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Livermore P, Kupiec K, Wedderburn LR, Knight A, Solebo AL, Shafran R, Robert G, Sebire NJ, Gibson F. Designing, Developing, and Testing a Chatbot for Parents and Caregivers of Children and Young People With Rheumatological Conditions (the IMPACT Study): Protocol for a Co-Designed Proof-of-Concept Study. JMIR Res Protoc 2024; 13:e57238. [PMID: 38568725 PMCID: PMC11024752 DOI: 10.2196/57238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 02/28/2024] [Accepted: 03/04/2024] [Indexed: 04/05/2024] Open
Abstract
BACKGROUND Pediatric rheumatology is a term that encompasses over 80 conditions affecting different organs and systems. Children and young people with rheumatological chronic conditions are known to have high levels of mental health problems and therefore are at risk of poor health outcomes. Clinical psychologists can help children and young people manage the daily difficulties of living with one of these conditions; however, there are insufficient pediatric psychologists in the United Kingdom. We urgently need to consider other ways of providing early, essential support to improve their current well-being. One way of doing this is to empower parents and caregivers to have more of the answers that their children and young people need to support them further between their hospital appointments. OBJECTIVE The objective of this co-designed proof-of-concept study is to design, develop, and test a chatbot intervention to support parents and caregivers of children and young people with rheumatological conditions. METHODS This study will explore the needs and views of children and young people with rheumatological conditions, their siblings, parents, and caregivers, as well as health care professionals working in pediatric rheumatology. We will ask approximately 100 participants in focus groups where they think the gaps are in current clinical care and what ideas they have for improving upon them. Creative experience-based co-design workshops will then decide upon top priorities to develop further while informing the appearance, functionality, and practical delivery of a chatbot intervention. Upon completion of a minimum viable product, approximately 100 parents and caregivers will user-test the chatbot intervention in an iterative sprint methodology to determine its worth as a mechanism for support for parents. RESULTS A total of 73 children, young people, parents, caregivers, and health care professionals have so far been enrolled in the study, which began in November 2023. The anticipated completion date of the study is April 2026. The data analysis is expected to be completed in January 2026, with the results being published in April 2026. CONCLUSIONS This study will provide evidence on the accessibility, acceptability, and usability of a chatbot intervention for parents and caregivers of children and young people with rheumatological conditions. If proven useful, it could lead to a future efficacy trial of one of the first chatbot interventions to provide targeted and user-suggested support for parents and caregivers of children with chronic health conditions in health care services. This study is unique in that it will detail the needs and wants of children, young people, siblings, parents, and caregivers to improve the current support given to families living with pediatric rheumatological conditions. It will be conducted across the whole of the United Kingdom for all pediatric rheumatological conditions at all stages of the disease trajectory. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/57238.
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Affiliation(s)
- Polly Livermore
- Rheumatology Department, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
- NIHR Biomedical Research Centre at Great Ormond Street Hospital for Children, London, United Kingdom
- University College London Great Ormond Street Institute of Child Health, London, United Kingdom
- Centre for Adolescent Rheumatology Versus Arthritis at UCL, UCLH and GOSH, London, United Kingdom
| | - Klaudia Kupiec
- Rheumatology Department, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Lucy R Wedderburn
- NIHR Biomedical Research Centre at Great Ormond Street Hospital for Children, London, United Kingdom
- University College London Great Ormond Street Institute of Child Health, London, United Kingdom
- Centre for Adolescent Rheumatology Versus Arthritis at UCL, UCLH and GOSH, London, United Kingdom
| | - Andrea Knight
- Division of Rheumatology, The Hospital for Sick Children, Toronto, ON, Canada
- Neurosciences and Mental Health Program, SickKids Research Institute, Toronto, ON, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Ameenat L Solebo
- University College London Great Ormond Street Institute of Child Health, London, United Kingdom
- Opthamology Department, Great Ormond Street Children's Hospital NHS Foundation Trust, London, United Kingdom
| | - Roz Shafran
- University College London Great Ormond Street Institute of Child Health, London, United Kingdom
| | | | - N J Sebire
- University College London Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Faith Gibson
- School of Health Sciences, University of Surrey, Surrey, United Kingdom
- Director of Research - Nursing and Allied Health, Great Ormond Street Children's Hospital, London, United Kingdom
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Monachelli R, Davis SW, Barnard A, Longmire M, Docherty JP, Oakley-Girvan I. Designing mHealth Apps to Incorporate Evidence-Based Techniques for Prolonging User Engagement. Interact J Med Res 2024; 13:e51974. [PMID: 38416858 PMCID: PMC11005439 DOI: 10.2196/51974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 11/14/2023] [Accepted: 02/27/2024] [Indexed: 03/01/2024] Open
Abstract
Maintaining user engagement with mobile health (mHealth) apps can be a challenge. Previously, we developed a conceptual model to optimize patient engagement in mHealth apps by incorporating multiple evidence-based methods, including increasing health literacy, enhancing technical competence, and improving feelings about participation in clinical trials. This viewpoint aims to report on a series of exploratory mini-experiments demonstrating the feasibility of testing our previously published engagement conceptual model. We collected data from 6 participants using an app that showed a series of educational videos and obtained additional data via questionnaires to illustrate and pilot the approach. The videos addressed 3 elements shown to relate to engagement in health care app use: increasing health literacy, enhancing technical competence, and improving positive feelings about participation in clinical trials. We measured changes in participants' knowledge and feelings, collected feedback on the videos and content, made revisions based on this feedback, and conducted participant reassessments. The findings support the feasibility of an iterative approach to creating and refining engagement enhancements in mHealth apps. Systematically identifying the key evidence-based elements intended to be included in an app's design and then systematically testing the implantation of each element separately until a satisfactory level of positive impact is achieved is feasible and should be incorporated into standard app design. While mHealth apps have shown promise, participants are more likely to drop out than to be retained. This viewpoint highlights the potential for mHealth researchers to test and refine mHealth apps using approaches to better engage users.
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Affiliation(s)
| | | | | | | | - John P Docherty
- Weill Cornell Medical College, White Plains, NY, United States
| | - Ingrid Oakley-Girvan
- Medable Inc, Palo Alto, CA, United States
- The Public Health Institute, Oakland, CA, United States
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Papachristofi O, Bornkamp B, Wright M, Friede T. Interim decision making in seamless trial designs: An application in an adaptive dose-finding study in a rare kidney disease. Pharm Stat 2024; 23:20-30. [PMID: 37691560 DOI: 10.1002/pst.2335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 06/30/2023] [Accepted: 08/03/2023] [Indexed: 09/12/2023]
Abstract
Adaptive seamless trial designs, combining the learning and confirming cycles of drug development in a single trial, have gained popularity in recent years. Adaptations may include dose selection, sample size re-estimation and enrichment of the study population. Despite methodological advances and recognition of the potential efficiency gains such designs offer, their implementation, including how to enable efficient decision making on the adaptations in interim analyzes, remains a key challenge in their adoption. This manuscript uses a case study of an adaptive seamless proof-of-concept (Phase 2a)/dose-finding (Phase 2b) to showcase potential adaptive features that can be implemented in trial designs at earlier development stages and the role of simulations in assessing the design operating characteristics and specifying the decision rules for the adaptations. It further outlines the elements needed to support successful interim analysis decision making on the adaptations while safeguarding study integrity, including the role of different stakeholders, interactive simulation-based tools to facilitate decision making and operational aspects requiring preplanning. The benefits of the adaptive Phase 2a/2b design chosen compared to following the traditional two separate studies (2a and 2b) paradigm are discussed. With careful planning and appreciation of their complexity and components needed for their implementation, seamless adaptive designs have the potential to yield significant savings both in terms of time and resources.
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Affiliation(s)
| | - Björn Bornkamp
- Clinical Development and Analytics, Novartis Pharma AG, Basel, Switzerland
| | - Melanie Wright
- Clinical Development and Analytics, Novartis Pharma AG, Basel, Switzerland
| | - Tim Friede
- Department of Medical Statistics, University Medical Center Göttingen, Göttingen, Germany
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Insley B, Bartkoski D, Balter P, Prajapati S, Tailor R, Salehpour M, Jaffray D. Proof-of-concept for a thin conical X-ray target optimized for intensity and directionality for use in a carbon nanotube-based compact X-ray tube. Med Phys 2024; 51:447-463. [PMID: 37947472 DOI: 10.1002/mp.16835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 10/20/2023] [Accepted: 10/29/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Carbon nanotube-based cold cathode technology has revolutionized the miniaturization of X-ray tubes. However, current applications of these devices required optimization for large, uniform fields with low intensity. PURPOSE This work investigated the feasibility and radiological characteristics of a novel conical X-ray target optimized for high intensity and high directionality to be used in a compact X-ray tube. METHODS The proposed device uses an ultrathin, conical tungsten-diamond target that exhibits significant heat loading while maintaining a small focal spot size and promoting forward-directedness of the X-ray field through preferential attenuation of oblique-angled photons. The electrostatic and thermal properties of the theoretical tube were calculated and analyzed using COMSOL Multiphysics software. The production, transport, and calculation of radiological properties associated with the resultant X-ray field were performed using the Geant4 toolkit via its wrapper, TOPAS. RESULTS Heat transfer analysis of this X-ray tube demonstrated the feasibility of a 200-kV electron beam bombarding the proposed target at a maximum current of 100 mA using a 1-ms symmetric duty cycle. The cathode of the X-ray tube was designed to be segmented into nine switchable electrical segments for modulation of the focal spot size from 0.4- to 10.8-mm. After importing the COMSOL-derived electron beam into TOPAS for X-ray production simulations, radiological analysis of the resultant field demonstrated high levels of intrinsic beam collimation while maintaining high intensity. A maximum dose rate of 17,887 cGy/min was calculated for 1-mm depth in water at 7-cm distance. CONCLUSIONS The proposed X-ray tube design can create highly directional X-ray fields with superior fluence compared to that of current commercial X-ray tubes of comparable size.
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Affiliation(s)
- Ben Insley
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Dirk Bartkoski
- Empyrean Medical Systems, Inc., 950 Peninsula Corp Cir, Boca Raton, USA
| | - Peter Balter
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Surendra Prajapati
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Ramesh Tailor
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Mohammad Salehpour
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - David Jaffray
- Division of Office of the Sr. VP & Chief Technology and Digital Officer, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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McElroy SL, Coloma PM, Berger B, Guerdjikova AI, Joyce JM, Liebowitz MR, Pain S, Rabasa C. Efficacy, safety, and tolerability of nivasorexant in adults with binge-eating disorder: A randomized, Phase II proof of concept trial. Int J Eat Disord 2023; 56:2120-2130. [PMID: 37584285 DOI: 10.1002/eat.24039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 07/25/2023] [Accepted: 07/25/2023] [Indexed: 08/17/2023]
Abstract
OBJECTIVE This Phase II, placebo-controlled, double-blind study investigated the efficacy, safety, and tolerability of nivasorexant in the treatment of adults with moderate to severe binge-eating disorder (BED). METHODS Adults meeting the DSM-5 BED criteria were randomized 1:1 to placebo or nivasorexant (100 mg b.i.d.). The primary endpoint was the change from baseline to Week 12 in the number of binge eating (BE) days per week. Exploratory efficacy endpoints included cessation of BE in the last 4 weeks of treatment; and change from baseline to Week 12 in the number of BE episodes/week, the clinician global impression (CGI) of change, the Yale-Brown Obsessive-Compulsive Scale modified for BE, and the Hamilton rating scale for depression (HAMD-17). Key safety outcomes included treatment-emergent adverse events (TEAEs) and adverse events of special interest (i.e., somnolence and fatigue). RESULTS Sixty-eight participants were randomized to each treatment arm. The change from baseline to Week 12 in the number of BE days/week was the same for placebo (least squares mean [LSM]: -2.93) and nivasorexant (LSM: -2.93), with no difference between the treatment groups (LSM difference = .000 [95% confidence interval (CI): -.69, .69], p = .9992). Furthermore, no differences between treatment groups were observed in the exploratory efficacy endpoints. Nivasorexant was well tolerated; the overall incidence of TEAEs was balanced between treatment groups, and the frequency of somnolence and fatigue in the nivasorexant group were similar to placebo. DISCUSSION In this proof-of-concept study, 100 mg b.i.d. nivasorexant did not improve BE in adults with moderate to severe BED. PUBLIC SIGNIFICANCE The results of this Phase II study indicate that nivasorexant was well tolerated in adults with BED, but did not improve binge eating behavior over placebo. Further research is needed to improve our understanding of the role of the orexin-1 receptor in BED.
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Affiliation(s)
- Susan L McElroy
- Lindner Center of HOPE, Department of Psychiatry & Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | | | | | - Anna I Guerdjikova
- Lindner Center of HOPE, Department of Psychiatry & Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - J Mark Joyce
- Clinical Neuroscience Solutions, Inc., Jacksonville, Florida, USA
| | - Michael R Liebowitz
- Medical Research Network, New York, New York, USA
- Department of Psychiatry, Columbia University, New York, New York, USA
| | - Scott Pain
- Idorsia Pharmaceuticals Ltd, Allschwil, Switzerland
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Chen L, Li Q, Chen J, Qiu Z, Xiao J, Tang M, Wu Q, Shen Y, Dai X, Fang G, Lu H. A new procedure for elimination of atrial fibrillation associated with mitral valve disease: a proof-of-concept study. Int J Surg 2023; 109:2914-2925. [PMID: 37352525 PMCID: PMC10583919 DOI: 10.1097/js9.0000000000000566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 06/10/2023] [Indexed: 06/25/2023]
Abstract
BACKGROUND Left atrial enlargement and fibrosis have been linked to the pathogenesis of atrial fibrillation (AF). The authors aimed to introduce a novel concept and develop a new procedure for AF treatment based on these characteristics. METHODS The study included three stages. The first stage was a descriptive study to clarify the characteristics of the left atrial enlargement and fibrosis' distribution in patients with mitral valve disease and long-standing persistent AF. Based on these characteristics, the authors introduced a novel concept for AF treatment, and then translated it into a new procedure. The second stage was a proof-of-concept study with this new procedure. The third stage was a comparative effectiveness research to compare the clinical outcomes between patients with this new procedure and those who received Cox-Maze IV treatment. RESULTS Based on the nonuniform fashion of left atrial enlargement and fibrosis' distribution, the authors introduced a novel concept: reconstructing a left atrium with appropriate geometry and uniform fibrosis' distribution for proper cardiac conduction, and translated it into a new procedure: left atrial geometric volume reduction combined with left appendage base closure. As compared to the Cox-Maze IV procedure, the new procedure spent significantly shorter total surgery time, cardiopulmonary bypass time, and aortic cross-clamp time ( P <0.001). Besides, the new procedure was related to a shorter ICU stay period (odd ratio (OR)=0.45, 95% CI=0.26-0.78), lower costs (OR=0.15, 95% CI=0.08-0.29), and a higher rate of A wave of transmitral and transtricuspid flow reappearance (OR=1.76, 95% CI=1.02-3.04). CONCLUSIONS The new procedure is safe and effective for eliminating AF associated with mitral valve disease.
