Molecular response in newly diagnosed chronic-phase chronic myeloid leukemia: prediction modeling and pathway analysis

Tyrosine kinase inhibitor therapy revolutionized chronic myeloid leukemia treatment and showed how targeted therapy and molecular monitoring could be used to substantially improve survival outcomes. We used chronic myeloid leukemia as a model to understand a critical question: Why do some patients have an excellent response to therapy, while others have a poor response? We studied gene expression in whole blood samples from 112 patients from a large phase 3 randomized trial, dichotomizing cases into good responders (BCR::ABL1 ≤10% International Scale by 3 and 6 months and ≤0.1% by 12 months) and poor responders (failure to meet these criteria). Predictive models based on gene expression demonstrated the best performance (area under the curve [SD], 0.76 [0.07]). All of the top 20 pathways overexpressed in good responders involved immune regulation, a finding validated in an independent data set. This study emphasizes the importance of pretreatment adaptive immune response in treatment efficacy and suggests biological pathways that can be targeted to improve response.

Abstract LB523: Biomarker assessment of PTEN protein expression and gene expression profiling (GEP) in a phase III study of copanlisib in combination with rituximab in patients with indolent non-Hodgkin lymphoma (iNHL)

Introduction: The combination of the PI3K inhibitor copanlisib (C) plus the anti-CD20 antibody rituximab (R) has been shown to be superior to R plus placebo (P) in patients with relapsed iNHL (Matasar et al. Lancet Oncol 2021). We report here the biomarker analysis to assess correlation with response of baseline samples for PTEN expression and GEP signatures.

Methods: Adult patients with relapsed B-cell iNHL were randomly assigned 2:1 to either C + R or P + R; standard dosing on a 28-day cycle applied. Either fresh or archival tumor tissues were collected for central pathology review and biomarker analysis. Extraction of the formalin-fixed, paraffin-embedded (FFPE) tissue slides was performed using the Qiagen AllPrep DNA/RNA FFPE Kit, where quality was assessed using a combination of Agilent TapeStation for integrity and ThermoFisher NanoDrop for quantity and purity. Immunohistochemistry (IHC) for PTEN expression was performed by Mosaic Laboratories (Lake Forest, CA, USA) and RNA sequencing analysis was performed by Almac Diagnostics (Durham, NC, USA). GEP was also conducted using claraT pathway signatures provided by Almac.

Results: Patients with complete, very good partial, and partial objective responses were combined in a “responders” group and compared against all other patients (“non-responders” group). Data from PTEN IHC were available for 222 patients (149 for C + R; 73 for P + R). There was no statistically significant difference in response with PTEN presence or absence for the 3 subgroups - total iNHL, follicular lymphoma (FL), and non-FL. Also, baseline PTEN expression did not show significant correlation with best overall response. C + R treatment improved median progression-free survival (PFS) for all patients, with a statistically significant benefit to those with PTEN presence in all 3 subgroups. For patients treated with P + R, Kaplan-Meier plots and log-rank tests showed statistically improved median PFS in patients with PTEN absence vs PTEN presence in overall iNHL (p=0.031) and FL (p=0.0021). Data from GEP were available for 202 patients (133 for C + R; 69 for P + R). The association with best overall response and PFS was analyzed using specific biomarker gene sets and/or 23 preselected clinical parameters. Association of GEP analysis based on hypothesis-based modeling, single-gene hypothesis-free modeling, and claraT pathway signatures showed no predicted responsiveness or PFS that was statistically significant.

Conclusions: C + R improved median PFS in the overall iNHL, FL, and non-FL groups, with a statistically significant improvement in the PTEN-positive population. In the P + R group, PTEN-positive patients had worse PFS in all 3 subgroups. Data from GEP and pathway analysis did not show correlation with overall response or PFS.

Citation Format: Shalini Chaturvedi, Anke Schulz, Lidia Mongay Soler, Barrett H. Childs, Matthew Matasar, Pier Luigi Zinzani. Biomarker assessment of PTEN protein expression and gene expression profiling (GEP) in a phase III study of copanlisib in combination with rituximab in patients with indolent non-Hodgkin lymphoma (iNHL) [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr LB523.

RNA-Based Targeted Gene Sequencing Improves the Diagnostic Yield of Mutant Detection in Chronic Myeloid Leukemia

Mutation detection is increasingly used for the management of hematological malignancies. Prior whole transcriptome and whole exome sequencing studies using total RNA and DNA identified diverse mutation types in cancer-related genes associated with treatment failure in patients with chronic myeloid leukemia. Variants included single-nucleotide variants and small insertions/deletions, plus fusion transcripts and partial or whole gene deletions. The hypothesis that all of these mutation types could be detected by a single cost-effective hybridization capture next-generation sequencing method using total RNA was assessed. A method was developed that targeted 130 genes relevant for myeloid and lymphoid leukemia. Retrospective samples with 121 precharacterized variants were tested using total RNA and/or DNA. Concordance of detection of precharacterized variants using RNA or DNA was 96%, whereas the enhanced sensitivity identified additional variants. Comparison between 24 matched DNA and RNA samples demonstrated 95.3% of 170 variants detectable using DNA were detected using RNA, including all but one variant predicted to activate nonsense-mediated decay. RNA identified an additional 10 variants, including fusion transcripts. Furthermore, the true effect of splice variants on RNA splicing was only evident using RNA. In conclusion, capture sequencing using total RNA alone is suitable for detecting a range of variants relevant in chronic myeloid leukemia and may be more broadly applied to other hematological malignancies where diverse variant types define risk groups.

