Leukemia_Blood Cancer

• Acute leukemia is characterized by a rapid increase in the numbers of immature blood cells. Crowding due to such cells makes the bone marrow unable to produce healthy blood cells. Immediate treatment is required in acute leukemia due to the rapid progression and accumulation of the malignant cells, which then spill over into the bloodstream and spread to other organs of the body. Acute forms of leukemia are the most common forms of leukemia in children.
• Chronic leukemia is characterized by the excessive build up of relatively mature, but still abnormal, white blood cells. Typically taking months or years to progress, the cells are produced at a much higher rate than normal, resulting in many abnormal white blood cells. Whereas acute leukemia must be treated immediately, chronic forms are sometimes monitored for some time before treatment to ensure maximum effectiveness of therapy. Chronic leukemia mostly occurs in older people, but can theoretically occur in any age group.

Additionally, the diseases are subdivided according to which kind of blood cell is affected. This split divides leukemias into lymphoblastic or lymphocytic leukemias and myeloid or myelogenous leukemias:

• In lymphoblastic or lymphocytic leukemias, the cancerous change takes place in a type of marrow cell that normally goes on to form lymphocytes, infection-fighting immune system cells. Most lymphocytic leukemias involve a specific subtype of lymphocyte, the B cell.
• In myeloid or myelogenous leukemias, the cancerous change takes place in a type of marrow cell that normally goes on to form red blood cells, some other types of white cells, and platelets.

Combining these two classifications provides a total of four main categories. Within each of these four main categories, there are typically several subcategories. Finally, some rarer types are usually considered to be outside of this classification scheme.

• Acute lymphoblastic leukemia (ALL) is the most common type of leukemia in young children. This disease also affects adults, especially those age 65 and older. Standard treatments involve chemotherapy and radiotherapy. The survival rates vary by age: 85% in children and 50% in adults.^[4] Subtypes include precursor B acute lymphoblastic leukemia, precursor T acute lymphoblastic leukemia, Burkitt's leukemia, and acute biphenotypic leukemia.
• Chronic lymphocytic leukemia (CLL) most often affects adults over the age of 55. It sometimes occurs in younger adults, but it almost never affects children. Two-thirds of affected people are men. The five-year survival rate is 75%.^[5] It is incurable, but there are many effective treatments. One subtype is B-cell prolymphocytic leukemia, a more aggressive disease.
• Acute myelogenous leukemia (AML) occurs more commonly in adults than in children, and more commonly in men than women. AML is treated with chemotherapy. The five-year survival rate is 40%.^[6] Subtypes of AML include acute promyelocytic leukemia, acute myeloblastic leukemia, and acute megakaryoblastic leukemia.
• Chronic myelogenous leukemia (CML) occurs mainly in adults. A very small number of children also develop this disease. Treatment is with imatinib (Gleevec in US, Glivec in Europe) ^[7] or other drugs. The five-year survival rate is 90%.^[8][9] One subtype is chronic monocytic leukemia.
• Hairy cell leukemia (HCL) is sometimes considered a subset of CLL, but does not fit neatly into this pattern. About 80% of affected people are adult men. There are no reported cases in children. HCL is incurable, but easily treatable. Survival is 96% to 100% at ten years.^[10]
• T-cell prolymphocytic leukemia (T-PLL) is a very rare and aggressive leukemia affecting adults; somewhat more men than women are diagnosed with this disease.^[11] Despite its overall rarity, it is also the most common type of mature T cell leukemia;^[12] nearly all other leukemias involve B cells. It is difficult to treat, and the median survival is measured in months.
• Large granular lymphocytic leukemia may involve either T-cells or NK cells; like hairy cell leukemia, which involves solely B cells, it is a rare and indolent (not aggressive) leukemia.^[13]
• Adult T-cell leukemia is caused by human T-lymphotropic virus (HTLV), a virus similar to HIV. Like HIV, HTLV infects CD4+ T-cells and replicates within them; however, unlike HIV, it does not destroy them. Instead, HTLV "immortalizes" the infected T-cells, giving them the ability to proliferate abnormally.

