Causal effect of gut microbiota on pancreatic cancer: A Mendelian randomization and colocalization study.

The causal relationship between gut microbiota (GM) and pancreatic cancer (PC) remains unclear. This study aimed to investigate the potential genes underlying this mechanism. GM Genome-wide association study (GWAS) summary data were from the MiBioGen consortium. PC GWAS data were from the National Human Genome Research Institute-European Bioinformatics Institute (NHGRI-EBI) GWAS Catalogue. To detect the causal relationship between GM and PC, we implemented three complementary Mendelian randomization (MR) methods: Inverse Variance Weighting (IVW), MR-Egger and Weighted Median, followed by sensitivity analyses. Furthermore, we integrated GM GWAS data with blood cis-expression quantitative trait loci (eQTLs) and blood cis-DNA methylation QTL (mQTLs) using Summary data-based Mendelian Randomization (SMR) methods. This integration aimed to prioritize potential GM-affecting genes through SMR analysis of two molecular traits. PC cis-eQTLs and cis-mQTLs were summarized from The Cancer Genome Atlas (TCGA) data. Through colocalization analysis of GM cis-QTLs and PC cis-QTLs data, we identified common genes that influence both GM and PC. Our study found a causal association between GM and PC, including four protective and five risk-associated GM [Inverse Variance Weighted (IVW), p < 0.05]. No significant heterogeneity of instrumental variables (IVs) or horizontal pleiotropy was found. The gene SVBP was identified as a GM-affecting gene using SMR analysis of two molecular traits (FDR<0.05, P_HEIDI>0.05). Additionally, two genes, MCM6 and RPS26, were implicated in the interaction between GM and PC based on colocalization analysis (PPH4>0.5). In summary, this study provides evidence for future research aimed at developing suitable therapeutic interventions and disease prevention.

The side effect registry immuno-oncology (SERIO) - A tool for systematic analysis of immunotherapy-induced side effects.

BACKGROUND: Immunotherapies such as immune checkpoint inhibitors (ICI) are effective in multiple tumor entities but induce a plethora of side effects. Comprehensive real-world analyses are essential to identify new signals, characterize diagnostic features, enable risk assessment, determine pathomechanisms, assess effectiveness of side effect management and compare tumor outcomes. METHODS: The international online `Side-Effect Registry Immuno-Oncology´ (SERIO; www.serio-registry.org) collects rare, complex, and severe immunotherapy-induced side effects across all tumor entities with a strong focus on ICI-induced immune-related adverse events (irAE). The relational database management system (RDMS) contains structured data on patient and tumor characteristics, type of immunotherapy, treatment of side effects, and outcome of tumor and irAE. Data are captured within 25 organ modules including new modules for immune effector cell-associated neurotoxicity syndrome (ICANS) for CAR-T-cell therapies and cytokine release syndrome (CRS) for bispecific antibodies. Information on biological samples is gathered. RESULTS: A total of 1398 irAE cases have been documented by 58 centers from 13 countries in patients with 17 tumor types. IrAEs were induced by nine different immunotherapies including tebentafusp and CAR-T cell therapies, and resulted, among others, in neurological (7.6%), pulmonary (4.0%), and cardiac toxicities (2.9%). 50.0% of all irAEs were graded severe or life-threatening and 23.0% of patients received second-line therapy for steroid-refractory or steroid-dependent irAE. SERIO has contributed to 44 original publications on topics ranging from irMyocarditis to irEncephalitis to long-term persistent sequelae of immunotherapy. CONCLUSIONS: A reliable evidence base is crucial for decision-making in rare, complex or therapy-refractory irAE. SERIO can help optimize side effect management and thereby reduce morbidity and mortality induced by immunotherapy.

Detection of sparse differential dependent functional brain connectivity.

