[Preliminary application of three-dimensional printing in dental education]

As one of the rapid prototyping technology, three-dimensional (3D) printing is booming since its birth. 3D printing has already been applied in biomedical engineering, medical mold processing and many healthcare fields, but its application in dental education is still in the exploratory stage. Nowadays, educators are seeking to integrate 3D printing and dental education. On the basis of the advantages of 3D printing, the quality of dental education will be further improved and students' enthusiasm for learning will be stimulated. This article will focus on elaborating the recent advances of 3D printing in dental education and exploring its direction in the field of teaching.

Identical and Nonidentical Twins: Risk and Factors Involved in Development of Islet Autoimmunity and Type 1 Diabetes

OBJECTIVE

There are variable reports of risk of concordance for progression to islet autoantibodies and type 1 diabetes in identical twins after one twin is diagnosed. We examined development of positive autoantibodies and type 1 diabetes and the effects of genetic factors and common environment on autoantibody positivity in identical twins, nonidentical twins, and full siblings.

RESEARCH DESIGN AND METHODS

Subjects from the TrialNet Pathway to Prevention Study (N = 48,026) were screened from 2004 to 2015 for islet autoantibodies (GAD antibody [GADA], insulinoma-associated antigen 2 [IA-2A], and autoantibodies against insulin [IAA]). Of these subjects, 17,226 (157 identical twins, 283 nonidentical twins, and 16,786 full siblings) were followed for autoantibody positivity or type 1 diabetes for a median of 2.1 years.

RESULTS

At screening, identical twins were more likely to have positive GADA, IA-2A, and IAA than nonidentical twins or full siblings (all P < 0.0001). Younger age, male sex, and genetic factors were significant factors for expression of IA-2A, IAA, one or more positive autoantibodies, and two or more positive autoantibodies (all P ≤ 0.03). Initially autoantibody-positive identical twins had a 69% risk of diabetes by 3 years compared with 1.5% for initially autoantibody-negative identical twins. In nonidentical twins, type 1 diabetes risk by 3 years was 72% for initially multiple autoantibody-positive, 13% for single autoantibody-positive, and 0% for initially autoantibody-negative nonidentical twins. Full siblings had a 3-year type 1 diabetes risk of 47% for multiple autoantibody-positive, 12% for single autoantibody-positive, and 0.5% for initially autoantibody-negative subjects.

CONCLUSIONS

Risk of type 1 diabetes at 3 years is high for initially multiple and single autoantibody-positive identical twins and multiple autoantibody-positive nonidentical twins. Genetic predisposition, age, and male sex are significant risk factors for development of positive autoantibodies in twins.

DUSP22 promotes senescence of HS-1 skin cancer cells through triggering MAPK signaling pathway

OBJECTIVE

Skin cancer severely threatens the public health. Dual-specificity protein phosphatase 22 (DUSP22) characterizes with multiple roles regulating cell growth, proliferation and gaining. This study aims to investigate the regulatory role of DUSP22 on aging of skin cancer cells and clarify molecular mechanisms, along with potential application value.

PATIENTS AND METHODS

HS-1 skin cancer cells were transfected with DUSP22 by liposome transfection approach. Western blot assay was used to evaluate the effects of DUSP22 on aging protein of HS-1 cells, and activation of mitogen-activated protein kinase cascade (MAPK) signal pathway. Real-time PCR (RT-PCR) and Western blot assay were used to examine the DUSP22 expression in HS-1 cancer cells. Meanwhile, the correlation between P53 protein and aging was also investigated.

RESULTS

Transfection of DUSP22 plasmid significantly elevated DUSP22 expression in HS-1 skin cancer cells compared to un-transfected cells (p<0.05), and activated MAPK to induce cell aging. Transfection of small interfere RNA (siRNA) DUSP22 significantly suppressed DUSP22 expression in HS-1 cancer cells, inhibited MAPK signal pathway, and decreased aging proteins P53 and P21 compared to the untreated group (p<0.05). DUSP22 was downregulated in HS-1 skin cancer cells, with MAPK signal pathway inhibition, and lower aging protein P53 expression. DUSP22 expression was positively correlated with aging protein P53 (p<0.05).

CONCLUSIONS

DUSP22 facilitated HS-1 skin cancer cell aging via activating MAPK signal pathway, possibly providing novel strategy against skin cancer.

High Bond Durability of Universal Adhesives on Glass Ceramics Facilitated by Silane Pretreatment

Objective:

This study aimed to investigate the long-term effectiveness of ceramic–resin bonding with universal adhesives in non–silane-pretreated and silane-pretreated modes after 10,000 cycles of thermal aging.

