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Acquired aplastic anemia - bone marrow histology complemented by immunohistochemistry in identifying unfavorable prognosis, defined by progression to MDS/AML: a comparison between children and adults
No full textAnemia aplástica adquirida (AAA) é doença rara e seu diagnóstico diferencial inclui a Síndrome mielodisplásica hipocelular (SMD-h). A evolução de AAA para SMD/LMA (Síndrome mielodisplásica/Leucemia mieloide aguda) ocorre em até 15% dos casos. Este estudo propõe-se a comparar parâmetros histológicos e imuno-histoquímicos de pacientes adultos e crianças com AAA que evoluíram e não para SMD/LMA. Seu objetivo é avaliar a ocorrência dos critérios morfológicos/imunofenotípicos nas biópsias de medula óssea do grupo pediátrico (<19 anos) com o grupo de adultos, comparar esses critérios associados à evolução para SMD/LMA nestes dois grupos e verificar se estes critérios superpõem-se àqueles descritos na literatura na SMD-hipocelular do adulto e, mais recentemente, na SMD pediátrica (Citopenia refratária da infância - CRI). Espera-se trazer uma contribuição para a discussão da intersecção entre essas entidades e a AAA, estudando essa \"zona cinzenta\" do ponto de vista dos pacientes com AAA, particularmente aqueles que progrediram para SMD/LMA. Foram analisadas, retrospectivamente, 118 biópsias de medula óssea ao diagnóstico de AAA, idiopática ou não, realizadas no Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo entre 1993 e 2012. O diagnóstico de AAA foi estabelecido de acordo com critérios clássicos. A evolução de AAA para SMD ou LMA foi considerada na presença de: disgranulopoese ou dismegacariopoese acentuadas, mais de 15% de sideroblastos em anel, blastos em sangue periférico ou mais de 5% de blastos na medula óssea ao mielograma e/ou à biópsia de medula óssea ou na presença de estudo citogenético (FISH ou cariótipo) da medula óssea, apresentando monossomia ou deleção do braço longo do cromossomo 7. Todas as biópsias foram submetidas à análise morfológica e imuno-histoquímica (MPO, Glicoforina A, Fator VIII, CD34, CD117 e Ki-67) por dois hematopatologistas sem conhecimento prévio da evolução dos pacientes. As variáveis qualitativas nominais foram analisadas pelo teste exato de Fisher para verificar se houve desproporção significativa entre os grupos. As variáveis qualitativas ordinais foram analisadas para a diferença entre os grupos pelo teste de Mann-Whitney. O nível de significância adotado foi 5% (p=0,05). A correlação entre os valores de celularidade geral das amostras e seu índice proliferativo foi avaliada pelo teste não paramétrico Rô de Spearman. Setenta e um pacientes (60,2%) eram do gênero masculino com mediana de idade 24,4 anos (mínimo de 7 meses até 76 anos), 42 do grupo pediátrico e 76 adultos, e tempo de seguimento de 5,1 anos (de 1 mês a 22,1 anos). Doze (10,2%) (seis em cada grupo) pacientes evoluíram para SMD/LMA. Avaliação dos parâmetros morfológicos e imuno-histoquímicos mostrou distribuição irregular do tecido hematopoético em 59 (50%) casos, mediana de celularidade geral de 10% (de 1% a 40%), distúrbio de maturação da série granulocítica (critério 1) em três (2,5%) casos, localização anormal da eritropoiese em 13 (11%) casos, agregados de pelo menos 20 precursores eritroides (critério 2), em 54 (45,7%) casos, presença de formas jovens eritroides (proeritroblastos) (critério 3) em 32 (27,1%) casos, aumento do número de mitoses dos elementos eritroides (critério 4) em 24 (20,3%) casos, displasia de megacariócitos (micromegacariócitos, megacariócitos bi ou multinucleados e elementos hipo ou monolobados) (critério 5) em 15 (12,7%) casos, localização anormal de megacariócitos em quatro (3,3%) casos, megacariócitos CD34-positivos não foram identificados, blastos CD34-positivos em 11 (9,3%) casos, reticulogênese discretamente aumentada (grau 1) em três (2,5%) casos e índice proliferativo (Ki-67) com mediana de 30 (de 0% a 90%). Critérios descritos por Bennett e Orazi sugestivos de SMD-h (critérios 1 e/ou 5) foram detectados em 16 (13,6%) casos. Critérios descritos por Baumann et al. sugestivos de SMD da infância (critérios 2 + 3 com ou sem 4) foram observados em 30 (25,4%) casos. Não houve diferença estatística nos achados morfológicos/imuno-histoquímicos entre a população total, adultos e crianças que evoluíram e que não evoluíram para SMD/LMA, incluindo a presença de critérios Bennett e Orazi para SMD-h do adulto. Houve diferença quanto aos critérios de Baumann et al. para CRI, e o grupo que não evoluiu para SMD/LMA apresentou com mais frequência os critérios do que o que evoluiu (p=0,036), ao contrário do previamente suposto. No entanto, ao testar esta hipótese no grupo adulto separado do pediátrico, a diferença estatística não foi comprovada. Houve uma correlação estatisticamente significante entre os valores da celularidade geral das amostras e seu índice proliferativo (p < 0,001). Pacientes adultos e pediátricos com AAA, incluindo os que evoluíram para SMD/LMA, têm características morfológicas/imuno-histoquímicas semelhantes. Algumas alterações descritas por Baumann et al. para SMD pediátrica são também encontradas em casos pediátricos e de adultos com AAA. Além disso, o índice proliferativo pode ser