A Bayesian adaptive dose-finding algorithm for balancing individual- and population-level ethics in Phase I clinical trials

Multiple Bayesian adaptive designs have been proposed for Phase I clinical trials since the continual reassessment method (CRM) was proposed by O’Quigley et al. (1990). Focused on dose-finding in cancer studies, the CRM seeks to allocate new patients to an estimated maximum tolerable dose (MTD). Later, Whitehead and Brunier (1995 Whitehead, J. and Brunier, H. (1995). Continual Reassessment Method: Bayesian Decision Procedures for Dose Determining Experiments, Statistics in Medicine 14: 885–893.[Crossref], [PubMed], [Web of Science ®] , [Google Scholar]) applied Bayesian decision theory to maximize statistical information for the MTD when allocating new patients. The two allocation rules reflect conflicting perspectives. The CRM emphasizes individual-level ethics, whereas the method of Whitehead and Brunier (1995 Whitehead, J. and Brunier, H. (1995). Continual Reassessment Method: Bayesian Decision Procedures for Dose Determining Experiments, Statistics in Medicine 14: 885–893.[Crossref], [PubMed], [Web of Science ®] , [Google Scholar]) emphasizes population-level ethics. In the design of a Phase I clinical trial to investigate hyperthermic intraperitoneal chemotherapy (HIPEC) we sought to compromise the two perspectives. To this end, we propose a novel dose allocation design referred to as the balanced information gain method. We first decompose the loss function used by Whitehead and Brunier and then modify it with a tuning parameter that allows a trialist to differentially weigh individual- and population-level ethics based on their particular clinical setting. Simulation studies show that the proposed design provides a reasonable compromise between the distribution of the estimated MTD and the distribution of the number of observed adverse events per trial when compared to the two existing methods.     

Colloidal Processing of Zirconium Diboride Ultra‐High Temperature Ceramics

Colloidal processing of the Ultra‐High Temperature Ceramic (UHTC) zirconium diboride (ZrB₂) to develop near?net‐shaping techniques has been investigated. The use of the colloidal processing technique produces higher particle packing that ultimately enables achieving greater densification at lower temperatures and pressures, even pressureless sintering. ZrB₂ suspension formulations have been optimized in terms of rheological behavior. Suspensions were shaped into green bodies (63% relative density) using slip casting. The densification was carried out at 1900°C, 2000°C, and 2100°C, using both hot pressing at 40 MPa and pressureless sintering. The colloidally processed materials were compared with materials prepared by a conventional dry processing route (cold pressed at 50 MPa) and subjected to the same densification procedures. Sintered densities for samples produced by the colloidal route are higher than produced by the dry route (up to 99.5% relative density by hot pressing), even when pressureless sintering is performed (more than 90% relative density). The promising results are considered as a starting point for the fabrication of complex‐shaped components that can be densified at lower sintering temperatures without pressure.     

HIPed Tailored Hollandite Waste Forms for the Immobilization of Radioactive Cs and Sr

Hot isostatically pressed tailored hollandite waste forms were used to demonstrate the immobilization of Cs and Sr are separable from spent nuclear fuel, as well as Ba and Rb. Four hollandite formulations were investigated, two samples with ∼12 wt% waste loading (on an oxide basis) and two with ∼18 wt% waste loading. Two of the samples were Al-substituted and the other two contained Mg. The hollandite in the Al-substituted samples contained all the waste cations, as designed, but this was not the case in the Mg-substituted samples. The hollandite in the Mg-substituted samples did not contain all the waste cations, with ∼50% of the Sr forming SrTiO₃ as a secondary phase. This resulted in waste forms that were not as durable, with respect to Cs, as their Al counterparts. The formation of SrTiO₃ had little effect on the Sr release rates and was not detrimental to the Mg-substituted hollandite waste form. For the Al-substituted samples, the MCC-1 normalized release rates were <0.06 g·(m²·day)⁻¹ at 0–28 days for all elements, while the Cs release rates remained at 2.0 g·(m²·day)⁻¹ at 0–28 days for the Mg-substituted samples.     

Videoendoscopic diagnosis of esophageal motility disorders

PURPOSE: Looking for a valid, reliable, and feasible method to collect data on the performances of practicing family physicians, the authors compare the measurement characteristics of a multiple-station examination (MSE) using standardized patients with those of a video assessment of regular consultations in daily practice (practice video assessment, PVA). METHOD: In a cross-sectional study, consultations of 90 family physicians were videotaped both in an MSE and in their daily practices. Peer-observers used a validated instrument (MAAS-Global) to assess the physicians' communication with patients and their medical performances. The physicians were randomly divided into two groups, comparable for demographic characteristics, and half underwent the assessments in reverse order to test for time-order effects. Content validity, criterion validity, reliability, and feasibility of the two methods were compared. RESULTS: Content validity of the PVA was superior to that of the MSE, since the domain of general family practice care was better covered. Observed participants judged the videotaped practice consultations to be "natural," whereas hardly any family physician, after reviewing the videotaped consultations of the MSE, recognized his or her usual working style. Specific criteria made it possible to standardize real practice. Concerning criterion validity, only the medical-performance components of the two methods correlated. No correlation was found for the communication components. Real-practice performance proved to be less influenced by observation than was performance during the MSE. The reliabilities of the two methods, expected to be better in the controlled MSE, were comparable. The administration of the PVA was more flexible, less costly, and better accepted by the family physicians than was that of the MSE. CONCLUSION: Assessment for quality improvement of family physicians' practices by video observation in daily practice is superior to video assessment in a simulated setting using standardized patients.     

