Durable remissions with venetoclax monotherapy in secondary AML refractory to hypomethylating agents and high expression of BCL‐2 and/or BIM

Acute myeloid leukemia (AML) is a disease of the elderly population and survival remains poor after failure of hypomethylating agents (HMA). The BCL‐2 inhibitor venetoclax demonstrated activity as monotherapy and in combination with chemotherapy or HMA in AML. In this case series, patients with secondary AML (sAML) not eligible for intensive chemotherapy and refractory to HMA were treated with venetoclax within a named patient program at our tertiary cancer center in Salzburg, Austria. Between April 2017 and September 2018, seven patients with sAML received venetoclax therapy. Two out of seven patients achieved a complete remission upon venetoclax initiation with a PFS of 505 days and 352 days and another patient achieved complete peripheral blood blast clearing within nine days after start of venetoclax. Among the venetoclax responders, primary refractory disease to prior HMA therapy was documented, 2 patients harbored IDH1/IDH2 mutations and one patient had an antecedent myeloproliferative neoplasm. High BCL‐2 and/or BIM expression in myeloblasts was found in venetoclax responders and response was significantly associated with overall survival (responders: 364 days versus non‐responders: 24 days, P = 0.018). Venetoclax monotherapy is safe and is able to induce durable responses in elderly patients with secondary AML after treatment failure with HMA.     

Augmented Vector Right ST-Segment Elevation: Pearls and Pitfalls

ST-segment elevation myocardial infarction (STEMI) is characterized by ST-segment elevation in at least 2 contiguous leads, chest discomfort, and the release of biomarkers requiring emergent revascularization. In 2013, the American College of Cardiology Foundation/American Heart Association revised STEMI guidelines to include augmented vector right (aVR) ST-segment elevation to be treated as a STEMI equivalent. However, aVR ST-segment elevation with multilead ST depression can occur in presentations other than occlusive myocardial infarctions. The purpose of this clinical feature is to provide a brief review of aVR ST-segment elevation, explore approaches to clinical decision making, and provide tools to support nurse practitioners caring for patients with cardiac issues.     

The proteome microenvironment determines the protective effect of preconditioning in cisplatin-induced acute kidney injury

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Systematic review of alternative access for cardiac catheterization and percutaneous coronary intervention: Dorsal distal radial and ulnar artery catheterization

The femoral and radial arteries are the standard access routes for cardiac catheterization. In cases where the right radial artery has been previously utilized or is not suitable for repeat procedures, the left dorsal distal radial artery (anatomical snuff box) or the ulnar artery may be an alternative access site. In this systematic review, alternative access sites are described along with the techniques of cannulation, technical considerations, ultrasound imaging, clinical studies, and their complications. As we routinely perform more radial procedures, increased complications will arise, so it becomes important to gain expertise in alternative access for future coronary interventions. Such a systematic review has not been previously published so it will enhance the reader's knowledge of alternative access.     

伴岛叶三层现象的急性坏死性脑病一家系临床及遗传学分析

目的探讨伴岛叶三层现象(TA)的急性坏死性脑病(ANE)临床及遗传学特征。方法回顾分析1个确诊为ANE家系的临床资料。结果先证者为男性,4.5岁时以惊厥、意识障碍起病,1岁时有热性惊厥史;头颅磁共振示对称性多灶性损害,岛叶存在TA。家系中有6例患者,起病年龄6月龄至50岁,主要以发热后惊厥或惊厥持续状态及意识障碍起病,3例因惊厥持续状态死亡;免疫治疗及能量支持可改善预后。基因检测发现家系RANBP2基因变异(NM_006267;c.1754 CT[p.T585M])。结论首次报道TA可出现于岛叶。     

The principles of ultra-low contrast percutaneous coronary intervention

Ultra-low contrast percutaneous coronary intervention (ULCPCI) can be performed electively in advanced chronic kidney disease. Engage guide catheter and advance guidewire into the coronary artery without using contrast. IVUS-guided PCI can reduce the contrast load. Perform co-registration of distal and proximal radio-opaque marker bands of intravascular ultrasound (IVUS) catheter. Deploy the stent at the target lesion under fluoroscopic guidance of these co-registered position of the IVUS-marking images. Complete the ULCPCI procedure with a final angiography using minimal contrast. Newer contrast sparing techniques and intravascular imaging technologies provide opportunities to perform ULCPCI efficiently with good results and the least complications.