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A sufficient number of participants should be included to adequately address the research interest in the surveys with sensitive questions. In this paper, sample size formulas/iterative algorithms are developed from the perspective of controlling the confidence interval width of the prevalence of a sensitive attribute under four non-randomized response models: the crosswise model, parallel model, Poisson item count technique model and negative binomial item count technique model. In contrast to the conventional approach for sample size determination, our sample size formulas/algorithms explicitly incorporate an assurance probability of controlling the width of a confidence interval within the pre-specified range. The performance of the proposed methods is evaluated with respect to the empirical coverage probability, empirical assurance probability and confidence width. Simulation results show that all formulas/algorithms are effective and hence are recommended for practical applications. A real example is used to illustrate the proposed methods., (© 2024 British Psychological Society.)

Background: Early detection of nasopharyngeal carcinoma (NPC) poses a significant challenge. The absence of highly sensitive and specific diagnostic biomarkers for nasopharyngeal carcinoma contributes to the unfavourable prognosis of NPC patients. Here, we aimed to establish a non-invasive approach for detecting NPC using circulating cell-free DNA (cfDNA)., Methods: We investigated the potential of next-generation sequencing (NGS) of peripheral blood cells as a diagnostic tool for NPC. We collected data on genome-wide nucleosome footprint (NF), 5'-end motifs, fragmentation patterns, CNV information, and EBV content from 553 Chinese subjects, including 234 NPC patients and 319 healthy individuals. Through case-control analysis, we developed a diagnostic model for NPC, and validated its detection capability., Findings: Our findings revealed that the frequencies of NF, fragmentation, and motifs were significantly higher in NPC patients compared to healthy controls. We developed an NPC score based on these parameters that accurately distinguished NPC from non-NPC cases according to the American Joint Committee on Cancer staging system from non-NPC (validation set: area under curve (AUC) = 99.9% (95% CI: 99.8%-100%), se: 98.15%, sp: 100%). This model showed superior performance over plasma EBV DNA. Additionally, the NPC score effectively differentiated between NPC patients and healthy controls, even after clinical treatment. Furthermore, the NPC score was found to be independent of potential confounders such as age, sex, or TNM stage., Interpretation: We have developed and verified a non-invasive approach with substantial potential for clinical application in detecting NPC., Funding: A full list of funding bodies that contributed to this study can be found in Funding section., Competing Interests: Declaration of interests We declare no competing interests., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Purpose: To minimize radiation exposure to the small bowel (SB) in patients undergoing treatment for gynecological tumors by adopting a comfortable positioning method., Methods and Patients: All 76 women undergoing Intensity-Modulated Radiation Therapy (IMRT) were included in this study. Patients were immobilized in a supine position using a vacuum bag and thermoplastic cast formation. In the trial group (n = 36), patients raised their buttocks and a solid foam pad was placed under the sacral tail before immobilization. The control group (n = 40) received treatment in the standard supine position. The SB was delineated from the pubic symphysis to the total iliac bifurcation in computed tomography (CT) scans., Result: In the trial group, a significant reduction in SB volume within the pelvic cavity was observed (mean 399.17 ± 158.7 cc) compared to the control group (mean 547.48 ± 166.9 cc), with a p-value less than 0.001. The trial group showed a statistically significant reduction in the absolute volume of irradiated SB at each dose, ranging from the low dose (10 Gy) to the high dose (45 Gy). In the control group, a negative correlation was found between SB and bladder volumes (R = -0.411, P = 0.008), whereas in the trial group, this correlation was weaker (R = -0.286, P = 0.091), with no significant relationship observed between bladder volume and SB., Conclusion: The high buttocks supine position effectively reduces SB radiation exposure without the need for bladder distension. This positioning method holds promise for reducing SB irradiation in various pelvic tumors., (© 2024. The Author(s).)

This paper discusses the problem of disease prevalence in clinical studies, focusing on multiple comparisons based on stratified partially validated series in the presence of a gold standard. Five test statistics, including two Wald-type test statistics, the inverse hyperbolic tangent transformation test statistic, likelihood ratio test statistic, and score test statistic, are proposed to conduct multiple comparisons. To control the overall type I error rate, several adjustment procedures are developed, namely the Bonferroni, Single-step adjusted MaxT, Single-step adjusted MinP, Holm's Step-down, and Hochberg's step-up procedures, based on these test statistics. The performance of the proposed methods is evaluated through simulation studies in terms of the empirical type I error rate and empirical power. Simulation results show that the Single-step adjusted MaxT procedure and Single-step adjusted MinP procedure generally outperform the other three procedures, and these two test procedures based on all test statistics have satisfactory performance. Notably, the Single-step adjusted MinP procedure tends to exhibit higher empirical power than the Single-step adjusted MaxT procedure. Furthermore, the Step-down and Step-up procedures show greater power compared to the Bonferroni method. The study also observes that as the validated ratio increases, the empirical type I errors of all test procedures approach the nominal level while maintaining higher power. Two real examples are presented to illustrate the proposed methods.