Functional brain connectivity analysis is an increasingly important technique in neuroscience, psychiatry, and autism research. Functional connectivity can be measured by considering co-activation of brain regions in resting-state functional magnetic resonance imaging (rs-fMRI). We propose a novel Bayesian model to detect differential connections in cross-correlated functional connectivity between region of interest (ROI) pairs. The proposed sparse clustered neighborhood model induces a lower-dimensional sparsity and clustering based on a nonparametric Bayesian approach to model sparse differentially connected ROI pairs. Second, it induces a structured dependence model for modeling potential dependence among ROI pairs. We demonstrate Bayesian inference and performance of the proposed model in simulation studies and compare with a standard model. We utilize the proposed model to contrast functional connectivities between participants with autism spectrum disorder and neurotypical participants using cross-correlated rs-fMRI data from four sites of the Autism Brain Image Data Exchange.

Association of Low-Normal Free T4 Levels With Future Major Depression Development.

Context: Hyperthyroidism and overt and subclinical hypothyroidism are associated with major depression; however, the association of major depression across the spectrum of thyroid function within the normal range is unknown. Objective: We investigated whether higher or lower levels of free thyroxine (T4) and thyrotropin (TSH) within the normal range are associated with major depression. Methods: This was a retrospective cohort study of 66 960 participants with normal thyroid function who visited for health checkups (St. Luke's International Hospital, 2005-2018). The primary outcome was the development of major depression during the follow-up period. Participants were divided into 3 equal groups based on baseline free T4 or TSH values (low-, middle-, or high-normal), and the incidence of major depression was compared using the Cox proportional hazard model after adjusting for potential covariates. Results: During the median follow-up of 1883 days, 1363 (2.0%) patients developed major depression. The low-normal free T4 group had a significantly higher risk of major depression (adjusted HR 1.15; 95% CI, 1.01-1.31), but not the high-normal free T4 group or TSH groups. The association between low-normal free T4 and the development of major depression was maintained, rather more obvious, upon exclusion of participants whose thyroid hormone levels became abnormal during follow-up compared with data from all participants (adjusted HR 1.24; 95% CI, 1.07-1.43). Conclusion: In this cohort, low-normal free T4 was associated with an increased risk of future major depression, even if subsequent hormone levels were maintained within the normal range. The magnitude of the impact of low-normal free T4 was relatively mild.

Prevalence of blood group antigens among regular blood donors: A single center study from South India with a review of national literature.

BACKGROUND AND OBJECTIVES: The antigen frequencies vary across different regions and ethnic groups. Hence, we aimed to study the prevalence of blood group antigens in our population and to systemize the zone-wise prevalence of the same across India. MATERIALS AND METHODS: Regular voluntary O group blood donors were screened for 21 blood group antigens; C, c, E, e, K, k, Kpa, Kpb, Jka, Jkb, Fya, Fyb, Lea, Leb, Lua, Lub, P1, M, N, S, s, using commercially available monoclonal antisera by column agglutination technology. A literature search was performed to identify all the studies that reported blood group antigens prevalence to estimate the zone-wise prevalence of these antigens in the country. RESULTS: A total of 521 participants of 9248 O group donors meeting all the inclusion criteria were included. Among the study group, the male-to-female ratio was 9:1 with a mean age of 32.6 years (±10.01) ranging from 18-60 years. The majority of the donors 446 (85.6%) were D positive. The most common phenotypes among Rh, Lewis, Kell, Duffy, Kidd, Lutheran and MNSs were CcDee (34.93%), Le(a-b+) (61.80%), K-k+(98.27%), Fy(a+b-) 43.19%, Jk(a+b+) 42.61%, Lu(a-b+) ( 99.61%), M+N+ (48.17%), S-s+ (45.29%) respectively. The prevalence of D and E antigens was significantly lower in the South zone compared to other zones of India. CONCLUSION: Significant difference in the prevalence of blood group antigens is observed between the South and other zones of India. Zone-wise prevalence of blood group phenotypes is essential in the timely management of alloimmunized patients.

Multi-omics analysis reveals focal adhesion characteristic associated tumor immune microenvironment in colon adenocarcinoma.

