Timeline to dysphagia resolution after endoscopic intervention of an interarytenoid defect based on Video Fluoroscopic Swallow Study dysphagia severity.

INTRODUCTION: We previously reported that endoscopic repair of a Type 1 Laryngeal Cleft (LC1) or Deep Interarytenoid Groove (DIG) improves swallowing function postoperatively. However, caregivers often ask about the timeline to resolution of the need for thickening. This study re-examines this cohort to answer this important caregiver-centered question. METHODS: We reassessed a 3-year retrospective, single-center dataset of children with dysphagia found to have a LC-1 or DIG on endoscopic exam. The primary outcome was rate of complete resolution of dysphagia at 2, 6, and 12 months after endoscopic intervention. A sub-group analysis was made based on severity of dysphagia prior to intervention and by type of endoscopic repair. RESULTS: Thirty-nine patients with mean age 1.35 years that had a LC-1 or DIG met criteria for inclusion. Rate of complete dysphagia resolution increased over time. Those with mild dysphagia (flow-reducing nipple and/or IDDSI consistency 1 or 2) had brisker resolution than those with moderate dysphagia (IDDSI consistency 3 or 4) at 2 months (67% vs 5%, p < 0.01) and at 6 months (80% vs 18%, p < 0.01) after endoscopic repair. There was no difference in dysphagia resolution between patients grouped by type of endoscopic repair. CONCLUSION: Addressing an interarytenoid defect in patients will not result in immediate, complete dysphagia resolution in most patients. However, patients that only require a flow-reducing nipple and/or thickening to an IDDSI consistency 1 or 2 have brisker resolution of the need for thickening than those that require an IDSSI consistency 3 or 4 prior to intervention. These results inform pre-operative discussions of the timeline to resolution based upon severity of dysphagia and help manage caregiver expectations.

Longitudinal Exposure-Response Modeling of Multiple Indicators of Alzheimer's Disease Progression.