Data on the Likert scale are ubiquitous in medical research, including randomized trials. Statistical analysis of such data may be conducted using the means of raw scores or the rank information of the scores. In the context of parallel-group randomized trials, we quantify treatment effects by the probability that a subject in the treatment group has a better score than (or a win over) a subject in the control group. Asymptotic parametric and nonparametric confidence intervals for this win probability and associated sample size formulas are derived for studies with only follow-up scores, and those with both baseline and follow-up measurements. We assessed the performance of both the parametric and nonparametric approaches using simulation studies based on real studies with Likert item and Likert scale data. The simulation results demonstrate that even without baseline adjustment, the parametric methods did not perform well, in terms of bias, interval coverage percentage, balance of tail error, and assurance of achieving a pre-specified precision. In contrast, the nonparametric approach performed very well for both the unadjusted and adjusted win probability. We illustrate the methods with two examples: one using Likert item data and the other using Like scale data. We conclude that non-parametric methods are preferable for two-group randomization trials with Likert data. Illustrative SAS code for the nonparametric approach using existing procedures is provided., (© 2022 The Authors. Pharmaceutical Statistics published by John Wiley & Sons Ltd.)

Randomized controlled trials with a pretest-posttest design frequently yield ordered categorical outcome data. Focusing on the estimation of the win probability that a treated participant would have a better score than (or win over) a control participant, we developed methods for analysis and sample size planning for such trials. We exploited the analysis of covariance framework with the dependent variable being individual participants' win fractions at posttest and the covariate being the win fractions at pretest. The win fractions were obtained using the mid-ranks of the ordinal data. Simulation evaluation based on a recent randomized trial on COVID-19 suggests that the methods perform very well. A sample SAS code for data analysis is presented., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023. Published by Elsevier Inc.)

Background: It remains controversial whether the application of chemotherapy has an impact on recurrent nasopharyngeal carcinoma (rNPC) patients with salvage radiotherapy. Here, we aimed to evaluate treatment outcomes of rNPC patients and derive a prognostic model to assess the benefit of chemotherapy in patients with re-radiotherapy. Methods: This study was conducted as a retrospective study. In total, 340 rNPC patients treated with salvage intensity-modulated radiotherapy (IMRT) or radiochemotherapy (RCT) from October 2006 to September 2019 were included in this study. Overall survival (OS) was the primary outcome. Kaplan-Meier method was employed to detect the prognostic difference with Log-rank tests. The Cox regression analysis was performed to explore the potential prognostic factors while the multivariate Cox analysis was used to identify candidate variables for the prognostic model of OS. Results: The 5-year actuarial rates of OS, progression-free survival, loco-regional progression-free survival, and distant metastases-free survival did not show significant difference between the IMRT and RCT groups ( P  > .05). Age at recurrence and rT category were found to be the independent prognostic factors for OS. We found that rNPC patients suffered poor OS in the high-risk group (patients with higher age at recurrence and advanced rT category) (high-risk vs low-risk, HR = 1.87, 95% CI: 1.36-2.57, P  < .001). Salvage RT alone may be superior to RCT for patients in the low-risk group (RCT group vs RT group, HR = 1.89, 95% CI: 1.11-3.20, P  = .038). Conclusion: Salvage RT combined with chemotherapy cannot improve survival outcomes for rNPC. More novel clinical trials should be explored to develop individualized strategies to improve survival and minimize toxicities.

Studies with sensitive questions should include a sufficient number of respondents to adequately address the research interest. While studies with an inadequate number of respondents may not yield significant conclusions, studies with an excess of respondents become wasteful of investigators' budget. Therefore, it is an important step in survey sampling to determine the required number of participants. In this article, we derive sample size formulas based on confidence interval estimation of prevalence for four randomized response models, namely, the Warner's randomized response model, unrelated question model, item count technique model and cheater detection model. Specifically, our sample size formulas control, with a given assurance probability, the width of a confidence interval within the planned range. Simulation results demonstrate that all formulas are accurate in terms of empirical coverage probabilities and empirical assurance probabilities. All formulas are illustrated using a real-life application about the use of unethical tactics in negotiation., (© 2022. The Author(s).)

This article investigates the confidence interval (CI) construction of proportion difference for two independent partially validated series under the double-sampling scheme in which both classifiers are fallible. Several CIs based on the variance estimates recovery method of combining confidence limits from asymptotic, bootstrap, and Bayesian methods for two independent binomial proportions are developed under two models. Simulation results show that all CIs except for the bootstrap percentile-t CI and Bayesian credible interval with uniform prior under the independence model and all CIs under the dependence model generally perform well and are recommended. Two examples are used to illustrate the methodologies.