Colon adenocarcinoma (COAD) is one of the most frequent malignant lesions of the digestive system in humans, with an insidious onset. At the time of diagnosis, most of them have developed to the middle and late stages, and cancer cells have metastasized, and the prognosis is poor. Treatment options for progressive COAD are limited, and despite the promise of immunotherapy, immunotherapy response rates are low. The assembly and disaggregation of focal adhesion are critical for the directional migration of tumor cells to different sites, and it is unclear whether focal adhesion-related genes are involved in the development and prognosis of colon adenocarcinoma. This study aimed to investigate the role of focal adhesion genes in the occurrence and prognosis of COAD. We obtained datasets of COAD patients, including RNA-sequencing data and clinical information, from the TCGA and GEO databases (GSE17538 and GSE39582). Through CNMF clustering, two molecular subtypes with different expression patterns of focal adhesion genes were identified, and it was found that the molecular subtype with low expression of focal adhesion genes had better prognosis. Then the prediction signature was constructed by LASSO-Cox regression model, and the receiver operating characteristic (ROC) curve showed that the 4-gene signature had a good prediction effect on COAD 1-, 2-, and 3-year OS. Gene function enrichment analysis showed that the high-risk group was mainly enriched in immune and adhesion-related signaling pathways, suggesting that focal adhesion genes may affect the development and prognosis of COAD by regulating the immune microenvironment and tumor metastasis. The interaction between focal adhesion genes and immunity during the occurrence of COAD may help improve the response rate of immunotherapy, which also provides new ideas for the molecular mechanism and targeted therapy in COAD.

Differential Expression of Autophagy-Related Long Non-Coding RNA in Melanoma.

To explore the role of autophagy-related differential long non-coding RNA (lncRNA) in the pathogenesis of melanoma, we established a prognostic prediction model for patients with melanoma based on the expression profiles of autophagy-related gene. Based on The Cancer Genome Atlas and GeneCard database, we used single-sample gene set enrichment analysis (ssGSEA), weighted gene co-expression network analysis (WGCNA), uniCOX in R software for COX proportional hazard regression analysis, and enrichment analysis to get an idea of biological processes with autophagy-related genes, which evaluates the relationship between autophagy-related genes and immune cell infiltration in patients with melanoma. The roles of identified lncRNA were evaluated by the risk score based on the results of single factor regression analysis for each lncRNA and on the prognosis for patients obtained from the database. Then, the whole sample was divided into high- and low-risk groups. Survival curve analysis showed that low-risk group had a better prognosis. Enrichment analysis revealed multiple key pathways enriched with lncRNA-associated genes. Analysis of immune cell infiltration revealed differences between high- and low-risk groups. Finally, 3 datasets verified the effect of our model on prognosis. There are important autophagy-related lncRNA in patients with melanoma. Top 6 lncRNA are significantly related to the overall survival rate of patients with melanoma and provide the basis for predicting the prognostic survival of patients.

[oregis-The German ophthalmological registry]. / oregis ­ Das deutsche ophthalmologische Register.

BACKGROUND: Medical registries have shown their potential for medical research in different areas of healthcare in the past. The United States of America uses the well-known national ophthalmology registry Intelligent Research in Sight (IRIS®), on the basis of which insights into the ophthalmological care situation in the USA can be gained. Comparable projects do not currently exist in Germany. The oregis is the first disease-independent registry to collect comprehensive data in the field of ophthalmology in Germany for the purpose of healthcare research. METHODS: The oregis collects anonymized clinical patient information from all subfields of ophthalmology and makes it available for research purposes. Participating centers read their data into the registry free of charge and preferably in an automated fashion. Currently, the oregis parameter list contains about 600 parameters, of which about 100 are used in the current pilot phase. RESULTS: Since its initiation, the German ophthalmological registry oregis has compiled data on more than 1.75 million physician visits for more than 400,000 patients from German ophthalmologic centers. As of late 2022, more than 2.8 million visual acuity measurements and an equal number of intraocular pressure measurements have been recorded. DISCUSSION: The aim of the oregis project is to establish a nationwide ophthalmology databank that forms the basis for a learning healthcare system in the field of ophthalmology. With the help of continuous updating, oregis can also illustrate short-term innovations in ophthalmological care.

Spinal Cord Stimulation for Neuropathic Pain in England From 2010 to 2020: A Hospital Episode Statistics Analysis.

