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

Tracking the reflexivity of the (dis)engaged citizen: some methodological reflections

The relationship between governments and citizens in many contemporary democracies is haunted by uncertainty and sociologists face the task of listening effectively to citizens’ own reflections on this uncertain relationship. This article reflects on the qualitative methodology of a recently completed UK project which used a combination of diary and multiple interviews/ focus groups to track over a fieldwork period of up to a year citizens’ reflections on their relationship to a public world and the contribution to this of their media consumption. In particular, the article considers how the project’s multiple methods enabled multiple angles on the inevitable artificiality and performative dimension of the diary process, resulting in rich data on people’s complex reflections on the uncertain position of the contemporary citizen

Anticoagulation in pediatric cancer–associated venous thromboembolism:a subgroup analysis of EINSTEIN-Jr

Anticoagulant treatment of pediatric cancer–associated venous thromboembolism (VTE) has not been prospectively evaluated. Management of anticoagulation for cancer-associated VTE is often challenged by drug interactions and treatment interruptions. A total of 56 of the 500 children (11.2%) with VTE who participated in the recent EINSTEIN-Jr randomized study had cancer (hematologic malignancy, 64.3%, solid malignant tumor, 35.7%). Children were allocated to either therapeutic-dose bodyweight-adjusted oral rivaroxaban (n=40) or standard anticoagulation with heparins, with or without vitamin K antagonists (n=16) and received a median of 30 concomitant medications. Based on sparse blood sampling at steady-state, pharmacokinetic (PK) parameters of rivaroxaban were derived using population PK modeling. During the 3 months of treatment, no recurrent VTE or major bleeding occurred (95% confidence interval, 0.0%-6.4%), and 3-month repeat imaging showed complete or partial vein recanalization in 20 and 24 of 52 evaluable children (38.5% and 46.2%, respectively). Anticoagulant treatment was interrupted 70 times in 26 (46.4%) children because of thrombocytopenia, invasive procedures, or adverse events, for a mean individual period of 5.8 days. Anticoagulant therapy was resumed in therapeutic doses and was not associated with thrombotic or bleeding complications. Rivaroxaban exposures were within the adult exposure range and similar to those observed in children with VTE who did not have cancer-associated VTE. Rivaroxaban and standard anticoagulants appeared safe and efficacious and were associated with reduced clot burden in most children with cancer-associated VTE, including those who had anticoagulant treatment interruptions. Rivaroxaban exposures were within the adult exposure range despite significant polypharmacy use. This trial was registered at www.clinicaltrials.gov as #NCT02234843

On the formation of a Hawking-radiation photosphere around microscopic black holes

We show that once a black hole surpasses some critical temperature $T_{crit}$, the emitted Hawking radiation interacts with itself and forms a nearly thermal photosphere. Using QED, we show that the dominant interactions are bremsstrahlung and electron-photon pair production, and we estimate $T_{crit} \sim m_{e}/\alpha^{5/2}$, which when calculated more precisely is found to be $T_{crit} \approx$45 GeV. The formation of the photosphere is purely a particle physics effect, and not a general relativistic effect, since the the photosphere forms roughly $\alpha^{-4}$ Schwarzschild radii away from the black hole. The temperature $T$ of the photosphere decreases with distance from the black hole, and the outer surface is determined by the constraint $T\sim m_{e}$ (for the QED case), since this is the point at which electrons and positrons annihilate, and the remaining photons free stream to infinity. Observational consequences are discussed, and it is found that, although the QED photosphere will not affect the Page-Hawking limits on primordial black holes, which is most important for 100MeV black holes, the inclusion of QCD interactions may significantly effect this limit, since for QCD we estimate $T_{crit}\sim \Lambda_{QCD}$. The photosphere greatly reduces possibility of observing individual black holes with temperatures greater than $T_{crit}$, since the high energy particles emitted from the black hole are processed through the photosphere to a lower energy, where the gamma ray background is much higher. The temperature of the plasma in the photosphere can be extremely high, and this offers interesting possibilities for processes such as symmetry restoration.Comment: Latex, 16 pages, 3 postscript figures, submitted to PRD. Also available at http://fnas08.fnal.gov

Elimination of onchocerciasis in Africa by 2025: an ambitious target requires ambitious interventions

To achieve the elimination of onchocerciasis transmission in all African countries will entail enormous challenges, as has been highlighted by the active discussion around onchocerciasis intervention strategies and evaluation procedures in this journal.Serological thresholds for onchocerciasis elimination, adapted for the African setting, need to be established. The Onchocerciasis Technical Advisory Subgroup of the World Health Organization is currently developing improved guidelines to allow country elimination commi

Les enseignants: à la recherche de leur profession

Les Enseignants: à la recherche de leur profession reprend les idées centrales présentées à la Conférence donnée, sur l'invitation de l'ATEE, au Séminaire de Barcelone, en 1993. Cet article est la reproduction du texte de support à la Conférence. Étant donné l'espace disponible, il n'a pas été possible de le travailler dans le sens d'une plus grande problématisation et élaboration théorique

Longitudinal double-spin asymmetry and cross section for inclusive neutral pion production at midrapidity in polarized proton collisions at sqrt(s) = 200 GeV

We report a measurement of the longitudinal double-spin asymmetry A_LL and the differential cross section for inclusive Pi0 production at midrapidity in polarized proton collisions at sqrt(s) = 200 GeV. The cross section was measured over a transverse momentum range of 1 < p_T < 17 GeV/c and found to be in good agreement with a next-to-leading order perturbative QCD calculation. The longitudinal double-spin asymmetry was measured in the range of 3.7 < p_T < 11 GeV/c and excludes a maximal positive gluon polarization in the proton. The mean transverse momentum fraction of Pi0's in their parent jets was found to be around 0.7 for electromagnetically triggered events.Comment: 6 pages, 3 figures, submitted to Phys. Rev. D (RC