347 KEYNOTE-365 cohort C: pembrolizumab + enzalutamide in patients with abiraterone acetate–pretreated metastatic castration-resistant prostate cancer (mCRPC)—data after minimum of 22 months of follow-up

Background

Previous data from cohort C of phase 1b/2 study KEYNOTE-365 (NCT02861573) showed that PD-1 inhibitor pembrolizumab + enzalutamide was well tolerated and showed antitumor activity in patients with abiraterone acetate–pretreated mCRPC. Updated data after a minimum of 22 months of follow-up are presented.

Methods

Patients in the prechemotherapy mCRPC state who were intolerant to ≥4 weeks‘ treatment with abiraterone acetate or for whom this treatment failed, had progressive disease ≤6 months before screening, and had ECOG PS 0-2 were enrolled. Patients received pembrolizumab 200 mg IV Q3W + enzalutamide 160 mg orally QD. Primary end points were PSA response rate (decrease ≥50% from baseline), confirmed ORR per RECIST v1.1 by blinded independent central review (BICR), and safety. Secondary end points were time to PSA progression; DCR (CR or PR of any duration + SD or non-CR/non-PD ≥6 months) and DOR per RECIST v1.1 by BICR; rPFS per PCWG3-modified RECIST v1.1 by BICR; and OS.

Results

Of 103 enrolled patients, 102 were treated. Median age was 70.0 years (range, 43–87); 29.4% of patients were PD-L1+; 37.3% had RECIST-measurable disease. Median follow-up (time from enrollment to data cutoff) was 40.2 months (range, 22.3–49.9). Confirmed PSA response rate in patients with baseline PSA measurement (N = 101) was 23.8%. Median time to PSA progression was 4.0 months (95% CI, 3.5–4.4). In 38 patients with measurable disease, ORR was 10.5% (2 CR; 2 PR). Median DOR was 11.8 months (4.3 to 38.3+ months); 1 patient had a response ≥12 months. DCR for the total population was 33.3%. Median (95% CI) rPFS was 6.0 months (4.1–6.3); rPFS at 12 months was 30.1%. Median (95% CI) OS was 20.1 months (16.9–25.2); OS at 12 months was 76.2%. Treatment-related AEs (TRAEs) occurred in 92.2% of patients; most common (≥20%) were fatigue (39.2%), nausea (21.6%), and rash (21.6%). Grade 3–5 TRAEs occurred in 42.2%, most commonly rash (7.8%) and fatigue (5.9%). Four patients died of AEs: 1 death was treatment-related (unknown cause).

Conclusions

After a minimum follow-up of 22 months, pembrolizumab + enzalutamide continued to show antitumor activity in abiraterone acetate–pretreated mCRPC. The safety profile of pembrolizumab + enzalutamide was generally consistent with individual profiles of each agent. There was a higher incidence than typically reported for the individual agents of all-grade (21.6%) and grade 3 (7.8%) rash, which resolved with standard-of-care treatment. The combination is being further evaluated in the phase 3 study KEYNOTE-641.

Acknowledgements

Medical writing and/or editorial assistance was provided by Matthew Grzywacz, PhD, of ApotheCom (Yardley, PA, USA). This assistance was funded by Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA. Funding for this research was provided by Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA.

Trial Registration

ClinicalTrials

gov, identifier: NCT02861573

Ethics Approval

The study and the protocol were approved by the Institutional Review Board or ethics committee at each site.

351 KEYNOTE-365 cohort D: pembrolizumab plus abiraterone acetate and prednisone in patients with chemotherapy-naive metastatic castration-resistant prostate cancer (mCRPC)

Background

Treatment with abiraterone acetate + prednisone can improve outcomes in mCRPC patients with or without prior chemotherapy. Cohort D of phase 1b/2 study KEYNOTE-365 (NCT02861573) evaluated safety and efficacy of PD-1 inhibitor pembrolizumab + abiraterone acetate and prednisone in patients who had not received chemotherapy for mCRPC.

Methods

Patients were enrolled who had not received second-generation hormonal manipulation for mCRPC or failed/were intolerant to enzalutamide for mCRPC; had progressive disease ≤6 months before screening; and had ECOG PS 0/1. Patients received pembrolizumab 200 mg IV Q3W + abiraterone acetate 1000 mg orally QD and prednisone 5 mg orally BID. Primary end points: safety, PSA response rate (PSA decrease ≥50% from baseline), and confirmed ORR per RECIST v1.1 by blinded independent central review (BICR). Secondary end points: rPFS per PCWG3-modified RECIST v1.1, DCR, DOR, and OS.

Results

One hundred three patients were treated. Median (range) age was 70.0 (46–89) years, 30.1% were PD-L1+, 35.9% had RECIST-measurable disease, 18.4% had visceral disease, and 26.2% had previously received enzalutamide only. Median (range) time from enrollment to data cutoff was 17.6 (9.7–27.0) months. Confirmed PSA response rate in patients with PSA measurement at baseline (n=103) was 56.3%. For 37 patients with RECIST-measurable disease, ORR was 16.2% (1 CR; 5 PRs); 2 patients with RECIST-nonmeasurable disease had CR. In total population, 5 patients had a response ≥6 months; DCR was 44.7%. ORR for RECIST-measurable patients was 7.7% for those who previously received enzalutamide only (n=13) and 21.7% for those who had not previously received NHAs (n=23); DCR was 11.1% in all patients who previously received enzalutamide (n=27) and 57.3% in all patients who had not received NHAs (n=75). Median (95% CI) rPFS was 15.1 (9.2-NR) months; rPFS at 12 months was 54.9%. Median (95% CI) OS was NR (23.3 months-NR); OS at 12 months was 82.9%. Sixty-nine patients (67.0%) discontinued treatment, mostly because of progressive disease (37.9%). Treatment-related AEs (TRAEs) were experienced by 90.3% of patients and most common (≥15%) were ALT increase (22.3%), AST increase (17.5%), asthenia (16.5%), and diarrhea (16.5%); 36.9% experienced grade 3–5 TRAEs. There were 18.4%/12.5% grade 3 or 4 ALT/AST laboratory elevations. Five patients died of AEs; 1 was treatment related (myasthenic syndrome).

Conclusions

Pembrolizumab + abiraterone acetate and prednisone demonstrated antitumor activity in patients with chemotherapy-naive mCRPC. Safety was generally consistent with individual profiles of each agent. There was an increased incidence of grade 3–4 ALT/AST laboratory elevations.