OBJECTIVES: Spinal cord stimulation (SCS) is a recognized intervention for the management of chronic neuropathic pain. The United Kingdom National Institute of Health and Care Excellence has recommended SCS as a management option for chronic neuropathic pain since 2008. The aim of this study is to undertake an assessment of SCS uptake across the National Health Service in England up to 2020. MATERIALS AND METHODS: Hospital Episode Statistics were obtained for patients with neuropathic pain potentially eligible for SCS and patients receiving an SCS-related procedure. Data were retrieved nationally and per region from the years 2010-2011 to 2019-2020. RESULTS: There were 50,288 adults in England attending secondary care with neuropathic pain in 2010-2011, increasing to 66,376 in 2019-2020. The number of patients with neuropathic pain with an SCS procedure increased on a year-to-year basis until 2018-2019. However, less than 1% of people with neuropathic pain received an SCS device with no evidence of an increase over time when considering the background increase in neuropathic pain prevalence. CONCLUSION: Only a small proportion of patients in England with neuropathic pain potentially eligible for SCS receives this intervention. The recommendation for routine use of SCS for management of neuropathic pain has not resulted in an uptake of SCS over the last decade.

Application of RNA processing factors for predicting clinical outcomes in colon cancer.

Background: Colon cancer is the fifth most common cause of cancer-related death worldwide, and despite significant advances in related treatment, the prognosis of colon cancer patients remains poor. Objective: This study performs systematic bioinformatics analysis of prognostic-associated RNA processing factor genes in colon cancer using the Cancer Related Genome Atlas database to explore their role in colon carcinogenesis and prognosis and excavate potential therapeutic targets. Methods: Data sets of colon cancer patients were obtained from GEO and TCGA databases. Univariate cox analysis was performed on the GSE39582 training set to identify prognosis-associated RNA processing factor genes and constructed a muticox model. The predictive performance of the model was validated by Correlation curve analysis. Similar results were obtained for the test dataset. Functional analyses were performed to explore the underlying mechanisms of colon carcinogenesis and prognosis. Results: A constructed muticox model consisting of ßi and prognosis-related RNA processing factor gene expression levels (Expi) was established to evaluate the risk score of each patient. The subgroup with a higher risk score had lower overall survival (OS), higher risk factor, and mortality. We found that the risk score, age, gender, and TNM Stage were strongly associated with OS, and the 13-gene signature as an independent prognostic factor for colon cancer. The model has good accuracy in predicting patient survival and is superior to traditional pathological staging. Conclusion: This study proposes 13 RNA processing factor genes as a prognostic factor for colon cancer patients, which can independently predict the clinical outcome by risk score. The gene expression profile in this model is closely related to the immune status and prognosis of colon cancer patients. The interaction of the 13 RNA processing factor genes with the immune system during colon carcinogenesis provides new ideas for the molecular mechanisms and targeted therapies for colon cancer.

Lithium in drinking water and Alzheimer's dementia: Epidemiological Findings from National Data Base of Japan.

OBJECTIVES: The aim of this study was to investigate the association between lithium levels in drinking water and prevalence of Alzheimer's dementia (AD). METHODS: Lithium levels in the drinking water of 808 cities and wards (i.e., 785 Japanese cities of 46 prefectures and 23 wards of Tokyo) in Japan were examined in relation to the prevalence of AD during the 5 years from 2010 to 2014, which was calculated on the basis of the national data base of Ministry of Health, Labor, and Welfare of Japan. Multiple regression analyses were used to investigate the association of lithium levels with the prevalence of AD with adjustment for relevant factors (proportions of one-person households as a family factor and people in primary industry employment as a job factor, annual total sunshine hours as a meteorological factor, and total number of beds of psychiatric hospitals as a medical factor) in total, male, and female elderly populations. RESULTS: The adjusted model showed a significant inverse association of lithium levels with female, but not with male, or total prevalence of AD. CONCLUSIONS: These findings suggest that higher lithium levels in drinking water may be associated with lower prevalence of AD in female, but not male, populations.

Comparative RNA-Seq analysis reveals insights in Salmonella disease resistance of chicken; and database development as resource for gene expression in poultry.