Responses from the paired organs are generally highly correlated in bilateral studies, statistical procedures ignoring the correlation could lead to incorrect results. Note the intraclass correlation in the study of combined unilateral and bilateral outcomes; 11 confidence intervals (CIs) including 7 asymptotic CIs and 4 Bootstrap-resampling CIs for assessing the equivalence of 2 treatments are derived under Rosner's correlated binary data model. Performance is evaluated with respect to the empirical coverage probability (ECP), the empirical coverage width (ECW) and the ratio of the mesial non-coverage probability to the non-coverage probability (RMNCP) via simulation studies. Simulation results show that (i) all CIs except for the Wald CI and the bias-corrected Bootstrap percentile CI generally produce satisfactory ECPs and hence are recommended; (ii) all CIs except for the bias-corrected Bootstrap percentile CI provide preferred RMNCPs and are more symmetrical; (iii) as the measurement of the dependence increases, the ECWs of all CIs except for the score CI and the profile likelihood CI show increasing patterns that look like linear, while there is no obvious pattern on the ECPs of all CIs except for the profile likelihood CI. A data set from an otolaryngologic study is used to illustrate the proposed methods., Competing Interests: No potential conflict of interest was reported by the author(s)., (© 2021 Informa UK Limited, trading as Taylor & Francis Group.)

This article investigates the homogeneity testing problem of binomial proportions for stratified partially validated data obtained by double-sampling method with two fallible classifiers. Several test procedures, including the weighted-least-squares test with/without log-transformation, logit-transformation and double log-transformation, and likelihood ratio test and score test, are developed to test the homogeneity under two models, distinguished by conditional independence assumption of two classifiers. Simulation results show that score test performs better than other tests in the sense that the empirical size is generally controlled around the nominal level, and hence be recommended to practical applications. Other tests also perform well when both binomial proportions and sample sizes are not small. Approximate sample sizes based on score test, likelihood ratio test and the weighted-least-squares test with double log-transformation are generally accurate in terms of the empirical power and type I error rate with the estimated sample sizes, and hence be recommended. An example from the malaria study is illustrated by the proposed methodologies.

A disease prevalence can be estimated by classifying subjects according to whether they have the disease. When gold-standard tests are too expensive to be applied to all subjects, partially validated data can be obtained by double-sampling in which all individuals are classified by a fallible classifier, and some of individuals are validated by the gold-standard classifier. However, it could happen in practice that such infallible classifier does not available. In this article, we consider two models in which both classifiers are fallible and propose four asymptotic test procedures for comparing disease prevalence in two groups. Corresponding sample size formulae and validated ratio given the total sample sizes are also derived and evaluated. Simulation results show that (i) Score test performs well and the corresponding sample size formula is also accurate in terms of the empirical power and size in two models; (ii) the Wald test based on the variance estimator with parameters estimated under the null hypothesis outperforms the others even under small sample sizes in Model II, and the sample size estimated by this test is also accurate; (iii) the estimated validated ratios based on all tests are accurate. The malarial data are used to illustrate the proposed methodologies., Competing Interests: No potential conflict of interest was reported by the authors., (© 2019 Informa UK Limited, trading as Taylor & Francis Group.)

Double sampling is usually applied to collect necessary information for situations in which an infallible classifier is available for validating a subset of the sample that has already been classified by a fallible classifier. Inference procedures have previously been developed based on the partially validated data obtained by the double-sampling process. However, it could happen in practice that such infallible classifier or gold standard does not exist. In this article, we consider the case in which both classifiers are fallible and propose asymptotic and approximate unconditional test procedures based on six test statistics for a population proportion and five approximate sample size formulas based on the recommended test procedures under two models. Our results suggest that both asymptotic and approximate unconditional procedures based on the score statistic perform satisfactorily for small to large sample sizes and are highly recommended. When sample size is moderate or large, asymptotic procedures based on the Wald statistic with the variance being estimated under the null hypothesis, likelihood rate statistic, log- and logit-transformation statistics based on both models generally perform well and are hence recommended. The approximate unconditional procedures based on the log-transformation statistic under Model I, Wald statistic with the variance being estimated under the null hypothesis, log- and logit-transformation statistics under Model II are recommended when sample size is small. In general, sample size formulae based on the Wald statistic with the variance being estimated under the null hypothesis, likelihood rate statistic and score statistic are recommended in practical applications. The applicability of the proposed methods is illustrated by a real-data example.