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Affiliation(s)
- Liangwan Chen
- Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, China
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Büscher R, Teismann T, Hartleitner P, Klein JP, Baumeister H, Sander LB. Remote blended treatment for individuals with suicidal ideation: A single-arm proof-of-concept trial. Clin Psychol Psychother 2023. [PMID: 37658710 DOI: 10.1002/cpp.2905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 08/09/2023] [Accepted: 08/21/2023] [Indexed: 09/03/2023]
Abstract
INTRODUCTION New digital treatment formats may reduce barriers to treatment for individuals with suicidal ideation. This study aimed to investigate the feasibility of a remote blended care programme for this population, defined as acceptability, demand, practicality, adaptation, indications of efficacy and safety. METHODS We conducted a mixed-methods single-arm trial for proof-of-concept. Participants were eligible if they were at least 18 years old, had sufficient German proficiency, a Beck Scale for Suicidal Ideation score ≥2, internet access and lived near the outpatient clinic. The treatment consisted of 12 sessions of cognitive-behavioural videotherapy combined with online modules over 6 weeks. RESULTS We included 10 participants. All patients were satisfied with the treatment; most patients (80%) reported unpleasant memories resurfacing. All patients completed all therapy sessions and a mean of 13.7 modules (SD = 5.7); three patients switched to face-to-face treatment, in one case due to safety concerns. All patients and most therapists (83.3%) found the treatment overall practicable. Most patients (66.7%) and therapists (66.7%) considered remote treatment equivalent to face-to-face therapy. There were no serious adverse events. CONCLUSION While promising, the results suggest changes to the programme might be needed, particularly for patients' safety. A controlled feasibility trial should investigate temporary deteriorations.
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Affiliation(s)
- Rebekka Büscher
- Department of Medical Psychology and Medical Sociology, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Tobias Teismann
- Mental Health Research and Treatment Center, Department of Psychology, Ruhr-Universität Bochum, Germany
| | - Paula Hartleitner
- Department of Medical Psychology and Medical Sociology, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Jan Philipp Klein
- Department of Psychiatry, Psychosomatics and Psychotherapy, Luebeck University, Luebeck, Germany
| | - Harald Baumeister
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Ulm, Germany
| | - Lasse B Sander
- Department of Medical Psychology and Medical Sociology, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Dirin A, Oliver I, Laine TH. A Security Framework for Increasing Data and Device Integrity in Internet of Things Systems. Sensors (Basel) 2023; 23:7532. [PMID: 37687988 PMCID: PMC10490583 DOI: 10.3390/s23177532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 08/26/2023] [Accepted: 08/28/2023] [Indexed: 09/10/2023]
Abstract
The trustworthiness of a system is not just about proving the identity or integrity of the hardware but also extends to the data, control, and management planes of communication between devices and the software they are running. This trust in data and device integrity is desirable for Internet of Things (IoT) systems, especially in critical environments. In this study, we developed a security framework, IoTAttest, for building IoT systems that leverage the Trusted Platform Module 2.0 and remote attestation technologies to enable the establishment of IoT devices' collected data and control plan traffic integrity. After presenting the features and reference architecture of IoTAttest, we evaluated the privacy preservation and validity through the implementation of two proof-of-concept IoT applications that were designed by two teams of university students based on the reference architecture. After the development, the developers answered open questions regarding their experience and perceptions of the framework's usability, limitations, scalability, extensibility, potential, and security. The results indicate that IoTAttest can be used to develop IoT systems with effective attestation to achieve device and data integrity. The proof-of-concept solutions' outcomes illustrate the functionalities and performance of the IoT framework. The feedback from the proof-of-concept developers affirms that they perceived the framework as usable, scalable, extensible, and secure.
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Affiliation(s)
- Amir Dirin
- Department of ICT, Metropolia University of Applied Sciences, 00920 Helsinki, Finland;
| | | | - Teemu H. Laine
- Department of Digital Media, Ajou University, Suwon 16499, Republic of Korea
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Jeannerat A, Meuli J, Peneveyre C, Jaccoud S, Chemali M, Thomas A, Liao Z, Abdel-Sayed P, Scaletta C, Hirt-Burri N, Applegate LA, Raffoul W, Laurent A. Bio-Enhanced Neoligaments Graft Bearing FE002 Primary Progenitor Tenocytes: Allogeneic Tissue Engineering & Surgical Proofs-of-Concept for Hand Ligament Regenerative Medicine. Pharmaceutics 2023; 15:1873. [PMID: 37514060 PMCID: PMC10385025 DOI: 10.3390/pharmaceutics15071873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 06/27/2023] [Accepted: 06/30/2023] [Indexed: 07/30/2023] Open
Abstract
Hand tendon/ligament structural ruptures (tears, lacerations) often require surgical reconstruction and grafting, for the restauration of finger mechanical functions. Clinical-grade human primary progenitor tenocytes (FE002 cryopreserved progenitor cell source) have been previously proposed for diversified therapeutic uses within allogeneic tissue engineering and regenerative medicine applications. The aim of this study was to establish bioengineering and surgical proofs-of-concept for an artificial graft (Neoligaments Infinity-Lock 3 device) bearing cultured and viable FE002 primary progenitor tenocytes. Technical optimization and in vitro validation work showed that the combined preparations could be rapidly obtained (dynamic cell seeding of 105 cells/cm of scaffold, 7 days of co-culture). The studied standardized transplants presented homogeneous cellular colonization in vitro (cellular alignment/coating along the scaffold fibers) and other critical functional attributes (tendon extracellular matrix component such as collagen I and aggrecan synthesis/deposition along the scaffold fibers). Notably, major safety- and functionality-related parameters/attributes of the FE002 cells/finished combination products were compiled and set forth (telomerase activity, adhesion and biological coating potentials). A two-part human cadaveric study enabled to establish clinical protocols for hand ligament cell-assisted surgery (ligamento-suspension plasty after trapeziectomy, thumb metacarpo-phalangeal ulnar collateral ligamentoplasty). Importantly, the aggregated experimental results clearly confirmed that functional and clinically usable allogeneic cell-scaffold combination products could be rapidly and robustly prepared for bio-enhanced hand ligament reconstruction. Major advantages of the considered bioengineered graft were discussed in light of existing clinical protocols based on autologous tenocyte transplantation. Overall, this study established proofs-of-concept for the translational development of a functional tissue engineering protocol in allogeneic musculoskeletal regenerative medicine, in view of a pilot clinical trial.
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Affiliation(s)
- Annick Jeannerat
- Preclinical Research Department, LAM Biotechnologies SA, CH-1066 Epalinges, Switzerland
| | - Joachim Meuli
- Plastic and Hand Surgery Service, Lausanne University Hospital, University of Lausanne, CH-1011 Lausanne, Switzerland
| | - Cédric Peneveyre
- Preclinical Research Department, LAM Biotechnologies SA, CH-1066 Epalinges, Switzerland
| | - Sandra Jaccoud
- Plastic and Hand Surgery Service, Lausanne University Hospital, University of Lausanne, CH-1011 Lausanne, Switzerland
- Laboratory of Biomechanical Orthopedics, Ecole Polytechnique Fédérale de Lausanne, CH-1015 Lausanne, Switzerland
| | - Michèle Chemali
- Plastic and Hand Surgery Service, Lausanne University Hospital, University of Lausanne, CH-1011 Lausanne, Switzerland
| | - Axelle Thomas
- Plastic and Hand Surgery Service, Lausanne University Hospital, University of Lausanne, CH-1011 Lausanne, Switzerland
| | - Zhifeng Liao
- Plastic and Hand Surgery Service, Lausanne University Hospital, University of Lausanne, CH-1011 Lausanne, Switzerland
| | - Philippe Abdel-Sayed
- Plastic and Hand Surgery Service, Lausanne University Hospital, University of Lausanne, CH-1011 Lausanne, Switzerland
- DLL Bioengineering, STI School of Engineering, Ecole Polytechnique Fédérale de Lausanne, CH-1015 Lausanne, Switzerland
| | - Corinne Scaletta
- Plastic and Hand Surgery Service, Lausanne University Hospital, University of Lausanne, CH-1011 Lausanne, Switzerland
| | - Nathalie Hirt-Burri
- Plastic and Hand Surgery Service, Lausanne University Hospital, University of Lausanne, CH-1011 Lausanne, Switzerland
| | - Lee Ann Applegate
- Plastic and Hand Surgery Service, Lausanne University Hospital, University of Lausanne, CH-1011 Lausanne, Switzerland
- Center for Applied Biotechnology and Molecular Medicine, University of Zurich, CH-8057 Zurich, Switzerland
- Oxford OSCAR Suzhou Center, Oxford University, Suzhou 215123, China
| | - Wassim Raffoul
- Plastic and Hand Surgery Service, Lausanne University Hospital, University of Lausanne, CH-1011 Lausanne, Switzerland
| | - Alexis Laurent
- Preclinical Research Department, LAM Biotechnologies SA, CH-1066 Epalinges, Switzerland
- Plastic and Hand Surgery Service, Lausanne University Hospital, University of Lausanne, CH-1011 Lausanne, Switzerland
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Sigle M, Berliner L, Richter E, van Iersel M, Gorgati E, Hubloue I, Bamberg M, Grasshoff C, Rosenberger P, Wunderlich R. Development of an Anticipatory Triage-Ranking Algorithm Using Dynamic Simulation of the Expected Time Course of Patients With Trauma: Modeling and Simulation Study. J Med Internet Res 2023; 25:e44042. [PMID: 37318826 PMCID: PMC10337428 DOI: 10.2196/44042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 03/14/2023] [Accepted: 05/03/2023] [Indexed: 06/17/2023] Open
Abstract
BACKGROUND In cases of terrorism, disasters, or mass casualty incidents, far-reaching life-and-death decisions about prioritizing patients are currently made using triage algorithms that focus solely on the patient's current health status rather than their prognosis, thus leaving a fatal gap of patients who are under- or overtriaged. OBJECTIVE The aim of this proof-of-concept study is to demonstrate a novel approach for triage that no longer classifies patients into triage categories but ranks their urgency according to the anticipated survival time without intervention. Using this approach, we aim to improve the prioritization of casualties by respecting individual injury patterns and vital signs, survival likelihoods, and the availability of rescue resources. METHODS We designed a mathematical model that allows dynamic simulation of the time course of a patient's vital parameters, depending on individual baseline vital signs and injury severity. The 2 variables were integrated using the well-established Revised Trauma Score (RTS) and the New Injury Severity Score (NISS). An artificial patient database of unique patients with trauma (N=82,277) was then generated and used for analysis of the time course modeling and triage classification. Comparative performance analysis of different triage algorithms was performed. In addition, we applied a sophisticated, state-of-the-art clustering method using the Gower distance to visualize patient cohorts at risk for mistriage. RESULTS The proposed triage algorithm realistically modeled the time course of a patient's life, depending on injury severity and current vital parameters. Different casualties were ranked by their anticipated time course, reflecting their priority for treatment. Regarding the identification of patients at risk for mistriage, the model outperformed the Simple Triage And Rapid Treatment's triage algorithm but also exclusive stratification by the RTS or the NISS. Multidimensional analysis separated patients with similar patterns of injuries and vital parameters into clusters with different triage classifications. In this large-scale analysis, our algorithm confirmed the previously mentioned conclusions during simulation and descriptive analysis and underlined the significance of this novel approach to triage. CONCLUSIONS The findings of this study suggest the feasibility and relevance of our model, which is unique in terms of its ranking system, prognosis outline, and time course anticipation. The proposed triage-ranking algorithm could offer an innovative triage method with a wide range of applications in prehospital, disaster, and emergency medicine, as well as simulation and research.
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Affiliation(s)
- Manuel Sigle
- University Department of Anesthesiology and Intensive Care Medicine, University Hospital Tübingen, Eberhard Karls University, Tübingen, Germany
- University Department of Cardiology and Angiology, University Hospital Tübingen, Eberhard Karls University, Tübingen, Germany
| | - Leon Berliner
- University Department of Anesthesiology and Intensive Care Medicine, University Hospital Tübingen, Eberhard Karls University, Tübingen, Germany
| | - Erich Richter
- University Department of Pediatrics and Adolescent Medicine, Ulm University Medical Center, Ulm, Germany
| | - Mart van Iersel
- Interactive Simulation Emergency Exercise support limited company, Wemmel, Belgium
| | - Eleonora Gorgati
- University Department of Anesthesiology and Intensive Care Medicine, University Hospital Tübingen, Eberhard Karls University, Tübingen, Germany
| | - Ives Hubloue
- Emergency Department, Universitair Ziekenhuis Brussel, Brussel, Belgium
- Research Group on Emergency and Disaster Medicine, Vrije Universiteit Brussel, Brussel, Belgium
| | - Maximilian Bamberg
- University Department of Anesthesiology and Intensive Care Medicine, University Hospital Tübingen, Eberhard Karls University, Tübingen, Germany
| | - Christian Grasshoff
- University Department of Anesthesiology and Intensive Care Medicine, University Hospital Tübingen, Eberhard Karls University, Tübingen, Germany
| | - Peter Rosenberger
- University Department of Anesthesiology and Intensive Care Medicine, University Hospital Tübingen, Eberhard Karls University, Tübingen, Germany
| | - Robert Wunderlich
- University Department of Anesthesiology and Intensive Care Medicine, University Hospital Tübingen, Eberhard Karls University, Tübingen, Germany
- German Society for Disaster Medicine (Deutsche Gesellschaft für Katastrophenmedizin), Kirchseeon, Germany
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11
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Otaki F, Gholami M, Fawad I, Akbar A, Banerjee Y. Students' Perception of Formative Assessment as an Instructional Tool in Competency-Based Medical Education: Proposal for a Proof-of-Concept Study. JMIR Res Protoc 2023; 12:e41626. [PMID: 36939831 PMCID: PMC10131604 DOI: 10.2196/41626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 02/19/2023] [Accepted: 02/26/2023] [Indexed: 03/02/2023] Open
Abstract
BACKGROUND In competency-based medical education (CBME), "Assessment for learning" or "Formative Assessment" (FA) plays a key role in augmenting student learning. FAs help students to measure their progress over time, enabling them to proactively improve their performance in summative assessments. FAs also encourage students to learn in a way where they address their knowledge gaps and gaps in their conceptualization of the subject matter. The effectiveness of an FA, as a learning and development instrument, relies on the degree of student involvement in the corresponding educational intervention's design and implementation. The extent of students' engagement in FA can be evaluated by appraising their perception regarding the educational intervention itself. OBJECTIVE This proof-of-concept study aims to develop a systemic understanding of a Formative Assessment as an Instructional Tool (FAIS) implemented in a biochemistry course in the Basic Medical Sciences component of an undergraduate entry, CBME. METHODS The educational intervention in question is an FAIS, which is implemented in a biochemistry course in the first semester of a 6-year bachelor of medicine, bachelor of surgery program. When developing the FAIS, each area of knowledge, skills, and attitudes were considered. Assessment formats are developed per Miller's learning pyramid. This multiphase study is meant to rely on a convergent mixed methods design, where qualitative and quantitative data are independently collected and analyzed. Thereafter, the outputs of analyses are systematically merged using joint display analysis process. Qualitative data are collected through a focus group session that captures the students' perception toward the FAIS. Data collection, integral to this focus group session, is exploratory. The inductive qualitative data analysis follows Braun and Clarke's 6-step framework. The quantitative component of this study revolves around investigating the effect of the FAIS on the course's summative assessment. The summative assessment performance of the 71 students, enrolled in the FAIS cohort, will be compared to that of the students in the non-FAIS cohort. The total duration of the proposed multiphase research study is 6 months. RESULTS This proposed multiphase study is expected to showcase, from a systemic perspective, the effectiveness of the respective educational intervention. It will shed light on the participating students' attitudes in relation to the usefulness of FA in achieving competency goals and in fostering self-directed learning. The proposed study could also uncover the hypothesized association between the FA intervention and enhanced performance in summative assessments. CONCLUSIONS Our findings will generate evidence regarding the application of FAs, which can be leveraged by other medical educators in contexts similar to those under investigation. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/41626.
