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Objectives: The objectives of the study were to determine and compare serum magnesium (Mg) and zinc (Zn) concentrations between breast carcinoma patients and healthy controls. Methods: Determination and comparison of serum Mg and Zn was done between 50 breast carcinoma patients and 50 healthy controls. Determination and comparison of LFT in between 50 breast cancer patient during different course of chemotherapy. Trace element analysis was done using atomic absorption spectrophotometry. Statistical comparison was done, results were expressed as Mean±SD, p0.05. Serum Mg concentrations in cases and controls (0.9920±0.38 mg/dL) and (1.49±0.58 mg/dL) respectively, p≤0.0001* serum Zn concentrations in cases and controls were (66.74±12.58 μg/dL) and (90.88±14.51 μg/dL), respectively, p≤0.0001*. Conclusion: Both serum (Zn) and (Mg) showed significant decreases in breast carcinoma patients as compare to healthy controls.

As the effects of climate change become more severe, environmental sustainability has become an urgent problem in public administration. The purpose of this research is to examine the approaches taken by governmental agencies to lessen their carbon footprints and boost renewable energy sources. The methodology incorporates a survey of relevant literature, an examination of relevant policies and laws, and a comparison of various national approaches. The findings demonstrate that carbon pricing and emissions trading systems are useful instruments for encouraging reductions in emissions, though their applicability may be constrained in some settings. Investment and deployment of renewable energy technologies can be prompted by goals for increased use of such sources, as well as by financial incentives and regulatory support. Investment in distributed renewable energy systems is encouraged by feed-in tariffs and net metering, but these policies may have unintended effects. There is a great deal of diversity in the policies and strategies employed by various nations, but there are also many similarities and shared experiences that can be used to create more effective policies. The research highlights the importance of public management in developing and implementing policies and strategies to combat climate change. The results are instructive for academics, policymakers, and practitioners in their pursuit of better methods of lowering carbon emissions and advancing sustainable energy.

Purpose To report 3 cases of reversible epitheliopathy induced by A166—a human epidermal growth factor receptor (HER2)-targeted antibody-drug conjugate (ADC) therapy for resistant HER2 tumours. Methods Advanced HER2 tumour patients were enrolled in A166 phase I/II clinical trial using Bayesian logistic regression model dose escalation. Key exclusion criteria were ≥grade 2 (G2) corneal pathology, severe organ disease, and other cancer therapy within 4 weeks. Eye exams were performed at baseline, regularly scheduled intervals, and additionally upon A166-induced ocular symptoms. Topical therapy with autologous serum tears (ASTs) was implemented based on visual acuity, symptoms, and slit lamp exam. A166 was withheld if ≥G2 ocular toxicity developed; if status improved to ≤G1, A166 therapy was resumed. Visual acuity, corneal exam, and subjective comfort were recorded. Results After ≥2 cycles of A166, 6 eyes of 3/23 enrolled patients developed whorl pattern epitheliopathy suggestive of limbal stem cell (LSC) dysfunction requiring cessation of A166 despite positive tumour response. Patients 1 and 3 received 3.6 mg/kg A166 dose, and patient 2 received 3.0 mg/kg. Topical steroids (2/4 eyes) failed to improve epitheliopathy. Adding ASTs improved vision, ocular comfort, and whorl pattern epitheliopathy in 6/6 eyes within 3 weeks. Patient 1 continues to improve on ASTs; patient 2 withdrew from the study; and patient 3 resumed A166 therapy. Conclusion A166 precipitates LSC dysfunction-like epitheliopathy. Combination therapy including aggressive lubrication, withholding drug, and ASTs help reverse toxicity. Recognizing that ADC-induced epitheliopathy can respond to ocular management may enable cancer patients to continue lifesaving therapy.

