Information about missing patient-reported outcome data in breast cancer trials is frequently not documented: a scoping review.

OBJECTIVES: This review addresses the common problem of missing patient-reported outcome (PRO) data in clinical trials by assessing the current practice of their statistical handling as reported in publications of randomized controlled trials (RCTs) in patients with breast cancer. STUDY DESIGN AND SETTING: We searched PubMed to identify RCTs evaluating biomedical treatments in breast cancer patients with at least one PRO endpoint published between January 2019 and February 2022. Two reviewers independently assessed the eligibility of the publications for this scoping review and extracted prespecified information on missing PRO data and related statistical practices. RESULTS: Of 1,598 publications identified, 118 trials met the inclusion criteria. Eighty-eight (74.6%) trials reported the extent of missing data, with 11 (9.3%) not containing any missing PRO data. Twenty-one (19.6%) trials explicitly stated the statistical approach for handling missing data, with a preference for single imputation over multiple imputation approaches (57.2%/19.0%). Only six (5.6%) trials reported a sensitivity analysis to examine the extent to the results being affected by changes in assumptions made about missing PRO data. CONCLUSION: International efforts to raise awareness of the importance of accurately reporting state-of-the-art handling of missing PRO data are not yet fully reflected in the current literature of breast cancer RCTs.

Diagnosing small fiber neuropathy in clinical practice: a deep phenotyping study.

BACKGROUND AND AIMS: Small fiber neuropathy (SFN) is increasingly suspected in patients with pain of uncertain origin, and making the diagnosis remains a challenge lacking a diagnostic gold standard. METHODS: In this case-control study, we prospectively recruited 86 patients with a medical history and clinical phenotype suggestive of SFN. Patients underwent neurological examination, quantitative sensory testing (QST), and distal and proximal skin punch biopsy, and were tested for pain-associated gene loci. Fifty-five of these patients additionally underwent pain-related evoked potentials (PREP), corneal confocal microscopy (CCM), and a quantitative sudomotor axon reflex test (QSART). RESULTS: Abnormal distal intraepidermal nerve fiber density (IENFD) (60/86, 70%) and neurological examination (53/86, 62%) most frequently reflected small fiber disease. Adding CCM and/or PREP further increased the number of patients with small fiber impairment to 47/55 (85%). Genetic testing revealed potentially pathogenic gene variants in 14/86 (16%) index patients. QST, QSART, and proximal IENFD were of lower impact. CONCLUSION: We propose to diagnose SFN primarily based on the results of neurological examination and distal IENFD, with more detailed phenotyping in specialized centers.

Mechanisms of small nerve fiber pathology.

Small fiber pathology is increasingly recognized as a potential contributor to neuropathic pain in different clinical syndromes, however, the underlying mechanisms leading to nociceptor sensitization and degeneration are unclear. With the diversity in clinical pain phenotypes and etiology of small fiber pathology, individual mechanisms are assumed, but are not yet fully understood. The thinly-myelinated Aδ- and unmyelinated C-nerve fibers are mainly affected and clinically require special small fiber test methods to capture functional, morphological, and electrophysiological alterations. Several methods have been established and implemented in clinical practice in the last years. In parallel, experimental and in vitro test systems have been developed allowing important insights into the molecular mechanisms underlying nociceptor sensitization and degeneration as main hallmarks of small fiber pathology. In our narrative review, we focus on these methods and current knowledge, and provide a synopsis of the achievements made so far in this exciting field.

Effects of tumor treating fields (TTFields) on glioblastoma cells are augmented by mitotic checkpoint inhibition.

Tumor treating fields (TTFields) are approved for glioblastoma (GBM) therapy. TTFields disrupt cell division by inhibiting spindle fiber formation. Spindle assembly checkpoint (SAC) inhibition combined with antimitotic drugs synergistically decreases glioma cell growth in cell culture and mice. We hypothesized that SAC inhibition will increase TTFields efficacy. Human GBM cells (U-87 MG, GaMG) were treated with TTFields (200 kHz, 1.7 V/cm) and/or the SAC inhibitor MPS1-IN-3 (IN-3, 4 µM). Cells were counted after 24, 48, and 72 h of treatment and at 24 and 72 h after end of treatment (EOT). Flow cytometry, immunofluorescence microscopy, Annexin-V staining and TUNEL assay were used to detect alterations in cell cycle and apoptosis after 72 h of treatment. The TTFields/IN-3 combination decreased cell proliferation after 72 h compared to either treatment alone (-78.6% vs. TTFields, P = 0.0337; -52.6% vs. IN-3, P = 0.0205), and reduced the number of viable cells (62% less than seeded). There was a significant cell cycle shift from G1 to G2/M phase (P < 0.0001). The apoptotic rate increased to 44% (TTFields 14%, P = 0.0002; IN-3 4%, P < 0.0001). Cell growth recovered 24 h after EOT with TTFields and IN-3 alone, but the combination led to further decrease by 92% at 72 h EOT if IN-3 treatment was continued (P = 0.0288). The combination of TTFields and SAC inhibition led to earlier and prolonged effects that significantly augmented the efficacy of TTFields and highlights a potential new targeted multimodal treatment for GBM.