Abstract P239: Safety and efficacy of copanlisib in combination with nivolumab: A phase Ib study in patients with advanced solid tumors

Introduction: Copanlisib (C) is a pan-class I PI3K inhibitor, with predominant activity against the PI3K-α and -δ isoforms, approved for patients (pts) with relapsed follicular lymphoma. The PD-1 inhibitor nivolumab (N) is approved for several advanced or metastatic solid tumors. Following preclinical demonstration of the immunomodulatory activity of C (Glaeske et al. AACR 2018), we report Phase Ib results evaluating the safety and efficacy of C+N in pts with advanced solid tumors (NCT03735628). Methods: PD-1 inhibitor-naive adult pts with advanced solid tumors received C 45 mg or 60 mg i.v. (days 1, 8, and 15; 28-day cycle) and N 240 mg (day 15 of cycle 1 and days 1 and 15 of subsequent cycles). The primary objective was determination of the recommended Phase II dose (RP2D) of C in combination with N. Secondary endpoints were safety/tolerability, pharmacokinetics (PK), and efficacy. Exploratory real-time evaluation of 77 pharmacodynamic and predictive immune cell biomarkers by flow cytometry on whole blood was performed. Results: 16 pts were treated (C 45 mg + N 240 mg, n=5; C 60 mg + N 240 mg, n=11). Median age was 65 years (range 37–89), 12 pts (75%) were male, and 8 pts (50%) had stage IV disease at diagnosis; the most common tumor types were head and neck squamous cell carcinoma (HNSCC; 7 pts) and bladder cancer (BC; 4 pts). No dose-limiting toxicities were reported. The RP2D of C+N 240 mg was 60 mg. As of 13 May 2020, 4 pts remain on treatment. The most common treatment-emergent adverse events (TEAEs) of any grade were hypertension and diarrhea (7 pts [44%] each, ≤ grade [G] 3) and maculo-papular rash and fatigue (6 pts [38%] each, ≤G3). C-related TEAEs were reported in 88% of pts, all ≤G3. AEs leading to C dose interruption/reduction were reported in 31%/19% of pts; TEAEs led to C discontinuation in 1 pt (60 mg; hematuria). Serious AEs occurred in 5 pts (31%). One G5 TEAE occurred (45 mg; general physical health deterioration, unrelated to C or N). No PK interactions were observed between C and N. Two pts had a partial response: 1 in the C 45 mg group (HNSCC) and 1 in the 60 mg group (BC; benefit sustained after 19 cycles). Stable disease was seen in 10 pts and disease progression in 3 pts; disease control rate (DCR) was 75%. Maximum decrease in circulating monocytic myeloid-derived suppressor cells (M-MDSCs; p<0.05) from baseline occurred on day 2 after C, returning to baseline on day 8. A significant increase in activated (HLA-DR+ and CD38+) natural killer and CD8+ T cells was seen 2 weeks post-treatment with C+N. Lower baseline levels of CD8+ Teffector memory (TEM) subset CD45RA-/CCR7- (CD3+/CD8+) seemed to associate with higher DCR. Conclusions: C+N showed acceptable safety and preliminary efficacy in pts with advanced solid tumors. The immunomodulatory effect of C on M-MDSCs was seen 2 days post-treatment, and lower TEM subset levels seemed to associate with better disease control. These results support further investigation of C+N in pts with advanced solid tumors. Funding: Bayer AG. Writing support: Complete HealthVizion.

Citation Format: Benedito A. Carneiro, Robert Jotte, Nashat Gabrail, Omid Hamid, Funan Huang, Shalini Chaturvedi, Matthias Herpers, Lidia Mongay Soler, Barrett H. Childs, Aaron Hansen. Safety and efficacy of copanlisib in combination with nivolumab: A phase Ib study in patients with advanced solid tumors [abstract]. In: Proceedings of the AACR-NCI-EORTC Virtual International Conference on Molecular Targets and Cancer Therapeutics; 2021 Oct 7-10. Philadelphia (PA): AACR; Mol Cancer Ther 2021;20(12 Suppl):Abstract nr P239.

Assessment of microhardness and color stability of micro-hybrid and nano-filled composite resins

Background and Aims

Composite resins are among the most popular restorative dental materials because of the strength and esthetic properties. The goal of this study was to assess the effect of commonly consumed beverages on microhardness and color stability of microhybrid (MH) and nanofilled NF) composite resins.

Material and Methods

240 samples were prepared from the composite material [MH = 120 (material I) and NF = 120 (material II)] and allocated into eight groups of 30 samples. In each group, half of the samples were tested for microhardness and another-half for color stability. After baseline measurements, the samples were immersed in test media, that is, distilled water and beverages (tea, cola, and coffee) for 15 days. Microhardness and color stability measurements were carried out after 15 days to assess the effect of beverages. The color stability and microhardness values were compared and evaluated by analysis of variance (ANOVA) using Tukey's alteration test.

Results

It was reported that the microhardness decreased for both the materials after immersion in all the beverages. Percentage change in microhardness was considerably higher in material II in comparison to the material I in cola drink. Color change was significantly higher in material II compared to material I in water and coffee. Cola drink caused the maximum change in microhardness among all the beverages and coffee caused the maximum color change among all the beverages.

Conclusion

Both composite materials (I and II) showed a reduction in microhardness and change in color after immersion in a different type of test media.

Activity of ibrutinib plus R-CHOP in diffuse large B-cell lymphoma: Response, pharmacodynamic, and biomarker analyses of a phase Ib study

INTRODUCTION

This unplanned post-hoc analysis was based on data from the phase Ib DBL1002 study (NCT01569750) and evaluated the association between molecular biomarkers and clinical response to combined treatment with ibrutinib plus rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) in diffuse large B-cell lymphoma (DLBCL) subtypes.

METHODS

DLBCL subtyping was conducted using immunohistochemistry. Next-generation sequencing using immunoglobulin H primers assessed minimal residual disease (MRD). A quantitative assay evaluated Bruton's tyrosine kinase (BTK) occupancy by ibrutinib in peripheral blood mononuclear cells. Targeted DNA sequencing examined genetic variants by DLBCL subtype. Secreted protein expression was evaluated with a SomaLogic analyte panel.

RESULTS

Among 21 patients with DLBCL (median age 53.5 years), 17 achieved a complete response (CR) and 4 a partial response (PR). Of the 11 subtyped patients, 9 had a CR (5/7 germinal center B-cell-like [GCB] and 4/4 non-GCB) and 2 had a PR (both GCB). Nine of 12 patients tested for MRD achieved early (cycle 2 day 1) MRD negativity; most had a CR. There was near-complete BTK occupancy at 4 h postdose. Mutation analysis (n = 19) revealed variants including CREBBP, KMT2D, LRP1B, BCL2, and TNFRSF14; only 1 CD79B and TP53 each; no CARD11 or MYD88.