BACKGROUND: Progression in Alzheimer's disease manifests as changes in multiple biomarker, cognitive, and functional endpoints. Disease progression modeling can be used to integrate these multiple measures into a synthesized metric of where a patient lies within the disease spectrum, allowing for a more dynamic measure over the range of the disease. OBJECTIVES: This study aimed to combine modeling techniques from psychometric research (e.g., item response theory) and pharmacometrics (e.g., hierarchical models) to describe the multivariate longitudinal disease progression for patients with mild-to-moderate Alzheimer's disease. Additionally, we aimed to extend the subsequent model to make it suitable for clinical trial simulation, with the inclusion of covariates, to explain variability in latent progression (i.e., disease progression) and to aid in the assessment of enrichment strategies. DESIGN: Multiple longitudinal endpoints in the Alzheimer's Disease Neuroimaging Initiative database were modeled. This model was validated internally using visual predictive checks, and externally by comparing data from the placebo arms of two Phase 2 crenezumab studies, ABBY (NCT01343966) and BLAZE (NCT01397578). SETTING: The Alzheimer's Disease Neuroimaging Initiative began in 2004: the initial 5-year study (ADNI-1) was extended by 2 years in 2009 by a Grand Opportunities grant (ADNI-GO), and in 2011 and 2016 by further competitive renewals of the ADNI-1 grant (ADNI-2 and ADNI-3, respectively). This work studies natural progression data from patients with confirmed Alzheimer's disease. The Phase 2 ABBY and BLAZE trials evaluated the safety and efficacy of crenezumab in patients with mild-to-moderate Alzheimer's disease. PARTICIPANTS: From the Alzheimer's Disease Neuroimaging Initiative database, 305 subjects who had a baseline diagnosis of mild-to-moderate Alzheimer's disease were included in modeling. From the ABBY and BLAZE studies, 158 patients were included from the studies' placebo arms. MEASUREMENTS: Longitudinal cognitive and functional assessments modeled included the Clinical Dementia Rating (both as Sum of Boxes and individual item scores), the Mini-Mental State Examination, the Alzheimer's Disease Assessment Scale - Cognitive Subscale, the Functional Activities Questionnaire, the Montreal Cognitive Assessment, and the Rey Auditory Verbal Learning Test. Also included were the imaging variable fluorodeoxyglucose-positron emission tomography and the following magnetic resonance imaging volumetrics: entorhinal, fusiform, hippocampal, intra-cranial, mid-temporal, ventricular, and whole brain. RESULTS: Applying item response theory approaches in this longitudinal setting showed clinical assessments informing a common disease scale in the following order (from early disease to late disease): Rey Auditory Verbal Learning Test, Functional Activities Questionnaire, Montreal Cognitive Assessment, Alzheimer's Disease Assessment Scale - Cognitive Subscale 12, Clinical Dementia Rating - Sum of Boxes, and Mini-Mental State Examination. The Clinical Dementia Rating communication and home-and-hobbies items were most informative at earlier disease stages, while memory, orientation, and personal care informed the disease status at later stages. A clinical trial simulation model was developed and accurately described within-sample longitudinal distribution of endpoints. Simplifying the model to use only baseline age, MMSE, and APOEε4 status as predictors, out-of-sample mean progression of ADAS-Cog and CDR Sum of Boxes in the ABBY and BLAZE placebo arms was accurately described; however, the variability in these endpoints was underpredicted and suggests possibility for further model refinement when extrapolating from the ADNI sample to trial data. Clinical trial simulations were performed to exemplify use of the model to investigate hypothetical disease modification effects on the multivariate, longitudinal progression on the Alzheimer's Disease Assessment Scale - Cognitive Subscale and the Clinical Dementia Rating - Sum of Boxes. CONCLUSIONS: The latent variable structure of item response theory can be extended to capture a variety of scales that are common assessments and indicators of disease status in mild-to-moderate Alzheimer's disease. These models are not intended to support causal inferences, but they do successfully characterize the observed correlation between endpoints over time and result in concise numerical indices of disease status that reflect the totality of evidence from considering the endpoints jointly. As such, the models have utility for a variety of tasks in clinical trial design, including simulation of hypothetical drug effects, interpolation of missing data, and assessment of in-sample information.

The future is now: model-based clinical trial design for Alzheimer's disease.

Failures in trials for Alzheimer's disease (AD) may be attributable to inadequate dosing, population selection, drug inefficacy, or insufficient design optimization. The Coalition Against Major Diseases (CAMD) was formed in 2008 to develop drug development tools (DDT) to expedite drug development for AD and Parkinson's disease. CAMD led a process that successfully advanced a clinical trial simulation (CTS) tool for AD through the formal regulatory review process at the US Food and Drug Administration (FDA) and European Medicines Agency (EMA).

A cell simulator platform: the cell collective.

Diseases are often a result of multiple malfunctions in complex, nonlinear biological/biochemical networks. As such, these processes are far more complicated to understand because they tend to give rise to functions that are emergent in nature, i.e., higher-level (mal)functions that are more than the sum of their parts. Systems biology provides a new approach to understanding biological systems and diseases from a holistic perspective.

Interaction of insulin, cholesterol-derivatized mannan, and carboxymethyl chitin with liposomes: A differential scanning calorimetry study.

The interaction of drugs and polymers used to incorporate in or surface modify/coat the liposomes can affect the phase transition, fluidity and other physical properties as well as in vivo fate of vesicles. In this study, differential scanning calorimetry (DSC) was used to investigate changes in the temperature and the enthalpy of phase transition of liposomes of various electrical charges following interaction with carboxymethyl chitin (CM-chitin) as a hydrophilic polymer, cholesterol-derivatized mannan (CHM) as a hydrophilic polymer bearing a hydrophobic moiety, and insulin as a model peptide. The results indicated that insulin incorporation or polymers caused no significant change in the phase transition temperature (T(m)) of liposomes. However, reduction in the enthalpy of the transition (ΔH°) following coating with CHM supports an anchoring mechanism to the bilayer by the polymer, whereas no change or little increase in the ΔH° after coating with carboxymethyl chitin suggests no significant interaction or electrostatic weak interactions of polymer with liposomes. The DSC data of liposome-polymer interaction may be suggestive of changes in membrane fluidity, drug release, and possibly the behavior of liposomes in biological milieu.