aumentado em casos de AAA, este dado não tem correlação com a evolução para SMD/LMA. Alterações morfológicas/imuno-histoquímicas em biópsias de medula óssea em AAA não identificaram um grupo com maior risco de progressão para SMD/LMA em nossa casuísticaAcquired Aplastic Anemia (AAA) is a rare disease which progresses to MDS / AML in up to 15% of cases. When this happens, hematopathologists are asked whether the diagnosis of hypocellular Myelodisplastic Syndrome (h-MDS) would not have been confused morphologically with aplastic anemia. This study aims to identify morphological/immunophenotypical findings that could predict this adverse prognosis in adults and children ( < 19y) diagnosed as AAA and verify if those criteria match with the ones described in literature in adult h-MDS and, more recently, in pediatric MDS (Refractory cytopenia of childhood - RCC), contributing to the discussion of this \"grey zone\". We retrospectively analyzed 118 patients/bone marrow (BM) biopsies at the moment of AAA diagnosis at Clinical Hospital of São Paulo Medical School from 1993 to 2012. Diagnosis of AAA was carried out according to classical criteria. Evolution to MDS or AML was considered in the presence of at least one of the findings: significant dysgranulopoiesis or dysmegakaryocytopoiesis, more than 15% ring sideroblasts, blasts in peripheral blood or more than 5% blasts in bone marrow smear and/or biopsy, or in the presence of monosomy or deletion of the long arm of chromosome 7 by cytogenetic analysis (FISH or karyotype) of the BM. All biopsies were submitted to morphological and immunophenotypic (MPO, Glycophorin A, Factor VIII, CD34, CD117 and Ki67) evaluation by two hematopathologists without previous knowledge about the evolution of the patients. Nominal qualitative variables were analyzed by using Fisher\'s exact test to check significant disproportion between the groups. The ordinal qualitative variables were analyzed for differences between groups by Mann-Whitney test. The significance level was 5% (p = 0.05). The correlation between the overall cellularity values of the samples and their proliferative index was evaluated by nonparametric Spearman Rô test. Seventy-one (60,2%) were male, median age 24.4 years (7 months to 76 years old), 42 belongs to the pediatric group and 76 to the adults group. Median follow-up was 5.1y (range, 1 month to 22.1 years). Twelve patients (12%) (6 in each group) progressed to MDS/AML. Evaluation of morphological/immunohistochemical parameters showed irregular distribution of hematopoietic tissue in 59 (50%) cases, median BM overall cellularity of 10% (range, 1 to 40%), marrow dysgranulopoiesis (criteria 1) in 3 (2,5%) cases, abnormal localization of erythropoiesis in 13 (11%) cases, clusters of at least 20 erythroid precursors (criteria 2) in 54 (45.7%) cases, increased number of proerythroblasts (criteria 3) in 32 (27,1%) cases, increased number of mitoses of the erythroid elements (criteria 4) in 24 (20,3%) cases, marrow dysplasia of megakaryocytes (micromegakaryocytes , two or more separeted nuclei, small round nuclei) (criteria 5) in 15 (12,7%) cases, abnormal localization of megakaryocytes in 4 (3,3%) cases, CD34-positive megakaryocytes were not identified, CD34-positive blast cells (criteria 6) in 11 (9,3%) cases, increment in reticulin fibers in 3 (2,5%) cases, and median proliferative index (Ki-67) 30 (range, 0 to 90%). Criteria described by Bennett and Orazi suggestive of h-SMD (criteria 1 and/or 5) were detected in 16 (13,6%) cases. Criteria described by Baumann et al suggestive of childhood MDS (criteria 2 + 3 with or without 4) were observed in 30 (25.4%) cases. There was no statistical difference in morphological/immunohistochemical findings among total population, adults and children who developed and did not develop MDS/AML, including the presence of Bennett and Orazi criteria for h-MDS. Regarding Baumann et al criteria were more frequently identified in the group that did not progress to MDS/AML than the one that did (p=0,036), the opposite of what was expected. But when the criteria were tested in pediatric and adults\' groups separately, the statistical significance was no longer observed. There was a statistical significant correlation between the overall cellularity values of the samples and their proliferative index (p=0,001). Adult and pediatric patients with AAA, including those that progress to MDS/AML, have similar morphological/immunohistochemical characteristics. Some changes described by Baumann et al for pediatric MDS are also found in pediatric and adults\' cases with AAA. In addition, the proliferative index may be increased in cases of AAA and this finding has no correlation with progression to MDS/AML. Morphological/immunohistochemical changes in bone marrow biopsies in AAA have failed to identify a group at higher risk for progression to MDS/AML in our serie
Going Beyond Counting First Authors in Author Co-citation Analysis
Get PDFThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Get PDF“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Appropriate Similarity Measures for Author Cocitation Analysis
Get PDFWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
Dispelling the Myths Behind First-author Citation Counts
