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Mutations in the kinase-binding domain of the BCR-ABL gene cause resistance to the BCR-ABL tyrosine kinase inhibitor imatinib in chronic myelogenous leukemia. This study found that dasatinib, a BCR-ABL inhibitor that targets most imatinib-resistant BCR-ABL mutations, has efficacy in imatinib-resistant chronic myelogenous leukemia or Philadelphia chromosome–positive acute lymphoid leukemia.
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This phase 1 study treated 119 patients with imatinib-resistant chronic myelogenous leukemia (CML) with nilotinib, an inhibitor of BCR-ABL tyrosine kinase. The drug had a relatively favorable safety profile and was active in patients who were in the blastic or accelerated phases of CML and in the chronic phase of CML with resistance to imatinib.
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In this study, serum levels of retinol-binding protein 4, a molecule secreted by adipocytes, correlated with the magnitude of insulin resistance in subjects with obesity, impaired glucose tolerance, or type 2 diabetes and in nonobese, nondiabetic subjects with a strong family history of type 2 diabetes. Levels of this molecule appear to be elevated in serum before the development of frank diabetes and might be used to identify insulin resistance and associated cardiovascular risk factors.
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One of the characteristics of acute lung injury is noncardiogenic pulmonary edema. Arguments have been made for the management of acute lung injury with either a liberal or conservative approach to fluid administration. In this trial, neither approach offered a mortality benefit; there were clinical and physiological benefits to conservative fluid management.
A healthy, active 12-year-old boy is in the first percentile for height (133.0 cm [52.4 in.]; −2.25 SD) and the third percentile for weight (29 kg [64 lb]). His physical examination is unremarkable, with normal proportions and no signs of puberty. His bone age is 10 years. His midparental height is 164.5 cm (64.8 in.), and his predicted height is 163.8 cm (64.5 in.). Is growth hormone therapy indicated?
A 57-year-old woman had had progressive numbness and weakness of the feet and legs since her early 30s. She had had dilated, fixed, and unequal pupils since adolescence. Her father had similar symptoms with his feet and legs, as well as dilated pupils and impotence. Two of her brothers, her son, and her daughter had neuropathy, dilated pupils, or both. A diagnostic procedure was performed.
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The growing prevalence of obesity among adults and children has prompted legal initiatives designed to combat this public health problem. The authors describe litigation and legislation that target obesity and discuss the potential for public health law to reduce obesity in the United States.
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