Assessing toxicities in a clinical trial: Bayesian inference for ordinal data nested within categories

This article addresses modeling and inference for ordinal outcomes nested within categorical responses. We propose a mixture of normal distributions for latent variables associated with the ordinal data. This mixture model allows us to fix without loss of generality the cutpoint parameters that link the latent variable with the observed ordinal outcome. Moreover, the mixture model is shown to be more flexible in estimating cell probabilities when compared to the traditional Bayesian ordinal probit regression model with random cutpoint parameters. We extend our model to take into account possible dependence among the outcomes in different categories. We apply the model to a randomized phase III study to compare treatments on the basis of toxicities recorded by type of toxicity and grade within type. The data include the different (categorical) toxicity types exhibited in each patient. Each type of toxicity has an (ordinal) grade associated to it. The dependence among the different types of toxicity exhibited by the same patient is modeled by introducing patient-specific random effects.

[Hsp90--a target for anticancer therapy]

Molecular chaperones help other proteins to achieve and maintain their proper conformation. Chaperones bind to newly synthesized or unfolded polypeptide chains, actively modify their conformation and participate on their transport or degradation. Chaperones play an important role in cancer cell, where their increased activity enables stabilization of many mutant proteins and overcoming the stress generated by genetic instability. Hsp90 represents a key chaperone in cancer cells. Growth factor receptors, steroid hormone receptors and signal proctor teins are among its substrates, so-called client proteins; many of them being targets for anti-cancer therapy. Adverse conditions of the tumor microenvironment, such as hypoxia and nutrient deficiency, contribute to destabilization of proteins and further escalate dependence on chaperones. This is why molecular chaperones, in particular Hsp90, may represent a promising target for anticancer therapy. Importantly also, tumour-based Hsp90 has a significantly higher sensitivity to inhibitors than that in normal cells, and Hsp90 activity inhibition in tumours leads to a suppression of cellular signaling in many different oncogenic pathways. Several inhibitors of Hsp90 are currently undergoing clinical evaluation and new agents with different mechanisms of action are continually being identified.

Synthesis of diamidopyrrolyl molybdenum complexes relevant to reduction of dinitrogen to ammonia

A potentially useful trianionic ligand for the reduction of dinitrogen catalytically by molybdenum complexes is one in which one of the arms in a [(RNCH(2)CH(2))(3)N](3-) ligand is replaced by a 2-mesitylpyrrolyl-alpha-methyl arm, that is, [(RNCH(2)CH(2))(2)NCH(2)(2-MesitylPyrrolyl)](3-) (R = C(6)F(5), 3,5-Me(2)C(6)H(3), or 3,5-t-Bu(2)C(6)H(3)). Compounds have been prepared that contain the ligand in which R = C(6)F(5) ([C(6)F(5)N)(2)Pyr](3-)); they include [(C(6)F(5)N)(2)Pyr]Mo(NMe(2)), [(C(6)F(5)N)(2)Pyr]MoCl, [(C(6)F(5)N)(2)Pyr]MoOTf, and [(C(6)F(5)N)(2)Pyr]MoN. Compounds that contain the ligand in which R = 3,5-t-Bu(2)C(6)H(3) ([Ar(t-Bu)N)(2)Pyr](3-)) include {[(Ar(t-Bu)N)(2)Pyr]Mo(N(2))}Na(15-crown-5), {[(Ar(t-Bu)N)(2)Pyr]Mo(N(2))}[NBu(4)], [(Ar(t-Bu)N)(2)Pyr]Mo(N(2)) (nu(NN) = 2012 cm(-1) in C(6)D(6)), {[(Ar(t-Bu)N)(2)Pyr]Mo(NH(3))}BPh(4), and [(Ar(t-Bu)N)(2)Pyr]Mo(CO). X-ray studies are reported for [(C(6)F(5)N)(2)Pyr]Mo(NMe(2)), [(C(6)F(5)N)(2)Pyr]MoCl, and [(Ar(t-Bu)N)(2)Pyr]MoN. The [(Ar(t-Bu)N)(2)Pyr]Mo(N(2))(0/-) reversible couple is found at -1.96 V (in PhF versus Cp(2)Fe(+/0)), but the [(Ar(t-Bu)N)(2)Pyr]Mo(N(2))(+/0) couple is irreversible. Reduction of {[(Ar(t-Bu)N)(2)Pyr]Mo(NH(3))}BPh(4) under Ar at approximately -1.68 V at a scan rate of 900 mV/s is not reversible. Ammonia in [(Ar(t-Bu)N)(2)Pyr]Mo(NH(3)) can be substituted for dinitrogen in about 2 h if 10 equiv of BPh(3) are present to trap the ammonia that is released. [(Ar(t-Bu)N)(2)Pyr]Mo-N=NH is a key intermediate in the proposed catalytic reduction of dinitrogen that could not be prepared. Dinitrogen exchange studies in [(Ar(t-Bu)N)(2)Pyr]Mo(N(2)) suggest that steric hindrance by the ligand may be insufficient to protect decomposition of [(Ar(t-Bu)N)(2)Pyr]Mo-N=NH through a variety of pathways. Three attempts to reduce dinitrogen catalytically with [(Ar(t-Bu)N)(2)Pyr]Mo(N) as a "catalyst" yielded an average of 1.02 +/- 0.12 equiv of NH(3).

