Kappa Ratio Research Articles

Retrospective evaluation of gestational trophoblastic disease - experience with ultrasounds.

Our study aims to determine the frequency and types of GTD (Gestational Trophoblastic Disease) in our clinic, to evaluate its relationship with clinical parameters, and the consistency of clinical prediagnosis and pathological definitive diagnosis. In the present study, hospital records of 120 patients with gestational trophoblastic disease between January 2019 and August 2022 were obtained and evaluated retrospectively. Demographic, hematological, biochemical, and clinical data were collected in detail, and the data were analyzed statistically. Our study included a total of 120 female patients, with an average age of 31.16±9.70. The average number of patients was 3. The average time for women to receive the diagnosis was 9.80±2.45 weeks, with the most frequent complaint on our part being bleeding (85.8%). When the pathology outcomes of the patients we included in our study were examined, it was found that the number of patients diagnosed with incomplete abortion was 34, the number of patients diagnosed with complete abortion was 82, the number of invasive moles diagnosed was 3, and the number of patient diagnosed with choriocarcinoma was 1. Kappa ratio was calculated as 0.419 (p<0.001) when the compliance of the clinical diagnosis was assessed. This value was consistent with median level alignment. In a study that examined the three years of our calism in our bulk, 1.8 per 1,000 births were followed frequently. We should inform patients in detail about gestational trophoblastic diseases and warn patients not to delay their consequences. We should recommend that pregnancy be avoided for 12 months for low-risk patients and 18 months for high-risk patients after GTD.

Abstract 14545: Extramedullary Plasmacytoma of Tonsil Presenting as Cardiac Amyloidosis

Introduction: AL amyloidosis is a systemic disease characterized by the deposition of misfolded immunoglobulin light chains produced from clonal plasma cells in multiple organs of the body causing its dysfunction. We present you an unusual case of AL cardiac amyloidosis in a patient with extramedullary plasmacytoma of the tonsils. Case Presentation 61-year-old female presented with dyspnea on exertion with NT-proBNP elevated to 1439 pg/ml. CXR showed increased pulmonary vascular congestion. The patient was started on IV furosemide 40 mg BID with good urine output. Transthoracic echocardiogram revealed left ventricular hypertrophy with an ejection fraction of 60-65% with a global longitudinal strain of -9.0% and regional longitudinal strain reduced in the basal and mid-left ventricular segment but preserved in apical segment consistent with infiltrative cardiomyopathy. The patient underwent a nuclear (nuclear technetium pyrophosphate) scan of the heart consistent with cardiac amyloid deposition. She also was noted to have increased tonsillar mass which was biopsied. In the hospital, the patient had a cardiac arrest with the initial rhythm being ventricular fibrillation. The patient received 6 rounds of shock, and multiple injections of epinephrine, amiodarone, and bicarbonate push. The patient died despite all efforts of resuscitation. Histopathology results of tonsillar mass were consistent with plasmacytoma with amyloid deposition on Congo-red stain. Lambda: Kappa ratio was 70:1. Discussion: In cardiac amyloidosis, light chain deposits between cardiac myocytes disrupt cell-cell interaction. It can present as restrictive cardiomyopathy, conduction system abnormalities, or sudden cardiac death. It is essential to diagnose cardiac amyloidosis earlier. If untreated, the median survival of patients with cardiac AL amyloidosis is 6 months from the onset of heart failure. Conclusion: Our case was unusual in which a rare tumor of tonsils had plasma cell tumor which led to cardiac amyloidosis

Professor Dowson's contribution to the bearing industry

Dowson’s film thickness relationship is used in the bearing industry and miscellaneous organizations (ISO, DIN, and FVA) for defining the Lamda ratio (film thickness/roughness) or Kappa ratio (viscosity/reference viscosity) and corresponding lubrication factor affecting bearing life. The film thickness is also used for defining the rolling element–race shear rate, hence traction force, defining bearing torque and power losses. Traction forces can also explain rolling element acceleration, skidding, risk of cage failure, and smearing.