To examine the awareness of low-dose computed tomography (LDCT) lung cancer screening among a population of current and former smokers using a nationally representative sample from the United States. Data for this study come from Wave 9 of the International Tobacco Control (ITC) United States Survey, conducted between 2013 and 2015. Among respondents age ≥ 40 (n = 1145), a 50% random sample were asked a series of questions pertaining to lung cancer screening. This study examines awareness and screening behaviors in relationship to demographic characteristics of respondents, health beliefs, psychosocial behaviors, and smoking behaviors. Descriptive tables and χ2 tests were used to examine the association between those who were aware and unaware. Logistic regression analyses were conducted, stratified on respondents’ smoking status. Data were weighed to be representative of the current smoking population in the US. Overall, 52% of current and former smokers reported being aware of lung cancer screening. Among the group with no prior screening, 80.6% said they would take a lung cancer screening exam if recommended by their physician. In the multivariate models, former smokers had significantly greater awareness of lung cancer screening compared to current smokers [odds ratio 1.42 (95% confidence interval 1.03, 1.97)]. Awareness of LDCT lung cancer screening was lower among current smokers compared to former smokers. Most smokers who had not ever been screened said they would have lung cancer screening if it were recommended by their physician, demonstrating the need for healthcare providers to encourage those eligible for screening to take the test.

We report a case of Macular Telangiectasia type 2 with crystalline retinopathy in a 42 year old female complaining of gradual decrease of vision in both eyes for the past one year. Both eye fundus showed perifoveal refractile crystals with lamellar macular holes. A diagnosis of crystalline retinopathy was made. Other causes of crystals were ruled out based on history, systemic examination, multimodal imaging & laboratory work-up. Presence of dilated perifoveal deep capillary plexus, foveal cavitation & temporal leakage on FFA conrmed association with Macular Telangiectasia. To our knowledge, there is no thorough documentation of crystalline reti-nopathy reported in Indian population.

Objective We assessed whether in-depth messaging delivered via a smoking cessation quitline results in participants: (1) speaking to their physician, or (2) insurance company regarding lung cancer screening (LCS). MethodsEligible participants lived in New York State and met the United States Preventive Services Task Force eligibility criteria for LCS (N = 1000). A randomized trial was conducted among New York State Smokers' Quitline participants to assess the impact of a brochure containing information on risks, benefits, and costs associated with LCS (control group) versus the brochure supplemented with phone-based in-depth messaging (treatment group). ResultsAfter a 4-month telephone survey (N = 431), associations between the study groups were examined for: (1) speaking with a physician regarding LCS, and (2) speaking with an insurance company about LCS coverage. Multivariate logistic regression models adjusted for demographics, insurance status, emphysema/COPD, and past 30-day cigarette use found no significant associations. However, sensitivity analyses among control participants found significant associations, including for speaking with a physician (p < .05) by receipt of the study brochure. Analyses repeated in the treatment group also had statistically significant findings emerge, including for speaking with insurance company (p < .05). ConclusionsThe educational brochure may be an effective and low-cost way to deliver information about LCS.

Introduction This study aimed to assess the association between current smoking and gender identity among transgender individuals. Methods Data were collected using a cross-sectional survey distributed among transgender individuals attending the Houston Pride Festival and those seeking care at a local transgender health clinic. Relevant variables were compared between female-to-male (FTM) and male-to-female (MTF) transgender individuals using χ2, Fisher's exact, and two-sample t-tests, when appropriate. Gender identity was used to predict current smoking status using logistic regression, adjusting for other sociodemographic determinants. Results The study sample (N=132) comprised 72 MTF (54.5%) and 60 FTM (45.5%) transgender individuals. Mean age of participants was 31.8 years. The sample was racially and ethnically diverse: 45.8% Caucasian, 25.2% Hispanic/Latino, 16.8% African American, and 12.2% other. Current smoking prevalence was 26.7% and 13.9% among FTM and MTF individuals, respectively. Transgender individuals were more likely to self-report current smoking if they were FTM (OR=3.76; 95% CI: 1.17-12.06; p=0.026) or were insured (OR=4.49; 95% CI: 1.53-13.18; p=0.006). Conclusions This study reports on important findings by examining intragroup differences in smoking behavior among the transgender population. However, further research is needed for tailoring smoking prevention and cessation interventions for transgender subgroups.

An 81-year-old man developed decreased vision associated with diffuse precipitates on his poly(methyl methacrylate) (PMMA) posterior chamber intraocular lens (IOL), on his corneal endothelium, and in his anterior chamber approximately 35 years after IOL implantation. Slitlamp evaluation showed diffuse white material on the surface of the IOL, white precipitates on the corneal endothelium, and visible debris in the anterior chamber. The patient had IOL exchange, and pathological analysis showed numerous calcium deposits within the Soemmerring ring that diffusely spread to the anterior surface of the PMMA IOL. This case of diffuse calcium precipitates on the IOL and the corneal endothelium and in the anterior chamber 35 years after implantation shows that even long after IOL implantation, lens epithelium proliferation and metabolism can result in sequestered material that can be released many years later. Financial Disclosure None of the authors has a financial or proprietary interest in any material or method mentioned.

