Statistical Methods for Targeted Clinical Trials under Enrichment Design

Background/PurposeAfter completion of the Human Genome Project, disease targets at the molecular level can be identified. Treatment for these specific targets can be developed with the individualized treatment of patients becoming a reality. However, the accuracy of diagnostic devices for molecular targets is not perfect and statistical inference for treatment effects of the targeted therapy is biased. We developed statistical methods for an unbiased inference for the targeted therapy in patients who truly have the molecular targets.MethodsUnder the enrichment design, for binary data, we propose using the expectation maximization (EM) algorithm with the bootstrap method, to incorporate the inaccuracy of the diagnostic device for detection of the molecular targets for inference of the treatment effects. A simulation study was conducted to empirically investigate the performance of the proposed estimation and testing procedures. A numerical example illustrates the application of the proposed method.ResultsSimulation results demonstrated that the proposed estimation method was unbiased, with adequate precision, and the confidence interval provided satisfactory coverage probability. The proposed testing procedure adequately controlled the size with sufficient power. The numerical example showed that a statistically significant treatment effect could be obtained when the inaccuracy of the diagnostic device was taken into account.ConclusionOur proposed estimation and testing procedures are adequate statistical methods for the inference of the treatment effect for patients who truly have the molecular targets

Commentary on the Regulation of Viral Proteins in Autophagy Process

The ability to subvert intracellular antiviral defenses is necessary for virus to survive as its replication occurs only in the host cells. Viruses have to modulate cellular processes and antiviral mechanisms to their own advantage during the entire virus life cycle. Autophagy plays important roles in cell regulation. Its function is not only to catabolize aggregate proteins and damaged organelles for recycling but also to serve as innate immunity to remove intracellular pathogenic elements such as viruses. Nevertheless, some viruses have evolved to negatively regulate autophagy by inhibiting its formation. Even more, some viruses have employed autophagy to benefit their replication. To date, there are more and more growing evidences uncovering the functions of many viral proteins to regulate autophagy through different cellular pathways. In this review, we will discuss the relationship between viruses and autophagy and summarize the current knowledge on the functions of viral proteins contributing to affect autophagy process

Room temperature gas sensing with a hybrid poly-Si/ZnO TFT cell

In this work, we study the capability of a novel poly-Si/Zno hybrid TFT cell in sensing NO2 gas. Fabrication and structural features of this cell are identical to that reported in one of our previous works [1] except that the IGZO TFT is replaced by a ZnO one. The equivalent circuit of the hybrid cell is shown in Fig. 1, in which the poly-Si TFT and ZnO TFT are employed as the amplifier and sensor, respectively. In the configuration, the top gate of the poly-Si TFT is electrically connected to the drain of the bottom-gated ZnO TFT, while the top surface of the ZnO channel is exposed to the environment for sensing purposes. For the electrical measurements conducted at room temperature, the current source (IIN) was set at 100 pA with a compliance VG of 2 V. Concentration of the NO2 gas in the ambient was varied from 0 ~100 ppm. Transfer characteristics of the cell are expressed by showing the drain current of the poly-Si TFT as a function of the back-gate bias (VBG) of the ZnO TFT. In the figure, we can see the I-V curves show a parallel and positive shift as the concentration of the NO2 gas is increased. Meanwhile, the transitions in the figure are steep with a slope of around -60 mV/dec whose absolute value is much smaller than the subthreshold slopes of the individual ZnO TFT (\u3e300 mV/dec). The finding provides good evidence showing the potential of this scheme in promoting measurement sensitivity compared with conventional oxide-semiconductor TFTs. The experimental results also show that UV irradiation can recover the characteristics. Please click Download on the upper right corner to see the full abstract

Rethinking Statistical Approaches to Evaluating Drug Safety

[[abstract]]The current methods used to evaluate the efficacy of drug products are inadequate. We propose a non-inferiority approach to prove the safety of drugs. Materials and Methods: Traditional hypotheses for the evaluation of the safety of drugs are based on proof of hazard, which have proven to be inadequate. Therefore, based on the concept of proof of safety, the non-inferiority hypothesis is employed to prove that the risk of new drugs does not exceed a pre-specified allowable safety margin, hence proving that a drug has no excessive risk. The results from papers published on Vioxx (R) and Avandia (R) are used to illustrate the difference between the traditional approach for proof of hazard and the non-inferiority approach for proof of safety. Results: The p-values from traditional hypotheses were greater than 0.05, and failed to demonstrate that Vioxx (R) and Avandia (R) are of cardiovascular hazard. However, these results cannot prove that both Vioxx (R) and Avandia (R) are of no cardiovascular risk. On the other hand, the non-inferiority approach can prove that they are of excessive cardiovascular risk. Conclusion: The non-inferiority approach is appropriate to prove the safety of drugs

Effect of Lower Extremity Bypass Surgery on Inflammatory Reaction and Endothelial Dysfunction in Type 2 Diabetic Patients

