A two-stage group-sequential design for delayed treatment responses with the possibility of trial restart

Common statistical theory applicable to confirmatory phase III trial designs usually assumes that patients are enrolled simultaneously and there is no time gap between enrollment and outcome observation. However, in practice, patients are enrolled successively and there is a lag between the enrollment of a patient and the measurement of the primary outcome. For single-stage designs, the difference between theory and practice only impacts on the trial duration but not on the statistical analysis and its interpretation. For designs with interim analyses, however, the number of patients already enrolled into the trial and the number of patients with available outcome measurements differ, which can cause issues regarding the statistical analyses of the data. The main issue is that current methodologies either imply that at the time of the interim analysis there are so-called pipeline patients whose data are not used to make a statistical decision (like stopping early for efficacy) or the enrollment into the trial needs to be at least paused for interim analysis to avoid pipeline patients. There are methods for delayed responses available that introduced error-spending stopping boundaries for the enrollment of patients followed by critical values to reject the null hypothesis in case the stopping boundaries have been crossed beforehand. Here, we will discuss other solutions, considering different boundary determination algorithms using conditional power and introducing a design allowing for recruitment restart while keeping the type I error rate controlled.

Clinical outcomes and predictors of delayed echocardiographic response to cardiac resynchronization therapy

INTRODUCTION

The clinical outcomes and mechanisms of delayed responses to cardiac resynchronization therapy (CRT) remain unclear. We aimed to investigate the differences in outcomes and gain insight into the mechanisms of early and delayed responses to CRT.

METHODS

This retrospective study included 110 patients who underwent CRT implantation. Positive response to CRT was defined as ≥15% reduction of left ventricular (LV) end-systolic volume on echocardiography at 1 year (early phase) and 3 years (delayed phase) after implantation. The latest mechanical activation site (LMAS) of the LV was identified using two-dimensional speckle-tracking radial strain analysis.

RESULTS

Seventy-eight (71%) patients exhibited an early response 1 year after CRT implantation. Of 32 non-responders in the early phase, 12 (38%) demonstrated a delayed response, and 20 (62%) were classified as non-responders after 3 years. During the follow-up time of 10.3 ± 0.5 years, the delayed and early responders had a similar prognosis of mortality and heart failure (HF) hospitalization. In contrast, non-responders had a worse prognosis. Multivariate analysis revealed that a longer duration (months) between initial HF hospitalization and CRT (odds ratio [OR]: 1.126; 95% confidence interval [CI]: 1.036-1.222; p = .005), non-exact concordance of LV lead location with LMAS (OR: 32.744; 95% CI: 1.101-973.518; p = .044), and pre-QRS duration (OR: 0.901; 95% CI: 0.827-0.981; p = .016) were independent predictors of delayed response to CRT compared with early response.

CONCLUSION

The prognoses were similar regardless of the response time after CRT. A longer history of HF, suboptimal LV lead position, and shorter pre-QRS duration were related to delayed response than early response.

A Model for Reinfections and the Transition of Epidemics

Reinfections of infected individuals during a viral epidemic contribute to the continuation of the infection for longer periods of time. In an epidemic, contagion starts with an infection wave, initially growing exponentially fast until it reaches a maximum number of infections, following which it wanes towards an equilibrium state of zero infections, assuming that no new variants have emerged. If reinfections are allowed, multiple such infection waves might occur, and the asymptotic equilibrium state is one in which infection rates are not negligible. This paper analyzes such situations by expanding the traditional SIR model to include two new dimensionless parameters, ε and θ, characterizing, respectively, the kinetics of reinfection and a delay time, after which reinfection commences. We find that depending on these parameter values, three different asymptotic regimes develop. For relatively small θ, two of the regimes are asymptotically stable steady states, approached either monotonically, at larger ε (corresponding to a stable node), or as waves of exponentially decaying amplitude and constant frequency, at smaller ε (corresponding to a spiral). For θ values larger than a critical, the asymptotic state is a periodic pattern of constant frequency. However, when ε is sufficiently small, the asymptotic state is a wave. We delineate these regimes and analyze the dependence of the corresponding population fractions (susceptible, infected and recovered) on the two parameters ε and θ and on the reproduction number R₀. The results provide insights into the evolution of contagion when reinfection and the waning of immunity are taken into consideration. A related byproduct is the finding that the conventional SIR model is singular at large times, hence the specific quantitative estimate for herd immunity it predicts will likely not materialize.

Time of onset and factors associated with delayed response post intradetrusor injection of onabotulinumtoxin a in patients with neurogenic and idiopathic overactive bladder syndrome

Objective

The objective of this study was to determine risk factors for delayed response in patients with neurogenic and idiopathic overactive bladder (OAB) after intradetrusor onabotulinumtoxin A injection.

