Data collection framework for electronic medical record-based real-world data to evaluate the effectiveness and safety of cancer drugs: a nationwide real-world study of the Korean Cancer Study Group

Background:

Electronic medical records (EMRs) have the highest value among real-world data (RWD). The aim of the present study was to propose a data collection framework of EMR-based RWD to evaluate the effectiveness and safety of cancer drugs by conducting a nationwide real-world study based on the Korean Cancer Study Group.

Methods:

We considered all patients who received ramucirumab plus paclitaxel (RAM/PTX) for gastric cancer and trastuzumab emtansine (T-DM1) for breast cancer at relevant institutions in South Korea. Standard operating procedures for systematic data collection were prospectively developed. Investigator reliability was evaluated using the concordance rate between the recommended input value for representative fictional cases and the input value of each investigator. Reliability of collected data was evaluated twice during the study period at three institutions randomly selected using the concordance rate between the previously collected data and data collected by an independent investigator. The reliability results of the investigators and collected data were used for revision of the electronic data capture system and site training.

Results:

Between the starting date of medical insurance coverage and December 2018, a total of 1063 patients at 56 institutions in the RAM/PTX cohort and 824 patients at 60 institutions in the T-DM1 cohort were included. Mean investigator reliability in the RAM/PTX and T-DM1 cohorts was 73.5% and 71.9%, respectively. Mean reliability of collected data in the RAM/PTX and T-DM1 cohort was 90.0% for both cohorts in the first analysis and 89.0% and 84.0% in the second analysis, respectively. Mean missing values of the RAM/PTX and T-DM1 cohorts at the time of simulation of fictional cases and final data analysis decreased from 20.7% to 0.46% and from 18.5% to 0.76%, respectively.

Conclusion:

This real-world study provides a framework that ensures relevance and reliability of EMR-based RWD for evaluating the effectiveness and safety of cancer drugs.

The roughening kinetics of hydrogenated graphene

The roughness is a common property of all growing surfaces – however, the way the roughness of a growing surface changes with time and space is uniquely related to the underlying growth process, i.e. to how the atoms stick to the surface during the first stage of nucleation. This concept allows getting insights on the nucleation process of a growing surface by measuring two scaling exponents, α and β, known as roughness and growth exponents, respectively. In this work, we studied hydrogenation of graphene using the roughening kinetics. The coverage of graphene will depend on how the H ions stick on the surface, giving rise to a unique roughness evolution in time and space. We measured a roughness exponent of ~0.5 (derived from a Fourier index of ~3), and a growth exponent of ~0.3. The values of the growth and roughness exponents are close to those reported for clustered carbon, suggesting a roughening mechanism by clustering, in good agreement with the theory. We also compared our coverage data with a different model, used to describe the dynamics of graphene coverage, during chemical vapour deposition. Our data are in agreement with a nucleation-dominated growth, further confirming that hydrogenation is happening by clustering.

Prospective multinational serosurveillance study of Bordetella pertussis infection among 10- to 18-year-old Asian children and adolescents

OBJECTIVES

Bordetella pertussis continues to cause outbreaks worldwide. To assess the role of children and adolescent in transmission of pertussis in Asia, we performed a multinational serosurveillance study.

METHODS

From July 2013 to June 2016, individuals aged 10 to 18 years who had not received any pertussis-containing vaccine within the prior year were recruited in 10 centres in Asia. Serum anti-pertussis toxin (PT) IgG was measured by ELISA. Demographic data and medical histories were obtained. In the absence of pertussis immunization, anti-PT IgG ≥62.5 IU/mL was interpreted as B. pertussis infection within 12 months prior, among them levels ≥125 IU/mL were further identified as infection within 6 months.

RESULTS

A total of 1802 individuals were enrolled. Anti-PT IgG geometric mean concentration was 4.5, and 87 (4.8%) individuals had levels ≥62.5 IU/mL; among them, 73 (83.9%) had received three or more doses of pertussis vaccine before age 6 years. Of 30 participants with persistent cough during the past 6 months, one (3.3%) had level ≥125 IU/mL. There was no significant difference in proportions with anti-PT IgG ≥62.5 IU/mL among age groups (13-15 vs. 10-12 years, 16-18 vs. 10-12 years), between types of diphtheria, pertussis and tetanus (DTP; whole cell vs. acellular), number of doses before age 6 years within the DTP whole-cell pertussis vaccine (five vs. four doses) or acellular pertussis vaccine (five vs. four doses) and history of persistent cough during the past 6 months (yes vs. no).

