% missingness in the vital status were introduced artificially in the complete data. Second, missing vital status data were handled by applying no, single or multiple imputations. Five-year overall survival estimates, relative survival or standardized incidence ratio were computed. Estimates were compared with the true value.

RESULTS

Standardized incidence ratio estimates for colorectal cancer obtained with multiple imputation yielded least biased results (-0.06 to -0.04), but the widest confidence intervals. Single imputation was more biased (-0.32) than using no imputation at all (-0.21). A similar pattern was observed for overall survival and relative survival.

CONCLUSION

This simulation study indicated that often used single imputation (sometimes referred to as simulating follow-up times) techniques to fill in missing vital status data are likely too biased to be useful in practice. Multiple imputation approaches yielded standardized incidence ratio, overall and relative survival estimates with the least bias, indicating reasonable performance that is likely to generalize to other settings.

Efficient termination of cardiac arrhythmias using optogenetic resonant feedback pacing

Malignant cardiac tachyarrhythmias are associated with complex spatiotemporal excitation of the heart. The termination of these life-threatening arrhythmias requires high-energy electrical shocks that have significant side effects, including tissue damage, excruciating pain, and worsening prognosis. This significant medical need has motivated the search for alternative approaches that mitigate the side effects, based on a comprehensive understanding of the nonlinear dynamics of the heart. Cardiac optogenetics enables the manipulation of cellular function using light, enhancing our understanding of nonlinear cardiac function and control. Here, we investigate the efficacy of optically resonant feedback pacing (ORFP) to terminate ventricular tachyarrhythmias using numerical simulations and experiments in transgenic Langendorff-perfused mouse hearts. We show that ORFP outperforms the termination efficacy of the optical single-pulse (OSP) approach. When using ORFP, the total energy required for arrhythmia termination, i.e., the energy summed over all pulses in the sequence, is 1 mJ. With a success rate of 50%, the energy per pulse is 40 times lower than with OSP with a pulse duration of 10 ms. We demonstrate that even at light intensities below the excitation threshold, ORFP enables the termination of arrhythmias by spatiotemporal modulation of excitability inducing spiral wave drift.

'We are all in the same boat': a qualitative cross-sectional analysis of COVID-19 pandemic imagery in scientific literature and its use for people working in the German healthcare sector

Background

The COVID-19 pandemic presents a significant challenge to professional responders in healthcare settings. This is reflected in the language used to describe the pandemic in the professional literature of the respective professions. The aim of this multidisciplinary study was to analyze the linguistic imagery in the relevant professional literature and to determine the identification of different professional groups with it and its emotional effects.

Method

A list of 14 typical, widespread and differing imageries for COVID-19 in form of single sentences (e.g., "Until the pandemic is over, we can only run on sight.") were presented to 1,795 healthcare professionals in an online survey. The imageries had been extracted from a qualitative search in more than 3,500 international professional journals in medicine, psychology and theology. Ratings of agreement with these imageries and feelings about them were subjected to factor analysis.

Results

Based on the list of imageries presented, it was possible to identify three factors for high/low agreement by experiences, and two factors for high/low induced feelings. Broad agreement emerged for imageries on "fight against the crisis" and "lessons learned from the crisis", while imageries on "acceptance of uncontrollability" tended to be rejected. Imageries of "challenges" tended to lead to a sense of empowerment among subjects, while imageries of "humility" tended to lead to a sense of helplessness.

Conclusion

Based on the qualitative and subsequential quantitative analysis, several factors for imageries for the COVID-19 pandemic were identified that have been used in the literature. Agreement with imageries is mixed, as is the assessment of how helpful they are.

