Genomic stability at the coding regions of the multidrug transporter gene : insights into the development of alternative drug resistance mechanisms in human leukemia cells.

Aim: Despite considerable efforts to reverse clinical multidrug resistance (MDR), targeting the predominant multidrug transporter ABCB1/P-glycoprotein (P-gp) using small molecule inhibitors has been unsuccessful, possibly due to the emergence of alternative drug resistance mechanisms. However, the non-specific P-gp inhibitor cyclosporine (CsA) showed significant clinical benefits in patients with acute myeloid leukemia (AML), which likely represents the only proof-of-principle clinical trial using several generations of MDR inhibitors. Nevertheless, the mutational mechanisms that may underlie unsuccessful MDR modulation by CsA are not elucidated because of the absence of CsA-relevant cellular models.

Emergency management: expanding the disaster plan.

A comprehensive emergency management plan (CEMP) is key to minimizing the disruption of patient care and services during and after a natural or man-made disaster. The home health nurse can play a key role in enhancing, expanding, and evaluating the effectiveness of the organization's disaster plan. The components of a CEMP and lessons learned from actual implementation of disaster plans in home care are addressed.