Could environmental exposure and climate change Be a key factor in the rising incidence of early onset colorectal cancer?

The emergence of early onset colorectal cancer (EOCRC) is believed to result from the complex interplay between external environmental factors and internal molecular processes. This review investigates the potential association between environmental exposure to chemicals and climate change and the increased incidence of EOCRC, focusing on their effects on gut microbiota (GM) dynamics. The manuscript explores the birth cohort effect, suggesting that individuals born after 1950 may be at higher risk of developing EOCRC due to cumulative environmental exposures. Furthermore, we also reviewed the impact of environmental pollution, including particulate matter and endocrine disrupting chemicals (EDCs), as well as global warming, on GM disturbance. Environmental exposures have the potential to disrupt GM composition and diversity, leading to dysbiosis, chronic inflammation, and oxidative stress, which are known risk factors associated with EOCRC. Particulate matter can enter the gastrointestinal tract, modifying GM composition and promoting the proliferation of pathogenic bacteria while diminishing beneficial bacteria. Similarly, EDCs, can induce GM alterations and inflammation, further increasing the risk of EOCRC. Additionally, global warming can influence GM through shifts in gut environmental conditions, affecting the host's immune response and potentially increasing EOCRC risk. To summarize, environmental exposure to chemicals and climate change since 1950 has been implicated as contributing factors to the rising incidence of EOCRC. Disruptions in gut microbiota homeostasis play a crucial role in mediating these associations. Consequently, there is a pressing need for enhanced environmental policies aimed at minimizing exposure to pollutants, safeguarding public health, and mitigating the burden of EOCRC.

12/15-Lipooxygenase Inhibition Reduces Microvessel Constriction and Microthrombi After Subarachnoid Hemorrhage in Mice.

Impaired cerebral circulation, induced by blood vessel constrictions and microthrombi, leads to delayed cerebral ischemia after subarachnoid hemorrhage (SAH). 12/15-Lipooxygenase (12/15-LOX) overexpression has been implicated in worsening early brain injury outcomes following SAH. However, it is unknown if 12/15-LOX is important in delayed pathophysiological events after SAH. Since 12/15-LOX produces metabolites that induce inflammation and vasoconstriction, we hypothesized that 12/15-LOX leads to microvessel constriction and microthrombi formation after SAH, and thus, 12/15-LOX is an important target to prevent delayed cerebral ischemia. SAH was induced in C57BL/6 and 12/15-LOX-/- mice of both sexes by endovascular perforation. Expression of 12/15-LOX was assessed in brain tissue slices and in vitro. C57BL/6 mice were administered either ML351 (12/15-LOX inhibitor) or vehicle. Mice were evaluated for daily neuroscore and euthanized on day 5 to assess cerebral 12/15-LOX expression, vessel constrictions, platelet activation, microthrombi, neurodegeneration, infarction, cortical perfusion, and development of delayed deficits. Finally, the effect of 12/15-LOX inhibition on platelet activation was assessed in SAH patient samples using a platelet spreading assay. In SAH mice, 12/15-LOX was upregulated in brain vascular cells, and there was an increase in 12-S-HETE. Inhibition of 12/15-LOX improved brain perfusion on days 4-5 and attenuated delayed pathophysiological events, including microvessel constrictions, microthrombi, neuronal degeneration, and infarction. Additionally, 12/15-LOX inhibition reduced platelet activation in human and mouse blood samples. Cerebrovascular 12/15-LOX overexpression plays a major role in brain dysfunction after SAH by triggering microvessel constrictions and microthrombi formation, which reduces brain perfusion. Inhibiting 12/15-LOX may be a therapeutic target to improve outcomes after SAH.

BATF is a major driver of NK cell epigenetic reprogramming and dysfunction in AML.