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Affiliation(s)
- Farah Otaki
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
- Strategy and Institutional Excellence, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - Mandana Gholami
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - Iman Fawad
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - Anjum Akbar
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - Yajnavalka Banerjee
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
- Centre of Medical Education, University of Dundee, Dundee, United Kingdom
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12
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Wang W, Lu G, Wu X, Wen Q, Zhang F. Colonic Transendoscopic Enteral Tubing Is a New Pathway to Microbial Therapy, Colonic Drainage, and Host-Microbiota Interaction Research. J Clin Med 2023; 12. [PMID: 36769429 DOI: 10.3390/jcm12030780] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 01/08/2023] [Accepted: 01/17/2023] [Indexed: 01/20/2023] Open
Abstract
The limitation of traditional delivery methods for fecal microbiota transplantation (FMT) gave birth to colonic transendoscopic enteral tubing (TET) to address the requirement of frequent FMTs. Colonic TET as a novel endoscopic intervention has received increasing attention in practice since 2015 in China. Emerging studies from multiple centers indicate that colonic TET is a promising, safe, and practical delivery method for microbial therapy and administering medication with high patient satisfaction. Intriguingly, colonic TET has been used to rescue endoscopy-related perforations by draining colonic air and fluid through the TET tube. Recent research based on collecting ileocecal samples through a TET tube has contributed to demonstrating community dynamics in the intestine, and it is expected to be a novel delivery of proof-of-concept in host-microbiota interactions and pharmacological research. The present article aims to review the concept and techniques of TET and to explore microbial therapy, colonic drainage, and microbial research based on colonic TET.
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13
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Denner J, Schuurman HJ. Early testing of porcine organ xenotransplantation products in humans: Microbial safety as illustrated for porcine cytomegalovirus. Xenotransplantation 2022; 29:e12783. [PMID: 36336900 DOI: 10.1111/xen.12783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 09/20/2022] [Indexed: 11/09/2022]
Affiliation(s)
- Joachim Denner
- Institute of Virology, Free University Berlin, Berlin, Germany
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14
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Laza-Vásquez C, Martínez-Alonso M, Forné-Izquierdo C, Vilaplana-Mayoral J, Cruz-Esteve I, Sánchez-López I, Reñé-Reñé M, Cazorla-Sánchez C, Hernández-Andreu M, Galindo-Ortego G, Llorens-Gabandé M, Pons-Rodríguez A, Rué M. Feasibility and Acceptability of Personalized Breast Cancer Screening (DECIDO Study): A Single-Arm Proof-of-Concept Trial. Int J Environ Res Public Health 2022; 19:10426. [PMID: 36012059 PMCID: PMC9407798 DOI: 10.3390/ijerph191610426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 08/11/2022] [Accepted: 08/18/2022] [Indexed: 06/15/2023]
Abstract
The aim of this study was to assess the acceptability and feasibility of offering risk-based breast cancer screening and its integration into regular clinical practice. A single-arm proof-of-concept trial was conducted with a sample of 387 women aged 40-50 years residing in the city of Lleida (Spain). The study intervention consisted of breast cancer risk estimation, risk communication and screening recommendations, and a follow-up. A polygenic risk score with 83 single nucleotide polymorphisms was used to update the Breast Cancer Surveillance Consortium risk model and estimate the 5-year absolute risk of breast cancer. The women expressed a positive attitude towards varying the frequency of breast screening according to individual risk and, especially, more frequently inviting women at higher-than-average risk. A lower intensity screening for women at lower risk was not as welcome, although half of the participants would accept it. Knowledge of the benefits and harms of breast screening was low, especially with regard to false positives and overdiagnosis. The women expressed a high understanding of individual risk and screening recommendations. The participants' intention to participate in risk-based screening and satisfaction at 1-year were very high.
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Affiliation(s)
- Celmira Laza-Vásquez
- Department of Nursing and Physiotherapy and Health Care Research Group (GRECS), IRBLleida—Institut de Recerca Biomèdica de Lleida, University of Lleida, 25198 Lleida, Spain
| | - Montserrat Martínez-Alonso
- IRBLleida—Institut de Recerca Biomèdica de Lleida, Department of Basic Medical Sciences, University of Lleida, 25198 Lleida, Spain
| | - Carles Forné-Izquierdo
- Department of Basic Medical Sciences, University of Lleida, 25198 Lleida, Spain
- Heorfy Consulting, 25007 Lleida, Spain
| | - Jordi Vilaplana-Mayoral
- Department of Computing and Industrial Engineering, University of Lleida, 25001 Lleida, Spain
| | - Inés Cruz-Esteve
- Primer de Maig Basic Health Area, Catalan Institute of Health, 25003 Lleida, Spain
| | | | - Mercè Reñé-Reñé
- Department of Radiology, Arnau de Vilanova University Hospital, 25198 Lleida, Spain
| | | | | | | | | | - Anna Pons-Rodríguez
- Example Basic Health Area, Catalan Institute of Health, 25006 Lleida, Spain
- Health PhD Program, University of Lleida, 25198 Lleida, Spain
| | - Montserrat Rué
- IRBLleida—Institut de Recerca Biomèdica de Lleida, Department of Basic Medical Sciences, University of Lleida, 25198 Lleida, Spain
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15
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Skeen SJ, Jones SS, Cruse CM, Horvath KJ. Integrating Natural Language Processing and Interpretive Thematic Analyses to Gain Human-Centered Design Insights on HIV Mobile Health: Proof-of-Concept Analysis. JMIR Hum Factors 2022; 9:e37350. [PMID: 35862171 PMCID: PMC9353680 DOI: 10.2196/37350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 06/13/2022] [Accepted: 06/13/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND HIV mobile health (mHealth) interventions often incorporate interactive peer-to-peer features. The user-generated content (UGC) created by these features can offer valuable design insights by revealing what topics and life events are most salient for participants, which can serve as targets for subsequent interventions. However, unstructured, textual UGC can be difficult to analyze. Interpretive thematic analyses can preserve rich narratives and latent themes but are labor-intensive and therefore scale poorly. Natural language processing (NLP) methods scale more readily but often produce only coarse descriptive results. Recent calls to advance the field have emphasized the untapped potential of combined NLP and qualitative analyses toward advancing user attunement in next-generation mHealth. OBJECTIVE In this proof-of-concept analysis, we gain human-centered design insights by applying hybrid consecutive NLP-qualitative methods to UGC from an HIV mHealth forum. METHODS UGC was extracted from Thrive With Me, a web app intervention for men living with HIV that includes an unstructured peer-to-peer support forum. In Python, topics were modeled by latent Dirichlet allocation. Rule-based sentiment analysis scored interactions by emotional valence. Using a novel ranking standard, the experientially richest and most emotionally polarized segments of UGC were condensed and then analyzed thematically in Dedoose. Design insights were then distilled from these themes. RESULTS The refined topic model detected K=3 topics: A: disease coping; B: social adversities; C: salutations and check-ins. Strong intratopic themes included HIV medication adherence, survivorship, and relationship challenges. Negative UGC often involved strong negative reactions to external media events. Positive UGC often focused on gratitude for survival, well-being, and fellow users' support. CONCLUSIONS With routinization, hybrid NLP-qualitative methods may be viable to rapidly characterize UGC in mHealth environments. Design principles point toward opportunities to align mHealth intervention features with the organically occurring uses captured in these analyses, for example, by foregrounding inspiring personal narratives and expressions of gratitude, or de-emphasizing anger-inducing media.
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Affiliation(s)
- Simone J Skeen
- Department of Social, Behavioral, and Population Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, United States.,Department of Psychology, Hunter College, City University of New York, New York, NY, United States
| | - Stephen Scott Jones
- Department of Psychology, Hunter College, City University of New York, New York, NY, United States
| | - Carolyn Marie Cruse
- Department of Psychology, Hunter College, City University of New York, New York, NY, United States
| | - Keith J Horvath
- Department of Psychology, San Diego State University, San Diego, CA, United States
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16
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Jain SM, Balamurugan R, Tandon M, Mozaffarian N, Gudi G, Salhi Y, Holland R, Freeman R, Baron R. Randomized, double-blind, placebo-controlled trial of ISC 17536, an oral inhibitor of transient receptor potential ankyrin 1, in patients with painful diabetic peripheral neuropathy: impact of preserved small nerve fiber function. Pain 2022; 163:e738-e747. [PMID: 34490850 PMCID: PMC9100440 DOI: 10.1097/j.pain.0000000000002470] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 08/10/2021] [Accepted: 08/23/2021] [Indexed: 11/26/2022]
Abstract
ABSTRACT Patients with chronic pain syndromes, such as those with painful peripheral neuropathy due to diabetes mellitus, have limited treatment options and suffer ongoing attrition of their quality of life. Safer and more effective treatment options are needed. One therapeutic approach encompasses phenotypic characterization of the neuropathic pain subtype, combined with the selection of agents that act on relevant mechanisms. ISC 17536 is a novel, orally available inhibitor of the widely expressed pain receptor, transient receptor potential ankyrin 1, which mediates nociceptive signaling in peripheral small nerve fibers. In this randomized, placebo-controlled, proof-of-concept trial, we assessed the safety and efficacy of 28-day administration of ISC 17536 in 138 patients with chronic, painful diabetic peripheral neuropathy and used quantitative sensory testing to characterize the baseline phenotype of patients. The primary end point was the change from baseline to end of treatment in the mean 24-hour average pain intensity score based on an 11-point pain intensity numeric rating scale. The study did not meet the primary end point in the overall patient population. However, statistically significant and clinically meaningful improvement in pain were seen with ISC 17536 in an exploratory hypothesis-generating subpopulation of patients with preserved small nerve fiber function defined by quantitative sensory testing. These results may provide a mechanistic basis for targeted therapy in specific pain phenotypes in line with current approaches of "precision medicine" or personalized pain therapeutics. The hypothesis is planned to be tested in a larger phase 2 study.
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Affiliation(s)
| | | | - Monika Tandon
- Clinical Sciences, Glenmark Pharmaceuticals Limited, Mumbai, India
| | | | - Girish Gudi
- Ichnos Sciences, Inc, New York, NY, United States
| | - Yacine Salhi
- Ichnos Sciences, Inc, New York, NY, United States
| | - Robert Holland
- Early Clinical Development Consulting Ltd, Macclesfield, United Kingdom
| | - Roy Freeman
- Department of Neurology, Harvard Medical School, Boston, MA, United States
| | - Ralf Baron
- Division of Neurological Pain Research and Therapy, Universitätsklinikum Schleswig-Holstein, Campus-Kiel, Germany
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17
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Qudah Y, Abdallah M, Barajas-Gamboa JS, Del Gobbo GD, Pablo Pantoja J, Corcelles R, Rodriguez J, Balci N, Kroh M. Personalized Health Care Technology in Managing Postoperative Gastrointestinal Surgery Complications: Proof of Concept Study. J Laparoendosc Adv Surg Tech A 2022; 32:1170-1175. [PMID: 35483077 DOI: 10.1089/lap.2022.0114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Advances in three-dimensional (3D) printing technology have allowed the development of customized medical devices. Endoscopic internal drainage (EID) is a novel method to facilitate drainage of an abscess cavity into the lumen of the gastrointestinal tract by placing a double pigtail biliary stent through the fistula opening, originally designed for biliary drainage. They are available in manufacture-determined sizes and shapes. The aim of this study is to explore the feasibility of 3D printing personalized internal drainage stents for the treatment of leaks following gastrointestinal surgery over a sequential period. Methods: We retrospectively identified patients who underwent gastrointestinal anastomotic surgery complicated by postoperative leaks and underwent serial EID for treatment. Computerized Tomography scans were reviewed over a period of time, abscess cavity dimensions and characterizations were evaluated, and 3D reconstructions were obtained. The stents were designed, their shape and size were customized to the unique dimensions of the abscess and lumen of the patient. Stereolithography (SLA) 3D printing technique was used to produce the stents. Results: A total of 8 stents were produced, representing 3 patients. These stents corresponded to 2 or 3 stents per patients. Each patient underwent several endoscopic treatments, before resolution of leak. Conclusions: Customized stents may improve drainage of intra-abdominal abscesses after gastrointestinal surgery, if based on unique anatomy. This proof-of-concept study is a real-world application of personalized health care, which introduces the novel description of customizable 3D printed stents to manage complications following gastrointestinal surgery and may advance therapy for this complex clinical condition. Research Ethics Committees (REC) number is A-2021-012.