Acknowledgements

Medical writing and/or editorial assistance was provided by Matthew Grzywacz, PhD, of ApotheCom (Yardley, PA, USA). This assistance was funded by Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA. Funding for this research was provided by Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA.

Trial Registration

ClinicalTrials

gov, identifier: NCT02861573

Ethics Approval

The study and the protocol were approved by the Institutional Review Board or ethics committee at each site.

419 Pembrolizumab + lenvatinib in patients with adenocarcinoma metastatic castration-resistant prostate cancer (mCRPC) or treatment-emergent neuroendocrine mCRPC: Phase 1b/2 KEYNOTE-365 cohorts E/F

Background

Treatment of adenocarcinoma mCRPC includes abiraterone, enzalutamide, or docetaxel but is not curative, and ~20% of patients develop treatment-emergent neuroendocrine mCRPC (t-NE) after diagnosis of adenocarcinoma. Monotherapy with the PD-1 inhibitor pembrolizumab showed promising antitumor activity in the phase 2 KEYNOTE-199 trial in adenocarcinoma mCRPC. The vascular endothelial growth factor (VEGF)/fibroblast growth factor receptor (FGFR) inhibitor lenvatinib inhibits proliferation and angiogenesis in mice models. Combined PD-1 and VEGF/FGFR inhibition may have enhanced benefit in adenocarcinoma mCRPC or t-NE.

Methods

The nonrandomized, open-label, multicohort, phase 1b/2 KEYNOTE-365 study (NCT02861573) will be conducted to evaluate several pembrolizumab combination therapies in patient populations with adenocarcinoma mCRPC or t-NE. In cohorts E and F each, 40–100 adults with Eastern Cooperative Oncology Group performance status score of 0/1 who received docetaxel for mCRPC will be enrolled. Prior therapy with ≤2 next-generation hormonal agents (NHAs) and 1 other chemotherapy for mCRPC is permitted. Patients in cohort E must have confirmed adenocarcinoma of the prostate without small cell histology at study entry. Patients in cohort F must have t-NE (≥1% neuroendocrine cells in a recent biopsy specimen confirmed by central histology review) that progressed within 6 months of starting an NHA for mCRPC or hormone-sensitive metastatic prostate cancer and progressed within 6 cycles of docetaxel for mCRPC. Both cohorts will receive pembrolizumab 200 mg intravenously every 3 weeks + oral lenvatinib 20 mg daily until disease progression, consent withdrawal, or other discontinuation event. Computed tomography or magnetic resonance imaging will be performed at screening, every 9 weeks through week 54, and every 12 weeks thereafter. Adverse events will be monitored through 30 days after discontinuation (90 days if serious) and graded per CTCAE v4.0. Primary end points are safety and tolerability, prostate-specific antigen (PSA) response rate, and objective response rate (ORR) per RECIST v1.1 by blinded independent central review (BICR). Secondary end points are time to PSA progression; ORR and radiographic progression-free survival (rPFS) per Prostate Cancer Working Group 3 (PCWG3)–modified RECIST v1.1 by BICR; duration of response and disease control rate per RECIST v1.1 and PCWG3-modified RECIST v1.1 by BICR; and overall survival.

Acknowledgements

Medical writing and/or editorial assistance was provided by Matthew Grzywacz, PhD, of ApotheCom (Yardley, PA, USA). This assistance was funded by Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA. Funding for this research was provided by Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA.

Trial Registration

Clinicaltrials.

gov, NCT02861573

Ethics Approval

The study and the protocol were approved by the Institutional Review Board or ethics committee at each site.

418 Phase 1b/2 KEYNOTE-365 cohort I: platinum-containing chemotherapy alone or in combination with pembrolizumab for treatment-emergent neuroendocrine prostate carcinoma

Background

Treatment-emergent neuroendocrine prostate carcinoma (t-NE) can occur de novo or after diagnosis of prostate adenocarcinoma. Treatment often includes platinum-containing chemotherapy because of t-NE’s histologic similarity to small cell lung cancer. The PD-1 inhibitor pembrolizumab has shown promising efficacy and acceptable safety when combined with olaparib, docetaxel, or enzalutamide for treatment of metastatic castration-resistant prostate cancer (mCRPC) in the multicohort phase 1b/2 KEYNOTE-365 study (NCT02861573). Cohort I will be used to compare platinum-containing chemotherapy alone with chemotherapy + pembrolizumab as treatment for t-NE.

Methods

Patients who have t-NE (≥1% neuroendocrine cells in a recent biopsy specimen confirmed by central histology review); experienced progression within 6 months of starting a next-generation hormonal agent (NHA) for mCRPC or hormone-sensitive prostate cancer and experienced progression within 6 cycles of docetaxel treatment for mCRPC; and have an Eastern Cooperative Oncology Group (ECOG) performance status score of 0 or 1 are eligible. Prior therapy with ≤2 NHAs and 1 other chemotherapy for mCRPC is permitted. Patients will be randomly assigned 1:1 to receive pembrolizumab 200 mg IV on day 1 of each cycle every 3 weeks + carboplatin AUC of 5 IV on day 1 + etoposide 100 mg/m2 IV on days 1, 2, and 3 of each 21-day cycle for 4 cycles (arm 1) or the same chemotherapy regimen without pembrolizumab (arm 2); in each arm 40–100 patients will be enrolled. Pembrolizumab treatment will continue up to 2 years until disease progression, unacceptable toxicity, or withdrawal of consent. Patients will be stratified by ECOG performance status score (0 or 1). Computed tomography or magnetic resonance imaging will be performed every 9 weeks through week 54 and every 12 weeks thereafter. Primary end points are safety and tolerability, prostate-specific antigen (PSA) response rate, and objective response rate (ORR) per RECIST v1.1 by blinded independent central review (BICR). Secondary end points are time to PSA progression; ORR and radiographic progression-free survival (PFS) per PCWG3-modified RECIST v1.1 by BICR; duration of response and disease control rate per RECIST v1.1 by BICR and PCWG3-modified RECIST v1.1 by BICR; and overall survival. End points will be summarized for each arm without formal hypothesis testing.

Acknowledgements

Medical writing and/or editorial assistance was provided by Matthew Grzywacz, PhD, of ApotheCom (Yardley, PA, USA). This assistance was funded by Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA. Funding for this research was provided by Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA.

Trial Registration

Clinicaltrials.

gov, NCT02861573

Ethics Approval

The study and the protocol were approved by the Institutional Review Board or ethics committee at each site.

