Amundsen Sea circulation controls bottom upwelling and Antarctic Pine Island and Thwaites ice shelf melting.

The Pine Island and Thwaites Ice Shelves (PIIS/TIS) in the Amundsen Sea are melting rapidly and impacting global sea levels. The thermocline depth (TD) variability, the interface between cold Winter Water and warm modified Circumpolar Deep Water (mCDW), at the PIIS/TIS front strongly correlates with basal melt rates, but the drivers of its interannual variability remain uncertain. Here, using an ocean model, we propose that the strength of the eastern Amundsen Sea on-shelf circulation primarily controls TD variability and consequent PIIS/TIS melt rates. The TD variability occurs because the on-shelf circulation meanders following the submarine glacial trough, creating vertical velocity through bottom Ekman dynamics. We suggest that a strong or weak ocean circulation, possibly linked to remote winds in the Bellingshausen Sea, generates corresponding changes in bottom Ekman convergence, which modulates mCDW upwelling and TD variability. We show that interannual variability of off-shelf zonal winds has a minor effect on ocean heat intrusion into PIIS/TIS cavities, contrary to the widely accepted concept.

Multi-omics analysis of pigmentation related to proanthocyanidin biosynthesis in brown cotton (Gossypium hirsutum L.).

Naturally-colored brown cotton (NBC) fiber is an environmentally friendly raw source of fiber for textile applications. The fiber of some NBC cultivars exhibits flame-retardant properties, which can be used in textiles that require flame resistance. Proanthocyanidins or their derivatives are responsible for the brown pigment in NBC; however, how flame retardancy is related to pigmentation in NBC is poorly understood. To gain insight into brown pigment biosynthesis, we conducted comparative transcripts and metabolites profiling analysis of developing cotton fibers between the brown (MC-BL) and white (MC-WL) cotton near-isogenic lines (NILs), genetically different only in the Lc1 locus. In this study, mass spectrometry was used to detect metabolites in BL and WL developing fibers at 8, 12, 16, 20, 24, 36, and 40 days post anthesis (DPA) and mature fibers. Transcripts analysis was performed at two critical fiber developmental points, 8 DPA (fiber elongation) and 20 DPA (secondary cell wall deposition). We found 5836 (ESI MS positive mode) and 4541 (ESI MS negative mode) metabolites significantly different accumulated between BL and WL. Among them, 142 were known non-redundant metabolites, including organic acids, amino acids, and derivatives of the phenylpropanoid pathway. Transcript analysis determined 1691 (8 DPA) and 5073 (20 DPA) differentially expressed genes (DEGs) between BL and WL, with the majority of DEGs down-regulated at 20 DPA. Organic acids of the citric acid cycle were induced, while most of the detected amino acids were reduced in the MC-BL line. Both cis- and trans-stereoisomers of flavan-3-ols were detected in developing MC-WL and MC-BL fibers; however, the gallocatechin and catechin accumulated multiple times higher. Gas chromatography-mass spectrometry (GC-MS) analysis of fatty acids determined that palmitic acid long-chain alcohols were the main constituents of waxes of mature fibers. Energy-dispersive X-ray spectrometry (EDS) analysis of mature fibers revealed that potassium accumulated three times greater in MC-BL than in MC-WL mature fibers. This study provides novel insights into the biosynthesis of pigments and its association with flame retardancy in NBC fibers.

Soil Biodegradation Resistance of Cotton Fiber Doped with Interior and Exterior Silver Nanoparticles.

