Polychromatic flow cytometry is more sensitive than microscopy in detecting small monoclonal plasma cell populations

Background There is an emerging role for flow cytometry (FC) in the assessment of small populations of plasma cells (PC). However, FC's utility has been questioned due to consistent underestimation of the percentage of PC compared to microscopy. Methods A retrospective study was performed on bone marrow samples analysed by 8-colour FC. Plasma cell populations were classified as polyclonal or monoclonal based on FC analysis. FC findings were compared with microscopy of aspirates, histology and immunohistochemistry of trephine biopsies, and immunofixation (IFX) of serum and/or urine. Results FC underestimated PC compared to aspirate and trephine microscopy. The 10% diagnostic cutoff for MM on aspirate microscopy corresponded to a 3.5% cutoff on FC. Abnormal plasma cell morphology by aspirate microscopy and clonality by FC correlated in 229 of 294 cases (78%). However, in 50 cases, FC demonstrated a monoclonal population but microscopy reported no abnormality. In 15 cases, abnormalities were reported by microscopy but not by FC. Clonality assessment by trephine microscopy and FC agreed in 251/280 cases (90%), but all 29 discordant cases were monoclonal by FC and not monoclonal by microscopy. These cases had fewer PC and proportionally more polyclonal PC, and when IFX detected a paraprotein, it had the same light chain as in the PC determined by FC. Conclusions FC was more sensitive in detecting monoclonal populations that were small or accompanied by polyclonal PC. This study supports the inclusion of FC in the evaluation of PC, especially in the assessment of small population

Properties of low-lying states in some high-nuclearity Mn, Fe and V clusters: Exact studies of Heisenberg models

Using an efficient numerical scheme that exploits spatial symmetries and spin parity, we have obtained the exact low-lying eigenstates of exchange Hamiltonians for the high nuclearity spin clusters, Mn_{12}, Fe_8 and V_{15}. The largest calculation involves the Mn_{12} cluster which spans a Fock space of a hundred million. Our results show that the earlier estimates of the exchange constants need to be revised for the Mn_{12} cluster to explain the level ordering of low-lying eigenstates. In the case of the Fe_8 cluster, correct level ordering can be obtained which is consistent with the exchange constants for the already known clusters with butterfly structure. In the V_{15} cluster, we obtain an effective Hamiltonian that reproduces exactly, the eight low-lying eigenvalues of the full Hamiltonian.Comment: Revtex, 12 pages, 16 eps figures; this is the final published versio

Thermal rates for baryon and anti-baryon production

We use a form of the fluctuation-dissipation theorem to derive formulas giving the rate of production of spin-1/2 baryons in terms of the fluctuations of either meson or quark fields. The most general formulas do not assume thermal or chemical equilibrium. When evaluated in a thermal ensemble we find equilibration times on the order of 10 fm/c near the critical temperature in QCD.Comment: 22 pages, 4 tables and 2 figures, REVTe

The macroeconomic imbalance procedure as European integration: a legalisation perspective

The Macroeconomic Imbalance Procedure seeks to prevent and correct destabilising economic imbalances in the European Union. Scholars are divided as to whether this instrument of economic policy coordination relies on the same intergovernmental modes of decision-making as the Broad Economic Policy Guidelines or reflects supranational institutions more significant role in EU economic policy following the euro crisis. Such diametrically opposed interpretations are symptomatic of longstanding concerns over the lack of a clear-cut definition of European integration. To address these definitional difficulties, this paper turns to the concept of legalisation. Taking account of the design and early implementation of the Macroeconomic Imbalance Procedure and using the Broad Economic Policy Guidelines as a point of comparison, it shows that the former can be understood as a modest but clear-cut increase in legalisation compared to the latter. On this basis, it considers whether legalisation, in spite of its own conceptual limitations, can contribute to a more rigorous definition of European integration

Updated meta-analysis of randomized controlled trials comparing conventional excisional haemorrhoidectomy with LigaSure for haemorrhoids