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Affiliation(s)
- Yaqeen Qudah
- Department of General Surgery, Digestive Disease Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Mohammed Abdallah
- Department of General Surgery, Digestive Disease Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Juan S Barajas-Gamboa
- Department of General Surgery, Digestive Disease Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Gabriel Diaz Del Gobbo
- Department of General Surgery, Digestive Disease Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Juan Pablo Pantoja
- Department of General Surgery, Digestive Disease Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Ricard Corcelles
- Department of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - John Rodriguez
- Department of General Surgery, Digestive Disease Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates.,Department of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Numan Balci
- Diagnostic Radiology, Imaging Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Matthew Kroh
- Department of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, Ohio, USA
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Boeschoten L, Mendrik A, van der Veen E, Vloothuis J, Hu H, Voorvaart R, Oberski DL. Privacy-preserving local analysis of digital trace data: A proof-of-concept. Patterns (N Y) 2022; 3:100444. [PMID: 35510190 PMCID: PMC9058917 DOI: 10.1016/j.patter.2022.100444] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 11/22/2021] [Accepted: 01/13/2022] [Indexed: 11/16/2022]
Abstract
We present PORT, a software platform for local data extraction and analysis of digital trace data. While digital trace data hold huge potential for social-scientific discovery, their most useful parts have been unattainable for scientists because of privacy concerns and prohibitive access to application programming interfaces. Recently, a workflow was introduced allowing citizens to donate their digital traces to scientists. In this workflow, citizens’ digital traces are processed locally on their machines before providing informed consent to share a subset of the data with researchers. In this paper, we present the newly developed software PORT that implements the local processing part of this workflow, protecting privacy by shielding sensitive data from outside observers, including the researchers themselves. When using PORT, researchers can tailor the local processing procedure suitable to the data download package and research question. Thus, PORT enables a host of potential applications of social data science to hitherto unobtainable data. Software that allows for privacy-preserving analysis of digital trace data Participants can give true informed consent regarding data they share with researchers The software is provided via open source The software can be tailored toward different research questions or data sources
Since the General Data Protection Regulation, individuals can request a copy of all the digital traces they leave behind, which are then provided in so-called data download packages (DDPs). This makes it theoretically possible for individuals to share these DDPs for research purposes. However, DDPs can contain very sensitive information, making individuals unwilling to share them with researchers. In addition, researchers are often interested in only a small part of the large amount of information that is found in the DDP. The software introduced in this paper overcomes this privacy issue that currently prevents the use of DDPs for scientific research. By doing so, the huge amount of digital traces that are left behind by individuals in many aspects of their lives are finally becoming available for research purposes, while the participants are involved in the sharing process and can provide true informed consent regarding the information that they share.
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Affiliation(s)
- Laura Boeschoten
- Department of Methodology and Statistics, Utrecht University, Padualaan 14, 3584 CH Utrecht, the Netherlands.,Centraal Bureau voor de Statistiek, Henri Faasdreef 312, 2492 JP The Hague, the Netherlands
| | - Adriënne Mendrik
- Eyra Leap B.V., Saturnusstraat 14, 2516 AH The Hague, the Netherlands
| | | | - Jeroen Vloothuis
- Eyra Leap B.V., Saturnusstraat 14, 2516 AH The Hague, the Netherlands
| | - Haili Hu
- Research and Data Management Services, Utrecht University, Heidelberglaan 8, 3584 CS Utrecht, the Netherlands
| | - Roos Voorvaart
- Research and Data Management Services, Utrecht University, Heidelberglaan 8, 3584 CS Utrecht, the Netherlands
| | - Daniel L Oberski
- Department of Methodology and Statistics, Utrecht University, Padualaan 14, 3584 CH Utrecht, the Netherlands.,Julius Center, University Medical Center Utrecht, Universiteitsweg 100, 3584 CG Utrecht, the Netherlands
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Argüello J, Weber JL, Negrutiu I. Ecosystem natural capital accounting: The landscape approach at a territorial watershed scale. Quant Plant Biol 2022; 3:e24. [PMID: 37077965 PMCID: PMC10095874 DOI: 10.1017/qpb.2022.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Revised: 05/22/2022] [Accepted: 05/27/2022] [Indexed: 05/02/2023]
Abstract
Most approaches to estimate ecological value use monetary valuation. Here, we propose a different framework accounting ecological value in biophysical terms. More specifically, we are implementing the ecosystem natural capital accounting framework as an operational adaptation and extension of the UN System of Economic and Environmental Accounting/Ecosystem Accounting. The proof-of-concept study was carried out at the Rhône river watershed scale (France). Four core accounts evaluate land use, water and river condition, bio-carbon content of various stocks of biomass and its uses, and the state of ecosystem infrastructure. Integration of the various indicators allows measuring ecosystems overall capability and their degradation. The 12-year results are based on spatial-temporal geographic information and local statistics. Increasing levels of intensity of use are registered over time, that is, the extraction of resources surpasses renewal. We find that agriculture and land artificialisation are the main drivers of natural capital degradation.
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Affiliation(s)
- Jazmin Argüello
- Institut des Systèmes Complexes (IXXI) and Laboratoire de Reproduction et Développement des Plantes, Université de Lyon, UCB Lyon 1, École Normale Supérieure de Lyon, INRAE, CNRS, 46 Allée d’Italie, 69364 Lyon Cedex 07, France
- Author for correspondence: J. Argüello E-mail:
| | - Jean-Louis Weber
- Institut des Systèmes Complexes (IXXI) and Laboratoire de Reproduction et Développement des Plantes, Université de Lyon, UCB Lyon 1, École Normale Supérieure de Lyon, INRAE, CNRS, 46 Allée d’Italie, 69364 Lyon Cedex 07, France
- European Environment Agency, Scientific committee, Frankrigshusene 9, 1 tv, 2300Copenhagen S, Denmark
| | - Ioan Negrutiu
- Institut des Systèmes Complexes (IXXI) and Laboratoire de Reproduction et Développement des Plantes, Université de Lyon, UCB Lyon 1, École Normale Supérieure de Lyon, INRAE, CNRS, 46 Allée d’Italie, 69364 Lyon Cedex 07, France
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Lin CY, Wu RC, Huang CY, Lai CH, Chao AS, Li HP, Tsai CL, Kuek EJ, Hsu CL, Chao A. A Patient-Derived Xenograft Model of Dedifferentiated Endometrial Carcinoma: A Proof-of-Concept Study for the Identification of New Molecularly Informed Treatment Approaches. Cancers (Basel) 2021; 13:5962. [PMID: 34885073 DOI: 10.3390/cancers13235962] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 11/20/2021] [Accepted: 11/23/2021] [Indexed: 01/04/2023] Open
Abstract
Simple Summary Reliable animal models of human malignancies are paramount for preclinical studies of novel treatment approaches. Here, we successfully developed a patient-derived xenograft (PDX) model of dedifferentiated endometrial carcinoma (DEC)–an uncommon uterine malignancy that is generally unresponsive to standard chemo- and radiotherapy. The murine model–termed PDX-mLung–was established through the implantation of lung metastatic lesions obtained from a woman with DEC. Histologic and molecular findings revealed that PDX-mLung was highly similar to the parent human malignant lesions (both primary DEC and lung metastases). Importantly, molecular analyses revealed that PDX-mLung exhibited druggable alterations including a FGFR2 mutation and CCNE2 amplification. The former was targeted with the FGFR inhibitor lenvatinib while the latter with the cell cycle inhibitor palbociclib. The combination of the two drugs exhibited synergistic therapeutic effects against in vivo tumor growth. Collectively, these data illustrate the value of PDX models for preclinical testing of new molecularly informed therapies in difficult-to-treat gynecologic malignancies. Our results may also prompt further clinical research to examine whether the combination of lenvatinib and palbociclib has potential to improve clinical outcomes of women with DEC. Abstract Conventional treatment of dedifferentiated endometrial carcinoma (DEC)–an uncommon and highly aggressive uterine malignancy–is beset by high failure rates. A line of research that holds promise to overcome these limitations is tailored treatments targeted on specific molecular alterations. However, suitable preclinical platforms to allow a reliable implementation of this approach are still lacking. Here, we developed a patient-derived xenograft (PDX) model for preclinical testing of investigational drugs informed by molecular data. The model–termed PDX-mLung was established in mice implanted with lung metastatic lesions obtained from a patient with DEC. Histologic and whole-exome genetic analyses revealed a high degree of identity between PDX-mLung and the patient’s parental lesions (both primary DEC and lung metastases). Interestingly, molecular analyses revealed that PDX-mLung harbored druggable alterations including a FGFR2 mutation and CCNE2 amplification. Targeted combined treatment with the FGFR inhibitor lenvatinib and the cell cycle inhibitor palbociclib was found to exert synergistic therapeutic effects against in vivo tumor growth. Based on the results of RNA sequencing, lenvatinib and palbociclib were found to exert anti-tumor effects by interfering interferon signaling and activating hormonal pathways, respectively. Collectively, these data provide proof-of-concept evidence on the value of PDX models for preclinical testing of molecularly informed drug therapy in difficult-to-treat human malignancies. Further clinical research is needed to examine more rigorously the potential usefulness of the lenvatinib and palbociclib combination in patients with DEC.
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Shield CG, Swift BMC, McHugh TD, Dedrick RM, Hatfull GF, Satta G. Application of Bacteriophages for Mycobacterial Infections, from Diagnosis to Treatment. Microorganisms 2021; 9:2366. [PMID: 34835491 PMCID: PMC8617706 DOI: 10.3390/microorganisms9112366] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 11/05/2021] [Accepted: 11/09/2021] [Indexed: 01/09/2023] Open
Abstract
Mycobacterium tuberculosis and other non-tuberculous mycobacteria are responsible for a variety of different infections affecting millions of patients worldwide. Their diagnosis is often problematic and delayed until late in the course of disease, requiring a high index of suspicion and the combined efforts of clinical and laboratory colleagues. Molecular methods, such as PCR platforms, are available, but expensive, and with limited sensitivity in the case of paucibacillary disease. Treatment of mycobacterial infections is also challenging, typically requiring months of multiple and combined antibiotics, with associated side effects and toxicities. The presence of innate and acquired drug resistance further complicates the picture, with dramatic cases without effective treatment options. Bacteriophages (viruses that infect bacteria) have been used for decades in Eastern Europe for the treatment of common bacterial infections, but there is limited clinical experience of their use in mycobacterial infections. More recently, bacteriophages' clinical utility has been re-visited and their use has been successfully demonstrated both as diagnostic and treatment options. This review will focus specifically on how mycobacteriophages have been used recently in the diagnosis and treatment of different mycobacterial infections, as potential emerging technologies, and as an alternative treatment option.
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Affiliation(s)
- Christopher G. Shield
- Department of Pathobiology and Population Sciences, Royal Veterinary College, Hatfield AL9 7TA, UK;
| | - Benjamin M. C. Swift
- Department of Pathobiology and Population Sciences, Royal Veterinary College, Hatfield AL9 7TA, UK;
| | - Timothy D. McHugh
- Centre for Clinical Microbiology, University College London, London NW3 2PF, UK; (T.D.M.); (G.S.)
| | - Rebekah M. Dedrick
- Biological Sciences, University of Pittsburgh, Pittsburgh, PA 15260, USA; (R.M.D.); (G.F.H.)
| | - Graham F. Hatfull
- Biological Sciences, University of Pittsburgh, Pittsburgh, PA 15260, USA; (R.M.D.); (G.F.H.)
| | - Giovanni Satta
- Centre for Clinical Microbiology, University College London, London NW3 2PF, UK; (T.D.M.); (G.S.)
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Jaing TH, Chang TY, Chen SH, Lin CW, Wen YC, Chiu CC. Molecular genetics of β-thalassemia: A narrative review. Medicine (Baltimore) 2021; 100:e27522. [PMID: 34766559 PMCID: PMC8589257 DOI: 10.1097/md.0000000000027522] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 07/22/2021] [Accepted: 07/26/2021] [Indexed: 01/05/2023] Open
Abstract
ABSTRACT β-thalassemia is a hereditary hematological disease caused by over 350 mutations in the β-globin gene (HBB). Identifying the genetic variants affecting fetal hemoglobin (HbF) production combined with the α-globin genotype provides some prediction of disease severity for β-thalassemia. However, the generation of an additive composite genetic risk score predicts prognosis, and guide management requires a larger panel of genetic modifiers yet to be discovered.Presently, using data from prior clinical trials guides the design of further research and academic studies based on gene augmentation, while fundamental insights into globin switching and new technology developments have inspired the investigation of novel gene therapy approaches.Genetic studies have successfully characterized the causal variants and pathways involved in HbF regulation, providing novel therapeutic targets for HbF reactivation. In addition to these HBB mutation-independent strategies involving HbF synthesis de-repression, the expanding genome editing toolkit provides increased accuracy to HBB mutation-specific strategies encompassing adult hemoglobin restoration for personalized treatment of hemoglobinopathies. Allogeneic hematopoietic stem cell transplantation was, until very recently, the curative option available for patients with transfusion-dependent β-thalassemia. Gene therapy currently represents a novel therapeutic promise after many years of extensive preclinical research to optimize gene transfer protocols.We summarize the current state of developments in the molecular genetics of β-thalassemia over the last decade, including the mechanisms associated with ineffective erythropoiesis, which have also provided valid therapeutic targets, some of which have been shown as a proof-of-concept.
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Affiliation(s)
- Tang-Her Jaing
- Divisions of Hematology and Oncology, Department of Pediatrics, Chang Gung Children's Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Tsung-Yen Chang
- Divisions of Hematology and Oncology, Department of Pediatrics, Chang Gung Children's Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Shih-Hsiang Chen
- Divisions of Hematology and Oncology, Department of Pediatrics, Chang Gung Children's Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Chen-Wei Lin
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yu-Chuan Wen
- Department of Nursing, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chia-Chi Chiu
- Department of Nursing, Chang Gung Memorial Hospital, Taoyuan, Taiwan
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Ledri M, Sørensen AT, Kokaia M, Woldbye DPD, Gøtzsche CR. Editorial: Gene Therapy in the CNS - Progress and Prospects for Novel Therapies. Front Mol Neurosci 2021; 14:778134. [PMID: 34744628 PMCID: PMC8564008 DOI: 10.3389/fnmol.2021.778134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 09/21/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Marco Ledri
- Laboratory of Molecular Neurophysiology and Epilepsy, Department of Clinical Sciences, Epilepsy Center, Faculty of Medicine, Lund University, Lund, Sweden
| | - Andreas T Sørensen
- Department of Neuroscience, University of Copenhagen, Copenhagen, Denmark
| | - Merab Kokaia
- Experimental Epilepsy Group, Department of Clinical Sciences, Epilepsy Center, Faculty of Medicine, Lund University, Lund, Sweden
| | - David P D Woldbye
- Department of Neuroscience, University of Copenhagen, Copenhagen, Denmark
| | - Casper R Gøtzsche
- Department of Neuroscience, University of Copenhagen, Copenhagen, Denmark
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Ma S, McDermott MP. Adaptive dose-response studies to establish proof-of-concept in learning-phase clinical trials. Biom J 2021; 64:146-164. [PMID: 34605043 DOI: 10.1002/bimj.202100044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 07/29/2021] [Accepted: 08/31/2021] [Indexed: 11/07/2022]
Abstract
In learning-phase clinical trials in drug development, adaptive designs can be efficient and highly informative when used appropriately. In this article, we extend the multiple comparison procedures with modeling techniques (MCP-Mod) procedure with generalized multiple contrast tests (GMCTs) to two-stage adaptive designs for establishing proof-of-concept. The results of an interim analysis of first-stage data are used to adapt the candidate dose-response models and the dosages studied in the second stage. GMCTs are used in both stages to obtain stage-wise p -values, which are then combined to determine an overall p -value. An alternative approach is also considered that combines the t -statistics across stages, employing the conditional rejection probability principle to preserve the Type I error probability. Simulation studies demonstrate that the adaptive designs are advantageous compared to the corresponding tests in a nonadaptive design if the selection of the candidate set of dose-response models is not well informed by evidence from preclinical and early-phase studies.
