Endocrine function was assessed in 31 children (17 boys) after fractionated total body irradiation used in the preparative regimen for bone marrow transplantation. Endocrine dysfunction was present in 25 children. Fifteen of 29 had growth hormone insufficiency 0-9-4-9 years after total body irradiation, yet only three of the 15 had received previous cranial irradiation. Five of 30 had thyroid dysfunction: two with a low thyroxine and raised thyroid stimulating hormone (TSH) concentration and three with a raised TSH and normal thyroxine concentration. Thus the incidence of thyroid dysfunction (16%) is much lower than that reported after single fraction total body irradiation (39-59%). In only two children were abnormalities of the hypothalamicpituitary-adrenal axis demonstrated. The majority of pubertal children assessed (n= 15) showed evidence of gonadal damage. All the pubertal girls (n=5) had ovarian failure, although there was evidence of recovery of ovarian function in one girl. All seven boys in late puberty showed evidence of damage to the germinal epithelium, and two of three in early puberty had raised follicle stimulating hormone concentrations. Despite the use of a fractionated total body irradiation regimen, endocrine morbidity is substantial and children undergoing such procedures wili require long term endocrine review and management.
children with acute myeloid leukaemia (AML) were treated in the MRC AML 10 trial. Three risk groups were identified based on cytogenetics and response to treatment. One hundred and twenty-five children relapsed -103 in the bone marrow only, 12 in the bone marrow combined with other sites, and six had isolated extramedullary relapses (site was not known in four cases). Eighty-seven children received further combination chemotherapy, one all-trans retinoic acid for acute promyelocytic leukaemia, and one a matched unrelated donor allograft in relapse, and 61 achieved a second remission. One patient with no details on reinduction therapy also achieved second remission. Treatment in second remission varied -44 children received a BMT (22 autografts, 12 matched unrelated donor allografts, 10 family donor allografts), and 17 were treated with chemotherapy alone. The overall survival rate for all children (treated and untreated) was 24% at 3 years, with a disease-free survival of 44% for those achieving a second remission. Length of first remission was the most important factor affecting response rates -children with a first remission of less than 1 year fared poorly (second remission rate 36%, 3 year survival 11%), whereas those with longer first remissions had a higher response rate (second remission rate 75%, 3 year survival 49%, P Ͻ 0.0001).
The clinical features, cytogenetics and response to treatment have been examined in 180 infants (aged Ͻ1 year) with acute leukaemia; 118 with acute lymphoblastic leukaemia (ALL) and 62 with acute myeloid leukaemia (AML). Comparison of clinical features showed no difference in age or sex distribution between infants with ALL and AML but infants with ALL tended to have higher leucocyte counts at presentation. Cytogenetic abnormalities involving 11q23 were found in 66% of ALL and 35% of AML cases, the commonest, t(4;11) being found only in ALL. The other recognised 11q23 translocations were found in both types of leukaemia. Few patients had the common cytogenetic abnormalities associated with ALL in older children and few with AML had good risk abnormalities. Four year eventfree survival 60% cf 30% (P = 0.001) and survival 65% cf 41% (P = 0.007) were significantly better in AML than ALL. These results were due to a lower risk of relapse 27% cf 62% at four years. Superior event-free survival was also seen in the subgroup of patients with 11q23 abnormalities and AML (55% cf 23%). The reasons for superior response in AML are unknown but may be related to the intensity of treatment, lineage of the leukaemia or other as yet unidentified factors. Leukemia (2002) 16, 776-784.
if (i) sufficient heat units are available to promote cover crop growth, root exploration, and N uptake during fall and winter; and (ii) mineralization rates of the green-Overwinter N leaching increases the potential for NO 3 contamination of ground water under irrigated desert soils. Our objectives were manured residues in the spring coincide with the timing to (i) identify winter cover crops for recovering N and (ii) determine of cash crop N demand. Effective fall-sown cover crops the N availability following green manure cover crops relative to N should exhibit rapid germination, aggressive and extenuptake by a succeeding potato (Solanum tuberosum L.) crop. A 2-yr sive rooting systems (Sainju et al., 1998), good winter field study was conducted on commercial fields on Quincy loamy hardiness, and early spring regrowth. Cereal and brassand (mixed mesic Xeric Torripsamments). Cover crops were seeded sica crops display these characteristics and are well following sweet corn (Zea mays L.) as fall-incorporated sudangrass suited for winter cover cropping (Wagger and Mengel, (Sorghum bicolor L., 'Sordan'); fall-and spring-incorporated white 1988; Brinsfield and Staver, 1991). These cover crops mustard (Brassica hirta Moench, 'Martegena'); and spring-incorpocan accumulate up to 150 kg N ha Ϫ1 (Hoyt and Mikrated wheat (Triticum aestivum L., 'Stevens'), rapeseed (B. napus kelsen, 1991; Shennan, 1992; Ditsch et al., 1993), with L., 'Jupiter'), and rye (Secale cereale L.). Potato ('Russet Burbank') was planted 3 to 5 wk after spring incorporation of green manures. rooting systems reaching depths of between 80 and 150All cover crops except sudangrass accumulated 112 to 142 kg N ha Ϫ1 cm Sarrantonio, 1992). when planted in August at Plymouth, WA, but N uptake was de-Following green manure incorporation, cover crops creased by Ͼ50% when planted in September at Quincy, WA. Overmay supply 20 to 55% of the recovered N to the subsewintering cover crops lowered soil mineral N at 0 to 180 cm by 155 quent crop (Sims and Slinkard, 1991; Malpassi et al., kg N ha Ϫ1 compared with bare fallow at Plymouth. Fall-incorporated 2000). Subsequent fertilizer requirements can be greatly mustard released greater inorganic N over the winter compared with reduced or eliminated (Griffin et al., 2000) if N release is spring incorporation. Soil NH 4 and NO 3 increased following overwinsynchronized with N demand of the succeeding summer tering cover crops by potato planting, providing timely increases in crop (Stute and Posner, 1995). Poor synchronization N availability to the potato crop. Winter cover crops can improve N or delays in N mineralization of cover crop residue, cycling and reduce the amount of N below the root zone in potatobased rotations.
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