Methods and Materials:

All Bond Universal, Adhese Universal, Clearfil Universal Bond, and Single Bond Universal were selected. Etched lithium disilicate glass ceramics were prepared, randomly assigned to groups, and pretreated with or without ceramic primer containing silane coupling agent prior to the application of universal adhesive (ie, silane-pretreated or non–silane-pretreated mode). The shear bond strength (SBS), microleakage, and field-emission scanning electron microscopy images of the ceramic–resin interfaces were examined after 24 hours of water storage or 10,000 thermal cycles. Light microscopy and confocal laser scanning microscopy (CLSM) were performed to analyze marginal sealing ability.

Results:

SBS and microleakage percentage were significantly affected by bonding procedure (non–silane-pretreated or silane-pretreated mode) and aging (24 hours or 10,000 thermal cycles). After the universal adhesives in the non–silane-pretreated mode were aged, SBS significantly decreased and microleakage percentage increased. By contrast, the SBS of Adhese Universal, Clearfil Universal Bond, and Single Bond Universal decreased, and the microleakage percentage of all of the adhesives increased in the silane-pretreated mode. However, after aging, the SBS of the silane-pretreated groups were higher and their microleakage percentages lower than those of the non–pretreated groups. In the non–silane-pretreated mode, adhesive failure was dominant and gaps between composite resin and the adhesive layer were significant when observed with CLSM.

Conclusions:

The simplified procedure reduced the ceramic–resin bonding effectiveness of universal adhesives after aging, and additional silane pretreatment helped improve the long-term durability.

[A Meta-analysis on the relations between short-term exposure to PM(2.5) and both mortality and related emergency visits in China]

Objective: To carry out a quantitative estimate that related to the effects of short-term exposure to PM(2.5) on all-cause mortality and emergency visits in China by using the systematic review and Meta-analysis. Methods: We selected all the studies published before March 2018 from China National Knowledge Infrastructure, Wanfang database, PubMed and EMBASE and data on relative risk (RR), excess risk (ER) and their 95%CIs: appeared in these papers were extracted. According to the differences in the size or direction (heterogeneity) of the results, we computed summary estimates of the effect values using a random-effect or fixed effect model. We also conducted the subgroup analysis and Meta-analysis to have assessed the selected studies for the evidence of study bias. Results: A total of 33 original studies, indexed in databases, were identified. Among those studies, 39 sets of data on mortality and 4 sets of data on emergency were valid to show that within the daily concentration range from 47.7 to 176.7 μg/m(3), for 10 μg/m(3) increases in PM(2.5) concentrations, it would increase the daily numbers of deaths by 0.49% (95%CI: 0.39%-0.59%) and 0.30% (95%CI: 0.10%-0.51%) for all-cause deaths and all-cause emergency-room visits, respectively. For subgroup analysis, the combined effect of PM(2.5) in causing short-term all-cause deaths in the northern areas (ER=0.42%, 95%CI: 0.30%-0.54%) seemed lower than that in the southern areas (ER=0.63%, 95%CI: 0.44%-0.82%). The combined effect of PM(2.5) concentration below 75 μg/m(3) (ER=0.50%, 95%CI: 0.37%-0.62%) was higher than that of PM(2.5) concentration ≥75 μg/m(3) (ER=0.39%, 95%CI: 0.26%-0.52%). Conclusion: Within the concentration range from 47.7 to 176.7 μg/m(3), short-term exposure to current level of PM(2.5) might increase both the all-cause daily mortality and daily emergency visits in China.

[A preliminary study on the three-dimensional trajectory of condyle]

Objective: To calculate the three-dimensional trajectory and motion morphology of condyle by combining the trajectory of the mandible movement and the three-dimensional model of the mandible. Methods: Cone beam CT (CBCT) scanning was performed on the volunteer. The mandible three-dimensional model was built with image data transferred to the graphical user interface of the computer workstation. The novel virtual articulator PN300 recorded the three-dimensional trajectory of mandible. All these data were transferred to software system of computer workstation calculating the three-dimensional trajectory of condyle. The motion morphology of condyle was simulated by merging function surface at each point. Results: When the mandible moved in an opening process, the recorded data was calculated and it was shown that: the condylar functional surface moved moved forward and downward inward in advance, and in the process of continuously increasing the opening degree, the function faced the front upper inner side. The straight-line distance between the position and the final position was 8.34 mm. During the forward movement of the mandible, the coracoid process slided forward downward and inward with a sliding distance of 8.64 mm. During lateral movement, the range of the working side condyle function surface motion was small, only slight rotation, the maximum range of motion was 1.97 mm; in the process of row side movement, the non-working condyle function surface had a larger movement range than the working side, the movement direction was the front lower inner side, and the movement distance was 7.65 mm. Conclusions: The novel virtual articulator PN300 and digital technology can achieve the accurate measurement of three-dimensional trajectory of the condyle, and furthermore simulate the motion morphology of the condyle.