Salmonella, one of the major infectious diseases in poultry, causes considerable economic losses in terms of mortality and morbidity, especially in countries that lack effective vaccination programs. Besides being resistant to diseases, indigenous chicken breeds are also a potential source of animal protein in developing countries. For understanding the disease resistance, an indigenous chicken line Kashmir faverolla, and commercial broiler were selected. RNA-seq was performed after challenging the chicken with Salmonella Typhimurium. Comparative differential expression results showed that following infection, a total of 3153 genes and 1787 genes were differentially expressed in the liver and spleen, respectively. The genes that were differentially expressed included interleukins, cytokines, NOS2, Avß-defensins, toll-like receptors, and other immune-related gene families. Most of the genes and signaling pathways involved in the innate and adaptive immune responses against bacterial infection were significantly enriched in the Kashmir faverolla. Pathway analysis revealed that most of the enriched pathways were MAPK signaling pathway, NOD-like receptor signaling pathway, TLR signaling pathway, PPAR signaling pathway, endocytosis, etc. Surprisingly some immune-related genes like TLRs were upregulated in the susceptible chicken breed. On postmortem examination, the resistant birds showed small lesions in the liver compared to large necrotic lesions in susceptible birds. The pathological manifestations and RNA sequencing results suggest a balancing link between resistance and infection tolerance in Kashmir faverolla. Here we also developed an online Poultry Infection Database (https://skuastk.org/pif/index.html), the first publicly available gene expression resource for disease resistance in chickens. The available database not only shows the data for gene expression in chicken tissues but also provides quick search, visualization and download capacity.

Images indexing and matched assessment of semantics and visuals similarities applied to a medical learning X-ray image base.

BACKGROUND: Medical diagnostic support systems are important tools in the field of radiology. However, the precision obtained, during the exploitation of high homogeneity image datasets, needs to be improved. OBJECTIVE: To develop a new learning system dedicated to public health practitioners. This study presents an upgraded version dedicated to radiology experts for better clinical decision-making when diagnosing and treating the patient (CAD approach). METHODS: Our system is a hybrid approach based on a matching of semantic and visual attributes of images. It is a combination of two complementary subsystems to form the intermodal system. The first one named α based on semantic attributes. Indexing and image retrieval based on specific keywords. The second system named ß based on low-level attributes. Vectors characterizing the digital content of the image (color, texture and shape) represent images. Our image database consists of 930 X-ray images including 320 mammograms acquired from the mini-MIAS database of mammograms and 610 X-rays acquired from the Public Hospital Establishment (EPH-Rouiba Algeria). The combination of two subsystems gives rise to the intermodal system: α-subsystem offers an overall result (based on visual descriptors), then ß-subsystem (low level descriptors) refines the result and increases relevance. RESULTS: Our system can perform a specific image search (in a database of images with very high homogeneity) with an accuracy of around 90% for a recall of 25%. The average (overall) accuracy of the system exceeds 70%. CONCLUSION: The results obtained are very encouraging, and demonstrate efficiency of our approach, particularly for the intermodal system.

Pituitary adenoma in the elderly: surgical outcomes and treatment trends in the United States.