Synthesis, assembly and applications of semiconductor nanomembranes.

Research in electronic nanomaterials, historically dominated by studies of nanocrystals/fullerenes and nanowires/nanotubes, now incorporates a growing focus on sheets with nanoscale thicknesses, referred to as nanomembranes. Such materials have practical appeal because their two-dimensional geometries facilitate integration into devices, with realistic pathways to manufacturing. Recent advances in synthesis provide access to nanomembranes with extraordinary properties in a variety of configurations, some of which exploit quantum and other size-dependent effects. This progress, together with emerging methods for deterministic assembly, leads to compelling opportunities for research, from basic studies of two-dimensional physics to the development of applications of heterogeneous electronics.

Forced swim test behavior in postpartum rats.

This study was undertaken to determine whether depression-like behavior can be observed in gonadally intact females that have experienced normal pregnancy. When tested on the forced swim test (FST) on postpartum days 1-7, previously pregnant rats spent slightly more time immobile, significantly less time swimming and diving, and defecated more than virgin controls. Subchronic treatment with nomifensine (DA reuptake inhibitor, 2.5mg/kg) but not sertraline (serotonin reuptake inhibitor, 10mg/kg) or desipramine (norepinephrine reuptake inhibitor, 10mg/kg) significantly decreased immobility on postpartum day 2. In rats pre-exposed to the FST in mid-pregnancy, neither subchronic nor chronic treatment with desipramine or sertraline decreased immobility on postpartum day 2; in contrast, chronic desipramine significantly decreased immobility in virgin controls. These results indicate that postpartum female rats, compared to virgin controls, show a reduction in some "active coping behaviors" but no significant increase in immobility when tested during the early postpartum period, unlike ovariectomized females that have undergone hormone-simulated pregnancy (HSP). Additionally, immobility that is increased by FST pre-exposure is not readily prevented by treatment with standard antidepressant medications in postpartum females. Depression-like behaviors previously observed in females that have undergone HSP may result from the more dramatic changes in estradiol, prolactin or corticosterone that occur during the early "postpartum" period, compared to the more subtle changes in these hormones that occur in actual postpartum females.

Mechanics of nanowire/nanotube in-surface buckling on elastomeric substrates.

A continuum mechanics theory is established for the in-surface buckling of one-dimensional nanomaterials on compliant substrates, such as silicon nanowires on elastomeric substrates observed in experiments. Simple analytical expressions are obtained for the buckling wavelength, amplitude and critical buckling strain in terms of the bending and tension stiffness of the nanomaterial and the substrate elastic properties. The analysis is applied to silicon nanowires, single-walled carbon nanotubes, multi-walled carbon nanotubes, and carbon nanotube bundles. For silicon nanowires, the measured buckling wavelength gives Young's modulus to be 140 GPa, which agrees well with the prior experimental studies. It is shown that the energy for in-surface buckling is lower than that for normal (out-of-surface) buckling, and is therefore energetically favorable.

Nanopost plasmonic crystals.

We describe a class of plasmonic crystal that consists of square arrays of nanoposts formed by soft nanoimprint lithography. As sensors, these structure show somewhat higher bulk refractive index sensitivity for aqueous solutions in the visible wavelength range as compared to plasmonic crystals consisting of square arrays of nanowells with similar dimensions, with opposite trends for the case of surface bound layers in air. Three-dimensional finite-difference time-domain simulations quantitatively capture the key features and assist in the interpretation of these and related results.