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Affiliation(s)
- Shiyang Ma
- Department of Biostatistics, Columbia University, New York, NY, USA
| | - Michael P McDermott
- Department of Biostatistics and Computational Biology, University of Rochester, Rochester, NY, USA
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25
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Juarez M, Diaz N, Johnston GI, Nayar S, Payne A, Helmer E, Cain D, Williams P, Devauchelle-Pensec V, Fisher BA, Giacomelli R, Gottenberg JE, Guggino G, Kvarnström M, Mariette X, Ng WF, Rosas J, Sánchez Bursón J, Triolo G, Barone F, Bowman SJ. A phase 2 randomized, double-blind, placebo-controlled, proof-of-concept study of oral seletalisib in primary Sjögren's syndrome. Rheumatology (Oxford) 2021; 60:1364-1375. [PMID: 32949140 DOI: 10.1093/rheumatology/keaa410] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 05/08/2020] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES This phase 2 proof-of-concept study (NCT02610543) assessed efficacy, safety and effects on salivary gland inflammation of seletalisib, a potent and selective PI3Kδ inhibitor, in patients with moderate-to-severe primary Sjögren's syndrome (PSS). METHODS Adults with PSS were randomized 1:1 to seletalisib 45 mg/day or placebo, in addition to current PSS therapy. Primary end points were safety and tolerability and change from baseline in EULAR Sjögren's Syndrome Disease Activity Index (ESSDAI) score at week 12. Secondary end points included change from baseline at week 12 in EULAR Sjögren's Syndrome Patient Reported Index (ESSPRI) score and histological features in salivary gland biopsies. RESULTS Twenty-seven patients were randomized (seletalisib n = 13, placebo n = 14); 20 completed the study. Enrolment challenges led to early study termination with loss of statistical power (36% vs 80% planned). Nonetheless, a trend for improvement in ESSDAI and ESSPRI [difference vs placebo: -2.59 (95% CI: -7.30, 2.11; P=0.266) and -1.55 (95% CI: -3.39, 0.28), respectively] was observed at week 12. No significant changes were seen in saliva and tear flow. Serious adverse events (AEs) were reported in 3/13 of patients receiving seletalisib vs 1/14 for placebo and 5/13 vs 1/14 discontinued due to AEs, respectively. Serum IgM and IgG concentrations decreased in the seletalisib group vs placebo. Seletalisib demonstrated efficacy in reducing size and organisation of salivary gland inflammatory foci and in target engagement, thus reducing PI3K-mTOR signalling compared with placebo. CONCLUSION Despite enrolment challenges, seletalisib demonstrated a trend towards clinical improvement in patients with PSS. Histological analyses demonstrated encouraging effects of seletalisib on salivary gland inflammation and organisation. TRIAL REGISTRATION https://clinicaltrials.gov, NCT02610543.
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Affiliation(s)
| | - Nieves Diaz
- Translational Medicine, UCB Pharma, Slough, UK
| | | | - Saba Nayar
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | | | - Eric Helmer
- Quantitative Clinical Pharmacology, Slough, UK
| | - Dionne Cain
- Global Clinical Sciences and Operations, UCB Pharma, Slough, UK
| | | | | | - Benjamin A Fisher
- National Institute for Health Research (NIHR) Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.,Rheumatology Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - Roberto Giacomelli
- Rheumatology Unit, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Jacques-Eric Gottenberg
- Department of Rheumatology, National Reference Centre For Rare Systemic Auto-Immune Diseases, Strasbourg University Hospital, University of Strasbourg, IBMC, CNRS UPR 3572, Strasbourg, France
| | - Giuliana Guggino
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, Rheumatology Section, University of Palermo, Palermo, Italy
| | - Marika Kvarnström
- Department of Medicine, Rheumatology Unit, Karolinska Institutet, Stockholm, Sweden
| | - Xavier Mariette
- Université Paris-Saclay, INSERM, CEA, Centre de recherche en Immunologie des Infections Virales et des Maladies auto-Immunes, AP-HP.Université Paris-Saclay, Hôpital Bicêtre, Rheumatology Department, Le Kremlin Bicêtre, France
| | - Wan Fai Ng
- Translational and Clinical Research Institute, Newcastle University & NIHR Newcastle Biomedical Research Centre, Newcastle upon Tyne, UK
| | - José Rosas
- Department of Rheumatology, Hospital Marina Baixa, Villajoyosa, Spain
| | | | - Giovanni Triolo
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, Rheumatology Section, University of Palermo, Palermo, Italy
| | - Francesca Barone
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - Simon J Bowman
- National Institute for Health Research (NIHR) Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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26
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Rosenkranz GK. Replicability of studies following a dual-criterion design. Stat Med 2021; 40:4068-4076. [PMID: 33928668 DOI: 10.1002/sim.9014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 03/20/2021] [Accepted: 04/13/2021] [Indexed: 11/11/2022]
Abstract
Replicability of results is regarded as the corner stone of science. Recent research seems to raise doubts about whether this requirement is generally fulfilled. Often, replicability of results is defined as repeating a statistically significant result. However, since significance may not imply scientific relevance, dual-criterion study designs that take both aspects into account have been proposed and investigated during the last decade. Originally developed for proof-of-concept trials, the design could be appropriate for phase III trials as well. In fact, a dual-criterion design has been requested for COVID-19 vaccine applications by major health authorities. In this article, replicability of dual-criterion designs is investigated. It turns out that the probability to replicate a significant and relevant result can become as low as 0.5. The replication probability increases if the effect estimator exceeds the minimum relevant effect in the original study by an extra amount.
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Ng QX, Yeung WLK, Tay JAM, Arulanandam S. Use of Technology to Aid Clinical Audit in an Asian Emergency Medical Services Department. Healthcare (Basel) 2021; 9:healthcare9050491. [PMID: 33921997 PMCID: PMC8143507 DOI: 10.3390/healthcare9050491] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 03/25/2021] [Accepted: 04/19/2021] [Indexed: 12/14/2022] Open
Abstract
Although clinical audit is generally accepted to be an essential part of quality review and continuous quality improvement, there are limited reports on and several barriers to the implementation of effective clinical audit in an emergency medicine services (EMS) organization. The barriers include the significant amount of time, resources, and effort often required to conduct the audit. In this paper, we present a technology-enabled clinical audit tool, termed Medical Service Transformation and Innovation Compass (MYSTIC), which has transformed the way the clinical audit is performed in our EMS department. MYSTIC is a Python program we developed in-house, that extracts data from data fields found in routine ambulance case records maintained by our paramedics, and automatically assigns "pass" or "fail" flags based on pre-defined audit criteria. Compared to previous manual auditing, implementation of the MYSTIC computerized audit system increased the coverage of cases undergoing audit from 10% to 100% of all EMS-attended cases, and we were able to promptly identify and address some deficits in training and knowledge amongst our paramedics.
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Affiliation(s)
- Qin Xiang Ng
- Emergency Medical Services Department, Singapore Civil Defence Force, 91 Ubi Ave 4, Singapore 408827, Singapore; (J.A.M.T.); (S.A.)
- Correspondence: ; Tel.: +65-(67)-945502
| | - Wesley Lok Kin Yeung
- Department of Medicine, National University Hospital, 5 Lower Kent Ridge Rd, Singapore 119074, Singapore;
| | - Joey Ai Meng Tay
- Emergency Medical Services Department, Singapore Civil Defence Force, 91 Ubi Ave 4, Singapore 408827, Singapore; (J.A.M.T.); (S.A.)
| | - Shalini Arulanandam
- Emergency Medical Services Department, Singapore Civil Defence Force, 91 Ubi Ave 4, Singapore 408827, Singapore; (J.A.M.T.); (S.A.)
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Vissers MFJM, Heuberger JAAC, Groeneveld GJ. Targeting for Success: Demonstrating Proof-of-Concept with Mechanistic Early Phase Clinical Pharmacology Studies for Disease-Modification in Neurodegenerative Disorders. Int J Mol Sci 2021; 22:1615. [PMID: 33562713 PMCID: PMC7915613 DOI: 10.3390/ijms22041615] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 02/02/2021] [Accepted: 02/03/2021] [Indexed: 12/23/2022] Open
Abstract
The clinical failure rate for disease-modifying treatments (DMTs) that slow or stop disease progression has been nearly 100% for the major neurodegenerative disorders (NDDs), with many compounds failing in expensive and time-consuming phase 2 and 3 trials for lack of efficacy. Here, we critically review the use of pharmacological and mechanistic biomarkers in early phase clinical trials of DMTs in NDDs, and propose a roadmap for providing early proof-of-concept to increase R&D productivity in this field of high unmet medical need. A literature search was performed on published early phase clinical trials aimed at the evaluation of NDD DMT compounds using MESH terms in PubMed. Publications were selected that reported an early phase clinical trial with NDD DMT compounds between 2010 and November 2020. Attention was given to the reported use of pharmacodynamic (mechanistic and physiological response) biomarkers. A total of 121 early phase clinical trials were identified, of which 89 trials (74%) incorporated one or multiple pharmacodynamic biomarkers. However, only 65 trials (54%) used mechanistic (target occupancy or activation) biomarkers to demonstrate target engagement in humans. The most important categories of early phase mechanistic and response biomarkers are discussed and a roadmap for incorporation of a robust biomarker strategy for early phase NDD DMT clinical trials is proposed. As our understanding of NDDs is improving, there is a rise in potentially disease-modifying treatments being brought to the clinic. Further increasing the rational use of mechanistic biomarkers in early phase trials for these (targeted) therapies can increase R&D productivity with a quick win/fast fail approach in an area that has seen a nearly 100% failure rate to date.
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Affiliation(s)
- Maurits F. J. M. Vissers
- Centre for Human Drug Research, Zernikedreef 8, 2333 CL Leiden, The Netherlands; (J.A.A.C.H.); (G.J.G.)
- Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Jules A. A. C. Heuberger
- Centre for Human Drug Research, Zernikedreef 8, 2333 CL Leiden, The Netherlands; (J.A.A.C.H.); (G.J.G.)
| | - Geert Jan Groeneveld
- Centre for Human Drug Research, Zernikedreef 8, 2333 CL Leiden, The Netherlands; (J.A.A.C.H.); (G.J.G.)
- Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
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Kimura T. [Non-coding Natural Antisense RNA: Mechanisms of Action in the Regulation of Target Gene Expression and Its Clinical Implications]. YAKUGAKU ZASSHI 2020; 140:687-700. [PMID: 32378673 DOI: 10.1248/yakushi.20-00002] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Recent advances in high-throughput technologies have revealed that 75% of the human genome is transcribed to RNA, whereas only 3% of transcripts are translated into proteins. Consequently, many long non-coding RNAs (lncRNAs) have been identified, which has improved our understanding of the complexity of biological processes. LncRNAs comprise multiple classes of RNA transcripts that regulate the transcription, stability and translation of protein-coding genes in a genome. Natural antisense transcripts (NATs) form one such class, and the GENCODE v30 catalog contains 16193 lncRNA loci, of which 5611 are antisense loci. This review outlines our emerging understanding of lncRNAs, with a particular focus on how lncRNAs regulate gene expression using interferon-α1 (IFN-α1) mRNA and its antisense partner IFN-α1 antisense (as)RNA as an example. We have identified and characterized the asRNA that determines post-transcriptional IFN-α1 mRNA levels. IFN-α1 asRNA stabilizes IFN-α1 mRNA by cytoplasmic sense-antisense duplex formation, which may enhance the accessibility of an RNA stabilizer protein or decrease the affinity of an RNA decay factor for the RNA. IFN-α1 asRNA can also act as competing molecules in the competing endogenous (ce)RNA network with other members of the IFNA multigene family mRNAs/asRNAs, and other cellular mRNA transcripts. Furthermore, antisense oligoribonucleotides representing functional domains of IFN-α1 asRNA inhibit influenza virus proliferation in the respiratory tract of virus-infected animals. Thus, these findings support, at least in part, the rationale that dissecting the activity of NAT on gene expression regulation promises to reveal previously unanticipated biology, with potential to provide new therapeutic approaches to diseases.
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Affiliation(s)
- Tominori Kimura
- Laboratory of Microbiology and Cell Biology, Department of Pharmacy, College of Pharmaceutical Sciences, Ritsumeikan University
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30
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Lang MJ, Dort JC, Stephen J, Lamont L, Giese-Davis J. Narrative-Informed, Emotion-Focused Psychotherapy in Synchronous, Online Chat Groups for Adolescents and Young Adults with Cancer: A Proof-of-Concept Study. J Adolesc Young Adult Oncol 2020; 9:676-682. [PMID: 32614264 PMCID: PMC7757545 DOI: 10.1089/jayao.2020.0030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Few, scalable, evidence-based psychosocial interventions exist for adolescent and young adult cancer survivors (AYAs, 18–39 years old). Using an existing, facilitated, online synchronous chat group-plus-education model (OSG+E), we replaced their educational workbook with an AYA-created film to stimulate an age-specific, emotion-focused group discussion (OSG+V). This randomized proof-of-concept trial compared the two models' content suitability, group processes, and feasibility over 9 months in 34 male and female AYAs with a range of cancers. AYAs rated the OSG + V model more suitable, cohesive, and as having higher levels of important group processes than the OSG+E. A larger randomized trial is feasible for this AYA-appropriate, emotion-focused OSG + V model.
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Affiliation(s)
- Michael J Lang
- Faculty of Nursing and Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Joseph C Dort
- Departments of Surgery, Oncology, and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Joanne Stephen
- Department of Psychosocial Oncology, Tom Baker Cancer Centre, Alberta Health Services, Calgary, Alberta, Canada
| | - Lisa Lamont
- Department of Psychosocial Oncology, Tom Baker Cancer Centre, Alberta Health Services, Calgary, Alberta, Canada
| | - Janine Giese-Davis
- Division of Psychosocial Oncology, Department of Oncology, Cumming School of Medicine, and Department of Psychology, University of Calgary, Calgary, Alberta, Canada
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Cummings J, Ritter A, Zhong K. Clinical Trials for Disease-Modifying Therapies in Alzheimer's Disease: A Primer, Lessons Learned, and a Blueprint for the Future. J Alzheimers Dis 2019; 64:S3-S22. [PMID: 29562511 PMCID: PMC6004914 DOI: 10.3233/jad-179901] [Citation(s) in RCA: 85] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Alzheimer’s disease (AD) has no currently approved disease-modifying therapies (DMTs), and treatments to prevent, delay the onset, or slow the progression are urgently needed. A delay of 5 years if available by 2025 would decrease the total number of patients with AD by 50% in 2050. To meet the definition of DMT, an agent must produce an enduring change in the course of AD; clinical trials of DMTs have the goal of demonstrating this effect. AD drug discovery entails target identification followed by high throughput screening and lead optimization of drug-like compounds. Once an optimized agent is available and has been assessed for efficacy and toxicity in animals, it progresses through Phase I testing with healthy volunteers, Phase II learning trials to establish proof-of-mechanism and dose, and Phase III confirmatory trials to demonstrate efficacy and safety in larger populations. Phase III is followed by Food and Drug Administration review and, if appropriate, market access. Trial populations include cognitively normal at-risk participants in prevention trials, mildly impaired participants with biomarker evidence of AD in prodromal AD trials, and subjects with cognitive and functional impairment in AD dementia trials. Biomarkers are critical in trials of DMTs, assisting in participant characterization and diagnosis, target engagement and proof-of-pharmacology, demonstration of disease-modification, and monitoring side effects. Clinical trial designs include randomized, parallel group; delayed start; staggered withdrawal; and adaptive. Lessons learned from completed trials inform future trials and increase the likelihood of success.