Myelodysplastic syndrome and acute myeloid leukemia (AML) belong to a continuous disease spectrum of myeloid malignancies with poor prognosis in the relapsed/refractory setting necessitating novel therapies. Natural killer (NK) cells from patients with myeloid malignancies display global dysfunction with impaired killing capacity, altered metabolism, and an exhausted phenotype at the single-cell transcriptomic and proteomic levels. In this study, we identified that this dysfunction was mediated through a cross-talk between NK cells and myeloid blasts necessitating cell-cell contact. NK cell dysfunction could be prevented by targeting the αvß-integrin/TGF-ß/SMAD pathway but, once established, was persistent because of profound epigenetic reprogramming. We identified BATF as a core transcription factor and the main mediator of this NK cell dysfunction in AML. Mechanistically, we found that BATF was directly regulated and induced by SMAD2/3 and, in turn, bound to key genes related to NK cell exhaustion, such as HAVCR2, LAG3, TIGIT, and CTLA4. BATF deletion enhanced NK cell function against AML in vitro and in vivo. Collectively, our findings reveal a previously unidentified mechanism of NK immune evasion in AML manifested by epigenetic rewiring and inactivation of NK cells by myeloid blasts. This work highlights the importance of using healthy allogeneic NK cells as an adoptive cell therapy to treat patients with myeloid malignancies combined with strategies aimed at preventing the dysfunction by targeting the TGF-ß pathway or BATF.

Circulating miRNA-373 and Vascular Endothelial Growth Factor as Potential Biomarkers for Early Detection of Breast Cancer.

Breast cancer is the leading cause of cancer-related mortality among women worldwide. MicroRNAs (miRNAs), short non-coding RNAs, have been implicated in cancer-related processes such as tumor development, metastasis, angiogenesis, and drug resistance. Circulating miRNA-373 demonstrates higher relative exosomal serum levels in breast cancer patients compared to healthy women, making it a potential non-invasive biomarker. Separately, vascular endothelial growth factor (VEGF) is crucial for angiogenesis, and is elevated in breast cancer. In this case-control study, we aimed to investigate the diagnostic accuracy of miRNA-373 and VEGF as biomarkers for early-stage breast cancer detection. Serum samples were collected from 120 participants, comprising 30 breast cancer patients, 30 benign breast tumor patients, and 60 healthy controls, over the period of April 2022 to January 2023. MiRNA-373 expression was analyzed by reverse transcription-quantitative PCR with GAPDH normalisation, while VEGF levels in serum samples were measured by ELISA. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the diagnostic performance of both biomarkers. MiRNA-373 expression (∆Ct) differed significantly between the three groups (breast cancer: - 12.20 ± 1.11; benign tumors: - 12.79 ± 1.09; controls: - 13.64 ± 0.93). ROC analysis revealed moderate discriminative power for miRNA-373 (specificity = 76.7%; sensitivity = 70.0%; AUC = 0.839) and excellent discriminative power for VEGF (specificity = 85.0%; sensitivity = 90.0%; AUC = 0.944) in distinguishing early-stage breast cancer patients from healthy controls. In summary, this study demonstrates the promising potential of miRNA-373 as an early diagnostic biomarker for breast cancer detection, requiring further validation in larger cohorts. Our findings also reinforce the diagnostic value of circulating VEGF levels for breast cancer screening. Supplementary Information: The online version contains supplementary material available at 10.1007/s12291-023-01174-9.

Harlequin sign due to an upper thoracic paravertebral lesion. A systematic review of the literature.

INTRODUCTION: Harlequin syndrome (HS) is an uncommon condition affecting the sympathetic nervous system, characterized by asymmetrical flushing and sweating impairment, which can affect the face or half of the body. When the dysfunction results from external factors like damage or compression, it's referred to as Harlequin Sign. Our objective was to document an exceedingly rare presentation of Harlequin Sign caused by a T3-T4 paravertebral mass and conduct the first systematic literature review on this subject. METHODS: We conducted a systematic review of English-language studies using PubMed, Scopus, and Embase databases. We excluded abstracts, posters, congenital and idiopathic Harlequin Syndrome cases, as well as iatrogenic and secondary Harlequin Sign cases related to pathologies other than upper thoracic lesions. RESULTS: We employed the PRISMA protocol and reviewed 1,538 papers, identifying 8 single case reports describing the Harlequin sign resulting from upper thoracic paravertebral lesions. The mean age of the patients was 41.25 years, with 6 (75 %) being female. The average time from onset to presentation was 8 months, and all patients (100 %) exhibited hemifacial flushing, while 4 (50 %) also had hemifacial anhidrosis. Stress or exercise exacerbated these symptoms in 50 % of cases. Additionally, 3 patients (37.5 %) presented with associated Horner Syndrome. The most commonly used diagnostic tool was a CT scan (50 %), revealing an average tumor diameter of 3.95 cm, with 50 % of cases located at T2-T3. Diagnosis indicated 57 % of cases as schwannomas and 29 % as lung adenocarcinoma (Superior Sulcus). Unfortunately, surgical treatment resolved symptoms in only 25 % of patients. CONCLUSIONS: Hemifacial or hemibody autonomic symptoms should raise concern for paraspinal lesions in the thoracic spine. In addition to the first comprehensive review on this topic, we present a rare case of a T3/4 paraspinal schwannoma causing Harlequin Syndrome successfully managed with neurosurgical intervention.