CONCLUSIONS

In this study, first-line ibrutinib plus R-CHOP benefited patients with DLBCL, with good overall response rate and early MRD negativity. With a caveat of small sample size, our results showed that a favorable genetic profile and younger patient age may be important to beneficial clinical outcome with ibrutinib plus R-CHOP in DLBCL.

A Critical Assessment of the Golden Hour and the Impact of Procedural Timing in Stroke Thrombectomy

BACKGROUND AND PURPOSE

Previous studies in acute ischemic stroke have demonstrated the importance of minimizing delays to endovascular treatment and keeping thrombectomy procedural times at <30-60 minutes. The purpose of this study was to investigate the impact of thrombectomy procedural times on clinical outcomes.

MATERIALS AND METHODS

We retrospectively compared 319 patients having undergone thrombectomy according to procedural time (<30 minutes, 30-60 minutes, and >60 minutes) and time from stroke onset to endovascular therapy (≤6 or >6 hours). Clinical characteristics of patients with postprocedural intracranial hemorrhage were also assessed. Logistic regression was used to determine independent predictors of poor outcome at 90 days (mRS ≥3).

RESULTS

Greater age (OR, 1.03; 95% CI, 1.01-1.06; P = .016), higher admission NIHSS score (OR, 1.10; 95% CI, 1.04-1.16; P = .001), history of diabetes mellitus (OR, 1.96; 95% CI, 1.05-3.65; P = .034), and postprocedural intracranial hemorrhage were independently associated with greater odds of poor outcome. Modified TICI scale scores of 2c (OR, 0.11; 95% CI, 0.04-0.28; P < .001) and 3 (OR, 0.15; 95% CI, 0.06-0.38; P < .001) were associated with reduced odds of poor outcome. Although not statistically significant on univariate analysis, onset to endovascular therapy of >6 hours was independently associated with increased odds of poor outcome (OR, 2.20; 95% CI, 1.11-4.36; P = .024) in the final multivariate model (area under the curve = 0.820). Procedural time was not independently associated with clinical outcome in the final multivariate model (P > .05).

CONCLUSIONS

Thrombectomy procedural times beyond 60 minutes are associated with lower revascularization rates and worse 90-day outcomes. Procedural time itself was not an independent predictor of outcome. While stroke thrombectomy procedures should be performed rapidly, our study emphasizes the significance of achieving revascularization despite the requisite procedural time. However, the potential for revascularization must be weighed against the risks associated with multiple thrombectomy attempts.

Prospective Nonrandomized Comparison Between Open and Robot-Assisted Kidney Transplantation: Analysis of Midterm Functional Outcomes

Introduction: To compare short- and midterm outcomes of the first 55 patients undergoing robot-assisted kidney transplant (RAKT) with patients undergoing open kidney transplant (OKT) during the same period in a tertiary care hospital. Materials and Methods: Data of all end-stage renal disease patients undergoing renal transplant were prospectively maintained. All graft kidneys were harvested laparoscopically. Both RAKT and OKT were performed using standardized techniques, and all RAKTs were performed by a single experienced robotic surgeon. Chi-square test/Fisher exact test was done for categorical data, and Mann-Whitney U test was done for continuous data. Discrete variables were expressed in absolute numbers and percentages. For all tests, p < 0.05 was considered significant. All results were expressed as mean ± standard deviation or median with range. Results: Between April 2016 and September 2018, 55 patients underwent RAKT. The same was compared with 152 patients who underwent OKT. The two groups were comparable in terms of age, gender, and body mass index. Duration on hemodialysis was significantly higher in the RAKT group, and hemoglobin and donor kidney glomerular filtration rate was significantly better in the RAKT group. Requirement of perioperative analgesia was significantly less in the RAKT group. Rewarm ischemia time was significantly longer in the RAKT group. The fall in serum creatinine was slower in RAKT group till 3 months. The serum creatinine levels were statistically similar in the two cohorts at 3 months (p = 0.082), which was maintained at median 29 months of follow-up (p = 0.067). Tacrolimus levels on postoperative day 2 were found to be significantly higher in RAKT cohort (17.98 ± 14.41) vs OKT cohort (11.38 ± 6.93). Surgical-site infections were rare in the RAKT group. Conclusions: RAKT confers advantage of decreased wound morbidity with similar functional outcomes compared with OKT in midterm. It looks promising; however, long-term follow-up of larger numbers of patients is needed.

0589 Arrhythmia Detection in Obstructive Sleep Apnea (ADIOS)

Introduction

Obstructive sleep apnea (OSA) is a recognized risk factor for ischemic stroke; however, there is a paucity of studies devoted to modifying stroke risk factors in patients with OSA. We aimed to evaluate the prevalence and treatment of stroke risk factors in newly diagnosed OSA patients.

Methods

We evaluated consecutive patients with an OSA diagnosis made within 12 months and CHADS2 score of &gt;2, consistent with high risk for atrial fibrillation. The patients completed polysomnography, sleep questionnaires, and systematic assessments for demographic variables, vascular risk factors, and medication use. Participants also completed up to four weeks of ambulatory cardiac monitoring. A six-month follow-up visit screened for new hospitalizations associated to vascular events and use of new anticoagulants or antiplatelet therapy.

Results

The sample consisted of 87 patients, mean age 59±8 years, 53% women, and 69% of Hispanic/Latino background. The mean BMI was 35±9. Hypertension was seen in 57% and diabetes mellitus in 33% of the sample. The mean apnea-hypopnea index was 41±27 events/hour. Atrial fibrillation was detected in 3% of the sample through prolonged monitoring. At six-month follow-up, 9% of the sample was hospitalized due to stroke, transient ischemic attack, or coronary artery disease, while 13% reported use of anticoagulants and 38% antiplatelet therapy.

Conclusion

In this high risk sample of OSA patients, there was a high prevalence of cerebrovascular events and use of medical treatment for secondary stroke prevention. Future studies evaluating the treatment of vascular risk factors in OSA can provide strategies to minimize stroke occurrence.