[Effect of butylphthalide on oxidative stress and cognitive function in old obstructive sleep apnea hypopnea syndrome patients]

Objective:To explore the effect of butylphthalide on oxidative stress and cognitive function in old obstructive sleep apnea hypopnea syndrome (OSAHS)patients.Method:A total of 90 old OSAHS patients with cognitive impairment were choosed with Polysomnography（PSG）. By random number table method OSAHS patients were randomly divided into non-invasive ventilator group (n=30), butylphthalide with non-invasive ventilator group(n=30) and treatment group of butylphthalide(n=30). Non-invasive ventilator group was given continuous positive airway pressure treatment for three months, butylphthalide with non-invasive ventilator group accepted oral butylphthalide therapy and continuous positive airway pressure treatment for three months, treatment group of butylphthalide only accepted oral butylphthalide therapy for three months. Cognitive function of three groups wered observed by the Montreal cognitive assessment scale (MoCA) before and after treatment, at the same time, the changes of serum superoxide dismutase(SOD) and malondialdehyde(MDA) were detected by immunoenzyme-linked adsorption.Result:The differences of serum SOD and MDA before treatment among the three groups were not statistically significant (P＞0.05). Compared with before treatment, the level of serum SOD increased and the level of MDA decreased in the three groups (P<0.05). Compared with non-invasive ventilator group after treatment，the level of SOD increased and the level of MDA decreased in butylphthalide with non-invasive ventilator group (P<0.05)， the level of SOD decreased and the level of MDA increased in treatment group of butylphthalide (P<0.05). Compared with treatment group of butylphthalide after treatment, the level of SOD increased and the level of MDA decreased in butylphthalide with non-invasive ventilator group (P<0.05); The scores of MoCA on cognitive function before treatment in the three groups was not statistically significant (P＞0.05). After treatment the scores of MoCA on cognitive function in the three groups were higher than those before treatment (P<0.05). Compared with non-invasive ventilator group after treatment， the scores of MoCA increased in butylphthalide with non-invasive ventilator group (P<0.05),the the scores of MoCA decreased in treatment group of butylphthalide (P<0.05). Compared with treatment group of butylphthalide after treatment, the scores of MoCA increased in butylphthalide with non-invasive ventilator group (P<0.05).Conclution: Butylphthalide can improve the activity of antioxidant enzymes in the serum of old patients with OSAHS, inhibit the oxygen free radical and lipid peroxidation and to a certain extent improve the cognitive function.

A Type 1 Diabetes Genetic Risk Score Predicts Progression of Islet Autoimmunity and Development of Type 1 Diabetes in Individuals at Risk

OBJECTIVE

We tested the ability of a type 1 diabetes (T1D) genetic risk score (GRS) to predict progression of islet autoimmunity and T1D in at-risk individuals.

RESEARCH DESIGN AND METHODS

We studied the 1,244 TrialNet Pathway to Prevention study participants (T1D patients' relatives without diabetes and with one or more positive autoantibodies) who were genotyped with Illumina ImmunoChip (median [range] age at initial autoantibody determination 11.1 years [1.2-51.8], 48% male, 80.5% non-Hispanic white, median follow-up 5.4 years). Of 291 participants with a single positive autoantibody at screening, 157 converted to multiple autoantibody positivity and 55 developed diabetes. Of 953 participants with multiple positive autoantibodies at screening, 419 developed diabetes. We calculated the T1D GRS from 30 T1D-associated single nucleotide polymorphisms. We used multivariable Cox regression models, time-dependent receiver operating characteristic curves, and area under the curve (AUC) measures to evaluate prognostic utility of T1D GRS, age, sex, Diabetes Prevention Trial-Type 1 (DPT-1) Risk Score, positive autoantibody number or type, HLA DR3/DR4-DQ8 status, and race/ethnicity. We used recursive partitioning analyses to identify cut points in continuous variables.

RESULTS

Higher T1D GRS significantly increased the rate of progression to T1D adjusting for DPT-1 Risk Score, age, number of positive autoantibodies, sex, and ethnicity (hazard ratio [HR] 1.29 for a 0.05 increase, 95% CI 1.06-1.6; P = 0.011). Progression to T1D was best predicted by a combined model with GRS, number of positive autoantibodies, DPT-1 Risk Score, and age (7-year time-integrated AUC = 0.79, 5-year AUC = 0.73). Higher GRS was significantly associated with increased progression rate from single to multiple positive autoantibodies after adjusting for age, autoantibody type, ethnicity, and sex (HR 2.27 for GRS >0.295, 95% CI 1.47-3.51; P = 0.0002).

