Cooperation under predation risk: a data-based ESS analysis

Two fish that jointly approach a predator in order to inspect it share the deadly risk of capture depending on the distance between them. Models are developed that seek ESS inspection distances of both single prey and pairs, based on experimental data of the risk that prey (sticklebacks) incur when they approach a predator (pike) to varying distances. Our analysis suggests that an optimal inspection distance can exist for a single fish, and for two equal fish behaving entirely cooperatively so as to maximize the fitness of the pair. Two equal fish inspecting cooperatively should inspect at an equal distance from the predator. The optimal distance is much closer to the predator for cooperative pairs than for single inspectors. However, optimal inspection for two equal fish behaving cooperatively operates across a rather narrow band of conditions relating to the benefits of cooperation. Evolutionarily stable inspection can also exist for two equal fish behaving non-cooperatively such that each acts to make a best reply (in terms of its personal fitness) to its opponent''s strategy. Non-cooperative pairs should also inspect at equal distance from the pike. Unlike the ''single fish'' and ''cooperative'' optima, which are unique inspection distances, there exists a range of ESS inspection distances. If either fish chooses to move to any point in this zone, the best reply of its opponent is to match it (move exactly alongside). Unilateral forward movement in the ''match zone'' may not be possible without some cooperation, but if the pair can ''agree'' to move forward synchronously, maintaining equal distance, inspection will occur at the nearest point in this zone to the predator. This ''near threshold'' is an ESS and is closer to the predator than the single fish optimum: pairs behaving almost selfishly can thus attain greater benefits from inspection by the protection gained from Hamilton''s dilution effect. That pairs should inspect more closely than single fish conforms with empirical findings. Phenotypic asymmetries in costs and benefits between the fish are not yet included in the model.     

A New Tradeoff Model for Fuzzy Supply Chain Network Design and Optimization

This article proposes a novel mixed integer linear programming model for solving a fuzzy supply chain network (SCN) design problem. This problem includes fuzzy parameters, choosing suppliers according to their quality of raw materials, and the supplier's engagement contracts. There is a tradeoff between raw material quality, and its purchasing and reprocessing costs. If a decision-maker (DM) wishes to work with a supplier that supplies a low-quality raw material, this raw material may be in need of reprocessing. To avoid the reprocessing costs, a supplier that provides a high-quality raw material can be chosen, but in this case the DM faces a high purchasing cost. An integrated fuzzy SCN system that consists of multiple suppliers, manufacturers, distribution centers, and retailers is considered in order to address problems under the aforementioned tradeoffs. Finally, concluding remarks and suggestions for future work are presented.     

基于在线供应链调查的产品生命周期评价

产品生命周期评价(LCA)中的供应链数据收集非常困难而且效率低下,因而在产品LCA研究中常常近似处理、甚至忽略供应链实际生产过程,严重影响了LCA的数据质量与可信度。开发专门的供应链数据收集工具是解决这一问题的有效途径。介绍了可进行在线供应链调查、建模与计算分析的LCA系统e Footprint,基于该系统提出了在线的LCA工作方法,通过长虹美菱冰箱的应用案例验证了系统与方法的可行性,为提高产品LCA的效率和质量提供了新的解决方案。     

Encoder-Decoder Optimization for Brain-Computer Interfaces

Neuroprosthetic brain-computer interfaces are systems that decode neural activity into useful control signals for effectors, such as a cursor on a computer screen. It has long been recognized that both the user and decoding system can adapt to increase the accuracy of the end effector. Co-adaptation is the process whereby a user learns to control the system in conjunction with the decoder adapting to learn the user''s neural patterns. We provide a mathematical framework for co-adaptation and relate co-adaptation to the joint optimization of the user''s control scheme ("encoding model") and the decoding algorithm''s parameters. When the assumptions of that framework are respected, co-adaptation cannot yield better performance than that obtainable by an optimal initial choice of fixed decoder, coupled with optimal user learning. For a specific case, we provide numerical methods to obtain such an optimized decoder. We demonstrate our approach in a model brain-computer interface system using an online prosthesis simulator, a simple human-in-the-loop pyschophysics setup which provides a non-invasive simulation of the BCI setting. These experiments support two claims: that users can learn encoders matched to fixed, optimal decoders and that, once learned, our approach yields expected performance advantages.     