Immunoglobulin D Multiple Myeloma, a More Aggressive Subtype

Immunoglobulin D (IgD) multiple Myeloma (MM) is a very rare subtype of myeloma. It accounts for only 1-2% of all MM patients. It is associated with a rapidly progressive disease and poorer outcomes compared with other MM subtypes. In this case report, we present a case of a sixty-year-old man who presented to our hospital with fatigue, anemia, thrombocytopenia, and acute renal failure. His bone marrow biopsy during admission showed 75.9% of plasma cells with significant light chain burden. He was also found to have severe immunoglobulin deficiency along with a lambda to kappa ratio was <0.01. The diagnosis of IgD MM was established, and he was started on CyBorD (Bortezomib, cyclophosphamide, and dexamethasone). Our patient also required hemodialysis for his kidney failure.

Localization of right ventricular non-apical lead position: comparison of three-dimensional echocardiography, computed tomography, and fluoroscopic imaging.

ObjectiveRight ventricular (RV) septal pacing is considered a better pacing procedure compared with traditional apical pacing. This study aimed to investigate agreement among computed tomography (CT), three-dimensional echocardiography (3D-echo), and fluoroscopy for evaluating the tip of the RV pacing lead in the non-apical position in patients with permanent pacemaker implantation.MethodsFifty-four patients were prospectively enrolled. Data on patients’ characteristics and imaging findings were analyzed. The agreement rate in distinguishing the RV septal lead position among the three imaging modalities was determined.ResultsThirty-three (61%) patients were men and the median age was 76 years. Overall, the agreement rate among the three imaging modalities was 87% (47/54; Kappa ratio: 0.734). The agreement of 3D-echo compared with thoracic CT (Kappa ratio: 0.893) was better than that for thoracic CT and fluoroscopy (Kappa ratio: 0.658). Agreement between fluoroscopy and 3D-echo was lowest (Kappa ratio: 0.632).ConclusionsAgreement in evaluating the position of the septal lead between thoracic CT and 3D-echo is better than that between other imaging modalities. Our findings indicate that 3D-echo imaging might be the best imaging tool for defining the tip of the RV non-apical lead position and be useful for guiding positioning of the RV lead.

An Intelligent Big Data Management System Using Haar Algorithm‐Based Nao Agent Multisensory Communication

Artificial intelligence (AI) is progressively changing techniques of teaching and learning. In the past, the objective was to provide an intelligent tutoring system without intervention from a human teacher to enhance skills, control, knowledge construction, and intellectual engagement. This paper proposes a definition of AI focusing on enhancing the humanoid agent Nao’s learning capabilities and interactions. The aim is to increase Nao intelligence using big data by activating multisensory perceptions such as visual and auditory stimuli modules and speech‐related stimuli, as well as being in various movements. The method is to develop a toolkit by enabling Arabic speech recognition and implementing the Haar algorithm for robust image recognition to improve the capabilities of Nao during interactions with a child in a mixed reality system using big data. The experiment design and testing processes were conducted by implementing an AI principle design, namely, the three‐constituent principle. Four experiments were conducted to boost Nao’s intelligence level using 100 children, different environments (class, lab, home, and mixed reality Leap Motion Controller (LMC). An objective function and an operational time cost function are developed to improve Nao’s learning experience in different environments accomplishing the best results in 4.2 seconds for each number recognition. The experiments’ results showed an increase in Nao’s intelligence from 3 to 7 years old compared with a child’s intelligence in learning simple mathematics with the best communication using a kappa ratio value of 90.8%, having a corpus that exceeded 390,000 segments, and scoring 93% of success rate when activating both auditory and vision modules for the agent Nao. The developed toolkit uses Arabic speech recognition and the Haar algorithm in a mixed reality system using big data enabling Nao to achieve a 94% success learning rate at a distance of 0.09 m; when using LMC in mixed reality, the hand sign gestures recorded the highest accuracy of 98.50% using Haar algorithm. The work shows that the current work enabled Nao to gradually achieve a higher learning success rate as the environment changes and multisensory perception increases. This paper also proposes a cutting‐edge research work direction for fostering child‐robots education in real time.

