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The observed radiation from hot gas accreting onto a black hole depends on both the details of the flow and the spacetime geometry. The lensing behavior of a black hole produces a distinctive pattern of autocorrelations within its photon ring that encodes its mass, spin, and inclination. In particular, the time autocorrelation of the light curve is expected to display a series of peaks produced by light echoes of the source, with each peak delayed by the characteristic time lapse τ between light echoes. However, such peaks are absent from the light curves of observed black holes. Here, we develop an analytical model for such light curves that demonstrates how, even though light echoes always exist in the signal, they do not produce autocorrelation peaks if the characteristic correlation timescale λ_{0} of the source is greater than τ. We validate our model against simulated light curves of a stochastic accretion model ray traced with a general-relativistic code, and then fit the model to an observed light curve for Sgr A^{*}. We infer that λ_{0}>τ, providing an explanation for the absence of light echoes in the time autocorrelations of Sgr A^{*} light curves. Our results highlight the importance for black hole parameter inference of spatially resolving the photon ring via future space-based interferometry.
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The Neutron Star Interior Composition Explorer (NICER) recently measured the mass and equatorial radius of the isolated neutron star PSR J0030+0451. We use these measurements to infer the moment of inertia, the quadrupole moment, and the surface eccentricity of an isolated neutron star for the first time, using relations between these quantities that are insensitive to the unknown equation of state of supranuclear matter. We also use these results to forecast the moment of inertia of neutron star A in the double pulsar binary J0737-3039, a quantity anticipated to be directly measured in the coming decade with radio observations. Combining this information with the measurement of the tidal Love number with LIGO/Virgo observations, we propose and implement the first theory-agnostic and equation-of-state-insensitive test of general relativity. Specializing these constraints to a particular modified theory, we find that consistency with general relativity places the most stringent constraint on gravitational parity violation to date, surpassing all other previously reported bounds by 7 orders of magnitude and opens the path for a future test of general relativity with multimessenger neutron star observations.
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Accurate prognostic tools are crucial to assess the risk/benefit ratio of allogeneic hematopoietic cell transplantation (allo-HCT) in patients with myelofibrosis (MF). We aimed to evaluate the performance of the Myelofibrosis Transplant Scoring System (MTSS) and identify risk factors for survival in a multicenter series of 197 patients with MF undergoing allo-HCT. After a median follow-up of 3.1 years, 47% of patients had died, and the estimated 5-year survival rate was 51%. Projected 5-year risk of nonrelapse mortality and relapse incidence was 30% and 20%, respectively. Factors independently associated with increased mortality were a hematopoietic cell transplantation-specific comorbidity index (HCT-CI) ≥3 and receiving a graft from an HLA-mismatched unrelated donor or cord blood, whereas post-transplant cyclophosphamide (PT-Cy) was associated with improved survival. Donor type was the only parameter included in the MTSS model with independent prognostic value for survival. According to the MTSS, 3-year survival was 62%, 66%, 37%, and 17% for low-, intermediate-, high-, and very high-risk groups, respectively. By pooling together the low- and intermediate-risk groups, as well as the high- and very high-risk groups, we pinpointed 2 categories: standard risk and high risk (25% of the series). Three-year survival was 62% in standard-risk and 25% in high-risk categories (P < .001). We derived a risk score based on the 3 independent risk factors for survival in our series (donor type, HCT-CI, and PT-Cy). The corresponding 5-year survival for the low-, intermediate-, and high-risk categories was 79%, 55%, and 32%, respectively (P < .001). In conclusion, the MTSS model failed to clearly delineate 4 prognostic groups in our series but may still be useful to identify a subset of patients with poor outcome. We provide a simple prognostic scoring system for risk/benefit considerations before transplantation in patients with MF.
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Transplante de Células-Tronco Hematopoéticas , Mielofibrose Primária , Humanos , Mielofibrose Primária/terapia , Prognóstico , Condicionamento Pré-Transplante , Transplante Homólogo , Resultado do TratamentoRESUMO
Introduction: Chronic myelomonocytic leukemia (CMML) and myelodysplastic syndromes (MDS) with ring sideroblasts (RS) or SF3B1 mutation (MDS-RS/SF3B1) differ in many clinical features, but share others, such as anemia. RS and SF3B1 mutation can also be found in CMML. Methods: We compared CMML with and without RS/SF3B1 and MDS-RS/SF3B1 considering the criteria established by the 2022 World Health Organization classification. Results: A total of 815 patients were included (CMML, n=319, CMML-RS/SF3B1, n=172 and MDS-RS/SF3B1, n=324). The percentage of RS was ≥15% in almost all CMML-RS/SF3B1 patients (169, 98.3%) and most (125, 72.7%) showed peripheral blood monocyte counts between 0.5 and 0.9 x109/L and low risk prognostic categories. CMML-RS/SF3B1 differed significantly from classical CMML in the main clinical characteristics, whereas it resembled MDS-RS/SF3B1. At a molecular level, CMML and CMML-RS/SF3B1 had a significantly higher frequency of mutations in TET2 (mostly multi-hit) and ASXL1 (p=0.013) and CMML had a significantly lower frequency of DNMT3A and SF3B1 mutations compared to CMML/MDS-RS/SF3B1. Differences in the median overall survival among the three groups were statistically significant: 6.75 years (95% confidence interval [CI] 5.41-8.09) for CMML-RS/SF3B1 vs. 3.17 years (95% CI 2.56-3.79) for CMML vs. 16.47 years (NA) for MDS-RS/SF3B1, p<0.001. Regarding patients with CMML and MDS, both with SF3B1 mutation, survival did not significantly differ. CMML had a higher risk of transformation to acute myeloid leukemia (24% at 8 years, 95%CI 19%-30%). Discussion: CMML-RS/SF3B1 mutation resembles MDS-RS/SF3B1 in terms of phenotype and clearly differs from CMML. The presence of ≥15% RS and/or SF3B1 in CMML is associated with a low monocyte count. SF3B1 mutation clearly improves the prognosis of CMML.