CONCLUSIONS

The T1D GRS independently predicts progression to T1D and improves prediction along T1D stages in autoantibody-positive relatives.

[Developing a Chinese PI-RADS v2-based nomogram for predicting clinically significant prostate cancer in patients with a prior negative biopsy]

Objective: To develop a nomogram based on prostate imaging reporting and data system version 2 (PI-RADS v2) to predict clinically significant prostate cancer in patients with a prior negative prostate biopsy. Methods: The clinical and pathological data of 231 patients who underwent repeat prostate biopsy and multiparametric MRI (mpMRI) were reviewed. Based on PI-RADS v2, the mpMRI results were assigned as PI-RADS grade from 0 to 2. A Logistic regression nomogram for predicting the probabilities of clinically significant prostate cancer were constructed. The performances of the nomogram were assessed using area under the receiver operating characteristic (ROC) curve, calibrations and decision curve analysis. Results: Of the total 231 repeat prostate biopsy patients, clinically significant prostate cancer was detected in 59 cases(25.5%). In multivariate Logistic regression analysis, age, prostate specific antigen (PSA), prostate volume (PV), digital rectal examination (DRE) and mpMRI results were significant independent predictors of the diagnosis of clinically significant prostate cancer (P<0.05). The nomogram with super predictive accuracy were constructed (AUC=0.927, P<0.001), and exhibited excellent calibration. Decision curve analysis also demonstrated a high net benefit across a wide range of threshold probabilities . Conclusions: PI-RADS v2 combined with age, PSA, PV and DRE can predict the probability of clinically significant prostate cancer in patients with negative initial biopsies. The nomogram generated may help the decision-making process in patients with prior benign histology before the performance of repeat biopsy.

Effect of Nd:YAG Laser Irradiation Pretreatment on the Long-Term Bond Strength of Etch-and-Rinse Adhesive to Dentin

PURPOSE

To investigate the effect of neodymium-doped yttrium aluminum garnet (Nd:YAG) laser irradiation pretreatment on the long-term bond strength of an etch-and-rinse adhesive to dentin.

METHODS

Fifty molars were sectioned parallel to the occlusal plane and randomly divided into two groups (n=25 per group): control group (no treatment) and laser group (dentin surfaces were treated with Nd:YAG laser at a setting of 100 mJ/10 Hz). Afterward, resin was bonded to the dentin surface using a two-step etch-and-rinse adhesive (Adper SingleBond 2), and then 150 beams of each group were produced. Each group was divided into three subgroups (n=50 each group): 24 hours of water storage, thermocycling, and NaOCl storage. The microtensile bond strength (MTBS), failure modes, nanoleakage expression, and Masson's trichrome staining were evaluated. An additional 20 molars were sectioned to obtain 2-mm-thick flat dentin slices. These slices were randomly divided into control and laser-treated groups as mentioned previously. Then slices of each group were examined by scanning electron microscopy, attenuated total reflection Fourier transform infrared spectroscopy (ATR-FTIR), X-ray diffraction (XRD), and the Knoop hardness test.

RESULTS

The results of ATR-FTIR and Masson's trichrome verified that laser irradiation partly removed collagen fibers from the dentin surface; however, no significant difference was found in the Knoop hardness (p>0.05). The XRD result showed similar crystalline structure regardless of laser pretreatment. There is no significant difference in short-term MTBS between control and laser-treated groups (p>0.05); however, long-term MTBS differed between the groups (p>0.05). Furthermore, the laser-treated group showed less silver deposition than the control group after aging (p<0.05).

CONCLUSION

Pretreatment by Nd:YAG laser irradiation appeared to have a positive effect on the adhesive-dentin bonding in vitro test, and the bonding effectiveness could be preserved after aging.

HIV incidence is rapidly increasing with age among young men who have sex with men in China: a multicentre cross-sectional survey

OBJECTIVES

The HIV epidemic is worsening among men who have sex with men (MSM) in China, especially among those who are younger than 25 years old [younger MSM (YMSM)]. The aim of the study was to compare the prevalences of HIV incidence and recent HIV infection as well as factors associated with recent HIV infection in YMSM and older MSM (OMSM).

METHODS

A multicentre cross-sectional survey was conducted among 4496 MSM recruited from seven Chinese cities. YMSM were defined as those aged < 25 years. Data on demographics and sexual behaviours were collected using structural questionnaires. Blood samples were tested for recent HIV infection and other sexually transmitted infections.

