text stringlengths 0 3.86k |
|---|
Most rails are secretive wetland birds that have made little cultural impression , but as a formerly common farmland bird with a loud nocturnal call that sometimes led to disturbed sleep for rural dwellers , the corn crake has acquired a variety of folk names and some commemoration in literature .
|
= = = Names = = =
|
The favoured name for this species among naturalists has changed over the years , with " landrail " and variants of " corncrake " being preferred at various times . " Crake gallinule " also had a period of popularity between 1768 and 1813 . The originally Older Scots " cornecrake " was popularised by Thomas Bewick , w... |
= = = In literature = = =
|
Corn crakes are the subject of three stanzas of the seventeenth century poet Andrew Marvell 's " Upon Appleton House " , written in 1651 about the North Yorkshire country estate of Thomas Fairfax . The narrator depicts the scene of a mower cutting the grass , before his " whistling Sithe " unknowingly " carves the Rai... |
John Clare , the nineteenth @-@ century English poet based in Northamptonshire , wrote " The Landrail " , a semi @-@ comic piece which is primarily about the difficulty of seeing corn crakes – as opposed to hearing them . In the fourth verse he exclaims : " Tis like a fancy everywhere / A sort of living doubt " . Clar... |
The Finnish poet Eino Leino also wrote about the bird in his poem " Nocturne " .
|
The proverbial use of the corn crake 's call to describe someone with a grating or unmelodious voice is illustrated in the quotation " thanks to a wee woman with a voice like a corncrake who believed she was an apprentice angel " . This usage dates from at least the first half of the nineteenth century , and continues... |
= Acute myeloid leukemia =
|
Acute myeloid leukemia ( AML ) , also known as acute myelogenous leukemia or acute nonlymphocytic leukemia ( ANLL ) , is a cancer of the myeloid line of blood cells , characterized by the rapid growth of abnormal white blood cells that accumulate in the bone marrow and interfere with the production of normal blood cel... |
The symptoms of AML are caused by replacement of normal bone marrow with leukemic cells , which causes a drop in red blood cells , platelets , and normal white blood cells . These symptoms include fatigue , shortness of breath , easy bruising and bleeding , and increased risk of infection . Several risk factors and ch... |
AML has several subtypes ; treatment and prognosis vary among subtypes . AML is cured in 35 – 40 % of people less than 60 years old and 5 – 15 % more than 60 years old . Older people who are not able to withstand intensive chemotherapy have an average survival of 5 – 10 months .
|
AML is treated initially with chemotherapy aimed at inducing a remission ; people may go on to receive additional chemotherapy or a hematopoietic stem cell transplant . Recent research into the genetics of AML has resulted in the availability of tests that can predict which drug or drugs may work best for a particular... |
= = Signs and symptoms = =
|
Most signs and symptoms of AML are caused by the replacement of normal blood cells with leukemic cells . A lack of normal white blood cell production makes people more susceptible to infections ; while the leukemic cells themselves are derived from white blood cell precursors , they have no infection @-@ fighting capa... |
The early signs of AML are often vague and nonspecific , and may be similar to those of influenza or other common illnesses . Some generalized symptoms include fever , fatigue , weight loss or loss of appetite , shortness of breath , anemia , easy bruising or bleeding , petechiae ( flat , pin @-@ head sized spots unde... |
Enlargement of the spleen may occur in AML , but it is typically mild and asymptomatic . Lymph node swelling is rare in AML , in contrast to acute lymphoblastic leukemia . The skin is involved about 10 % of the time in the form of leukemia cutis . Rarely , Sweet 's syndrome , a paraneoplastic inflammation of the skin ... |
Some people with AML may experience swelling of the gums because of infiltration of leukemic cells into the gum tissue . Rarely , the first sign of leukemia may be the development of a solid leukemic mass or tumor outside of the bone marrow , called a chloroma . Occasionally , a person may show no symptoms , and the l... |
= = Risk factors = =
|
A number of risk factors for developing AML have been identified , including : other blood disorders , chemical exposures , ionizing radiation , and genetics .
|
= = = Preleukemia = = =
|
" Preleukemic " blood disorders , such as myelodysplastic syndrome ( MDS ) or myeloproliferative disease ( MPS ) , can evolve into AML ; the exact risk depends on the type of MDS / MPS .
