Simple sequential boundaries for treatment selection in multi-armed randomized clinical trials with a control

Summary .   In situations when many regimens are possible candidates for a large phase III study, but too few resources are available to evaluate each relative to the standard, conducting a multi-armed randomized selection trial is a useful strategy to remove inferior treatments from further consideration. When the study has a relatively quick endpoint such as an imaging-based lesion volume change in acute stroke patients, frequent interim monitoring of the trial is ethically and practically appealing to clinicians. In this article, I propose a class of sequential selection boundaries for multi-armed clinical trials, in which the objective is to select a treatment with a clinically significant improvement upon the control group, or to declare futility if no such treatment exists. The proposed boundaries are easy to implement in a blinded fashion, and can be applied on a flexible monitoring schedule in terms of calendar time. Design calibration with respect to prespecified levels of confidence is simple, and can be accomplished when the response rate of the control group is known only up to an interval. One of the proposed methods is applied to redesign a selection trial with an imaging endpoint in acute stroke patients, and is compared to an optimal two-stage design via simulations: The proposed method imposes smaller sample size on average than the two-stage design; this advantage is substantial when there is in fact a superior treatment to the control group.     

A comparison of methods for adaptive treatment selection

Traditionally drug development is generally divided into three phases which have different aims and objectives. Recently so-called adaptive seamless designs that allow combination of the objectives of different development phases into a single trial have gained much interest. Adaptive trials combining treatment selection typical for Phase II and confirmation of efficacy as in Phase III are referred to as adaptive seamless Phase II/III designs and are considered in this paper. We compared four methods for adaptive treatment selection, namely the classical Dunnett test, an adaptive version of the Dunnett test based on the conditional error approach, the combination test approach, and an approach within the classical group-sequential framework. The latter two approaches have only recently been published. In a simulation study we found that no one method dominates the others in terms of power apart from the adaptive Dunnett test that dominates the classical Dunnett by construction. Furthermore, scenarios under which one approach outperforms others are described.     

Fast and sensitive delineation of brain tumor with clinically compatible moxifloxacin labeling and confocal microscopy

Delineation of brain tumor margins during surgery is critical to maximize tumor removal while preserving normal brain tissue to obtain optimal clinical outcomes. Although various imaging methods have been developed, they have limitations to be used in clinical practice. We developed a high‐speed cellular imaging method by using clinically compatible moxifloxacin and confocal microscopy for sensitive brain tumor detection and delineation. Moxifloxacin is a Food and Drug Administration (FDA) approved antibiotic and was used as a cell labeling agent through topical administration. Its strong fluorescence at short visible excitation wavelengths allowed video‐rate cellular imaging. Moxifloxacin‐based confocal microscopy (MBCM) was characterized in normal mouse brain specimens and visualized their cytoarchitecture clearly. Then, MBCM was applied to both brain tumor murine models and two malignant human brain tumors of glioblastoma and metastatic cancer. MBCM detected tumors in all the specimens by visualizing dense and irregular cell distributions, and tumor margins were easily delineated based on the cytoarchitecture. An image analysis method was developed for automated detection and delineation. MBCM demonstrated sensitive delineation of brain tumors through cytoarchitecture visualization and would have potentials for human applications, such as a surgery‐guiding method for tumor removal.      

序贯血液净化对严重创伤合并MODS患者炎性因子以及血流动力学的影响

目的:探讨序贯血液净化(SBP)对严重创伤合并多器官功能障碍综合征(MODS)患者血清炎性因子及血流动力学的影响。方法:选取2015年7月-2017年5月第三军医大学新桥医院收治的严重创伤合并MODS患者48例,根据患者的治疗方式分为对照组21例以及观察组27例,其中对照组接受常规内科治疗,观察组在对照组的基础上进行SBP治疗,在治疗前后对两组患者的肝肾功能、血清炎性因子水平、血流动力学指标进行检测,并对比两组患者ICU住院时间、病死率、机械通气时间。结果:治疗后两组患者的总胆红素(TBIL)、直接胆红素(DBIL)、谷草转氨酶(AST)、谷丙转氨酶(ALT)、血尿素氮(BUN)、肌酐(Cr)水平均较治疗前降低,且治疗后观察组患者各指标低于对照组(P0.05);治疗后两组患者血清C反应蛋白(CRP)、白介素-6(IL-6)、白介素-1β(IL-1β)、肿瘤坏死因子-α(TNF-α)水平均较治疗前显著降低,且治疗后观察组患者各炎性因子水平显著低于对照组(P0.05);治疗后两组患者的心率(HR)、中心静脉压(CVP)较治疗前降低,平均动脉压(MAP)、心脏指数(CI)较治疗前升高,且治疗后观察组患者的HR、CVP显著低于对照组,MAP、CI显著高于对照组(P0.05);观察组患者的ICU住院时间、机械通气时间均较对照组缩短,病死率较对照组明显降低(P0.05)。结论:SBP应用于严重创伤合并MODS患者的治疗可以有效减轻患者的炎性反应,并可以显著改善患者血流动力学以及预后。     

Distinguishing three subtypes of hematopoietic cells based on gene expression profiles using a support vector machine

Hematopoiesis is a complicated process involving a series of biological sub-processes that lead to the formation of various blood components. A widely accepted model of early hematopoiesis proceeds from long-term hematopoietic stem cells (LT-HSCs) to multipotent progenitors (MPPs) and then to lineage-committed progenitors. However, the molecular mechanisms of early hematopoiesis have not been fully characterized. In this study, we applied a computational strategy to identify the gene expression signatures distinguishing three types of closely related hematopoietic cells collected in recent studies: (1) hematopoietic stem cell/multipotent progenitor cells; (2) LT-HSCs; and (3) hematopoietic progenitor cells. Each cell in these cell types was represented by its gene expression profile among a total number of 20,475 genes. The expression features were analyzed by a Monte-Carlo Feature Selection (MCFS) method, resulting in a feature list. Then, the incremental feature selection (IFS) and a support vector machine (SVM) optimized with a sequential minimum optimization (SMO) algorithm were employed to access the optimal classifier with the highest Matthews correlation coefficient (MCC) value of 0.889, in which 6698 features were used to represent cells. In addition, through an updated program of MCFS method, seventeen decision rules can be obtained, which can classify the three cell types with an overall accuracy of 0.812. Using a literature review, both the rules and the top features used for building the optimal classifier were confirmed to be commonly used or potential biological markers for distinguishing the three cell types of HSPCs. This article is part of a Special Issue entitled: Accelerating Precision Medicine through Genetic and Genomic Big Data Analysis edited by Yudong Cai & Tao Huang.     

Temporally changing male reproductive success and resource allocation strategy in protandrousHeracleum lanatum (Apiaceae)

Few observations have been made on temporal changes in the siring success of flowers in the male stage. In this study, we estimated both male and female contributions to fitness for 21 plants of protandrous andromonoeciosHeracleum lanatum with differing dates of first flowering. The results of multiple regression analysis showed that total male fitness significantly increases with the advance of the first-flowering date but does not depend upon plant size, whereas female fitness increases with plant size but does not depend upon the first-flowering date. We also showed that the earlier-flowering plants have more late-blooming male flowers in their secondary umbels. Based on these results, we suggest that polymorphism of the early- and late-bloomers may be maintained by frequency-dependent selection through temporally changing male reproductive success.