CONCLUSIONS

There is significant circulation of B. pertussis amongst Asian children and adolescents, with one in 20 having serologic evidence of recent infection regardless of vaccination background.

Impact of Early Hospital Readmissions After Kidney Transplantation on Graft Function

Early hospital readmissions are common after kidney transplantation. This single-center retrospective study investigated the relationship between early hospital readmissions and clinical outcomes. All adult patients receiving a kidney transplant at this center between March 2009 and June 2015 were included. The early hospital readmissions within the first 30 days were numbered, and the diagnosis was ascertained. The patients were divided into None and Readmission groups. Clinical outcomes and patient- and death-censored graft survival were compared. Among the 103 patients included in the study, 32 (31.1%) had 1 or more readmissions within 30 days. Surgical complications, electrolyte imbalance, and acute rejection were common causes of readmission. No differences were observed in baseline characteristics between the two groups. Patients with early readmissions exhibited low renal function at 3, 6, and 12 months postoperatively (P = .002, .020, and .013, respectively). No difference in graft function was found 12 months after transplantation between the None and Readmission groups. Five-year graft and patient survival also showed no difference between the two groups (P = .424 and .442, respectively). In conclusion, early readmission after kidney transplantation affected lower graft function until 1 year after kidney transplantation. However, the long-term effect on graft function is limited in this study.

Early Weight Gain After Transplantation Can Cause Adverse Effect on Transplant Kidney Function

BACKGROUND

The outcomes of kidney transplant recipients with increased body mass index (BMI) remain controversial. We studied the relationship between changes in BMI and kidney transplant function, especially during the first year after transplantation.

METHODS

We performed an observational cohort study of all kidney transplant recipients at our center from March 2009 to June 2014 to determine whether changes in BMI were associated with kidney transplant function, as measured by estimated glomerular filtration rate (eGFR). Recipient BMI and eGFR were calculated pre-transplant and at 1, 3, 6, 9, and 12 postoperative months (POM) after transplantation. The correlation between changes in BMI and eGFR was then evaluated.

RESULTS

Eighty-one patients were studied. There was a strong negative correlation between changes in BMI and eGFR from pre-transplant to POM 1 (correlation coefficient, -0.406; P < .0001) and from POM 1 to POM 3 (r = -0.324, P = .004).

CONCLUSIONS

We found that increased BMI caused a significant decline in renal function as measured by eGFR, especially in the initial 3 months after kidney transplantation.

Adjustment Experience of Kidney Transplantation Recipients in Korea

BACKGROUND

The purpose of this study was to understand the adjustment process after kidney transplantation.

METHODS

The research method followed grounded theory methodology of Strauss and Corbin. Twelve recipients after kidney transplantation were selected. The data were collected through in-depth, face-to-face interviews or e-mailing or phone-interviews and analyzed by means of a constant comparative method.

RESULTS

Through the category analysis, "struggling for independence" was verified as the central phenomenon of recipients, and the causal conditions that influence this phenomenon were "unpredictable physical status," "the difficulty of self-care," "apathy of families and friends," and "emotional instability." The contextual conditions were "social prejudice" and "difficulty in returning to society," and the intervening conditions were "significant others support" and "religious support." The action/interaction strategies were "inner reviewing strategies," "interactive strategies," and "active self-maintaining strategies." From this observation, "establishing guidelines for living" was derived as the result.

CONCLUSIONS

The results of this study provided deep understanding on the adjustment process after kidney transplantation, and this would help to provide a frame for individualized medical and nursing intervention strategies in assisting the psychosocial adaptation of the kidney transplantation recipient.

Indole derivatives inhibit hepatitis C virus replication through induction of pro-inflammatory cytokines

Previously, we discovered a series of indole derivatives as a new class of hepatitis C virus (HCV) replication inhibitors by using a target-free chemical genetic strategy. Through a structure-activity relationship study, the compound 12e was identified as the most potent inhibitor of this class (EC50 = 1.1 μmol/l) with minimal cytotoxicity (CC50 = 61.8 μmol/l). In order to gain insight into its detailed antiviral mechanism of action, we performed PCR array analyses and found that 12e was able to activate transcription of a number of pro-inflammatory as well as antiviral cytokine genes including CXCL-8, IL-1α, TNF-α, IL-3, IRAK-1, and DDX58. Their induction by 12e was verified by individual RT-PCR analyses. In addition, 12e was found to stimulate secretion of soluble factors with anti-HCV replication activity. Among the 12e-induced pro-inflammatory cytokines, CXCL-8 showed a strong positive correlation between its transcriptional activation and antiviral potency. Interestingly, a recombinant CXCL-8 protein also reduced HCV replication, though only moderately. In conclusion, we found a novel mode of action of indole derivatives in inhibiting HCV replication, particularly the induction of pro-inflammatory cytokines.