Lung cancer is one of the most lethal cancers in the USA. In 2013, new guidelines issued by the United States Preventive Services Task Force recommended lung cancer screening using low-dose computed tomography among a selected group of high-risk individuals. Specifically, lung cancer screening is recommended for heavy smokers between the ages of 55 to 79, with at least 30 pack-year smoking exposure. Former smokers who meet these guidelines and stopped smoking ≤ 15 years ago are also eligible. There is a need to promote lung cancer screening to increase early diagnosis rates and treatment options, thereby decreasing disease-specific mortality. This study was conducted to refine educational materials used to inform eligible high-risk individuals about the risks and benefits of lung cancer screening. Focus groups (n = 16) and in-depth telephone interviews (n = 5) were conducted among screening-eligible participants recruited from western New York. Main themes that emerged from the discussions included cost of obtaining the exam, eligibility criteria/information about the exam, apprehension regarding results, and an increased desire for discussions with their physician to learn more about the screening. The information gained from this study is vital to understanding concerns held by current and former smokers regarding lung cancer screening, as well as critical to determining which information is most valuable for decreasing barriers and correcting misperceptions about the lung cancer screening exam.

Objective Pall Mall gained significant brand share in the cigarette market between 2002 and 2013. We sought to determine whether demographic shifts occurred among the participants reporting Pall Mall as their usual brand during this time span. Method We examined National Survey of Drug Use and Health (NSDUH) data from 2002-2014. Demographic characteristics included age, education, ethnicity, income, and cigarette use (cigarettes per day, daily/non-daily smoking, and nicotine dependence). We also examined RJ Reynolds investor reports and shareholder documents to determine the impact of tobacco marketing on the growth of Pall Mall. Results Over 2002-2014, Pall Mall has gained among smokers 26 to 34 years of age. More Pall Mall smokers in 2014 report higher incomes (over $75000), and also report lower scores on measures of cigarette dependence, compared to 2002. Pall Mall smokers over time seem to share characteristics of premium cigarette brands smokers. Conclusion The profile of the typical Pall Mall smoker has changed as the brand has gained market share. An association exists between brand positioning and economic forces, which has contributed to an increase in the market share for Pall Mall. Implications It is well known that cigarette marketing drives the sale of tobacco products. The growth in the market share of Pall Mall serves as an excellent example to demonstrate how economic uncertainty paired with brand positioning and advertising worked together to serve as a catalyst for the rapid growth observed for this brand. This paper also looked at various demographic changes that occurred among Pall Mall smokers over a 12 year period and compared them to smokers of all other cigarette brands. The results of this analysis demonstrate the importance of monitoring trends over time among cigarette smokers.

Purpose To describe 2 unrelated families with multiple members demonstrating a less commonly recognized vortex pattern of corneal deposits confirmed to be granular corneal dystrophy type 1 (GCD1) after identification of the p.(Arg555Trp) mutation in the transforming growth factor β-induced gene (TGFBI). Methods A slit-lamp examination was performed on individuals from 2 families, one of Mexican descent and a second of Italian descent. After DNA extraction from affected individuals and their unaffected relatives, TGFBI screening was performed. Results Eight of 20 individuals in the Mexican family and 20 of 55 in the Italian family demonstrated corneal stromal opacities. Seven of the 8 affected individuals in the Mexican family and 4 of the 20 affected individuals in the Italian family demonstrated a phenotype characterized by a "sea fan" or vortex pattern of superficial stromal corneal deposits originating from the inferior aspect of the cornea. Screening of TGFBI in both families revealed a heterozygous missense mutation [p.(Arg555Trp)] in exon 12, confirming the diagnosis of GCD1. Conclusions Our findings demonstrate that GCD1 may present with a vortex pattern of anterior stromal deposits. Although this pattern of dystrophic deposits is not recognized by clinicians as a typical phenotype of GCD1, it is consistent with the production of the majority of the TGFBI protein by the corneal epithelium.