Engineering fibers with nanomaterials is an effective way to modify their properties and responses to external stimuli. In this study, we doped cotton fibers with silver nanoparticles, both on the surface (126 ± 17 nm) and throughout the fiber cross section (18 ± 4 nm), and examined the resistance to soil biodegradation. A reagent-free one-pot treatment of a raw cotton fabric, where noncellulosic constituents of the raw cotton fiber and starch sizing served as reducing agents, produced silver nanoparticles with a total concentration of 11 g/kg. In a soil burial study spanning 16 weeks, untreated cotton underwent a sequential degradation process-fibrillation, fractionation, and merging-corresponding to the length of the soil burial period, whereas treated cotton did not exhibit significant degradation. The remarkable biodegradation resistance of the treated cotton was attributed to the antimicrobial properties of silver nanoparticles, as demonstrated through a test involving the soil-borne fungus Aspergillus flavus. The nonlinear loss behavior of silver from the treated cotton suggests that nanoparticle depletion in the soil depends on their location, with interior nanoparticles proving durable against environmental exposure.

Assessment of Cellulose Nanofiber-Based Elastase Biosensors to Inflammatory Disease as a Function of Spacer Length and Fluorescence Response.

Inflammatory disease biomarker detection has become a high priority in point-of-care diagnostic research in relation to chronic wounds, with a variety of sensor-based designs becoming available. Herein, two primary aspects of biosensor design are examined: (1) assessment of a cellulose nanofiber (CNF) matrix derived from cotton ginning byproducts as a sensor transducer surface; and (2) assessment of the relation of spacer length and morphology between the CNF cellulose backbone and peptide fluorophore as a function of sensor activity for porcine pancreatic and human neutrophil elastases. X-ray crystallography, specific surface area, and pore size analyses confirmed the suitability of CNF as a matrix for wound care diagnostics. Based upon the normalized degree of substitution, a pegylated-linker connecting CNF transducer substrate to peptide fluorophore showed the greatest fluorescence response, compared to short- and long-chain alkylated linkers.

Preparation and Activity of Hemostatic and Antibacterial Dressings with Greige Cotton/Zeolite Formularies Having Silver and Ascorbic Acid Finishes.

The need for prehospital hemostatic dressings that exert an antibacterial effect is of interest for prolonged field care. Here, we consider a series of antibacterial and zeolite formulary treatment approaches applied to a cotton-based dressing. The design of the fabric formulations was based on the hemostatic dressing TACGauze with zeolite Y incorporated as a procoagulant with calcium and pectin to facilitate fiber adherence utilizing silver nanoparticles, and cellulose-crosslinked ascorbic acid to confer antibacterial activity. Infra-red spectra were employed to characterize the chemical modifications on the dressings. Contact angle measurements were employed to document the surface hydrophobicity of the cotton fabric which plays a role in the contact activation of the coagulation cascade. Ammonium Y zeolite-treated dressings initiated fibrin equal to the accepted standard hemorrhage control dressing and showed similar improvement with antibacterial finishes. The antibacterial activity of cotton-based technology utilizing both citrate-linked ascorbate-cellulose conjugate analogs and silver nanoparticle-embedded cotton fibers was observed against Staphylococcus aureus and Klebsiella pneumoniae at a level of 99.99 percent in the AATCC 100 assay. The hydrogen peroxide levels of the ascorbic acid-based fabrics, measured over a time period from zero up to forty-eight hours, were in line with the antibacterial activities.

The Effects of Oil Content on the Structural and Textural Properties of Cottonseed Butter/Spread Products.

Plant-based butters from nuts and seeds have steadily increased in consumer popularity due to their unique flavors and healthy nutritional properties. Oil content is a critical parameter to measure the proper consistency and stability of plant butter and spread products. Previous work has shown that glandless cottonseed can be used to formulate cottonseed butter products to increase the values of cottonseed. As part of the efforts made in the valorization of cottonseed, this work evaluated the effects of oil content on the microstructural and textural properties of cottonseed butter/spread products. While the oil content in the raw cottonseed kernels was 35% of the kernel biomass, additional cottonseed oil was added to make cottonseed butter products with six oil content levels (i.e., 36, 43, 47, 50, 53, and 57%). The values of three textural parameters, firmness, spreadability, and adhesiveness, decreased rapidly in an exponential mode with the increasing oil content. The particle size population in these butter samples was characterized by similar trimodal distribution, with the majority in the middle mode region with particle sizes around 4.5-10 µm. Higher oil content decreased the butter particle size slightly but increased oil separation during storage. The oxidation stability with a rapid oxygen measurement was gradually reduced from 250 min with 36% oil to 65 min with 57% oil. The results of this work provide information for the further optimization of formulation parameters of cottonseed butter products.

