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Precision medicine can significantly improve outcomes for patients with cancer, but implementation requires comprehensive characterization of tumor cells to identify therapeutically exploitable vulnerabilities. Here, we describe somatic biallelic TET2 mutations in an elderly patient with acute myeloid leukemia (AML) that was chemoresistant to anthracycline and cytarabine but acutely sensitive to 5 '-azacitidine (5 '-Aza) hypomethylating monotherapy, resulting in long-term morphological remission. Given the role of TET2 as a regulator of genomic methylation, we hypothesized that mutant TET2 allele dosage affects response to 5 '-Aza. Using an isogenic cell model system and an orthotopic mouse xenograft, we demonstrate that biallelic TET2 mutations confer sensitivity to 5 '-Aza compared with cells with monoallelic mutations. Our data argue in favor of using hypomethylating agents for chemoresistant disease or as first-line therapy in patients with biallelic TET2-mutated AML and demonstrate the importance of considering mutant allele dosage in the implementation of precision medicine for patients with cancer.

Background: According to the definition of World Health Organization, hand hygiene is a general term referring to any action of hand cleansing , it is the act of cleaning one’s hands with or without the use of water or another liquid or with the use of soap for the purpose of removing soil, dirt, and/or microorganisms(9).Healthcare-associated infections (HCAIs) play a major role when it comes to patient safety. Objectives: The present study aimed to assess the prevalence of the practice of hand hygiene among medical students in Hail collage of medicine, the knowledge about hand hygiene technique and its importance among medical students and Measure the student awareness regarding the "my five hand hygiene technique" and time consumed during it. Methods: This is a cross-sectional study conducted in the period from the first of August to the end of September 2017 among medical students in the Department of General Surgery and Medicine ,Hail,Saudi Arabia, after having been approved by the research and ethics committee . An open and close electronic-based questionnaire (8) was distributed among 250 students during clinical years “4th year to 6th year". Results: Total 124 medical students (4th year, 5th year and 6th year) took part in this study. 70.9% of them were female; 33.1% of them was from 4th year, 32.3% from 5th year and 34.8% from 6th year (Table 1) . Only 32.3% (n = 40) respondents knew about WHO and CDC guideline for hand hygiene before the beginning of clinical training. Conclusion :The present study had shown that healthcare associated infection is a very serious obstacle worldwide. Thus hand hygiene has a major role in controlling infections. In our study we conclude that, there is a considerable number of students knew about WHO and CDC guidelines for hand hygiene before their clinical training, and the remaining are willing to know about it. recommendation: Include teaching about hand hygiene in the curriculum of medical students. This can be introduced either in the courses like community and patient safety or during the bedside teaching in hospitals or primary care facilities. Keywords: Hand hygiene , Healthcare, students, clinical training, infection.