425 Pembrolizumab + vibostolimab in patients with adenocarcinoma metastatic castration-resistant prostate cancer (mCRPC) or treatment-emergent neuroendocrine mCRPC: phase 1b/2 KEYNOTE-365 cohorts G/H

Background

Frontline treatment for patients with adenocarcinoma mCRPC includes docetaxel, radium 223, or the next-generation hormonal agents (NHAs) abiraterone or enzalutamide. For patients with disease progression on these therapies, approximately 20% will develop treatment-emergent neuroendocrine mCRPC (t-NE) after diagnosis of prostate adenocarcinoma. The PD-1 inhibitor pembrolizumab showed antitumor activity when combined with olaparib in cohort A of the phase 1b/2 KEYNOTE-365 trial, and the TIGIT inhibitor vibostolimab showed antitumor activity in preclinical models. Combining PD-1 and TIGIT inhibition may have enhanced benefit in adenocarcinoma mCRPC or t-NE.

Methods

KEYNOTE-365 is a nonrandomized, open-label, multicohort study (NCT02861573) to assess several pembrolizumab combination therapies in patient populations with adenocarcinoma mCRPC or t-NE. In each of cohorts G and H, 40–100 adults with Eastern Cooperative Oncology Group performance status (ECOG PS) 0/1 who received docetaxel for mCRPC will be enrolled. Prior therapy with ≤2 NHAs and 1 other chemotherapy for adenocarcinoma mCRPC is permitted. Patients in cohort G must have adenocarcinoma of the prostate without small cell histology at study entry. Patients in cohort H must have t-NE (≥1% neuroendocrine cells in a recent biopsy specimen confirmed by central histology review) that progressed within 6 months of starting an NHA for mCRPC or hormone-sensitive prostate cancer and progressed within 6 cycles of docetaxel for mCRPC. All patients will receive MK-7684A, a coformulation of pembrolizumab 200 mg and vibostolimab 200 mg intravenously every 3 weeks until disease progression, consent withdrawal, or other discontinuation event. Adverse events will be monitored through 30 days after discontinuation (90 days if serious) and graded per CTCAE v4.0. Computed tomography or magnetic resonance imaging will be performed at screening, every 9 weeks through week 54, and every 12 weeks thereafter. Primary end points are safety and tolerability, prostate-specific antigen (PSA) response rate, and objective response rate (ORR) per RECIST v1.1 by blinded independent central review (BICR). Secondary end points are time to PSA progression, ORR and radiographic progression-free survival per Prostate Cancer Working Group 3 (PCWG3)–modified RECIST v1.1 by BICR; duration of response and disease control rate per RECIST v1.1 and PCWG3-modified RECIST v1.1 by BICR; and overall survival.

Acknowledgements

Medical writing and/or editorial assistance was provided by Matthew Grzywacz, PhD, of ApotheCom (Yardley, PA, USA). This assistance was funded by Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA. Funding for this research was provided by Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA.

Trial Registration

Clinicaltrials.

gov, NCT02861573

Ethics Approval

The study and the protocol were approved by the Institutional Review Board or ethics committee at each site.

[Epidemiological characteristics of close contacts of COVID-19 cases and infection-related risk factors in Beijing]

Objective: To analyze the epidemiological characteristics of close contacts of COVID-19 cases and infection-related risk factors in Beijing and provide evidences for COVID-19 prevention and control. Methods: A total of 20 681 close contacts of COVID-19 cases, who had exposures during January 6, 2020 to February 15, 2021, were traced in Beijing. The information about their demographic characteristics, exposure history, and quarantine outcomes were collected and analyzed with descriptive statistics. The logistic regression analysis was used to identify the risk factors for COVID-19. Results: The infection rate SARS-CoV-2 in close contacts was 2.16% (447/20 681). The age M(P₂₅, P₇₅) was 35 (27, 49) years. The majority of the close contacts were aged 20-59 years, accounting for 81.77% (16 912/20 681). Centralized isolation was the major type of medical observation, accounting for 82.15% (16 989/20 681). Among the exposure types, working and studying in the same room (16.06%, 3 322/20 681), sharing same transport vehicle (12.88%, 2 664/20 681), performing diagnosis and treatment nursing (7.80%,1 612/20 681), and living together (7.23%,1 495/20 681), accounting for 43.96% (9 093/20 681). The index cases included staff (19.34%, 3 999/20 681), the unemployed (17.34%, 3 586/20 681), people engaged in business service (13.85%, 2 864/20 681), people engaged in food service (10.77%, 2 228/20 681), their close contacts accounted for 61.30% (12 677/20 681). Multivariate logistic regression analysis showed that compared with other types of exposure, the risk factors for infection were having meal together (OR=3.96, 95%CI: 2.30-6.83) and living together (OR=6.41, 95%CI:4.48-9.17); Compared with the other occupations, the index case being engaged in food service (OR=3.06, 95%CI:1.29-7.25) and teacher (OR=4.94, 95%CI:1.43-17.08) were risk factors for the infection. Conclusions: The main environmental exposure types of SARS-CoV-2 infection in close contacts were having meal together and living together. Contact with the index case being engaged in food service and teacher increased the risk for COVID-19. Comprehensive prevention and control measures such as centralized isolation and vaccination should be continued.

Effects of water deficiency on preference and performance of an insect herbivore Ostrinia furnacalis

With further climate change still expected, it is predicted to increase the frequency with plants will be water stressed, which subsequently influences phytophagous insects, particularly Lepidoptera with limited mobility of larvae. Previous studies have indicated that oviposition preference and offspring performance of Lepidoptera insects are sensitive to drought separately. However, the integration of their two properties is not always seen. Here, we evaluated changes in oviposition selection and offspring fitness of a Lepidoptera insect under three water-stressed treatments using a model agroecosystem consisting of maize Zea mays, and Asian corn borer Ostrinia furnacalis. Results found that female O. furnacalis preferred to laying their eggs on well-watered maize, and then their offspring tended to survive better, attained bigger larvae mass, and developed more pupae and adults on the preferred maize. Oviposition selection of O. furnacalis positively correlated with height and leaf traits of maize, and offspring fitness positively related with water content and phytochemical traits of hosts. Overall, these results suggest that oviposition choice performed by O. furnacalis reflects the maximization of offspring fitness, supporting preference-performance hypothesis. This finding further highlights that the importance of simultaneous evaluation of performance and performance for water driving forces should be involved, in order to accurately predict population size of O. furnacalis under altered precipitation pattern.