Support

Boehringer Ingelheim

Evaluation of sagittal condylar guidance angles using computerized pantographic tracings, protrusive interocclusal records, and 3D-CBCT imaging techniques for oral rehabilitation

Objective

The goal of registering the condylar guidance is to recreate the patient's occlusion as exactly as possible on the articulator, and is therefore essential for successful prosthodontic rehabilitation. Clinical, radiographic, and pantographic methods are used to determine sagittal condylar guidance angles (SCGAs). These methods generate different angles in the same patients. The present study is the first disquisition to evaluate and correlate SCGAs determined by the use of pantographic tracing (PT), protrusive records (PR), and radiographic (CBCT) techniques.

Materials and Methods

The condylar guidance was measured using PT, PR, and CBCT imaging techniques in 23 nonpatient participants aged between 18 and 30 years irrespective of sex. PT was recorded using Cadiax® Compact system, a computerized recorder of SCGAs. PR was obtained using polyvinyl siloxane bite registration material, transferred to a semiadjustable articulator (Denar Mark II, Whip Mix Corp., USA) using facebow transfer (Denar Mark II, Whip Mix Corp., USA) and CR records, to determine SCGAs. Images of the mid-facial region were obtained using CBCT scan for 3D reconstruction. The angle formed between Frankfort horizontal plane (FHP) and a line extending from the most supero-anterior point on the glenoid fossa to the most convex point on the apex of articular eminence (AE) was measured to obtain SCGAs.

Results

The mean left and right SCGAs were as follows: PT (34.42° and 33.93°, respectively), PR (32.14° and 31.82°), and CBCT (38.96° and 38.12°). The Pearson coefficients for the correlations with PT and PR on the left and right sides were 0.899 and 0.907, respectively, while it was 0.911 and 0.934, and 0.842 and 0.874 from PT and CBCT, and PR and CBCT, respectively.

Conclusion

Strong correlations were found between SCGAs obtained using PT, PR, and CBCT techniques.

CBCT analysis of schneiderian membrane thickness and its relationship with gingival biotype and arch form

Objective

The purpose of this study was to investigate a relationship between gingival tissue biotypes and arch form with Schneiderian membrane thickness, using limited cone beam computed tomography.

Materials and Methods

A total of 90 subjects were selected. For each subject three parameters were assessed - gingival biotype - clinically by Probe transparency method as thin or thick and coded as 0 and 1, respectively, gingival thickness and Schneiderian membrane thickness in mm, arch form as square, oval, or tapered (radiographically by cone beam computed tomography images). Central incisors and first molars were assessed for gingival biotype and gingival thickness and Schneiderian membrane thickness was determined at 16. Numerical data were estimated for normal distribution. Analysis of Variance test was followed by Tukey honestly significant difference test and Pearson's correlation coefficient test for analysis.

Results

Thin gingival biotype was found associated with the central incisors and thick gingival biotype with molars. Limited cone beam computed tomography scans evaluation revealed highest prevalence of square arch form followed by oval, and tapered. The average thickness of the Schneiderian membrane was 1.18 ± 0.43 mm on left side and 1.09 ± 0.41 mm on right side with a range of 0.50 - 2.00 mm. Mean Schneiderian membrane thickness was more in case of thick gingival biotype and with square arc form both on right and left sides.

Conclusions

The Schneiderian membrane thickness was positively and highly associated with gingival biotype. The gingival biotype and arch form had significant effect on Schneiderian membrane thickness and can provide valuable clinical information on Schneiderian membrane thickness preoperatively for implant placement and sinus lift procedures.

Association of sociodemographic factors and emotional intelligence with academic performance in clinical and preclinical dental courses

Background

The dental graduation program is stressful and challenging as it is essential to master various skills. The emotional intelligence (EI) is reported to help in perceiving, moderating emotions and also play a significant role in academic excellence.

Aim

The aim of this study was to assess the sociodemographic factors influencing EI and to determine the association of EI in academic performance of clinical and preclinical courses.

Materials and Methods

This cross-sectional study included the 113 dental clinical internship students from five different dental schools at Pakistan. The self-administered questionnaire data included sociodemographic factors, academic performance in preclinical, clinical courses, and San Diego City College MESA Program-based EI responses. The results were analyzed with multiple linear regression and ordinal regression to identify the independent predictor for EI and academic performance.

Results

The female participants had marginally higher mean EI score (109.67) in comparison to male counterparts (108.10). The independent predictors among sociodemographic factors for EI were having siblings (P = 0.016), loss of parents (P = 0.002), parents' education (P = 0.022), and relation with parents (P = 0.03). The students enjoy studying dentistry were also associated with higher EI scores (P = 0.002). The mean EI score was an independent predictor of academic performance predominantly in clinical courses [β = -0.041 (95% confidence interval - 0.063 to - 0.020); P = 0.000].

Conclusion

The finding of the study indicates the influence of family and social factors in the development of EI. The dental students' EI is vital for higher academic performance in clinical courses.

3-D mapping of cortical bone thickness in subjects with different face form and arch form: A CBCT analysis

Objective

To determine the relationship between face form (FF), arch form (AF), and cortical bone thickness in anterior and posterior region of the mandibular jaws, using cone beam computed tomography (CBCT).

Patients and Methods

Total 90 subjects were selected. For each subject FF (euryprosopic, mesoprosopic, and leptoprosopic) was determined using Prosopic Index. CBCT scans were done for each subject to determine mandibular AF (as tapered, oval, or square in horizontal sections) and cortical bone thickness (at two vertical levels 4 and 7 mm from the alveolar crest in the anterior and posterior region of mandible in sagittal sections). Numerical data so obtained were analyzed using descriptive statistics, analysis of variance followed by Tukey HSD (honestly significant difference) test at a statistical significance level of 5%.

Results

Significant difference in thickness of cortical bone was noted between various AF and face. In square AF, mean value of thickness of cortical bone was highest both at 4 and 7 mm vertical level and tapered AF had minimum mean values at 4 mm and oval at 7 mm in anterior region and posterior region on buccal and lingual sides, in all the three-FF.