[edit] Signs and symptoms

Common symptoms of chronic or acute leukemia^[14]

Damage to the bone marrow, by way of displacing the normal bone marrow cells with higher numbers of immature white blood cells, results in a lack of blood platelets, which are important in the blood clotting process. This means people with leukemia may easily become bruised, bleed excessively, or develop pinprick bleeds (petechiae).
White blood cells, which are involved in fighting pathogens, may be suppressed or dysfunctional. This could cause the patient's immune system to be unable to fight off a simple infection or to start attacking other body cells. Because leukemia prevents the immune system from working normally, some patients experience frequent infection, ranging from infected tonsils, sores in the mouth, or diarrhea to life-threatening pneumonia or opportunistic infections.
Finally, the red blood cell deficiency leads to anemia, which may cause dyspnea and pallor.
Some patients experience other symptoms, such as feeling sick, having fevers, chills, night sweats, feeling fatigued and other flu-like symptoms. Some patients experience nausea or a feeling of fullness due to an enlarged liver and spleen; this can result in unintentional weight loss. Blasts affected by the disease may come together and become swollen in the liver or in the lymph nodes causing pain and leading to nausea. ^[15]
If the leukemic cells invade the central nervous system, then neurological symptoms (notably headaches) can occur. All symptoms associated with leukemia can be attributed to other diseases. Consequently, leukemia is always diagnosed through medical tests.
The word leukemia, which means 'white blood', is derived from the disease's namesake high white blood cell counts that most leukemia patients have before treatment. The high number of white blood cells are apparent when a blood sample is viewed under a microscope. Frequently, these extra white blood cells are immature or dysfunctional. The excessive number of cells can also interfere with the level of other cells, causing a harmful imbalance in the blood count.
Some leukemia patients do not have high white blood cell counts visible during a regular blood count. This less-common condition is called aleukemia. The bone marrow still contains cancerous white blood cells which disrupt the normal production of blood cells, but they remain in the marrow instead of entering the bloodstream, where they would be visible in a blood test. For an aleukemic patient, the white blood cell counts in the bloodstream can be normal or low. Aleukemia can occur in any of the four major types of leukemia, and is particularly common in hairy cell leukemia.^[16]

[edit] Causes

No single known cause for any of the different types of leukemia exists. The known causes, which are not generally factors within the control of the average person, account for relatively few cases.^[17] The different leukemias likely have different causes.
Leukemia, like other cancers, results from mutations in the DNA. Certain mutations can trigger leukemia by activating oncogenes or deactivating tumor suppressor genes, and thereby disrupting the regulation of cell death, differentiation or division. These mutations may occur spontaneously or as a result of exposure to radiation or carcinogenic substances.^[18]
Among adults, the known causes are natural and artificial ionizing radiation, a few viruses such as Human T-lymphotropic virus, and some chemicals, notably benzene and alkylating chemotherapy agents for previous malignancies.^[19][20][21] Use of tobacco is associated with a small increase in the risk of developing acute myeloid leukemia in adults.^[19] Cohort and case-control studies have linked exposure to some petrochemicals and hair dyes to the development of some forms of leukemia. A few cases of maternal-fetal transmission have been reported.^[19] Diet has very limited or no effect, although eating more vegetables may confer a small protective benefit.^[17]
Viruses have also been linked to some forms of leukemia. Experiments on mice and other mammals have demonstrated the relevance of retroviruses in leukemia, and human retroviruses have also been identified. The first human retrovirus identified was Human T-lymphotropic virus, or HTLV-1, which is known to cause adult T-cell leukemia.^[22]
Some people have a genetic predisposition towards developing leukemia. This predisposition is demonstrated by family histories and twin studies.^[19] The affected people may have a single gene or multiple genes in common. In some cases, families tend to develop the same kind of leukemia as other members; in other families, affected people may develop different forms of leukemia or related blood cancers.^[19]
In addition to these genetic issues, people with chromosomal abnormalities or certain other genetic conditions have a greater risk of leukemia.^[20] For example, people with Down syndrome have a significantly increased risk of developing forms of acute leukemia (especially acute myeloid leukemia), and Fanconi anemia is a risk factor for developing acute myeloid leukemia.^[19]
Whether non-ionizing radiation causes leukemia has been studied for several decades. The International Agency for Research on Cancer expert working group undertook a detailed review of all data on static and extremely low frequency electromagnetic energy, which occurs naturally and in association with the generation, transmission, and use of electrical power.^[23] They concluded that there is limited evidence that high levels of ELF magnetic (but not electric) fields might cause childhood leukemia. Exposure to significant ELF magnetic fields might result in twofold excess risk for leukemia for children exposed to these high levels of magnetic fields.^[23] However, the report also says that methodological weaknesses and biases in these studies have likely caused the risk to be overstated.^[23] No evidence for a relationship to leukemia or another form of malignancy in adults has been demonstrated.^[23] Since exposure to such levels of ELFs is relatively uncommon, the World Health Organization concludes that ELF exposure, if later proven to be causative, would account for just 100 to 2400 cases worldwide each year, representing 0.2 to 4.9% of the total incidence of childhood leukemia for that year (about 0.03 to 0.9% of all leukemias).^[24]

