Evaluation of planktonic cyanobacteria in Peruvian freshwater lentic water bodies: prevalence and regulatory framework to aid policy making.

Increasing reports of cyanobacteria or cyanotoxins around the world expose a major threat for the environment, animal, and human health. Current water treatment processes are ineffective at eliminating cyanotoxins; hence, risk management relies mostly on early detection and on the development of specific regulatory frameworks. In developed countries, well-documented monitoring activities offer a good assessment of the cyanobacterial and/or cyanotoxin status and are used to prevent intoxications. In developing countries such as Peru, despite their potential threat to the environment and public health, cyanobacteria and cyanotoxins are still poorly studied. We found that the regulatory measures regarding cyanobacteria and/or cyanotoxin are almost non-existent. We also present and discuss some examples of recent monitoring efforts underwent by isolated local authorities and scientific reports that, whereas limited, may provide some important insights to be considered nationally. A revision of the available information of planktonic cyanobacteria or cyanotoxins in Peruvian freshwater lentic water bodies revealed a total of 50 documented reports of 15 different genera across 19 water bodies, including the reported highly toxic Dolichospermum and Microcystis. A unique case of microcystin-LR has been documented. We propose some recommendations to be implemented to improve potential toxic cyanobacteria risk management that include incorporating a widespread monitoring of cyanobacterial communities in lakes and reservoirs used for human consumption via specific guidelines. Aligning Peruvian regulations on cyanobacteria and cyanotoxins to international standards may also support law enforcement and ensure compliance.

Four-Year Disease-Free Remission in a Patient With POLE Mutation-Associated Colorectal Cancer Treated Using Anti-PD-1 Therapy.

The stability of the human genome depends upon a delicate balance between replication by high- and low-fidelity DNA polymerases. Aberrant replication by error-prone polymerases or loss of function of high-fidelity polymerases predisposes to genetic instability and, in turn, cancer. DNA polymerase epsilon (Pol ε) is a high-fidelity, processive polymerase that is responsible for the majority of leading strand synthesis, and mutations in Pol ε have been increasingly associated with various human malignancies. The clinical significance of Pol ε mutations, including how and whether they should influence management decisions, remains poorly understood. In this report, we describe a 24-year-old man with an aggressive stage IV high-grade, poorly differentiated colon carcinoma who experienced a dramatic response to single-agent checkpoint inhibitor immunotherapy after rapidly progressing on standard chemotherapy. His response was complete and durable and has been maintained for more than 48 months. Genetic testing revealed a P286R mutation in the endonuclease domain of POLE and an elevated tumor mutational burden of 126 mutations per megabase, both of which have been previously associated with response to immunotherapy. Interestingly, tumor staining for PD-L1 was negative. This case study highlights the importance of genetic profiling of both early and late-stage cancers, the clinical significance of POLE mutations, and how the interplay between genetic instability and immune-checkpoint blockade can impact clinical decision-making.