Predicting treatment effects using biomarker data in a meta-analysis of clinical trials

A biomarker (S) measured after randomization in a clinical trial can often provide information about the true endpoint (T) and hence the effect of treatment (Z). It can usually be measured earlier and more easily than T and as such may be useful to shorten the trial length. A potential use of S is to completely replace T as a surrogate endpoint to evaluate whether the treatment is effective. Another potential use of S is to serve as an auxiliary variable to help provide information and improve the inference on the treatment effect prediction when T is not completely observed. The objective of this report is to focus on its role as an auxiliary variable and to identify situations when S can be useful to increase efficiency in predicting the treatment effect in a new trial in a multiple-trial setting. Both S and T are continuous. We find that higher efficiency gain is associated with higher trial-level correlation but not individual-level correlation when only S, but not T is measured in a new trial; but, the amount of information recovery from S is usually negligible. However, when T is partially observed in the new trial and the individual-level correlation is relatively high, there is substantial efficiency gain by using S. For design purposes, our results suggest that it is often important to collect markers that have high adjusted individual-level correlation with T and at least a small amount of data on T. The results are illustrated using simulations and an example from a glaucoma clinical trial.

Stimulatory effect of LPS and feedback effect of PGE2 on IL-27 production

Interleukin (IL)-27 is a new member of the IL-6/IL-12 family, composed of two subunits, the Epstein-Barr virus-induced gene 3 (EBI3) and p28 chains (p28), and produced by activated monocytes and dendritic cells. IL-27 plays an important role in the regulation of differentiation of naive T helper cells and has diverse effects on innate immune cells. However, the pro-inflammatory mechanisms of IL-27 are still not well known. In this study, we investigated the effect of lipopolysaccharide (LPS) on the production of IL-27. We found that LPS-stimulated IL-27 production was in a dose-dependent and time-dependent manner in THP-1 cells. We have also shown that IL-27 induced PGE2 production and COX-2 gene expression at the level of mRNA as well as protein. Moreover, we found feed back effect of PGE2 on the production of IL-27 in THP-1 cells. The results suggest that PGE2 significantly inhibits LPS-induced IL-27 production, without affecting basal IL-27 expression. Further experiment suggests that PGE2 and LPS regulate IL-27 through NF-κB pathway. Our findings may have wide implication for IL-27 in inflammatory diseases.

Statistical characterization and segmentation of drusen in fundus images

Age related Macular Degeneration (AMD) is a disease of the retina associated with aging. AMD progression in patients is characterized by drusen, pigmentation changes, and geographic atrophy, which can be seen using fundus imagery. The level of AMD is characterized by standard scaling methods, which can be somewhat subjective in practice. In this work we propose a statistical image processing approach to segment drusen with the ultimate goal of characterizing the AMD progression in a data set of longitudinal images. The method characterizes retinal structures with a statistical model of the colors in the retina image. When comparing the segmentation results of the method between longitudinal images with known AMD progression and those without, the method detects progression in our longitudinal data set with an area under the receiver operating characteristics curve of 0.99.

Recombinant human endostatin, Endostar, enhances the effects of chemo-radiotherapy in a mouse cervical cancer xenograft model

BACKGROUND

The effects of recombinant human endostatin, Endostar, combined with concurrent chemo-radiotherapy (CCRT) on tumor growth, angiogenesis and lymphangiogenesis in a mouse xenograft model of cervical cancer was investigated.

METHODS

HeLa cells were injected subcutaneously to establish mouse xenograft models and mice were treated with normal saline (control), CCRT with cisplatin (CDDP), Endostar, or a combination of Endostar and CCRT. Growth, metastasis, and angiogenesis of tumors was monitored.

RESULTS

Tumorogenic activity of tumor cells in the CCRT, Endostar and combination Endostar-CCRT treatment groups was markedly decreased compared with the activity in the NS group (p < 0.05). The most significant inhibition of tumor growth was observed in the Endostar with CCRT group. Lymph node metastases in the Endostar with CCRT group (12.5%) and Endostar alone group (25%) were lower compared to the CCRT group (42.8%) and NS group (66.7%; p < 0.05). Endostar was also found to inhibit tumor angiogenesis. Endostar induced apoptosis of HeLa cells in vivo, and inhibited expression of VEGF and HIF-1alpha in vivo and in vitro.

CONCLUSION

Endostar enhanced the anti-cancer effect of CCRT in a mouse xenograft model of cervical cancer. These findings thus provide a new strategy to treat cervical cancer.

Ang-(1-7) might prevent the development of monocrotaline induced pulmonary arterial hypertension in rats

OBJECTIVES

To investigate whether Angiotensin-(1-7) [Ang-(1-7)] could prevent the development of monocrotaline (MCT) induced pulmonary arterial hypertension and vascular remodeling.

