Search

Objective: In older adults with acute myeloid leukemia (AML), the overall outcome is still dismal and long-term data on survival are scarce, particularly outside of clinical trials. Here, we assess characteristics, prognostic factors and long-term survival in patients ≥60 years who were treated for AML at our center over the past 17 years., Methods: 590 older adults with newly diagnosed AML were characterized according to Eastern Cooperative Oncology Group (ECOG) score, Charlson comorbidity index (CCI), European LeukemiaNet (ELN) risk, type of therapy, serum ferritin (SF) and further baseline characteristics. Survival analysis was performed accordingly., Results: Median age was 68 years and most patients were in good general condition. Median follow-up was 55.8 months. Of all patients, 66% received intensive chemotherapy (IC) +/- allogeneic hematopoietic stem cell transplantation (allo-HSCT). The remaining cohort received palliative chemotherapy (PC, 26%) or best supportive care only (BSC, 8%). Enrollment rate for interventional clinical trials was 26%. 5-year overall survival (OS) and relapse-free survival (RFS) were 18% (median 12.5 months) and 11,5% (median 10.0 months). Long-term survival was independently influenced by ECOG score, ELN risk group, baseline SF, previous myocardial infarction, and choice of therapy, but not consistently by age or CCI. Considering therapeutic subgroups, the contribution of particular parameters in predicting OS was most compelling in IC patients, but less consistent with PC or BSC., Conclusion: Our results provide thorough insights into prognostication within therapeutic subgroups and emphasize the need for more detailed prognostic algorithms and routine geriatric assessment in the treatment of older adults with AML., Competing Interests: Declaration of Competing Interest The authors declare that there is no conflict of interest with respect to this work., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Background: Permanent cardiac pacemakers (PCM) are accepted as the most effective treatment for symptomatic bradyarrhythmias. Serum uric acid (UA) levels are associated with various inflammatory markers, oxidative stress, and endothelial dysfunction. This study aimed to investigate the association between serum UA and ventricular pacing threshold (VPT) levels in patients who underwent permanent pacemaker implantation., Materials and Methods: We retrospectively analyzed a total of 198 patients who underwent PCM implantation for indications such as symptomatic bradycardia without a reversible etiology and high-degree and complete atrioventricular block., Results: VPT values were found to correlate with serum UA levels (r=0.591, p<0.001), high sensitivity C-reactive protein (hs-CRP) levels (r=0.505, p<0.001), and ventricular impedance (r=0.220, p=0.016). The serum UA levels and hs-CRP levels were also correlated (r=0.691, p<0.001). To identify independent risk factors for VPT values, a multivariate linear regression model was conducted, and serum UA levels (β=0.361, p=0.001), hs-CRP levels (β=0.277, p=0.012), and impedance values (β=0.207, p=0.011) were found to be independent risk factors for VPT., Conclusion: In the present study, VPT values at the time of implantation and at the 30th day were increased in patients with high serum UA levels. To further extend the life of pacemakers, as well as other factors that affect threshold values, serum UA levels should be noted., (Copyright © 2014 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.)

Wild animal attacks are potential occurrences in rural areas of Turkey. Wolf attacks, however, are rare this century, but there are many anecdotal reports from previous times. Attacks by wolves are generally directed against animals, such as cows and sheep, and for feeding purposes. Wolf attacks on humans are a little known and unexpected phenomenon. A 60-year-old man was brought to the emergency department with facial injuries caused by a wolf emerging from a rural area and leaping at his face as he was sitting in his garden. During the incident, the patient strangled the wolf to death. Despite postexposure prophylaxis the patient likely died because of rabies., (Copyright © 2012 Wilderness Medical Society. Published by Elsevier Inc. All rights reserved.)

Mesenchymal stromal cells (MSCs) are an essential cell type of the hematopoietic microenvironment. Concerns have been raised about the possibility that MSCs undergo malignant transformation. Several studies, including one from our own group, have shown the presence of cytogenetic abnormalities in MSCs from leukemia patients. The aim of the present study was to compare genetic aberrations in hematopoietic cells (HCs) and MSCs of myelodysplastic syndrome (MDS) and acute myeloid leukemia (AML) patients. Cytogenetic aberrations were detected in HCs from 25 of 51 AML patients (49%) and 16 of 43 MDS patients (37%). Mutations of the FLT3 and NPM1 genes were detected in leukemic blasts in 12 (23%) and 8 (16%) AML patients, respectively. Chromosomal aberrations in MSCs were detected in 15 of 94 MDS/AML patients (16%). No chromosomal abnormalities were identified in MSCs of 36 healthy subjects. We demonstrate herein that MSCs have distinct genetic abnormalities compared with leukemic blasts. We also analyzed the main characteristics of patients with MSCs carrying chromosomal aberrations. In view of these data, the genetic alterations in MSCs may constitute a particular mechanism of leukemogenesis.

The proteasome is a proteolytic complex for intracellular degradation of ubiquitinated proteins which are involved in cell-cycle regulation and apoptosis. A constitutively increased proteasome activity has been found in myeloma cells. We studied circulating proteasome levels and their prognostic significance in sera of 50 control subjects, 20 persons with monoclonal gammopathies of undetermined significance (MGUS), and 141 previously untreated patients with multiple myeloma (MM) by an anti-20S proteasome enzyme-linked immunoabsorbent assay (ELISA). Serum proteasome concentrations were significantly elevated in MM compared with controls (P < .001), in MM versus MGUS (P = .03), and in active (n = 101) versus smoldering (n = 40) MM (P < .001). In patients with active MM, there was a significant (P < .001) decrease from pretreatment to post-treatment proteasome concentrations in responders to chemotherapy, but not in nonresponders. Circulating proteasome levels were identified as a prognostic factor for overall survival in the univariate (P < .001 log-rank test) and in the multivariate (hazard ratio, 4.38) survival analysis in patients with active MM. We demonstrate for the first time that increased serum proteasome concentrations correlate with advanced disease and are an independent prognostic factor in MM.