Multiplicative Auditory Spatial Receptive Fields Created by a Hierarchy of Population Codes

A multiplicative combination of tuning to interaural time difference (ITD) and interaural level difference (ILD) contributes to the generation of spatially selective auditory neurons in the owl''s midbrain. Previous analyses of multiplicative responses in the owl have not taken into consideration the frequency-dependence of ITD and ILD cues that occur under natural listening conditions. Here, we present a model for the responses of ITD- and ILD-sensitive neurons in the barn owl''s inferior colliculus which satisfies constraints raised by experimental data on frequency convergence, multiplicative interaction of ITD and ILD, and response properties of afferent neurons. We propose that multiplication between ITD- and ILD-dependent signals occurs only within frequency channels and that frequency integration occurs using a linear-threshold mechanism. The model reproduces the experimentally observed nonlinear responses to ITD and ILD in the inferior colliculus, with greater accuracy than previous models. We show that linear-threshold frequency integration allows the system to represent multiple sound sources with natural sound localization cues, whereas multiplicative frequency integration does not. Nonlinear responses in the owl''s inferior colliculus can thus be generated using a combination of cellular and network mechanisms, showing that multiple elements of previous theories can be combined in a single system.     

What Is the Optimal Threshold at Which to Recommend Breast Biopsy?

Background

A 2% threshold, traditionally used as a level above which breast biopsy recommended, has been generalized to all patients from several specific situations analyzed in the literature. We use a sequential decision analytic model considering clinical and mammography features to determine the optimal general threshold for image guided breast biopsy and the sensitivity of this threshold to variation of these features.

Methodology/Principal Findings

We built a decision analytical model called a Markov Decision Process (MDP) model, which determines the optimal threshold of breast cancer risk to perform breast biopsy in order to maximize a patient’s total quality-adjusted life years (QALYs). The optimal biopsy threshold is determined based on a patient’s probability of breast cancer estimated by a logistic regression model (LRM) which uses demographic risk factors (age, family history, and hormone use) and mammographic findings (described using the established lexicon–BI-RADS). We estimate the MDP model''s parameters using SEER data (prevalence of invasive vs. in situ disease, stage at diagnosis, and survival), US life tables (all cause mortality), and the medical literature (biopsy disutility and treatment efficacy) to determine the optimal “base case” risk threshold for breast biopsy and perform sensitivity analysis. The base case MDP model reveals that 2% is the optimal threshold for breast biopsy for patients between 42 and 75 however the thresholds below age 42 is lower (1%) and above age 75 is higher (range of 3–5%). Our sensitivity analysis reveals that the optimal biopsy threshold varies most notably with changes in age and disutility of biopsy.

Conclusions/Significance

Our MDP model validates the 2% threshold currently used for biopsy but shows this optimal threshold varies substantially with patient age and biopsy disutility.     

A multiscale simulation framework for the manufacturing facility and supply chain of autologous cell therapies

Background aimsAutologous cell therapy (AuCT) is an emerging therapeutic treatment that is undergoing transformation from laboratory- to industry-scale manufacturing with recent regulatory approvals. Various challenges facing the complex AuCT manufacturing and supply chain process hinder the scale out and broader application of this highly potent treatment.MethodsWe present a multiscale logistics simulation framework, AuCT-Sim, that integrates novel supply chain system modeling algorithms, methods, and tools. AuCT-Sim includes a single facility model and a system-wide network model. Unique challenges of the AuCT industry are analyzed and addressed in AuCT-Sim. Decision-supporting tools can be developed based on this framework to explore “what-if” manufacturing and supply chain scenarios of importance to various cell therapy stakeholder groups.ResultsTwo case studies demonstrate the decision-supporting capability of AuCT-Sim where one investigates the optimal reagent base stocking level, and the other one simulates a reagent supply disruption event. These case studies serve as guidelines for designing computational experiments with AuCT-Sim to solve specific problems in AuCT manufacturing and supply chain.DiscussionThis simulation framework will be useful in understanding the impact of possible manufacturing and supply chain strategies, policies, regulations, and standards informing strategies to increase patient access to AuCT.     

Order quantity flexibility as a form of customer service in a supply chain contract model

This paper analyzes the Quantity-Flexibility (QF) contract, under which the buyer provides to the supplier information about expected future orders for the predetermined horizon and the supplier, in return, provides the buyer with the flexibility to adjust future orders later. Under this scheme, the flexibility profile of the contract can be perceived by the buyer as a form of customer service, by which the supplier commits to fulfil the buyer??s maximum likely order at the cost of the supplier??s inventory risk. The simulation results show that the benefit of the contract to either party clearly depends on the flexibility profile of the contract. For the supplier, there exists a trade-off between customer service level and inventory risk associated with the flexibility profile. However, for the buyer, the flexibility demonstrates a principle of diminishing returns, which is contrary to the general notion that buyers always prefer more order quantity flexibility. In fact, greater flexibility does not always translate into better customer service to buyers.     

