Sensitivity and specificity of fluorescence microlymphography for detecting lymphedema of the lower extremity

Fluorescence microlymphography (FML) is used to visualize the lymphatic capillaries. A maximum spread of the fluorescence dye of ≥ 12 mm has been suggested for the diagnosis of lymphedema. However, data on sensitivity and specificity are lacking. The aim of this study was to investigate the accuracy of FML for diagnosing lymphedema in patients with leg swelling. Patients with lower extremity swelling were clinically assessed and separated into lymphedema and non-lymphatic edema groups. FML was studied in all affected legs and the maximum spread of lymphatic capillaries was measured. Test accuracy and receiver operator characteristic (ROC) analysis was performed to assess possible threshold values that predict lymphedema. Between March 2008 and August 2011 a total of 171 patients (184 legs) with a median age of 43.5 (IQR 24, 54) years were assessed. Of those, 94 (51.1%) legs were diagnosed with lymphedema. The sensitivity, specificity, positive and negative likelihood ratio and positive and negative predictive value were 87%, 64%, 2.45, 0.20, 72% and 83% for the 12-mm cut-off level and 79%, 83%, 4.72, 0.26, 83% and 79% for the 14-mm cut-off level, respectively. The area under the ROC curve was 0.82 (95% CI: 0.76, 0.88). Sensitivity was higher in the secondary versus primary lymphedema (95.0% vs 74.3%, p = 0.045). No major adverse events were observed. In conclusion, FML is a simple and safe technique for detecting lymphedema in patients with leg swelling. A cut-off level of ≥ 14-mm maximum spread has a high sensitivity and high specificity of detecting lymphedema and should be chosen.

Rare decays and MSSM phenomenology

In this article I review some aspects of flavour phenomenology in the MSSM. After an overview of various flavour observables I discuss the constraints on the off-diagonal elements of the squark mass matrices. In this context I present the Fortran code SUSY_FLAVOR which calculates these processes in the generic MSSM including the complete resummation of all chirally enhanced effects as a new feature of version 2. Than I discuss where large new physics effects in the MSSM are still possible. As an example of a model which can give large effects in flavour physics I review a model with "radiative flavour violation" (RFV) and update the results in the light of the recent LHCb measurement of Bs -> \mu \mu. Finally, I recall that the MSSM can generate a sizable right-handed W-coupling which affects B -> \tau\nu and can solve the Vub problem.