A stratified study is often designed for adjusting a confounding effect or effect of different centers/groups in two treatments or diagnostic tests, and the risk difference is one of the most frequently used indices in comparing efficiency between two treatments or diagnostic tests. This article presented five simultaneous confidence intervals (CIs) for risk differences in stratified bilateral designs accounting for the intraclass correlation and developed seven CIs for the common risk difference under the homogeneity assumption. The performance of the CIs is evaluated with respect to the empirical coverage probabilities, empirical coverage widths and ratios of mesial noncoverage probability and the noncoverage probability under various scenarios. Empirical results show that Wald simultaneous CI, Haldane simultaneous CI, Score simultaneous CI based on Bonferroni method and simultaneous CI based on bootstrap-resampling method perform satisfactorily and hence be recommended for applications, the CI based on the weighted-least-square (WLS) estimator, the CIs based on Mantel-Haenszel estimator, the CI based on Cochran statistic and the CI based on Score statistic for the common risk difference behave well even under small sample sizes. A real data example is used to demonstrate the proposed methodologies.

Double-sampling schemes using one classifier assessing the whole sample and another classifier assessing a subset of the sample have been introduced for reducing classification errors when an infallible or gold standard classifier is unavailable or impractical. Inference procedures have previously been proposed for situations where an infallible classifier is available for validating a subset of the sample that has already been classified by a fallible classifier. Here, we consider the case where both classifiers are fallible, proposing and evaluating several confidence interval procedures for a proportion under two models, distinguished by the assumption regarding ascertainment of two classifiers. Simulation results suggest that the modified Wald-based confidence interval, Score-based confidence interval, two Bayesian credible intervals, and the percentile Bootstrap confidence interval performed reasonably well even for small binomial proportions and small validated sample under the model with the conditional independent assumption, and the confidence interval derived from the Wald test with nuisance parameters appropriately evaluated, likelihood ratio-based confidence interval, Score-based confidence interval, and the percentile Bootstrap confidence interval performed satisfactory in terms of coverage under the model without the conditional independent assumption. Moreover, confidence intervals based on log- and logit-transformations also performed well when the binomial proportion and the ratio of the validated sample are not very small under two models. Two examples were used to illustrate the procedures.

Interferon γ (IFN-γ), a multifunctional cytokine, was upregulated in the resected gastric cancer tissue. However, whether IFN-γ is involved in the regulation of gastric cancer has not been well elucidated. Herein, we aimed to investigate the effects and mechanism of IFN-γ on gastric cancer. In this study, we found a vital role of IFN-γ in enhancing proliferation, inhibiting apoptosis, and promoting cell migration and invasion in gastric cancer cells SGC-7901 and MGC-803. Additionally, IFN-γ activated nuclear factor κB (NF-κB) signaling pathway by upregulating the phosphorylation expression of p65 and IκBα, and induced the expression of integrin β3 in vitro. Therefore, to further investigate the relationship between IFN-γ and integrin β3, SGC-7901 cells were transfected with integrin β3 siRNA. And then cells expressed lower cell viability, migration, and invasion rates, while cell apoptosis was significantly enhanced. Meanwhile, expression of integrin β3, MMP-2, MMP-9, and NF-κB, including p65 and IκBα, and the nuclear translocation of NF-κB/p65 were dramatically repressed, whereas IFN-γ significantly improved the effects. Moreover, in vivo, the experiment of xenograft model and pulmonary metastasis model also retarded in integrin β3 siRNA group. And the expression of integrin β3, MMP-2, MMP-9, and NF-κB was repressed. However, the treatment with IFN-γ improved tumor volume, lung/total weight, tumor nodules, and the protein expression described above compared with integrin β3 siRNA group. Overall, the results indicated that IFN-γ induces gastric cancer cell proliferation and metastasis partially through the upregulation of integrin β3-mediated NF-κB signaling. Hence, the inhibition of IFN-γ or integrin β3 may be the key for the treatment of gastric cancer., (Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.)

Introduction: Apolipoprotein E4 (APOE4) is a major genetic risk factor for late-onset sporadic Alzheimer disease. Emerging evidence demonstrates a hippocampus-associated learning and memory deficit in aged APOE4 human carriers and also in aged mice carrying human APOE4 gene. This suggests that either exogenous APOE4 or endogenous APOE4 alters the cognitive profile and hippocampal structure and function. However, little is known regarding how Apoe4 modulates hippocampal dendritic morphology, synaptic function, and neural network activity in young mice., Aim: In this study, we compared hippocampal dendritic and spine morphology and synaptic function of young (4 months) mice with transgenic expression of the human APOE4 and APOE3 genes., Methods: Hippocampal dendritic and spine morphology and synaptic function were assessed by neuronal imaging and electrophysiological approaches., Results: Morphology results showed that shortened dendritic length and reduced spine density occurred at hippocampal CA1 neurons in Apoe4 mice compared to Apoe3 mice. Electrophysiological results demonstrated that in the hippocampal CA3-CA1 synapses of young Apoe4 mice, basic synaptic transmission, and paired-pulse facilitation were enhanced but long-term potentiation and carbachol-induced hippocampal theta oscillations were impaired compared to young Apoe3 mice. However, both Apoe genotypes responded similarly to persistent stimulations (4, 10, and 40 Hz for 4 seconds)., Conclusion: Our results suggest significant alterations in hippocampal dendritic structure and synaptic function in Apoe4 mice, even at an early age., (© 2017 John Wiley & Sons Ltd.)