Predicting the Risk of Rheumatoid Arthritis and Its Age of Onset through Modelling Genetic Risk Variants with Smoking

The improved characterisation of risk factors for rheumatoid arthritis (RA) suggests they could be combined to identify individuals at increased disease risks in whom preventive strategies may be evaluated. We aimed to develop an RA prediction model capable of generating clinically relevant predictive data and to determine if it better predicted younger onset RA (YORA). Our novel modelling approach combined odds ratios for 15 four-digit/10 two-digit HLA-DRB1 alleles, 31 single nucleotide polymorphisms (SNPs) and ever-smoking status in males to determine risk using computer simulation and confidence interval based risk categorisation. Only males were evaluated in our models incorporating smoking as ever-smoking is a significant risk factor for RA in men but not women. We developed multiple models to evaluate each risk factor''s impact on prediction. Each model''s ability to discriminate anti-citrullinated protein antibody (ACPA)-positive RA from controls was evaluated in two cohorts: Wellcome Trust Case Control Consortium (WTCCC: 1,516 cases; 1,647 controls); UK RA Genetics Group Consortium (UKRAGG: 2,623 cases; 1,500 controls). HLA and smoking provided strongest prediction with good discrimination evidenced by an HLA-smoking model area under the curve (AUC) value of 0.813 in both WTCCC and UKRAGG. SNPs provided minimal prediction (AUC 0.660 WTCCC/0.617 UKRAGG). Whilst high individual risks were identified, with some cases having estimated lifetime risks of 86%, only a minority overall had substantially increased odds for RA. High risks from the HLA model were associated with YORA (P<0.0001); ever-smoking associated with older onset disease. This latter finding suggests smoking''s impact on RA risk manifests later in life. Our modelling demonstrates that combining risk factors provides clinically informative RA prediction; additionally HLA and smoking status can be used to predict the risk of younger and older onset RA, respectively.     

Mutation accumulation may be a minor force in shaping life history traits

Is senescence the adaptive result of tradeoffs between younger and older ages or the nonadaptive burden of deleterious mutations that act at older ages? To shed new light on this unresolved question we combine adaptive and nonadaptive processes in a single model. Our model uses Penna''s bit-strings to capture different age-specific mutational patterns. Each pattern represents a genotype and for each genotype we find the life history strategy that maximizes fitness. Genotypes compete with each other and are subject to selection and to new mutations over generations until equilibrium in gene-frequencies is reached. The mutation-selection equilibrium provides information about mutational load and the differential effects of mutations on a life history trait - the optimal age at maturity. We find that mutations accumulate only at ages with negligible impact on fitness and that mutation accumulation has very little effect on the optimal age at maturity. These results suggest that life histories are largely determined by adaptive processes. The non-adaptive process of mutation accumulation seems to be unimportant at evolutionarily relevant ages.     

Cooperation under predation risk: experiments on costs and benefits

Two fish that cooperatively inspect a predator may have negotiated the share of the risk that each takes. A test of both the costs of predator inspection dependent on the distance from which the predator is approached and the potential benefits of cooperation was carried out strictly experimentally. We made either singletons or pairs of dead sticklebacks, Gasterosteus aculeatus, approach hungry pike, Esox lucius, by remote control according to an algorithm that mimicked natural inspection. The predation risk of both single inspectors and parallel inspecting pairs increased with closer inspection distances. A member of an inspecting pair had only about half the risk of that of a single inspector. In pairs, a companion diluted the lead fish''s risk of being caught, depending on its distance behind the leader. The absolute risk difference between leader and follower was greatest for close inspection distances and decreased further away from the predator. The leader''s relative risk increased with its distance ahead of the laggard. However, for a given distance between leader and laggard, the relative risks of the two fish remained similar with distance from the predator. The cost side of the inequalities that define a ''Prisoner''s Dilemma'' has thus been measured for this system. In a second experiment the ''attack deterrence hypothesis'' of predator inspection (i.e. inspection decreases attack probability) was tested. The pike was offered a choice between two sticklebacks, one of which had carried out a predator inspection visit. There was no indication of attack deterrence through predator inspection.     