Diabetes mellitus (DM) is a metabolic disorder characterized by hyperglycemia and dyslipidemia. The abnormalities in nutrient metabolism and elevated inflammatory mediators resulting from DM lead to impairment of wound healing and vulnerability to infection and foot ulcers. Diabetic lower limb ischemia often leads to limb necrosis. Lower extremity bypass surgery (LEBS) is indicated to prevent limb loss in patients with critical leg ischemia. This study investigated the alteration of inflammatory and endothelium dysfunction markers before and after LEBS in DM patients. Twenty one type 2 DM patients with LEBS were included. Blood was drawn before and at 1 day and 7 days after surgery in the patients. Plasma soluble cellular adhesion molecule levels and blood leukocyte integrin expressions were measured. Also, plasma concentrations of endothelin-1 and nitric oxide were analyzed to evaluate the vascular endothelial function. The results showed that there were no significant differences in plasma cellular adhesion molecules, endothelin-1 and nitric oxide levels, nor did any differences in leukocyte integrin expressions before and after the operation. These results suggest that the efficacy of LEBS on alleviating inflammatory reaction and improving endothelial function in DM patients was not obvious

Galloway-Mowat syndrome: Prenatal ultrasound and perinatal magnetic resonance imaging findings

AbstractObjectiveTo present prenatal ultrasound and perinatal magnetic resonance imaging (MRI) findings of Galloway-Mowat syndrome.Case ReportA 31-year-old woman, gravida 3, para 2, was referred for genetic counseling at 29 weeks of gestation because of abnormal ultrasound findings and a previous child with Galloway-Mowat syndrome. During this pregnancy, microcephaly, intrauterine growth restriction (IUGR), and oligohydramnios were first noted at 27 weeks of gestation. Repeated ultrasounds showed microcephaly, IUGR, and oligohydramnios. MRI performed at 32 weeks of gestation showed reduced sulcation of the brain, pachygyria, poor myelination of the white matter, and cerebellar atrophy. A diagnosis of recurrent Galloway-Mowat syndrome was made. At 40 weeks of gestation, a 2,496-g female baby was delivered with microcephaly, a narrow slopping forehead, epicanthic folds, microphthalmos, a highly arched palate, a small midface, a beaked nose, thin lips, large low-set floppy ears, clenched hands, and arachnodactyly. Postnatal MRI findings were consistent with the prenatal diagnosis. Renal ultrasound showed enlarged bilateral kidneys with increased echogenicity. At the age of 2 weeks, the infant became edematous and developed nephrotic syndrome.ConclusionMicrocephaly, IUGR, and oligohydramnios are significant ultrasound triad of fetal Galloway-Mowat syndrome. Prenatal ultrasound diagnosis of microcephaly, IUGR, and oligohydramnios in late second trimester or in early third trimester should alert clinicians to the possibility of Galloway-Mowat syndrome and prompt a detailed search of abnormal sulcation, cortical gyral maldevelopment, and cerebellar atrophy by fetal ultrafast MRI

Drastic population fluctuations explain the rapid extinction of the passenger pigeon

To assess the role of human disturbances in species' extinction requires an understanding of the species population history before human impact. The passenger pigeon was once the most abundant bird in the world, with a population size estimated at 3-5 billion in the 1800s; its abrupt extinction in 1914 raises the question of how such an abundant bird could have been driven to extinction in mere decades. Although human exploitation is often blamed, the role of natural population dynamics in the passenger pigeon's extinction remains unexplored. Applying high-throughput sequencing technologies to obtain sequences from most of the genome, we calculated that the passenger pigeon's effective population size throughout the last million years was persistently about 1/10,000 of the 1800's estimated number of individuals, a ratio 1,000-times lower than typically found. This result suggests that the passenger pigeon was not always super abundant but experienced dramatic population fluctuations, resembling those of an "outbreak" species. Ecological niche models supported inference of drastic changes in the extent of its breeding range over the last glacial-interglacial cycle. An estimate of acorn-based carrying capacity during the past 21,000 y showed great year-to-year variations. Based on our results, we hypothesize that ecological conditions that dramatically reduced population size under natural conditions could have interacted with human exploitation in causing the passenger pigeon's rapid demise. Our study illustrates that even species as abundant as the passenger pigeon can be vulnerable to human threats if they are subject to dramatic population fluctuations, and provides a new perspective on the greatest human-caused extinction in recorded history

Liposome-based polymer complex as a novel adjuvant: enhancement of specific antibody production and isotype switch

The aim of vaccination is to induce appropriate immunity against pathogens. Antibody-mediated immunity is critical for protection against many virus diseases, although it is becoming more evident that coordinated, multifunctional immune responses lead to the most effective defense. Specific antibody (Ab) isotypes are more efficient at protecting against pathogen invasion in different locations in the body. For example, compared to other Ab isotypes, immunoglobulin (Ig) A provides more protection at mucosal areas. In this study, we developed a cationic lipopolymer (liposome-polyethylene glycol-polyethyleneimine complex [LPPC]) adjuvant that strongly adsorbs antigens or immunomodulators onto its surface to enhance or switch immune responses. The results demonstrate that LPPC enhances uptake ability, surface marker expression, proinflammatory cytokine release, and antigen presentation in mouse phagocytes. In contrast to Freund’s adjuvant, LPPC preferentially activates Th1- immunity against antigens in vivo. With lipopolysaccharides or CpG oligodeoxynucleotides, LPPC dramatically enhances the IgA or IgG2A proportion of total Ig, even in hosts that have developed Th2 immunities and high IgG1 serum titers. Taken together, the results demonstrate that the LPPC adjuvant not only increases the immunogenicity of antigens but also modulates host immunity to produce an appropriate Ab isotype by combining with immunomodulators