RESULTS

Among the participants, 1313 were YMSM and 3183 were OMSM. Compared with OMSM, YMSM had a higher prevalence of recent HIV infection [5.4% (71 of 1313) for YMSM vs. 3.6% (115 of 3175) for OMSM; P = 0.006] and a higher HIV incidence [11.8 per 100 person-years (PY) (95% confidence interval (CI) 9.0-14.5) for YMSM vs. 7.6 per 100 PY (95% CI 6.3-9.0) for OMSM]. The incidence increased with age among YMSM, especially between the ages of 16 and 21 years. In contrast, the incidence declined with age among OMSM. Anal bleeding, recreational drug use, syphilis and herpes simplex virus 2 (HSV-2) infection were independent risk factors for recent HIV infection among YMSM. The prevalence of all these risk factors increased with age between the ages of 16 and 21 years. Anal bleeding (19.8%) and recreational drug use (19.5%) had the highest adjusted population attributable fractions (aPAFs) among YMSM. The highest aPAFs of anal bleeding (27.4%) and syphilis infection (25.5%) were found between the ages of 19 and 21 years.

CONCLUSIONS

The HIV incidence in Chinese YMSM was significantly higher than that in OMSM. YMSM aged 16-21 years had an extremely high risk of recent HIV infection.

Leukotriene D4 induces cellular senescence in osteoblasts

Aging is associated with the development of osteoporosis, in which cellular senescence in osteoblasts plays a key role. Leukotriene D4 (LTD4), an important cysteinyl leukotriene (cysLT), is a powerful pro-inflammatory mediator formed from arachidonic acid. However, little information regarding the effects of LTD4 on the pathogenesis of osteoporosis has been reported before. In the present study, we defined the physiological roles of LTD4 in cellular senescence in osteoblasts. Our results indicate that LTD4 treatment decreased the expression of SIRT1 in a dose-dependent manner in MC3T3-E1 osteoblastic cells. Additionally, LTD4 significantly increased the expression of p53, p21 and plasminogen activator inhibitor-1 (PAI-1). LTD4 was also found to elevate the activity of β-galactosidase (SA-β-Gal) but to prevent BrdU incorporation. Our results indicate that cysteinyl leukotriene receptor 1 (cysLT1R) could be detected in MC3T3-E1 osteoblastic cells at both the mRNA and protein levels. However, cysLT2R was not expressed in these cells. Interestingly, we found that knockdown of cysLT1R or use of the selective cysLT1R antagonist montelukast abolished the LTD4-induced reduction in SIRT1 and increase in p53, p21, and PAI-1. Notably, knockdown of cysLT1R by transfection with cysLT1R siRNA or treatment with montelukast attenuated the LTD4-induced increase in SA-β-Gal activity. Our study shows for the first time that LTD4 has a significant impact on cellular senescence in osteoblasts.

Abstract OT3-05-07: PATINA: A randomized open label phase III trial to evaluate the efficacy and safety of palbociclib + anti HER2 therapy + endocrine therapy vs anti HER2 therapy + endocrine therapy after induction treatment for hormone receptor positive, HER2 positive metastatic breast cancer

Background

Pre-clinical data and initial results from clinical studies point to the added benefit of CDK4/6 inhibition when combined with anti-HER2 tx. The current study is designed to evaluate the added benefit of palbociclib when given in combination with anti-HER2 and endocrine tx maintenance in the 1st†line setting of metastatic HER2+HR+ breast cancer.

Trial design

PATINA is an international, open-label, pivotal Phase III study. Primary objective is to demonstrate that the combination of palbociclib with anti-HER2 plus endocrine tx is superior to anti-HER2 plus endocrine tx in prolonging PFS. Sample size is 496 pts. The study starts after completion of 6-8 cycles of chemotherapy-containing anti-HER2 tx for metastatic breast cancer in the 1st line setting. Pts are eligible provided they are without evidence of disease progression by local assessment (i.e. CR, PR or SD). To account for the need for less intense tx regimens for a subset of pts diagnosed with HER2+ER+ disease, clinicians may recommend the combination of trastuzumab with either a taxane or vinorelbine prior to study initiation. Clinicians might also choose a non-pertuzumab option for pts previously treated with pertuzumab in the neo(adjuvant) setting. Secondary objectives include measures of tumor control (OR, CBR, DOR), OS, safety and QOL. The translational science main objective is to compare PFS estimates according to PIK3CA mutation status assessed by cfDNA analysis. Endocrine tx options are AI or fulvestrant. Premenopausal pts must receive ovarian suppression. The study has a 90% power to detect a hazard ratio of 0.667 in favor of the palbociclib arm. Pts approached to participate in AFT-38 will be asked to indicate on the informed consent forms whether remaining biospecimens and clinical data from the control arm of the study can be shared with the Mastering Breast Cancer (MBC) Initiative. The overarching purpose of the MBC is to create a mechanism for understanding the natural history of metastatic breast cancer by cataloguing longitudinally studied tumor-specific markers and treatment effects.

