Bayesian estimation of two-part joint models for a longitudinal semicontinuous biomarker and a terminal event with INLA: Interests for cancer clinical trial evaluation

Two-part joint models for a longitudinal semicontinuous biomarker and a terminal event have been recently introduced based on frequentist estimation. The biomarker distribution is decomposed into a probability of positive value and the expected value among positive values. Shared random effects can represent the association structure between the biomarker and the terminal event. The computational burden increases compared to standard joint models with a single regression model for the biomarker. In this context, the frequentist estimation implemented in the R package frailtypack can be challenging for complex models (i.e., a large number of parameters and dimension of the random effects). As an alternative, we propose a Bayesian estimation of two-part joint models based on the Integrated Nested Laplace Approximation (INLA) algorithm to alleviate the computational burden and fit more complex models. Our simulation studies confirm that INLA provides accurate approximation of posterior estimates and to reduced computation time and variability of estimates compared to frailtypack in the situations considered. We contrast the Bayesian and frequentist approaches in the analysis of two randomized cancer clinical trials (GERCOR and PRIME studies), where INLA has a reduced variability for the association between the biomarker and the risk of event. Moreover, the Bayesian approach was able to characterize subgroups of patients associated with different responses to treatment in the PRIME study. Our study suggests that the Bayesian approach using the INLA algorithm enables to fit complex joint models that might be of interest in a wide range of clinical applications.     

右美托咪定联合经皮穴位电刺激对混合痔剥扎术后患者肠胃功能及术后疼痛的影响

摘要 目的：探讨右美托咪定联合经皮穴位电刺激对混合痔剥扎术后患者肠胃功能及术后疼痛的影响。方法：选择2022年3月-2022年7月我院行混合痔剥扎术的患者60例,将60例患者随机分为对照组（30例）与观察组（30例）,对照组患者给予右美托咪定镇痛,观察组给予术前经皮穴位电刺激,时间为手术开始前2 min至手术结束,右美托咪定使用方法、剂量同对照组。对比两组患者术前、术后0.5 h、1 h、2 h、3 h的疼痛评分,对比两组患者的术后疼痛疗效,对比两组创面愈合时间、腐肉完全脱落时间、住院时间及胃肠功能恢复情况,对比两组术前、术后的血管活性肠肽、胃动素及胃泌素水平。结果：术前及术后3 h时,两组的疼痛评分对比无统计学意义（P>0.05）;术后0.5 h、1 h、2 h时,观察组的疼痛评分明显较对照组低（P<0.05）。观察组的术后疼痛有效率明显较对照组高,P<0.05。观察组的创面愈合时间、腐肉完全脱落时间及住院时间明显较对照组低（P<0.05）。观察组的肠鸣音恢复时间、术后恶心呕吐发生率及排气时间明显较对照组短（P<0.05）。术前,两组的血管活性肠肽、胃动素及胃泌素水平对比无统计学意义（P>0.05）;术后,两组血管活性肠肽、胃泌素水平升高,胃动素水平降低,且观察组变化幅度明显较对照组低（P<0.05）。结论：右美托咪定联合经皮穴位电刺激可改善混合痔剥扎术后患者肠胃功能及术后疼痛情况。     

针刺对术后胃肠功能紊乱大鼠胃肠传输功能及脑肠肽的影响

摘要 目的：探讨针刺三里穴、中脘对大鼠胃大部切除术后胃肠传输功能恢复的影响及可能的作用机制。方法：将60只 SD 大鼠随机分为空白组、模型组和针刺组,每组 20 只。造模成功后第3天开始,针刺组进行针刺足三里、中脘,连续治疗14天。于末次针刺结束后,各组记录进食量、体重等;后各组禁食24 h后进行胃残留率和小肠推进率测定,腹主动脉取血测定胃泌素、胃动素、食欲素A及食欲素1型受体。结果：造模前,三组大鼠体重和进食量差异无统计学意义,P>0.05。造模后3天,模型组及针刺组体重和进食量低于空白组,差异有统计学意义,P<0.05。针刺干预后,模型组体重和进食量低于空白组和针刺组,差异有统计学意义,P<0.05。针刺干预后,针刺组大鼠胃残留率、小肠推进率、胃泌素、胃动素、食欲素A及食欲素1型受体高于模型组,差异有统计学意义,P<0.05;模型组胃残留率、小肠推进率、胃泌素、胃动素、食欲素A及食欲素1型受体低于空白组,差异有统计学意义,P<0.05;针刺组与空白组胃残留率、小肠推进率、胃泌素、胃动素、食欲素A及食欲素1型受体差异无统计学意义,P>0.05。结论：针刺胃大部切除术后大鼠足三里穴、中脘穴,改善胃排空和小肠推进功能,促进术后胃肠功能的恢复,其作用机制可能为改变脑肠肽代谢,增加食欲素A水平,激活食欲素1型受体,促进胃泌素、胃动素分泌。     