Correlation reflectometry at TEXTOR

In high temperature fusion plasmas the transport of energy and particles is commonly believed to be driven by turbulence. Turbulence quantities as correlation length and decorrelation time are important for the confinement properties of a plasma. Besides other diagnostics, correlation reflectometry has proven to be a suitable tool for the measurement of turbulence properties. At the medium sized Toroidal EXperiment for Technical Oriented Research (TEXTOR) the existing correlation reflectometry has been recently upgraded. A new reflectometer based on a microwave synthesizer has been developed and installed for the investigation of turbulence properties in a fusion plasma. Together with the existing reflectometer the measurement of radial correlation length and decorrelation time becomes available. Both reflectometers are computer controlled and allow to program individual frequency sequences and the duration of each frequency step. With the existing poloidal antenna array at θ=0° and on top of the vacuum vessel, the system allows the measurement of radial correlation and poloidal correlations at the same time. First experiments have been performed and the results on the radial correlation length of density fluctuations in a fusion plasma are presented.

Analysis of Her2/neu membrane protein clusters in different types of breast cancer cells using localization microscopy

The Her2/neu tyrosine kinase receptor is a member of the epidermal growth factor family. It plays an important role in tumour genesis of certain types of breast cancer and its overexpression correlates with distinct diagnostic and therapeutic decisions. Nevertheless, it is still under intense investigation to improve diagnostic outcome and therapy control. In this content, we applied spectral precision distance/position determination microscopy, a technique based on the general principles of localization microscopy in order to study tumour typical conformational changes of receptor clusters on cell membranes. We examined two different mamma carcinoma cell lines as well as cells of a breast biopsy of a healthy donor. The Her2/neu receptor sites were labelled by immunofluorescence using conventional fluorescent dyes (Alexa conjugated antibodies). The characterization of the Her2/neu distribution on plasma membrane sections of 176 different cells yielded a total amount of 20 637 clusters with a mean diameter of 67 nm. Statistical analysis on the single molecule level revealed differences in clustering of Her2/neu between all three different cell lines. We also showed that using spectral precision distance/position determination microscopy, a dual colour reconstruction of the 3D spatial arrangement of Her2/neu and Her3 is possible. This indicates that spectral precision distance/position determination microscopy could be used as an enhanced tool offering additional information of Her2/neu receptor status.