Partially validated series are common when a gold-standard test is too expensive to be applied to all subjects, and hence a fallible device is used accordingly to measure the presence of a characteristic of interest. In this article, confidence interval construction for proportion difference between two independent partially validated series is studied. Ten confidence intervals based on the method of variance estimates recovery (MOVER) are proposed, with each using the confidence limits for the two independent binomial proportions obtained by the asymptotic, Logit-transformation, Agresti-Coull and Bayesian methods. The performances of the proposed confidence intervals and three likelihood-based intervals available in the literature are compared with respect to the empirical coverage probability, confidence width and ratio of mesial non-coverage to non-coverage probability. Our empirical results show that (1) all confidence intervals exhibit good performance in large samples; (2) confidence intervals based on MOVER combining the confidence limits for binomial proportions based on Wilson, Agresti-Coull, Logit-transformation, Bayesian (with three priors) methods perform satisfactorily from small to large samples, and hence can be recommended for practical applications. Two real data sets are analysed to illustrate the proposed methods., (© The Author(s) 2014.)

Disease prevalence is an important topic in medical research, and its study is based on data that are obtained by classifying subjects according to whether a disease has been contracted. Classification can be conducted with high-cost gold standard tests or low-cost screening tests, but the latter are subject to the misclassification of subjects. As a compromise between the two, many research studies use partially validated datasets in which all data points are classified by fallible tests, and some of the data points are validated in the sense that they are also classified by the completely accurate gold-standard test. In this article, we investigate the determination of sample sizes for disease prevalence studies with partially validated data. We use two approaches. The first is to find sample sizes that can achieve a pre-specified power of a statistical test at a chosen significance level, and the second is to find sample sizes that can control the width of a confidence interval with a pre-specified confidence level. Empirical studies have been conducted to demonstrate the performance of various testing procedures with the proposed sample sizes. The applicability of the proposed methods are illustrated by a real-data example., (© The Author(s) 2012.)

Human hypothalamic hamartoma (HH) is a rare developmental malformation often characterized by gelastic seizures, which are refractory to medical therapy. Ictal EEG recordings from the HH have demonstrated that the epileptic source of gelastic seizures lies within the HH lesion itself. Recent advances in surgical techniques targeting HH have led to dramatic improvements in seizure control, which further supports the hypothesis that gelastic seizures originate within the HH. However, the basic cellular and molecular mechanisms of epileptogenesis in this subcortical lesion are poorly understood. Since 2003, Barrow Neurological Institute has maintained a multidisciplinary clinical program to evaluate and treat patients with HH. This program has provided a unique opportunity to investigate the basic mechanisms of epileptogenesis using surgically resected HH tissue. The first report on the electrophysiological properties of HH neurons was published in 2005. Since then, ongoing research has provided additional insights into the mechanisms by which HH generate seizure activity. In this review, we summarize this progress and propose a cellular model that suggests that GABA-mediated excitation contributes to epileptogenesis in HH lesions., (© 2014 John Wiley & Sons Ltd.)