[Investigation on prevention and treatment status of VTE in pregnant women of general hospitals and specialized hospitals in China]

Objective: To investigate the prevention and treatment status of venous thromboembolism (VTE) of pregnant women in general hospitals and specialized hospitals in China. Methods: This study was a cross-sectional survey about VTE prevention and treatment in 112 hospitals across China from January 1st to December 31st, 2019, including general information, resource accessibility, hospital system and strategy. According to the characteristics, the hospitals were divided into general hospital group (70 hospitals) and specialized hospital group (42 hospitals). The basic information, VTE diagnosis and treatment resources, prevention systems and the preference of the VTE risk assessment form of the two groups were compared. Logistic regression was used to analyze the proportion of VTE incidence and related factors in the two groups of hospitals. Results: (1) The median annual delivery volume of the general hospital group was significantly lower than that of the specialized hospital group (3 428 vs 9 969 cases, P<0.01), the diagnostic accessibility of CT pulmonary angiography (CTPA) was significantly higher than that of the specialized hospital [92.9% (65/70) vs 59.5% (25/42), P<0.01], and the proportion of obstetric VTE risk assessment was significantly higher than that of the specialized hospital group [85.7% (60/70) vs 66.7% (28/42), P=0.017]. (2) Among the 88 hospitals using the VTE risk assessment sheet, the utilization rate of the evaluation sheet recommended by the obstetric VTE guideline in specialized hospitals (78.6%, 22/28) was higher than that of general hospitals (48.3%, 29/60), and the difference was statistically significant (P=0.007). (3) The proportion of VTE incidence in general hospital group was 0.126% (360/286 517), and the proportion of VTE incidence in specialized hospital group was 0.032% (154/484 111). Logistic regression analysis showed that the OR value of the specialized hospital group was 0.253 (95%CI: 0.209-0.305) and the difference was statistically significant (P<0.01) compared with the general hospital group. After adjusting the hospital level, B-ultrasonography and CTPA accessibility, whether to establish a risk assessment and obstetric VTE system, the proportion of VTE incidence in specialized hospitals was still lower than that in general hospitals (OR=0.307, 95%CI: 0.251-0.376, P<0.01). Conclusions: General hospitals have higher access to resources for diagnosing VTE than specialized hospitals, and the VTE evaluation system is better implemented. The utilization rate of the obstetric VTE guidelines in specialized hospitals is higher than that of general hospitals.

[Application of different kinds of endotracheal intubation in the combined thoracoscopic and laparoscopic esophagectomy]

Objective: To observe the application of three different kinds of endotracheal intubation in the combined thoracoscopic and laparoscopic esophagectomy. Methods: one hundred and eighty patients undergoing combined thoracoscopic and laparoscopic esophagectomy under general anesthesia from the Affiliated Cancer Hospital of Zhengzhou University from February to September 2019 were randomly divided into three groups which include: double-lumen endotracheal intubation group (group S,n=60),single-lumen endotracheal intubation group (group D,n=60) and Coopdech occlusion of bronchial catheter combined with a single-lumen endotracheal intubation group (group C,n=60). The arterial blood samples were collected immediately after endotracheal intubation (T₀), 30 min after artificial pneumothorax (single lung ventilation) (T₁), 30 min after artificial pneumothorax (double lung ventilation) (T₂), and 30 min after extubation (T₃) to detect arterial blood gas. Patients' heart rate (HR), blood oxygen partial pressure (PaO₂), blood carbon dioxide partial pressure (PaCO₂) and airway pressure(Paw) were recorded at T₀-T₃.Completion time of endotracheal intubation, carbon dioxide intrathoracic inflation pressure, degree of lung collapse and incidence of postoperative 3-day pneumonia in three groups were recorded. The bronchoalveolar lavage fluid (BALF) of patients at T₀, T₂ and the end of the operation (T₄) were collected to detect the levels of tumor necrosis factor-α(TNF-α), interleukin-6 (IL-6) and interleukin-8 (IL-8) in BALF by enzyme-linked immunosorbent assay (ELISA). Results: A total of 14 patients were excluded during the operation, of which 9 cases lasted longer than 6 hours, 3 cases had arrhythmia during the operation and 2 cases lasted less than 1 hour. Finally, 56 cases in group S, 54 cases in group D and 56 cases in group C completed the experiment. The satisfaction rates of lung collapse in group S, group D and group C were 85.7% (48/56), 100.0% (54/54), 89.2% (50/56), respectively, with no statistically significant difference (χ²=1.308, P>0.05). The intrathoracic inflation pressure of carbon dioxide in group D was (10.2±2.2) mmHg (1 mmHg=0.133 kPa), which was higher than (5.1±3.4) mmHg in group S and (5.6±3.1) mmHg in group C, the difference was statistically significant (F=-9.303, P<0.05). The incidence of postoperative 3-day pneumonia in group D was 14.8%, which was lower than 39.3% in group S and 17.8% in group C, the difference was statistically significant (χ²=8.300, P<0.05). At T₄, the value of TNF-α in group D was (122.4±4.4) ng/L, which was lower than that in group S and group C, (257.9±6.3) and (185.8±5.6) ng/L, with statistically significant difference (F=69.020, P<0.05). At T₄, the value of IL-6 in group D was (175.4±4.9) ng/L, which was lower than that of patients in group S and group C, (289.6±6.8) and (226.2±4.4) ng/L, with statistically significant difference (F=59.750, P<0.05). At T₄, the value of IL-8 in group D was (303.1±7.2) ng/L, which was lower than in group S and group C, (595.4±22.1) and (436.8±10.9) ng/L, with statistically significant difference (F=55.359, P<0.05). Conclusion: All the three endotracheal intubations can produce satisfactory ventilation effect in the combined thoracoscopic and laparoscopic esophagectomy, however, single-lumen endotracheal intubation has less effect on lung injury.