Effects of AT1- and beta-adrenergic receptor antagonists on TGF-beta1-induced fibrosis in transgenic mice

BACKGROUND

Transforming growth factor-beta1 (TGF-beta1) is involved in interstitial remodelling promoting collagen synthesis and suppressing collagen degradation by inhibition of collagenases. TGF-beta1 mediates angiotensin II-dependent effects and modulates beta1-adrenergic signalling. To study the effect of neuroendocrine antagonism on TGF-beta-induced hypertrophic and fibrotic phenotype, we treated TGF-beta1 (Cys223,225Ser) transgenic mice (TGF-beta1-TG) with either the beta1-receptor blocker metoprolol (MET), the angiotensin II type I (AT1)-receptor antagonist telmisartan (TEL) or an antibody blocking TGF-beta1 signalling (TGFbeta1-sR-Ab).

MATERIAL AND METHODS

Transforming growth factor-beta1-TG mice (8 weeks) overexpressing TGF-beta1 were treated with either TEL (10 mg kg(-1)), MET (350 mg kg(-1)) or a soluble TGF-beta1 receptor antibody (1 mg kg(-1)) for 6 weeks. Morphological analyses of interstitium and cardiomyocytes were related to expression of matrix metalloproteinases (MMPs) and their inhibitors (TIMPs) by immunoblotting and zymography.

RESULTS

In TGF-beta1-TG mice, myocardial interstitial total collagen content was fourfold elevated compared to that of controls (P < 0.05) and was lowered under the treatment with TEL (P < 0.05). Protein expression of TIMP-1 and -4 was increased in TGF-beta1-TG but inhibited by TEL (TIMP-1 and TIMP-4) and MET (TIMP-1), while collagenase activity was decreased in TGF-beta1-TG and normalized by treatment with TEL (MMP-1 and MMP-13) and MET (MMP-1) (P < 0.05). Morphometric measurements of cardiomyocyte diameter and area demonstrated similar antihypertrophic effects for all treatment groups.

CONCLUSION

The AT1-antagonist TEL reduced myocardial hypertrophy and interstitial fibrosis in TGF-beta1-TG mice by normalizing MMP/TIMP ratio. beta1-Adrenergic inhibition by MET as well as TGF-beta1 antagonism induced antihypertrophic rather than antifibrotic effects. Inhibition of both renin-angiotensin system and beta1-adrenergic system may exert different but synergistic effects to reduce myocardial remodelling.

Trace detection of 41Ca in nuclear reactor concrete by diode-laser-based resonance ionization mass spectrometry

The content of the long-lived isotope 41Ca in concrete samples obtained from the biological shield of a shut-down nuclear research reactor has been determined by diode-laser-based resonance ionization mass spectrometry (RIMS). Standard procedures were applied for the chemical separation of calcium. A radioactive tracer of 47Ca was used to determine the chemical yield. The total calcium concentration in the final nitric acid solution was measured by x-ray fluorescence (XRF) spectroscopy. The RIMS measurement yielded the abundance of 41Ca relative to the total calcium content with a detection limit of 5×10-10, limited by background effects at mass 41. The detection limit corresponds to a minimum detectable specific 41Ca activity of ~100 mBq/g in the concrete. Reproducibility and accuracy were determined with 41Ca spikes and found to be in the range of 15%, limited predominantly by ion counting statistics.

Impact of platelets and fresh frozen plasma in contrast to red cell concentrate on unstimulated and stimulated cytokine release in an in vitro model of transfusion