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Affiliation(s)
- Jeffrey Cummings
- Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV, USA
| | - Aaron Ritter
- Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV, USA
| | - Kate Zhong
- Global Alzheimer Platform, Washington, DC, USA
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Gamez J, Salvadó M, Reig N, Suñé P, Casasnovas C, Rojas-Garcia R, Insa R. Transthyretin stabilization activity of the catechol- O-methyltransferase inhibitor tolcapone (SOM0226) in hereditary ATTR amyloidosis patients and asymptomatic carriers: proof-of-concept study . Amyloid 2019; 26:74-84. [PMID: 31119947 DOI: 10.1080/13506129.2019.1597702] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objective: To assess the transthyretin (TTR) stabilization activity of tolcapone (SOM0226) in patients with hereditary ATTR amyloidosis, asymptomatic carriers and healthy volunteers. Methods: A phase IIa proof-of-concept trial included two phases separated by a 6-week washout period. Phase A: single 200 mg dose of tolcapone; phase B: three 100 mg doses taken at 4 h intervals. The primary efficacy variable was TTR stabilization. Results: Seventeen subjects were included (wild type, n = 6; mutation TTR Val30Met, n = 11). TTR stabilization was observed in all participants. Two hours after dosing, 82% of participants in phase A and 93% of those in phase B reached a TTR stabilization value of at least 20%. In phase A, there was an increase of 52% in TTR stabilization vs baseline values 2 h after dosing, which decreased to 22.9% at 8 h. In phase B, there was a significant increase of 38.8% in TTR stabilization 2 h after the first 100 mg dose. This difference was maintained after 10 h and decreased after 24 h. No serious adverse events were observed. Conclusions: The ability of tolcapone for stabilizing TTR supports further development and repositioning of the drug for the treatment of ATTR amyloidosis. EudraCT trial number: 2014-001586-27 ClinicalTrials.gov Identifier: NCT02191826.
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Affiliation(s)
- Josep Gamez
- a Neuromuscular Disorders Clinic, Department of Neurology , Vall d'Hebron University Hospital, VHIR, European Reference Network on Rare, Neuromuscular Disorders (ERN EURO-NMD), UAB , Barcelona , Spain
| | - María Salvadó
- a Neuromuscular Disorders Clinic, Department of Neurology , Vall d'Hebron University Hospital, VHIR, European Reference Network on Rare, Neuromuscular Disorders (ERN EURO-NMD), UAB , Barcelona , Spain
| | - Núria Reig
- b Research and Development Department , SOM Biotech, S.L , Barcelona , Spain
| | - Pilar Suñé
- c Pharmacy Department, Vall d'Hebron Research Institute (VHIR) , Hospital Universitari Vall d'Hebron , Barcelona , Spain
| | - Carles Casasnovas
- d Neuromuscular Disorders Unit, Neurology Department , Bellvitge University Hospital - IDIBELL , Barcelona , Spain
| | - Ricard Rojas-Garcia
- e Department of Neurology, Neuromuscular Diseases Unit Hospital de la Santa Creu i Sant Pau , Center for Networked Biomedical Research into Rare Diseases (CIBERER), UAB , Barcelona , Spain
| | - Raúl Insa
- b Research and Development Department , SOM Biotech, S.L , Barcelona , Spain
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Pellegrini F, Copetti M, Bovis F, Cheng D, Hyde R, de Moor C, Kieseier BC, Sormani MP. A proof-of-concept application of a novel scoring approach for personalized medicine in multiple sclerosis. Mult Scler 2019; 26:1064-1073. [PMID: 31144577 DOI: 10.1177/1352458519849513] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Stratified medicine methodologies based on subgroup analyses are often insufficiently powered. More powerful personalized medicine approaches are based on continuous scores. OBJECTIVE We deployed a patient-specific continuous score predicting treatment response in patients with relapsing-remitting multiple sclerosis (RRMS). METHODS Data from two independent randomized controlled trials (RCTs) were used to build and validate an individual treatment response (ITR) score, regressing annualized relapse rates (ARRs) on a set of baseline predictors. RESULTS The ITR score for the combined treatment groups versus placebo detected differential clinical response in both RCTs. High responders in one RCT had a cross-validated ARR ratio of 0.29 (95% confidence interval (CI) = 0.13-0.55) versus 0.62 (95% CI = 0.47-0.83) for all other responders (heterogeneity p = 0.038) and were validated in the other RCT, with the corresponding ARR ratios of 0.31 (95% CI = 0.18-0.56) and 0.61 (95% CI = 0.47-0.79; heterogeneity p = 0.036). The strongest treatment effect modifiers were the Short Form-36 Physical Component Summary, age, Visual Function Test 2.5%, prior MS treatment and Expanded Disability Status Scale. CONCLUSION Our modelling strategy detects and validates an ITR score and opens up avenues for building treatment response calculators that are also applicable in routine clinical practice.
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Affiliation(s)
| | - Massimiliano Copetti
- Unit of Biostatistics, Fondazione IRCCS Casa Sollievo della Sofferenza Hospital, San Giovanni Rotondo, Italy
| | - Francesca Bovis
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - David Cheng
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Robert Hyde
- Biogen International GmbH, Baar, Switzerland
| | | | - Bernd C Kieseier
- Biogen Inc., Cambridge, MA, USA; Department of Neurology, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - Maria Pia Sormani
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy
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Powell LH, Appelhans BM, Ventrelle J, Karavolos K, March ML, Ong JC, Fitzpatrick SL, Normand P, Dawar R, Kazlauskaite R. Development of a lifestyle intervention for the metabolic syndrome: Discovery through proof-of-concept. Health Psychol 2018; 37:929-939. [PMID: 30234352 PMCID: PMC6589338 DOI: 10.1037/hea0000665] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVE The aim was to describe the early phases of the progressive development of a lifestyle treatment for sustained remission of the metabolic syndrome (MetS) using the Obesity-Related Behavioral Intervention Trials (ORBIT) model for behavioral treatment development as a guide. METHODS Early discovery and design phases produced a 3-component (diet, physical activity, stress), group-based lifestyle treatment with an intensive 6-month phase followed by monthly, participant-led maintenance meetings. In the proof-of-concept phase, 26 participants with the MetS (age 53 ± 7 years, 77% female, and 65% ethnic minority) were recruited in a quasi-experimental design to determine if treatment could achieve the prespecified benchmark of MetS remission in ≥50% at 2.5 years. Exploratory outcomes focused on MetS components, weight, and patient-centered benefits on energy/vitality and psychosocial status. RESULTS MetS remission was achieved in 53.8% after a median of 2.5 years. At 2.5 years, an increase of +15.4% reported eating ≥3 servings of vegetables/day, +7.7% engaged in ≥150 minutes of moderate-to-vigorous physical activity/week; and +11.5% reported experiencing no depression in the past 2 weeks. Weight loss ≥5% was achieved by 38.5%, and energy/vitality, negative affect, and social support improved. Median group attendance over 2.5 years was 73.8%. CONCLUSIONS It is plausible that this lifestyle program can produce a remission in the MetS, sustained through 2.5 years. After refinements to enhance precision and strength, progression to feasibility pilot testing and a randomized clinical trial will determine its efficacy as a cost-effective lifestyle option for managing the MetS in the current health care system. (PsycINFO Database Record
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Affiliation(s)
- Lynda H. Powell
- Department of Preventive Medicine, Rush University Medical Center, Chicago, IL
- Department of Behavioral Sciences, Rush University Medical Center, Chicago, IL
| | - Bradley M. Appelhans
- Department of Preventive Medicine, Rush University Medical Center, Chicago, IL
- Department of Behavioral Sciences, Rush University Medical Center, Chicago, IL
| | - Jennifer Ventrelle
- Department of Preventive Medicine, Rush University Medical Center, Chicago, IL
| | - Kelly Karavolos
- Department of Preventive Medicine, Rush University Medical Center, Chicago, IL
| | - Michelle L. March
- Department of Preventive Medicine, Rush University Medical Center, Chicago, IL
| | - Jason C. Ong
- Department of Neurology, Center for Circadian and Sleep Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | | | - Patricia Normand
- Department of Preventive Medicine, Rush University Medical Center, Chicago, IL
- Department of Behavioral Sciences, Rush University Medical Center, Chicago, IL
- Department of Psychiatry, Rush University Medical Center, Chicago, IL
| | - Rebecca Dawar
- Department of Preventive Medicine, Rush University Medical Center, Chicago, IL
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Abstract
One of the most critical decision points in clinical development is Go/No-Go decision-making after a proof-of-concept study. Traditional decision-making relies on a formal hypothesis testing with control of type I and type II error rates, which is limited by assessing the strength of efficacy evidence in a small isolated trial. In this article, we propose a quantitative Bayesian/frequentist decision framework for Go/No-Go criteria and sample size evaluation in Phase II randomized studies with a time-to-event endpoint. By taking the uncertainty of treatment effect into consideration, we propose an integrated quantitative approach for a program when both the Phase II and Phase III trials share a common endpoint while allowing a discount of the observed Phase II data. Our results confirm the argument that an increase in the sample size of a Phase II trial will result in greater increase in the probability of success of a Phase III trial than increasing the Phase III trial sample size by equal amount. We illustrate the steps in quantitative decision-making with a real example of a randomized Phase II study in metastatic pancreatic cancer.
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Affiliation(s)
- Bo Huang
- a Pfizer Inc ., Groton , CT , USA
| | | | - Lixin Han
- b Sarepta Therapeutics , Cambridge , MA , USA
| | - Pei-Fen Kuan
- c Department of Applied Math and Statistics , Stony Brook University , Stony Brook , NY , USA
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Muri HI, Hjelme DR. LSPR Coupling and Distribution of Interparticle Distances between Nanoparticles in Hydrogel on Optical Fiber End Face. Sensors (Basel) 2017; 17:s17122723. [PMID: 29186839 PMCID: PMC5751684 DOI: 10.3390/s17122723] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Revised: 11/16/2017] [Accepted: 11/20/2017] [Indexed: 02/05/2023]
Abstract
We report on a new localized surface plasmon resonance (LSPR)-based optical fiber (OF) architecture with a potential in sensor applications. The LSPR-OF system is fabricated by immobilizing gold nanoparticles (GNPs) in a hydrogel droplet polymerized on the fiber end face. This design has several advantages over earlier designs. It dramatically increase the number nanoparticles (NP) available for sensing, it offers precise control over the NP density, and the NPs are positioned in a true 3D aqueous environment. The OF-hydrogel design is also compatible with low-cost manufacturing. The LSPR-OF platform can measure volumetric changes in a stimuli-responsive hydrogel or measure binding to receptors on the NP surface. It can also be used as a two-parameter sensor by utilizing both effects. We present results from proof-of-concept experiments exploring the properties of LSPR and interparticle distances of the GNP-hydrogel OF design by characterizing the distribution of distances between NPs in the hydrogel, the refractive index of the hydrogel and the LSPR attributes of peak position, amplitude and linewidth for hydrogel deswelling controlled with pH solutions.
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Affiliation(s)
- Harald Ian Muri
- Department of Electronic Systems, Norwegian University of Science and Technology, Gunnerus gate 1, 7012 Trondheim, Norway.
| | - Dag Roar Hjelme
- Department of Electronic Systems, Norwegian University of Science and Technology, Gunnerus gate 1, 7012 Trondheim, Norway.
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Leite J, Morales-Quezada L, Carvalho S, Thibaut A, Doruk D, Chen CF, Schachter SC, Rotenberg A, Fregni F. Surface EEG-Transcranial Direct Current Stimulation (tDCS) Closed-Loop System. Int J Neural Syst 2017; 27:1750026. [PMID: 28587498 DOI: 10.1142/s0129065717500265] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Conventional transcranial direct current stimulation (tDCS) protocols rely on applying electrical current at a fixed intensity and duration without using surrogate markers to direct the interventions. This has led to some mixed results; especially because tDCS induced effects may vary depending on the ongoing level of brain activity. Therefore, the objective of this preliminary study was to assess the feasibility of an EEG-triggered tDCS system based on EEG online analysis of its frequency bands. Six healthy volunteers were randomized to participate in a double-blind sham-controlled crossover design to receive a single session of 10[Formula: see text]min 2[Formula: see text]mA cathodal and sham tDCS. tDCS trigger controller was based upon an algorithm designed to detect an increase in the relative beta power of more than 200%, accompanied by a decrease of 50% or more in the relative alpha power, based on baseline EEG recordings. EEG-tDCS closed-loop-system was able to detect the predefined EEG magnitude deviation and successfully triggered the stimulation in all participants. This preliminary study represents a proof-of-concept for the development of an EEG-tDCS closed-loop system in humans. We discuss and review here different methods of closed loop system that can be considered and potential clinical applications of such system.