The Anomalous Diffusion of a Tumor Invading with Different Surrounding Tissues

We simulated the invasion of a proliferating, diffusing tumor within different surrounding tissue conditions using a hybrid mathematical model. The in silico invasion of a tumor was addressed systematically for the first time within the framework of a generalized diffusion theory. Our results reveal that a tumor not only migrates using typical Fickian diffusion, but also migrates more generally using subdiffusion, superdiffusion, and even ballistic diffusion, with increasing mobility of the tumor cell when haptotaxis and chemotaxis toward the host tissue surrounding the proliferative tumor are involved. Five functional terms were included in the hybrid model and their effects on a tumor''s invasion were investigated quantitatively: haptotaxis toward the extracellular matrix tissue that is degraded by matrix metalloproteinases; chemotaxis toward nutrients; cell-cell adhesion; the proliferation of the tumor; and the immune response toward the tumor. Haptotaxis and chemotaxis, which are initiated by extracellular matrix and nutrient supply (i.e., glucose) respectively, as well as cell-cell adhesions all drastically affect a tumor''s diffusion mode when a tumor invades its surrounding host tissue and proliferates. We verified the in silico invasive behavior of a tumor by analyzing experimental data gathered from the in vitro culturing of different tumor cells and clinical imaging observations that used the same approach as was used to process the simulation data. The different migration modes of a tumor suggested by the simulations generally conform to the results observed in cell cultures and in clinical imaging. Our study not only discloses some migration modes of a tumor that proliferates and invades under different host tissues conditions, but also provides a heuristic method to characterize the invasion of a tumor in clinical medical imaging analysis.     

Choosing a mate in a high predation environment: Female preference in the fiddler crab Uca terpsichores

The interplay between a receiver's sensory system and a sender's courtship signals is fundamental to the operation of sexual selection. Male courtship signals that match a female receiver's preexisting perceptual biases can be favored yet the message they communicate is not always clear. Do they simply beacon the male's location or also indicate his quality? We explored this question in a species of fiddler crab Uca terpsichores that courts under elevated predation risk and that mates and breeds underground in the safety of males' burrows. Sexually receptive females leave their own burrows and are thereby exposed to avian predators as they sequentially approach several courting males before they choose one. Males court by waving their single greatly enlarge claw and sometimes by building a sand hood next to their burrow entrance. Hoods are attractive because they elicit a risk‐reducing orientation behavior in females, and it has been suggested that claw waving may also serve primarily to orient the female to the male. If the wave communicates male quality, then females should discriminate mates on the basis of variation in elements of the wave, as has been shown for other fiddler crabs. Alternatively, variation in elements of the claw waving display may have little effect on the display's utility as a beacon of the location of the male and his burrow. We filmed courting males and females under natural conditions as females responded to claw waving and chose mates. Analysis of the fine‐scale courtship elements between the males that females rejected and those they chose revealed no differences. When predation risk during courtship is high, males' courtship displays may serve primarily to guide females to safe mating and breeding sites and not as indicators of male quality apart from their roles as beacons.     

Bone Marrow-Derived Stem Cell (BMDSC) Transplantation Improves Fertility in a Murine Model of Asherman's Syndrome

Asherman''s Syndrome is characterized by intrauterine adhesions or fibrosis resulting as a consequence of damage to the basal layer of endometrium and is associated with infertility due to loss of normal endometrium. We have previously shown that bone marrow derived stem cells (BMDSCs) engraft the endometrium in mice and humans and Ischemia/reperfusion injury of uterus promoted BMDSCs migration to the endometrium; however, the role of BMDSCs in Asherman''s syndrome has not been characterized. Here a murine model of Asherman''s syndrome was created by traumatizing the uterus. We evaluate stem cell recruitment and pregnancy after BMDSCs transplantation in a model of Asherman''s syndrome. In the Asheman''s syndrome model, after BMDSC transplant, the Y chromosome bearing CD45-cells represented less than 0.1% of total endometrial cells. Twice the number of Y+CD45- cells was identified in the damaged uterus compared to the uninjured controls. There was no significant difference between the damaged and undamaged uterine horns in mice that received injury to a single horn. In the BMDSC transplant group, 9 of the 10 mice conceived, while only 3 of 10 in the non-transplanted group conceived (Chi-Square p = 0.0225); all mice in an uninjured control group conceived. The time to conception and mean litter size were not different between groups. Taken together, BMDSCs are recruited to endometrium in response to injury. Fertility improves after BMDSC transplant in Asherman''s Syndrome mice, demonstrating a functional role for these cells in uterine repair. BMDSC transplantation is a potential novel treatment for Asherman''s Syndrome and may also be useful to prevent Asherman''s syndrome after uterine injury.     