[Role of 1, 25-dihydroxyvitamin D3 in liver lipid metabolism induced by methionine-choline-deficient diet in rats]

Objective: To investigate the role of 1, 25-dihydroxyvitamin D3 [1.25(OH) (2)D(3)] in liver lipid metabolism so as to provide the clues for elucidating the mechanism of non-alcoholic fatty liver. Methods: 26 SD rats were randomly divided into control group (methionine-choline-sufficient diet, MCS), model group (methionine-choline-deficiency diet, MCD) and intervention group [MCD+1.25(OH) (2)D(3)]. The intervention, control, and model group was given 3 ng/100 g 1.25(OH) (2)D(3) peanut oil solution per day by gavage according to body mass. After 4 weeks the experiment was ended up, and the blood was collected from the inferior vena cava to detect alanine aminotransferase (ALT) and aspartate aminotransferase (AST). The liver tissue was collected to observe the liver morphological and pathological changes (oil red O and HE staining). The changes in the level of liver total triglyceride (TG) content and liver lipid metabolism-related genes [fatty acid transfer protein (FAT/CD36), acetyl-coenzyme A carboxylase (ACC1)] mRNA and protein were detected. One-way analysis of variance was used to compare the means between groups. Results: Oil red O staining and HE staining showed that lipid droplet-vacuoles were significantly increased in the liver tissue of the model group than that of the intervention group. The liver TG content (2.23 ± 0.98) μmol/g of the intervention group was significantly lower than that of the model group (3.53 ± 1.06) μmol/g (F = 5.930, P = 0.035). The ALT content of the intervention group (35.99±9.54) U/L was significantly lower than that of the model group (57.65 ± 19.42) U/L (F = 13.790, P = 0.034). The AST content of the intervention group (16.9 ± 3.73) U/L was significantly lower than that of the model group (27.81 ± 13.31) U/L (F = 3.084, P = 0.046). The relative expression levels of mRNA and protein (mRNA: 1.21 ± 0.61, protein: 1.54 ± 0.75) of FAT/CD36 in the intervention group were significantly lower than those of the model group (mRNA: 2.31 ± 0.81, protein: 2.83 ± 1.42) (mRNA: F = 8.370, P = 0.001, protein: F = 7.212, P = 0.043). The relative expression level of mRNA and protein of ACC1 (mRNA: 0.89 ± 0.54, protein: 0.28 ± 0.11) were also significantly lower than those in model group (mRNA: 1.39 ± 0.19, protein: 0.47 ± 0.24) (mRNA: F = 3.948, P = 0.036, protein: F = 10.933, P = 0.048). Conclusion: 1.25(OH) (2)D(3) can reduce liver fat deposition in rats fed with MCD by inhibiting the expression of fat / CD36 and ACC1.

KEYNOTE-365 cohort B: Pembrolizumab (pembro) plus docetaxel and prednisone in abiraterone (abi) or enzalutamide (enza)–pretreated patients with metastatic castration-resistant prostate cancer (mCRPC)—New data after an additional 1 year of follow-up

10

Background: For men with mCRPC, systemic therapies such as docetaxel and cabazitaxel improve survival, but more effective treatments are needed. KEYNOTE-365 (NCT02861573) is a phase 1b/2 study to examine the safety and efficacy of pembro in combination with 4 different study medications (cohorts A, B, C, D) in mCRPC. Previous data from cohort B with a median of 20 months of follow-up showed that pembro + docetaxel and prednisone was well tolerated and had antitumor activity in patients (pts) with mCRPC previously treated with abi or enza. New efficacy and safety data after an additional year of follow-up are presented. Methods: Cohort B enrolled pts who did not respond to or were intolerant to ≥4 weeks of abi or enza in the prechemotherapy mCRPC state and whose disease progressed within 6 months of screening (determined by PSA progression or radiologic bone/soft tissue progression). Pts received pembro 200 mg IV every 3 weeks (Q3W), docetaxel 75 mg/m2 IV Q3W, and oral prednisone 5 mg twice daily. Primary end points were safety, PSA response rate (PSA decrease >50% from baseline), and ORR per RECIST v1.1 by blinded independent central review. Efficacy and safety were assessed in all pts as treated. Results: Of the 104 treated pts, median age was 68.0 years (range, 50-86), 23.1% had PD-L1–positive tumors (combined positive score ≥1), 25.0% had visceral disease, and 50.0% had measurable disease. Median time from enrollment to data cutoff was 32.4 months (range 13.9-40.3); 101 pts discontinued, primarily because of disease progression (77.9%). Efficacy outcomes are reported in the table below. Treatment-related adverse events (TRAEs) occurred in 100 pts (96.2%); the most frequent (≥30%) were diarrhea (41.3%), fatigue (41.3%), and alopecia (40.4%). Grade 3-5 TRAEs occurred in 46 pts (44.2%). Five pts (4.8%) died of AEs; 2 were treatment-related pneumonitis. Conclusions: After another year of follow-up, pembro + docetaxel and prednisone showed improved ORR and PSA response rates compared to the prior dataset in pts with mCRPC previously treated with abi or enza. Safety was consistent with known profiles of each agent and will be further evaluated in a phase 3 study (KEYNOTE-921). Clinical trial information: NCT02861573. [Table: see text]

[Comparative analysis of the clinical application of two femtosecond laser-assisted cataract operation platforms]

Objective: To evaluate the operability and clinical application effects of femtosecond laser-assisted cataract surgery systems of LenSx and LenSAR. Methods: This was a randomized controlled study. A total of 86 patients (90 eyes) who underwent femtosecond laser-assisted cataract surgery in Wuhan Aier Eye Hospital from April 2018 to November 2018 were enrolled and divided into two groups randomly, including 44 patients (45 eyes) in the LenSx group and 42 patients (45 eyes) in the LenSAR group. During the operation, the following observation indexes were obtained. Operational indicators included the number of docking attempts, anterior capsulotomy time, nucleus pre-treatment time, total femtosecond laser emission time, and total vacuum suction duration. Clinical outcome indicators included changes in the patient's intraocular pressure during femtosecond laser surgery, the rate of subconjunctival hemorrhage, capsulotomy integrity (yes/no), roundness and centricity of the anterior capsule opening (yes/no), the rate of anterior capsule opening tear, and the rate of posterior capsule rupture. The t-test, rank-sum test or chi-square test were used for statistical analysis. Results: There were no significant differences between groups in the age and the lens density (both P>0.05). The number of docking attempts in the LenSx group was 1 (1 to 4) and in the LenSAR group was 1 (1 to 2); there was statistically significant difference (Z =-2.23, P<0.05). The difference in the anterior capsulotomy time between the two groups was statistically significant [13.00 (10.00 to 22.00) s compared with 3.00 (1.00 to 3.00) s, Z=-8.71, P<0.05]. The femtosecond laser pre-nucleation time and total femtosecond laser emission time of the LenSx group were (16.67±3.36) s and (30.49±3.53) s, and those of the LenSAR group were (12.38±4.36) s and (15.36±4.29) s, respectively; the differences between the two groups were statistically significant (t=-5.23, -18.26; both P<0.05). The total vacuum suction duration in the LenSx group was (97.23±19.96) s, shorter than that in the LenSAR group [(123.76±16.81) s] (t=6.82, P<0.05). The intraocular pressure after femtosecond laser surgery in both groups was higher than that before surgery. The increase of intraocular pressure in the LenSAR group was (5.64±5.42) mmHg (1 mmHg=0.133 kPa), higher than that in the LenSx group [(2.99±4.66) mmHg] (t=-2.49, P<0.05). The rate of subconjunctival hemorrhage in the LenSx group was 33.3% (15/45), while it was 8.9% (4/45) in the LenSAR group; the difference between the two groups was statistically significant (χ²=6.67, P<0.05). There were no significant differences between groups in capsulotomy integrity, roundness and centricity of the anterior capsule opening, the rate of anterior capsule opening tear, and the rate of posterior capsule rupture (all P>0.05). Conclusion: The docking process of the LenSAR system is convenient, and there is less subconjunctival hemorrhage; the total vacuum suction duration of LenSx is short, and the increase of intraocular pressure is low. (Chin J Ophthalmol, 2020, 56: 530-535).