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Mutations commonly associated with acute myeloid leukemia (AML), such as CEBPA, FLT3, IDH1/2 and NPM1 are rarely found in chronic myelomonocytic leukemia (CMML) and their prognostic significance in CMML has not been clearly identified. In 127 CMML patients, we have retrospectively analyzed next-generation sequencing and PCR data from analyses of bone marrow samples performed at diagnosis of CMML. Seven patients harbored CEBPA mutations, eight FLT3 mutations, 12 IDH1 mutations, 26 IDH2 mutations and 11 NPM1 mutations. CMML patients harboring CEBPA, FLT3, and/or NPM1 mutations (mutCFN)were more frequently associated with the myeloproliferative subtype (MP-CMML) , a high prevalence of severe cytopenia, and elevated blast counts. Regardless of their CPSS-Mol classification, mutCFN CMML patients had a poor prognosis, and the multivariate analysis identified mutCFN as an independent marker of overall survival. The genetic profile of these mutCFN CMML patients closely resembled that of AML, with higher-risk clinical characteristics. Our findings lead us to suggest including the assessment of these mutations in CMML prognostic models and treating these patients with AML-type therapies, including intensive chemotherapy and allogeneic stem cell transplantation, whenever feasible, and consider certain targeted therapies approved for use in AML.
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The University Hospital of Salamanca, in Spain, had its first COVID-19 case on March 1st and as of May 11th, we had 1,100 positive cases. Based on the vulnerability of patients with blood cancers, on March 9th, the Hematology Department developed a protocol, amended as the new information was available, to maintain the Hematology Unit as a "free COVID-19 island." The protocol included symptom-based surveys and screening tests to patients, caregivers, and healthcare personnel to identify early potential positive cases and prevent its spread. Between March 9 and April 28, 32 asymptomatic patients and caregivers were tested and 68 rT-PCR diagnostic assays have been performed with two positive results. A 106 healthcare workers have been tested (208 rT-PCR) and seven of them were positive. In summary, the implementation of preemptive measures after the first case appeared allowed us to be able to provide treatment to our patients.
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Leucemia Mieloide Aguda , Nucleofosmina , Humanos , Medula Óssea , Leucemia Mieloide Aguda/genética , MutaçãoRESUMO
Quienes se inician en la investigación suelen encontrarse con dificultades en el análisis estadístico de los datos para la verificación de su hipótesis de trabajo, particularmente en la selección de la técnica estadística apropiada, su aplicación e interpretación. Se plantea que lo anterior resulta de una actitud negativa hacia el análisis cuantitativo, relacionado con dificultades percibidas en clases de estadística y metodología de la investigación en educación superior. El objetivo del presente artículo es ofrecer una guía de referencia para investigadores no expertos en el uso de algunas técnicas estadísticas con amplia aplicación en la generación de conocimiento. Se define cada técnica multivariada presentada y se especifican las condiciones en las cuales es posible su aplicación enumerando los supuestos mínimos que debe cumplir. Adicionalmente, se presentan tres ejemplos que muestran las inconsistencias estadísticas que resultan de no considerar algunos supuestos en el análisis de los datos.
New researchers often face difficulties in the statistical analysis of data for verification of the working hypotheses, particularly in the selection of an appropriate statistical technique, its application and interpretation. It is often argued that the foregoing of a negative attitude toward the quantitative analysis related to perceived difficulties in statistics classes and research methodology in education. The purpose of this article is to provide a reference guide for non-expert researchers in the use of some statistical techniques with broad applications in the generation of knowledge. Each multivariate technique is defined and the conditions under which it is possible its application are enumerated, presenting the minimum conditions to be met. In addition, three examples are presented showing inconsistencies resulting from a wrong use of statistics and assumptions in analyzing the data.