Carbon monoxide and nitric oxide interactions in magnocellular neurosecretory neurones during water deprivation

Nitric oxide (NO) and carbon monoxide (CO) are diffusible gas messengers in the brain. Previously, we have shown their independent involvement in central fluid/electrolyte homeostasis control. In the present study, we investigated a possible functional interaction between NO/CO in the regulation of vasopressin (VP) and oxytocin (OT) magnocellular neurosecretory cells (MNCs) activity in euhydrated (EU) and dehydrated [48-h water-deprived (48WD)] rats. Using brain slices from EU and 48WD rats, we measured, by immunohistochemistry, the expression of neuronal NO synthase (nNOS, which synthesises NO) and haeme-oxygenase (HO-1, which synthesises CO) in the hypothalamic supraoptic nucleus (SON). In addition, we used patch-clamp electrophysiology to investigate whether regulation of SON MNC firing activity by endogenous CO was dependent on NO bioavailability and GABAergic inhibitory synaptic function. We found a proportion of OT and VP SON MNCs in EU rats to co-express both of HO-1 and nNOS (33.2 ± 2.9% and 15.3 ± 1.4%, respectively), which was increased in 48WD rats (55.5 ± 0.9% and 21.0 ± 1.7%, respectively, P < 0.05 for both). Inhibition of endogenous HO activity [chromium mesoporphyrin IX chloride (CrMP) 20 μm] induced MNC membrane hyperpolarisation and decreased firing activity, and these effects were blunted by previous blockade of endogenous NOS activity (l-NAME, 2 mm) or blockade of inhibitory GABA function [Picrotoxin (Sigma-Aldrich, St Louis, MO, USA), 50 μm]. No significant changes in SON NO bioavailability (4,5 diaminofluorescein diacetate fluorescence) were observed after CrMP treatment. Taken together, our results support a state-dependent functional inter-relationship between NO and CO in MNCs, in which CO acts as an excitatory gas molecule, whose effects are largely dependent on interactions with the inhibitory SON signals NO and GABA.

Non-invasive assessment of cutaneous wound healing using fluorescent imaging

BACKGROUND/PURPOSE

Optical imaging is a very important technique in the biomedical sciences. The purpose of this study was to develop an in vivo optical system for fluorescent imaging and molecular imaging applications using quantum dots (QDs).

METHODS

The in vivo optical system was composed of modular parts, including a light source, light guide, excitation filter wheel, excitation filters, emission filter wheel, emission filters, liquid crystal tunable filter (LCTF), macro lens, dark chamber, and a cooled charged-coupled device (CCD) camera for recording images. Filters were selected based on the excitation and absorption spectra of QDs to allow spectral separation and optimization of the acquired image. In contrast with conventional systems, our system allows selection of the emission bandwidth.

RESULTS

The system was tested in an in vivo study using a wound-healing model in nude mice. The healing process was examined after injection of fibroblasts and keratinocytes labeled with two different sets of QDs. The different QD probes were readily detected and distinguished using our system.

CONCLUSION

An in vivo optical system is a very useful tool for the detection of genes, proteins, and small-molecule drugs inside living animals, and this imaging modality can also be adopted for real-time visualization of cancer cell metastasis in live animals.

Frequency downshift of Nd:YAG lasers and terahertz radiation

The interaction between an intense laser and a cotraveling relativistic dense electron beam could result in the downshifting of the laser frequency. It is theoretically analyzed that this process can generate a coherent terahertz radiation. The radiation energy could reach the order of 1 mJ per shot in the duration of 100 ps, or a temporal radiation power of 10 MW, with a set of practically relevant parameters.