Obtaining the Manning roughness with terrestrialremote sensing technique and flood modeling using FLO-2D

Determining the Manning roughness coefficients is one of the most important steps in flood modeling. The roughness coefficients cause differences in flood areas, water levels, and velocities in the process of modeling. This study aims to determine both the Manning roughness coefficient in the river sections and outside of the river regions by using the Cowan method and remote sensing technique in the flood modeling. In the flood modeling, FLO-2D Pro program which can simulate flood propagation in two dimensions was utilized. Mert River in Samsun province located in the northern part of Turkey was chosen as the study area. Samples taken from the river were subjected to sieve analysis, the types of constituent material were determined according to the median diameters and the roughness coefficients were obtained using the Cowan method. For regions outside of the river were applied the maximum likelihood method being one of the controlled classification methods. Manning roughness values were assigned the classified image sections. Remote sensing techniques were meticulously employed to achieve time management in areas outside the river and a new approach was proposed in the Manning assessment of flood areas to ensure uniformity in the study area. In the classification made using the maximum likelihood method, the overall classification accuracy was 92.9% and the kappa ratio “κ” was 90.64%. The results were calibrated with the last hazardous flood images in 2012 and HEC-RAS 2D program, another flood modeling program.

390 Poor Agreement between Cardiac Computed Tomographic Angiography and Stress Echocardiography in Assessment of Stable Chest Pain.

Cardiac computed tomographic angiography (CCTA) and stress echocardiogram are used in patients with stable chest pain to determine who may benefit from medical therapy. CCTA is the considered most sensitive test for detecting atherosclerosis but does not provide a functional assessment. Data on the concordance between CCTA and stress echocardiogram is limited. We reviewed 282 patients who had both CCTA and stress echo at a single centre from September 2014-August 2019. 280 of these patients had coronary artery calcium score (CAC) performed. Moderate or greater plaque burden was defined as CAC >100. Stenosis on CCTA was defined according to the Coronary Artery Disease-Reporting and Data System criteria. Stress echocardiograms were graded as normal or abnormal (unable to exclude inducible ischaemia, another test required). These results were compared using Cohen’s Kappa ratio (κ) to assess agreement between tests. There was only slight agreement between moderate or greater plaque burden on CAC and abnormal stress echocardiogram (κ=0.13). There was slight agreement between severe stenosis on CCTA and abnormal stress echocardiogram (κ=0.079). 43 patients (15%) who had normal stress echocardiogram had severe stenosis on CCTA. 77 patients (27%) had an abnormal stress echocardiogram with no severe stenosis on CCTA. There was only slight agreement between CCTA and on stress echocardiogram with a high proportion of abnormal stress echocardiograms without significant atherosclerosis on CCTA. Understanding the strengths and limitations of non-invasive assessment of cardiac chest pain is necessary to help guide appropriate management.

The 5-Item Modified Frailty Index Is Predictive of Severe Adverse Events in Patients Undergoing Surgery for Adult Spinal Deformity.

A retrospective review of 281 consecutive cases of adult spine deformity (ASD) surgery (age 55 ± 19 yrs, 91% female, follow-up 4.3 ± 1.9 yrs) from a multicenter database. To compare the value and predictive ability of the 5-item modified frailty index (mFI-5) to the conventional 11-item modified frailty index (mFI-11) for severe adverse events (SAEs). Several recent studies have described associations between frailty and surgical complications. However, the predictive power and usefulness of the mFI-5 have not been proven. SAEs were defined as: Clavien-Dindo grade >3, reoperation required, deterioration of motor function at discharge, or new motor deficit within 2 years. The patients' frailty was categorized by the mFI-5 and mFI-11 (robust, prefrail, or frail). Spearman's rho was used to assess correlation between the mFI-5 and mFI-11. Univariate and multivariate Poisson regression analyses were conducted to analyze the relative risk of mFI-5 and mFI-11 as a predictor for SAEs in ASD surgery. Age, sex, and baseline sagittal alignment (Schwab-SRS classification subcategories) were used to adjust the baseline variance of the patients. Of the 281 patients, 63 (22%) had developed SAE at 2 years. The weighted Kappa ratio between the mFI-5 and mFI-11 was 0.87, indicating excellent concordance across ASD surgery. Frailty was associated with increased total complications, perioperative complications, implant-related complications, and SAEs. Adjusted and unadjusted models showed similar c-statistics for mFI-5 and mFI-11 and a strong predictive ability for SAEs in ASD surgery. As the mFI-5 increased from 0 to ≥2, the rate of SAEs increased from 17% to 63% (P < 0.01), and the relative risk was 2.2 (95% CI: 1.3-3.7). The mFI-5 and the mFI-11 were equally effective predictors of SEA development in ASD surgery. The evaluation of patient frailty using mFI-5 may help surgeons optimize procedures and counsel patients. 4.