Get PDFWe conducted a full-scale evaluative citation analysis study of scholars in the XML research field to explore just how different from each other author rankings resulting from different citation counting methods actually are, and to demonstrate the capability of emerging data and tools on the Web in supporting more realistic citation counting methods. Our results contest some common arguments for the continued
use of first-author citation counts in the evaluation of scholars, such as high correlations between author rankings by first-author citation counts and other citation
counting methods, and high costs of using more realistic citation counting methods that are not well-supported by the ISI databases. It is argued that increasingly available digital full text research papers make it possible for citation analysis studies to go beyond what the ISI databases have directly supported and to employ more
sophisticated methods
koamabayili/VECTRON-author-checklist: VECTRON author checklist
No full textWe have done our best to complete the author checklist relating to the use of animals in the hut study. Note that the objective for the hut study was to evaluate the IRS treatment applications for residual efficacy against Anopheles mosquitoes, including the local An. coluzzii mosquito population. Cows were only used to attract mosquitoes into the huts and no tests were carried out directly on the cows. The author checklist is intended for use with studies where experiments are carried out on animals, which is why we have had such difficulty in completing this for the hut study, as many of the questions do not relate to how the cows were used
Author-wise bibliometric analysis based on entropy.
No full textAuthor-wise bibliometric analysis based on entropy.</p
Author Under Sail The Imagination of Jack London, 1893-1902
No full textIn Author Under Sail, Jay Williams offers the first complete literary biography of Jack London as a professional writer engaged in the labor of writing. It examines the authorial imagination in London's work, the use of imagination in both his fiction and nonfiction, and the ways he defined imagination in the creative process in his business dealings with his publishers, editors, and agents. In this first volume of a two-volume biography, Williams traverses the years 1893 to 1902, from London's "Story of a Typhoon" to The People of the Abyss. The Jack London who emerges in the pages of Author Under Sail is a writer whose partnership with publishers, most notably his productive alliance with George Brett of Macmillan, was one of the most formative in American literary history. London pioneered many author models during the heyday of realism and naturalism, blurring the boundaries of these popular genres by focusing on absorption and theatricality and the representation of the seen and unseen. London created an impassioned, sincere, and extremely personal realism unlike that of other American writers of the time. Author Under Sail is a literary tour de force that reveals the full range of London as writer, creative citizen, and entrepreneur at the same time it sheds light on the maverick side of machine-age literature.Intro -- Title Page -- Copyright Page -- Dedication -- Contents -- Acknowledgments -- Introduction -- 1. Spirit Truth -- 2. From Absorption to Theatricality and Back Again -- 3. "I Will Build a New Present" -- 4. Sons as Authors -- 5. Fathers as Publishers -- 6. The Daughter as Author -- 7. Lovers as Authors -- 8. At Sea with the Family -- 9. Yellow News, Yellow Stories -- 10. The Return Home -- Notes -- Bibliography -- Index -- About Jay WilliamsIn Author Under Sail, Jay Williams offers the first complete literary biography of Jack London as a professional writer engaged in the labor of writing. It examines the authorial imagination in London's work, the use of imagination in both his fiction and nonfiction, and the ways he defined imagination in the creative process in his business dealings with his publishers, editors, and agents. In this first volume of a two-volume biography, Williams traverses the years 1893 to 1902, from London's "Story of a Typhoon" to The People of the Abyss. The Jack London who emerges in the pages of Author Under Sail is a writer whose partnership with publishers, most notably his productive alliance with George Brett of Macmillan, was one of the most formative in American literary history. London pioneered many author models during the heyday of realism and naturalism, blurring the boundaries of these popular genres by focusing on absorption and theatricality and the representation of the seen and unseen. London created an impassioned, sincere, and extremely personal realism unlike that of other American writers of the time. Author Under Sail is a literary tour de force that reveals the full range of London as writer, creative citizen, and entrepreneur at the same time it sheds light on the maverick side of machine-age literature.Description based on publisher supplied metadata and other sources.Electronic reproduction. Ann Arbor, Michigan : ProQuest Ebook Central, YYYY. Available via World Wide Web. Access may be limited to ProQuest Ebook Central affiliated libraries
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