Objectives The main objective of this study is to examine trends in market share for leading cigarette brands, both before (2002–2008) and after (2009–2013) Food and Drug Administration (FDA) regulation of tobacco products. Design Data come from the annual National Survey on Drug Use and Health from 2002 through 2013. Descriptive statistics, cross tabulations, and logistic regression were employed. Data were weighted to the US population and adjusted for cigarette consumption. Our analysis is restricted to 164 343 current cigarette smokers who were at least 12 years of age or older, had smoked at least one cigarette in the 30 days prior to the survey, and reported a usual cigarette brand at the time of the survey. Results Over 12 years, 14 brands comprised over 77% of the cigarette market. Marlboro consistently held over 38% of the market. Newport held the second highest market share, and increased from 7.2% in 2002 to 10.9% by 2013. Market share of Pall Mall grew by over 400% (1.7% in 2002 vs 8.9% in 2013), likely aided by the 2009 Federal excise tax increase. No clear associations of changes in market share with the implementation of FDA9s regulatory authority over tobacco in 2009 were noted. Conclusions Tracking market share trends offers clues about brand marketing changing preferences of consumers. Rapidly growing cigarette brands should be monitored to determine if specific marketing practices or design changes are drivers, as these could represent public health concerns. Monitoring trends in cigarette market share could inform regulatory decision-making efforts related to marketing and advertising.

The macrolide antibiotic rapamycin inhibits the mammalian target of rapamycin protein (mTOR) kinase resulting in the global inhibition of cap-dependent protein synthesis, a blockade in ribosome component biosynthesis, and G1 cell cycle arrest. G1 arrest may occur by inhibiting the protein synthesis of critical factors required for cell cycle progression. Hypersensitivity to mTOR inhibitors has been demonstrated in cells having elevated levels of AKT kinase activity, whereas cells containing quiescent AKT activity are relatively resistant. Our previous data suggest that low AKT activity induces resistance by allowing continued cap-independent protein synthesis of cyclin D1 and c-Myc proteins. In support of this notion, the current study demonstrates that the human cyclin D1 mRNA 5' untranslated region contains an internal ribosome entry site (IRES) and that both this IRES and the c-myc IRES are negatively regulated by AKT activity. Furthermore, we show that cyclin D1 and c-myc IRES function is enhanced following exposure to rapamycin and requires both p38 MAPK and RAF/MEK/ERK signaling, as specific inhibitors of these pathways reduce IRES-mediated translation and protein levels under conditions of quiescent AKT activity. Thus, continued IRES-mediated translation initiation may permit cell cycle progression upon mTOR inactivation in cells in which AKT kinase activity is relatively low.

Introduction: Like medicine, public health practitioners seek to understand causes of mortality, practices of humans and issues that can change population conditions, in order to preserve and care for life. The murder pandemic has been such in Jamaica that the World Bank sponsored a qualitative study on crime in urban areas in Jamaica in the late 1990s to provide a platform to guide policy intervention and programmes. As a result this study will fill the gap in the literature by providing the evidence to support that divorce and marriage are public health concerns from the perspective of murders. Objective: To evaluate the role of divorce and marital relationships on murders. Materials and methods: The data for this study are taken from various Jamaica Government Publications. The period for this work is from 1950 through 2013. Data were recorded, stored and retrieved using the Statistical Packages for the Social Sciences (SPSS) for Windows, Version 21.0. The level of significance that is used to determine statistical significance is less than 5% (0.05). Ordinary least square (OLS) regression analyses and curve estimations were used to determine models and best fitted models. Results: On average, annually, 523 Jamaicans are murdered (? 484), with there being 9,531 marriages (?22,747) and 904 divorces (?468). Logged marriage rate and divorce rate are factors of murder rate, with both independent factors accounting for 82.2% of the variability in the murder rate. Both factors are positively correlated with the murder rate, with the divorce rate accounting for most of the variance in the murder rate (R2 = 79.2%). Conclusion: Death can be extremely devasting to families, however, murder among married couples can severely disrupt the lives of both families along with any children from such relationship.