Unveiling the Hidden Value of Cotton Gin Waste: Natural Synthesis and Hosting of Silver Nanoparticles.

Cotton gin waste presents a significant challenge in the cotton ginning industry due to its abundant generation and limited disposal options. In this study, we explored the potential of cotton gin waste as a naturally occurring source material that can synthesize and host silver nanoparticles. The noncellulosic constituents of cotton gin waste served as effective reducing agents, facilitating the conversion of silver ions into silver atoms, while its porous structure acted as a microreactor, enabling controlled particle growth. A simple heat treatment of cotton gin waste powder in an aqueous silver precursor solution actualized the in situ synthesis of silver nanoparticles, without the need for additional chemical agents. Remarkably, a high concentration of silver nanoparticles (14.7%) with an average diameter of approximately 27 nm was produced throughout the entire volume of cotton gin waste. Electron microscopic images of cross-sectioned cotton gin waste confirm the internal formation of nanoparticles. Rietveld refinement analysis of X-ray diffraction patterns showed that the majority of the nanoparticles possess a cubic silver crystal structure. By leveraging the well-known biocidal properties of silver nanoparticles, the resulting silver nanoparticle-filled cotton gin waste holds promise for novel antimicrobial and antifungal material applications.

Development of an Electrophoretic Deposition Method for the In Situ Fabrication of Ultra-Thin Composite-Polymer Electrolytes for Solid-State Lithium-Metal Batteries.

All-solid-state lithium-metal batteries offer higher energy density and safety than lithium-ion batteries, but their practical applications have been pushed back by the sluggish Li+ transport, unstable electrolyte/electrode interface, and/or difficult processing of their solid-state electrolytes. Li+ -conducting composite polymer electrolytes (CPEs) consisting of sub-micron particles of an oxide solid-state electrolyte (OSSE) dispersed in a solid, flexible polymer electrolyte (SPE) have shown promises to alleviate the low Li+ conductivity of SPE, and the high rigidity and large interfacial impedance of OSSEs. Solution casting has been by far the most widely used procedure for the preparation of CPEs in research laboratories; however, this method imposes several drawbacks including particle aggregation and settlement during a long-term solvent evaporation step, excessive use of organic solvents, slow production time, and mechanical issues associated with handling of ultra-thin films of CPEs (<50 µm). To address these challenges, an electrophoretic deposition (EPD) method is developed to in situ deposit ultra-thin CPEs on lithium-iron-phosphate (LFP) cathodes within just a few minutes. EPD-prepared CPEs have shown better electrochemical performance in the lithium-metal battery than those CPEs prepared by solution casting due to a better dispersion of OSSE within the SPE matrix and improved CPE contact with LFP cathodes.

Validation of resonance Raman spectroscopy-measured skin carotenoid status as a biomarker for fruit and vegetable intake in Korean adults.

