Effect of serum albumin level on high-dose methotrexate induced toxicities in acute lymphoblastic leukemia patients.

Objectives: Methotrexate (MTX) is a key therapeutic agent for leukemias. When given in high doses, leucovorin rescue is added to reduce its toxicity. It has been postulated that low albumin levels are associated with delayed clearance and increased toxicity of MTX. Hence, this prospective cohort study was proposed to evaluate the correlation between serum albumin level and HDMTX toxicity in acute lymphocytic leukemia (ALL) patients and to compare the MTX toxicity in hypo and normoalbuminemic patients. Methods: Forty-six ALL patients of either gender aged 2-40 years receiving HDMTX for 1st time were included in the study. The serum albumin levels were measured before chemotherapy before each cycle. The patients received 24-h infusion of HDMTX on days 8, 22, 36, and 50 (four cycles). The serum concentration of MTX was measured after first cycle only. The patients were followed for toxicities that were graded according to CTCAE-V4.0. Results: There was a negligible correlation between cumulative albumin levels of all four cycles and cumulative toxic events. The median toxic events were 19 (16-23). The Spearmen correlation coefficient ρ was 0.055 (P = 0.460). No association was found between albumin level and MTX toxicity in cycle wise analysis also. In each cycle, there was no significant difference in the toxicities between the hypo and normoalbuminemic patients. Only vomiting showed significant (P < 0.05) inverse correlation with albumin levels. Hypoalbuminemic patients showed significantly (P < 0.01) higher grade of nausea compared to normoalbuminemia. Conclusion: There was negligible correlation between albumin levels and MTX toxicity despite delayed clearance supporting the safety of MTX in mildly hypoabuminemic patients.

Efficacy of Bacillus clausii UBBC - 07 spores in the amelioration of oral mucositis in head and neck cancer patients undergoing radiation therapy.

BACKGROUND: The natural flora of healthy mucosa offer protection to the host. The loss of this barrier during radiotherapy enhances insults from physical, chemical and microbial agents. METHODOLOGY: A randomized, double blind, placebo-controlled, parallel study on forty-six patients who underwent radiotherapy for head and neck cancers was undertaken. Patients were randomized either to standard treatment plus Bacillus clausii UBBC07 or standard treatment plus placebo. Bacillus clausii UBBC07 was given as an oral suspension of 2 billion spores twice every day for 30 days or until completion of total fractions of radiation. Grading of the mucositis was performed using CTCAE v.4.03 severity scale. The time taken for the appearance, resolution and severity of mucositis was evaluated. RESULTS: There was a significant increase (p < 0.01) in median time for the onset of mucositis i.e., 10 days in test and 8 days in control groups respectively. The median time for remission was found to be 12 days in test and 14 days in the control group (p < 0.05). Grade IV mucositis was observed in no patients in test group and 2 patients in the control group (p < 0.05). No adverse events attributed to the Bacillus clausii were seen. Bacillus clausii UBBC07 therapy delayed the onset, decreased the time to remission and displayed strong impact on suppressing the occurrence of high-grade mucositis amongst the test group. CONCLUSIONS: This study provides a positive trend that probiotics like Bacillus clausii UBBC07 spores could act as a tool to ameliorate oral mucositis.

Optimizing agent behavior over long time scales by transporting value.

Humans prolifically engage in mental time travel. We dwell on past actions and experience satisfaction or regret. More than storytelling, these recollections change how we act in the future and endow us with a computationally important ability to link actions and consequences across spans of time, which helps address the problem of long-term credit assignment: the question of how to evaluate the utility of actions within a long-duration behavioral sequence. Existing approaches to credit assignment in AI cannot solve tasks with long delays between actions and consequences. Here, we introduce a paradigm where agents use recall of specific memories to credit past actions, allowing them to solve problems that are intractable for existing algorithms. This paradigm broadens the scope of problems that can be investigated in AI and offers a mechanistic account of behaviors that may inspire models in neuroscience, psychology, and behavioral economics.

Challenges in representation learning: a report on three machine learning contests.

The ICML 2013 Workshop on Challenges in Representation Learning(1) focused on three challenges: the black box learning challenge, the facial expression recognition challenge, and the multimodal learning challenge. We describe the datasets created for these challenges and summarize the results of the competitions. We provide suggestions for organizers of future challenges and some comments on what kind of knowledge can be gained from machine learning competitions.