The alpha attenuation test: assessing excessive daytime sleepiness in narcolepsy-cataplexy

Daytime sleep tendency was assessed in 10 drug-free patients with narcolepsy-cataplexy and 10 normals matched for age and gender. Following nocturnal polysomnography, the alpha attenuation test (AAT) and the multiple sleep latency test (MSLT) were administered during five sessions occurring at 2-hour intervals beginning at 0900 and 1000 hours, respectively. For the AAT, participants were polysomnographically recorded for 8 minutes while seated in an illuminated room with their eyes alternately opened and closed. Power spectral analyses of electroencephalograph (EEG) activity at 02-A1 (10 second epochs) were calculated using fast Fourier transformations (FFT) within the alpha frequency range (8-12 Hz) to obtain ratios of mean eyes-closed to mean eyes-open alpha power (i.e. the alpha attenuation coefficient, AAC). The narcoleptics were sleepier than the normals as indicated by a significantly smaller mean AAC and a significantly shorter mean latency to stage 1 on the MSLT. These findings suggest that the AAT may provide a quick and practical objective assessment of the excessive daytime sleepiness (EDS) associated with narcolepsy.     

Desipramine restricts estral cycle oscillations in swimming

1. Desipramine (DMI) is a tricyclic antidepressant which reduces the immobility in rats forced to swim; however, it is unknown whether estral cycle phases impinge on DMI actions on immobility in daily swimming tests during several weeks. 2. In female wistar rats, vaginal smears taken before testing defined four estral phases. Afterwards, the authors assessed the latency for the first period of immobility in five-min forced swim tests practiced on 21-day DMI (DMI group), 21-day washout saline given after a 21-day DMI treatment (washout-saline group), or non-treated rats (control group). 3. We observed a longer latency for the first period of immobility in proestrus-estrus from the control and washout-saline groups. The 21-day treatment with DMI (2.1 mg/kg i.p., once a day) significantly (p < 0.001) increased the latency by about 160% from control regardless of the estral cycle phase. 4. It is concluded that proestrus-estrus relates to increased struggling behavior. DMI enhances struggling behavior independently of hormonal state.     

Cytotoxicity of curcuminoids and some novel compounds from Curcuma zedoaria

Bioassay-directed fractionation of an EtOH extract of Curcuma zedoaria led to isolation of an active curcuminoid, which was identified as demethoxycurcumin (2) by comparison of its 1H and 13C NMR spectra with literature data and by direct comparison with synthetic material. Curcumin (1) and bisdemethoxycurcumin (3) were also obtained. Curcuminoids (1-3) were synthesized and demonstrated to be cytotoxic against human ovarian cancer OVCAR-3 cells. The observed CD50 values of 1, 2, and 3 were 4.4, 3.8, and 3.1 microg/mL, respectively. Three additional novel compounds, 3, 7-dimethylindan-5-carboxylic acid (4), curcolonol (5), and guaidiol (6), were also isolated from the EtOH extract. The structures and relative stereochemistry of 4-6 were determined by spectroscopic methods and X-ray crystallographic analysis.     

The contribution of noncatalytic phosphate-binding subsites to the mechanism of bovine pancreatic ribonuclease A

The enzymatic catalysis of polymeric substrates such as proteins, polysaccharides or nucleic acids requires precise alignment between the enzyme and the substrate regions flanking the region occupying the active site. In the case of ribonucleases, enzyme-substrate binding may be directed by electrostatic interactions between the phosphate groups of the RNA molecule and basic amino acid residues on the enzyme. Specific interactions between the nitrogenated bases and particular amino acids in the active site or adjacent positions may also take place. The substrate-binding subsites of ribonuclease A have been characterized by structural and kinetic studies. In addition to the active site (p1), the role of other noncatalytic phosphate-binding subsites in the correct alignment of the polymeric substrate has been proposed. p2 and p0 have been described as phosphate-binding subsites that bind the phosphate group adjacent to the 3' side and 5' side, respectively, of the phosphate in the active site. In both cases, basic amino acids (Lys-7 and Arg-10 in p2, and Lys-66 in p0) are involved in binding. However, these binding sites play different roles in the catalytic process of ribonuclease A. The electrostatic interactions in p2 are important both in catalysis and in the endonuclease activity of the enzyme, whilst the p0 electrostatic interaction contributes only to binding of the RNA.     

Activation of T lymphocytes by syngeneic murine intestinal smooth muscle cells

BACKGROUND & AIMS: Intestinal smooth muscle cells (ISMCs) express major histocompatibility complex II (MCH II) and intercellular adhesion molecule 1 (ICAM-1) after exposure to interferon gamma (IFN-gamma). T lymphocytes invade the intestinal musculature during Crohn's disease or pseudoobstruction. The aim of this study was to determine whether ISMCs activate syngeneic T cells via MHC II and ICAM-1. METHODS: Cultured murine ISMCs were exposed to IFN-gamma for 72 hours and analyzed for Mac-1 (CD11B CD18) antigen, MHC II, and ICAM-1 expression using enzyme-linked immunosorbent assay and fluorescence-activated cell sorter scan. T lymphocytes from mesenteric lymph nodes of ovalbumin-sensitized mice were examined for their ability to proliferate after coculture with IFN-gamma-pretreated and ovalbumin-pretreated ISMCs using [3H]thymidine incorporation. RESULTS: ISMCs expressed smooth muscle alpha-actin before and after IFN-gamma exposure. No macrophages were identified in these cultures. Exposure to IFN-gamma and ovalbumin for 72 hours induced MHC II and ICAM-1 expression; these treated ISMCs induced T-cell proliferation, whereas untreated ISMCs did not. T-cell proliferation was markedly enhanced by adding interleukin 2 and was blocked by antibodies against MHC II and ICAM-1. CONCLUSIONS: ISMCs activate T lymphocytes in an MHC II-linked manner and thus possess the ability to modulate immune function in the gut.