[edit] Diagnosis

Diagnosis is usually based on repeated complete blood counts and a bone marrow examination following observations of the symptoms, however, in rare cases blood tests may not show if a patient has leukemia, usually this is because the leukemia is in the early stages or has entered remission. A lymph node biopsy can be performed as well in order to diagnose certain types of leukemia in certain situations.
Following diagnosis, blood chemistry tests can be used to determine the degree of liver and kidney damage or the effects of chemotherapy on the patient. When concerns arise about visible damage due to leukemia, doctors may use an X-ray, MRI, or ultrasound. These can potentially view leukemia's effects on such body parts as bones (X-ray), the brain (MRI), or the kidneys, spleen, and liver (ultrasound). Finally, CT scans are rarely used to check lymph nodes in the chest.
Despite the use of these methods to diagnose whether or not a patient has leukemia, many people have not been diagnosed because many of the symptoms are vague, unspecific, and can refer to other diseases. For this reason, the American Cancer Society predicts that at least one-fifth of the people with leukemia have not yet been diagnosed.^[16]
Mutation in SPRED1 gene has been associated with a predisposition to childhood leukemia.^[25] SPRED1 gene mutations can be diagnosed with genetic sequencing.

[edit] Treatment

Most forms of leukemia are treated with pharmaceutical medication, typically combined into a multi-drug chemotherapy regimen. Some are also treated with radiation therapy. In some cases, a bone marrow transplant is useful.

[edit] Acute lymphoblastic

Further information: Acute lymphoblastic leukemia#Treatment

Management of ALL focuses on control of bone marrow and systemic (whole-body) disease. Additionally, treatment must prevent leukemic cells from spreading to other sites, particularly the central nervous system (CNS) e.g. monthly lumbar punctures. In general, ALL treatment is divided into several phases:

• Induction chemotherapy to bring about bone marrow remission. For adults, standard induction plans include prednisone, vincristine, and an anthracycline drug; other drug plans may include L-asparaginase or cyclophosphamide. For children with low-risk ALL, standard therapy usually consists of three drugs (prednisone, L-asparaginase, and vincristine) for the first month of treatment.
• Consolidation therapy or intensification therapy to eliminate any remaining leukemia cells. There are many different approaches to consolidation, but it is typically a high-dose, multi-drug treatment that is undertaken for a few months. Patients with low- to average-risk ALL receive therapy with antimetabolite drugs such as methotrexate and 6-mercaptopurine (6-MP). High-risk patients receive higher drug doses of these drugs, plus additional drugs.
• CNS prophylaxis (preventive therapy) to stop the cancer from spreading to the brain and nervous system in high-risk patients. Standard prophylaxis may include radiation of the head and/or drugs delivered directly into the spine.
• Maintenance treatments with chemotherapeutic drugs to prevent disease recurrence once remission has been achieved. Maintenance therapy usually involves lower drug doses, and may continue for up to three years.
• Alternatively, allogeneic bone marrow transplantation may be appropriate for high-risk or relapsed patients.^[26]You may also go through a white blood cell transfer.