Background: Inspite of the body of knowledge which exists on mortality, the literature is void of a study on ‘Time-specific Mortality’. Objectives: This study aims to evaluate ‘Time-specific Mortality’ in Jamaica, the role of urbanization, and sexratio on mortality. Materials and method: The data were derived from various Jamaica Government Publications including The Economic and Social Survey of Jamaica; 2011 Census of Population and Housing report for Jamaica and the Demographic Statistics, and the Statistical Department of the Jamaica Constabulary Force. Data were recorded, stored and retrived using the Statistical Packages for the Social Sciences for Windows, Version 21.0, as well as Microsoft Excel. The level of significance that is used to determine statistical significance is less than 5% (0.05). Results: The annual probability of mortality in Jamaica, for the studied period is 0.005 ≤ px ≤ 0.008. The probability of dying in Kingston and Saint Andrew is generally greater than that of Jamaica, which is equally the case in Saint James (i.e., 0.005 ≤ px ≤ 0.008), Manchester (i.e., 0.006 ≤ px ≤ 0.008), with the probability of dying being the least in Hanover (0.003 ≤ px ≤ 0.005). The majority of deaths occurred in January (9.8%), with the least being in December (7.8%). Although on average the least number of deaths occurred in December 2011 (7.8%), 11% of Jamaicans died in December compared to 8% in Feburary and 9% in August as well as April-to-June. Urbanization and the sex-ratio explain 88% of the variability in mortality in Jamaica, with urbanization explaining 79.9% of the variability and the sex-ratio contributing the remaining 8.1%. Conclusion: The results presented in this study speaks to the dominance of urbanization in the mortality discourse, urbanization’s role in reducing life expectancy and that the time as well as the sex-ratio, which offers some insights into changes in mortality. These findings offer policy makers critical information that can be used to develop intervention programmes as well as provide scholars with new insights into the mortality discourse.

To develop a nomogram for femtosecond laser astigmatic keratotomy (AK) to treat post-keratoplasty astigmatism.Three academic medical centers.Retrospective interventional case series.A review of post-keratoplasty femtosecond laser AK was performed. Uncorrected (UDVA) and corrected (CDVA) distance visual acuities, manifest refraction, and keratometry were recorded preoperatively and 1, 3, 6, and 12 months postoperatively. The location, length, depth, and diameter of the AK incisions were recorded, and the surgically induced astigmatic correction was related to these variables using regression analysis.One hundred forty femtosecond laser AK procedures were performed after penetrating keratoplasty (PKP) (n = 129) or deep anterior lamellar keratoplasty (DALK) (n =11), with 89 procedures (80 PKP, 9 DALK) included in the analysis. The mean CDVA improved from 20/59 (0.47 logMAR ± 0.38 [SD]) preoperatively to 20/45 (0.35 ± 0.31 logMAR) postoperatively (P = .013) (n = 46). The mean keratometric astigmatism decreased from 8.26 ± 2.90 diopters (D) preoperatively to 3.62 ± 2.59 D postoperatively (P.0001) (n = 89). The mean refractive cylinder decreased from 6.77 ± 2.80 D preoperatively to 2.85 ± 2.57 D postoperatively (P.0001) (n = 69). A nomogram for femtosecond laser AK to treat post-keratoplasty astigmatism was generated using regression analysis.Femtosecond laser AK significantly improved UDVA and CDVA and significantly reduced keratometric astigmatism and refractive cylinder after keratoplasty. The nomogram generated should improve the accuracy of post-keratoplasty femtosecond laser AK.None of the authors has a financial or proprietary interest in any material or method mentioned.

Dry eye syndrome is a disease of the ocular surface and tear film that is prevalent in older adults. Even though the degree of visual acuity loss in dry eye patients is commonly mild-to-moderate, in the aging population, this minimal change in visual status can lead to a significant decrease in visual function and quality of life. A healthy ocular surface is maintained by appropriate tear production and tear drainage, and deficiencies in this delicate balance can lead to dryness. In the aging eye, risk factors such as polypharmacy, androgen deficiency, decreased blink rates, and oxidative stress can predispose the patient to developing dry eye that is frequently more severe, has higher economic costs, and leads to worse consequences to the well-being of the patient. Understanding why elderly patients are at higher risk for developing dry eyes can provide insights into the diagnosis and management of the growing number of older adults struggling with dry eye and minimize the burden of disease on our aging population.