The Homo erectus cranium from Gongwangling, Lantian County, Shaanxi Province is the oldest fossil hominin specimen from North China. It was found in 1964 in a layer below the Jaramillo subchron and was attributed to loess (L) L15 in the Chinese loess-palaeosol sequence, with an estimated age of ca. 1.15 Ma (millions of years ago). Here, we demonstrate that there is a stratigraphical hiatus in the Gongwangling section immediately below loess 15, and the cranium in fact lies in palaeosol (S) S22 or S23, the age of which is ca. 1.54-1.65 Ma. Closely spaced palaeomagnetic sampling at two sections at Gongwangling and one at Jiacun, 10 km to the north, indicate that the fossil layer at Gongwangling and a similar fossil horizon at Jiacun were deposited shortly before a short period of normal polarity above the Olduvai subchron. This is attributed to the Gilsa Event that has been dated elsewhere to ca. 1.62 Ma. Our investigations thus demonstrate that the Gongwangling cranium is slightly older than ca. 1.62 Ma, probably ca. 1.63 Ma, and significantly older than previously supposed. This re-dating now makes Gongwangling the second oldest site outside Africa (after Dmanisi) with cranial remains, and causes substantial re-adjustment in the early fossil hominin record in Eurasia., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Background: To explore the independent prognostic factors for the recurrence/metastasis of patients with locoregionally advanced nasopharyngeal carcinoma (LANPC)., Materials and Methods: A total of 604 patients initially diagnosed as LANPC by pathohistology in Fujian Provincial Cancer Hospital were selected to analyze the relationship between the clinical pathological patterns, therapeutic protocols and clinical stages with the recurrence/metastasis of LANPC., Results: The 1-, 3- and 5-year locoregionally recurrent rates of LANPC patients were 2.0%, 9.5% and 12.9% respectively, with average recurrent period being 78 months. Univariate analysis results indicated that clinical stages had certain influence on the recurrent period of LANPC patients. However, COX regression models showed that ages, genders and clinical stages were not the independent prognostic factors influencing the recurrence. The 1-, 3- and 5-year metastatic rates of LANPC patients were 6.6%, 17.5% and 18.8% respectively, with average metastatic period of 73 months. Univariate analysis results demonstrated that ages, N stages, clinical stages, locations of lymph node, retropharyngeal lymph node and extracapsular invasion of lymph node had certain influence on the metastatic period of LANPC patients. Additionally, further COX regression analysis results suggested that T stages, reduction protocols and extracapsular invasion of lymph node were the independent prognostic factors influencing the metastasis of patients with LANPC, in which T stages and extracapsular invasion of lymph node were the pestilent factors while reduction protocols the protective factor., Conclusions: Induction chemotherapy is beneficial to LANPC patients with initial treatment, and the metastatic rate decreases greatly after the application of reduction chemotherapy.

The aim of this study was to evaluate the long-term survival outcomes in patients with advanced thymic carcinoma and identify prognostic factors influencing the survival. We retrospectively analyzed 90 consecutive patients with pathologically confirmed advanced thymic carcinoma (Masaoka III and IV) in our institute, from December 2000 to 2012. Age, sex, clinical characteristics, laboratory findings, Masaoka and tumor node metastasis staging, pathologic grade, and treatment modalities were analyzed to identify prognostic factors associated with the progress-free survival (PFS) and the overall survival (OS) rates. Statistical analysis was conducted using SPSS, version 19.0 (SPSS, Inc, Chicago, IL). A total of 73 (81.1%) male and 17 (18.9%) female patients participated in the study. The median follow-up time was 75 months (range, 20-158 months). The 5-year PFS and OS rates were 23.6% (95% confidence interval [CI], 14.6%-33.8%) and 35.7% (95% CI, 25.1%-46.4%), respectively. The multivariate Cox regression model analysis showed that factors improving the PFS were the normal lactate dehydrogenase (LDH) level (P<0.001), Masaoka III stage (P=0.028), and radiotherapy (RT) (P<0.001). The LDH (P<0.001), T stage (P<0.001), and the pathologic grade (P=0.047) were independently prognostic of OS. Long-term follow-up of the advanced thymic carcinoma showed poor outcomes of PFS and OS. LDH, Masaoka stage, and RT affected the PFS, and LDH, T stage, and pathologic grade seemed to affect the OS. Establishing a better staging system for predicting outcomes would be warranted.

In stratified matched-pair studies, risk difference between two proportions is one of the most frequently used indices in comparing efficiency between two treatments or diagnostic tests. This article presents five simultaneous confidence intervals and two bootstrap simultaneous confidence intervals for risk differences in stratified matched-pair designs. The proposed confidence intervals are evaluated with respect to their coverage probabilities, expected widths, and ratios of the mesial noncoverage to noncoverage probability. Empirical results show that (1) hybrid simultaneous confidence intervals outperform nonhybrid simultaneous confidence intervals; (2) hybrid simultaneous confidence intervals based on median estimator outperform those based on maximum likelihood estimator; and (3) hybrid simultaneous confidence intervals incorporated with Wilson score and Agresti coull intervals and the bootstrap t-percentile simultaneous interval based on median unbiased estimators behave satisfactorily for small to large sample sizes in the sense that their empirical coverage probabilities are close to the prespecified nominal confidence level, and their ratios of the mesial noncoverage to noncoverage probabilities lie in [0.4,0.6] and are hence recommended. Real examples from clinical studies are used to illustrate the proposed methodologies.

Objective: To understand the biochemical characteristics, virulence genes and pathogenicity of Shigella flexneri Xv isolated in Beijing., Methods: 61 strains of S. flexneri Xv isolated from diarrhea patients in Beijing were systematically determined through biochemical reactions and serological tests. Application of PCR technique in detection of virulence genes on ipaH, sen, virF, ial and pulsed-field gel electrophoresis (PFGE) was used to identify the related characteristics and on rat lung slices to determine its pathogenicity., Results: All of the S. flexneri Xv could ferment glucose, mannitol, melibiose and arabinose. Using serum agglutination, we found that the antigen structure was (IV: 7, 8). IpaH, sen, virF and ial that carried rates of virulence genes appeared to be 100%, 81.97%, 75.41% and 80.30%, respectively. Among 61 strains of S. flexneri Xv, the PFGE typing of Shigella bacteria could be divided into 25 belt types while the results from rat lung slices showed inflammatory change of Xv., Conclusion: S. flexneri Xv was found that it carried high rate of Shigella virulence genes, exhibiting genetic polymorphism and highly invasive.