Vitamin D receptor gene rs2228570 (FOKI) polymorphism associated with essential hypertension in Iraqi patients.

OBJECTIVE: Aim: To understand how vitamin D receptor gene polymorphism (VDR rs2228570) affects blood pressure in Iraqi patients with essential hypertension in Al Diwaniya province. PATIENTS AND METHODS: Materials and Methods: This is a single-center observational cross-sectional descriptive study of 90 patients with essential hypertension. Using the PCRTETRA ARM technique, blood samples were genotyped and examined for the polymorphisms of FOKI (rs2228570) gene. RESULTS: Results: The most frequent allele was A (121, 67%) while the most frequent genotype was AG (55, 61%). There was no statistical difference between the actual and expected frequency distribution, according to Hardy-Weinberg equilibrium. The effect of VDR polymorphism rs 2228570 on blood pressure indicates (the mean systolic blood pressure in AA, AG, and GG carrier patients was 149, 150 and 166 respectively, P=0.29. On the other hand, the mean diastolic blood pressure in AA, AG, and GG carrier patients was 89, 89, and 94 respectively P=0.6) there was no statistically significant effect on systolic and diastolic blood pressure. CONCLUSION: Conclusions: there is no statistically significant effect of VDR rs2228570 on SBP and DBP (p = 0.6), vitamin D receptor gene polymorphism rs2228570 was related to vitamin D level.

Association between rs1799983 polymorphism of eNOS gene and essential hypertension in Iraqi hypertensive patients.

OBJECTIVE: Aim: To investigate allele frequencies of rs1799983 polymorphism eNOS genes and to determine association between rs1799983 polymorphism of eNOS gene and essential hypertension in Iraqi hypertensive patients. PATIENTS AND METHODS: Materials and Methods: This is an observational cross sectional descriptive single center study. ninety hypertensive patients were recruited by specialist cardiologist and conducted at AL-Diwaniyah teaching hospital and department of pharmacology and therapeutics, college of medicine, university of Al-Qadisiyah, Iraq. DNA samples were genotyped by PCR-tetra-arm method. NO level was measured by using ELISA kit. RESULTS: Results: Regarding rs1799983 the most frequent allele was G (73%) and the most frequent genotype was GG (55%). Our results indicate lack of substantial link between genotype frequencies of rs1799983 polymorphism and NO level (p=0.88) and thereby there is no statistically significant effect on SBP and DBP (p = 0.051). CONCLUSION: Conclusions: our study demonstrated lack of significant association between this polymorphism and essential hypertension in Iraqi hypertensive patients.

Outcome of Primary Hyperparathyroidism: Retrospective Tertiary Center Experience From Basrah, Iraq.