[Digital evaluation of supracrestal gingival thickness induced by periodontal regenerative and corticotomy surgery in patients with skeletal class Ⅲ malocclusion]

Objective: To establish a quantitative three-dimensional method based on intraoral scan to evaluate the changes of soft tissue, and to evaluate the changes of supracrestal gingival thickness (SGT) in skeletal class Ⅲ patients induced by periodontal regenerative and corticotomy surgery (PRCS). Methods: Twenty-two systematically and periodontally healthy skeletal class Ⅲ patients (4 males and 18 females, aged between 19 and 35 years), who were in need of combined orthodontic-orthognathic treatment and referred to the Department of Periodontology from the Department of Orthodontics and the Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology from January, 2018 to March, 2019, were collected in the study. The teeth involved were 112 anterior teeth (46 maxillary anterior teeth and 66 mandibular anterior teeth). PRCS in anterior tooth area was conducted before orthodontic decompensation. Probing depth (PD), bleeding index (BI) and keratinized gingiva width (KGW) were recorded before surgery and 6 months post-surgery. The intraoral digital impressions of maxillary and mandibular anterior teeth were obtained by 3-shape intraoral scanner before surgery and 6 months after surgery. The Standard Tessellation Language (STL) files were processed using Geomagic qualify 12.2 software to establish the soft tissue morphological measurement model, and to quantitatively analyze the changes of gingival thickness situated 1 to 2 mm apical to the free gingival margin on the median sagittal measurement plane. Results: Probing depth and bleeding index had no significant difference before and 6 months after operation (P>0.05). KGW in 6-month post-operation group [(5.18±2.32) mm] was significantly higher than that in pre-operation group [(4.22±1.43) mm] (P<0.05). Supracrestal gingival thickness situated 1 to 2 mm apical to the free gingival margin also significantly increased 6 months after surgery (P<0.05). The changes of gingival thickness situated 1 to 2 mm apical to the free gingival margin in the upper anterior area were (0.68±0.56) and (1.00±0.69) mm, respectively. The changes in the lower anterior area were (0.38±0.42) and (0.58±0.45) mm, respectively. The gingival changes of the upper anterior teeth were also significantly higher than those of the lower anterior teeth (P<0.01). Conclusions: The described quantitative measurement based on intraoral scan could be an effective method for quantitative evaluation of the changes of soft tissue. PRCS could safely increase the supracrestal gingival thickness as well as KGW in skeletal class Ⅲ patients who were in need of combined orthodontic-orthognathic treatment.

[Prevalence and risk factors of Blastocystis hominis infection in inpatients in Jiangjin District, Chongqing City]

OBJECTIVE

To understand the prevalence and risk factors of Blastocystis hominis infection in inpatients in Jiangjin District, Chongqing City.

METHODS

A cross-sectional study was conducted in a community hospital in Jiangjin District, Chongqing City, and the inpatients were surveyed by questionnaires. After obtaining the informed consent from the inpatients or legal guardians, the stool and blood samples were collected and examined by microscopy and PCR from April 17 to May 1, 2018. The univariate analysis and logistic regression analysis were used to analyze the risk factors of the B. hominis infection.

RESULTS

A total of 198 hospitalized patients were investigated, and the infection rate of B. hominis was 10.61% (21/198), and the infection rate of the females (12.10%) was higher than that of the males (8.11%), but the difference was not statistically significant. The highest rate of infection was 19.23% in the age group of 10 to 20 years, followed by 17.74% in the age group of 60 years and above, and the lowest rate was 2.38% in the age group of 20 to 40 years. The difference in infection rates of B. hominis among the different age groups was statistically significant (P < 0.05). The infection rate of B. hominis in the people who used dry pail latrines was 33.30%, which was higher than that of the people who used water flush toilets (9.10%) (P < 0.05). The genotypes of B. hominis were ST1, ST3, ST6 and ST7, and ST6 and ST3 being the most predominant genotypes which accounted for 47.62% (10/21) and 38.10% (8/21) respectively, and among the infected males, the genotypes were only ST3 and ST6. The multiple logistic regression analysis showed that among the factors affecting B. hominis infection, only keeping pets was a risk factor [OR = 3.798, 95% CI (1.245, 11.581), P < 0.05].

CONCLUSIONS

A high prevalence of B. hominis infection is found in the inpatients in Jiangjin District, Chongqing City, the predominant genotypes are ST6 and ST3, and keeping pets may be one of the main risk factors.

Health-related quality-of-life among patients with premature ovarian insufficiency: a systematic review and meta-analysis

PURPOSE

To systematically review studies investigating health-related quality-of-life (HrQoL) in patients with premature ovarian insufficiency (POI), to examine questionnaires used and to conduct a meta-analysis of control studies with normal ovarian function.

METHODS

Data sources: PubMed, Embase, Web of science, CNKI, and CQVIP, searched from inception until June 2018. The search strategy was a combination of medical (e.g. POI), subjective (e.g. well-being) and methodological (e.g. questionnaires) keywords. PRISMA guidelines were used to assess outcome data quality/validity by one reviewer, verified by a second reviewer. Risk of bias within studies was evaluated. A meta-analysis compared HrQoL in patients and non-patients. Due to measurement differences in the studies, the effect size was calculated as standard mean difference.