Применение автоматизированного дешифрирования данных Sentinel-2 для создания актуализированных карт-схем страт ГИЛ на территории труднодоступных районов Российской Федерации

Изложена технология создания актуализированных карт-схем страт, которая базируется на применении материалов съёмки среднего разрешения Sentinel-2 и их классификации. Приведены ее преимущества: использование методов математической статистики; отсутствие необходимости в актуализации данных; повторная классификация мультиспектральных спутниковых изображений на основании полевых данных с заложенных пробных площадей. The technological scheme of work within the State Forest Inventory (SFI) in terms of determining the quantitative and qualitative characteristics of forests implies at the first stage obtaining initial data on the object of work (materials of the last forest inventory, materials of the state forest registry, etc.) and the subsequent creation of a digital cartographic basis due to the updating and generalization of the received maps. In the case of hard-to-reach territories, this technology has a number of significant drawbacks, the most serious of which is stratification based on irrelevant forest inventory materials on the territory of hard-to-reach areas. The technology of creating updated maps of stratums based on the use of Sentinel-2 free medium resolution and its classification is proposed. It has several advantages: based on the methods of mathematical statistics; there is no need to update the data, because use of the current year; The final stage of the proposed technology is the reclassification of multispectral satellite images based on the field data obtained from thetest plots. Automated thematic interpretation was performed using the object-oriented method using ScanEx IMAGE Processor v5.0. Processing and visualization of the results of the work was carried out in an environment of freely distributed geographic information system QGIS, the calculation of accuracy (the creation of an error matrix) was performed using MS Excel. Analysis of the classification results showed its high accuracy (total accuracy was 80.4%, kappa ratio - 0.77), which indicates good prospects for the application of the proposed technology during the SFIon the territory of hard-to-reach areas.

Kappa ratios and (higher-order) stochastic dominance

This paper first shows the sufficient relationship between the $$(n+1)$$ -order SD and the n-order Kappa ratio. In fact, we clarify the restrictions on necessary beating of the target for the higher-order SD consistency of the Kappa ratios. Thereafter, we show that, in general, the necessary relationship between SD/RSD and the Kappa ratio cannot be established. We find that when the variables being compared belong to the same location-scale family or the same linear combination of location-scale families, we can get the necessary relationship between the $$(n+1)$$ -order SD with the n-order Kappa ratio after imposing some conditions on the means. Our findings enable academics and practitioners to draw better decision in their analysis.

Structured products under generalized kappa ratio

We examine the maximization problem of performance measure of financial structured products. For this purpose, we introduce the kappa ratios, based on downside risk measures which take account of the asymmetry of the return probability distribution. First, we deal with the optimization of some standard structured portfolios. We examine in particular the optimal combination of risk free, stock and call/put instruments with respect to kappa performance measures and in particular to the Sharpe–Omega ratio. Then, we provide the general solution of the optimal positioning problem with respect to kappa ratios. We analyze its properties and compare it to the portfolio profile that is optimal with respect to the standard expected utility criterion.