Blood carotenoid concentration measurement is considered the gold standard for fruit and vegetable (F&V) intake estimation; however, this method is invasive and expensive. Recently, skin carotenoid status (SCS) measured by optical sensors has been evaluated as a promising parameter for F&V intake estimation. In this cross-sectional study, we aimed to validate the utility of resonance Raman spectroscopy (RRS)-assessed SCS as a biomarker of F&V intake in Korean adults. We used data from 108 participants aged 20-69 years who completed SCS measurements, blood collection and 3-d dietary recordings. Serum carotenoid concentrations were quantified using HPLC, and dietary carotenoid and F&V intakes were estimated via 3-d dietary records using a carotenoid database for common Korean foods. The correlations of the SCS with serum carotenoid concentrations, dietary carotenoid intake and F&V intake were examined to assess SCS validity. SCS was positively correlated with total serum carotenoid concentration (r = 0·52, 95 % CI = 0·36, 0·64, P < 0·001), serum ß-carotene concentration (r = 0·60, 95 % CI = 0·47, 0·71, P < 0·001), total carotenoid intake (r = 0·20, 95 % CI = 0·01, 0·37, P = 0·04), ß-carotene intake (r = 0·30, 95 % CI = 0·11, 0·46, P = 0·002) and F&V intake (r = 0·40, 95 % CI = 0·23, 0·55, P < 0·001). These results suggest that SCS can be a valid biomarker of F&V intake in Korean adults.

Characterization of the Nonpolar and Polar Extractable Components of Glanded Cottonseed for Its Valorization.

Cottonseed is the second major product of cotton (Gossypium spp.) crops after fiber. Thus, the characterization and valorization of cottonseed are important parts of cotton utilization research. In this work, the nonpolar and polar fractions of glanded (Gd) cottonseed were sequentially extracted by 100% hexane and 80% ethanol aqueous solutions and subjected to 13C and 1H nuclear magnetic resonance (NMR) spectroscopy and Fourier-transform ion cyclotron resonance mass spectrometry (FT-ICR MS), respectively. The nonpolar (crude oil) extracts showed the characteristic NMR peak features of edible plant oils with the absence of ω-3 linolenic acid. Quantitative analysis revealed the percentage of polyunsaturated, monounsaturated, and saturated fatty acids as 48.7%, 16.9%, and 34.4%, respectively. Both general unsaturated fatty acid features and some specific olefinic compounds (e.g., oleic, linolenic, and gondonic acids) were found in the nonpolar fraction. In the polar extracts, FT-ICR MS detected 1673 formulas, with approximately 1/3 being potential phenolic compounds. Both the total and phenolic formulas fell mainly in the categories of lipid, peptide-like, carbohydrate, and lignin. A literature search and comparison further identifies some of these formulas as potential bioactive compounds. For example, one compound [2,5-dihydroxy-N'-(2,3,4-trihydroxybenzylidene) benzohydrazide] identified in the polar extracts is likely responsible for the anticancer function observed when used on human breast cancer cell lines. The chemical profile of the polar extracts provides a formulary for the exploration of bioactive component candidates derived from cottonseed for nutritive, health, and medical applications.

A Transparent Poly(vinyl alcohol) Ion-Conducting Organohydrogel for Skin-Based Strain-Sensing Applications.

The increasing demand for cost-efficient and user-friendly wearable electronic devices has led to the development of stretchable electronics that are both cost-effective and capable of maintaining sustained adhesion and electrical performance under duress. This study reports on a novel physically crosslinked poly(vinyl alcohol) (PVA)-based hydrogel that serves as a transparent, strain-sensing skin adhesive for motion monitoring. By incorporating Zn2+ into the ice-templated PVA gel, a densified amorphous structure is observed through optical and scanning electron microscopy, and it is found that the material can stretch up to 800% strain according to tensile tests. Fabrication in a binary glycerol:water solvent results in electrical resistance in the kΩ range, a gauge factor of 0.84, and ionic conductivity on the scale of 10-4 S cm-1 , making it a potentially low-cost candidate for a stretchable electronic material. This study characterizes the relationship between improved electrical performance and polymer-polymer interactions through spectroscopic techniques, which play a role in the transport of ionic species through the material.

Oxidative Stability of Cottonseed Butter Products under Accelerated Storage Conditions.