The present study aims to explore the possible mechanisms that trichostatin A (TSA), a histone deacetylases inhibitor (HDACi), affects the inflammatory signaling pathways of lipopolysaccharide/toll-like receptor 4/nuclear factor-κB (LPS/TLR4/NF-κB). Murine macrophage cell line RAW264.7 cells were employed. MTT assay was used to assess cell viability. The contents of TNF-α, IL-1β and IL-6 in culture supernatant were assayed by enzyme-linked immunosorbent assay (ELISA). TLR4 expression and NF-κB/p65 (Lys310) acetylation were examined by Western blotting. DNA binding activity of NF-κB/p65 was detected by using TransAM(TM) NF-κB/p65 activity assay kit. The results showed that, compared with control group, which was treated by DMSO, the cells treated with TSA (20, 40, 80 ng/mL) showed decreased percentages of cell survival (P < 0.05). The contents of TNF-α, IL-1β and IL-6 in culture supernatant were all increased by LPS (100 ng/mL), whereas reduced by 40 ng/mL TSA pretreatment (P < 0.05). TSA pretreatment inhibited LPS-induced up-regulation of TLR4 protein expression. Acetylation of NF-κB/p65(Lys310), which was already increased by LPS, was further enhanced by TSA (P < 0.05). On the contrary, LPS-increased DNA binding activity of NF-κB/p65 was decreased by pretreatment with TSA (P < 0.05). The results suggest that TSA-induced anti-inflammation may be attributed to decreases in the expression of TLR4 and DNA binding activity of NF-κB/p65.

Comparing disease prevalence in two groups is an important topic in medical research, and prevalence rates are obtained by classifying subjects according to whether they have the disease. Both high-cost infallible gold-standard classifiers or low-cost fallible classifiers can be used to classify subjects. However, statistical analysis that is based on data sets with misclassifications leads to biased results. As a compromise between the two classification approaches, partially validated sets are often used in which all individuals are classified by fallible classifiers, and some of the individuals are validated by the accurate gold-standard classifiers. In this article, we develop several reliable test procedures and approximate sample size formulas for disease prevalence studies based on the difference between two disease prevalence rates with two independent partially validated series. Empirical studies show that (i) the Score test produces close-to-nominal level and is preferred in practice; and (ii) the sample size formula based on the Score test is also fairly accurate in terms of the empirical power and type I error rate, and is hence recommended. A real example from an aplastic anemia study is used to illustrate the proposed methodologies., (© 2012 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.)

Investigating the prevalence of a disease is an important topic in medical studies. Such investigations are usually based on the classification results of a group of subjects according to whether they have the disease. To classify subjects, screening tests that are inexpensive and nonintrusive to the test subjects are frequently used to produce results in a timely manner. However, such screening tests may suffer from high levels of misclassification. Although it is often possible to design a gold-standard test or device that is not subject to misclassification, such devices are usually costly and time-consuming, and in some cases intrusive to the test subjects. As a compromise between these two approaches, it is possible to use data that are obtained by the method of double-sampling. In this article, we derive and investigate four test statistics for testing a hypothesis on disease prevalence with double-sampling data. The test statistics are implemented through both the asymptotic method suitable for large samples and approximate unconditional method suitable for small samples. Our simulation results show that the approximate unconditional method usually produces a more satisfactory empirical type I error rate and power than its asymptotic counterpart, especially for small to moderate sample sizes. The results also suggest that the score test and the Wald test based on an estimate of variance with parameters estimated under the null hypothesis outperform the others. An real example is used to illustrate the proposed methods.

Bilateral dichotomous data are very common in modern medical comparative studies (e.g. comparison of two treatments in ophthalmologic, orthopaedic and otolaryngologic studies) in which information involving paired organs (e.g. eyes, ears and hips) is available from each subject. In this article, we study various confidence interval estimators for proportion difference based on Wald-type statistics, Fieller theorem, likelihood ratio statistic, score statistics and bootstrap resampling method under the dependence or/and independence models for bilateral binary data. Performance is evaluated with respect to the coverage probability and expected width via simulation studies. Our empirical results show that (1) ignoring the dependence feature of bilateral data could lead to severely incorrect coverage probabilities; and (2) Wald-type, score-type and bootstrap confidence intervals based on the dependence model perform satisfactorily for small to large sample sizes in the sense that their empirical coverage probabilities are close to the pre-specified nominal confidence level and are hence recommended. A real data from an otolaryngologic study is used to illustrate the proposed methods.