ClinicalTrials.gov Identifier: NCT02947685

Citation Format: Metzger-Filho O, Mandrekar S, Loibl S, Ciruelos E, Gianni L, Lim E, Miller K, Huang C, Koehler M, Francis P, Valagussa P, Goel S, Prat A, Goetz M, Loi S, Krop I, Carey L, Lanzillotti J, Winer E, Tripathy D, DeMichele A. PATINA: A randomized open label phase III trial to evaluate the efficacy and safety of palbociclib + anti HER2 therapy + endocrine therapy vs anti HER2 therapy + endocrine therapy after induction treatment for hormone receptor positive, HER2 positive metastatic breast cancer [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr OT3-05-07.

Abstract P5-21-03: Palbociclib (PAL) + letrozole (LET) as first-line therapy in estrogen receptor–positive (ER+)/human epidermal growth factor receptor 2–negative (HER2−) advanced breast cancer (ABC): Efficacy and safety updates with longer follow-up across patient subgroups

BACKGROUND: Endocrine therapy (ET) has been the primary first-line (1L) therapy for ER+ ABC. In the PALOMA-2 study (NCT01740427), PAL (P)+LET (L) significantly prolonged progression-free survival (PFS; HR=0.58, P&lt;.001) after a median 23 mo follow-up (FU) (Finn et al. NEJM 2016). Here we report more mature PFS overall and in subgroups, with (w/) longer FU. The study is ongoing for overall survival FU.

METHODS: Postmenopausal pts w/ ER+/HER2- ABC and no prior systemic therapy in the ABC setting were randomized 2:1 to P (125 mg/d) + L (2.5 mg QD) or placebo (PBO) + L. Key endpoints: investigator-assessed PFS and safety. Median PFS (mPFS) was estimated (intent-to-treat population).

RESULTS: 666 pts (444, P+L; 222, PBO+L) were enrolled. Arms were well balanced: visceral (48%)/nonvisceral (52%) disease and prior ET (56%)/no prior ET (44%). After a median FU of 38 mo w/ P+L and 37 mo w/ PBO+L, mPFS was 27.6 and 14.5 mo, respectively, in the overall population (HR=0.56, P&lt;.0001; Table).

TABLE. mPFS overall and by relevant subgroupsP+LPBO+LP+L vs PBO+LmPFS, mo (95% CI)mPFS, mo (95% CI)HR (95% CI)P* Overall27.6 (22.4–30.3)14.5 (12.3–17.1)0.56 (0.46–0.69)&lt;.0001 Measurable disease23.7 (19.3–27.6)14.5 (12.3–18.5)0.63 (0.50–0.79)&lt;.0001 Nonmeasurable disease36.2 (27.6?NE)16.5 (8.3–19.6)0.39 (0.25–0.60)&lt;.0001 Visceral19.3 (16.4–24.2)12.3 (8.4–16.4)0.62 (0.47–0.81)&lt;.0005 Nonvisceral35.9 (27.7–NE)17.0 (13.8–24.8)0.50 (0.37–0.67)&lt;.0001 Bone only†36.2 (27.6–NE)11.2 (8.2–22.0)0.41 (0.26–0.63)&lt;.0001 Not bone only24.2 (19.4–27.7)14.5 (12.9–18.5)0.62 (0.50–0.78)&lt;.0001 De novo metastatic27.9 (22.1–33.4)22.0 (13.9–27.4)0.61 (0.44–0.85)&lt;.005 Prior ET24.2 (18.8–27.6)11.2 (8.4–14.5)0.54 (0.42–0.71)&lt;.0001 No prior ET30.3 (24.5–35.7)21.9 (15.9–27.4)0.59 (0.43–0.80)&lt;.0005 Nonvisceral36.2 (27.9–NE)27.6 (19.1–35.6)0.59 (0.38–0.92)&lt;.01 Visceral23.7 (16.8–30.3)13.9 (10.2–22.2)0.55 (0.36–0.85)&lt;.005 Disease sites130.4 (24.8–NE)16.5 (11.0–22.1)0.52 (0.36–0.75)&lt;.0005228.1 (19.4–NE)16.3 (11.0–27.4)0.57 (0.37–0.89)&lt;.01323.7 (19.2–27.6)13.8 (8.8–17.0)0.61 (0.46–0.82)&lt;.0005NE=not estimable. *Not adjusted for multiple analyses; 1-sided P values. †Per tumor site.