女性乳房血供及神经支配的应用解剖进展

乳房作为女性身体的一个重要器官,不仅具有孕育生命的作用,更是女性形体美最显著的标志。然而由于各种原因导致女性乳房的形态千差万别,这不仅严重影响了女性的形体美,而且会对女性带来各种轻重程度不等的身体不适,更严重者甚至会对女性的心理健康造成极大的影响。这就需要整形外科医生通过乳房整形手术重新塑造女性乳房的形态美。由于术后易发生皮瓣及乳头乳晕血供障碍、乳头乳晕区域支配神经的损伤以及乳房形态不佳,使得巨乳缩小整形术具有手术难度大,手术风险高,术后患者满意度较差的特点,成为乳房整形手术中的一大难点。究其原因,我们对于女性乳房的血供和神经支配,尤其是乳房内血管神经的具体走行和分支仍然未能了解得十分清晰。因此,开展乳房血供及神经支配的应用解剖研究,对于改良目前的乳房整形手术特别是巨乳缩小整形术术式,以降低手术相关并发症的发生率,具有及其重要的临床指导意义。本文主要从乳房的血供和神经支配两个方面,对乳房的应用解剖进展进行综述。     

Potent antitumoral activity of TRAIL through generation of tumor-targeted single-chain fusion proteins

In an attempt to improve TRAIL''s (tumor necrosis factor-related apoptosis-inducing ligand) tumor selective activity a variant was designed, in which the three TRAIL protomers are expressed as a single polypeptide chain (scTRAIL). By genetic fusion with a single-chain antibody fragment (scFv) recognizing the extracellular domain of ErbB2, we further equipped scTRAIL with tumor-targeting properties. We studied tumor targeting and apoptosis induction of scFv–scTRAIL in comparison with non-targeted scTRAIL. Importantly, the tumor antigen-targeted scTRAIL fusion protein showed higher apoptotic activity in vitro, with a predominant action by TRAIL-R2 signaling. Pharmacokinetic studies revealed increased plasma half-life of the targeted scTRAIL fusion protein compared with scTRAIL. In vivo studies in a mouse tumor model with xenotransplanted Colo205 cells confirmed greater response to the ErbB2-specific scTRAIL fusion protein compared with non-targeted scTRAIL both under local and systemic application regimen. Together, in vitro and in vivo data give proof of concept of higher therapeutic activity of tumor-targeted scFv–scTRAIL molecules. Further, we envisage that through targeting of scTRAIL, potential side effects should be minimized. We propose that scFv-mediated tumor targeting of single-chain TRAIL represents a promising strategy to improve TRAIL''s antitumoral action and to minimize potential unwanted actions on normal tissues.     

Sperm competition games: a prospective analysis of risk assessment.

We develop the logic of assessment of sperm competition risk by individual males where the mechanism of sperm competition follows a ''loaded raffle'' (first and second inseminates of a female have unequal prospects). Male roles (first or second to mate) are determined randomly. In model 1, males have no information about the risk associated with individual females and ejaculation strategy depends only on the probability, q, that females mate twice. Evolutionarily stable strategy (ESS) ejaculate expenditure increases linearly from zero with q, and reduces with increasing inequality between ejaculates, though the direction of the loading (which role is favoured) is unimportant. In model 2, males have perfect information and can identify each of three risk states: females that will (1) mate just once (''no risk''), (2) mate twice but have not yet mated (''future risk''), and (3) mate twice and have already mated (''past risk''). The ESS is to ejaculate minimally with ''no risk'' females, and to expand equally with ''past'' and ''future'' risk females; the direction of the competitive loading is again unimportant. Expenditure again increases with risk, but is now non-zero at extremely low risk. Model 3 examines three cases of partial information where males can identify only one of the three risk states and cannot distinguish between the other two: they therefore have just two information sets or ''contexts''. Expenditure in both contexts typically rises non-linearly from zero with q, but (whatever the loading direction) expenditure is higher in the context with higher risk (e.g. if contexts are ''mated'' and ''virgin'', males spend more with mated females). However, in highly loaded raffles, sperm expenditure can decrease over part of the range of risk. Also, the direction of the loading now affects expenditure. Biological evidence for the predictions of the models is summarized and discussed.     