Ångstrom-Depth Resolution with Chemical Specificity at the Liquid-Vapor Interface

The determination of depth profiles across interfaces is of primary importance in many scientific and technological areas. Photoemission spectroscopy is in principle well suited for this purpose, yet a quantitative implementation for investigations of liquid-vapor interfaces is hindered by the lack of understanding of electron-scattering processes in liquids. Previous studies have shown, however, that core-level photoelectron angular distributions (PADs) are altered by depth-dependent elastic electron scattering and can, thus, reveal information on the depth distribution of species across the interface. Here, we explore this concept further and show that the experimental anisotropy parameter characterizing the PAD scales linearly with the average distance of atoms along the surface normal obtained by molecular dynamics simulations. This behavior can be accounted for in the low-collision-number regime. We also show that results for different atomic species can be compared on the same length scale. We demonstrate that atoms separated by about 1 Å along the surface normal can be clearly distinguished with this method, achieving excellent depth resolution.

Cu-doped TiO2 nanoparticles improve local antitumor immune activation and optimize dendritic cell vaccine strategies

Nanoparticle-mediated cancer immunotherapy holds great promise, but more efforts are needed to obtain nanoformulations that result in a full scale activation of innate and adaptive immune components that specifically target the tumors. We generated a series of copper-doped TiO₂ nanoparticles in order to tune the kinetics and full extent of Cu²⁺ ion release from the remnant TiO₂ nanocrystals. Fine-tuning nanoparticle properties resulted in a formulation of 33% Cu-doped TiO₂ which enabled short-lived hyperactivation of dendritic cells and hereby promoted immunotherapy. The nanoparticles result in highly efficient activation of dendritic cells ex vivo, which upon transplantation in tumor bearing mice, exceeded the therapeutic outcomes obtained with classically stimulated dendritic cells. Efficacious but simple nanomaterials that can promote dendritic cancer cell vaccination strategies open up new avenues for improved immunotherapy and human health.

Hip and Groin Pain Prevalence and Prediction in Elite Gaelic Games: 2703 Male Athletes Across Two Seasons

OBJECTIVE

Hip and groin pain is highly prevalent in sub-elite Gaelic Athletic Association (GAA) athletes, but its prevalence at the elite level is unknown. The aims of this study were to report hip and groin pain prevalence in elite male athletes, to report changes in Copenhagen Hip and Groin Outcome Score (HAGOS) across two seasons and to assess if previous hip and groin pain or pre-season HAGOS could predict future hip and groin pain.

METHODS

During the 2017 and 2018 pre-season male Gaelic Players Association (GPA) playing members were invited to complete two questionnaires. The first questionnaire collected demographic information including age, GAA code played (Gaelic football or Hurling) and prevalence of hip and groin pain in the previous season. The second questionnaire was the HAGOS. Step-wise logistic regression models were fitted to HAGOS subscales, to examine if pre-season HAGOS subscale scores could predict future hip and groin pain.

RESULTS

The prevalence of hip and groin pain across the elite GAA cohort was 38%. Hip and groin pain in the previous season was the strongest predictor of future hip and groin pain (r² =0.19, AUC=0.73, 95% CI 1.76-2.27) whereas pre-season HAGOS subscale scores had limited and no additional predictive ability (AUC 0.05-0.18).

CONCLUSIONS

Hip and groin pain prevalence is high in elite male GAA, with one in three athletes reporting pain. Previous season hip and groin pain is the strongest predictor of future hip and groin pain, while pre-season HAGOS scores have limited ability to predict future hip and groin pain.

NMR-based Fragment Screening in a Minimum Sample but Maximum Automation Mode

Fragment-based screening (FBS) is a well-validated and accepted concept within the drug discovery process both in academia and industry. The greatest advantage of NMR-based fragment screening is its ability not only to detect binders over 7-8 orders of magnitude of affinity but also to monitor purity and chemical quality of the fragments and thus to produce high quality hits and minimal false positives or false negatives. A prerequisite within the FBS is to perform initial and periodic quality control of the fragment library, determining solubility and chemical integrity of the fragments in relevant buffers, and establishing multiple libraries to cover diverse scaffolds to accommodate various macromolecule target classes (proteins/RNA/DNA). Further, an extensive NMR-based screening protocol optimization with respect to sample quantities, speed of acquisition and analysis at the level of biological construct/fragment-space, in condition-space (buffer, additives, ions, pH, and temperature) and in ligand-space (ligand analogues, ligand concentration) is required. At least in academia, these screening efforts have so far been undertaken manually in a very limited fashion, leading to limited availability of screening infrastructure not only in the drug development process but also in the context of chemical probe development. In order to meet the requirements economically, advanced workflows are presented. They take advantage of the latest state-of-the-art advanced hardware, with which the liquid sample collection can be filled in a temperature-controlled fashion into the NMR-tubes in an automated manner. ¹H/¹⁹F NMR ligand-based spectra are then collected at a given temperature. High-throughput sample changer (HT sample changer) can handle more than 500 samples in temperature-controlled blocks. This together with advanced software tools speeds up data acquisition and analysis. Further, application of screening routines on protein and RNA samples are described to make aware of the established protocols for a broad user base in biomacromolecular research.

