The cure of leukemia through the optimist's prism

Progress is occurring at a dizzying rate across all leukemias. Since the authors' review of the topic in Cancer in 2018, numerous discoveries have been made that have improved the therapy and outcomes of several leukemia subsets. Hairy cell leukemia is potentially curable with a single course of cladribine followed by rituximab (10-year survival, ≥90%). Acute promyelocytic leukemia is curable at a rate of 80% to 90% with a nonchemotherapy regimen of all-trans retinoic acid and arsenic trioxide. The cure rate for core-binding factor acute myeloid leukemia (AML) is ≥75% with fludarabine, high-dose cytarabine, and gemtuzumab ozogamicin. Survival for patients with chronic myeloid leukemia is close to that for an age-matched normal population with BCR-ABL1 tyrosine kinase inhibitors (TKIs). Chronic lymphocytic leukemia, a previously incurable disease, may now be potentially curable with a finite duration of therapy with Bruton tyrosine kinase inhibitors and venetoclax. The estimated 5-year survival rate for patients with Philadelphia chromosome–positive acute lymphoblastic leukemia (ALL) exceeds 70% with intensive chemotherapy and ponatinib, a third-generation BCR-ABL1 TKI, and more recent nonchemotherapy regimens using dasatinib or ponatinib with blinatumomab are producing outstanding results. Survival in both younger and older patients with ALL has improved with the addition of antibodies targeting CD20, CD19 (blinatumomab), and CD22 (inotuzumab) to chemotherapy. Several recent drug discoveries (venetoclax, FLT3 and IDH inhibitors, and oral hypomethylating agents) are also improving outcomes for younger and older patients with AML and for those with higher risk myelodysplastic syndrome.     

Decision tree outcome prediction of acute acetaminophen exposure in the United States: A study of 30,000 cases from the National Poison Data System

Acetaminophen is one of the most commonly used analgesic drugs in the United States. However, the outcomes of acute acetaminophen overdose might be very serious in some cases. Therefore, prediction of the outcomes of acute acetaminophen exposure is crucial. This study is a 6-year retrospective cohort study using National Poison Data System (NPDS) data. A decision tree algorithm was used to determine the risk predictors of acetaminophen exposure. The decision tree model had an accuracy of 0.839, an accuracy of 0.836, a recall of 0.72, a specificity of 0.86 and an F1_score of 0.76 for the test group and an accuracy of 0.848, a recall of 0.85, a recall of 0.74, a specificity of 0.87 and an F1_score of 0.78 for the training group. Our results showed that elevated serum levels of liver enzymes, other liver function test abnormality, anorexia, acidosis, electrolyte abnormality, increased bilirubin, coagulopathy, abdominal pain, coma, increased anion gap, tachycardia and hypotension were the most important factors in determining the outcome of acute acetaminophen exposure. Therefore, the decision tree model is a reliable approach in determining the prognosis of acetaminophen exposure cases and can be used in an emergency room or during hospitalization.     

miRNA expression patterns in normal breast tissue and invasive breast cancers of BRCA1 and BRCA2 germ-line mutation carriers

miRNA deregulation has been found to promote carcinogenesis. Little is known about miRNA deregulation in hereditary breast tumors as no miRNA expression profiling studies have been performed in normal breast tissue of BRCA1 and BRCA2 mutation carriers. miRNA profiles of 17 BRCA1- and 9 BRCA2-associated breast carcinomas were analyzed using microarrays. Normal breast tissues from BRCA1 and BRCA2 mutation carriers (both n = 5) and non-mutation carriers (n = 10) were also included. Candidate miRNAs were validated by qRT-PCR. Breast carcinomas showed extensive miRNA alteration compared to normal breast tissues in BRCA1 and BRCA2 mutation carriers. Moreover, normal breast tissue from BRCA1 mutation carriers already showed miRNA alterations compared to non-mutation carriers. Chromosomal distribution analysis showed several hotspots containing down- or up-regulated miRNAs. Pathway analysis yielded many similarities between the BRCA1 and BRCA2 axes with miRNAs involved in cell cycle regulation, proliferation and apoptosis. Lesser known pathways were also affected, including cellular movement and protein trafficking. This study provides a comprehensive insight into the potential role of miRNA deregulation in BRCA1/2-associated breast carcinogenesis. The observed extensive miRNA deregulation is likely the result of genome-wide effects of chromosomal instability caused by impaired BRCA1 or BRCA2 function. This study''s results also suggest the existence of common pathways driving breast carcinogenesis in both BRCA1 and BRCA2 germ-line mutation carriers.     