乳腺良恶肿瘤患者超声弹性成像定量参数与临床分期、病理分子分型的相关性分析

摘要 目的：探讨乳腺良恶肿瘤患者超声弹性成像定量参数与临床分期、病理分子分型的相关性。方法：选择2020年1月至2022年12月来我院诊治的乳腺肿块患者85例,均行超声弹性成像检查,分析85例乳腺肿块患者的病理检查结果,对比良恶性肿瘤患者的弹性成像参数,对弹性应变率、直径变化率、面积比及三者联合绘制ROC曲线,分析不同乳腺肿瘤患者临床分期的弹性成像参数,分析乳腺肿瘤患者病理分子分型的弹性成像参数。结果：85例乳腺肿块患者中,良性肿块35例,恶性肿块50例。恶性组的弹性应变率、肿块直径、直径变化率、肿块面积、面积比明显较良性组低（P<0.05）。面积比ROC曲线AUC为0.580,以1.73为临界值,乳腺恶性肿瘤的诊断灵敏度为73.5 %,特异度为38.5 %;直径变化率ROC曲线AUC为0.630,以0.28为临界值,诊断灵敏度为75.5 %,特异度为47.5 %;弹性应变率ROC曲线AUC为0.790,以15.2 cm²为临界值,诊断灵敏度为64.5 %,特异度为83.5 %,以三者联合绘制ROC曲线,AUC为0.920,诊断灵敏度为82.5 %,特异度为92.5 %。乳腺恶性肿瘤患者TNM分期Ⅰ、Ⅱ、Ⅲ、Ⅳ期者的弹性应变率、肿块直径、直径变化率、肿块面积、面积比对比有统计学意义（P<0.05）;其中Ⅳ期者的弹性应变率、肿块直径、直径变化率、肿块面积、面积比明显较Ⅲ、Ⅱ、Ⅰ期者高,Ⅲ期者明显较Ⅱ、Ⅰ期者高,Ⅱ期者明显较Ⅰ期高。乳腺恶性肿瘤患者Luminal A型者、Liminal B型者、Her2过表达型者、基底样型者的弹性应变率、肿块直径、直径变化率、肿块面积、面积比对比有统计学意义（P<0.05）;其中Liminal B型者的弹性应变率、肿块直径、直径变化率、肿块面积、面积比明显较Luminal A型者、Her2过表达型者、基底样型者高,Her2过表达型者明显较Luminal A型者、基底样型者高（P均<0.05）,Luminal A型者与基底样型者对比无统计学意义（P>0.05）。结论：超声弹性成像可用于乳腺良恶肿瘤的诊断,超声弹性成像定量参数可用于恶性乳腺肿瘤临床分期、Liminal B型、Her2过表达型的判断。     

Establishment and characterization of a novel human myoepithelial cell line and matrix-producing xenograft from a parotid basal cell adenocarcinoma

Summary Myoepithelial cells exert important paracrine effects on epithelial morphogenesis and mitogenesis through direct cell-cell interactions and through synthesis of a basement membrane extracellular matrix. To study these effects further, this study established the first immortalized human myoepithelial cell line, HMS-1, and transplantable xenograft, HMS-X, from the rare parotid basal cell adenocarcinoma. The cell line exhibited a fully differentiated myoepithelial phenotype and the xenograft exhibited the rare property of accumulating an abundant extracellular matrix composed of both basement membrane and nonbasement membrane components with the latter predominating. With HMS-1 as a feeder layer, dramatic and specific induction of epithelial morphogenesis (sheroid formation) occurred with selected normal epithelial and primary carcinoma target cells. HMS-1 and HMS-X provide distinct advantages over the conventional murine matrices in existence. They will be invaluable in future studies of human tumor-myoepithelial and matrix interactions important for tumor cell growth, invasion, and metastasis.     