Cottonseed is a natural product of cotton (Gossypium spp.) crops. This work evaluated the oxidative stability of cottonseed butters through accelerated autoxidation by storage at 60 °C for 25 days. Three oxidative stability parameter values (peroxide value, p-anisidine value, and total oxidation value) were monitored over the storage time. These chemical measurements revealed that the storage stability of the butter products was dominated by primary oxidation of lipid (oil) components, while the secondary oxidation levels were relatively unchanged over the storage time. An analysis of the tocopherols (natural oxidants in cottonseed) suggested not only the protection function of the molecules against oxidation of the cottonseed butter during storage, but also the dynamic mechanism against the primary oxidation of lipid components. Attenuated total reflectance-Fourier-transform infrared spectroscopy (ATR-FTIR) data confirmed no changes in the major C functional groups of cottonseed butters over the storage time. On the other hand, characteristic minor peaks of conjugated dienes and trienes related to lipid oxidation were impacted by the accelerated storage. As each day of accelerated oxidation at 60 °C is equivalent to 16 days of storage at 20 °C, observations in this work should have reflected the oxidative stability behaviors of the cottonseed butters after about 13 months of shelf storage under ambient storage conditions. Thus, these data that were collected under the accelerated oxidation testing would be useful not only to create a better understanding of the autooxidation mechanism of lipid molecules in cottonseed butters, but also in developing or recommending appropriate storage conditions for cottonseed end products to prevent them from quality degradation.

Washable Antimicrobial Wipes Fabricated from a Blend of Nanocomposite Raw Cotton Fiber.

In this study, a simple and effective way to produce washable antimicrobial wipes was developed based on the unique ability of raw cotton fiber to produce silver nanoparticles. A nanocomposite substructure of silver nanoparticles (25 ± 3 nm) was generated in raw cotton fiber without reducing and stabilizing agents. This nanocomposite raw cotton fiber (2100 ± 58 mg/kg in the concentration of silver) was blended in the fabrication of nonwoven wipes. Blending small amounts in the wipes-0.5% for antimicrobial properties and 1% for wipe efficacy-reduced the viability of S. aureus and P. aeruginosa by 99.9%. The wipes, fabricated from a blend of 2% nanocomposite raw cotton fiber, maintained their antibacterial activities after 30 simulated laundering cycles. The washed wipes exhibited bacterial reductions greater than 98% for both Gram-positive and Gram-negative bacteria.

Molecular level characterization of the effect of roasting on the extractable components of glandless cottonseed by Fourier transform ion cyclotron resonance mass spectrometry.

Roasting is a technological process in some food applications of agricultural products. To investigate the composition changes of the extractable functional/bioactive components of cottonseed, in this work, glandless cottonseed kernels were roasted at 110, 120, 140 and 150 °C for 15 min, respectively. The UV/vis data of the 80 % ethanol extracts found that roasting increased the level of phenolic compounds. Electrospray ionization Fourier transform ion cyclotron resonance mass spectrometry of the extracts identified about 44 % to 55 % of total formulas as potential phenolic compounds. Roasting (up to 140 °C) mainly increased carbohydrate-, lignin-, and tannin-like compounds while lipid-like compounds decreased. The compositional changes at 150 °C were less than those at 140 °C, attributed to devolatilization at the higher temperature. The information of chemical profiling of cottonseed and the roasting impact would be greatly useful in enhanced utilization of cottonseed as nutrient and functional foods or food supplements.

Self-induced transformation of raw cotton to a nanostructured primary cell wall for a renewable antimicrobial surface.