Chemical characterization and quality assessment of some bottled water brands from the Kohgiluyeh-va-Boyer Ahmad province market,SW Iran

Recently, bottled water consumption has been increased in Iran, because of the priority change from tap water to bottled water usage; therefore, conducting studies on quality control of the bottled drinking waters seems very necessary. In this study, a comparison between the amounts of mineral elements present in 10 bottled water brands from the Kohgiluyeh-va-Boyer Ahmad Province market, SW Iran, and recommended limits by national and international standards and guidelines for drinking water was carried out, with the aim to assess the quality of bottled waters as an outdoor supply source for drinking water. The chosen bottled water brands were analyzed for more than 50 physicochemical parameters, using inductively coupled plasma optical emission spectrometry (ICP-OES), ionic chromatography (IC), hydride generation atomic absorption spectroscopy (HGAAS), spectrophotometry, titration, and conductometry standard methods. The comparison between obtained results and Iranian, United States Environmental Protection Agency (USEPA) and World Health Organization (WHO) standards and guidelines showed that all levels of analyzed parameters do not exceed the permitted limits, indicating that the bottled waters have safe quality for drinking use. Results revealed that bottled waters are a valid substitute of tap water, especially for outdoor drinking purpose. Nevertheless, the mineral elements such as Ca, Mg, Na, and K are not provided by the bottled waters in sufficient levels needed daily by human body.     

The influence of crystallization inhibition of HPMC and HPMCAS on model substance dissolution and release in swellable matrix tablets

One of the drawbacks with solid solution systems is their thermodynamic instability in solution. Considering the release of these systems from extended-release formulations, in particular swellable matrix tablets, a successful tablet formulation can be regarded as a composition able to maintain the molecular state of the poorly soluble crystalline drug through diffusion in the matrix. This may in turn provide molecular rather than particulate delivery of the substance from the matrix. In this study, the solid state and dissolution behavior of amorphous solid dispersions of a model crystalline substance, butyl paraben in HPMC and HPMCAS, was investigated. In addition, the suitability of HPMCAS as both effective solid solution carrier and as extended-release matrix forming polymer was examined. The release from all systems investigated showed extended-release capacity with a release rate similar to the rate of matrix erosion. However, a detailed study of the factors affecting the release mechanism revealed that upon hydration, the model substance crystallized in the gel layer of the HPMC-based formulation, whereas it remained in amorphous form in the HPMCAS tablets. In the case of HPMCAS formulation, this effect was attributed to (i) the ability of this polymer to keep the model substance in a supersaturated state and (ii) the very slow matrix hydration, resulting in a steep concentration gradient of the drug substance and a short diffusion path through the matrix into the dissolution bulk.     

The role of breast imaging in macrolane injection—A review and report of three cases

The demand for minimally invasive cosmetic procedures is increasing. Injectable hyaluronic acid is an effective and well tolerated procedure that can be used for breast augmentation and provides predictable long-lasting results if administered appropriately in the correct tissue plane. Concerns already exist regarding the effect of Macrolane™ on breast cancer screening, and we raise a new concern about the need for imaging for its safe administration. We present three cases referred to our centre in the last 2 years with complications associated with Macrolane™ injection, possibly from injection into an incorrect tissue plane. Complications included breast pain, haematoma, cellulitis and abscess formation. We suggest that such aesthetic procedures should be carried out under ultrasound guidance to ensure administration into the correct site, potentially avoiding such complications.     

High-intensity endurance training improves adiponectin mRNA and plasma concentrations

Adiponectin is an anti-inflammatory protein that reduced in obesity. Exercise training may reduce the adipose tissue (AT), although it is not well known whether exercise-induced change in AT, increases the adiponectin mRNA expression and plasma concentrations or not; therefore, the purpose of this study was to investigate the adiponectin mRNA and plasma concentrations in middle-aged men after 12 weeks high-intensity exercise training and after a week detraining. Sixteen sedentary overweight and obese middle-aged men (age 41.18 ± 6.1 years; ± SD) volunteered to participate in this study. The subjects were randomly assigned to training group (n = 8) or control group (n = 8). The training group performed endurance training 4 days a week for 12 weeks at an intensity corresponding to 75–80% individual maximum oxygen consumption for 45 min. After 12 weeks of training, subjects underwent a week of detraining. The results showed that the BMI as well as central and peripheral AT volume were decreased in the training group compared to the control group (P < 0.05). After 12 weeks, the training group resulted in a significant increase (P < 0.05) in the adiponectin gene expression in abdominal and gluteal subcutaneous AT when compared with the control group. The results showed that plasma adiponectin concentrations increased and insulin resistance decreased after training compared to the control group (P < 0.05). After a week of detraining, the variables were not changed significantly in the training group. In conclusion, high-intensity endurance training caused an increase adiponectin mRNA in obese middle-aged men.