Experimental and theoretical studies of transport through large scale, partially aligned arrays of single-walled carbon nanotubes in thin film type transistors.

Gate-modulated transport through partially aligned films of single-walled carbon nanotubes (SWNTs) in thin film type transistor structures are studied experimentally and theoretically. Measurements are reported on SWNTs grown by chemical vapor deposition with systematically varying degrees of alignment and coverage in transistors with a range of channel lengths and orientations perpendicular and parallel to the direction of alignment. A first principles stick-percolation-based transport model provides a simple, yet quantitative framework to interpret the sometimes counterintuitive transport parameters measured in these devices. The results highlight, for example, the dramatic influence of small degrees of SWNT misalignment on transistor performance and imply that coverage and alignment are correlated phenomena and therefore should be simultaneously optimized. The transport characteristics reflect heterogeneity in the underlying anisotropic metal-semiconductor stick-percolating network and cannot be reproduced by classical transport models.

Activation of alpha7 acetylcholine receptors augments stimulation-induced hippocampal theta oscillation.

In the septohippocampal formation alpha7 nicotinic receptors (alpha7 nAChRs) are predominantly expressed by neurons well positioned to modulate hippocampal theta oscillation, such as GABAergic interneurons in the hippocampus, and by both GABAergic and cholinergic septal neurons. In the present experiments, we evaluated the efficacy of the recently developed selective alpha7 nAChR agonist PNU-282987 on hippocampal theta oscillation in anaesthetized rats. This compound shows high affinity for the rat alpha7 nAChRs (Ki = 26 nM) but a negligible activity at other nAChRs. Systemic administration of PNU-282987 significantly enhanced the power (by 40%) of hippocampal theta oscillation induced by electrical stimulation of the brainstem reticular formation. In contrast, the amnesic and muscarinic receptor antagonist scopolamine significantly decreased the power (by 68%) of the stimulation-induced theta oscillation. Given the connection between hippocampal theta oscillation and cognitive processes, it is proposed that precognitive actions of alpha7 nAChR agonists could be mediated, at least in part, by modulation of hippocampal oscillatory activity.

Trisomy of chromosome 18 in the baboon (Papio hamadryas anubis).

Trisomy 18 is usually a lethal chromosomal abnormality and is the second most common autosomal trisomy in humans, with an incidence of 1:8000 live births. It is commonly associated with abnormalities of the lower and upper extremities, having the frequency of 95% and 65%, respectively. A newborn female olive baboon (Papio hamadryas anubis) was diagnosed with intrauterine growth retardation and severe arthrogryposis-like congenital joint deformities. Cytogenetic analysis including G-banding and fluorescence in situ hybridization (FISH) revealed that the congenital abnormalities were associated with chromosomal mosaicism for trisomy 18. Genetic analysis with microsatellites from chromosome 18 confirmed the maternal origin of the extra chromosome 18. This is the first report of trisomy 18 in the baboon, which may be a promising animal model of human disease.

Hall effect in the accumulation layers on the surface of organic semiconductors.

We have observed the Hall effect in the field-induced accumulation layer on the surface of single-crystal samples of a small-molecule organic semiconductor rubrene. The Hall mobility muH increases with decreasing temperature in both the intrinsic (high-temperature) and trap-dominated (low-temperature) conduction regimes. In the intrinsic regime, the density of mobile field-induced charge carriers extracted from the Hall measurements, nH, coincides with the density n calculated using the gate-channel capacitance and becomes smaller than n in the trap-dominated regime. The Hall data are consistent with the diffusive bandlike motion of field-induced charge carriers between trapping events.

Intrinsic charge transport on the surface of organic semiconductors.

The air-gap field-effect technique enabled realization of the intrinsic (not limited by static disorder) polaronic transport on the surface of rubrene (C42H28) crystals over a wide temperature range. The signatures of this intrinsic transport are the anisotropy of the carrier mobility, mu, and the growth of mu with cooling. Anisotropy of mu vanishes in the activation regime at low temperatures, where the transport is dominated by shallow traps. The deep traps, introduced by x-ray radiation, increase the field-effect threshold without affecting mu, an indication that the filled traps do not scatter polarons.