MATERIALS AND METHODS

30 Sprgue-Dawely rats were randomly assigned into three groups: control group, pulmonary arterial hypertension (PAH) group and PAH +Ang-(1-7) group. Rats in PAH group and PAH +Ang-(1-7) group received 60 mg/kg monocrotaline (MCT) injection subcutaneously and after 24 hours received either saline or 24 microg/kg/h of Ang-(1-7) injection via osmotic minipumps for 4 weeks. Those rats in control group were firstly injected saline subcutaneously and then received saline injection via osmotic minipumps.

RESULTS

After four weeks, in PAH group, right ventricular systolic pressure (RVSP), right ventricular hypertrophy index (RVHI), percentage of wall thickness (WT%) and percentage of wall area (WA%) were significantly increased, and the level of endothelial nitric oxide synthase (eNOS) protein, eNOS ser 1177-phosphorylati, Akt-phosphorylation were significantly decreased compared with control group. However, RVSP, RVHI, WT%, WA% were dramatically decreased in PAH+Ang-(1-7) group and the level of eNOS protein, eNOS ser 1177-phosphorylation, Akt-phosphorylation were significantly increased compared with PAH group.

CONCLUSION

Those results suggest that Ang-(1-7) could prevent the development of monocrotaline induced pulmonary arterial hypertension and vascular remodeling, which appears to be associated with up-regulation of eNOS activation via Akt pathway.

Luminal serotonin time-dependently modulates vagal afferent driven antinociception in response to colorectal distention in rats

BACKGROUND

Compelling evidence shows that vagal afferents mediate antinociception in response to visceral insults. Our recent findings implied that luminal serotonin (5-hydroxytryptamine, 5-HT) might mediate chronic food allergen sensitized visceral hyperalgesia, in which vagal afferents might be implicated. Here, to test this hypothesis, we investigated the effects of luminal infused 5-HT on visceral nociception and the involvement of vagal antinociceptive pathway.

METHODS

The vagus-intact or vagotomized rats were given acute intraluminally or intraperitoneally administered 5-HT, or chronic luminal infusion of 5-HT. The visceromotor response (VMR) to colorectal distension (CRD) was electrophysiologically recorded.

KEY RESULTS

Acute intraluminal infusion of 5-HT (10 or 100 nmol) significantly attenuated VMR to CRD, while systemic administered 5-HT at similar doses resulted in markedly augmented nociception. Pretreatment with luminal application of granisetron or lidocaine, or pharmacological depletion of endogenous 5-HT with injection of p-chlorophenylalanine, a 5-HT synthesis inhibitor, and subdiaphragmatic vagotomy or functional deafferentation with capsaicin abolished the effect of luminal (but not systemic) 5-HT. Chronic infusion of 5-HT (10 nmol d(-1) for 5 days) produced gradual augmentation of baseline VMR. And, the VMR to CRD after 5-HT infusion decreased on day 1 and 2, then gradually increased from day 3. Surgical vagotomy or daily preperfusion with granisetron canceled these time-dependent patterns.

CONCLUSIONS & INFERENCES

Luminal 5-HT time-dependently modulates vagal afferent driven antinociception. Acute infusion of 5-HT attenuates visceral nociception via activation of vagal afferent 5-HT type 3 receptors (5-HT(3)Rs)within intestinal mucosa; while chronic luminal 5-HT caused gradually developed visceral hyperalgesia, which may also involve vagal 5-HT(3)Rs.

Purification and characterization of two new allergens from the salivary glands of the horsefly, Tabanus yao

BACKGROUND

Horsefly bite can cause allergic reactions in humans. There is no information about allergenic horsefly proteins.

OBJECTIVES

The current work aims to purify and characterize IgE-binding proteins from horsefly salivary glands.

METHODS

Two IgE-binding proteins, Tab a 1 and Tab a 2 with molecular weight of 26 and 35 kd, respectively, were purified and characterized from 60,000 pairs of horsefly salivary glands of Tabanus yao, respectively. Their primary sequences were determined by Edman degradation and cDNA cloning. Their allergenicity was examined using enzyme-linked immunosorbent assay (ELISA), ELISA inhibition tests, and immunoblots.

RESULTS

Immunoblotting demonstrated IgE binding by 32 and 34 of 37 (86.5% and 91.8%) subjects' sera to Tab a 1 and Tab a 2, respectively. They were identified as an antigen 5-related (Ag 5) protein and hyaluronidase, respectively. ELISA inhibitions of serum IgE reactivity to the horsefly salivary gland extract (SGE) using purified Tab a 1 and Tab a 2 were significant (about 45%). In addition, these proteins showed some IgE-binding capacity to sera of subjects with wasp sting allergy.