Conclusion

Significant effects of FF and AF on cortical bone thickness were seen both on buccal and lingual side and the effect of AF was more compared to FF. The availability of the cortical bone in euryprosopic FF and square AF patients was more; therefore, implants with a shorter length may be used in these clinical cases.

Acquaintance of dental implants as a treatment modality in edentulous states among health workers in Aseer Province, KSA

Purpose

To identify the acquaintance of dental implant (DI) as a treatment modality in edentulous states among health workers in the Aseer region and also to assess the level of understanding about DI among them.

Materials and Methods

A questionnaire set of 18 questions was used for 500 health workers from the concerned area about DI. Questionnaire set basically consists of questions to assess the attitude, perception, and knowledge among them about DI. The data collected and association with the factors were tested for significance using the Chi-square test and P < 0.05 was considered statistically significant.

Results

The response rate was 89%. More than 75% were aware of DI, but only 50% of the total respondents were knowing about the difference between the DI, fixed prosthesis, and removable prosthesis. Of the latter, 47.4% have suggested implants for patients and about 55% respondents were agreeing to get DI done for themselves. Dental health care workers have more knowledge than the medical health workers, and the difference was found to be statistically significant. Of respondents, >90% were willing to know more about DI.

Conclusion

The practice of implant dentistry is growing in the Aseer region. However, general health workers are not fully aware of proper DI information. In addition, all the efforts should be made to include basic implant education in all the branches of health sciences and the CDE program should be conducted regularly to enhance the knowledge, so that correct information can be channelized to the patients.

A novel perspective for predicting gingival biotype via dentopapillary measurements on study models in the Saudi population: Cross-sectional study

Background/Purpose

Gingival biotype (GB) is a crucial factor in predicting the success of soft tissue periodontal and peri-implant surgical interventions. Consequently, contemplating noninvasive, less time-consuming procedure to anticipate it has become a part and parcel of the current practice. This article presents a novel algorithm to detect GB in the Saudi population based on the dentopapillary measurements taken on laboratory models. In addition, it targets to allocate a range of values for thick and thin biotypes.

Materials and Methods

Model analysis was done on 160 patients to measure eight gingival parameters, and an algorithm was developed according to the results of multiple and linear regression analyses. Applying the dentopapillary parameters to the algorithm revealed a prediction of the biotype. Finally, the resultant values and the exact thickness were reassessed directly in a sample of patients using a modified caliper.

Results

The regression analysis revealed an algorithm predicting biotypes among patients based on their measured dentopapillary values. Discriminant analysis was used to allocate the values to thin and thick biotypes to further demystify that they coincide with <0.7 mm and >1.5 mm, respectively. However, gingival thickness between 0.7 and 1.5 mm was considered intermediate biotype.

Conclusion

GB could be predicted based on the dentopapillary measurements taken on laboratory models, which may further reduce the chairside time and increase the success rate of the surgical procedures. Significant variations in the range of values of the thick and thin biotype were detected in the Saudi population compared to other races.

Clinical Significance

The escalating invasion of interventional procedures in the dental practice necessitates measuring the GB as a predictor of procedure success. This study introduces an algorithm for detecting the GB and updates the range of values for thick and thin biotypes in the Saudi population that would consequently reduce chairside time.

Mapping neuroreceptors with metal-labeled radiopharmaceuticals

The growing epidemiological and economic burden of neurological diseases on society is tremendous. A correct and timely diagnosis can help in lowering the burden and improving the life quality of both the diseased person and the caretaker. Imaging of the brain (neuroimaging) using CT, MRI, and nuclear imaging methods can provide anatomical and functional information. Neuroreceptors are central to neurotransmission and neuromodulation in the CNS. In vivo imaging of receptors in the brain provides powerful tools for the functional study of the central nervous system (CNS) in normal or diseased states. Presently, PET imaging using non-metallic radiotracers dominates the imaging of neuroreceptors. Metal-based probes for SPECT and PET can be economical and logistically easier to use without compromising the information. This review focuses on the development of metallic radiotracers for (99mTc) SPECT and (68Ga) PET along with future directions based on the metallic probes developed for other imaging modalities namely MRI.

Metabolomics approach discriminates toxicity index of pyrazinamide and its metabolic products, pyrazinoic acid and 5-hydroxy pyrazinoic acid

Pyrazinamide (PYZ)-an essential component of primary drug regimen used for the treatment and management of multidrug resistant or latent tuberculosis-is well known for its hepatoxicity. However, the mechanism of PYZ-induced hepatotoxicity is still unknown to researchers. Studies have shown that the drug is metabolized in the liver to pyrazinoic acid (PA) and 5-hydroxy pyrazinoic acid (5-OHPA) which individually may cause different degrees of hepatotoxicity. To evaluate this hypothesis, PYZ, PA, and 5-OHPA were administered to albino Wistar rats orally (respectively, at 250, 125, and 125 mg kg^-1 for 28 days). Compared to normal rats, PYZ and its metabolic products decreased the weights of dosed rats and induced liver injury and a status of oxidative stress as assessed by combined histopathological and biochemical analysis. Compared to normal controls, the biochemical and morphological changes were more aberrant in PA- and 5-OHPA-dosed rats with respect to those dosed with PYZ. Finally, the serum metabolic profiles of rats dosed with PYZ, PA, and 5-OHPA were measured and compared with those of normal control rats. With respect to normal control rats, the rats dosed with PYZ and 5-OHPA showed most aberrant metabolic perturbations in their sera as compared to those dosed with PA. Altogether, the study suggests that PYZ-induced hepatotoxicity might be associated with its metabolized products, where 5-OHPA contributes to a higher degree in its overall toxicity than PA.