BACKGROUND: Primary hyperparathyroidism is regarded as a common endocrine disorder that is biochemically identified and could be symptomatic or asymptomatic. A detailed history and a thorough evaluation with regular follow-ups are required until a definite diagnosis is made. The study aims to evaluate the characteristics of patients and the performance of a tertiary endocrine center in managing the disease in Basrah, Iraq. MATERIAL AND METHODS: A retrospective study was conducted at the Faiha Specialized Diabetes, Endocrine, and Metabolism Center in Basrah, southern Iraq, on 106 patients diagnosed with primary hyperparathyroidism between 2012 and 2023. The patients' general characteristics were assessed, and those who underwent parathyroidectomy were evaluated post-surgery, and the cure rate was determined. RESULTS: The mean age of presentation was 47.5 ± 14.6 years, with a median of 50 years. The highest occurrence is in the sixth decade. Females comprised 79 (75%) of the patients, and the female-to-male ratio was 3:1. Symptomatic patients were 84 (90%), 30 (70%) of the patients had nephrolithiasis, and 52 (68%) had osteoporosis. The cure rate was 15 (83%). CONCLUSION: In our single-center study, the frequency of primary hyperparathyroidism has increased with time. The disease's highest occurrence was seen in the sixth decade. Females were substantially higher than males. Most patients were symptomatic. The cure rate was 83%.

Investigating the impact of shear and bulk viscosity on the damping of confined acoustic modes in phononic crystal sensors.

Phononic crystal (PnC) sensors are recognized for their capability to control acoustic wave propagation through periodic structures, presenting considerable potential across various applications. Despite advancements, the effects of fluid viscosity on PnC performance remain intricate and inadequately understood. This study theoretically investigates the influence of shear (dynamic) and bulk viscosity on acoustic wave damping in defective one-dimensional phononic crystal (1D PnC) sensors designed for detecting liquid analytes. Acetic acid with varying viscosities is considered to fill a cavity layer intermediated by a multilayer stack of lead and epoxy. The effects of dynamic and bulk viscosity on the resonance characteristics of the defective mode were analyzed. Numerical results reveal that increased dynamic viscosity leads to substantial broadening and decreased intensity of resonance peaks, accompanied by a shift to higher frequencies due to enhanced elastic wave attenuation and damping. At low dynamic viscosity (η = 0.2 ηd), numerous resonance peaks with varying intensities are observed. However, at higher viscosities (η = 2.0 ηd to η = 10.0 ηd), only one prominent peak appears in the spectrum. The intensity of this resonant peak starts at 98% for η = 2 ηd and decreases to 58.8% as the dynamic viscosity increases to η = 10 ηd. Additionally, the combined effect of dynamic and bulk viscosity introduces further damping, causing a strong shift of the resonance peak to higher frequencies, along with an increase in the full width at half maximum (FWHM) and a decrease in the quality factor (QF). These findings emphasize the necessity of incorporating both shear and bulk viscosity in the design of PnC sensors to enhance their sensitivity and accuracy in practical applications. This theoretical framework provides critical insights for optimizing sensor performance and bridging gaps between theoretical predictions and experimental observations, especially in 1D PnCs, offering potential solutions to challenges in real-world PnC sensor applications.

Menin inhibitors in pediatric acute leukemia: a comprehensive review and recommendations to accelerate progress in collaboration with adult leukemia and the international community.

Aberrant expression of HOX and MEIS1 family genes, as seen in KMT2A-rearranged, NUP98-rearranged, or NPM1-mutated leukemias leads to arrested differentiation and leukemia development. HOX family genes are essential gatekeepers of physiologic hematopoiesis, and their expression is regulated by the interaction between KMT2A and menin. Menin inhibitors block this interaction, downregulate the abnormal expression of MEIS1 and other transcription factors and thereby release the differentiation block. Menin inhibitors show significant clinical efficacy against KMT2A-rearranged and NPM1-mutated acute leukemias, with promising potential to address unmet needs in various pediatric leukemia subtypes. In this collaborative initiative, pediatric and adult hematologists/oncologists, and stem cell transplant physicians have united their expertise to explore the potential of menin inhibitors in pediatric leukemia treatment internationally. Our efforts aim to provide a comprehensive clinical overview of menin inhibitors, integrating preclinical evidence and insights from ongoing global clinical trials. Additionally, we propose future international, inclusive, and efficient clinical trial designs, integrating pediatric populations in adult trials, to ensure broad access to this promising therapy for all children and adolescents with menin-dependent leukemias.

Nontuberculosis mycobacteria (NTM) infections in patients with leukemia: a single center case series.

