The Cancer Clinical Library Database (CCLD) from the Korea-Clinical Data Utilization Network for Research Excellence (K-CURE) Project.

The common data model (CDM) has found widespread application in healthcare studies, but its utilization in cancer research has been limited. This article describes the development and implementation strategy for Cancer Clinical Library Databases (CCLDs), which are standardized cancer-specific databases established under the Korea-Clinical Data Utilization Network for Research Excellence (K-CURE) project by the Korean Ministry of Health and Welfare. Fifteen leading hospitals and fourteen academic associations in Korea are engaged in constructing CCLDs for 10 primary cancer types. For each cancer type-specific CCLD, cancer data experts determine key clinical data items essential for cancer research, standardize these items across cancer types, and create a standardized schema. Comprehensive clinical records covering diagnosis, treatment, and outcomes, with annual updates, are collected for each cancer patient in the target population, and quality control is based on six-sigma standards. To protect patient privacy, CCLDs follow stringent data security guidelines by pseudonymizing personal identification information and operating within a closed analysis environment. Researchers can apply for access to CCLD data through the K-CURE portal, which is subject to Institutional Review Board and Data Review Board approval. The CCLD is considered a pioneering standardized cancer-specific database, significantly representing Korea's cancer data. It is expected to overcome limitations of previous CDMs and provide a valuable resource for multicenter cancer research in Korea.

Referred otalgia: Common causes and evidence-based strategies for assessment and management.

OBJECTIVE: To provide family physicians and general otolaryngologists with a practical, evidence-based, and comprehensive approach to the management of patients presenting with suspected referred otalgia. SOURCES OF INFORMATION: The approach described is a review based on the authors' clinical practices along with research and clinical review articles published between 2000 and 2020. MEDLINE and PubMed were searched using the terms otalgia, referred otalgia, and secondary otalgia. Current guidelines for the management of referred otalgia were also reviewed. MAIN MESSAGE: Otalgia is defined as pain localized to the ear. It is one of the most common head and neck presentations in primary care, otolaryngology, and emergency medicine. Secondary otalgia arises from nonotologic pathology and represents nearly 50% of otalgia cases. Otalgia in the absence of other otologic symptoms is highly indicative of a secondary cause. A thorough assessment of patients presenting with referred otalgia requires an understanding of the possible causes of this condition, including dental and oral mucosal pathologies, temporomandibular joint disorders, cervical spine pathology, sinusitis, upper airway infection, and reflux, as well as head and neck malignancy. This paper aims to highlight the most common causes of referred otalgia, their presentations, and initial options for assessment and management. CONCLUSION: The prevalence of referred otalgia makes this an important condition for family physicians to be able to assess, manage, and triage based on patient presentation and examination. Understanding the common causes of referred otalgia will help reduce wait times for specialist assessment and allow ease and speed of access to management options for patients in community clinics.

Otalgie référée: Causes habituelles et stratégies d'évaluation et de prise en charge fondées sur des données probantes.

OBJECTIF: Présenter aux médecins de famille et aux otorhinolaryngologistes généraux une approche pratique, exhaustive et fondée sur des données probantes pour la prise en charge des patients chez qui l'on soupçonnne une otalgie référée. SOURCES DE L'INFORMATION: L'approche décrite est une revue qui se fonde sur les pratiques cliniques des auteurs, et sur des articles de recherche et des revues cliniques publiés entre 2000 et 2020. Une recension a été effectuée dans MEDLINE et PubMed à l'aide des expressions en anglais otalgia, referred otalgia et secondary otalgia. Les lignes directrices actuelles sur la prise en charge de l'otalgie référée ont aussi été passées en revue. MESSAGE PRINCIPAL: L'otalgie désigne une douleur localisée à l'oreille. Il s'agit de l'une des présentations liées à la tête et au cou les plus fréquentes en soins primaires, en otorhinolaryngologie et en médecine d'urgence. L'otalgie secondaire découle d'une pathologie non otologique, et près de 50 % des cas d'otalgie lui sont attribuables. L'otalgie sans autres symptômes otologiques évoque fortement une cause secondaire. Une évaluation rigoureuse des patients qui présentent une otalgie référée nécessite une bonne compréhension des causes possibles de ce problème, notamment des pathologies dentaires et des muqueuses buccales, des troubles de l'articulation temporo-mandibulaire, des pathologies de la colonne cervicale, de la sinusite, des infections des voies aériennes supérieures et du reflux, de même que des cancers de la tête et du cou. Cet article a pour but de mettre en évidence les causes les plus fréquentes d'une otalgie référée, leurs caractéristiques, et les options initiales pour l'évaluation et la prise en charge. CONCLUSION: La prévalence de l'otalgie référée fait en sorte qu'il importe que les médecins de famille soient en mesure d'évaluer, de prendre en charge et de trier les patients d'après la présentation et l'examen. Une bonne compréhension des causes courantes de l'otalgie référée aide à réduire le temps d'attente avant une évaluation spécialisée, et permet de faciliter et d'accélérer l'accès par les patients à des options de prise en charge dans les cliniques communautaires.