Enhanced expression of heme oxygenase-1 and carbon monoxide excitatory effects in oxytocin and vasopressin neurones during water deprivation

A growing body of evidence indiates that carbon monoxide (CO) acts as a gas neurotransmitter within the central nervous system. Although CO has been shown to affect neurohypophyseal hormone release in response to osmotic stimuli, the precise sources, targets and mechanisms underlying the actions of CO within the magnocellular neurosecretory system remain largely unknown. In the present study, we combined immunohistochemistry and patch-clamp electrophysiology to study the cellular distribution of the CO-synthase enzyme heme oxygenase type 1 (HO-1), as well as the actions of CO on oxytocin (OT) and vasopressin (VP) magnocellular neurosecretory cells (MNCs), in euhydrated (EU) and 48-h water-deprived rats (48WD). Our results show the expression of HO-1 immunoreactivity both in OT and VP neurones, as well as in a small proportion of astrocytes, both in supraoptic (SON) and paraventricular (PVN) nuclei. HO-1 expression, and its colocalisation with OT and VP neurones within the SON and PVN, was significantly enhanced in 48WD rats. Inhibition of HO activity with chromium mesoporphyrin IX chloride (CrMP; 20 μm) resulted in a slight membrane hyperpolarisation in SON neurones from EU rats, without significantly affecting their firing activity. In 48WD rats, on the other hand, CrMP resulted in a more robust membrane hyperpolarisation, significantly decreasing neuronal firing discharge. Taken together, our results indicate that magnocellular SON and PVN neurones express HO-1, and that CO acts as an excitatory gas neurotransmitter in this system. Moreover, we found that the expression and actions of CO were enhanced in water-deprived rats, suggesting that the state-dependent up-regulation of the HO-1/CO signalling pathway contributes to enhance MNCs firing activity during an osmotic challenge.

Current-drive efficiency in a degenerate plasma

In a degenerate plasma, the rates of electron processes are much smaller than the classical model would predict, affecting the efficiencies of current generation by external noninductive means, such as by electromagnetic radiation or intense ion beams. For electron-based mechanisms, the current-drive efficiency is higher than the classical prediction by more than a factor of 6 in a degenerate hydrogen plasma, mainly because the electron-electron collisions do not quickly slow down fast electrons. Moreover, electrons much faster than thermal speeds are more readily excited without exciting thermal electrons. In ion-based mechanisms of current drive, the efficiency is likewise enhanced due to the degeneracy effects, since the electron stopping power on slow ion beams is significantly reduced.

[Prevalence of hepatitis A, B, C and E virus markers among patients with elevated levels of Alanine aminotransferase and Aspartate aminotransferase in Phnom Penh (Cambodia) and Nha Trang (Central Vietnam)]

In order to describe the respective part of viral hepatitis in liver diseases observed in Cambodia and Vietnam, ninety consecutive patients with Aspartate aminotransferase (AST) and Alanine aminotransferase (ALT) > or = 100 Ul/l were tested for hepatitis A, B, C and E markers in Phnom Penh and Nha Trang. The markers were IgM antibodies to hepatitis A virus (anti-HAV IgM), hepatitis B surface antigen (HBsAg), antibodies to hepatitis C virus (anti-HCVAb) and IgG antibodies to hepatitis E virus (anti-HEV IgG). Recruited patients were predominantly adults and male (sex ratio 76%). Among these patients, 81% were tested positive to at least one marker in Nha Trang and 79% in Phnom Penh. In Nha Trang, HBsAg was more frequent (73%) than anti-HCV Ab (9%) while in Phnom Penh both markers were closely similar (HBsAg: 41%, anti-HCV Ab: 39%). In both population samples, HBsAg was more prevalent among young people whereas anti-HCV Ab were only detected in adults. No case of acute HAV infection was diagnosed in Nha Trang while anti-HAV IgM were detected in 20% of Cambodian patients. Anti-HEV IgG were infrequent (2% in Nha Trang, 5.5% in Phnom Penh). Only one case was notified, a male Vietnamese patient probably suffering from acute hepatitis E. More studies would be useful to improve the control measures against viral hepatitis in the public health programs.

Caffeic acid phenethyl ester (CAPE): synthesis and X-ray crystallographic analysis

The structure of caffeic acid phenethyl ester [2-propenoic acid, 3-(3,4-dihydroxyphenyl)-, 2-phenethyl ester] (I), C17H16O4 x 1/2C6H6, synthesized by base-catalyzed alkylation of caffeic acid salt with beta-bromoethylbenzene in HMPA (hexamethylphosphoramide) and recrystallized from benzene, was confirmed by single crystal X-ray diffraction. The crystals are triclinic, space group P1, Z=2, unit cell dimension a=5.8129 (9) A, b=11.122 (2) A, c=13.226 (2) A, alpha=97.080 (3) degrees, beta=101.467 (3) degrees, gamma=95.405 (3) degrees , V=825.4 (2) A3, Dcalc=1.301 g/cm3, F(000)=342. The packing of the molecule is stabilized by intermolecular O1H...O4 (2.69 A) and O1...HO2 (2.82 A) hydrogen bonds.