The Viscoelastic Properties of Passive Eye Muscle in Primates. II: Testing the Quasi-Linear Theory

We have extensively investigated the mechanical properties of passive eye muscles, in vivo, in anesthetized and paralyzed monkeys. The complexity inherent in rheological measurements makes it desirable to present the results in terms of a mathematical model. Because Fung''s quasi-linear viscoelastic (QLV) model has been particularly successful in capturing the viscoelastic properties of passive biological tissues, here we analyze this dataset within the framework of Fung''s theory.We found that the basic properties assumed under the QLV theory (separability and superposition) are not typical of passive eye muscles. We show that some recent extensions of Fung''s model can deal successfully with the lack of separability, but fail to reproduce the deviation from superposition.While appealing for their elegance, the QLV model and its descendants are not able to capture the complex mechanical properties of passive eye muscles. In particular, our measurements suggest that in a passive extraocular muscle the force does not depend on the entire length history, but to a great extent is only a function of the last elongation to which it has been subjected. It is currently unknown whether other passive biological tissues behave similarly.     

Activation of Parallel Fiber Feedback by Spatially Diffuse Stimuli Reduces Signal and Noise Correlations via Independent Mechanisms in a Cerebellum-Like Structure

Correlations between the activities of neighboring neurons are observed ubiquitously across systems and species and are dynamically regulated by several factors such as the stimulus'' spatiotemporal extent as well as by the brain''s internal state. Using the electrosensory system of gymnotiform weakly electric fish, we recorded the activities of pyramidal cell pairs within the electrosensory lateral line lobe (ELL) under spatially localized and diffuse stimulation. We found that both signal and noise correlations were markedly reduced (>40%) under the latter stimulation. Through a network model incorporating key anatomical features of the ELL, we reveal how activation of diffuse parallel fiber feedback from granule cells by spatially diffuse stimulation can explain both the reduction in signal as well as the reduction in noise correlations seen experimentally through independent mechanisms. First, we show that burst-timing dependent plasticity, which leads to a negative image of the stimulus and thereby reduces single neuron responses, decreases signal but not noise correlations. Second, we show trial-to-trial variability in the responses of single granule cells to sensory input reduces noise but not signal correlations. Thus, our model predicts that the same feedback pathway can simultaneously reduce both signal and noise correlations through independent mechanisms. To test this prediction experimentally, we pharmacologically inactivated parallel fiber feedback onto ELL pyramidal cells. In agreement with modeling predictions, we found that inactivation increased both signal and noise correlations but that there was no significant relationship between magnitude of the increase in signal correlations and the magnitude of the increase in noise correlations. The mechanisms reported in this study are expected to be generally applicable to the cerebellum as well as other cerebellum-like structures. We further discuss the implications of such decorrelation on the neural coding strategies used by the electrosensory and by other systems to process natural stimuli.     

Three-tiered risk stratification model to predict progression in Barrett's esophagus using epigenetic and clinical features

Background

Barrett''s esophagus predisposes to esophageal adenocarcinoma. However, the value of endoscopic surveillance in Barrett''s esophagus has been debated because of the low incidence of esophageal adenocarcinoma in Barrett''s esophagus. Moreover, high inter-observer and sampling-dependent variation in the histologic staging of dysplasia make clinical risk assessment problematic. In this study, we developed a 3-tiered risk stratification strategy, based on systematically selected epigenetic and clinical parameters, to improve Barrett''s esophagus surveillance efficiency.

Methods and Findings

We defined high-grade dysplasia as endpoint of progression, and Barrett''s esophagus progressor patients as Barrett''s esophagus patients with either no dysplasia or low-grade dysplasia who later developed high-grade dysplasia or esophageal adenocarcinoma. We analyzed 4 epigenetic and 3 clinical parameters in 118 Barrett''s esophagus tissues obtained from 35 progressor and 27 non-progressor Barrett''s esophagus patients from Baltimore Veterans Affairs Maryland Health Care Systems and Mayo Clinic. Based on 2-year and 4-year prediction models using linear discriminant analysis (area under the receiver-operator characteristic (ROC) curve: 0.8386 and 0.7910, respectively), Barrett''s esophagus specimens were stratified into high-risk (HR), intermediate-risk (IR), or low-risk (LR) groups. This 3-tiered stratification method retained both the high specificity of the 2-year model and the high sensitivity of the 4-year model. Progression-free survivals differed significantly among the 3 risk groups, with p = 0.0022 (HR vs. IR) and p<0.0001 (HR or IR vs. LR). Incremental value analyses demonstrated that the number of methylated genes contributed most influentially to prediction accuracy.

Conclusions

This 3-tiered risk stratification strategy has the potential to exert a profound impact on Barrett''s esophagus surveillance accuracy and efficiency.