Subjects and Methods

This is a retrospective study that included 87 patients who underwent onabotulinumtoxin A intradetrusor injection from October 2011 to November 2019. Patients were followed up at 2, 4, and 12 weeks post intervention in the outpatient clinic and over the phone. The data of patients with early response were compared with those with late response using univariate and multivariate analyses.

Results

The study included 87 patients. The mean age was 41 ± 15.3 standard deviation, and 69% of the participants were female. Fifty-one percent were diagnosed with neurogenic OAB. A median response time to onabotulinumtoxin A injection of 7 days was demonstrated, and patients who responded during the first 7 days post procedure were considered early responders. Independent predictors for late response include diabetes (Relative risk: 3.89, P = 0.018, and 95% confidence interval [CI]: 1.26-11.98), >1 BTX-A session (Relative risk: 4, P = 0.011, and 95% CI: 1.38-11.6), and wet OAB (RR: 9.94, P = 0.002, and 95% CI: 2.31-42.17).

Conclusions

The median time of onset post intradetrusor injection of onabotulinumtoxin A was found to be 7 days. Diabetes mellitus, wet OAB, and <1 Botox sessions were independent risk factors for late onset of response.

Partial SAA patients benefit from delayed response of IST

Introduction

Severe aplastic anemia(SAA)is a severe disease characterized by immune-mediated bone marrow failure and pancytopenia. Immunosuppressive therapy (ATG plus CsA, IST) is the standard treatment for patients who are not suitable for allogeneic hematopoietic stem cell transplantation (allo-HSCT). Some patients have a delayed response after 6 months of ATG, and unnecessary to be given secondary ATG or allo-HSCT. We attempted to distinguish patients who may get potential delayed response from those who were really not responsive to IST.

Methods

We collected data from 45 SAA patients who were assessed no-response to IST at 6 months after rATG and failed to receive secondary ATG or allo-HSCT.

Results

CsA plus eltrombopag (EPAG) group has an extra 75% response rate while CsA maintenance group has an extra 44% response rate at 12 months. ATG was applied within 30 days after diagnosis, ATG dosage was suffificient (ATG/lymphocyte ≥2), and absolute reticulocyte count (ARC) was ≥30×109 /L at 6 months, indicated patients could get delayed response and benefifit from CsA maintenance. Addition of EPAG could give an even better response. Otherwise, secondary ATG or allo-HSCT treatment were recommended to be given immediately.

Clinical Trial Registration

https://www.chictr.org.cn/searchproj.aspx, identifier ChiCTR2300067615.

[Numerical Response Analysis of PM2.5-O3 Compound Pollution in Beijing]

The multi-scale variation trend of PM_2.5-O₃ compound pollution events was analyzed based on air quality data, meteorological data, and COVID-19 data in Beijing from 2015 to 2020. For the threshold of compound pollution, a compound pollution index was proposed, and the numerical response trend was evaluated based on the generalized additive model. A distributed lag nonlinear model was introduced to analyze the risk response relationship between compound pollution and influencing factors. The results showed that the events of PM_2.5-O₃ compound pollution in Beijing decreased annually. At the same time, due to the influence of pollutant emissions and meteorological conditions, there were obvious seasonal effects, week effects, holiday effects, and epidemic effects. The composite pollution index had no correlation with rainfall but had a linear positive correlation with O₃ and air temperature and a nonlinear correlation with other explanatory variables. Air pollutants and meteorological conditions had obvious lag effects on the composite pollution index, and the lag effects were mainly concentrated in 1-3 d. PM_2.5, PM₁₀, O₃, SO₂, and air temperature in high-value areas significantly increased the risk of compound pollution. The CO (1-6 mg·m^-3), NO₂ (38-118 μg·m^-3), and relative humidity (54%-87%) in the median section would also increase the risk of compound pollution, as would low wind speed. The compound pollution events showed a trend of multi-day continuous pollution in the numerical response. Compared with PM_2.5 and PM₁₀, compound pollution events were more dependent on O₃, and the compound pollution rate in high-value areas was 30.7%-47.5%. CO and relative humidity had little effect on compound pollution events. The air temperature had the greatest impact, and 84.7% of the composite pollution incidents occurred at 20-30℃.