|
= = = Chemical exposure = = =
|
Exposure to anticancer chemotherapy , in particular alkylating agents , can increase the risk of subsequently developing AML . The risk is highest about three to five years after chemotherapy . Other chemotherapy agents , specifically epipodophyllotoxins and anthracyclines , have also been associated with treatment @-... |
Occupational chemical exposure to benzene and other aromatic organic solvents is controversial as a cause of AML . Benzene and many of its derivatives are known to be carcinogenic in vitro . While some studies have suggested a link between occupational exposure to benzene and increased risk of AML , others have sugges... |
= = = Radiation = = =
|
High amounts of ionizing radiation exposure can increase the risk of AML . Survivors of the atomic bombings of Hiroshima and Nagasaki had an increased rate of AML , as did radiologists exposed to high levels of X @-@ rays prior to the adoption of modern radiation safety practices . People treated with ionizing radiati... |
= = = Genetics = = =
|
A hereditary risk for AML appears to exist . Multiple cases of AML developing in a family at a rate higher than predicted by chance alone have been reported . Several congenital conditions may increase the risk of leukemia ; the most common is probably Down syndrome , which is associated with a 10- to 18 @-@ fold incr... |
= = Diagnosis = =
|
The first clue to a diagnosis of AML is typically an abnormal result on a complete blood count . While an excess of abnormal white blood cells ( leukocytosis ) is a common finding , and leukemic blasts are sometimes seen , AML can also present with isolated decreases in platelets , red blood cells , or even with a low... |
Marrow or blood is examined under light microscopy , as well as flow cytometry , to diagnose the presence of leukemia , to differentiate AML from other types of leukemia ( e.g. acute lymphoblastic leukemia - ALL ) , and to classify the subtype of disease . A sample of marrow or blood is typically also tested for chrom... |
Cytochemical stains on blood and bone marrow smears are helpful in the distinction of AML from ALL , and in subclassification of AML . The combination of a myeloperoxidase or Sudan black stain and a nonspecific esterase stain will provide the desired information in most cases . The myeloperoxidase or Sudan black react... |
The diagnosis and classification of AML can be challenging , and should be performed by a qualified hematopathologist or hematologist . In straightforward cases , the presence of certain morphologic features ( such as Auer rods ) or specific flow cytometry results can distinguish AML from other leukemias ; however , i... |
The two most commonly used classification schemata for AML are the older French @-@ American @-@ British ( FAB ) system and the newer World Health Organization ( WHO ) system . According to the widely used WHO criteria , the diagnosis of AML is established by demonstrating involvement of more than 20 % of the blood an... |
Because acute promyelocytic leukemia ( APL ) has the highest curability and requires a unique form of treatment , it is important to quickly establish or exclude the diagnosis of this subtype of leukemia . Fluorescent in situ hybridization performed on blood or bone marrow is often used for this purpose , as it readil... |
= = = World Health Organization = = =
|
The WHO 2008 classification of acute myeloid leukemia attempts to be more clinically useful and to produce more meaningful prognostic information than the FAB criteria . Each of the WHO categories contains numerous descriptive subcategories of interest to the hematopathologist and oncologist ; however , most of the cl... |
The WHO subtypes of AML are :
|
Acute leukemias of ambiguous lineage ( also known as mixed phenotype or biphenotypic acute leukemia ) occur when the leukemic cells can not be classified as either myeloid or lymphoid cells , or where both types of cells are present .
|
= = = French @-@ American @-@ British = = =
|
The French @-@ American @-@ British ( FAB ) classification system divides AML into eight subtypes , M0 through to M7 , based on the type of cell from which the leukemia developed and its degree of maturity . This is done by examining the appearance of the malignant cells with light microscopy and / or by using cytogen... |
Eight FAB subtypes were proposed in 1976 .
|
The morphologic subtypes of AML also include rare types not included in the FAB system , such as acute basophilic leukemia , which was proposed as a ninth subtype , M8 , in 1999 .