Investigation of the First Seven Reported Cases of Candida auris, a Globally Emerging Invasive, Multidrug-Resistant Fungus-United States, May 2013-August 2016

November 11, 2016/65(44);1234-1237. What is already known about this topic? Candida auris is an emerging pathogenic fungus that has been reported from at least a dozen countries on four continents during 2009-2015. The organism is difficult to identify using traditional biochemical methods, some isolates have been found to be resistant to all three major classes of antifungal medications, and C. auris has caused health care-associated outbreaks. What is added by this report? This is the first description of C. auris cases in the United States. C. auris appears to have emerged in the United States only in the last few years, and U.S. isolates are related to isolates from South America and South Asia. Evidence from U.S. case investigations suggests likely transmission of the organism occurred in health care settings. What are the implications for public health practice? It is important that U.S. laboratories accurately identify C. auris and for health care facilities to implement recommended infection control practices to prevent the spread of C. auris. Local and state health departments and CDC should be notified of possible cases of C. auris and of isolates of C. haemulonii and Candida spp. that cannot be identified after routine testing.

Time-constrained mother and expanding market: emerging model of under-nutrition in India

Background

Persistent high levels of under-nutrition in India despite economic growth continue to challenge political leadership and policy makers at the highest level. The present inductive enquiry was conducted to map the perceptions of mothers and other key stakeholders, to identify emerging drivers of childhood under-nutrition.

Methods

We conducted a multi-centric qualitative investigation in six empowered action group states of India. The study sample included 509 in-depth interviews with mothers of undernourished and normal nourished children, policy makers, district level managers, implementer and facilitators. Sixty six focus group discussions and 72 non-formal interactions were conducted in two rounds with primary caretakers of undernourished children, Anganwadi Workers and Auxiliary Nurse Midwives.

Results

Based on the perceptions of the mothers and other key stakeholders, a model evolved inductively showing core themes as drivers of under-nutrition. The most forceful emerging themes were: multitasking, time constrained mother with dwindling family support; fragile food security or seasonal food paucity; child targeted market with wide availability and consumption of ready-to-eat market food items; rising non-food expenditure, in the context of rising food prices; inadequate and inappropriate feeding; delayed recognition of under-nutrition and delayed care seeking; and inadequate responsiveness of health care system and Integrated Child Development Services (ICDS). The study emphasized that the persistence of child malnutrition in India is also tied closely to the high workload and consequent time constraint of mothers who are increasingly pursuing income generating activities and enrolled in paid labour force, without robust institutional support for childcare.

Conclusion

The emerging framework needs to be further tested through mixed and multiple method research approaches to quantify the contribution of time limitation of the mother on the current burden of child under-nutrition.

Electronic supplementary material

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Abstract 3163: Peripheral blood circulating multiple myeloma cells (CMMCs) correlate with disease burden and can be used to characterize high-risk cytogenetics in newly diagnosed and smoldering myeloma

There is an increasing interest in the ability to dynamically track disease burden and perform molecular subtyping of patients with plasma cell disorders without invasive bone marrow sampling. Circulating multiple myeloma cells (CMMC) have been detected in elevated numbers in the peripheral blood of patients with plasma cell disorders using flow cytometry or circulating cell enrichment platforms. We developed an automated CELLSEARCH® assay to enrich, enumerate, and perform a triplex FISH assay for t(4;14), t(14;16), and del 17p on CMMC (CD138+CD38+, CD45-CD19-) isolated from a 4 mL peripheral blood sample (Gross, et.al. Blood 2011; 118(21):1825). Here we present the enumeration and cytogenetic profiling of CMMC from separate cohorts of patients across the spectrum of plasma cell disorders.

The first cohort consisted of newly diagnosed multiple myeloma patients enrolled in the CoMMpass study (ClinicalTrials.gov Identifier: NCT01454297). One or more CMMC per four ml blood were detected in 684/698 (98%) of newly diagnosed myeloma patients with median CMMC count of 413 per 4 mL of blood. CMMC counts decreased significantly from baseline when a remission was achieved due to treatment (p&lt;0.001). CMMC counts &lt;100 at remission were associated with improved PFS and OS compared to those patients whose CMMC counts were &gt; 100 at remission. CMMC FISH results (n = 57) showed overall agreement of 85%, 91% and 80% with bone marrow FISH results and 81%, 91%, and 95% agreement with bone marrow CNV/RNAseq results for the t(4;14), t(14;16), and del 17p assays, respectively.

The second cohort of patients consisted of intermediate/high risk smoldering myeloma patients enrolled in a Phase 2 study of Siltuximab (ClinicalTrials.gov Identifier: NCT01484275). One or more CMMC per 4 mL blood was detected at baseline in 74/79 (94%) of intermediate/high risk smoldering myeloma patients with median CMMC count of 100 per 4 mL of blood. Significantly higher CMMC counts were observed between patients in the placebo arm that progressed versus those without progression (n = 34, p = 0.031). This is in contrast to standard metrics of percentage of bone marrow plasma cells and serum M protein levels where statistically significant differences were not seen between progressors and non-progressors in the placebo arm (p = 0.068 and p = 0.070, respectively).

CMMCs were collected from a third cohort of 35 patients across the plasma cell disease spectrum with an emphasis on MGUS and SMM. CMMC counts were associated with the disease burden of patients within this cohort.

CMMC may be a useful non-invasive tool for disease monitoring and characterization across the plasma cell disorder spectrum. In myeloma, CMMC may be a useful prognostic marker at remission to delineate those patients at risk for relapse. In SMM, CMMC may be useful for predictive patients at risk of progression to MM.

Citation Format: Brad Foulk, Mike Schaffer, Steve Gross, Chandra Rao, Denis Smirnov, Shalini Chaturvedi, Manjula Reddy, Madeline Repollet, Claudia Rojas, Daniel Auclair, Mary DeRome, The MMRF CoMMpass Network, Brendan Weiss, A. Kate Sasser. Peripheral blood circulating multiple myeloma cells (CMMCs) correlate with disease burden and can be used to characterize high-risk cytogenetics in newly diagnosed and smoldering myeloma. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 3163.

Abstract 365: High throughput screen to evaluate combinations with ibrutinib in various B-cell malignancies

The primary objective of this study was to discover synergies leading to mechanistic insights and novel combinations for ibrutinib, a small-molecule inhibitor of Bruton's tyrosine kinase (BTK). Ibrutinib has been approved for relapsed/refractory (R/R) and del(17p) chronic lymphocytic leukemia, and R/R mantle-cell lymphoma (MCL). BTK is part of the B-cell receptor (BCR) signaling pathway, so it is of interest to examine synergy between ibrutinib and agents that target other aspects of the BCR pathway. These include PI3K and IRAK inhibitors and apoptosis inhibitors. Combinations were evaluated in a high-throughput, tumor microenvironment-directed format.