Robust group sequential designs for trials with survival endpoints and delayed response

Randomized clinical trials in oncology typically utilize time-to-event endpoints such as progression-free survival or overall survival as their primary efficacy endpoints, and the most commonly used statistical test to analyze these endpoints is the log-rank test. The power of the log-rank test depends on the behavior of the hazard ratio of the treatment arm to the control arm. Under the assumption of proportional hazards, the log-rank test is asymptotically fully efficient. However, this proportionality assumption does not hold true if there is a delayed treatment effect. Cancer immunology has evolved over time and several cancer vaccines are available in the market for treating existing cancers. This includes sipuleucel-T for metastatic hormone-refractory prostate cancer, nivolumab for metastatic melanoma, and pembrolizumab for advanced nonsmall-cell lung cancer. As cancer vaccines require some time to elicit an immune response, a delayed treatment effect is observed, resulting in a violation of the proportional hazards assumption. Thus, the traditional log-rank test may not be optimal for testing immuno-oncology drugs in randomized clinical trials. Moreover, the new immuno-oncology compounds have been shown to be very effective in prolonging overall survival. Therefore, it is desirable to implement a group sequential design with the possibility of early stopping for overwhelming efficacy. In this paper, we investigate the max-combo test, which utilizes the maximum of two weighted log-rank statistics, as a robust alternative to the log-rank test. The new test is implemented for two-stage designs with possible early stopping at the interim analysis time point. Two classes of weights are investigated for the max-combo test: the Fleming and Harrington (1981) G ρ , γ weights and the Magirr and Burman (2019) modest ( τ ∗ )  weights.

Extending the two-stage single arm phase II clinical trial design to the delayed response scenario

Two-stage single arm designs are widely used in phase II clinical trials with binary endpoints. The trial may be stopped early due to insufficient positive responses in the first stage. There may be some enrolled subjects who have yet to respond by the end of the first stage, and their data are ignored if the first stage results in rejection of the trial. It is possible that the result after the first stage is rejection by a slim margin, while the results of pipeline subjects are quite positive. In this case, combining the data from the two sources may provide a valuable opportunity to rescue a promising treatment that was mistakenly rejected. We propose a novel double-check design to take advantage of the pipeline subjects' data to establish a rescue criterion based on two-stage design. When the rescue criterion is met, the decision to reject the trial at the end of the first stage can be reversed, allowing the trial to continue. A derivation based on a binomial distribution shows that the double-check strategy can strictly preserve the type I error rate. Further examination shows that the strategy can provide a slight increase in overall power and a substantial increase in conditional power when the proportion of positive response at the end of the first stage is at the margin. The extra rescue opportunity's cost is pretty low, only a slight increasing in the expected sample size.

Rapid suppression and sustained activation of distinct cortical regions for a delayed sensory-triggered motor response

The neuronal mechanisms generating a delayed motor response initiated by a sensory cue remain elusive. Here, we tracked the precise sequence of cortical activity in mice transforming a brief whisker stimulus into delayed licking using wide-field calcium imaging, multiregion high-density electrophysiology, and time-resolved optogenetic manipulation. Rapid activity evoked by whisker deflection acquired two prominent features for task performance: (1) an enhanced excitation of secondary whisker motor cortex, suggesting its important role connecting whisker sensory processing to lick motor planning; and (2) a transient reduction of activity in orofacial sensorimotor cortex, which contributed to suppressing premature licking. Subsequent widespread cortical activity during the delay period largely correlated with anticipatory movements, but when these were accounted for, a focal sustained activity remained in frontal cortex, which was causally essential for licking in the response period. Our results demonstrate key cortical nodes for motor plan generation and timely execution in delayed goal-directed licking.

The Tipping Effect of Delayed Interventions on the Evolution of COVID-19 Incidence

We combine infectious disease transmission and the non-pharmaceutical (NPI) intervention response to disease incidence into one closed model consisting of two coupled delay differential equations for the incidence rate and the time-dependent reproduction number. The model contains three parameters, the initial reproduction number, the intervention strength, and the response delay. The response is modeled by assuming that the rate of change of the reproduction number is proportional to the negative deviation of the incidence rate from an intervention threshold. This delay dynamical system exhibits damped oscillations in one part of the parameter space, and growing oscillations in another, and these are separated by a surface where the solution is a strictly periodic nonlinear oscillation. For the COVID-19 pandemic, the tipping transition from damped to growing oscillations occurs for response delays of about one week, and suggests that, without vaccination, effective control and mitigation of successive epidemic waves cannot be achieved unless NPIs are implemented in a precautionary manner, rather as a response to the present incidence rate. Vaccination increases the quiet intervals between waves, but with delayed response, future flare-ups can only be prevented by establishing a post-pandemic normal with lower basic reproduction number.