Patients with leukemia experience profound immunosuppression both from their underlying disease as well as chemotherapeutic treatment. Little is known about the prevalence and clinical presentation of nontuberculous mycobacteria (NTM) in this patient population. We identified six cases of NTM infection from 29,743 leukemia patients who had acid-fast bacilli (AFB) cultures. Four cases had bloodstream infections and five had disseminated disease, including one who presented with an unusual case of diffuse cellulitis/myositis. All patients were lymphopenic at time of diagnosis, and two patients ultimately died from their NTM infection. NTM infections are a rare, but potentially life-threatening infection in patients with leukemia. Sending AFB cultures early is important to direct appropriate antimicrobial therapy and allow for future leukemia-directed therapy.

Improved performance of temperature sensors based on the one-dimensional topological photonic crystals comprising hyperbolic metamaterials.

This paper seeks to progress the field of topological photonic crystals (TPC) as a promising tool in face of construction flaws. In particular, the structure can be used as a novel temperature sensor. In this regard, the considered TPC structure comprising two different PC designs named PC1 and PC2. PC1 is designed from a stack of multilayers containing Silicon (Si) and Silicon dioxide (SiO2), while layers of SiO2 and composite layer named hyperbolic metamaterial (HMM) are considered in designing PC2. The HMM layer is engineered using subwavelength layers of Si and Bismuth Germinate, or BGO ( Bi 4 Ge 3 O 12 ). The mainstay of our suggested temperature sensor is mainly based on the emergence of some resonant modes inside the transmittance spectrum that provide the stability in the presence of the geometrical changes. Meanwhile, our theoretical framework has been introduced in the vicinity of transfer matrix method (TMM), effective medium theory (EMT) and the thermo-optic characteristics of the considered materials. The numerical findings have extensively introduced the role of some topological parameters such as layers' thicknesses, filling ratio through HMM layers and the periodicity of HMM on the stability or the topological features of the introduced sensor. Meanwhile, the numerical results reveal that the considered design provides some topological edge states (TESs) of a promising robustness and stability against certain disturbances or geometrical changes in the constituent materials. In addition, our sensing tool offers a relatively high sensitivity of 0.27 nm/°C.

Impact of p53-associated acute myeloid leukemia hallmarks on metabolism and the immune environment.

Acute myeloid leukemia (AML), an aggressive malignancy of hematopoietic stem cells, is characterized by the blockade of cell differentiation, uncontrolled proliferation, and cell expansion that impairs healthy hematopoiesis and results in pancytopenia and susceptibility to infections. Several genetic and chromosomal aberrations play a role in AML and influence patient outcomes. TP53 is a key tumor suppressor gene involved in a variety of cell features, such as cell-cycle regulation, genome stability, proliferation, differentiation, stem-cell homeostasis, apoptosis, metabolism, senescence, and the repair of DNA damage in response to cellular stress. In AML, TP53 alterations occur in 5%-12% of de novo AML cases. These mutations form an important molecular subgroup, and patients with these mutations have the worst prognosis and shortest overall survival among patients with AML, even when treated with aggressive chemotherapy and allogeneic stem cell transplant. The frequency of TP53-mutations increases in relapsed and recurrent AML and is associated with chemoresistance. Progress in AML genetics and biology has brought the novel therapies, however, the clinical benefit of these agents for patients whose disease is driven by TP53 mutations remains largely unexplored. This review focuses on the molecular characteristics of TP53-mutated disease; the impact of TP53 on selected hallmarks of leukemia, particularly metabolic rewiring and immune evasion, the clinical importance of TP53 mutations; and the current progress in the development of preclinical and clinical therapeutic strategies to treat TP53-mutated disease.

Chemotaxonomy compared to morphological and anatomical taxonomy of five Hibiscus species.