Herein, raw cotton is shown to undergo self-induced transformation into a nanostructured primary cell wall. This process generates a metal nanoparticle-mediated antimicrobial surface that is regenerable through multiple washings. Raw cotton, without being scoured and bleached, contains noncellulosic constituents including pectin, sugars, and hemicellulose in its primary cell wall. These noncellulosic components provide definitive active binding sites for the in situ synthesis of silver nanoparticles (Ag NPs). Facile heating in an aqueous solution of AgNO3 activated raw cotton to produce Ag NPs (ca. 28 nm in diameter and 2261 mg kg-1 in concentration). Compared with scoured and bleached cotton, raw cotton requires lower concentrations of AgNO3-ten times lower for Klebsiella pneumonia and two times lower for Staphylococcus aureus-to achieve 99.9% reductions of both Gram-positive and Gram-negative bacteria. The Ag NPs embedded in the primary cell wall, which was confirmed via transmission electron microscopy images of the fiber cross-sections, are immobilized, exhibiting resistance to leaching as judged by continuous laundering. A remarkable percentage (74%) of the total Ag NPs remained in the raw cotton after 50 laundering cycles.

Intrafibrillar Dispersion of Cuprous Oxide (Cu2O) Nanoflowers within Cotton Cellulose Fabrics for Permanent Antibacterial, Antifungal and Antiviral Activity.

With increasingly frequent highly infectious global pandemics, the textile industry has responded by developing commercial fabric products by incorporating antibacterial metal oxide nanoparticles, particularly copper oxide in cleaning products and personal care items including antimicrobial wipes, hospital gowns and masks. Current methods use a surface adsorption method to functionalize nanomaterials to fibers. However, this results in poor durability and decreased antimicrobial activity after consecutive launderings. In this study, cuprous oxide nanoparticles with nanoflower morphology (Cu2O nanoflowers) are synthesized in situ within the cotton fiber under mild conditions and without added chemical reducing agents from a copper (II) precursor with an average maximal Feret diameter of 72.0 ± 51.8 nm and concentration of 17,489 ± 15 mg/kg. Analysis of the Cu2O NF-infused cotton fiber cross-section by transmission electron microscopy (TEM) confirmed the internal formation, and X-ray photoelectron spectroscopy (XPS) confirmed the copper (I) reduced oxidation state. An exponential correlation (R2 = 0.9979) between the UV-vis surface plasmon resonance (SPR) intensity at 320 nm of the Cu2O NFs and the concentration of copper in cotton was determined. The laundering durability of the Cu2O NF-cotton fabric was investigated, and the superior nanoparticle-leach resistance was observed, with the fabrics releasing only 19% of copper after 50 home laundering cycles. The internally immobilized Cu2O NFs within the cotton fiber exhibited continuing antibacterial activity (≥99.995%) against K. pneumoniae, E. coli and S. aureus), complete antifungal activity (100%) against A. niger and antiviral activity (≥90%) against Human coronavirus, strain 229E, even after 50 laundering cycles.

Periodontal disease and cancer risk: A nationwide population-based cohort study.

Background: Although emerging evidence suggests that periodontitis might increase the risk of cancer, comorbidity and lifestyle behaviors, such as smoking and body mass index (BMI), may have confounded this reported association. This study aimed to investigate whether chronic periodontitis is associated with cancer risk using a large, nationwide database. Methods: We conducted a population-based, retrospective cohort study using data from the Korean National Health Insurance Cohort Database obtained between January 2003 and December 2015. We included 713,201 individuals without a history of cancer who were followed up to 10 years. Confounding factors included demographic factors (age, sex, income, and residential area), lifestyle behaviors (smoking history and BMI), and comorbidities, such as hypertension, diabetes, heart failure, and pulmonary disease, using the Charlson Comorbidity Index. Multivariable Cox regression analysis was applied to estimate the adjusted hazard ratio (aHR) for cancer risk. Results: Of the 713,201 participants, 53,075 had periodontitis and were placed in the periodontitis group; the remaining 660,126 individuals were included as the control group. Overall, the cumulative incidence of cancer in the periodontitis group was 2.2 times higher than that in the control group. The periodontitis group had an increased risk of total cancer compared to the control group after adjusting for age, sex, comorbidities, BMI, and smoking history (aHR, 1.129; 95% confidence interval [CI], 1.089-1.171; P<0.0001). When examining specific cancer types, significant associations were also observed between periodontitis and stomach cancer (aHR, 1.136; 95% CI, 1.042-1.239; P=0.0037), colon cancer (aHR, 1.129; 95% CI, 1.029-1.239; P=0.0105), lung cancer (aHR, 1.127; 95% CI, 1.008-1.260; P=0.0353), bladder cancer (aHR, 1.307; 95% CI, 1.071-1.595; P=0.0085), thyroid cancer (aHR, 1.191; 95% CI, 1.085-1.308; P=0.0002), and leukemia (aHR, 1.394; 95% CI, 1.039-1.872; P=0.0270). There was no significant association between the development of secondary malignancy and periodontitis in cancer survivors who were alive 5 years after they were diagnosed with the primary malignancy. Conclusions: Periodontal disease, including periodontitis, was associated with increased risk of cancer, which persisted after controlling for confounding factors. Further prospective research is warranted to establish a causal relationship.