CONCLUSIONS

We have first identified and characterized two IgE-binding proteins, Tab a 1, an Ag 5-like protein and Tab a 2, a hyaluronidase, from the horsefly salivary glands. They appear to be of importance for the allergic reactions induced by horsefly bite. These allergens are thus not only found in stinging but also found in hematophagous insects. These results also provided support for the presence of the so-called wasp-horsefly syndrome (WHS).

Adenosine 2A receptor is protective against renal injury in MRL/lpr mice

OBJECTIVE

Adenosine is considered as a potent endogenous anti-inflammatory and immunosuppressive molecule. We examined the roles of A2A-adenosine receptor (A(2A)R) in the progression of lupus nephritis.

METHODS

MRL/lpr mice were given a selective A(2A)R agonist, CGS21680 (0.4 mg/kg per day, i.p.) while control mice received saline only. After 8 weeks of treatment, mice were sacrificed for assessment of functional and histological parameters as well as inflammatory infiltration in the kidneys. MCP-1, IFN-γ, MHC-II and A(2A)R mRNA expression was evaluated by RT-PCR. Expression of A(2A)R and nuclear NFκB p65 protein was determined by Western blot analysis. Levels of anti-dsDNA antibody and IFN-γ were measured by ELISA.

RESULTS

CGS21680 treatment resulted in significant decrease in proteinuria, blood urea and creatinine as well as improvement in renal histology. Renal macrophage and T-cell infiltration were significantly attenuated in association with suppressed expression of MCP-1, IFN-γ and MHC-II. CGS21680 treatment reduced the level of serum anti-dsDNA and renal immune complex deposition. CGS21680 inhibited the activation of NFκB and suppressed the expression of IFN-γ, MCP-1 and MHC-II in MRL/lpr splenocytes.

CONCLUSIONS

A(2A)R activation suppressed inflammation in the kidneys of MRL/lpr mice and can be considered as a novel therapeutic approach for human lupus nephritis.

Susceptibility of North-American and European crickets to Acheta domesticus densovirus (AdDNV) and associated epizootics

The European house cricket, Acheta domesticus L., is highly susceptible to A. domesticus densovirus (AdDNV). Commercial rearings of crickets in Europe are frequently decimated by this pathogen. Mortality was predominant in the last larval stage and young adults. Infected A. domesticus were smaller, less active, did not jump as high, and the adult females seldom lived more than 10-14 days. The most obvious pathological change was the completely empty digestive caecae. Infected tissues included adipose tissue, midgut, epidermis, and Malpighian tubules. Sudden AdDNV epizootics have decimated commercial mass rearings in widely separated parts of North America since the autumn of 2009. Facilities that are producing disease-free crickets have avoided the importation of crickets and other non-cricket species (or nonliving material). Five isolates from different areas in North America contained identical sequences as did AdDNV present in non-cricket species collected from these facilities. The North American AdDNVs differed slightly from sequences of European AdDNV isolates obtained in 1977, 2004, 2006, 2007 and 2009 and an American isolate from 1988. The substitution rate of the 1977 AdDNV 5kb genome was about two nucleotides per year, about half of the substitutions being synonymous. The American and European AdDNV strains are estimated to have diverged in 2006. The lepidopterans Spodoptera littoralis and Galleria mellonella could not be infected with AdDNV. The Jamaican cricket, Gryllus assimilis, and the European field cricket, Gryllus bimaculatus, were also found to be resistant to AdDNV.

Development of gold standard ion-selective electrode-based methods for fluoride analysis

BACKGROUND/AIMS

Currently available techniques for fluoride analysis are not standardized. Therefore, this study was designed to develop standardized methods for analyzing fluoride in biological and nonbiological samples used for dental research.

METHODS

A group of nine laboratories analyzed a set of standardized samples for fluoride concentration using their own methods. The group then reviewed existing analytical techniques for fluoride analysis, identified inconsistencies in the use of these techniques and conducted testing to resolve differences. Based on the results of the testing undertaken to define the best approaches for the analysis, the group developed recommendations for direct and microdiffusion methods using the fluoride ion-selective electrode.

RESULTS

Initial results demonstrated that there was no consensus regarding the choice of analytical techniques for different types of samples. Although for several types of samples, the results of the fluoride analyses were similar among some laboratories, greater differences were observed for saliva, food and beverage samples. In spite of these initial differences, precise and true values of fluoride concentration, as well as smaller differences between laboratories, were obtained once the standardized methodologies were used. Intraclass correlation coefficients ranged from 0.90 to 0.93, for the analysis of a certified reference material, using the standardized methodologies.