The effect of thyrotropin releasing hormone and morphine on gastrointestinal transit

The effect of thyrotropin releasing hormone (TRH) alone and in combination with morphine on the gastrointestinal transit was investigated by using the charcoal meal test in mice. The intraperitoneal (IP) administration of TRH decreased the transit when given in a dose of 1.0 mg/kg 10 min prior to the meal. The intracerebroventricular (ICV) administration of TRH (10 μg/mouse) also inhibited the transit when given just prior to the charcoal meal. Subcutaneous (SC) administration of morphine (5, 10 and 20 mg/kg) inhibited gastrointestinal transit in a dose dependent manner. When TRH (1, 3 and 10 mg/kg, IP as well as 0.3 μg, ICV) which had no effect on the transit by itself was combined with morphine (10 mg/kg, SC), an enhancement in the inhibition of the transit was observed. TRH-induced inhibition of the transit was antagonized by naloxone (0.1 mg/kg, SC). It is concluded that TRH inhibits gastrointestinal transit in the mouse possibly via the opiate receptor system.     

The distribution and cellular origin of vasoactive intestinal polypeptide in the avian gastrointestinal tract and pancreas

Summary The distribution and origins of vasoactive intestinal peptide (VIP) in the gut and pancreas of the turkey were studied by radioimmunoassay of tissue extracts and by immunocytochemistry. Several antisera were used that vary in their specificity for different regions of porcine or chicken VIP. Radioimmunoassays using NH₂-terminal specific antisera that react almost equally with porcine and chicken VIP's revealed significant amounts of immunoreactive VIP in extracts of pancreas, brain and all regions of the gastrointestinal tract from crop to colon. Highest concentrations (300pmol/g) were found in the colon muscle, and concentrations were generally low (< 20 pmol/g) in the mucosal layers of the small intestine. After ion exchange chromatography of extracts on CM-Sephadex three immunoreactive forms of VIP were separated corresponding to the three molecular forms previously found in mammalian gut extracts. In immunocytochemical studies nerve fibres were found throughout the gut, and in the pancreas. Immunoreactive nerve cell bodies were also identified in the submucous plexus throughout the gut, but were particularly prominent in the oesophagus and pancreas. It has previously been shown that VIP is a strong stimulant of the flow of pancreatic juice in birds whereas the structurally related hormone secretin, which is known to control the flow of pancreatic juice in mammals, is a weak stimulant. It is proposed that in birds VIP might regulate the pancreas, and other aspects of gut function, as a neurotransmitter or neurohormone.     

Gastrointestinal somatostatin cells in the human fetus

Summary The stomach, duodenum, jejunum and ileum from 6 to 24 week-old human fetuses or deceased premature infants and from one totally anencephalic fetus were stained with antisomatostatin serum. The somatostatin containing cells appear in different segments of the gastrointestinal tract from the tenth week of gestation. The somatostatin-containing cells are lead haematoxylin positive. Somatostatin was also detected in the duodenum of the anencephalic fetus. The study of inhibition of the immunofluorescent reaction by homologous and heterologous antigens confirmed the specificity of antiserum.These data demonstrate that somatostatin can be synthetized elsewhere than in the hypothalamus.We are indebted to Professor P. Magnin, Hôpital Edouard Herriot, Professor M. Dumont, Hôpital de la Croix-Rousse, Professor Notter and Professor Garmier, Hôtel Dieu, Professor M. Bethenod, Hôpital Debrousse, Lyon, whose kind cooperation allowed us to carry out the rapid removal of gastrointestinal tracts for these studies. We thank Professor Assan, Hôtel Dieu, Paris and Professor Lambert U. 45, Inserm, Lyon, who graciously provided us with antisera. We also wish to express our gratitude to Professor Roger Guillemin, The Salk Institute, La Jolla, California, whose interest and cooperation made these studies possible.This work was supported by a grant of the Institut National de la Santé et de la Recherche Médicale.     

Design,synthesis and biological evaluation of coumarin-3-carboxamides as selective carbonic anhydrase IX and XII inhibitors

A series of novel 7-hydroxycoumarin-3-carboxamides was synthesized by the reaction of 7-hydroxy-2-oxo-2H-chromene-3-carboxylic acid with various substituted aromatic amines. The newly synthesized compounds were evaluated for their inhibitory activity against the four physiologically relevant human carbonic anhydrase (hCA, EC 4.2.1.1) isoforms CA I, CA II, CA IX and CA XII. The CA inhibition results show that the newly synthesized 7-hydroxycoumarin-3-carboxamides (4a-n) exhibited selective inhibition of the tumor associated isoforms, CA IX and CA XII over CA I and II isoforms. The inhibition constants ranged from sub micromolar to low micromolar. Amongst all the compounds tested, compound 4m was the most effective inhibitor exhibiting sub micromolar potency against both hCA IX and hCA XII, with a K_i of 0.2 µM. Therefore, it can be anticipated that compound 4m can serve as a lead for development of anticancer therapy by exhibiting a novel mechanism of action. The binding modes of the most potent compounds within hCA IX and XII catalytic clefts were investigated by docking studies.