RESULTS

We identified 6869 HrQoL studies. Nineteen geographically diverse studies met inclusion criteria, dated from 2006, using 23 questionnaires. The meta-analysis included six studies with 645 POI participants (age 33.3 ± 5.47) and 492 normal-ovarian control subjects (age 32.87 ± 5.61). Medium effect sizes were found for lower overall HrQoL (pooled SMD = - 0.73, 95% CI - 0.94, - 0.51; I² = 54%) and physical function (pooled SMD = - 0.54, 95% CI - 0.69, - 0.39; I² = 55%). Heterogeneity was investigated. Effect sizes varied for sexual function depending on the measure (SMD = - 0.27 to - 0.74), overall HrQoL (SF-36) had the largest effect size (- 0.93) in one study. The effect sizes for psychological and social HrQoL were small.

CONCLUSION

POI is associated with low-to-medium effect size on HrQoL compared to normal ovarian controls. The greatest effects are found in general HrQoL and most sexual function areas. Condition-specific questionnaires and RCTs are recommended for further investigation.

[Investigation and analysis of thyroid function of medical occupational population in a tertiary-A hospital in Nanjing]

Objective: To evaluate the effect of low-dose of ionizing radiation on thyroid function of medical occupational group with long-term exposure, furthermore, to analyze the relationship between the thyroid hormones and the risk factors, such as exposure length, department and comulative radiation dose. Ultimately, providing the scientific basis for setting the ionizing radiation protection standards. Methods: The population who engaged radiodiagnosis and radiotherapy in a tertiary-A hospital was set up as occupational exposure, and the administrative staffs in a company were considered as control. According to the inclusion and exclusion criteria, 161 medical professionals and 159 administrative staffs as the research object.We figured out the basic information and general condition of the groups by face-to-face questionnaire survey, calculated the annual comulative radiation dose through local center for disease control and prevention, By means of the thyroid hormone testing, we analyzed the thyroid hormone levels with different population, occupational exposure factors. Applying Epidata、Excel in data management. All the data was analyzed by statistical software package Stata12.0. Descriptive statistics, single factor analysis of variance and other statistical methods were used for data analysis. Test standard: α=0.05、P<0.05 statistical significant. Results: Age, sex and seniority were proportionality between exposure and control groups. The dosages of occupational population exposure to ionizing radiation were about 1/10 of national permit value, belonging to low-dose exposure. The T(3), FT(3) level of the exposure group was decreased than the control group (P<0.001). especially the FT(3) level has statitical discrepancy among groups with different exposure length (P<0.05). Conclusion: Long-term exposure to low-dose ionizing radiatiom can induce the thyroid damage of medical occupational population, which should be broader concerned.

Effects of polyester microfibers on soil physical properties: Perception from a field and a pot experiment

Understanding soil physical properties is essential for soil quality management and sustainable land use. With the growing accumulation of microplastics in soils, a better understanding of the impact of microplastics on soil physical properties is crucial to conserve and manage soil quality. This study explored the effects of polyester microfiber (PMF) concentrations (0, 0.1% and 0.3%) on bulk density, porosity, aggregation and hydraulic conductivity of a clayey soil from a field experiment (1 year) and a pot experiment (6 wet-dry cycles). Polyester microfibers significantly increased the volume of >30 μm pores and reduced the volume of <30 μm pores compared to the control treatment. However, there were no detectable changes in the soil bulk density and saturated hydraulic conductivity between the PMF treatments and the control treatment. Interestingly, we observed that polyester microfibers significantly increased the contents of water stable large macroaggregates (>2 mm) in the 0.3% PMF (44%) and 0.1% PMF (39%) treatments compared to the control treatment (31%) in the pot experiment, but this was not true in the field experiment. The efficient interaction between polyester microfibers and fine soil particles and the frequent wet-dry cycles enhanced the formation and stability of macro-aggregates induced by polyester microfibers in the pot experiment. Overall, our results provide valuable evidence for microplastic influences on soil physical properties. Because microplastics are long-term anthropogenic contaminants, it is necessary to further study the impacts of microplastics on soil quality for terrestrial ecosystem sustainability.

Application of Dispersive Liquid-Liquid Microextraction in Forensic Toxicological Analysis

Currently, the main sample pretreatment methods for forensic toxic analysis are liquid-liquid extraction （LLE） and solid-phase extraction （SPE）. As a simple, convenient, and low-cost LLE method, dispersion liquid-liquid microextraction （DLLME） has high enrichment factor and good extraction efficiency, and therefore has attracted the attention of many researchers in the field of toxicology analysis in recent years. As a multi-functional microextraction method, DLLME has been widely used in the analysis of pesticides, sleeping sedatives, drugs and heavy metal poisons in forensic toxic analysis. Meanwhile, it can also be used in combination with such a variety of analytical instruments as gas chromatography-electron capture detectors （GC-ECD）, high performance liquid chromatography-diode array detectors （HPLC-DAD）. As a sample pretreatment method, DLLME has the advantages of simple operation, less use of organic solvent, reliable results and good reproducibility, thus can meet the requirements of modern court toxic analysis.

[Analysis on the trend of cancer incidence and age change in cancer registry areas of China, 2000 to 2014]

Objective: To analyze the trends of cancer incidence and age changes in China with using cancer registration data, and to provide evidence for the development of cancer prevention and control. Methods: Twenty-two cancer registries with continuous (2000-2014) data were selected. The incidence of different sex and regional population, the standardized incidence rate by Chinese population, the average annual change percentage (AAPC) and annual change percentage(APC) were calculated. Age-period-cohort model were used to analyze the changes of cancer incidence, age-adjusted mean ages. The age-standardized proportion of 2000 and 2014 with were compared. Results: The cancer incidence in China increased by 3.9% (95%CI: 3.7%-4.1%) from 2000 to 2014 in APC, and the age-standardized incidence rate increased by 1.2% (95%CI: 1.0%-1.4%) in AAPC. The age-specific incidence showed that each age groups increased significantly in female, ranged between 0.9% to 6.0%. The APC in male aged from 60 years old showed decline trend, the APC in 60-69, 70-79, ≥80 years old were -0.2, -0.3, -0.3, while in the population aged 0-29, 30-39 years old increased dramatically, APC were 3.5, 2.0. Female under 60 also increased, and APC in 0-29, 30-39, 40-49, 0-59 years old were 5.7, 6.0, 3.4, 2.9, respectively. The mean age of patients diagnosed with cancer were increased during the past 15 years, with about 0.11 years per year increased. However, the mean age of the patients diagnosed with cancer showed decreased trend by 0.13 years after age structure adjusted. Conclusion: The trend of mean age for cancer incidence in China were getting younger than before, and the trend in women is more obviously than in man.