Photon-electron coincidence experiments at synchrotron radiation facilities with arbitrary bunch modes

We report the adaptation of an electron-photon coincidence detection scheme to the multibunch hybrid mode of the synchrotron radiation source BESSY II (Helmholtz-Zentrum Berlin). Single-event-based data acquisition and evaluation, combined with the use of relative detection times between the coincident particles, enable the acquisition of proper coincidence signals from a quasi-continuous excitation pattern. The background signal produced by accidental coincidences in the time difference representation is modeled using the non-coincident electron and photon spectra. We validate the method by reproducing previously published results, which were obtained in the single bunch mode, and illustrate its usability for the multibunch hybrid mode by investigating the photoionization of CO₂ into CO₂ ⁺ B satellite states, followed by subsequent photon emission. The radiative lifetime obtained and the electron binding energy are in good agreement with earlier publications. We expect this method to be a useful tool to extend the versatility of coincident particle detection to arbitrary operation modes of synchrotron radiation facilities and other excitation sources without the need for additional experimental adjustments.

1H, 13C, and 15N backbone chemical shift assignments of coronavirus-2 non-structural protein Nsp10

The international Covid19-NMR consortium aims at the comprehensive spectroscopic characterization of SARS-CoV-2 RNA elements and proteins and will provide NMR chemical shift assignments of the molecular components of this virus. The SARS-CoV-2 genome encodes approximately 30 different proteins. Four of these proteins are involved in forming the viral envelope or in the packaging of the RNA genome and are therefore called structural proteins. The other proteins fulfill a variety of functions during the viral life cycle and comprise the so-called non-structural proteins (nsps). Here, we report the near-complete NMR resonance assignment for the backbone chemical shifts of the non-structural protein 10 (nsp10). Nsp10 is part of the viral replication-transcription complex (RTC). It aids in synthesizing and modifying the genomic and subgenomic RNAs. Via its interaction with nsp14, it ensures transcriptional fidelity of the RNA-dependent RNA polymerase, and through its stimulation of the methyltransferase activity of nsp16, it aids in synthesizing the RNA cap structures which protect the viral RNAs from being recognized by the innate immune system. Both of these functions can be potentially targeted by drugs. Our data will aid in performing additional NMR-based characterizations, and provide a basis for the identification of possible small molecule ligands interfering with nsp10 exerting its essential role in viral replication.

A TLR3 Ligand Reestablishes Chemotherapeutic Responses in the Context of FPR1 Deficiency

For anthracycline-based chemotherapy to be immunogenic, dying cancer cells must release annexin A1 (ANXA1) that subsequently interacts with the pattern recognition receptor, formyl peptide receptor 1 (FPR1), on the surface of dendritic cells (DC). Approximately 30% of individuals bear loss-of-function alleles of FPR1, calling for strategies to ameliorate their anticancer immune response. Here, we show that immunotherapy with a ligand of Toll-like receptor-3, polyinosinic:polycytidylic acid (pIC), restores the deficient response to chemotherapy of tumors lacking ANXA1 developing in immunocompetent mice or those of normal cancers growing in FPR1-deficient mice. This effect was accompanied by improved DC- and T-lymphocyte-mediated anticancer immunity. Of note, carcinogen-induced breast cancers precociously developed in FPR1-deficient mice as compared with wild-type controls. A similar tendency for earlier cancer development was found in patients carrying the loss-of-function allele of FPR1. These findings have potential implications for the clinical management of FPR1-deficient patients. SIGNIFICANCE: The loss-of-function variant rs867228 in FPR1, harbored by approximately 30% of the world population, is associated with the precocious manifestation of breast, colorectal, esophageal, and head and neck carcinomas. pIC restores deficient chemotherapeutic responses in mice lacking Fpr1, suggesting a personalized strategy for compensating for the FPR1 defect.This article is highlighted in the In This Issue feature, p. 211.