Hibiscus is a charismatic genus of the Malvaceae family that is noted for its diversity, lacking identifiable characteristics for distinguishing its various species. Therefore, there is an urgent need to develop authentication methods for genus delimitation and species delineation. The present study aims to discern the taxonomic relationships between the well-known, globally familiar, and economically important five Hibiscus species, namely: H. × rosa-sinensis, H. sabdariffa, H. schizopetalus, H. syriacus and H. tiliaceus based on traditional morphological and anatomical characteristics compared to the contemporary chemotaxonomy. In this context, the leaf-based methanolic extracts of the studied species were analyzed by Gas Chromatography-Mass Spectrometer (GC-MS) to estimate their secondary metabolites similarity. In addition, selected qualitative morphological and anatomical traits including leaf venation patterns, epidermal micromorphology, stomata types and trichomes diversity, petiole serial sectioning (outline, adaxial groove features, vasculature traces arrangement), and midrib characteristics of the studied species were investigated. The results of both chemotaxonomy and traditional taxonomy exhibited a remarkable agreement in the delineation of the five studied species. Specifically, the chemotaxonomy-based dendrogram separates the studied species into two main clusters with the H. sabdariffa as an outlier species in a single cluster and the remaining four species as another cluster with variant distances in its similarity indices. Similarly, the traditional morphological and anatomical characteristics revealed distinct traits for H. sabdariffa compared to the remaining four species. The findings of this study highlight the significance of integrating the structural features with phytochemicals profiling as a potential approach that could be harnessed for the delineation of the taxonomically challenging Hibiscus genus.

Ultra-sensitive optimized one-dimensional phononic crystal as a fluidic sensor to enhance the measurement of acetic acid concentration.

The current investigation theoretically presents a one-dimensional phononic crystal (PnC) as a fluidic sensor. The sensor under consideration aims to distinguish the concentration of acetic acid. The primary configuration of the proposed sensor is constructed with lead, epoxy, and a defect layer in the middle of the structure, that is filled with acetic acid (vinegar). As a result of the rise in density and decline in the speed of sound at a 100% concentration of acetic acid in comparison to pure water, the peak frequency of the output has shifted towards lower frequencies. Given that the maximum permissible concentration of acetic acid in water for vinegar is above 30%, sensor simulations were conducted within the concentration range of 25-35% with a step size of 1%. Interestingly, the sensitivity of the sensor exhibits a polynomial change in response to the concentration of acetic acid. Consequently, the highest level of sensitivity, which corresponds to the lowest concentration of vinegar, is recorded as 48.44 × 106 (Hz). The proposed system exhibits a remarkable value of the quality factor of 2802.91. Furthermore, the optimal figure of merit (FOM) is achieved when the concentration is at its lowest, with a value of 94.00. Furthermore, the temperature effects are taken into account for a wide range between 10 and 60 °C. A pronouncing sensitivity is obtained for all temperatures changes and the highest one reached the value of 1.57 × 106 (Hz/°C) at a temperature of 25 °C. Considering the present circumstances, the suggested sensor configuration has the potential to cater to a diverse array of other fluids, specifically their concentration and temperature, thereby offering a broad scope of applications.

Associations of the PPARα and Lipoprotein Lipase Enzyme Gene Polymorphisms with Dyslipidemia in Obese and Non-obese Males.

Background: Peroxisome proliferator-activated receptor α (PPARα) is a nuclear transcription factor responsible for gene expression, particularly those associated with lipid metabolism. The lipoprotein lipase enzyme (LPL) is considered a key enzyme in lipid metabolism and transport. The link between dyslipidemia and obesity is well understood. Dyslipidemia is also an established risk feature for cardiovascular disease. Thus, it becomes progressively essential to identify the role of genetic factors as risk markers for the development of dyslipidemia among obese males. Methods: A case-control study was performed including 469 males. Anthropometric characteristics and serum lipid profiles such as triglycerides (TG), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C) were evaluated. Genomic DNA extraction and purification were performed using whole blood samples. Restriction enzyme fragment length polymorphism was used to genotype PPARα and LPL single nucleotide polymorphisms. The associations between these polymorphisms and dyslipidemia were examined. Results: The CC and CG genotypes of PPARα gene polymorphisms were significantly associated with higher TC and LDL-C levels (P<0.05). The TT genotype of the LPL gene polymorphism was significantly associated with higher TG levels and lower HDL-C levels (P<0.05). In contrast, the GG genotype may have a protective action against dyslipidemia. Conclusion: The study reaches the interesting conclusion that there was a significant association between PPARα as well as LPL gene polymorphisms and dyslipidemia among obese and non-obese males.