Dynamic Suppression of Average Facial Structure Shapes Neural Tuning in Three Macaque Face Patches

The visual perception of identity in humans and other primates is thought to draw upon cortical areas specialized for the analysis of facial structure. A prominent theory of face recognition holds that the brain computes and stores average facial structure, which it then uses to efficiently determine individual identity, though the neural mechanisms underlying this process are controversial. Here, we demonstrate that the dynamic suppression of average facial structure plays a prominent role in the responses of neurons in three fMRI-defined face patches of the macaque. Using photorealistic face stimuli that systematically varied in identity level according to a psychophysically based face space, we found that single units in the AF, AM, and ML face patches exhibited robust tuning around average facial structure. This tuning emerged after the initial excitatory response to the face and was expressed as the selective suppression of sustained responses to low-identity faces. The coincidence of this suppression with increased spike timing synchrony across the population suggests a mechanism of active inhibition underlying this effect. Control experiments confirmed that the diminished responses to low-identity faces were not due to short-term adaptation processes. We propose that the brain's neural suppression of average facial structure facilitates recognition by promoting the extraction of distinctive facial characteristics and suppressing redundant or irrelevant responses across the population.

Delayed response to an injection of U-500 regular insulin is not rare

Highlights Since the PK/PD of U-500 regular insulin more closely resembles that of NPH insulin, it is commonly given before breakfast and dinner. However, a delayed response in which the major effect of the concentrated insulin takes place overnight occurs in about 10% of patients. This necessitates converting the regimen to a basal/bolus one in which the before breakfast injection serves as the basal insulin and short- or rapid-acting insulin is given before meals to control daytime hyperglycemia.

Estrogen Alters the Synaptic Distribution of Phospho-GluN2B in the Dorsolateral Prefrontal Cortex While Promoting Working Memory in Aged Rhesus Monkeys

Age- and menopause-related deficits in working memory can be partially restored with estradiol replacement in women and female nonhuman primates. Working memory is a cognitive function reliant on persistent firing of dorsolateral prefrontal cortex (dlPFC) neurons that requires the activation of GluN2B-containing glutamate NMDA receptors. We tested the hypothesis that the distribution of phospho-Tyr1472-GluN2B (pGluN2B), a predominant form of GluN2B seen at the synapse, is sensitive to aging or estradiol treatment and coupled to working memory performance. First, ovariectomized young and aged rhesus monkeys (Macaca mulatta) received long-term cyclic vehicle (V) or estradiol (E) treatment and were tested on the delayed response (DR) test of working memory. Then, serial section electron microscopic immunocytochemistry was performed to quantitatively assess the subcellular distribution of pGluN2B. While the densities of pGluN2B immunogold particles in dlPFC dendritic spines were not different across age or treatment groups, the percentage of gold particles located within the synaptic compartment was significantly lower in aged-E monkeys compared to young-E and aged-V monkeys. On the other hand, the percentage of pGluN2B gold particles in the spine cytoplasm was decreased with E treatment in young, but increased with E in aged monkeys. In aged monkeys, DR average accuracy inversely correlated with the percentage of synaptic pGluN2B, while it positively correlated with the percentage of cytoplasmic pGluN2B. Together, E replacement may promote cognitive health in aged monkeys, in part, by decreasing the relative representation of synaptic pGluN2B and potentially protecting the dlPFC from calcium toxicity.

Synaptic distributions of pS214-tau in rhesus monkey prefrontal cortex are associated with spine density, but not with cognitive decline

Female rhesus monkeys and women are subject to age- and menopause-related deficits in working memory, an executive function mediated by the dorsolateral prefrontal cortex (dlPFC). Long-term cyclic administration of 17β-estradiol improves working memory, and restores highly plastic axospinous synapses within layer III dlPFC of aged ovariectomized monkeys. In this study, we tested the hypothesis that synaptic distributions of tau protein phosphorylated at serine 214 (pS214-tau) are altered with age or estradiol treatment, and couple to working memory performance. First, ovariectormized young and aged monkeys received vehicle or estradiol treatment, and were tested on the delayed response (DR) test of working memory. Serial section electron microscopic immunocytochemistry was then performed to quantitatively assess the subcellular synaptic distributions of pS214-tau. Overall, the majority of synapses contained pS214-tau immunogold particles, which were predominantly localized to the cytoplasm of axon terminals. pS214-tau was also abundant within synaptic and cytoplasmic domains of dendritic spines. The density of pS214-tau immunogold within the active zone, cytoplasmic, and plasmalemmal domains of axon terminals, and subjacent to the postsynaptic density within the subsynaptic domains of dendritic spines, were each reduced with age. None of the variables examined were directly linked to cognitive status, but a high density of pS214-tau immunogold particles within presynaptic cytoplasmic and plasmalemmal domains, and within postsynaptic subsynaptic and plasmalemmal domains, accompanied high synapse density. Together, these data support a possible physiological, rather than pathological, role for pS214-tau in the modulation of synaptic morphology in monkey dlPFC.

Multiannual effects of induced plant defenses: Are defended plants good or bad neighbors?

