Treatment of Relapsed B/T-cell Mixed Phenotype Acute Leukemia With Blinatumomab.

Here, we describe the treatment of a patient with relapsed/refractory B/T mixed phenotype acute leukemia (MPAL) using blinatumomab monotherapy, the first bispecific T cell engager (BiTE) approved by the FDA for relapsed/refractory B cell acute lymphoblastic leukemia (B-ALL). A 64-year-old man with a history of stage 3 chronic kidney disease and type 2 diabetes mellitus was discovered to have B/T MPAL on bone marrow biopsy during hospitalization for dyspnea due to pulmonary embolism. The patient achieved brief remission with blinatumomab treatment before succumbing to neutropenic sepsis. The lack of sufficient data to guide therapy in MPAL remains a challenge, highlighting the potential of new targeted approaches such as blinatumomab to improve outcomes in relapsed/refractory MPAL.

Management strategy and novel ophthalmological findings in neonatal severe hypertriglyceridemia: a case report and literature review.

BACKGROUND: Neonatal severe hypertriglyceridemia is rarely reported in the literature and there is no consensus for hypertriglyceridemia management at this age group. METHODS: The index case is a 4-week-old male infant with severe hypertriglyceridemia accidentally discovered during a circumcision surgery. His clinical and genetic characteristics and his successful management strategy are described. Furthermore, a detailed ophthalmological examination of the proband was conducted at 3 and 6 months of age using Fourier-domain-optical coherence tomography. RESULTS: Triglycerides level at presentation was extremely high 33,727 mg/dL (380.8 mmol/L). Two sessions of exchange blood transfusion on two consecutive days successfully reduced triglycerides to 382 mg/dL (4.3 mmol/L) with no adverse effects. The infant was discharged 3 days later. At discharge, the mother was advised to continue breastfeeding together with a medium-chain triglycerides formula. Satisfactory growth parameters and lipid profile values were obtained for a follow-up duration of 5 months with no reported attacks of acute pancreatitis. Lipoprotein lipase deficiency was confirmed by the detection of the LPL homozygous pathogenic variant c.805G > A; p.(Glu269Lys). Early corneal and macular lesions were detected and persisted on follow-up despite relatively good lipemic control. CONCLUSION: This case highlights the importance of the early discovery of severe hypertriglyceridemia during the neonatal period, which is needed for prompt management and prevention of severe complications. Rationalized breastfeeding can be tolerated within the diet plan of the disease with satisfactory outcomes. To our knowledge, it is the first study reporting early corneal and macular affection by severe hypertriglyceridemia in a neonate. Prolonged follow-up is needed to determine the extent of ophthalmological lesions.

Competition between Solvent-Solvent and Solvent-Solute Interactions in the Microhydration of the Hexafluorophosphate Anion, PF6-(H2O)n=1,2.

This study systematically examines the interactions of the hexafluorophosphate anion (PF6-) with one or two solvent water molecules (PF6-(H2O)n where n = 1, 2). Full geometry optimizations and subsequent harmonic vibrational frequency computations are performed on each stationary point using a variety of common density functional theory methods (B3LYP, B3LYP-D3, M06-2X, and ωB97XD) and the MP2 and CCSD(T) ab initio methods with a triple-ζ correlation consistent basis set augmented with diffuse functions on all non-hydrogen atoms (cc-pVTZ for H and aug-cc-pVTZ for P, O, and F; denoted as haTZ). Five new stationary points of PF6-(H2O)2 have been identified, one of which has an electronic energy of approximately 2 kcal mol-1 lower than the only other dihydrate structure reported for this system. The CCSD(T) computations also reveal that the detailed interactions between PF6- and H2O can be quite difficult to model reliably, with some methods struggling to correctly characterize stationary points for n = 1 or accurately reproduce the vibrational frequency shifts induced by the formation of the hydrated complex. Although the interactions between the solvent and ionic solute are quite strong (CCSD(T) electronic dissociation energy ≈10 kcal mol-1 for the monohydrate minimum), the solvent-solvent interactions in the lowest-energy PF6-(H2O)2 minimum give rise to appreciable cooperative effects not observed in the other dihydrate minima. In addition, this newly identified structure exhibits the largest frequency shifts in the OH stretching vibrations for the waters of hydration (with Δω exceeding -100 cm-1 relative to the values for an isolated H2O molecule).