[Effect of low-dose ionizing radiation exposure on thyroid function in a medical occupational population]

Objective: We evaluated the effect of low-dose of ionizing radiation on thyroid function of medical occupational group with long-term exposure; furthermore; we analyzed the relationship between the thyroid hormones and the risk factors; such as exposure length; department. Ultimately; providing the scientific basis for setting the ionizing radiation protection standards. Methods: The population who engaged radiodiagnosis and radiotherapy in a tertiary-A hospital were set up as occupational exposure; 724 medical professionals as the research object. We figured out the basic information and general condition of the groups by face-to-face questionnaire survey; By means of the thyroid hormone testing; we analyzed the thyroid hormone levels with different population; occupational exposure factors. Then; obtained the prevalence of thyroid nodules by the thyroid ultrasound. Besides; we used the logistic regression model to analyze the risk factors related to thyroid nodule. Applying Epidata、Excel in data management. All the data was analyzed by statistical software package Stata12.0. Descriptive statistics; single factor analysis of variance and other statistical methods were used for data analysis. Test standard: α=0.05、P<0.05 statistical significant. Results: 1. Based on the work experience; we divided the study population into four groups; such as 1-9; 10-19; 20-29; and>30 years. The difference of the TSH level among the four groups was statistically significant (P<0.05) . 2. The multiple logistic regression showed that sex and seniority were the independent risk factors for the abnormal rate of thyroid nodules. Conclusion: Long-term exposure to low-dose ionizing radiatiom could induce the thyroid damage of medical occupational population; which should be broader concerned.

Novel lncRNA-ZNF281 regulates cell growth, stemness and invasion of glioma stem-like U251s cells

Glioma is the most common sub-type of brain tumor. Due to the presence of stem-like cells, it is characterized by poor prognosis, aggressive ability and high post-surgical recurrence rates. Hence, there is critical need to identify molecular mechanisms of glioma stem-like cells. We found a novel lncRNA in the ZNF281 gene and named it lncRNA-ZNF281. We detected the expression of lncRNA-ZNF281 in glioma stem-like cells (U251s), the glioma cell line (U251) and also in normal brain tissue. The expression of lncRNA-ZNF281 was lower in glioma stem-like cells (U251s) and this indicates that lncRNA-ZNF281 can regulate the self-renewal capacity of glioma stem-like cells and stem cell marker expression. Most significantly, lncRNA-ZNF281 inhibits the invasion of glioma stem-like cells by regulating the expression of the NF-κB1 signaling pathway. Our data demonstrates that lncRNA-ZNF281 inhibits the self-renewing ability and invasion of GSCs in vitro and in vivo and can reduce tumorigenicity in the glioma stem-like cell (U251s). The underlying mechanisms may involve the regulation of stem cell markers (CD133, Nestin, OCT4 and Nanog) to reduce the self-renewal ability and regulate the NF-κB1 signaling pathway and inhibit U251s glioma stem-like cell invasion. These finding suggest that lncRNA-ZNF281 could be a successful new therapeutic target in glioma.

Cycle oxidation behavior and anti-oxidation mechanism of hot-dipped aluminum coating on TiBw/Ti6Al4V composites with network microstructure

Controlled and compacted TiAl₃ coating was successfully fabricated on the network structured TiBw/Ti6Al4V composites by hot-dipping aluminum and subsequent interdiffusion treatment. The network structure of the composites was inherited to the TiAl₃ coating, which effectively reduces the thermal stress and avoids the cracks appeared in the coating. Moreover, TiB reinforcements could pin the TiAl₃ coating which can effectively improve the bonding strength between the coating and composite substrate. The cycle oxidation behavior of the network structured coating on 873 K, 973 K and 1073 K for 100 h were investigated. The results showed the coating can remarkably improve the high temperature oxidation resistance of the TiBw/Ti6Al4V composites. The network structure was also inherited to the Al₂O₃ oxide scale, which effectively decreases the tendency of cracking even spalling about the oxide scale. Certainly, no crack was observed in the coating after long-term oxidation due to the division effect of network structured coating and pinning effect of TiB reinforcements. Interfacial reaction between the coating and the composite substrate occurred and a bilayer structure of TiAl/TiAl₂ formed next to the substrate after oxidation at 973 K and 1073 K. The anti-oxidation mechanism of the network structured coating was also discussed.

[Accuracy analysis of alveolar dehiscence and fenestration of maxillary anterior teeth of Angle class III by cone-beam CT]

OBJECTIVE

To evaluate the accuracy and reliability of detecting alveolar bone dehiscence and fenestration of maxillary anterior teeth of Angle class III by cone-beam computed tomography (CBCT).

METHODS

Eighteen Angle class III patients with 108 maxillary anterior teeth were included (3 males and 15 females) who accepted modified corticotomy in orthodontic therapy. The mean age was 23.6 years (18-30 years). The clinical detection of dehiscence and fenestration was done when modified corticotomy was performed by the same periodontist. The CBCT examination was conducted pre-operation and the detection of dehiscence and fenestration by CBCT was done by two periodontists. The data in modified corticotomy were used as the golden standard to calculate the parameters, such as sensitivity, specificity, positive and negative predictive values, Youden index (YI), positive and negative likelihood ratio. Kappa statistic was used to analyze the agreement between the clinical detection and the CBCT detection.

RESULTS

The incidence of dehiscence and fenestration was about 10.19% and 13.89% respectively, which mainly occurred on lateral incisors and canines. The median values of length and width of dehiscence were about 5 mm and 4 mm, and the median values of length and width of fenestration were 3 mm and 2 mm, respectively. Most fenestrations were detected on the middle third to the apical third of the root. For dehiscence, the agreement between clinical detection and CBCT detection was statistically significant (P<0.05). For fenestration, the agreement between clinical detection and CBCT detection was statistically significant (P<0.05). The values of sensitivity and specificity for detecting dehiscence were more than 0.7. The values of positive and negative predictive values for detecting dehiscence were 0.44 and 0.97. The values of sensitivity and specificity for detecting fenestration were 0.93 and 0.52. The values of positive and negative predictive values for detecting fenestration were 0.24 and 0.98.

CONCLUSION

For dehiscence, the agreement between clinical detection and CBCT detection was good. For fenestration, the agreement between clinical detection and CBCT detection was general. Detection of dehiscence and fenestration of maxillary anterior teeth of Angle class III by CBCT had limited diagnostic value in clinical practice with overestimation of dehiscence and fenestration incidence.