Defenses induced by herbivore feeding or phytohormones such as methyl jasmonate (MeJA) can affect growth, reproduction, and herbivory, not only on the affected individual but also in its neighboring plants. Here, we report multiannual defense, growth, and reproductive responses of MeJA-treated bilberry (Vaccinium myrtillus) and neighboring ramets. In a boreal forest in western Norway, we treated bilberry ramets with MeJA and water (control) and measured responses over three consecutive years. We observed the treatment effects on variables associated with herbivory, growth, and reproduction in the MeJA-treated and untreated ramet and neighboring ramets distanced from 10 to 500 cm. MeJA-treated ramets had fewer grazed leaves and browsed shoots compared to control, with higher effects in 2014 and 2015, respectively. In 2013, growth of control ramets was greater than MeJA-treated ramets. However, MeJA-treated ramets had more flowers and berries than control ramets 2 years after the treatment. The level of insect and mammalian herbivory was also lower in untreated neighboring ramets distanced 10-150 cm and, consistent with responses of MeJA-treated ramets, the stronger effect was also one and 2 years delayed, respectively. The same neighboring ramets had fewer flowers and berries than untreated ramets, indicating a trade-off between defense and reproduction. Although plant-plant effects were observed across all years, the strength varied by the distance between the MeJA-treated ramets and its untreated neighbors. We document that induced defense in bilberry reduces both insect and mammalian herbivory, as well as growth, over multiple seasons. The defense responses occurred in a delayed manner with strongest effects one and 2 years after the induction. Additionally, our results indicate defense signaling between MeJA-treated ramets and untreated neighbors. In summary, this study shows that induced defenses are important ecological strategies not only for the induced individual plant but also for neighboring plants across multiple years in boreal forests.

Local Insect Damage Reduces Fluctuating Asymmetry in Next-year's Leaves of Downy Birch

Insect herbivory imposes stress on host plants. This stress may cause an increase in leaf fluctuating asymmetry (FA), which is defined as the magnitude of the random deviations from a symmetrical leaf shape. We tested the hypothesis that differences in leaf FA among individual shoots of downy birch, Betula pubescens, are at least partly explained by local damage caused by insects in the previous year. Unexpectedly, we found that in the year following the damage imposed by miners, leafrollers and defoliators, damaged birch shoots produced leaves with lower FAs compared to shoots from the same tree that had not been damaged by insects. This effect was consistent among the different groups of insects investigated, but intra-species comparisons showed that statistical significance was reached only in shoots that had been damaged by the birch leaf roller, Deporaus betulae. The detected decrease in leaf FA in the year following the damage agrees with the increases in shoot performance and in antiherbivore defence. The present results indicate that within-plant variation in leaf FA may have its origin in previous-year damage by insects, and that FA may influence the current-year’s distribution of herbivory.

The incidence and outcomes of delayed response to cardiac resynchronization therapy

BACKGROUND

The incidence and clinical outcomes of delayed response to cardiac resynchronization therapy (CRT) have not been well clarified. We aimed to observe the incidence and prognosis of delayed response and to identify its possible mechanisms.

METHODS

A total of 115 CRT patients were retrospectively analyzed in our study. Patients who met the enrollment criteria were divided into two groups: group A, conventional responders who showed response at 1-year follow-up, and group B, delayed responders who showed response after 1-year follow-up. CRT response was defined as an absolute increase of ≥10% in left ventricular ejection fraction.

RESULTS

Fifty-two patients (61 ± 12 years, 37 male) experienced conventional response to CRT and 17 patients (63 ± 11 years, 10 male) experienced delayed response. The mean follow-up time was 5.2 ± 2.4 years. The incidence of delayed response was 14.8% (17/115). All-cause mortality and hospitalization rates for heart failure were similar for delayed and conventional responders. Multivariate logistic regression analysis revealed that scar burden > 35% was an independent predictor of CRT delayed response (odds ratio 8.794, P  =  0.038).

CONCLUSIONS

A significant proportion of patients demonstrated delayed response to CRT. The delayed responders had a good prognosis that was similar to that of conventional responders. More scar burden might be related to the incidence of delayed response.

Diverse Synaptic Distributions of G Protein-coupled Estrogen Receptor 1 in Monkey Prefrontal Cortex with Aging and Menopause

Age- and menopause-related impairment in working memory mediated by the dorsolateral prefrontal cortex (dlPFC) occurs in humans and nonhuman primates. Long-term cyclic 17β-estradiol treatment rescues cognitive deficits in aged ovariectomized rhesus monkeys while restoring highly plastic synapses. Here we tested whether distributions of G protein-coupled estrogen receptor 1 (GPER1) within monkey layer III dlPFC synapses are sensitive to age and estradiol, and coupled to cognitive function. Ovariectomized young and aged monkeys administered vehicle or estradiol were first tested on a delayed response test of working memory. Then, quantitative serial section immunoelectron microscopy was used to determine the distributions of synaptic GPER1. GPER1-containing nonperforated axospinous synapse density was reduced with age, and partially restored with estrogen treatment. The majority of synapses expressed GPER1, which was predominately localized to presynaptic cytoplasm and mitochondria. GPER1 was also abundant at plasmalemmas, and within cytoplasmic and postsynaptic density (PSD) domains of dendritic spines. GPER1 levels did not differ with age or treatment, and none of the variables examined were tightly associated with cognitive function. However, greater representation of GPER1 subjacent to the PSD accompanied higher synapse density. These data suggest that GPER1 is positioned to support diverse functions key to synaptic plasticity in monkey dlPFC.