Ibrutinib was combined with inhibitors of the BCR pathway and apoptosis, whose targets included MCL-1, BCL2, XPO1, and isoforms of PI3K, IRAK, and BRD. Histologies examined included follicular lymphoma (FL), diffuse large B-cell lymphoma (DLBCL), MCL, acute myeloid leukemia (AML), acute B-lymphoblastic leukemia, and Burkitt's lymphoma. Cell lines were screened in the presence of human marrow stromal-cell-conditioned media and B-cell receptor stimulation via anti-IgG/anti-IgM antibodies in a 72-hour cell viability ATP lite assay (384-well plate, 9×9 optimized matrix, 4 replicates). Dose response matrix screening was used to measure combination effects, which manifest as potency shifts or efficacy boosts. Combination effects can be characterized by comparing each data point to a combination reference model derived from single-agent curves using the Loewe additivity model.

Ibrutinib demonstrated varying activity across cell lines. Combination activity was classified based on synergy score raw values. The best combination among tested compounds was with ABT-199, a BCL2i. This combination showed high or medium synergy in 2/5 DLBCL, 3/4 FL, and 2/5 MCL cell lines; this was also the only agent to show good synergy in AML (3/5 lines). Interestingly, ABT-737, a BCL2i that also targets BCL-XL, has previously been shown to be synergistic with ibrutinib in DLBCL lines. Synergy was also seen with other apoptotic agents such as MCL-1i and the epigenetic BETi JQ-1 across B-NHL, but in fewer lines. Among the PI3Ki, PI3Kα/δi did not show much activity, but the PI3Kδ/γi IPI-145 was synergistic in 2/5 DLBCL, 3/4 FL cell lines, and 1/5 MCL cell lines, a pattern very similar to the PI3Kδi CAL-101 (idelalisib). Ibrutinib also combined well with IRAK1/4i and XPO1i selinexor, with high activity in 1/5 DLBCL cell lines each, and medium activity in 1/5 DLBCL, 1/4 FL, and 2/5 MCL (XPO1i) and 1/5 DLBCL, 2/4 FL, and 1/5 MCL cell lines (IRAK1/4i).

Synergy was mostly observed in B-cell malignancies, but interesting synergy was observed with ABT-199 in AML. In B-NHL, ibrutinib combined with BCL2i and PI3Ki showed the best combination activity. Ibrutinib was also synergistic with other agents in selected B-NHL lines with no observed antagonism, suggesting that further study in specific histologies is warranted.

Citation Format: Shalini Chaturvedi, Michael Schaffer, Cuc Davis, Regina Aquino, Emily Stepanchick, Matthias Versele, Sriram Balasubramanian. High throughput screen to evaluate combinations with ibrutinib in various B-cell malignancies. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 365.

Role of 24-h ambulatory blood pressure monitoring in children with chronic kidney disease

Hypertension is common in children with chronic kidney disease (CKD) and is a major determinant of CKD progression. Ambulatory blood pressure monitoring (ABPM) has been proposed to be better in detecting hypertension as compared to casual blood pressure (CBP). This study aims to study the usefulness of ABPM in detecting masked hypertension, evaluating the adequacy of blood pressure (BP) control and predicting left ventricular hypertrophy (LVH) amongst children with CKD. A prospective cross-sectional study of 46 children with stage 3–5 CKD was conducted at the Pediatric Nephrology department of a tertiary hospital in South India. All children underwent CBP, ABPM and an echocardiography. Results were categorized as normal BP; confirmed hypertension; masked hypertension and white coat hypertension. Out of 46 children studied, 11 were undergoing dialysis. While 39.1% children had stage 3 and 4 CKD each, 21.7% had stage 5 CKD. Masked hypertension was detected in 19.6% and 21.7% had confirmed hypertension. Thirty-four (73.9%) children were already receiving antihypertensive medication. In these, CBP was elevated in 23.5% and ABP in 47%. Among children with hypertension as defined by ABPM, LVH was detected in 32.2%. We found that higher the number of abnormal ABPM indices (assessed by BP Index, nocturnal dipping and BP Load) higher the likelihood of LVH (P = 0.046). ABPM is better in detecting hypertension and monitoring adequacy of treatment in children with CKD. The high prevalence of masked hypertension and its association with LVH supports early echocardiography and ambulatory BP monitoring to evaluate cardiovascular risks in this population.

Molecular dynamics analysis of the transient temperature increase at void locations in shocked materials: RDX and Cu

Molecular dynamics (MD) simulations of high velocity impact (1-6 km/s) of RDX crystal with a nanometer-sized void, has been carried out to understand the mechanism of increase in temperature at void locations under shock loading. Similar simulations are then carried out on single-crystal copper for better interpretation of the results. A reactive potential that can simulate chemical reactions (ReaxFF) has been used for RDX, whereas an EAM potential has been used for Cu. Increased temperature at the void locations are observed under shock loading. The atomic motion, temperature, average potential energy per atom (PE), and average kinetic energy per atom (KE) in and around the voids are closely monitored in order to understand the reason for temperature increase. We compare our results with existing proposed mechanisms and show that some of the proposed mechanisms are not necessary for increased temperature at a void location. It is shown that the directed particle velocity is efficiently is converted into randomized velocity due to the presence of voids thereby increasing the local temperature transiently. In this initial stage (few picoseconds) of the shock, chemical reactions of energetic materials do not play a part in the temperature rise.

Can Patients Select the Best Hospital for Carotid Revascularization?

BACKGROUND

Public reporting of cardiac surgery outcomes has been available for many years in the USA. Whether public information regarding carotid endarterectomy or stenting outcomes is available has not been studied previously.

METHODS

The Medicare Hospital Compare website was analyzed for carotid endarterectomy and stenting volume and complications data.