Background:\ud To compare the surgical outcome of haemorrhoidectomy performed using LigaSure bipolar diathermy with conventional haemorrhoidectomy.\ud \ud Methods:\ud Only randomized and alternate allocated studies were included from the major electronic databases using the search terms "ligasure" and "haemorrhoids" Duration of operation, blood loss during operation, postoperative pain score, wound healing, in-hospital stay, time to return to normal activities and complications were assessed.\ud \ud Results:\ud The 11 trials contained a total of 1,046 patients; the largest study was based on 273 patients and two earlier studies were based on 34 patients. No significant gender mismatch between the groups was reported in any of the studies. The patients’ ages were similar between groups in the studies, as was disease severity. All 11 studies reported a shorter duration of the operation when using LigaSure compared to the conventional technique (p<0.001). The postoperative pain score (p=0.001) and blood loss during operation (p=0.001) were significantly reduced. After LigaSure haemorrhoidectomy wound healing (p=0.004) and the return to normal activities (p=0.001) were significantly faster than after conventional haemorrhoidectomy. However, the overall incidence of complications reported was not significantly different (p=0.056).\ud \ud Conclusions:\ud LigaSure is an effective instrument for haemorrhoidectomy which results in less blood loss, quicker wound healing and earlier return to work.\u

New precision measurement of the J/ψJ/\psi- and ψ′\psi' -meson masses

A new high precision measurement of the $J/\psi$- and $\psi'$-meson masses has been performed at the VEPP-4M collider using the KEDR detector. The resonant depolarization method has been employed for the absolute calibration of the beam energy. The following mass values have been obtained: $M_{J/\psi} = 3096.917 \pm 0.010 \pm 0.007$ MeV, $M_{\psi'} = 3686.111 \pm 0.025 \pm 0.009$ MeV. The relative measurement accuracy has reached $4. 10^{-6}$ for $J/\psi$ and $7. 10^{-6}$ for $\psi'$, approximately 3 times better than in the previous precise experiments.Comment: 12 pages, 4 tables, 10 figure

Patient characteristics, anaesthetic workload and techniques in the UK: an analysis from the 7th National Audit Project (NAP7) activity survey

Detailed contemporary knowledge of the characteristics of the surgical population, national anaesthetic workload, anaesthetic techniques and behaviours are essential to monitor productivity, inform policy and direct research themes. Every 3–4 years, the Royal College of Anaesthetists, as part of its National Audit Projects (NAP), performs a snapshot activity survey in all UK hospitals delivering anaesthesia, collecting patient-level encounter data from all cases under the care of an anaesthetist. During November 2021, as part of NAP7, anaesthetists recorded details of all cases undertaken over 4 days at their site through an online survey capturing anonymous patient characteristics and anaesthetic details. Of 416 hospital sites invited to participate, 352 (85%) completed the activity survey. From these, 24,177 reports were returned, of which 24,172 (99%) were included in the final dataset. The work patterns by day of the week, time of day and surgical specialty were similar to previous NAP activity surveys. However, in non-obstetric patients, between NAP5 (2013) and NAP7 (2021) activity surveys, the estimated median age of patients increased by 2.3 years from median (IQR) of 50.5 (28.4–69.1) to 52.8 (32.1–69.2) years. The median (IQR) BMI increased from 24.9 (21.5–29.5) to 26.7 (22.3–31.7) kg.m–2. The proportion of patients who scored as ASA physical status 1 decreased from 37% in NAP5 to 24% in NAP7. The use of total intravenous anaesthesia increased from 8% of general anaesthesia cases to 26% between NAP5 and NAP7. Some changes may reflect the impact of the COVID-19 pandemic on the anaesthetic population, though patients with confirmed COVID-19 accounted for only 149 (1%) cases. These data show a rising burden of age, obesity and comorbidity in patients requiring anaesthesia care, likely to impact UK peri-operative services significantly