Transfusion of blood may contribute to immunomodulation. Leuco-depleted standard blood products are supposed to result in less immunomodulation compared with whole blood. To determine the influence of leuco-depleted blood products on the cytokine response, red blood cell concentrates (RBC), fresh frozen plasma (FFP) and platelet concentrates (PC) were investigated in an in vitro model of blood transfusion. Leuco-depleted standard blood bank RBC, FFP and PC were mixed in vitro with AB0 compatible venous blood from healthy volunteers in ratios of 3:1, 1:1 and 1:3. Specimens were incubated in presence or absence of lipopolysaccharide, 1 mug/ml. After 24 h of incubation cytokine release of tumour necrosis factor (TNF)-alpha and interleukin-10 (IL-10) was measured in cell culture supernatants by means of enzyme-linked immunsorbent assay. Addition of RBC, FFP and PC to venous blood from healthy volunteers led to a significant and dose-dependent increase in spontaneous TNF-alpha and IL-10 release. After endotoxin stimulation, RBC, FFP and PC significantly suppressed the TNF-alpha response, while the stimulated release of IL-10 tended to increase, reaching significance only after high doses of FFP. Addition of leuco-depleted blood products changed the spontaneous and stimulated cytokine response in an in vitro model of transfusion. These data may suggest a possible contribution of transfused FFP and PC to immunomodulation after transfusion similar to RBC.

The Synthesis and X-ray Structural Characterization of mer and fac isomers of the Technetium(I) Nitrosyl Complex [TcCl(2)(NO)(PNPpr)]

The nitrosyl complex H[TcNOCl(4)] reacts with the tridentate ligand bis[(2-diphenylphosphino)propyl]amine (PNPpr) to yield a mixture of the mer or fac isomers of [TcCl(2)(NO)(PNPpr)]. In acetonitrile, where the ligand is freely soluble, reaction occurs at room temperature to yield mostly the mer isomer with the linear nitrosyl ligand cis to the amine ligand; and the phosphine ligands arranged in a mutually trans orientation. The reaction in methanol requires reflux to dissolve the lipophilic ligand and generates the fac isomer of [TcCl2(NO)(PNPpr)] as the major product, with the tridentate ligand in a facial arrangement, leaving the chlorides and nitrosyl ligand in the remaining facial sites. The steric bulk of the tridentate ligand's diphenylphophino- moieties results in a significant distortion from octahedral geometry, with the P-Tc-P bond angle expanded to 99.48(4)°. The infrared spectra display absorptions from these nitrosyl ligands in the 1700 and 1800 cm(-1) regions for the fac and mer isomers respectively. The ESI(+) mass spectra each display the parent ion at 647 m/z.

Single nucleotide polymorphisms in matrix metalloproteinase genes and lung cancer chemotherapy response and prognosis

The prognosis for lung cancer patients treated with chemotherapy is poor. Single nucleotide polymorphisms (SNPs) in matrix metalloproteinase (MMP) genes could influence treatment outcome by altering apoptotic pathways. Eight SNPs with known or suspected phenotypic effect in six genes (MMP1, MMP2, MMP3, MMP7, MMP9 and MMP12) were investigated. For 349 Caucasian patients with primary lung cancer, receiving first-line chemotherapy, three different endpoints were analysed: response after the second cycle, progression free survival (PFS) and overall survival (OS). The prognostic value of the SNPs was analysed using multiple logistic regression for all patients and histology-, stage- and treatment-specific subgroups. Hazard ratio estimates for PFS and OS were calculated using Cox regression methods. None of the investigated polymorphisms modified response significantly in the whole patient population. However, tumour stage IIIB variant allele carriers of MMP2 C-735T showed a significantly worse response. PFS was significantly prolonged in MMP1 G-1607GG variant allele carriers and OS in small cell lung cancer patients carrying the MMP12 A-82G variant allele. In conclusion, this study identified SNPs in MMP1, MMP2, MMP7 and MMP12 for further investigation as possible predictors of chemotherapy outcome in lung cancer patients.