Thermosensitive textiles made from silver nanoparticle-filled brown cotton fibers.

Filling fibers with nanomaterials can create new functions or modify the existing properties. However, as nanocomposite formation for natural cellulosic fibers has been challenging, little information is available on how the embedded nanomaterials alter the properties of cellulosic fibers. Here we filled brown cotton fibers with silver nanoparticles (Ag NPs) to examine their thermosensitive properties. Using naturally present tannins in brown cotton fibers as a reducing agent, Ag NP-filled brown cotton fibers (nanoparticle diameter of about 28 nm, weight fraction of 12 500 mg kg-1) were produced through a one-step process without using any external agents. The in situ formation of Ag NPs was uniform across the nonwoven cotton fabric and was concentrated in the lumen of the fibers. The insertion of Ag NPs into the fibers shifted the thermal decomposition of cellulose to lower temperatures with increased activation energy and promoted heat release during combustion. Ag NPs lowered the thermal effusivity of the fabric, causing the fabric to feel warmer than the control brown cotton. Ag NP-filled brown cotton was more effectively heated to higher temperatures than control brown cotton under the same heating treatments.

Long-term follow-up results of cytarabine-containing chemotherapy for acute promyelocytic leukemia.

BACKGROUND/AIMS: We evaluated the feasibility and long-term efficacy of the combination of cytarabine, idarubicin, and all-trans retinoic acid (ATRA) for treating patients with newly diagnosed acute promyelocytic leukemia (APL). METHODS: We included 87 patients with newly diagnosed acute myeloid leukemia and a t(15;17) or promyelocytic leukemia/retinoic acid receptor alpha (PML-RARα) mutation. Patients received 12 mg/m2/day idarubicin intravenously for 3 days and 100 mg/m2/day cytarabine for 7 days, plus 45 mg/m2/day ATRA. Clinical outcomes included complete remission (CR), relapse-free survival (RFS), overall survival (OS), and the secondary malignancy incidence during a 20-year follow-up. RESULTS: The CR, 10-year RFS, and 10-year OS rates were 89.7%, 94.1%, and 73.8%, respectively, for all patients. The 10-year OS rate was 100% for patients that achieved CR. Subjects were classified according to the white blood cell (WBC) count in peripheral blood at diagnosis (low-risk, WBC < 10,000/mm3; high-risk, WBC ≥ 10,000/mm3). The low-risk group had significantly higher RFS and OS rates than the high-risk group, but the outcomes were not superior to the current standard treatment (arsenic trioxide plus ATRA). Toxicities were similar to those observed with anthracycline plus ATRA, and higher than those observed with arsenic trioxide plus ATRA. The secondary malignancy incidence after APL treatment was 2.7%, among the 75 patients that achieved CR, and 5.0% among the 40 patients that survived more than 5 years after the APL diagnosis. CONCLUSION: Adding cytarabine to anthracycline plus ATRA was not inferior to anthracycline plus ATRA alone, but it was not comparable to arsenic trioxide plus ATRA. The probability of secondary malignancy was low.