The distal arm of the fourth (“dot”) chromosome of Drosophila melanogaster is unusual in that it exhibits an amalgamation of heterochromatic properties (e.g., dense packaging, late replication) and euchromatic properties (e.g., gene density similar to euchromatic domains, replication during polytenization). To examine the evolution of this unusual domain, we undertook a comparative study by generating high-quality sequence data and manually curating gene models for the dot chromosome of D. virilis (Tucson strain 15010–1051.88). Our analysis shows that the dot chromosomes of D. melanogaster and D. virilis have higher repeat density, larger gene size, lower codon bias, and a higher rate of gene rearrangement compared to a reference euchromatic domain. Analysis of eight “wanderer” genes (present in a euchromatic chromosome arm in one species and on the dot chromosome in the other) shows that their characteristics are similar to other genes in the same domain, which suggests that these characteristics are features of the domain and are not required for these genes to function. Comparison of this strain of D. virilis with the strain sequenced by the Drosophila 12 Genomes Consortium (Tucson strain 15010–1051.87) indicates that most genes on the dot are under weak purifying selection. Collectively, despite the heterochromatin-like properties of this domain, genes on the dot evolve to maintain function while being responsive to changes in their local environment.

GATA-4 is a key member of the GATA family of transcription factors involved in cardiac development and growth as well as in cardiac hypertrophy and heart failure. Our previous studies suggest that GATA-4 protein synthesis may be translationally regulated. We report here that the 518-nt long 5'-untranslated region (5'-UTR) of the GATA-4 mRNA, which is predicted to form stable secondary structures (-65 kcal/mol) such as to be inhibitory to cap-dependent initiation, confers efficient translation to monocistronic reporter mRNAs in cell-free extracts. Moreover, uncapped GATA-4 5'-UTR containing monocistronic reporter mRNAs continue to be well translated while capped reporters are insensitive to the inhibition of initiation by cap-analog, suggesting a cap-independent mechanism of initiation. Utilizing a dicistronic luciferase mRNA reporter containing the GATA-4 5'-UTR within the intercistronic region, we demonstrate that this leader sequence confers functional internal ribosome entry site (IRES) activity. The activity of the GATA-4 IRES is unaffected in trans-differentiating P19CL6 cells, however, is strongly stimulated immediately following arginine-vasopressin exposure of H9c2 ventricular myocytes. IRES activity is then maintained at submaximal levels during hypertrophic growth of these cells. Supraphysiological Ca(2+) levels diminished stimulation of IRES activity immediately following exposure to vasopressin and inhibition of protein kinase C activity utilizing a pseudosubstrate peptide sequence blocked IRES activity during hypertrophy. Thus, our data suggest a mechanism for GATA-4 protein synthesis under conditions of reduced global cap-dependent translation, which is maintained at a submaximal level during hypertrophic growth and point to the regulation of GATA-4 IRES activity by sarco(ER)-reticular Ca(2+) stores and PKC.

Inhibitors of the mammalian target of rapamycin (mTOR), such as rapamycin and CCI-779, have potential as anti-tumor agents against multiple myeloma (MM). In a murine xenograft model, CCI-779 demonstrated efficacy against in vivo growth of OPM-2 and 8226 MM cells. In this model, OPM-2 tumors (ED50=2 mg/kg) were considerably more sensitive than 8226 (ED50=20 mg/kg) tumors. CCI-779-induced anti-tumor responses were associated with significant inhibition of proliferation and angiogenesis and concomitant upregulation of apoptosis. OPM-2 cells were also significantly more sensitive to these CCI-779-mediated effects. Other tumor models have demonstrated that heightened AKT activity induces hypersensitivity to mTOR inhibitors. As OPM-2 cells express high levels of activated AKT (due to PTEN mutations) and 8226 cells contain predominantly quiescent AKT, this regulatory role for AKT may be present in MM cells as well. To further test this, we stably expressed an activated AKT allele in U266 (U266myr-AKT) MM cells. The in vivo growth of U266myr-AKT cells was considerably more sensitive than control U266 cells to the anti-tumor effects of CCI-779. The differential sensitivity induced by AKT activation was mirrored in an enhanced sensitivity to CCI-779-mediated apoptosis and inhibition of angiogenesis. Since previous studies demonstrated the ability of AKT/mTOR to regulate the expression of vascular endothelial growth factor (VEGF), we hypothesized that MM cells with heightened AKT activity may be more sensitive to the CCI-779-mediated inhibition of this critical angiogenic factor. In vitro, mTOR inhibitor, rapamycin, was markedly more effective at inhibiting VEGF secretion from U266myr-AKT than control cells. Our results demonstrate that AKT regulates the sensitivity of MM cells to the anti-tumor effects of mTOR inhibitors and that this may be mediated through the inhibition of AKT-dependent survival and growth factors.