CONDIÇÕES SENSÍVEIS À ATENÇÃO PRIMÁRIA: CONFIABILIDADE DIAGNÓSTICA EM SANTA CRUZ DO SUL, RS

Introduction: Ambulatory Care Sensitive Conditions (ACSC) are illnesses that could be prevented with adjusted ambulatorial care. ACSC have been used as indicator in effectiveness of the primary healthcare attention, through the evaluation of hospital admissions. However, we do not have studies to certify the reliability of diagnosis of ACSC in our country. Objective: To determine if the classification of ACSC from the main diagnostic field of the authorization of hospital internment (AHI) is reliable. Methods: Transversal study carried through February of 2010 to January of 2011, in the city of Santa Cruz of Sul (RS). A random sample of 389 medical records was selected and evaluated by two medical appraisers. The main diagnosis in the AHI was compared with the classification in ACSC or not ACSC given for the appraisers after the study of each medical record. Kappa ratio agreement was used to calculate the reliability of the ACSC diagnostic. Results: The ratio of agreement between diagnosis from the AIH and CSAP assessment contained in the records was 92%, with a kappa coefficient of 0,784. Conclusions: The diagnostic of ACSC found in main diagnostic field of AHI showed agreement ratios over expected by chance, with kappa value equal to 0.784 and the correlation rated between substantial and almost perfect.

Diagnostic performance of dual-energy contrast-enhanced subtracted mammography in dense breasts compared to mammography alone: interobserver blind-reading analysis.

To analyse the accuracy of dual-energy contrast-enhanced spectral mammography in dense breasts in comparison with contrast-enhanced subtracted mammography (CESM) and conventional mammography (Mx). CESM cases of dense breasts with histological proof were evaluated in the present study. Four radiologists with varying experience in mammography interpretation blindly read Mx first, followed by CESM. The diagnostic profiles, consistency and learning curve were analysed statistically. One hundred lesions (28 benign and 72 breast malignancies) in 89 females were analysed. Use of CESM improved the cancer diagnosis by 21.2% in sensitivity (71.5% to 92.7%), by 16.1% in specificity (51.8% to 67.9%) and by 19.8% in accuracy (65.9% to 85.8%) compared with Mx. The interobserver diagnostic consistency was markedly higher using CESM than using Mx alone (0.6235 vs. 0.3869 using the kappa ratio). The probability of a correct prediction was elevated from 80% to 90% after 75 consecutive case readings. CESM provided additional information with consistent improvement of the cancer diagnosis in dense breasts compared to Mx alone. The prediction of the diagnosis could be improved by the interpretation of a significant number of cases in the presence of 6% benign contrast enhancement in this study. • DE-CESM improves the cancer diagnosis in dense breasts compared with mammography. • DE-CESM shows greater consistency than mammography alone by interobserver blind reading. • Diagnostic improvement of DE-CESM is independent of the mammographic reading experience.

Prospective evaluation of a rapid nanoparticle-based lateral flow immunoassay (STic Expert(®) HIT) for the diagnosis of heparin-induced thrombocytopenia.

A rapid lateral flow immunoassay (LFIA) (STic Expert(®) HIT), recently developed for the diagnosis of heparin-induced thrombocytopenia (HIT), was evaluated in a prospective multicentre cohort of 334 consecutive patients. The risk of HIT was estimated by the 4Ts score as low, intermediate and high in 28·7%, 61·7% and 9·6% of patients, respectively. Definite HIT was diagnosed in 40 patients (12·0%) with positive results on both enzyme-linked immunosorbent assay (Asserachrom(®) HPIA IgG) and serotonin release assay. The inter-reader reproducibility of results obtained was excellent (kappa ratio > 0·9). The negative predictive value of LFIA with plasma samples was 99·6% with a negative likelihood ratio (LR) of 0·03, and was comparable to those of the particle gel immunoassay (H/PF4-PaGIA(®) ) performed in 124 cases. Positive predictive value and positive LR were 44·4% and 5·87, respectively, and the results were similar for serum samples. The probability of HIT in intermediate risk patients decreased from 11·2% to 0·4% when the LFIA result was negative and increased to 42·5% when it was positive. In conclusion, the STic Expert(®) HIT combined with the 4Ts score is a reliable tool to rule out the diagnosis of HIT.

