Overcoming Steroid Resistance in Pediatric Acute Lymphoblastic Leukemia-The State-of-the-Art Knowledge and Future Prospects.

Acute lymphoblastic leukemia (ALL) is the most common malignancy among children. Despite the enormous progress in ALL therapy, resulting in achieving a 5-year survival rate of up to 90%, the ambitious goal of reaching a 100% survival rate is still being pursued. A typical ALL treatment includes three phases: remission induction and consolidation and maintenance, preceded by a prednisone prephase. Poor prednisone response (PPR) is defined as the presence of ≥1.0 × 109 blasts/L in the peripheral blood on day eight of therapy and results in significantly frequent relapses and worse outcomes. Hence, identifying risk factors of steroid resistance and finding methods of overcoming that resistance may significantly improve patients' outcomes. A mitogen-activated protein kinase/extracellular signal-regulated kinase (MAPK-ERK) pathway seems to be a particularly attractive target, as its activation leads to steroid resistance via a phosphorylating Bcl-2-interacting mediator of cell death (BIM), which is crucial in the steroid-induced cell death. Several mutations causing activation of MAPK-ERK were discovered, notably the interleukin-7 receptor (IL-7R) pathway mutations in T-cell ALL and rat sarcoma virus (Ras) pathway mutations in precursor B-cell ALL. MAPK-ERK pathway inhibitors were demonstrated to enhance the results of dexamethasone therapy in preclinical ALL studies. This report summarizes steroids' mechanism of action, resistance to treatment, and prospects of steroids therapy in pediatric ALL.

Lifestyle Practices, Satisfaction with Life and the Level of Perceived Stress of Polish and Foreign Medical Students Studying in Poland.

The adaptation of foreign students to a new country can be complicated due to different cultural values, language barriers and the way university courses are structured. The aim of the study was to analyze the lifestyle practices, satisfaction with life and the level of perceived stress of Polish and foreign students studying various medical disciplines in Poland with regard to chosen sociodemographic characteristics. The study included 231 foreign and 213 Polish students (n = 444) taking different medical disciplines at the medical university in eastern Poland. Three research tools were used: Fantastic Lifestyle Questionnaire (FLQ), Satisfaction with Life Scale (SWLS), Perceived Stress Scale (PSS-10). Additionally, students' sociodemographic data was collected. Two-factor analysis of variance (ANOVA) was performed and correlations between variables were also examined. Our research indicated that Polish students obtained higher results in FLQ than foreign students. It also demonstrated a significantly higher level of stress among Polish students in comparison to foreign students. The self-assessment of their health condition, lifestyle, and rank associated to being healthy correlated with FLQ, SWLS and PSS-10. The present research can aid the development of support programs for foreign students so that the cultural adaptation processes would more positively influence their lifestyle and an education environment.