[edit] Chronic lymphocytic

Further information: Chronic lymphocytic leukemia#Treatment

[edit] Decision to treat

Hematologists base CLL treatment on both the stage and symptoms of the individual patient. A large group of CLL patients have low-grade disease, which does not benefit from treatment. Individuals with CLL-related complications or more advanced disease often benefit from treatment. In general, the indications for treatment are:

• Falling hemoglobin or platelet count
• Progression to a later stage of disease
• Painful, disease-related overgrowth of lymph nodes or spleen
• An increase in the rate of lymphocyte production ^[27]

[edit] Typical treatment approach

CLL is probably incurable by present treatments. The primary chemotherapeutic plan is combination chemotherapy with chlorambucil or cyclophosphamide, plus a corticosteroid such as prednisone or prednisolone. The use of a corticosteroid has the additional benefit of suppressing some related autoimmune diseases, such as immunohemolytic anemia or immune-mediated thrombocytopenia. In resistant cases, single-agent treatments with nucleoside drugs such as fludarabine,^[28] pentostatin, or cladribine may be successful. Younger patients may consider allogeneic or autologous bone marrow transplantation.^[29]

[edit] Acute myelogenous

Further information: Acute myeloid leukemia#Treatment

Many different anti-cancer drugs are effective for the treatment of AML. Treatments vary somewhat according to the age of the patient and according to the specific subtype of AML. Overall, the strategy is to control bone marrow and systemic (whole-body) disease, while offering specific treatment for the central nervous system (CNS), if involved.
In general, most oncologists rely on combinations of drugs for the initial, induction phase of chemotherapy. Such combination chemotherapy usually offers the benefits of early remission and a lower risk of disease resistance. Consolidation and maintenance treatments are intended to prevent disease recurrence. Consolidation treatment often entails a repetition of induction chemotherapy or the intensification chemotherapy with additional drugs. By contrast, maintenance treatment involves drug doses that are lower than those administered during the induction phase

developing students' character

Character Education in the United States

Scholarly debate on moral development and character formation extends at least as far back as Aristotle's Nichomacean Ethics and Socrates' Meno and continues through to modern times (Nucci, 1989). In the last several hundred years, character education has been seen as a primary function of educational institutions. For example, John Locke, 17th century English philosopher, advocated education as education for character development. This theme was continued in the 19th century by English philosophers John Stuart Mill (e.g., "development of character is a solution to social problems and a worthy educational ideal," Miller & Kim, 1988) and Herbert Spencer (e.g., "education has for its object the formation of character," Purpel & Ryan, 1976). American education has had a focus on character development from its inception. The American philosopher, John Dewey, an influential philosopher and educator of the early 20th century, saw moral education as central to the school's mission (Dewey, 1934).
However, since the 1930's American education has increasingly turned away from character education as a primary focus (Power, Higgens & Kohlberg, 1989). This is in spite of the fact that both educators and the public believe character education to be an important aspect of schooling. Spears' (1973) survey of members of Phi Delta Kappa (an education honorary society) on goals of education showed the following ranking of the goals of public schools:

1. develop skills in reading, writing, speaking, and listening;
2. develop pride in work and feeling of self-worth; and
3. develop good character and self-respect.

In terms of defining good character, educators stated that this should include developing:

1. moral responsibility and sound ethical and moral behavior;
2. capacity for discipline;
3. a moral and ethical sense of the values, goals, and processes of a free society;
4. standards of personal character and ideas.