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Affiliation(s)
- Jorge Leite
- 1 Spaulding Neuromodulation Center, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA.,2 Neuropsychophysiology Laboratory, CIPsi, School of Psychology, University of Minho, Campus de Gualtar, Braga, 4710-057, Portugal
| | - Leon Morales-Quezada
- 1 Spaulding Neuromodulation Center, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA
| | - Sandra Carvalho
- 1 Spaulding Neuromodulation Center, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA.,2 Neuropsychophysiology Laboratory, CIPsi, School of Psychology, University of Minho, Campus de Gualtar, Braga, 4710-057, Portugal
| | - Aurore Thibaut
- 1 Spaulding Neuromodulation Center, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA
| | - Deniz Doruk
- 1 Spaulding Neuromodulation Center, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA
| | - Chiun-Fan Chen
- 1 Spaulding Neuromodulation Center, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA.,3 Engineering Science, Loyola University Chicago, Chicago, IL, USA
| | - Steven C Schachter
- 4 Center for Integration of Medicine and Innovative Technology, Harvard Medical School, Boston, MA, USA
| | - Alexander Rotenberg
- 5 Neuromodulation Program, Division of Epilepsy and Clinical Neurophysiology and the F.M. Kirby Neurobiology Center, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Felipe Fregni
- 1 Spaulding Neuromodulation Center, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA
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Nandal S, Burt T. Integrating Pharmacoproteomics into Early-Phase Clinical Development: State-of-the-Art, Challenges, and Recommendations. Int J Mol Sci 2017; 18:E448. [PMID: 28218733 DOI: 10.3390/ijms18020448] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 01/17/2017] [Accepted: 01/18/2017] [Indexed: 12/13/2022] Open
Abstract
Pharmacoproteomics is the study of disease-modifying and toxicity parameters associated with therapeutic drug administration, using analysis of quantitative and temporal changes to specific, predetermined, and select proteins, or to the proteome as a whole. Pharmacoproteomics is a rapidly evolving field, with progress in analytic technologies enabling processing of complex interactions of large number of unique proteins and effective use in clinical trials. Nevertheless, our analysis of clinicaltrials.gov and PubMed shows that the application of proteomics in early-phase clinical development is minimal and limited to few therapeutic areas, with oncology predominating. We review the history, technologies, current usage, challenges, and potential for future use, and conclude with recommendations for integration of pharmacoproteomic in early-phase drug development.
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Bethoux F, Fatemi A, Fowler E, Marciniak C, Mayadev A, Waksman J, Zackowski K, Suarez G, Blight AR, Rabinowicz AL, Carrazana E. Safety, Tolerability, and Sensorimotor Effects of Extended-release Dalfampridine in Adults With Cerebral Palsy: A Pilot Study. Clin Ther 2017; 39:337-346. [PMID: 28131322 DOI: 10.1016/j.clinthera.2016.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 12/21/2016] [Accepted: 12/29/2016] [Indexed: 11/19/2022]
Abstract
PURPOSE The goal of this study was to evaluate the safety and tolerability of dalfampridine extended release (D-ER) in a pilot study of adults with cerebral palsy (CP) and limited ambulatory ability, and to explore drug effects on sensorimotor function. METHODS An initial double-blind, single-dose crossover study was performed in 11 individuals randomized 1:1 to receive D-ER (10 mg) or placebo, followed by a 2-day washout period and the opposite treatment, with evaluation for safety and tolerability. A twice daily dosing, double-blind, placebo-controlled, crossover study was then performed. Participants were randomized in a 1:1 ratio to 1 of 2 sequences: 1 week of D-ER (10 mg BID) or placebo, followed by a 1-week washout and 1 week of the opposite treatment. Key inclusion criteria were age 18 to 70 years, body mass index 18.0 to 30.0 kg/m2, diagnosis of CP, and ability to perform all study procedures. Key exclusion criteria were severe CP, moderate or severe renal impairment, history of nonfebrile seizures, and prior dalfampridine use. Primary outcomes were safety profile and tolerability. Exploratory functional outcomes comprised changes in upper and lower extremity sensorimotor function (grip and pinch strength tests), manual dexterity (Box and Block Tests), and walking speed (Timed 25-Foot Walk). The most pronounced measured functional deficit in each individual was defined as the exploratory primary functional end point. Full crossover data were analyzed by using a mixed effects model. FINDINGS Among the 24 total participants who were randomized to treatment and completed the twice daily dosing phase study, their mean age was 38.6 years (range, 20-62 years), 54% were women, and 83% had spastic CP. Adverse events were consistent with previous D-ER trials, most commonly headache (13% D-ER, 4% placebo), fatigue (13% D-ER, 0% placebo), insomnia (8% D-ER, 4% placebo), diarrhea (4% D-ER, 4% placebo), and nausea (4% D-ER, 4% placebo). The mixed model analysis of full crossover data identified no significant difference between D-ER and placebo in the primary functional analysis (the most pronounced deficit; P = 0.70) or in the secondary analyses (hand strength [P = 0.48], manual dexterity [P = 0.13], or walking speed [P = 0.42]). IMPLICATIONS In this preliminary study of adults with CP, a BID dose of 10-mg D-ER was generally safe and well tolerated. The exploratory functional assessments for upper and lower sensorimotor deficits did not establish that the study population was markedly responsive to D-ER relative to placebo. These findings do not provide the proof-of-concept that would support further evaluation of D-ER as a potential intervention to improve function in adults with CP. ClinicalTrials.gov identifier: NCT01468350.
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Affiliation(s)
- Francois Bethoux
- Mellen Center for MS Treatment and Research, Cleveland Clinic Foundation, Cleveland, Ohio.
| | - Ali Fatemi
- The Kennedy Krieger Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Eileen Fowler
- Center for Cerebral Palsy, Department of Orthopaedic Surgery, University of California, Los Angeles, California
| | - Christina Marciniak
- Rehabilitation Institute of Chicago, Department of Physical Medicine and Rehabilitation, Department of Neurology, Northwestern University, Chicago, Illinois
| | | | - Joel Waksman
- Brightech International, LLC, Somerset, New Jersey
| | - Kathleen Zackowski
- The Kennedy Krieger Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland
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Ruvio G, Cuccaro A, Solimene R, Brancaccio A, Basile B, Ammann MJ. Microwave bone imaging: a preliminary scanning system for proof-of-concept. Healthc Technol Lett 2016; 3:218-221. [PMID: 27733930 PMCID: PMC5047277 DOI: 10.1049/htl.2016.0003] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Revised: 05/21/2016] [Accepted: 05/31/2016] [Indexed: 11/20/2022] Open
Abstract
This Letter introduces a feasibility study of a scanning system for applications in biomedical bone imaging operating in the microwave range 0.5–4 GHz. Mechanical uncertainties and data acquisition time are minimised by using a fully automated scanner that controls two antipodal Vivaldi antennas. Accurate antenna positioning and synchronisation with data acquisition enables a rigorous proof-of-concept for the microwave imaging procedure of a multi-layer phantom including skin, fat, muscle and bone tissues. The presence of a suitable coupling medium enables antenna miniaturisation and mitigates the impedance mismatch between antennas and phantom. The three-dimensional image of tibia and fibula is successfully reconstructed by scanning the multi-layer phantom due to the distinctive dielectric contrast between target and surrounding tissues. These results show the viability of a microwave bone imaging technology which is low cost, portable, non-ionising, and does not require specially trained personnel. In fact, as no a-priori characterisation of the antenna is required, the image formation procedure is very conveniently simplified.
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Affiliation(s)
- Giuseppe Ruvio
- Antenna and High Frequency Research Centre , Dublin Institute of Technology , Kevin Street , Dublin 8 , Ireland
| | - Antonio Cuccaro
- Dipartimento di Ingegneria Industriale e dell'Informazione , Seconda Università di Napoli , Via Roma 29 , 81031 Aversa (CE) , Italy
| | - Raffaele Solimene
- Dipartimento di Ingegneria Industriale e dell'Informazione , Seconda Università di Napoli , Via Roma 29 , 81031 Aversa (CE) , Italy
| | - Adriana Brancaccio
- Dipartimento di Ingegneria Industriale e dell'Informazione , Seconda Università di Napoli , Via Roma 29 , 81031 Aversa (CE) , Italy
| | - Bruno Basile
- B&B Sas , Strada Fienile 1, Napoli 80013, Casalnuovo di Napoli (NA) , Italy
| | - Max J Ammann
- Antenna and High Frequency Research Centre , Dublin Institute of Technology , Kevin Street , Dublin 8 , Ireland
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Lanza J, Sanchez L, Gomez D, Elsaleh T, Steinke R, Cirillo F. A Proof-of-Concept for Semantically Interoperable Federation of IoT Experimentation Facilities. Sensors (Basel) 2016; 16:s16071006. [PMID: 27367695 PMCID: PMC4970056 DOI: 10.3390/s16071006] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 06/10/2016] [Accepted: 06/23/2016] [Indexed: 11/16/2022]
Abstract
The Internet-of-Things (IoT) is unanimously identified as one of the main pillars of future smart scenarios. The potential of IoT technologies and deployments has been already demonstrated in a number of different application areas, including transport, energy, safety and healthcare. However, despite the growing number of IoT deployments, the majority of IoT applications tend to be self-contained, thereby forming application silos. A lightweight data centric integration and combination of these silos presents several challenges that still need to be addressed. Indeed, the ability to combine and synthesize data streams and services from diverse IoT platforms and testbeds, holds the promise to increase the potentiality of smart applications in terms of size, scope and targeted business context. In this article, a proof-of-concept implementation that federates two different IoT experimentation facilities by means of semantic-based technologies will be described. The specification and design of the implemented system and information models will be described together with the practical details of the developments carried out and its integration with the existing IoT platforms supporting the aforementioned testbeds. Overall, the system described in this paper demonstrates that it is possible to open new horizons in the development of IoT applications and experiments at a global scale, that transcend the (silo) boundaries of individual deployments, based on the semantic interconnection and interoperability of diverse IoT platforms and testbeds.
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Affiliation(s)
- Jorge Lanza
- Network Planning and Mobile Communications Lab. Universidad de Cantabria, Edificio Ingeniería de Telecomunicación, Plaza de la Ciencia, Santander, 39005 Cantabria, Spain.
| | - Luis Sanchez
- Network Planning and Mobile Communications Lab. Universidad de Cantabria, Edificio Ingeniería de Telecomunicación, Plaza de la Ciencia, Santander, 39005 Cantabria, Spain.
| | - David Gomez
- Network Planning and Mobile Communications Lab. Universidad de Cantabria, Edificio Ingeniería de Telecomunicación, Plaza de la Ciencia, Santander, 39005 Cantabria, Spain.
| | - Tarek Elsaleh
- Institute for Communication Systems (ICS), University of Surrey, James Clerk Maxwell Building, Guildford, Surrey, GU2 7XH Guildford, UK.
| | - Ronald Steinke
- Fraunhofer FOKUS, Kaiserin-Augusta-Allee 31, 10589 Berlin, Germany.
| | - Flavio Cirillo
- NEC Europe Ltd., Kurfürsten-Anlage 36, 69115 Heidelberg, Germany.
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Mutsvari T, Tytgat D, Walley R. Addressing potential prior-data conflict when using informative priors in proof-of-concept studies. Pharm Stat 2015; 15:28-36. [PMID: 26762570 DOI: 10.1002/pst.1722] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Revised: 10/05/2015] [Accepted: 10/05/2015] [Indexed: 11/06/2022]
Abstract
Bayesian methods are increasingly used in proof-of-concept studies. An important benefit of these methods is the potential to use informative priors, thereby reducing sample size. This is particularly relevant for treatment arms where there is a substantial amount of historical information such as placebo and active comparators. One issue with using an informative prior is the possibility of a mismatch between the informative prior and the observed data, referred to as prior-data conflict. We focus on two methods for dealing with this: a testing approach and a mixture prior approach. The testing approach assesses prior-data conflict by comparing the observed data to the prior predictive distribution and resorting to a non-informative prior if prior-data conflict is declared. The mixture prior approach uses a prior with a precise and diffuse component. We assess these approaches for the normal case via simulation and show they have some attractive features as compared with the standard one-component informative prior. For example, when the discrepancy between the prior and the data is sufficiently marked, and intuitively, one feels less certain about the results, both the testing and mixture approaches typically yield wider posterior-credible intervals than when there is no discrepancy. In contrast, when there is no discrepancy, the results of these approaches are typically similar to the standard approach. Whilst for any specific study, the operating characteristics of any selected approach should be assessed and agreed at the design stage; we believe these two approaches are each worthy of consideration.
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Affiliation(s)
- Timothy Mutsvari
- UCB BioPharma SPRL, Global Exploratory Development, Chemin du Foriest, Belgium, B-1420 Braine-l'Alleud, (currently at Arlenda S.A., 93 Chaussée Verte, 4470 Saint-Georges sur Meuse, Belgium)
| | - Dominique Tytgat
- UCB BioPharma SPRL, Global Exploratory Development, Chemin du Foriest, B-1420 Braine-l'Alleud, Belgium, (currently at Clinical Pharmacokinetics/Pharmacometrics, Sanofi-Aventis Deutschland GmbH, Frankfurt am Main, Germany)
| | - Rosalind Walley
- UCB Pharma, Global Exploratory Development, 208 Bath Road, Slough, Berkshire SL1 3WE, UK
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Abstract
Small molecule drug discovery commonly ventures into previously unknown and unexplored target space. For such programs, an important role of medicinal chemistry is to generate molecules that enable the most reliable conclusions from a preclinical target validation/invalidation study. Multiple facets of chemistry that provide the most rigorous results for such an experiment are highlighted.
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Affiliation(s)
- Ramzi F. Sweis
- AbbVie, Inc., 1 North
Waukegan Road, North Chicago, Illinois 60064, United States
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Szabo ST, Kinon BJ, Brannan SK, Krystal AK, van Gerven JMA, Mahableshwarkar A, Sachs GS. Lessons Learned and Potentials for Improvement in CNS Drug Development: ISCTM Section on Designing the Right Series of Experiments. Innov Clin Neurosci 2015; 12:11S-25S. [PMID: 25977837 PMCID: PMC4571294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Once a molecule has been characterized as engaging an identified target at the appropriate location (affinity and potency), the next step involves designing experiments that will determine its pharmacodynamic activities both for efficacy (on target) and safety-tolerability (on/off target). Two expert presentations focused on looking back at completed programs and two concentrated on looking forward at ongoing programs. Specific discussions pertain to assessment of pharmacologic agonists (mGluR2/3, k-opiate, peroxisome proliferator-activated receptor gamma) and antagonists (orexin and cannabinoid) in disorders of cognition, mood, and anxiety. Advanced experimental study designs using genetics to guide a treatment trial in Alzheimer's disease and neural target-based approaches as the primary outcome measure in the National Institute of Mental Health-sponsored Fast-Fail Trials (FAST)-Mood and Anxiety Spectrum Disorders (MAS) initiative for depression showcases novel methodological approaches. Of interest, some of these initiatives were successful, while others were not, and two are currently ongoing. In conclusion, methodologies that were utilized and are currently employed to reach a successful clinical drug trial outcome are appreciated, and in case of failure, approaches to reviewing programs to enable learning that would be helpful to future programs are brought forth. This article is based on proceedings from the "Designing the Right Series of Experiments" session, which was held during the International Society for Clinical Trials Meeting (ISCTM) in Philadelphia, Pennsylvania, September 30 to October 2, 2013.