12/15-Lipooxygenase Inhibition Reduces Microvessel Constriction and Microthrombi after Subarachnoid Hemorrhage in Mice.

Background and Purpose: Impaired cerebral circulation, induced by blood vessel constrictions and microthrombi, leads to delayed cerebral ischemia after subarachnoid hemorrhage (SAH). 12/15-Lipooxygenase (12/15-LOX) overexpression has been implicated in worsening early brain injury outcomes following SAH. However, it is unknown if 12/15-LOX is important in delayed pathophysiological events after SAH. Since 12/15-LOX produces metabolites that induce inflammation and vasoconstriction, we hypothesized that 12/15-LOX leads to microvessel constriction and microthrombi formation after SAH, and thus 12/15-LOX is an important target to prevent delayed cerebral ischemia. Methods: SAH was induced in C57BL/6 and 12/15-LOX-/- mice of both sexes by endovascular perforation. Expression of 12/15-LOX was assessed in brain tissue slices and in vitro. C57BL/6 mice were administered either ML351 (12/15-LOX inhibitor) or vehicle. Mice were evaluated for daily neuroscore and euthanized on day five to assess cerebral 12/15-LOX expression, vessel constrictions, platelet activation, microthrombi, neurodegeneration, infarction, cortical perfusion, and for development of delayed deficits. Finally, the effect of 12/15-LOX inhibition on platelet activation was assessed in SAH patient samples using a platelet spreading assay. Results: In SAH mice, 12/15-LOX was upregulated in brain vascular cells and there was an increase in 12-S-HETE. Inhibition of 12/15-LOX improved brain perfusion on days 4-5 and attenuated delayed pathophysiological events, including microvessel constrictions, microthrombi, neuronal degeneration, and infarction. Additionally, 12/15-LOX inhibition reduced platelet activation in human and mouse blood samples. Conclusions: Cerebrovascular 12/15-LOX overexpression plays a major role in brain dysfunction after SAH by triggering microvessel constrictions and microthrombi formation, which reduces brain perfusion. Inhibiting 12/15-LOX may be a therapeutic target to improve outcomes after SAH.

Outcomes of Patients With Newly Diagnosed AML and Hyperleukocytosis.

PURPOSE: AML presenting with hyperleukocytosis is associated with poor outcomes. We aim to understand the factors associated with early mortality and overall survival (OS) to help guide management and improve early mortality. METHODS: We retrospectively reviewed data from 129 consecutive patients with newly diagnosed AML and a WBC count ≥100 × 109/L between January 2010 and April 2020. Logistic regression models estimated odds ratios for 4-week mortality. Cox proportional hazard models estimated hazard ratios for OS. RESULTS: The median age was 65 years (range, 23-86); the median WBC was 146 × 109/L (range, 100-687). Seventy-five (58%) patients had clinical leukostasis (CL). FLT3, NPM1, and RAS pathway mutations were detected in 63%, 45%, and 27% of patients, respectively. Cytoreduction consisted of hydroxyurea in 124 (96%) patients, cytarabine in 69 (54%), and leukapheresis in 31 (24%). The cumulative 4-week and 8-week mortality rates were 9% and 13%, respectively, all in patients age 65 years and older. By multivariate analysis, older age, CL, and thrombocytopenia <40 × 109/L were independently associated with a higher 4-week mortality rate. After a median follow-up of 49.4 months, the median OS was 14.3 months (95% CI, 7 to 21.6), with 4-year OS of 29%. Age 65 years and older, CL, tumor lysis syndrome, elevated LDH ≥2,000 U/L, elevated lactate ≥2.2 mmol/L, and poor-risk cytogenetics were independent factors associated with worse OS. CONCLUSION: Hyperleukocytosis is a life-threatening hematologic emergency. Early recognition and intervention including cytoreduction, blood product support, antibiotics, and renal replacement therapy may help mitigate the risk of morbidity and early mortality.