|
= = Pathophysiology = =
|
The malignant cell in AML is the myeloblast . In normal hematopoiesis , the myeloblast is an immature precursor of myeloid white blood cells ; a normal myeloblast will gradually mature into a mature white blood cell . In AML , though , a single myeloblast accumulates genetic changes which " freeze " the cell in its im... |
Much of the diversity and heterogeneity of AML stems is because leukemic transformation can occur at a number of different steps along the differentiation pathway . Modern classification schemes for AML recognize the characteristics and behavior of the leukemic cell ( and the leukemia ) may depend on the stage at whic... |
Specific cytogenetic abnormalities can be found in many people with AML ; the types of chromosomal abnormalities often have prognostic significance . The chromosomal translocations encode abnormal fusion proteins , usually transcription factors whose altered properties may cause the " differentiation arrest " . For ex... |
The clinical signs and symptoms of AML result from the growth of leukemic clone cells , which tends to displace or interfere with the development of normal blood cells in the bone marrow . This leads to neutropenia , anemia , and thrombocytopenia . The symptoms of AML are , in turn , often due to the low numbers of th... |
An important pathophysiological mechanism of leukemogenesis in AML is the epigenetic induction of dedifferentiation by genetic mutations that alter the function of epigenetic enzymes , such as the DNA demethylase TET2 and the metabolic enzymes IDH1 and IDH2 , which lead to the generation of a novel oncometabolite , D ... |
= = Treatment = =
|
First @-@ line treatment of AML consists primarily of chemotherapy , and is divided into two phases : induction and postremission ( or consolidation ) therapy . The goal of induction therapy is to achieve a complete remission by reducing the number of leukemic cells to an undetectable level ; the goal of consolidation... |
= = = Induction = = =
|
All FAB subtypes except M3 are usually given induction chemotherapy with cytarabine ( ara @-@ C ) and an anthracycline ( most often daunorubicin ) . This induction chemotherapy regimen is known as " 7 + 3 " ( or " 3 + 7 " ) , because the cytarabine is given as a continuous IV infusion for seven consecutive days while ... |
The M3 subtype of AML , also known as acute promyelocytic leukemia ( APL ) , is almost universally treated with the drug all @-@ trans @-@ retinoic acid ( ATRA ) in addition to induction chemotherapy , usually an anthracycline . Care must be taken to prevent disseminated intravascular coagulation ( DIC ) , complicatin... |
The goal of the induction phase is to reach a complete remission . Complete remission does not mean the disease has been cured ; rather , it signifies no disease can be detected with available diagnostic methods . Complete remission is obtained in about 50 % – 75 % of newly diagnosed adults , although this may vary ba... |
= = = Consolidation = = =
|
Even after complete remission is achieved , leukemic cells likely remain in numbers too small to be detected with current diagnostic techniques . If no further postremission or consolidation therapy is given , almost all people with AML will eventually relapse . Therefore , more therapy is necessary to eliminate nonde... |
The specific type of postremission therapy is individualized based on a person 's prognostic factors ( see above ) and general health . For good @-@ prognosis leukemias ( i.e. inv ( 16 ) , t ( 8 ; 21 ) , and t ( 15 ; 17 ) ) , people will typically undergo an additional three to five courses of intensive chemotherapy ,... |
For people who are not eligible for a stem cell transplant , immunotherapy with a combination of histamine dihydrochloride ( Ceplene ) and interleukin 2 ( Proleukin ) after the completion of consolidation has been shown to reduce the absolute relapse risk by 14 % , translating to a 50 % increase in the likelihood of m... |
= = = Relapsed AML = = =
|
For people with relapsed AML , the only proven potentially curative therapy is a hematopoietic stem cell transplant , if one has not already been performed . In 2000 , the monoclonal antibody @-@ linked cytotoxic agent gemtuzumab ozogamicin ( Mylotarg ) was approved in the United States for people aged more than 60 ye... |
Since treatment options for relapsed AML are so limited , palliative care or enrolment in a clinical trial may be offered .
|
For relapsed acute promyelocytic leukemia ( APL ) , arsenic trioxide is approved by the US FDA . Like ATRA , arsenic trioxide does not work with other subtypes of AML .
|
Subsets and Splits
No community queries yet
The top public SQL queries from the community will appear here once available.