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Affiliation(s)
- Steven T Szabo
- Dr. Szabo is with Duke University Medical Center, Durham, North Carolina, and Veterans Administration Medical Center, Durham, North Carolina; Dr. Kinon is with Lundbeck LLC, Deerfield, Illinois (Dr. Kinon was with Eli Lilly and Company, Indianapolis, Indiana, when this material was presented); Dr. Brannan is with Takeda Global Research & Development Center, Inc., Deerfield, Illinois; Dr. Krystal is with Duke University Medical Center, Durham, North Carolina; Dr. van Gerven is with Centre for Human Drug Research, Leiden, The Netherlands; Dr. Mahableshwarkar is with Takeda Global Research & Development Center, Inc., Deerfield, Illinois; Dr. Sachs is with Massachusetts General Hospital, Boston, Massachusetts
| | - Bruce J Kinon
- Dr. Szabo is with Duke University Medical Center, Durham, North Carolina, and Veterans Administration Medical Center, Durham, North Carolina; Dr. Kinon is with Lundbeck LLC, Deerfield, Illinois (Dr. Kinon was with Eli Lilly and Company, Indianapolis, Indiana, when this material was presented); Dr. Brannan is with Takeda Global Research & Development Center, Inc., Deerfield, Illinois; Dr. Krystal is with Duke University Medical Center, Durham, North Carolina; Dr. van Gerven is with Centre for Human Drug Research, Leiden, The Netherlands; Dr. Mahableshwarkar is with Takeda Global Research & Development Center, Inc., Deerfield, Illinois; Dr. Sachs is with Massachusetts General Hospital, Boston, Massachusetts
| | - Stephen K Brannan
- Dr. Szabo is with Duke University Medical Center, Durham, North Carolina, and Veterans Administration Medical Center, Durham, North Carolina; Dr. Kinon is with Lundbeck LLC, Deerfield, Illinois (Dr. Kinon was with Eli Lilly and Company, Indianapolis, Indiana, when this material was presented); Dr. Brannan is with Takeda Global Research & Development Center, Inc., Deerfield, Illinois; Dr. Krystal is with Duke University Medical Center, Durham, North Carolina; Dr. van Gerven is with Centre for Human Drug Research, Leiden, The Netherlands; Dr. Mahableshwarkar is with Takeda Global Research & Development Center, Inc., Deerfield, Illinois; Dr. Sachs is with Massachusetts General Hospital, Boston, Massachusetts
| | - Andrew K Krystal
- Dr. Szabo is with Duke University Medical Center, Durham, North Carolina, and Veterans Administration Medical Center, Durham, North Carolina; Dr. Kinon is with Lundbeck LLC, Deerfield, Illinois (Dr. Kinon was with Eli Lilly and Company, Indianapolis, Indiana, when this material was presented); Dr. Brannan is with Takeda Global Research & Development Center, Inc., Deerfield, Illinois; Dr. Krystal is with Duke University Medical Center, Durham, North Carolina; Dr. van Gerven is with Centre for Human Drug Research, Leiden, The Netherlands; Dr. Mahableshwarkar is with Takeda Global Research & Development Center, Inc., Deerfield, Illinois; Dr. Sachs is with Massachusetts General Hospital, Boston, Massachusetts
| | - Joop M A van Gerven
- Dr. Szabo is with Duke University Medical Center, Durham, North Carolina, and Veterans Administration Medical Center, Durham, North Carolina; Dr. Kinon is with Lundbeck LLC, Deerfield, Illinois (Dr. Kinon was with Eli Lilly and Company, Indianapolis, Indiana, when this material was presented); Dr. Brannan is with Takeda Global Research & Development Center, Inc., Deerfield, Illinois; Dr. Krystal is with Duke University Medical Center, Durham, North Carolina; Dr. van Gerven is with Centre for Human Drug Research, Leiden, The Netherlands; Dr. Mahableshwarkar is with Takeda Global Research & Development Center, Inc., Deerfield, Illinois; Dr. Sachs is with Massachusetts General Hospital, Boston, Massachusetts
| | - Atul Mahableshwarkar
- Dr. Szabo is with Duke University Medical Center, Durham, North Carolina, and Veterans Administration Medical Center, Durham, North Carolina; Dr. Kinon is with Lundbeck LLC, Deerfield, Illinois (Dr. Kinon was with Eli Lilly and Company, Indianapolis, Indiana, when this material was presented); Dr. Brannan is with Takeda Global Research & Development Center, Inc., Deerfield, Illinois; Dr. Krystal is with Duke University Medical Center, Durham, North Carolina; Dr. van Gerven is with Centre for Human Drug Research, Leiden, The Netherlands; Dr. Mahableshwarkar is with Takeda Global Research & Development Center, Inc., Deerfield, Illinois; Dr. Sachs is with Massachusetts General Hospital, Boston, Massachusetts
| | - Gary S Sachs
- Dr. Szabo is with Duke University Medical Center, Durham, North Carolina, and Veterans Administration Medical Center, Durham, North Carolina; Dr. Kinon is with Lundbeck LLC, Deerfield, Illinois (Dr. Kinon was with Eli Lilly and Company, Indianapolis, Indiana, when this material was presented); Dr. Brannan is with Takeda Global Research & Development Center, Inc., Deerfield, Illinois; Dr. Krystal is with Duke University Medical Center, Durham, North Carolina; Dr. van Gerven is with Centre for Human Drug Research, Leiden, The Netherlands; Dr. Mahableshwarkar is with Takeda Global Research & Development Center, Inc., Deerfield, Illinois; Dr. Sachs is with Massachusetts General Hospital, Boston, Massachusetts
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Boland BS, Boyle DL, Sandborn WJ, Firestein GS, Levesque BG, Hillman J, Zhang B, Proudfoot J, Eckmann L, Ernst PB, Rivera-Nieves J, Pola S, Copur-Dahi N, Zou G, Chang JT. Validation of gene expression biomarker analysis for biopsy-based clinical trials in Crohn's disease. Inflamm Bowel Dis 2015; 21:323-30. [PMID: 25545378 DOI: 10.1097/MIB.0000000000000264] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The ability to measure the expression of proinflammatory cytokines from intestinal biopsies in patients with Crohn's disease in an accurate and reproducible way is critical for proof-of-concept and mechanism-of-action trials; however, the number of biopsies from a segment of the ileum or colon required to yield reproducible results has not been rigorously evaluated. We examined intestinal biopsies from patients with Crohn's disease to validate methods for detecting changes in inflammatory gene expression. METHODS To evaluate the reproducibility of gene expression measurements, intestinal biopsies were obtained from designated segments from 6 healthy controls, 6 patients with active Crohn's disease, and 6 patients with inactive Crohn's disease. Disease activity was based on the simple endoscopic score for Crohn's disease. Expression of 7 proinflammatory genes was measured from each biopsy using quantitative polymerase chain reaction. Using a linear mixed effects model, the power to detect transcriptional changes corresponding to active and inactive Crohn's disease was calculated. RESULTS Total simple endoscopic score for Crohn's disease score corresponds with expression of most inflammatory biomarkers. For most genes, 2 to 5 biopsies are needed to reduce sampling error to <25% for most genes. To measure changes in mRNA expression corresponding to active versus inactive Crohn's disease, 1 to 2 intestinal biopsies from 3 patients before and after treatment are needed to yield power of at least 80%. CONCLUSIONS Measuring proinflammatory gene expression from mucosal biopsies from patients with Crohn's disease is practicable and provides objective biomarkers that can be used in proof-of-concept and mechanism-of-action trials to assess response to therapy.
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Ostacher MJ, Iosifescu DV, Hay A, Blumenthal SR, Sklar P, Perlis RH. Pilot investigation of isradipine in the treatment of bipolar depression motivated by genome-wide association. Bipolar Disord 2014; 16:199-203. [PMID: 24372835 DOI: 10.1111/bdi.12143] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2012] [Accepted: 06/19/2013] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Motivated by genetic association data implicating L-type calcium channels in bipolar disorder liability, we sought to estimate the tolerability, safety, and efficacy of isradipine in the adjunctive treatment of bipolar depression. METHODS A total of 12 patients with bipolar I or II depression entered this pilot, proof-of-concept eight-week investigation and 10 returned for at least one post-baseline visit. They were initiated on isradipine at 2.5 mg and titrated up to 10 mg daily, with blinded assessments of depression using the Montgomery-Åsberg Depression Rating Scale (MADRS) as well as adverse effects. RESULTS Among the 10 patients, three had bipolar II disorder; all but two reported current episode duration longer than six months. In all, four of 10 completed the study; no significant adverse events were observed, although one subject discontinued treatment per protocol because of possible hypomanic symptoms which had resolved prior to study visit. In a mixed-effects model, mean improvement in depression severity, assessed by MADRS, was 2.1 (standard error = 0.36) points/week (p < 0.001). Two of the 10 subjects remitted and four of the 10 subjects experienced 50% or greater symptomatic improvement with treatment. CONCLUSIONS Isradipine merits further investigation for the treatment of bipolar depression. This preliminary trial illustrates the potential utility of genetic investigation in identifying psychiatric treatment targets.
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Affiliation(s)
- Michael J Ostacher
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA, USA
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Lim SP, Wang QY, Noble CG, Chen YL, Dong H, Zou B, Yokokawa F, Nilar S, Smith P, Beer D, Lescar J, Shi PY. Ten years of dengue drug discovery: progress and prospects. Antiviral Res 2013; 100:500-19. [PMID: 24076358 DOI: 10.1016/j.antiviral.2013.09.013] [Citation(s) in RCA: 261] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Revised: 09/07/2013] [Accepted: 09/15/2013] [Indexed: 01/26/2023]
Abstract
To combat neglected diseases, the Novartis Institute of Tropical Diseases (NITD) was founded in 2002 through private-public funding from Novartis and the Singapore Economic Development Board. One of NITD's missions is to develop antivirals for dengue virus (DENV), the most prevalent mosquito-borne viral pathogen. Neither vaccine nor antiviral is currently available for DENV. Here we review the progress in dengue drug discovery made at NITD as well as the major discoveries made by academia and other companies. Four strategies have been pursued to identify inhibitors of DENV through targeting both viral and host proteins: (i) HTS (high-throughput screening) using virus replication assays; (ii) HTS using viral enzyme assays; (iii) structure-based in silico docking and rational design; (iv) repurposing hepatitis C virus inhibitors for DENV. Along the developmental process from hit finding to clinical candidate, many inhibitors did not advance beyond the stage of hit-to-lead optimization, due to their poor selectivity, physiochemical or pharmacokinetic properties. Only a few compounds showed efficacy in the AG129 DENV mouse model. Two nucleoside analogs, NITD-008 and Balapiravir, entered preclinical animal safety study and clinic trial, but both were terminated due to toxicity and lack of potency, respectively. Celgosivir, a host alpha-glucosidase inhibitor, is currently under clinical trial; its clinical efficacy remains to be determined. The knowledge accumulated during the past decade has provided a better rationale for ongoing dengue drug discovery. Though challenging, we are optimistic that this continuous, concerted effort will lead to an effective dengue therapy.
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Affiliation(s)
- Siew Pheng Lim
- Novartis Institute for Tropical Diseases, 10 Biopolis Road, 05-01 Chromos, Singapore 138670, Singapore
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Reddy KSK, Naidu MUR, Rani PU, Rao TRK. Human experimental pain models: A review of standardized methods in drug development. J Res Med Sci 2012; 17:587-95. [PMID: 23626642 PMCID: PMC3634303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2011] [Revised: 11/27/2011] [Accepted: 05/03/2012] [Indexed: 11/16/2022]
Abstract
Human experimental pain models are essential in understanding the pain mechanisms and appear to be ideally suited to test analgesic compounds. The challenge that confronts both the clinician and the scientist is to match specific treatments to different pain-generating mechanisms and hence reach a pain treatment tailored to each individual patient. Experimental pain models offer the possibility to explore the pain system under controlled settings. Standardized stimuli of different modalities (i.e., mechanical, thermal, electrical, or chemical) can be applied to the skin, muscles, and viscera for a differentiated and comprehensive assessment of various pain pathways and mechanisms. Using a multimodel-multistructure testing, the nociception arising from different body structures can be explored and modulation of specific biomarkers by new and existing analgesic drugs can be profiled. The value of human experimental pain models is to link animal and clinical pain studies, providing new possibilities for designing successful clinical trials. Spontaneous pain, the main compliant of the neuropathic patients, but currently there is no human model available that would mimic chronic pain. Therefore, current human pain models cannot replace patient studies for studying efficacy of analgesic compounds, although being helpful for proof-of-concept studies and dose finding.
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Affiliation(s)
- K. Sunil kumar Reddy
- Department of Clinical Pharmacology and Therapeutics, ICMR Advance Centre for Clinical Pharmacodynamic, Nizam's Institute of Medical Sciences, Hyderabad, India,Address for correspondence: Mr. K. Sunil Kumar Reddy, Department of Clinical Pharmacology and Therapeutics, ICMR Advance Centre for Clinical Pharmacodynamic, Nizam's Institute of Medical Sciences, Panjagutta, Hyderabad - 500 082, Andhra Pradesh, India. E-mail:
| | - M. U. R. Naidu
- Department of Clinical Pharmacology and Therapeutics, ICMR Advance Centre for Clinical Pharmacodynamic, Nizam's Institute of Medical Sciences, Hyderabad, India
| | - P. Usha Rani
- Department of Clinical Pharmacology and Therapeutics, ICMR Advance Centre for Clinical Pharmacodynamic, Nizam's Institute of Medical Sciences, Hyderabad, India
| | - T. Ramesh Kumar Rao
- Department of Clinical Pharmacology and Therapeutics, ICMR Advance Centre for Clinical Pharmacodynamic, Nizam's Institute of Medical Sciences, Hyderabad, India
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Abstract
There is a need for safe medications that can effectively support recovery by treating symptoms of protracted abstinence that may precipitate relapse in alcoholics, e.g. craving and disturbances in sleep and mood. This proof-of-concept study reports on the effectiveness of gabapentin 1200 mg for attenuating these symptoms in a non-treatment-seeking sample of cue-reactive, alcohol-dependent individuals. Subjects were 33 paid volunteers with current Diagnostic and Statistical Manual of Mental Disorders-IV alcohol dependence and a strength of craving rating 1 SD or greater for alcohol than water cues. Subjects were randomly assigned to gabapentin or placebo for 1 week and then participated in a within-subjects trial where each was exposed to standardized sets of pleasant, neutral and unpleasant visual stimuli followed by alcohol or water cues. Gabapentin was associated with significantly greater reductions than placebo on several measures of subjective craving for alcohol as well as for affectively evoked craving. Gabapentin was also associated with significant improvement on several measures of sleep quality. Side effects were minimal, and gabapentin effects were not found to resemble any major classes of abused drugs. Results suggest that gabapentin may be effective for treating the protracted abstinence phase in alcohol dependence and that a randomized clinical trial would be an appropriate next step. The study also suggests the value of cue-reactivity studies as proof-of-concept screens for potential antirelapse drugs.
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Affiliation(s)
- Barbara J Mason
- The Pearson Center for Alcoholism and Addiction Research and Laboratory of Clinical Psychopharmacology, The Scripps Research Institute, USA.
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