OBJECTIVE: Decision-making in how to manage pituitary adenomas (PAs) in the elderly (age ≥ 65 years) can be challenging given the benign nature of these tumors and concerns about surgical morbidity in these patients. In this study involving a large multicenter national registry, the authors examined treatment trends and surgical outcomes in elderly compared to nonelderly patients. METHODS: The National Cancer Data Base (NCDB) was queried for adults aged ≥ 18 years with PA diagnosed by MRI (in observed cases) or pathology (in surgical cases) from 2004 to 2016. Univariate and multivariate logistic regressions were used to evaluate the prognostic impact of age and other covariates on 30- and 90-day postsurgical mortality (30M/90M), prolonged (≥ 5 days) length of inpatient hospital stay (LOS), and extent of resection. RESULTS: A total of 96,399 cases met the study inclusion criteria, 27% of which were microadenomas and 73% of which were macroadenomas. Among these cases were 25,464 elderly patients with PA. Fifty-three percent of these elderly patients were treated with surgery, 1.9% underwent upfront radiotherapy, and 44.9% were observed without treatment. Factors associated with surgical treatment compared to observation included younger age, higher income, private insurance, higher Charlson-Deyo comorbidity (CD) score, larger tumor size, and receiving treatment at an academic hospital (each p ≤ 0.01). Elderly patients undergoing surgery had increased rates of 30M (1.4% vs 0.6%), 90M (2.8% vs 0.9%), prolonged LOS (26.1% vs 23.0%), and subtotal resection (27.2% vs 24.5%; each p ≤ 0.01) compared to those in nonelderly PA patients. On multivariate analysis, age, tumor size, and CD score were independently associated with worse postsurgical mortality. High-volume facilities (HVFs) had significantly better outcomes than low-volume facilities: 30M (0.9% vs 1.8%, p < 0.001), 90M (2.0% vs 3.5%, p < 0.001), and prolonged LOS (21.8% vs 30.3%, p < 0.001). A systematic literature review composed of 22 studies demonstrated an elderly PA patient mortality rate of 0.7%, which is dramatically lower than real-world NCDB outcomes and speaks to substantial selection bias in the previously published literature. CONCLUSIONS: The study findings confirm that elderly patients with PA are at higher risk for postoperative mortality than younger patients. Surgical risk in this age group may have been previously underreported in the literature. Resection at HVFs better reflects these historical rates, which has important implications in elderly patients for whom surgery is being considered.

Identification of Algerian field-caught mosquito vectors by MALDI-TOF MS.

Vector-borne diseases represent a real threats worldwide, in reason of the lack of vaccine and cure for some diseases. Among arthropod vectors, mosquitoes are described to be the most dangerous animal on earth, resulting in an estimated 725,000 deaths per year due to their borne diseases. Geographical position of Algeria makes this country a high risk area for emerging and re-emerging diseases, such as dengue coming from north (Europe) and malaria from south (Africa). To prevent these threats, rapid and continuous surveillance of mosquito vectors is essential. For this purpose we aimed in this study to create a mosquito vectors locale database using MALDI-TOF mass spectrometry technology for rapid identification of these arthropods. This methodology was validated by testing 211 mosquitoes, including four species (Aedes albopictus, Culex pipiens, Culex quinquefasciatus, and Culiseta longiareolata), in two northern wilayahs of Algeria (Algiers and Bejaia). Species determination by MALDI TOF MS was highly concordant with reference phenotypic and genetic methods. Using this MALDI-TOF MS tool will allow better surveillance of mosquito species able to transmit mosquito borne diseases in Algeria.

Validation and extension of the METSSS score in a metastatic cancer patient cohort after palliative radiotherapy within the last phase of life.

Introduction and background: Choosing the right treatment for the right patient in a setting of metastatic cancer disease remains a challenge. To facilitate clinical decision-making, predictive tools have been developed to personalize treatment. Here, we aim to assess the use of the recently proposed "METSSS score" as a prognostic tool for overall survival of cancer patients after palliative radiotherapy in the last phase of life. Methods: All patients treated with palliative radiotherapy at the end-of-life at the Department of Radiation Oncology of the University Hospital Zurich between January 2010 and December 2019 were included in this study. Data on demographics, diagnosis, treatment and comorbidities was extracted from the treatment planning and the electronical medical records system. To statistically assess the validity of the "METSSS score", the mortality risk score was calculated, followed by stratification of all patients to prognostic risk groups. The prediction of the 1-year overall survival estimates was subsequently calculated. Results: Over the past decade, 274 patients have received palliative radiotherapy during the end-of-life period. One third of patients was female (34%, n = 93). The most frequent primary tumor was lung cancer (n = 121, 44%), and 55% of patients (n = 152) had no comorbidities according to the Charlson-Deyo comorbidity index. The most common radiotherapy site was the brain and eye region (42%, n = 115). The median actual overall survival of all patients was 40 days from the start of radiotherapy. The "METSSS score" survival model predicted that 269 patients (98.1%) belong into the high-risk, four patients (1.5%) into the medium-risk, and one patient (0.4%) into the low-risk group. The predicted median 1-year overall survival was 10%. Discussion: The METSSS score correctly predicted the survival of our end-of-life patient cohort by assigning them into the highest risk category, and it can therefore serve as a decision-making tool when assigning patient to symptomatic radiotherapy.