Next-Generation Sequencing-Based Cancer Panel Data Conversion Using International Standards to Implement a Clinical Next-Generation Sequencing Research System: Single-Institution Study.

BACKGROUND: The analytical capacity and speed of next-generation sequencing (NGS) technology have been improved. Many genetic variants associated with various diseases have been discovered using NGS. Therefore, applying NGS to clinical practice results in precision or personalized medicine. However, as clinical sequencing reports in electronic health records (EHRs) are not structured according to recommended standards, clinical decision support systems have not been fully utilized. In addition, integrating genomic data with clinical data for translational research remains a great challenge. OBJECTIVE: To apply international standards to clinical sequencing reports and to develop a clinical research information system to integrate standardized genomic data with clinical data. METHODS: We applied the recently published ISO/TS 20428 standard to 367 clinical sequencing reports generated by panel (91 genes) sequencing in EHRs and implemented a clinical NGS research system by extending the clinical data warehouse to integrate the necessary clinical data for each patient. We also developed a user interface with a clinical research portal and an NGS result viewer. RESULTS: A single clinical sequencing report with 28 items was restructured into four database tables and 49 entities. As a result, 367 patients' clinical sequencing data were connected with clinical data in EHRs, such as diagnosis, surgery, and death information. This system can support the development of cohort or case-control datasets as well. CONCLUSIONS: The standardized clinical sequencing data are not only for clinical practice and could be further applied to translational research.

The Korea Cancer Big Data Platform (K-CBP) for Cancer Research.

Data warehousing is the most important technology to address recent advances in precision medicine. However, a generic clinical data warehouse does not address unstructured and insufficient data. In precision medicine, it is essential to develop a platform that can collect and utilize data. Data were collected from electronic medical records, genomic sequences, tumor biopsy specimens, and national cancer control initiative databases in the National Cancer Center (NCC), Korea. Data were de-identified and stored in a safe and independent space. Unstructured clinical data were standardized and incorporated into cancer registries and linked to cancer genome sequences and tumor biopsy specimens. Finally, national cancer control initiative data from the public domain were independently organized and linked to cancer registries. We constructed a system for integrating and providing various cancer data called the Korea Cancer Big Data Platform (K-CBP). Although the K-CBP could be used for cancer research, the legal and regulatory aspects of data distribution and usage need to be addressed first. Nonetheless, the system will continue collecting data from cancer-related resources that will hopefully facilitate precision-based research.

Identification of altered protein abundances in cholesteatoma matrix via mass spectrometry-based proteomic analysis.

BACKGROUND: Cholesteatoma are cyst-like structures lined with a matrix of differentiated squamous epithelium overlying connective tissue. Although epithelium normally exhibits self-limited growth, cholesteatoma matrix erodes mucosa and bone suggesting changes in matrix protein constituents that permit destructive behaviour. Differential proteomic studies can measure and compare the cholesteatoma proteome to normal tissues, revealing protein alterations that may propagate the destructive process. METHODS: Human cholesteatoma matrix, cholesteatoma-involved ossicles, and normal middle ear mucosa, post-auricular skin, and non-involved ossicles were harvested. These tissues were subjected to multiplex peptide labeling followed by liquid chromatography and tandem mass spectrometry analysis. Relative protein abundances were compared and evaluated for ontologic function and putative involvement in cholesteatoma. RESULTS: Our methodology detected 10 764 peptides constituting 1662 unique proteins at 95 % confidence or greater. Twenty-nine candidate proteins were identified in soft tissue analysis, with 29 additional proteins showing altered abundances in bone samples. Ontologic functions and known relevance to cholesteatoma are discussed, with several candidates highlighted for their roles in epithelial integrity, evasion of apoptosis, and immunologic function. CONCLUSION: This study produced an extensive cholesteatoma proteome and identified 58 proteins with altered abundances contributing to disease pathopathysiology. As well, potential biomarkers of residual disease were highlighted. Further investigation into these proteins may provide useful options for novel therapeutics or monitoring disease status.