1H, 13C, and 15N backbone chemical shift assignments of the apo and the ADP-ribose bound forms of the macrodomain of SARS-CoV-2 non-structural protein 3b

The SARS-CoV-2 genome encodes for approximately 30 proteins. Within the international project COVID19-NMR, we distribute the spectroscopic analysis of the viral proteins and RNA. Here, we report NMR chemical shift assignments for the protein Nsp3b, a domain of Nsp3. The 217-kDa large Nsp3 protein contains multiple structurally independent, yet functionally related domains including the viral papain-like protease and Nsp3b, a macrodomain (MD). In general, the MDs of SARS-CoV and MERS-CoV were suggested to play a key role in viral replication by modulating the immune response of the host. The MDs are structurally conserved. They most likely remove ADP-ribose, a common posttranslational modification, from protein side chains. This de-ADP ribosylating function has potentially evolved to protect the virus from the anti-viral ADP-ribosylation catalyzed by poly-ADP-ribose polymerases (PARPs), which in turn are triggered by pathogen-associated sensing of the host immune system. This renders the SARS-CoV-2 Nsp3b a highly relevant drug target in the viral replication process. We here report the near-complete NMR backbone resonance assignment (¹H, ¹³C, ¹⁵N) of the putative Nsp3b MD in its apo form and in complex with ADP-ribose. Furthermore, we derive the secondary structure of Nsp3b in solution. In addition, ¹⁵N-relaxation data suggest an ordered, rigid core of the MD structure. These data will provide a basis for NMR investigations targeted at obtaining small-molecule inhibitors interfering with the catalytic activity of Nsp3b.

Transient Rotamerism and Photoisomerization Dynamics of trans- and cis-Naphthylstilbene

The rotamerism and photoisomerization of trans- and cis-1,2-di-(2-naphthyl)ethylene (tN and cN) are studied with stationary and transient absorption spectroscopies assisted by quantum chemical calculations. Absorption and emission spectra of rotamers (rotational isomers) tN-S (C_2h-symmetric), tN-A (C₁), and tN-S' (C₂) are derived with a 53:47 ratio of tN-S to tN-A. Upon photoexcitation, the equilibration of the rotamers in S₀ (rotamerization) is observed in the bleach region with characteristic time τ_rotamer ≈ 0.5 ns. With excitation at 364 nm, the S₀ equilibrium shifts because, mainly, tN-A is bleached and the rotamerization becomes traceable, whereas with excitation at 345 nm, the equilibrium is preserved and the bleach spectrum remains unchanged. It is just long-lived (∼2 ns) S₁ that allows for monitoring the rotamer dynamics in S₀. Replacement of the stilbene phenyl rings with larger naphthyls increases the S₁ → P torsional barrier E_1act toward perpendicular configuration P both from cis and trans configurations. In tN, the radiative relaxation with τ_R ≈ 3.7 ns becomes the main deactivation channel, and accordingly, the measured decays show nearly no dependence on the solvent viscosity. The cis-to-trans photoisomerization occurs via two paths: adiabatic cS₁ → P → tS₁ (20%) and more common nonadiabatic cS₁ → P → S₀ (80%). The barrier cS₁ → P in the cis-isomer is reduced in polar solvents because of a zwitterionic character of P. The P-state is directly detected with the cN isomer in acetonitrile by an excited-state absorption band at 400 nm developing with 0.7 ps and decaying with 1.6 ps. Two dihydrophenanthrene (DHP)-like products result from photoexcited cN. The metastable DHP-A builds up transiently from cN-A, and its spectrum at about 550 nm matches the published DHP absorption. The stable DHP-S' accumulates under stationary illumination and is formed either from excited cN-S' or metastable DHP-A.