CONCLUSION

The results of this study demonstrate that the development and use of standardized protocols for F analysis significantly decreased differences among laboratories and resulted in more precise and true values.

Clinicopathological implications of tumour-associated macrophages and vascularization in sinonasal melanoma

This study investigated tumour-associated macrophages (TAMs) and their effects on tumour vascularization in sinonasal melanoma (SNM). Data on 45 patients with SNM undergoing surgery were reviewed retrospectively. Tumour sections were analysed immunohistochemically for TAMs, microvessels, lymph vessels, and vasculogenic mimicry in both intra- and peritumoural areas. The density of intratumoural TAMs was associated with tumour thickness and with overall survival in SNM stages I and II but there were no correlations between micro- or lymph vessel density and TAM infiltration. Greater TAM infiltration was observed in tumour tissues with vasculogenic mimicry although this was not statistically significant. These data suggest that high intratumoural TAM infiltration is associated with tumour aggressiveness and a poor prognosis for SNM, and that activation of macrophages can be polarized by different micro-environments. TAMs could be potential prognostic indicators for patients with SNM.

Synchronous multicentric osteosarcoma involving mandible and maxillas

Synchronous multicentric osteosarcoma (SMO) is rare with fewer than 100 well-documented cases in the medical literature. SMO affecting the jaw is even rarer with only three cases involving the mandible having been reported. SMO in the maxilla has not been previously reported. The authors report the first case of SMO involving both mandible and maxilla in an 18-year-old girl. The clinical course, radiological and histological appearance of the lesion indicated it was an SMO rather than metastasis arising from a single osteosarcoma. This case could be regarded as powerful evidence to support the multicentric theory related to SMO.

Treatment of a fusiform vertebral aneurysm with double stent placement. A technical case report and review of the literature

A 34-year-old man admitted to another hospital presented with sudden onset of headache. The CT scan was unremarkable, but magnetic resonance angiography revealed a fusiform aneurysm in the left vertebral artery. Six days later, the patient was sent to our institution for further diagnosis and treatment. Cerebral angiography confirmed a fusiform aneurysm located in the right vertebral artery. At first, we placed a neuroform-3 stent and could see contrast medium stasis in the aneurysm, so we did not fill coils into the aneurysm. Four months later, the patient was admitted for rechecking. DSA showed the aneurysm remained and we placed a LEO stent in the lumen of the Neuroform stent. A control DSA eight months later showed the aneurysm had almost healed. Overlapping stents may induce spontaneous thrombosis of vertebral artery aneurysms and facilitate parent artery reconstruction through flow remodeling and stent endothelialization. This technique may be an option in treating dissecting or fusiform intracranial aneurysms that are not amenable to open surgical treatment or endovascular coil embolization.

Successful Management of Hemorrhagic Complications during Onyx-18 Embolization of Cerebral Arteriovenous Malformations

The most frequent and devastating complication of the endovascular treatment of cerebral AVMs is hemorrhage. This report describes three patients with cerebral AVM who encountered bleeding during Onyx-18 embolization. The bleeding was discovered promptly during the procedure and hemorrhage quickly prevented using Onyx-18. All three patients recovered without any new neurological symptoms. Early detection and prevention of bleeding are very important during interventional procedures to avoid craniotomy and improve the prognosis of patients.

Magnetic and upconverted luminescent properties of multifunctional lanthanide doped cubic KGdF4 nanocrystals

Lanthanide (Ln3+) doped KGdF4 (Ln=Yb3+, Er3+, Ho3+, Tm3+) nanocrystals with a mean diameter of approximately 12 nm were synthesized by a hydrothermal method using oleic acid as a stabilizing agent at 180 °C. The nanocrystals crystallize in the cubic phase as α-NaGdF4. When excited by a 980 nm laser, these Ln3+ doped nanocrystals exhibit multicolor up-conversion (UC) emissions in red, yellow, blue and white. The calculated color coordinates demonstrate that white UC emission (CIE-X=0.352, CIE-Y=0.347) can be obtained by varying the dopant concentrations in the Yb3+/Ho3+/Tm3+ triply-doped nanocrystals to yield different RGB emission intensities. The measured field dependence of magnetization (M-H curves) of the KGdF4 nanocrystals shows their paramagnetic characteristics that can be ascribed to the non-interacting localized nature of the magnetic moment of Gd3+ ions. Moreover, low temperature thermal treatment can enhance UC properties, magnetization and magnetic mass susceptibility of Ln3+ doped KGdF4 nanocrystals. The multifunctional Ln3+ doped KGdF4 nanocrystals have potential applications in color displays, bioseparation, and optical-magnetic dual modal nanoprobes in biomedical imaging.