In-line liquid-crystal microcell polarimeter for high-speed polarization analysis.

We report a type of high-speed microcell polarimeter that utilizes microelectrodes, liquid-crystal films, and ultrathin high-contrast polarizers, all integrated between the tips of two optical fibers. When combined with optimized nematic liquid-crystal materials, this compact (2.5 cm x 0.5 cm x 0.5 cm) device offers excellent optical properties and continuous, high-speed operation at > 2 kHz with moderately low operating voltages. It requires no bulk optical elements, and it shows excellent performance when implemented for the measurement of degree of polarization in 10-Gbit/s test systems. Polarimeters based on this design have promising potential applications in polarization analysis for high-speed optical communication systems.

Investigation into the relationship between body surface area and total body potassium using Monte Carlo and measurement.

The use of body surface area (BSA) as a means of indexing chemotherapy doses is widespread even though the value of this practice is uncertain. In principle, the body cell mass (BCM) more closely represents the body's metabolic size and this is investigated here as an alternative to BSA; since 98% of body potassium is intracellular the derivation of total body potassium (TBK) via the measurement of 40K in a whole body counter (WBC) will provide a useful normalizing index for metabolic size, potentially avoiding toxicity and underdosing. The Queen Elizabeth Hospital WBC has been used in this study, initially involving single geometrical phantoms and then combinations of these to simulate human body habitus. Monte Carlo N-particle (MCNP) codes were constructed to model the phantoms and simulate the measurements made in the WBC. Efficiency corrections were derived by comparing measurement and modelled data for each detector separately. A method of modelling a person in the WBC as a series of ellipsoids was developed. Twenty-four normal males and 24 females were measured for their 40K emissions. Individual MCNP codes were constructed for each volunteer and the results used in conjunction with the measurements to derive TBK, correcting for body habitus effects and detector efficiencies. An estimate of the component of error arising from sources other than counting statistics was included by analysing data from the measurement of phantoms. The total residual errors (expressed as coefficients of variation) for males and females were 10.1% and 8.5% respectively. The measurement components were determined to be 2.4% and 2.5%, implying that the biological components were 9.8% and 8.1% respectively. These results suggest that the use of BSA for indexing chemotherapy doses is likely to give rise to clinically significant under- or overdosing.

Formulation and evaluation of a folic acid receptor-targeted oral vancomycin liposomal dosage form.

PURPOSE: To demonstrate utility of folic acid-coated liposomes for enhancing the delivery of a poorly absorbed glycopeptide, vancomycin. via the oral route. METHODS: Liposomes prepared as dehydration-rehydration vesicles (DRVs) containing vancomycin were optimized for encapsulation efficiency and stability. A folic acid-poly(ethylene oxide)-cholesterol construct was synthesized for adsorption at DRV surfaces. Liposomes were characterized by differential scanning calorimetry (DSC) and assessed in vitro in the Caco-2 cell model and in vivo in male Sprague-Dawley rats. Non-compartmental pharmacokinetic analysis of vancomycin was conducted after intravenous and oral administration of solution or liposome-encapsulated vancomycin with or without 0.05 mole ratio FA-PEO-Chol adsorbed at liposome surfaces. RESULTS: Optimal loading of vancomycin (32%) was achieved in DRVs of DSPC:Chol:DCP, 3:1:0.25 mole ratio (m.r.) after liposome extrusion. Liposomes released less than 40% of the entrapped drug after 2 hours incubation in simulated gastrointestinal (GI) fluid and simulated intestinal fluid containing a 10 mM bile salt cocktail. Incorporation of FA-PEO-Chol in liposomes increased drug leakage by 20% but resulted in a 5.7-fold increase in Caco-2 cell uptake of vancomycin. Liposomal delivery significantly increased the area under the curve of oral vancomycin resulting in a mean 3.9-fold and 12.5-fold increase in relative bioavailability for uncoated and FA-PEO-Chol-coated liposomes, respectively, compared with an oral solution. CONCLUSIONS: The design of FA-PEO-Chol-coated liposomes resulted in a dramatic increase in the oral delivery of a moderate-size glycopeptide in the rat compared with uncoated liposomes or oral solution. It is speculated that the cause of the observed effect was due to binding of liposome-surface folic acid to receptors in the GI tract with subsequent receptor-mediated endocytosis of entrapped vancomycin by enterocytes.