[Benign testicular tumors in children. Value of simple tumorectomy]

From 1984 to 1999, the authors observed 18 intratesticular tumours, 13 of which corresponded to benign lesions. The objective of this study is to define preoperative and intraoperative criteria of benign lesions in order to allow conservative management (simple excision or enucleation) and to analyse the results of this treatment. The 13 boys of this series were between the ages of 5 months and 14 years (mean: 7.1 years). The lesion presented as scrotal swelling in 12 cases and gynaecomastia in 1 case. Tumour markers (alphafoetoprotein, beta HCG) were at the limit of normal for age. Ultrasonography was performed in every case. In each case, treatment consisted of primary exposure of the pediclc with clamping then exteriorization and macroscopic examination of the lesion. Frozen section examination was performed in 11 cases. Treatment consisted of 9 enucleations and 4 orchidectomies. The final histology concluded on epidermoid cyst or simplified teratoma with exclusively ectodermal development in 4 cases, multi-differentiated teratoma in 2 cases, sex cord tumour in 2 cases, simple cyst in 2 cases, rete testis dysplasia in 1 case, cavernous haemangioma in 1 case, and vestigial cyst in 1 case. There was no discordance between the final histological examination and the frozen section examination. The mean follow-up is 4.4 years. No secondary atrophy and no local or distant recurrence was observed in the 9 cases of enucleation. In conclusion, testicular tumours are often benign in children. Selection based on a body of clinical, laboratory, radiological and frozen section histological evidence should allow carcinologically safe conservative surgery with an aesthetic, psychological and functional benefit for the child.

The relationship between gelatinase A activity in aqueous humor and glaucoma

PURPOSE

To investigate whether abnormal expression of gelatinase A in aqueous humor may be related to the development of glaucoma, the activity of gelatinase A in aqueous humor of patients with glaucoma and patients with cataract was measured and compared.

METHODS

Six primary patients with open-angle glaucoma (POAG), four patients with chronic angle closure glaucoma (CACG), four patients with normal tension glaucoma (NTG), and 14 patients with cataract were enrolled. The aqueous humor of each patient was collected during surgery, and total protein concentration and gelatinase activity in the aqueous humor were measured by protein assay kit and zymography, respectively.

RESULTS

In patients with POAG, total protein concentration doubled and gelatinase A activity increased by 3.9 times compared with patients with cataract. However, there were no statistically significant differences in total protein concentration and gelatinase A activity in patients with CACG or NTG compared with patients with cataract.

CONCLUSION

The development of POAG may be associated with the abnormal expression of gelatinase A in aqueous humor.

[Mini-invasive surgery of the retroperitoneal space in children]

Although laparoscopic surgery now represents today an essential surgical technique, its use remains limited in urology and especially in pediatric urology for many reasons, main because of the lack of indications. After a large experience acquired in abdominal laparoscopic surgery, and because we were convinced of the advantages offered by this new mini-invasive approach, we have tried to develop it for the retroperitoneal space.

METHODS

Over a five-year period we performed 88 retroperitoneal procedures in children:--50 nephrectomies (44 total, 10 partial) for the following indications: 15 polycystic dysplastic kidney, 13 kidney destroyed by reflux, 18 by obstruction, hypertensive uropathy 3, pyonephrosis 1.--5 renal cystectomies, 3 pyelolithotomies, 2 pyeloureteral obstructions, 2 adrenalectomies, 1 retrocaval ureter, 25 varicoceles. The age range was 2 months to 16 years (mean: 3.7 years, 25 children under 1 year). The patients were placed in the lateral debubitus. The retroperitoneal space was created by dissection under direct vision, then insufflation was performed directly in the retroperitoneal space without balloon. Three or four ports were used except for varicocelectomy which was performed with only one port and an operating channel telescope.

RESULTS

Follow-up range was 6 months to 5 years. The mean operating time was 96 minutes (35 to 210 min.). Average postoperative stay was 2 days. Conversion was needed in 7 cases (8%). Operative incidents consisted of one duodenal perforation, one ureteral burn, 21 peritoneal perforations (24%). There were 5 postoperative complications (2 urinomas after partial nephrectomy, 1 hydrocele, 1 varicocele recurrence, 1 recurrent stones) not related to the technique. 3 cases needed reoperation (ureteral injury, varicocele recurrence, recurrence of cystine stones) with good result.

CONCLUSION

Like other laparoscopic techniques, retroperitoneoscopy requires a training: it remains delicate in children because of the reduced working space and the fragility of the peritoneum. However the advantages seem sufficiently obvious for us to recommend and promote this procedure.