Estrogen Restores Multisynaptic Boutons in the Dorsolateral Prefrontal Cortex while Promoting Working Memory in Aged Rhesus Monkeys

Humans and nonhuman primates are vulnerable to age- and menopause- related decline in working memory, a cognitive function reliant on area 46 of the dorsolateral prefrontal cortex (dlPFC). We showed previously that presynaptic mitochondrial number and morphology in monkey dlPFC neurons correlate with working memory performance. The current study tested the hypothesis that the types of synaptic connections these boutons form are altered with aging and menopause in rhesus monkeys and that these metrics may be coupled with mitochondrial measures and working memory. Using serial section electron microscopy, we examined the frequencies and characteristics of nonsynaptic, single-synaptic, and multisynaptic boutons (MSBs) in the dlPFC. In contrast to our previous observations in the monkey hippocampal dentate gyrus, where MSBs comprised ∼40% of boutons, the vast majority of dlPFC boutons were single-synaptic, whereas MSBs constituted a mere 10%. The frequency of MSBs was not altered by normal aging, but decreased by over 50% with surgical menopause induced by ovariectomy in aged monkeys. Cyclic estradiol treatment in aged ovariectomized animals restored MSB frequencies to levels comparable to young and aged premenopausal monkeys. Notably, the frequency of MSBs positively correlated with working memory scores, as measured by the average accuracy on the delayed response (DR) test. Furthermore, MSB incidence positively correlated with the number of healthy straight mitochondria in dlPFC boutons and inversely correlated with the number of pathological donut-shaped mitochondria. Together, our data suggest that MSBs are coupled to cognitive function and mitochondrial health and are sensitive to estrogen. Significance statement: Many aged menopausal individuals experience deficits in working memory, an executive function reliant on recurrent firing of prefrontal cortex (PFC) neurons. However, little is known about the organization of presynaptic inputs to these neurons and how they may be altered with aging and menopause. Multisynaptic boutons (MSBs) were of particular interest, because they form multiple synapses and can enhance coupling between presynaptic and postsynaptic neurons. We found that higher MSB frequency correlated with better working memory performance in rhesus monkeys. Additionally, aged surgically menopausal monkeys experienced a 50% loss of MSBs that was restored with cyclic estradiol treatment. Together, our findings suggest that hormone replacement therapy benefits cognitive aging, in part by retaining complex synaptic organizations in the PFC.

Cases with Refractory Ascites and a Delayed Response to Tolvaptan

The patient was a 67-year-old female with liver cirrhosis due to hepatitis C. She was administered furosemide at 20 mg/day and spironolactone at 25 mg/day, but the ascites did not improve. Despite the additional administration of tolvaptan at 3.75 mg/day, the response to ascites was still poor. While the dose of tolvaptan was thereafter increased to 7.5 mg/day on the 7th hospital day, the ascites still persisted. However, she continued to receive tolvaptan (7.5 mg/day) because the worsening of her subjective symptoms was mild and she wished to do so. The ascites was later found to have almost completely disappeared on computed tomography (CT) at 6 months.

Delayed Response of Lake Area Change to Climate Change in Siling Co Lake, Tibetan Plateau, from 2003 to 2013

The Tibetan Plateau is a key area for research on global environmental changes. During the past 50 years, the climate in the Siling Co lake area has become continuously warmer and wetter, which may have further caused the increase in Siling Co lake area. Based on the Siling Co lake area (2003 to 2013) and climate data acquired from the Xainza and Baingoin meteorological stations (covering 1966 to 2013), we analyzed the delayed responses of lake area changes to climate changes through grey relational analysis. The following results were obtained: (1) The Siling Co lake area exhibited a rapid expansion trend from 2003 to 2013. The lake area increased to 2318 km², with a growth ratio of 14.6% and an annual growth rate of 26.84 km²·year⁻¹; (2) The rate of air temperature increase was different in the different seasons. The rate in the cold season was about 0.41 °C per ten years and 0.32 °C in hot season. Precipitation evidently increased, with a change rate of 17.70 mm per ten years in the hot season and a slight increase with a change rate of 2.36 mm per ten years in the cold season. Pan evaporation exhibited evidently decreasing trends in both the hot and cold seasons, with rates of −33.35 and −14.84 mm per ten years, respectively; (3) An evident delayed response of lake area change to climate change is observed, with a delay time of approximately one to two years.