Portfolio Performance Maximization with Generalized Kappa Ratio

We examine the maximization problem of performance measure of financial structured products. For this purpose, we introduce the Kappa ratios, based on downside risk measures which take account of the asymmetry of the return probability distribution. First, we deal with the optimization of some standard structured portfolios. We examine in particular the optimal combination of risk free, stock and call/put instruments with respect to Kappa performance measures and in particular to the SharpeOmega ratio. Then, we provide the general solution of the optimal positioning problem with respect to Kappa ratios. We analyze its properties and compare it to the portfolio profile that is optimal with respect to the standard expected utility criterion.

Role of Free Light Chain Assay Ratio to Distinguish Between CR According EBMT Criteria or Stringent Complete Remission (sCR) According IMWG in Multiple Myeloma Patients.

Abstract 1787Poster Board I-813 IntroductionThe qualitative assay for free light chain has been reported to be sensitive and specific for detecting and monitoring diseases caused by monoclonal gammopathies such as multiple myeloma. More recently the International Myeloma Working Group proposed uniform response criteria including a new definition of stringent complete remission (sCR). The definition of stringent complete remission requires beside absence of clonal cells in bone marrow by immunohistochemistry or immunofluorescence also normalization of free light chain ratio in serum. Patients and MethodsWe evaluate the value of free light chain assay to determine stringent CR by monitoring 87 patients with multiple myeloma who achieved complete remission (n=52) or very good partial remission (n=35) between January 2003 and December 2008. Free light chain measurements were performed with the commercially available Free liteTM Kit (Binding Site, Heidelberg, Germany). Because of the shorter half-life of free light chain assay ratio, only patients were included, if the complete or very good partial remission remains stable for at least 3 months. The comparison between immunofixation and free light chain ratio was performed at least 6 weeks after immunofixation becomes negative for the first time. 87 patients (50 mal and 37 female) were included, 67 had intact immunoglobulin and 11 had light chain immunoglobulin at time of diagnosis. The remission status was determined either after allogeneic (n = 73) or autologous (n = 7) stem cell transplantation or after conventional bortezomib or lenalidomide containing chemotherapy (n = 7). Results35 out of 87 patients achieved a very good partial or near complete remission with still positive immunofixation. In 22 out of those 35 patients the free light chain kappa ratio was within the normal range of 0.26 – 1.65 mg/l (63 %). Only in 13 patients with persistent immunofixation positivity the free light chain ratio was outside the normal range (37%). 52 patients achieved complete remission according to the EBMT criteria with negative immunofixation for at least 3 months. In those patients all (100 %) had a normal free light chain kappa/lambda ratio. In a subgroup of patients (n = 10) who relapsed during follow-up from complete remission sequential monitoring of immunofixation and free light assay was performed as recently described [4]. In 9 out of 10 patients a free light chain ratio became abnormal at a median 90 days before immunofixation became positive. ConclusionsThe free light chain assay ratio is a useful marker for a faster detection of remission or progression in myeloma patients. However, these results do not support additional value of free light chain ratio to determine the depth of remission in immunofixation negative patients. More sensitive methods such as imunophenotyping analysis by FACS or molecular primer should be used to determine depth of complete remission since these methods have shown relevant clinical impact.VGPR or near CR (positive immunofixation) n = 35CR (negative immunofixation) n = 52free light chain ratio:abnormal 37 % normal 63 %abnormal 0 % normal 100 % DisclosuresNo relevant conflicts of interest to declare.

Abnormal Serum Free Light Chain Ratios Are Associated with Earlier Time to First Treatment and Poor Survival in Patients with Chronic Lymphocytic Leukaemia