A confidence-set approach for finding tightly linked genomic regions.

As more studies adopt the approach of whole-genome screening, geneticists are faced with the challenge of having to interpret results from traditional approaches that were not designed for genome-scan data. Frequently, two-point analysis by the LOD method is performed to search for signals of linkage throughout the genome, for each of hundreds or even thousands of markers. This practice has raised the question of how to adjust the significance level for the fact that multiple tests are being performed. Various recommendations have been made, but no consensus has emerged. In this article, we propose a new method, the confidence-set approach, that circumvents the need to correct for the level of significance according to the number of markers tested. In the search for the gene location of a monogenic disorder, multiplicity adjustment is not needed in order to maintain the desired level of confidence. For complex diseases involving multiple genes, one needs only to adjust the level of significance according to the number of disease genes--a much smaller number than the number of markers in a genome screen-to ensure a predetermined genomewide confidence level. Furthermore, our formulation of the tests enables us to localize disease genes to small genomic regions, an extremely desirable feature that the traditional LOD method lacks. Our simulation study shows that, for sib-pair data, even when the coverage probability of the confidence set is chosen to be as high as 99%, our approach is able to implicate only the markers that are closely linked to the disease genes.

Paper-like electronic displays: large-area rubber-stamped plastic sheets of electronics and microencapsulated electrophoretic inks.

Electronic systems that use rugged lightweight plastics potentially offer attractive characteristics (low-cost processing, mechanical flexibility, large area coverage, etc.) that are not easily achieved with established silicon technologies. This paper summarizes work that demonstrates many of these characteristics in a realistic system: organic active matrix backplane circuits (256 transistors) for large ( approximately 5 x 5-inch) mechanically flexible sheets of electronic paper, an emerging type of display. The success of this effort relies on new or improved processing techniques and materials for plastic electronics, including methods for (i) rubber stamping (microcontact printing) high-resolution ( approximately 1 microm) circuits with low levels of defects and good registration over large areas, (ii) achieving low leakage with thin dielectrics deposited onto surfaces with relief, (iii) constructing high-performance organic transistors with bottom contact geometries, (iv) encapsulating these transistors, (v) depositing, in a repeatable way, organic semiconductors with uniform electrical characteristics over large areas, and (vi) low-temperature ( approximately 100 degrees C) annealing to increase the on/off ratios of the transistors and to improve the uniformity of their characteristics. The sophistication and flexibility of the patterning procedures, high level of integration on plastic substrates, large area coverage, and good performance of the transistors are all important features of this work. We successfully integrate these circuits with microencapsulated electrophoretic "inks" to form sheets of electronic paper.

Noncontact quantitative spatial mapping of stress and flexural rigidity in thin membranes using a picosecond transient grating photoacoustic technique.

This paper describes a purely optical technique for measuring and spatially mapping out stress and rigidity in thin membranes. Its application to a membrane of aluminum nitride that has significant spatial nonuniformities in its elastic properties demonstrates the method. The attractive features of this technique--fast, noncontacting measurement, good spatial resolution, ability to quantify in-plane anisotropy--make it potentially useful for characterizing elements of microelectromechanical structures, masks for advanced lithography systems, acoustic filters, and other devices in which the mechanical properties of membranes are important.