Did COVID-19 impact stroke services? A multicenter study.

BACKGROUND: It has been reported that acute stroke services were compromised during COVID-19 due to various pandemic-related issues. We aimed to investigate these changes by recruiting centers from different countries. METHODS: Eight countries participated in this cross-sectional, observational, retrospective study by providing data from their stroke data base. We compared 1 year before to 1 year during COVID-19 as regards onset to door (OTD), door to needle (DTN), door to groin (DTG), duration of hospital stay, National Institute of Health Stroke Scale (NIHSS) at baseline, 24 h, and at discharge as well as modified Rankin score (mRS) on discharge and at 3 months follow-up. RESULTS: During the pandemic year, there was a reduction in the number of patients, median age was significantly lower, admission NIHSS was higher, hemorrhagic stroke increased, and OTD and DTG showed no difference, while DTN time was longer, rtPA administration was decreased, thrombectomy was more frequent, and hospital stay was shorter. mRS was less favorable on discharge and at 3 months. CONCLUSION: COVID-19 showed variable effects on stroke services. Some were negatively impacted as the number of patients presenting to hospitals, DTN time, and stroke outcome, while others were marginally affected as the type of management.

Active Surveillance for Early Stage Lung Cancer.

OBJECTIVES: Data describing outcomes for patients with early stage lung cancer who undergo expectant management is lacking, despite evidence of a sub-population with indolent malignancies. We used the National Cancer Data Base (NCDB) to identify factors associated with active surveillance for early stage lung cancer. Additionally, we sought to describe outcomes of three different care plans: active surveillance, no treatment, and Stereotactic Body Radiation Therapy (SBRT). METHODS: Patients diagnosed in 2010 to 2017 with early stage lung cancer who underwent active surveillance, no treatment, and SBRT were retrospectively identified in the NCDB. Multinomial logistic regression was used to assess care plan selection. Kaplan Meier analysis was used to assess overall survival (OS). RESULTS: We identified 30,107 patients that met our inclusion criteria: 838 (3%) underwent active surveillance, 6388 patients (21%) received no treatment, and 22,881 (76%) underwent SBRT. Black race (relative risk ratio (RRR): 1.66) and older age (RRR: 1.02) were significant positive predictors of active surveillance selection. Conversely, higher tumor stage (RRR: 0.26) and squamous cell carcinoma (RRR: 0.35) were significant negative predictors of active surveillance selection. Kaplan Meier analysis revealed a longer median OS associated with active surveillance compared to no treatment at 49.3 months versus 26.5 months, respectively. SBRT OS was 43.1 months. CONCLUSIONS: We identified a population of lung cancer patients who underwent expectant management with favorable outcomes. Additionally, we identified factors associated with active surveillance selection. The selection of active surveillance over no treatment was associated with significantly longer OS.

Technical procedures and REDCap tools for internet-based clinical trials.

In March of 2020 our team of researchers developed and opened three clinical trials to investigate hydroxychloroquine as prophylaxis or treatment for the coronavirus disease 2019 (COVID-19). We simultaneously built corresponding Research Electronic Data Capture (REDCap) projects for these low-touch, remote trials that relied on participant-reported data. REDCap has built-in features that support pragmatic, internet-based studies, and REDCap is flexible enough to allow creative solutions for specific trials. We describe challenges, choices, and suggestions based on our experience with REDCap for our COVID-19 trials.

[Towards cultivation of the abilities of young uro-andrological surgeons in clinical practice and research in the big data era].

With the rise of individualized medicine, precision medicine and translational medicine in the big data era, the application of Internet big data in the medical field is becoming an irresistible trend. Confronted with this new trend, it is urgent to improve the abilities of young uro-andrological surgeons in clinical practice and research exploration with the help of big data. This paper explored the methods of cultivating the abilities of young uro-andrological surgeons in clinical practice and research using big data bases.