In this article, we consider approximate sample size formulas for testing difference between two proportions for bilateral studies with binary outcomes. Sample size formulas are derived to achieve a prespecified power of a statistical test at a prechosen significance level. Four statistical tests are considered. Simulation studies are conducted to investigate the accuracy of various formulas. In general, the sample size formula for Rosner's statistic based on the dependence assumption is highly recommended in the sense that its actual power is satisfactorily close to the desired power level. An example from an otolaryngological study is used to demonstrate the proposed methodologies.

Objective: To investigate the effect of ethyl acetate extract from Chrysanthemum Morifolium Ramat (CME) on experimental arrhythmia induced by ischemia/reperfusion or aconitine in rats and to explore its underlying mechanisms., Methods: Arrhythmia model in intact rat was induced by aconitine (30 microg/kg body weight, i.v.). In isolated Langendorff perfused rat hearts, regional ischemia and reperfusion was induced by ligation and release of left anterior descending artery. The ventricular fibrillation threshold (VFT), effective refractory period (ERP), and diastolic excitation threshold (DET) in the isolated heart were measured. The action potentials of papillary muscle in rat right ventricle were recorded by conventional glass microelectrode technique., Results: Compared with control group CME significantly decreased the number and duration of ventricular tachycardia (VT); delayed the occurrence of ventricular premature beats (VPB) and VT induced by aconitine. Arrhythmia score of the CME group was lower than that in aconitine-treated group. CME markedly prolonged the ERP and increased the VFT in the isolated perfused rat hearts during ischemia and reperfusion. CME prolonged action potential duration at 50% and 90% repolarization of the right ventricular papillary muscles and decreased the maximal rate of rise of the action potential upstroke, but did not affect the resting potential, amplitude of action potential., Conclusion: CME can reduce myocardial vulnerability and exerts its antiarrhythmic effects induced by aconitine or ischemia/reperfusion, which may be related to its prolongation of action potential duration and effective refractory period that enhance the electrophysiological stability of myocardiaium.

Oxidative stress is believed to contribute to neuronal damage induced by cerebral ischemia/reperfusion (I/R) injury. The present study was undertaken to evaluate the possible antioxidant neuroprotective effect of genistein against neuronal death in hippocampal CA1 neurons following transient global cerebral ischemia in the rat. Transient global cerebral ischemia was induced in male Sprague-Dawley rats by four-vessel-occlusion for 10min. At various times of reperfusion, the histopathological changes and the levels of mitochondria-generated reactive oxygen species (ROS), malondialdehyde (MDA), cytosolic cytochrome c and caspase-3 activity in hippocampus were measured. We found extensive neuronal death in the CA1 region at day 5 after I/R. The ischemic changes were preceded by increases in ROS generation and MDA concentration and followed by increased cytosolic cytochrome c, and subsequently caspase-3 activation and apoptosis. Treatment with genistein (15mg/kg, i.p.) significantly attenuated ischemia-induced neuronal death. Genistein administration also decreased ROS generation, MDA concentration and the apoptotic indices. These results suggest that genistein protects neurons from transient global cerebral I/R injury in rat hippocampus by attenuating oxidative stress, lipid peroxidation and the signaling cascade leading to apoptotic cell death.

Background: Bone morphogenetic protein-2 (BMP-2) plays a key role both in vascular development and pathophysiological processes. However, the effects of oxidized low-density lipoprotein (ox-LDL) combined with atorvastatin on BMP-2 expression are entirely unknown in human umbilical vein endothelial cells (HUVECs). The present study investigates the effects of ox-LDL on BMP-2 expression. Furthermore, the influence of atorvastatin on ox-LDL-induced BMP-2 expression is also examined., Methods and Results: The HUVECs were treated by ox-LDL or combined with pyrrolidine dithiocarbamate (PDTC) or atorvastatin. The expression level of BMP-2 mRNA was examined by real-time PCR and RT-PCR analysis. The expression of BMP-2 protein was assayed by enzyme-linked immunosorbent assay. The malondialdehyde (MDA) and activities of total superoxide dismutase (SOD) were detected by routine methods. The activation of nuclear factor kappaB (NF-kappaB) in HUVECs was determined using an assay kit from active motif and western blot analysis. Ox-LDL treatment significantly increased BMP-2 expression, which is associated with NF-kappaB activation, but BMP-2 expression was suppressed by treatment with PDTC or atorvastatin. Furthermore, the increase in MDA levels and decrease in activities of total SOD caused by ox-LDL treatment were reversed by the treatment of PDTC or atorvastatin., Conclusions: Ox-LDL-induced BMP-2 expression was suppressed by PDTC or atorvastatin treatment. The effects of atorvastatin might contribute to the mechanisms by inhibiting NF-kappaB activation.