RESULTS

Within a large metropolitan area, endarterectomy volume data was provided in less than half of hospitals, with no information provided on morbidity or mortality. No information was available on carotid stenting.

CONCLUSIONS

The quality of information available to patients in the USA contemplating a carotid revascularization procedure is suboptimal. Considering the volume of these procedures, greater transparency with regard to outcomes is desirable. Adoption of carotid procedure reporting practices as used in the UK should be considered.

Bortezomib, thalidomide and dexamethasone, with or without cyclophosphamide, for patients with previously untreated multiple myeloma: 5-year follow-up

This follow-up extension of a randomised phase II study assessed differences in long-term outcomes between bortezomib-thalidomide-dexamethasone (VTD) and VTD-cyclophosphamide (VTDC) induction therapy in multiple myeloma. Newly diagnosed patients (n = 98) were randomised 1:1 to intravenous bortezomib (1·3 mg/m(2); days 1, 4, 8, 11), thalidomide (100 mg; days 1-21), and dexamethasone (40 mg; days 1-4, 9-12), with/without cyclophosphamide (400 mg/m(2); days 1, 8), for four 21-day cycles before stem-cell mobilisation/transplantation. After a median follow-up of 64·8 months, median time-to-next therapy was 51·8 and 47·9 months with VTD and VTDC, respectively. Type of subsequent therapy was similar in both arms. After adjusting for asymmetric censoring, median time to progression was not significantly different between VTD and VTDC [35·7 vs. 34·5 months; Hazard ratio (HR) 1·26, 95% confidence interval: 0·76-2·09; P = 0·370]. Five-year survival was 69·1% and 65·3% with VTD and VTDC, respectively. When analysed by minimal residual disease (MRD) status, overall survival was longer in MRD-negative versus MRD-positive patients with bone marrow-confirmed complete response (HR 3·66, P = 0·0318). VTD induction followed by transplantation provides long-term disease control and, consistent with the primary analysis, there is no additional benefit from adding cyclophosphamide. This study was registered at ClinicalTrials.gov (NCT00531453).

Analysis of Inflammatory and Anemia-Related Biomarkers in a Randomized, Double-Blind, Placebo-Controlled Study of Siltuximab (Anti-IL6 Monoclonal Antibody) in Patients With Multicentric Castleman Disease

PURPOSE

Siltuximab (IL6 antibody) is approved for the treatment of multicentric Castleman disease (MCD). Effects of IL6 inhibition on the inflammatory milieu accompanying MCD have not been characterized.

EXPERIMENTAL DESIGN

Trends in inflammatory- and anemia-associated markers, measured over the course of a placebo-controlled study of siltuximab (11 mg/kg q3w) in patients with MCD (n = 79), were characterized.

RESULTS

Baseline IL6 and C-reactive protein (CRP) levels were significantly correlated (r = 0.708; P < 0.0001). CRP levels decreased (median, 92%) by cycle 1 day 8 (C1D8), remaining suppressed during siltuximab treatment while remaining stable in the placebo group. There were no associations between baseline CRP or IL6 and MCD symptom burden, histologic subtype, ethnicity, maximum CRP decrease, and response parameters. A hemoglobin response (change ≥ 15 g/L at week 13) was observed with siltuximab (61%; P = 0.0002). Median hepcidin decrease from baseline at C1D8 with siltuximab was 47% versus median 11% increase with placebo. Maximum post-baseline changes in hepcidin levels among siltuximab recipients were correlated with maximum changes for hemoglobin (r = -0.395; P = 0.00607), total iron-binding capacity (TIBC; r = -0.354; P = 0.01694), and ferritin (r = 0.599; P = 0.0001). Greater median changes from baseline in ferritin, hemoglobin, and TIBC were observed in anemic siltuximab-treated patients.

CONCLUSIONS

IL6 neutralization with siltuximab resulted in sustained CRP suppression and improvement of anemia, in part, by hepcidin pathway inhibition.

Development and validation of panoptic Meso scale discovery assay to quantify total systemic interleukin-6

AIM

Interleukin-6 (IL-6), a multifunctional cytokine, exists in several forms ranging from a low molecular weight (MW 20-30 kDa) non-complexed form to high MW (200-450 kDa), complexes. Accurate baseline IL-6 assessment is pivotal to understand clinical responses to IL-6-targeted treatments. Existing assays measure only the low MW, non-complexed IL-6 form. The present work aimed to develop a validated assay to measure accurately total IL-6 (complexed and non-complexed) in serum or plasma as matrix in a high throughput and easily standardized format for clinical testing.

METHODS

Commercial capture and detection antibodies were screened against humanized IL-6 and evaluated in an enzyme-linked immunosorbent assay format. The best antibody combinations were screened to identify an antibody pair that gave minimum background and maximum recovery of IL-6 in the presence of 100% serum matrix. A plate-based total IL-6 assay was developed and transferred to the Meso Scale Discovery (MSD) platform for large scale clinical testing.

RESULTS

The top-performing antibody pair from 36 capture and four detection candidates was validated on the MSD platform. The lower limit of quantification in human serum samples (n = 6) was 9.77 pg l(-1) , recovery ranged from 93.13-113.27%, the overall pooled coefficients of variation were 20.12% (inter-assay) and 8.67% (intra-assay). High MW forms of IL-6, in size fractionated serum samples from myelodysplastic syndrome and rheumatoid arthritis patients, were detected by the assay but not by a commercial kit.

CONCLUSION

This novel panoptic (sees all forms) IL-6 MSD assay that measures both high and low MW forms may have clinical utility.

Classical light beams and geometric phases

We present a study of geometric phases in classical wave and polarization optics using the basic mathematical framework of quantum mechanics. Important physical situations taken from scalar wave optics, pure polarization optics, and the behavior of polarization in the eikonal or ray limit of Maxwell's equations in a transparent medium are considered. The case of a beam of light whose propagation direction and polarization state are both subject to change is dealt with, attention being paid to the validity of Maxwell's equations at all stages. Global topological aspects of the space of all propagation directions are discussed using elementary group theoretical ideas, and the effects on geometric phases are elucidated.