All subgroups benefited from addition of P to L. Notably, pts w/ low disease burden (bone only, nonvisceral disease, few disease sites) derived significant PFS benefit, including those w/ both nonvisceral disease and no prior ET (mPFS, 36.2 vs 27.6 mo; HR=0.59, P&lt;.01). Importantly, median time from randomization to start of 2nd subsequent systemic anticancer therapy was 39 vs 29 mo for P+L vs PBO+L (HR=0.72, P&lt;.005). There were no new safety signals w/ longer FU.

CONCLUSIONS: This is the longest FU of a phase 3 study of a cyclin-dependent kinase 4/6 inhibitor for ABC. P+L continues to consistently improve PFS vs PBO+L across all subgroups while toxicity remains manageable; notably P+L delays time to starting 2nd subsequent anticancer therapies by 10 mo. Pts w/ low disease burden or sensitivity to ET alone had PFS &gt;3 y (significant vs PBO+L), demonstrating the clinical benefit of P+ET. These data confirm P+L should be a 1L therapy option for pts w/ HR+/HER2- ABC.

Funding: Pfizer

Citation Format: Rugo HS, Finn RS, Dieras V, Ettl J, Lipatov O, Joy A, Harbeck N, Castrellon A, Lu DR, Mori A, Gauthier ER, Huang C, Gelmon KA, Slamon DJ. Palbociclib (PAL) + letrozole (LET) as first-line therapy in estrogen receptor–positive (ER+)/human epidermal growth factor receptor 2–negative (HER2−) advanced breast cancer (ABC): Efficacy and safety updates with longer follow-up across patient subgroups [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P5-21-03.

The prognosis of pulmonary arterial hypertension associated with primary Sjögren's syndrome: a cohort study

Pulmonary arterial hypertension (PAH) is a rare and severe complication of primary Sjögren's syndrome (pSS). Cohort studies indicate that the underlying diseases of PAH associated with connective tissue disease (CTD-PAH) in Asian countries are different from that in the United States and in Europe. This study investigated the clinical characteristics, survival, and prognostic factors of pSS-PAH in Chinese patients. We enrolled 29 patients with pSS-PAH who visited our referral center during August 2007 and May 2015. PAH was confirmed by right heart catheterization (RHC). Baseline demographic data, clinical manifestations, laboratory tests, autoantibody results, hemodynamics data, and treatment regimens were analyzed. All patients were followed up at the Department of Rheumatology, Peking Union Medical College Hospital (PUMCH) every three to six months. All patients were female. Mean age of pSS onset was 34.4 ± 11.1 years. Mean age of PAH diagnosed by RHC was 40.6 ± 9.0 years. There was no significant difference in age, disease duration, and hemodynamic findings between the survivors and the non-survivors in this cohort. The overall one-, three-, and five-year survival rates were 80.2%, 74.8%, and 67.4%, respectively. Prognostic factors of mortality were time between pSS onset and PAH onset (HR 1.102, 95% CI 1.017-1.185, p = 0.018) and cardiac index < 2 l/min/m² (HR 5.497, 95% CI 1.063-28.434, p = 0.042). In contrast, the use of immunosuppressants (HR 0.110, 95% CI 0.024-0.495, p = 0.004) was related to better survival. This study demonstrates that the predictors of mortality in patients with pSS-PAH include delayed onset of PAH in pSS and worse cardiac function. Immunosuppressants can improve the prognosis of pSS-PAH.

High Expression of Nuclear Factor of Activated T Cells in Chinese Primary Non-Small Cell Lung Cancer Tissues

Purpose

Nuclear factor of activated T cells (NFAT) has been reported to be involved in the development of various types of cancer including adenocarcinoma of the breast. This research was the first to investigate NFAT protein expression in primary non-small cell lung cancer (NSCLC) tissues from Chinese patients.

Methods

NFAT protein expression was determined in 130 surgically resected primary NSCLC and matched normal tissues by immunohistochemical analysis. The association between NFAT expression and clinical categorical variables was further analyzed with the SPSS software.

Results

We found that NFAT expression was much higher in 85 tumor tissues (65.4%) and lower in 45 tumor tissues (34.6%) compared with the matched normal tissues. Further statistical analysis by the chi-square test showed that high expression of NFAT proteins was significantly associated with tumor differentiation (p=0.045), invasion (p=0.031), histology (p<0.0001), tumor size (p=0.038) and cigarette smoking history (p=0.024). However, there was no correlation between the expression of NFAT proteins and pTNM classification, and no difference in 5-year survival rate between patients with high or low expression of NFAT proteins. Multivariate logistic regression analysis for the correlation between NFAT protein expression levels and various characteristics showed a significant association with histology (p=0.008, OR=0.273).