P03.04 Signaling questions assessing brain tumor patients’ distress in clinical routine - a feasibility study

BACKGROUND

Approximately 20%-35% of patients with intracranial tumors show depressive symptoms and distress. Assessment in these patients remains challenging due to cognitive and/or neurological deficits. We developed 3 signaling questions in order to assess patients during patient-doctor consultation. The aim is to implement them in clinical routine and to compare the results with patient reported outcome measures (PROMs) along disease trajectory.

MATERIAL AND METHODS

Patients were prospectively examined in a structured interview applying the 3 following questions: 1),Has your mood worsened? (I)”; 2),Are you strained by physical changes? (II)”; 3),Has your faculty of thought decreased? (III)”. Simultaneously, patients filled in the Distress Thermometer (DT) and the EORTC QLQ-C30 + BN20. The first patient group was assessed twice pre- and postoperatively in the very early disease trajectory (A), the second patient group once in the outpatient setting during adjuvant therapy or follow-up (B). The results of the 3 signaling questions were compared to the results of the PROMs.

RESULTS

A total of n=62 patients gave informed consent and n= 61 were assessed so far. In general, the signaling questions were feasible to answer for all patients. However, patients frequently needed more detailed examples for symptoms emphasizing the intention of the question.

In group A (n= 20), patients had a mean age of 59 years, n= 12 (60%) were male. Main diagnoses were glioblastomas, meningiomas and metastases. The results of the signaling questions did not reflect the screening by DT: N= 11 (55%) reported that their mood has worsened (I) prior to the operation, which then improved to n= 5 (31%) patients afterwards. The same applied to physical changes (II, 10 (50%) vs. 7 (44%), as well as lower cognition (III, 7 (35%) vs. 4 (25%) respectively). In contrast, mean DT (5.7 vs. 6 after) as well as the mean number of positive responses to the problem lists on the DT was similar pre- and postoperatively (8.7 pre-op vs. 9.4 post-op).

Group B, (n= 41) consisted of patients harboring malignant gliomas, n= 27 (66%) were male. Patients had a mean DT score = 6.8, n= 22 (53%) named a worse mood (I), n= 23 (56%) patients reported physical changes (II) and n= 22 (54%) patients reported lower cognition (III), global health scale (GHS) according to the EORTC instrument was 60 (0–100). The majority of patients with a DT ≥6 also reported strain in the signaling questions and had a lower mean GHS = 54,8. DT ≥ 6 was linked to worse mood (I, Fishers exact, p=0.02).

CONCLUSION

According to our preliminary data, the signaling questions seem to be more useful in the outpatient setting in glioma patients than perioperatively. “Has your mood worsened” was associated with higher burden according to DT. Screening in brain tumor patients could probably complemented by direct questions in order to avoid missing patients who are not able to fill in questionnaires.

Setup for multicoincidence experiments of photons in the extreme ultraviolet to visible spectral range and charged particles-The solid angle maximization approach

The coincident detection of particles is a powerful method in experimental physics, enabling the investigation of a variety of projectile-target interactions. The vast majority of coincidence experiments is performed with charged particles, as they can be guided by electric or magnetic fields to yield large detection probabilities. When a neutral species or a photon is one of the particles recorded in coincidence, its detection probability typically suffers from small solid angles. Here, we present two optical assemblies considerably enhancing the solid angle for photon detection in the extreme ultraviolet to visible spectral range. The efficiency and versatility of these assemblies are demonstrated for electron-photon coincidence detection, where electrons and photons emerge from fundamental processes after photoexcitation of gaseous samples by synchrotron radiation.