Seasonal variation in the serum 25-hydroxyvitamin D levels of young and elderly active and inactive adults in São Paulo, Brazil: The São PAulo Vitamin D Evaluation Study (SPADES)

OBJECTIVE

To evaluate the 25-hydroxyvitamin D [25(OH)D] concentrations in individuals in the city of São Paulo belonging to different age groups and exhibiting specific behavioral characteristics and to correlate the 25(OH)D concentration with the level of UV radiation (UVR).

PATIENTS AND METHODS

A total of 591 individuals were included, distributed as follows: 177 were living in institutions (NURSING, 76.2 ± 9.0 y old), 243 were part of the community elderly (COMMUNITY, 79.6 ± 5.3 y old), 99 were enrolled in a physical activity program targeting the elderly (ACTIVE, 67.6 ± 5.4 y old) and 72 were young (YOUNG, 23.9 ± 2.8 y old). Blood samples from all individuals were collected throughout the year. UVR measurements were taken by an official meteorology institution.

RESULTS

The UVR values varied throughout the year, following a sinusoidal-like pattern. Because of the Earth's orbit, we hypothesized that there would be cyclic patterns for the 25(OH)D and UVR values that repeat every 12 mo. The general formula is represented by the equation P1+P2⋅sin(-2⋅π12⋅(t-P3)) The mean 25(OH)D concentration and the amplitude of the variation were significantly higher for the YOUNG and ACTIVE groups than for the COMMUNITY and NURSING groups. The nadir for UVR was in June, whereas the nadir for the 25(OH)D concentration was in the spring, corresponding to a delay of one season.

CONCLUSIONS

There was seasonal variation in the 25(OH)D concentration for all the groups studied; however, the amplitude of the variation was higher for the groups of young and physically active people, possibly due to the higher level of sunlight exposure for these groups. The lowest 25(OH)D concentration was detected in the spring.

Stigmergy, collective actions, and animal social spacing

Collective animal behavior studies have led the way in developing models that account for a large number of individuals, but mostly have considered situations in which alignment and attraction play a key role, such as in schooling and flocking. By quantifying how animals react to one another's presence, when interaction is via conspecific avoidance rather than alignment or attraction, we present a mechanistic insight that enables us to link individual behavior and space use patterns. As animals respond to both current and past positions of their neighbors, the assumption that the relative location of individuals is statistically and history independent is not tenable, underscoring the limitations of traditional space use studies. We move beyond that assumption by constructing a framework to analyze spatial segregation of mobile animals when neighbor proximity may elicit a retreat, and by linking conspecific encounter rate to history-dependent avoidance behavior. Our approach rests on the knowledge that animals communicate by modifying the environment in which they live, providing a method to analyze social cohesion as stigmergy, a form of mediated animal-animal interaction. By considering a population of animals that mark the terrain as they move, we predict how the spatiotemporal patterns that emerge depend on the degree of stigmergy of the interaction processes. We find in particular that nonlocal decision rules may generate a nonmonotonic dependence of the animal encounter rate as a function of the tendency to retreat from locations recently visited by other conspecifics, which has fundamental implications for epidemic disease spread and animal sociality.

Differential effects on visual and spatial recognition memory of a novel hormone therapy regimen of estrogen alone or combined with progesterone in older surgically menopausal monkeys

Building upon our initial studies in young adult surgically menopausal monkeys, this study examined the effects of a novel schedule of administration of estradiol therapy alone, or in combination with progesterone, on visual and spatial recognition memory in older monkeys. Monkeys were preoperatively trained on a delayed matching-to-sample task and a delayed response task. At the time of ovariectomy, monkeys began their hormonal treatments and were cognitively assessed at 2, 12 and 24 weeks following treatment initiation. A schedule of hormone administration was used that closely modeled the normal fluctuations of hormones during the course of a normal primate menstrual cycle. Monkeys receiving placebo had lower levels of accuracy than monkeys receiving estrogen therapies on the delayed matching-to-sample task that were not apparent until 12 weeks following initiation of therapy and were no longer detected at the 24-week assessment. There was no effect of hormone therapy on accuracy in the delayed response task at any of the postoperative assessments. In both tasks, monkeys treated with estrogen plus progesterone had longer choice response latencies, especially on trials in which they made errors; however these effects did not influence accuracy measures in these animals. Our findings indicate that visual recognition ability may be more sensitive than spatial recognition memory to this novel hormone therapy regimen, that treatment with estradiol plus progesterone was equivalent to that of estradiol alone, and that neither therapy had significant negative impact on memory profiles.