In two more recent Gallup (1975, 1980) surveys of public attitudes toward public schools, 79% of respondents indicated they favor "instruction in schools that would deal with morals and moral behavior."
Since the 1960's teacher education has downplayed the teacher's role as a transmitter of social and personal values and emphasized other areas such teaching techniques, strategies, models, and skills (e.g., Nucci, 1986a). More and more the vision of a good teacher is as the good technician, the skilled craftsman, who has acquired those behavioral skills and strategies that the "effective teacher" research claims are related to achievement. However, the fact that "effective" is defined as the students' scores on standardized tests of basic skills, but without reference to higher-order intellectual processes or concern about the students' morals, is of concern to many parents and educators. Educational psychology, rather than philosophy and religion, has become the basis of teacher training (Ryan, 1989). In most cases, educational psychology focuses on the individual, separated from the social context. Additionally, modern education has been heavily influenced by the behavioral approach, which has proved adept at developing instructional methods that impact achievement as measured by standardized tests. In the opinion of most researchers in the area of character and moral development (e.g., Lickona, 1991; Nucci, 1989), additional emphasis must be placed on the philosophical "why" of education in addition to the technical "how."
The two educational goals most desired by both the public and educators--academic competence and character development--are not mutually exclusive, but complementary (Wynne & Walberg, 1985). Competence allows character to be manifested in highest forms and vice versa. For example, Stallings (1978) found a positive impact of attempts to improve student achievement on independence, task persistence, cooperation, and question-asking. Etzioni (1984) and Ginsburg and Hanson (1986) reported that students who were self-disciplined or more religious, hard working, or valued learning scored higher on achievement tests. Kagan (1981) and Wynne and Walberg (1985) argue that good character ought to be the more primary focus as it is a goal in reach of more children than is high academic achievement and can result in less alienation from the school.
The relative lack of interest in character education in the last three decades has begun to change (Lickona, 1990). In 1987, the National School Boards Association proposed to the United States Department of Education a project, "Building Character in the Public Schools," designed to enhance character development in the schools through involvement of more than 15,000 local school boards in this country. The project had two overall goals:

1. to heighten national awareness of the importance of character development programs in local public schools to the continued success and stability of American society; and
2. to encourage the establishment and improvement of character development programs in public elementary and secondary schools.

Impacting Moral and Character Development

Campbell and Bond (1982) state there are four major questions to be addressed when focusing on character development:

1. what is good character;
2. what causes or prevents it;
3. how can it be measured so that efforts at improvement can have corrective feedback;and
4. how can it best be developed?

As previously discussed, good character is defined in terms of one's actions. Character development traditionally has focused on those traits or values appropriate for the industrial age such as obedience to authority, work ethic, working in group under supervision, etc. However, as discussed in the SCANS report (1991) and Huitt's (1997) critique, modern education must promote character based on values appropriate for the information age: truthfulness, honesty, integrity, individual responsibility, humility, wisdom, justice, steadfastness, dependability, etc.
In terms of what influences character development, Campbell and Bond (1982) propose the following as major factors in the moral development and behavior of youth in contemporary America:

1. heredity
2. early childhood experience
3. modeling by important adults and older youth
4. peer influence
5. the general physical and social environment
6. the communications media
7. what is taught in the schools and other institutions
8. specific situations and roles that elicit corresponding behavior.

These sources of influence are listed in approximate order of least tractable to most tractable in order to suggest why we often seek solutions to social problems through schools. It is important to realize that while schools do and should play a role in the development of character, families, communities, and society in general also have an important influence (Huitt, 1999).
The measurement of character has proven difficult since character, by definition, involves behavior, but character is often defined in terms of traits (i.e., honesty, integrity, etc.). Some possible measures suggested by Campbell and Bond (1982) are:

1. student discipline;
2. student suicide rates;
3. crimes: assault, burglary, homicides;
4. pregnancy rates of teenage girls; and
5. prosocial activities.

Learning English is Fun

Posted Sab, 20/02/2010 - 14:19 by semadi yasa

Most of students think that learning English is difficult. It is the same as they learn Mathematics, Chemistry, Physics, and Accounting. English looks like a horrible and frightening subject for the students. Is it true? To find the answer is actually not so difficult. Firstly the teachers should think the way how they teach. It is frightening the students or not. Secondly the methods the teachers use in teaching monotonuous or various. And finally whether the teachers know the students' need or not.
Solution:
1. Don't ever frighten the students with English. Ensure the students that English is not difficult. Assure them that you teach them in relax, unstressed atmosphere;
2. Apply various methods and approaches in teaching. Cosider the students' situation and condition. If tiring situation, try to refresh them. Don't give teaching learning process directly. Invite them to sing, for example. You can also perform games. Not related but it will make them fresh and cheerful again;
3. Try to know what your students want from you. Learning English in Laboratory, Library, Classroom, Open area, personally, in pairs or groupically.
And last but not least, motivate the students to study whatever the subject is.
Be a good teacher, be a fun teacher.