[The patient's satisfaction in relation with the treatment in hospital psychiatry: a comparison between Italy and Germany]

The aim of this study is to compare psychiatric patients' satisfaction with their treatment in Munich and in South Tirol. For this purpose, besides clinical and social-demographic factors, for each sample-group of patients, their general satisfaction, their valuation of the different aspects of hospital treatment and life quality were considered and compared. The relevance of these elements in the global satisfaction was examined with linear multiple regression models. The results of the research show a rather high level of global satisfaction in both sample-groups, even if statistically relevant differences occur in evaluations of several aspects of the treatment. In Munich's sample-group a higher rate of satisfaction emerged in relation with the treatment: the attitude of the medical staff, the psycho-pharmacological treatments, the clinic's image and the conduct of the nursing staff. In both groups the most relevant factor for patients' satisfaction, besides the positive results of the treatment, was the attitude of the doctor, and in particular way his empathy with the patient. In regard to the age, the diagnosis and the duration of the hospitalization, it was not possible to demonstrate, in both sample-groups, any statistically relevant connection with the general satisfaction rate, while a high rate of trust in the doctors and in the medicines was found to be, in each group, a significant condition for a positive evaluation of the treatment. The influence of the personal life-quality was proven statistically relevant but weak. Altogether, regardless of the medical structure that was examined, the results underline the predominant importance of the curing doctor's social and emotional skills for patients' satisfaction.

Gender differences in onset of symptoms in AV nodal re-entrant and accessory pathway-mediated re-entrant tachycardia

PURPOSE

Is onset of symptoms in AV nodal re-entrant tachycardia (AVNRT) and accessory pathway-mediated re-entrant tachycardia (AVRT) patients gender-specific?

METHODS

Intra- and inter-gender differences in onset of symptoms and mechanism of supraventricular tachycardia in adult patients undergoing catheter ablation for AVNRT or AVRT (N=230) were documented.

RESULTS

Women with AVNRT were significantly younger at onset of symptoms compared to men (38+/-18, 51+/-18 years, p=0.01). Male AVNRT patients were significantly older at onset of symptoms compared to male AVRT patients (51+/-18, 25+/-11 years, p=0.04) but there was no difference in women. Symptoms beginning <30 years in men predicted AVRT in 73%, and beginning >or=30 years the predominant mechanism was AVNRT (85%). In women AVNRT was the most likely mechanism independent of symptom onset (>75%).

CONCLUSIONS

Symptoms beginning in patients with AVNRT and AVRT prior to age 30 correlates with a 70% incidence of AVRT in men and a 80% incidence of AVNRT in women. Onset of palpitations >or= age 30 relates to AVNRT in 85% of patients.

Soliton ratchets in sine-Gordon systems with additive inhomogeneities

We investigate the ratchet dynamics of solitons of a sine-Gordon system with additive inhomogeneities. We show by means of a collective coordinate approach that the soliton moves like a particle in an effective potential which is a result of the inhomogeneities. Different degrees of freedom of the soliton are used as collective coordinates in order to study their influence on the motion of the soliton. The collective coordinates considered are the soliton position, its width and offset, and the height of the spikes that appear on the soliton. The results of the theory are compared with numerical simulations of the full system.

Chaotic transport in deterministic sine-Gordon soliton ratchets

We investigate homogeneous and inhomogeneous sine-Gordon ratchet systems in which a temporal symmetry and the spatial symmetry, respectively, are broken. We demonstrate that in the inhomogeneous systems with ac driving the soliton dynamics is chaotic in certain parameter regions, although the soliton motion is unidirectional. This is qualitatively explained by a one-collective-coordinate theory which yields an equation of motion for the soliton that is identical to the equation of motion for a single particle ratchet which is known to exhibit chaotic transport in its underdamped regime. For a quantitative comparison with our simulations we use a two-collective-coordinate (2CC) theory. In contrast to this, homogeneous sine-Gordon ratchets with biharmonic driving, which breaks a temporal shift symmetry, do not exhibit chaos. This is explained by a 2CC theory which yields two ODEs: one is linear, the other one describes a parametrically driven oscillator which does not exhibit chaos. The latter ODE can be solved by a perturbation theory which yields a hierarchy of linear equations that can be solved exactly order by order. The results agree very well with the simulations.