Conclusion

Our results revealed that high NFAT expression was present in Chinese NSCLCs and that NFAT expression might be involved in the process of human lung cancer development.

[Development of a Chinese nomogram based on muti-parametric magnetic resonance for predicting the probability of prostate cancer in patients after initial negative biopsy]

Objective: To develop a predictive nomogram based on multi-parametric magnetic resonance imaging (mpMRI) information to identify men more likely to have a cancer diagnosed on repeat prostate biopsy. Methods: The clinical data of 237 patients who received repeat prostate biopsy after initial negative biopsy from Department of Urology of Peking University First Hospital between January 2001 and August 2016 was reviewed. Patient age, body mass index (BMI), serum total prostate-specific antigen (PSA), percent free PSA (f/t), prostate volume (PV), PSA density (PSAD), PSA velocity (PSAV), digital rectal examination (DRE), transrectal ultrasound (TRUS)and mpMRI results were included in the univariate and multivariate analysis. A nomogram was developed using selected variables and the area under the receiver operating characteristic (ROC) curve was calculated as a measure of discrimination. Results: A total of 76 patients (32.07%) had prostate cancer (PCa) detected on repeat biopsy. Based on univariate and multivariate logistic regression analysis, the patient age, PSA, PV, DRE and mpMRI results were independent predictors for the diagnosis of PCa on repeat biopsy. The current nomogram performed well (AUC=0.910) and showed excellent calibration. Conclusions: Multi-parametric magnetic resonance imaging combined with age, PSA, PV and DRE can predict the probability of PCa in patients with initial negative biopsy. The nomogram might help in decision-making for men with prior benign histology before the performance of repeat biopsy.

The cysteinyl leukotriene receptor 1 (CysLT1R) antagonist montelukast suppresses matrix metalloproteinase-13 expression induced by lipopolysaccharide

Bacterial products such as LPS are critical factors responsible for bone destruction. MMP-13, a member of the matrix metalloproteinase family, plays a critical role in the proteolytic degradation of extracellular matrix components, which includes collagen fibrils in the bone matrix. Montelukast is a selective cysteinyl leukotrienes receptor 1 (cysLT1R) antagonist used clinically for the treatment of asthma, as it reduces eosinophilic inflammation in airways. This study aims to explore the role of montelukast in regulating MMP-13 expression induced by LPS in osteoblasts. Our results indicate that LPS stimulated cysLT1R expression in mouse MC3T3-E1 osteoblasts in a dose- and time-dependent manner. Notably, LPS-induced up-regulation of MMP-13 was ameliorated by treatment with montelukast in a dose-dependent manner. Furthermore, treatment with montelukast stimulated the expression of SOCS3, an inhibitor of MMP-13. Silencing of SOCS3 abolished the inhibitory effects of montelukast on MMP-13 expression. Mechanistically, we found that montelukast suppressed LPS-induced nuclear translocation of NF-κB p65 as well as NF-κB transcriptional activity by inhibiting the phosphorylation and degradation of IκBα. These data suggest that montelukast can modulate inflammatory events in bone diseases.

Aberrant promoter hypermethylation of p16, survivin, and retinoblastoma in gastric cancer

BACKGROUND

Gastric cancer is common and can be found throughout the world. Notoriously like other cancers, gastric cancer is a consequence of cellular regulation disorder. Epigenetics, including many oncogenes or tumour suppressor genes, can provide some clues for this kind of disorder. DNA methylation, especially promoter methylation, which causes the silence/decrease of tumour related genes, has become a focus in various tumour types. The aim of this study was to investigate promoter methylation of certain genes: p16, survivin, retinoblastoma (Rb), all of which have been regarded as genes related to gastric cancer.

MATERIAL AND METHODS

To detect the promoter methylation of p16, survivin, and Rb genes, peripheral blood samples from 106 gastric cancer patients as well as 18 healthy individuals were collected for Methylation-Specific Polymerase Chain Reaction (MSP) analysis.

RESULTS

According to the statistical analysis, positive methylation ratio of p16 was 72.6 % (77 cases), 6 % had methylated survivin (7 cases), and positive methylation ratio of Rb was only 17.9 % (19 cases). The differences of promoter methylation of these genes between the patients group and control group were observed: P (P16) = 5.097E-08, P (survivin) = 0.262, and P (Rb) = 0.187. In the control group, methylated p16 was found in only one case that also had a methylated Rb. However, Survivin could not be found methylated in control cases.

CONCLUSION

In this study, promoter methylation was observed for the p16 gene, which was considered an early potential marker in gastric cancer. This data supports that further investigations should study Rb and survivin as candidate markers for gastric cancer (Tab. 2, Fig. 1, Ref. 35).