In a study of leukemia cells that were resistant or sensitive to prednisolone, vincristine, asparaginase, or daunorubicin — four drugs used in the treatment of childhood acute lymphoblastic leukemia — 124 genes were linked to resistance or sensitivity. The pattern of expression of resistance genes was independently related to the outcome of treatment.

This work adds a new dimension to the formulation of a prognosis in childhood leukemia and promises to stimulate a broad attack on resistance to chemotherapy.

The Randomized Aldactone Evaluation Study (RALES) showed that spironolactone reduces mortality in patients with severe heart failure; however, the drug can cause hyperkalemia, especially when given with angiotensin-converting–enzyme (ACE) inhibitors. The current study found that, after the publication of RALES, there was an abrupt increase in the rate of prescriptions for spironolactone and in hyperkalemia-associated morbidity and mortality in patients with heart failure who were receiving an ACE inhibitor.

During spironolactone therapy, it is important to monitor serum potassium levels and renal function.

Smad3 is a signaling molecule that has a key role in the cascade evoked by the binding of transforming growth factor , a tumor suppressor, to its receptor on the cell surface. The principal result reported in this study is a lack of Smad3 in malignant cells from children with T-cell acute lymphoblastic leukemia. This novel finding places Smad3 on the list of tumor-suppressing molecules and provides a fresh look at the mechanisms behind childhood leukemia.

Normally, the growth of airway smooth-muscle cells is kept in check by the antiproliferative effects of glucocorticoids acting in concert with the glucocorticoid receptor and CCAAT/enhancer binding protein (C/EBP). These investigators show that airway smooth muscle from patients with asthma has a selective deficiency of C/EBP, thus obviating the antiproliferative effects of glucocorticoids.

These data suggest that the airway smooth muscle in patients with asthma is intrinsically different from that of healthy subjects and those with emphysema. This work changes the focus of asthma pathobiology from airway immunology to smooth-muscle biology.

In this study of Medicare patients and primary care doctors, 22 percent of physicians accounted for 80 percent of visits with black patients. Doctors who treated black patients were less likely to be board certified than those who treated white patients (77 percent vs. 86 percent, P=0.02) and more likely to report an inability to provide high-quality care to all their patients (28 percent vs. 19 percent, P=0.005).

Inferior qualifications and less access to resources among physicians who care for black patients may contribute to racial disparities in the quality of health care.

Hyperkalemia can develop as a result of treatment with angiotensin-converting–enzyme inhibitors or angiotensin-receptor blockers. This side effect is most common in patients with risk factors such as diabetes mellitus, heart failure, chronic kidney disease, or advanced age. This review explains the pathophysiology and offers clinical guidance for management.

A 53-year-old woman presented to an outpatient urgent care clinic with persistent nausea and vomiting. On the previous evening, she had an acute onset of nausea that was followed by vomiting and light-headedness. The patient also reported mild discomfort in the chest and abdomen.

The most common cystic fibrosis mutation prevents the mutant protein (which forms a chloride channel) from reaching its usual destination: the cell surface. A recent study suggests that curcumin, a nutraceutical, may correct the effect of the mutation.