Uncovering the (un-)occupied electronic structure of a buried hybrid interface

The energy level alignment at organic/inorganic (o/i) semiconductor interfaces is crucial for any light-emitting or -harvesting functionality. Essential is the access to both occupied and unoccupied electronic states directly at the interface, which is often deeply buried underneath thick organic films and challenging to characterize. We use several complementary experimental techniques to determine the electronic structure of p -quinquephenyl pyridine (5P-Py) adsorbed on ZnO(1 0   -1 0). The parent anchoring group, pyridine, significantly lowers the work function by up to 2.9 eV and causes an occupied in-gap state (IGS) directly below the Fermi level E _F. Adsorption of upright-standing 5P-Py also leads to a strong work function reduction of up to 2.1 eV and to a similar IGS. The latter is then used as an initial state for the transient population of three normally unoccupied molecular levels through optical excitation and, due to its localization right at the o/i interface, provides interfacial sensitivity, even for thick 5P-Py films. We observe two final states above the vacuum level and one bound state at around 2 eV above E _F, which we attribute to the 5P-Py LUMO. By the separate study of anchoring group and organic dye combined with the exploitation of the occupied IGS for selective interfacial photoexcitation, this work provides a new pathway for characterizing the electronic structure at buried o/i interfaces.

Photoisomerization pathways and Raman activity of 1,1'-difluorostilbene

The photoisomerization of 1,1'-difluorostilbene, following S₀→S₁ optical excitation in solution, was studied with femtosecond broadband transient absorption and stimulated Raman spectroscopy, and by quantum-chemical calculations. In n-hexane, trans-to-cis (t→c) isomerization starts with Franck-Condon relaxation (τ_1t = 0.07 ps) followed by nearly barrierless torsion around the ethylenic bond (τ_2t ≈ 0.3 ps) to a perpendicular conformation P. About 50% of the excited molecules are trapped in P, while others reach the S₁(cis) conformation adiabatically. For the opposite cis-to-trans (c→t) path, the dynamics in n-hexane (τ_1c = 0.04 ps, τ_2c = 0.7 ps) suggest a 5 kJ/mol barrier between the relaxed S₁(cis) and P states. The subsequent P decay with τ₃ = 0.4 ps is followed by much slower ground-state recovery (τ₄ ≈ 3 ps), indicating an intermediate state X. The t→P and c→P torsion depend on solvent viscosity and polarity, whereas the P→X→S₀ relaxation and residual torsion is viscosity-independent but still polarity-dependent. Photoisomerization yields are derived from the transient absorption data and compared to those from actinometric measurements. Low-frequency oscillations in the transient signal are assigned to nuclei motions. Transient and stationary stimulated Raman spectra are compared to calculations. Early Franck-Condon Raman spectra differ from those of the quasistationary trans or cis S₁ state. The photoisomerization behavior of stilbene and vinyl-substituted derivatives is compared and the general features are discussed.

Is stiffness related to athletic groin pain?

Athletic groin pain (AGP) is a common injury prevalent in field sports. One biomechanical measure that may be of importance for injury risk is stiffness. To date, [corrected] however, stiffness has not been examined in AGP. The primary aim was to determine whether AGP affects vertical and joint stiffness and if so, whether successful rehabilitation is associated with a change in stiffness. Sixty-five male patients with AGP and fifty male controls were recruited to this study. Assessment included a biomechanical examination of stiffness during a lateral hurdle hop test. Subjects with AGP were tested pre- and post-rehabilitation, while controls were tested once. AGP subjects were cleared for return to play in a median time of 9.14 weeks (5.14-29.0). Stiffness was significantly different at pre-rehabilitation in comparison with controls for three [corrected] of the ten stiffness values examined: ankle plantar flexor, knee extensor, hip abductor, and vertical stiffness (P <  .05, D = 0.38-0.81). [corrected]. Despite clearance for return to play, of these four variables, only hip abductor stiffness changed significantly from pre- to post-rehabilitation (P = .05, D = 0.36) [corrected] to become non-significantly different to the uninjured group (P = .23, D = 0.23). [corrected]. These findings suggest that hip abductor stiffness may represent a target for AGP rehabilitation. Conversely, given the clearance for return to play, the lower sagittal plane and vertical stiffness in the AGP group in comparison with the uninjured controls likely represents either a compensatory mechanism to reduce the risk of further injury or a consequence of neuromuscular detraining.