Quantitation of Acyl Chain Oxidation Products Formed upon Thermo-oxidation of Phytosteryl/-stanyl Oleates and Linoleates.

A GC-based approach involving preseparation via solid-phase extraction was established for the quantitation of acyl chain oxidation products (ACOPs) formed upon thermo-oxidation (180 °C, 40 min) of oleates and linoleates of phytostanols and phytosterols. The concentrations of ACOPs resulting from initially formed 9-hydroperoxides (octanoates, 8-hydroxyoctanoates, 9-oxononanoates) were higher than those from 8-hydroperoxides (heptanoates, 7-hydroxy- and 7-oxoheptanoates, 8-oxooctanoates) in both oleates and linoleates. Significantly higher amounts of ACOPs were found in heat-treated linoleates compared to oleates. However, despite lower thermally induced losses of stanyl oleates and linoleates compared to the respective steryl esters, higher concentrations of ACOPs (approximately 9 and 10% of the ester losses, respectively) were observed in the heat-treated stanyl esters. In contrast, in the heated steryl oleates and linoleates the contribution of the ACOPs to the ester losses was lower (approximately 3 and 5%, respectively), and there was a more pronounced formation of oxidation products of the sterol moieties (approximately 26 and 18% of the ester losses, respectively).

Frames as visual links between paintings and the museum environment: an analysis of statistical image properties.

Frames provide a visual link between artworks and their surround. We asked how image properties change as an observer zooms out from viewing a painting alone, to viewing the painting with its frame and, finally, the framed painting in its museum environment (museum scene). To address this question, we determined three higher-order image properties that are based on histograms of oriented luminance gradients. First, complexity was measured as the sum of the strengths of all gradients in the image. Second, we determined the self-similarity of histograms of the orientated gradients at different levels of spatial analysis. Third, we analyzed how much gradient strength varied across orientations (anisotropy). Results were obtained for three art museums that exhibited paintings from three major periods of Western art. In all three museums, the mean complexity of the frames was higher than that of the paintings or the museum scenes. Frames thus provide a barrier of complexity between the paintings and their exterior. By contrast, self-similarity and anisotropy values of images of framed paintings were intermediate between the images of the paintings and the museum scenes, i.e., the frames provided a transition between the paintings and their surround. We also observed differences between the three museums that may reflect modified frame usage in different art periods. For example, frames in the museum for 20th century art tended to be smaller and less complex than in the two other two museums that exhibit paintings from earlier art periods (13th-18th century and 19th century, respectively). Finally, we found that the three properties did not depend on the type of reproduction of the paintings (photographs in museums, scans from books or images from the Google Art Project). To the best of our knowledge, this study is the first to investigate the relation between frames and paintings by measuring physically defined, higher-order image properties.

TENS compared to opioids in postoperative analgesic therapy after major spinal surgery with regard to cognitive function.

BACKGROUND: Long-term use of opioids causes cognitive decline. Transcutaneous nerve stimulation (TENS) applied preincisionally and postoperatively reduces postoperative opioid requirement and provides sufficient analgesia after major spinal surgery. Aim of this study was to find out the impact of TENS compared to opioids, prescribed for postoperative analgesia on early postoperative cognitive function. METHODS: This study was prospective and randomised-controlled. Patients and observers were blinded to the study design. Forty-one patients of both sexes planned for lumbar interbody fusion were admitted and divided randomly into 2 groups. 35 Patients finished the study. Group A received TENS preincisionally and postoperatively, group B received piritramide intravenously (i.v.) by patient-controlled analgesia pump. The adjuvant analgesic therapy diclofenac 75 mg i.v. and the rescue medication paracetamol 1g i.v. was the same for all patients. Pain intensity was assessed by visual analogue scale (VAS). A battery of objective, standardized psychological tests was administered in the same order the day before surgery and 24 to 30 hours postoperatively. RESULTS: The two groups were compared by pairs. Pre- and postoperative attention and memory differed significantly in both groups (p < 0.05). The postoperative fatigue was lower in group A (p < 0.05). Neither age, sex, body mass index, duration of operation, the need of rescue medication nor the incidents of hypotensive phases showed any significant association with postoperative cognitive decline. CONCLUSIONS: Augmentation of fatigue in early postoperative phase was less in patients treated with TENS than with opioids for analgesic therapy after major spinal surgery. Further investigations on the duration of opioid therapy when cognitive functions decline are necessary.