Introduction: Serum free light chains (sFLC) have prognostic significance in plasma cell disorders. In B-cell chronic lymphocytic leukemia (CLL), a small study found 8/18 (44%) of patients to have abnormal FLC ratios but no assessment of prognostic value was published. The aim of the present study was to determine whether abnormal serum FLC concentrations are indicative of a poor prognosis in CLL patients.Methods: Sera were analysed from 381 previously diagnosed CLL patients (Stage A 307; B 30; C 26; 18 missing; male: Female Ratio 1.6:1, mean age 71 (29–98)) with samples taken before their first treatment (303) or after treatment (78). The study was approved by the Birmingham Heart of England NHS Trust Review Board. Patients were described using the Binet staging system and measured for prognostic markers including CD38, Zap70, mutational status, β2M and FLC. Kaplan Meier survival curves and Cox proportional hazards regression (age, sex, CD38, Zap 70, mutational status, β2M and sFLC) were calculated using SPSS v14.Results: 147/381 (39%) patient sera had abnormal sFLC ratios. Kaplan Meier analysis of all deaths showed abnormal ratios were significantly associated with worse survival (n=350, p<0.001). Analysis of deaths attributed to CLL (n=30) also indicated that an abnormal FLC ratio was predictive of shorter survival (p=0.001). However, for deaths not attributed to CLL (n=32), the FLC ratio was not significantly predictive of outcome (p=0.112). For Cox regression analysis (n=228) of deaths attributed to CLL only, three significant, independent, prognostic factors were identified: CD38 (p<0.001), abnormal ratio (p<0.001) and Stage (p=0.027). Analysis of the untreated patient population (n=303), using Kaplan Meier analysis of time to first treatment, found that an abnormal lambda ratio (p=0.04) but not an abnormal kappa ratio (p=0.443) predicted earlier treatment. For patients with an abnormal lambda ratio, the mean time to first treatment was 38 months earlier than those patients with a normal ratio. Cox regression analysis (n=171) of time to first treatment, found 4 significant, independent factors predicting earlier treatment: Zap70 (p<0.001), Age (p<0.001), abnormal sFLC ratio (p=0.001) and Stage (p=0.027).Conclusions: As shown in other monoclonal gammopathies, abnormal sFLC ratios were associated with poorer outcomes in patients with CLL. Furthermore, in an untreated population, patients with an abnormal lambda sFLC ratio required earlier treatment, indicating a pathological mechanism which is as yet unclear but which warrants further investigation.

Vertical wave packets observed in a crystallized hexagonal monolayer complex plasma

Propagation of vertical wave packets was observed experimentally in a crystallized hexagonal monolayer complex plasma. It was found that the phase velocity exceeded the group velocity by a factor 65 and was directed into the opposite direction as expected for an inverse optical-like dispersion relation. The wave packets propagated keeping their width constant. The explanation of this behavior is based on three-dimensional equations of motion and uses a long-wavelength weak dispersion weak inhomogeneity approximation. While the wave dispersion causes the wave packet to spread, lattice inhomogeneity and neutral gas drag counteract spreading. A plasma diagnostic method was developed that is based on the ratio between vertical and dust-lattice wave speeds. This ratio is very sensitive to the lattice parameter kappa (ratio of the particle separation to the screening length) in a very useful range of kappa < or = 2 . It was found that only a two-dimensional lattice model can provide a quantitative description of the vertical waves, while a linear chain model gives only a qualitative agreement.

Flow cytometric immunophenotyping in fine-needle aspiration of lymph nodes.

Fine-needle aspiration (FNA) of lymph nodes has been regarded as a useful method in the diagnosis of lymphadenopathy. However, this procedure has been shown to be of limited value in the diagnosis of low or intermediate grade malignant lymphomas in some studies. Immunophenotyping is an essential adjunct to cytomorphology for the diagnosis of lymphoma by FNA. Immunophenotyping using flow cytometry (FCM) is rapid, objective and reliable. Using FCM, multiparametric analysis of 33 FNA materials from lymph nodes was performed and profiles of surface markers of lymphoid cells were assessed. In reactive hyperplasia, patterns of cell surface markers were quite variable, but disclosed polyclonality. Most of the B-cell lymphomas showed immunophenotypes for B-cell lineages with their kappa: lambda or lambda: kappa ratio being over 3:1. In T-cell lymphomas, T-cell surface markers were predominantly expressed as well. In conclusion, our results suggest that immunophenotyping of lymph node aspirates is a valuable diagnostic adjunct for lymphoproliferative disorders, particularly in B-cell lymphomas because immunophenotyping can be easily and adequately performed by FCM.