Resonant synchronization in heterogeneous networks of inhibitory neurons

Brain rhythms arise through the synchronization of neurons and their entrainment in a regular firing pattern. In this process, networks of reciprocally connected inhibitory neurons are often involved, but what mechanism determines the oscillation frequency is not completely understood. Analytical studies predict that the emerging frequency band is primarily constrained by the decay rate of the unitary IPSC. We observed a new phenomenon of resonant synchronization in computer-simulated networks of inhibitory neurons in which the synaptic current has a delayed onset, reflecting finite spike propagation and synaptic transmission times. At the resonant level of network excitation, all neurons fire synchronously and rhythmically with a period approximately four times the mean delay of the onset of the inhibitory synaptic current. The amplitude and decay time constant of the synaptic current have relatively minor effects on the emerging frequency band. By varying the axonal delay of the inhibitory connections, networks with a realistic synaptic kinetics can be tuned to frequencies from 40 to >200 Hz. This resonance phenomenon arises in heterogeneous networks with, on average, as few as five connections per neuron. We conclude that the delay of the synaptic current is the primary parameter controlling the oscillation frequency of inhibitory networks and propose that delay-induced synchronization is a mechanism for fast brain rhythms that depend on intact inhibitory synaptic transmission.

Association of storage and processing functions in the dorsolateral prefrontal cortex of the nonhuman primate

The prominent role of the prefrontal cortex (PFC) in working memory (WM) is widely acknowledged both in nonhuman primates and in humans. However, less agreement exists on the issue of functional segregation within different subregions of the PFC with regard to the domains of spatial and nonspatial processing or involvement in simpler versus more complex aspects of WM, e.g., maintenance versus processing function. To address these issues, six monkeys were trained to perform four WM tasks that differed with respect to domain (spatial vs nonspatial) and level of WM demand (recall of one vs three items). The delayed response format was used to assess simple one-item memory, whereas self-ordering tasks were used to require the monkey to maintain and organize three items of information within WM. After training, the monkeys received bilateral PFC lesions in one of two different areas, Walker's areas 9 and 8B (dorsomedial convexity; n = 3) or areas 46 and 8A (dorsolateral cortex, n = 3) and then tested postoperatively on all tasks. Monkeys with lesions of the dorsomedial convexity were not impaired either on spatial or nonspatial WM tasks, whether the task required simple storage or sequential processing. By contrast, lesions of the dorsolateral cortex produced a significant and persistent impairment in both simple and complex spatial WM but no impairment in the two nonspatial WM tasks. These results support a functional segregation within the dorsolateral prefrontal cortex for WM: the dorsolateral prefrontal cortex (area 46/8A) is selectively involved in spatial WM, whereas the dorsomedial convexity (area 9/8B) is not critically engaged in either spatial or nonspatial working memory. Furthermore, the specific involvement of area 46/8A in spatial sequencing as well as in single-item storage WM tasks supports, in the nonhuman primate, an areal dissociation based on domain rather than on processing demand.

Dopamine and spatial working memory in rats and monkeys: pharmacological reversal of stress-induced impairment

The anxiogenic benzodiazepine inverse agonist FG7142 increases dopamine turnover in rodent prefrontal cortex but not in other dopamine terminal field areas. FG7142-induced increases in prefrontal cortical dopamine receptor stimulation impair prefrontal-dependent, but not nonprefrontal-dependent, cognitive tasks in rats and monkeys. The degree of impairment correlates with levels of prefrontal cortical dopamine turnover in rats and can be blocked in rats and monkeys with dopamine receptor antagonists, suggesting that increased dopamine turnover is directly related to the cognitive deficits. The current study examined nondopaminergic drug effects on FG7142-perturbed biochemistry and cognition. Both the noradrenergic alpha-2 agonist clonidine and the glycine/NMDA antagonist (+)HA966 prevented the FG7142-induced increase in dopamine turnover in rodent prefrontal cortex. Infusion of (+)HA966 into the ventral tegmental area (VTA) also blocked this increase in dopamine turnover, indicating that critical modulatory effects of (+)HA966 on FG7142-induced changes in dopamine turnover are occurring at the level of mesoprefrontal dopamine neuron cell bodies. Systemic (+)HA966 and clonidine, but not propranolol or D-cycloserine, prevented FG7142-associated spatial working memory deficits in rats and monkeys. These results support the idea of a critical range of dopamine turnover for optimal prefrontal cortical cognitive functioning, with excessive dopamine turnover leading to cognitive impairment. These studies also provide evidence for the regulation of prefrontal cortical dopamine turnover and cognition by multiple neurotransmitter systems and suggest that the VTA is an important regulatory site for these effects.