Microwave photon detector in circuit QED

In this Letter we design a metamaterial composed of discrete superconducting elements that implements a high-efficiency microwave photon detector. Our design consists of a microwave guide coupled to an array of metastable quantum circuits, whose internal states are irreversibly changed due to the absorption of photons. This proposal can be widely applied to different physical systems and can be generalized to implement a microwave photon counter.

[Telemedicine and teledermatology (II): current state of research on dermatology teleconsultations]

The rapid increase in the use of telemedicine makes a critical appraisal of these services essential. This article reviews the current evidence from studies of teledermatology with sufficiently rigorous methodology to allow reasonable conclusions to be drawn. The review is organized according to areas of research in teledermatology: reliability of diagnosis and management, accuracy, outcomes, costs, and satisfaction. The conclusion of this review is that teledermatology has been shown to be feasible and reliable but that it has a long way to go before maturing as a medical technology in daily practice. The largest body of evidence relates to the reliability of diagnosis and management, but although numerous studies have been performed, many have marked methodological shortcomings. Accuracy studies have been conducted in skin oncology with appropriate methodology that show an accuracy comparable to that of face-to-face consultations. Studies of health outcomes should be designed such that a faithful assessment of the final outcomes, costs, and satisfaction with teledermatology systems can be carried out.

[Telemedicine and teledermatology (I): concepts and applications]

Telemedicine refers to the use of telecommunications technology to provide health care and medical information. The practice of medicine--and dermatology in particular--is undergoing a great upheaval due to advances in information technology. This article briefly reviews the origin, development, applications, benefits, methodology, and components of telemedicine. Specifically, we will analyze the types and applications of teledermatology, paying particular attention to technical, organizational, and legal aspects.

Sudden birth versus sudden death of entanglement in multipartite systems

We study the entanglement dynamics of two cavities interacting with independent reservoirs. Expectedly, as the cavity entanglement is depleted, it is transferred to the reservoir degrees of freedom. We find also that when the cavity entanglement suddenly disappears, the reservoir entanglement suddenly and necessarily appears. Surprisingly, we show that this entanglement sudden birth can manifest before, simultaneously, or even after entanglement sudden death. Finally, we present an explanatory study of other entanglement partitions and of higher dimensional systems.

[Preliminary results of DERMATEL: prospective randomized study comparing synchronous and asynchronous modalities of teledermatology]

INTRODUCTION

There is considerable variability in the results of studies that evaluate diagnostic reliability in teledermatology. There are only two studies that compare the synchronous and asynchronous modalities of teleconsult in the same sample. We present the results of the pilot project DERMATEL, a study of diagnostic concordance that aims to increase the evidence of these aspects.

MATERIAL AND METHODS

One-hundred-fifty.nine patients referred by the general practitioner in the first consult were randomized (algorithm 3:2:1) in three arms: asyncronous teledermatology (store-and-forward or SAF), synchronous teldermatology (real-time or VTC), and conventional consult (CC). We used high-quality, fixed digital images in all cases. The patients on the VTC teledermatology arm were also evaluated by videoconference. Finally all patients attended a face-to-face consult, considered the gold standard of patient care. A second dermatologist evaluated the diagnostic and management concordance between the teleconsults and the face-to-face consults.

RESULTS

One-hundred.forty-seven patients completed the study as follows: 74 in the SAF teledermatology arm, 47 in the VTC teledermatology arm and 26 in the conventional consult (control group). The teledermatological (SAF and VTC) and face-to-face evaluations were identical in 100 of 121 patients (82.6%). The errors were mild in 14 cases (11.6%) and severe in 7 (5.8%). The diagnostic concordance was very high (kappa=0,813). The errors grouped by diseases were as follows: 6/54 (11%) for tumors, 10/30 (33.3%) for inflammatory conditions, 1/20 (5%) for infectious diseases, 3/12 (25%) for alopecia/acne and 1/5 (20%) for others. There were 15 errors in the SAF teledermatology arm (20.3%) and 6 in the VTC teledermatology arm (12.8%); these differences were not statistically significant (chi2 1.12; p=0.288).

CONCLUSION

The reliability of dermatological teleconsult is very high, especially for tumoral or infectious diseases. The synchronous interaction with audio requires more resources, is difficult to coordinate and its diagnostic efficacy is not superior to SAF teledermatology.

Comparative study between nadolol and 5-isosorbide mononitrate vs. endoscopic band ligation plus sclerotherapy in the prevention of variceal rebleeding in cirrhotic patients: a randomized controlled trial

BACKGROUND

After variceal bleeding, cirrhotic patients should receive secondary prophylaxis.

AIM

To compare nadolol plus 5-isosorbide mononitrate (5-ISMN) with endoscopic band ligation. The end points were rebleeding, treatment failure and death.

METHODS

One hundred and nine cirrhotic patients with a recent variceal bleeding were randomized: nadolol plus 5-ISMN in 57 patients and endoscopic band ligation in 52 patients.

RESULTS

The mean follow-up was 17 and 19 months in nadolol plus 5-ISMN and endoscopic band ligation groups, respectively. No differences were observed between groups in upper rebleeding (47% vs. 46%), variceal rebleeding (40% vs. 36%), failure (32% vs. 22%), major complications (7% vs. 13.5%) and death (19% vs. 20%), respectively. The actuarial probability of remaining free of rebleeding, failure and deaths were similar in both groups. Time to rebleeding shows that endoscopic band ligation patients had an early rebleed, with a median of 0.5 month (95% CI: 0.0-4.2) compared with patients from nadolol plus 5-ISMN, 7.6 months (95% CI: 2.9-12.3, P < 0.013). Multivariate analysis indicated that outcome-specific predictive factor(s) for rebleeding was Child A vs. B + C (P < 0.01); for failure was Child A vs. B + C (P < 0.02); and for death ascites (P < 0.01) and rebleeding (P < 0.02).

CONCLUSION

This trial suggests no superiority of endoscopic band ligation over nadolol plus 5-ISMN mononitrate for the prevention of rebleeding in cirrhotic patients.

19 PREGNANCY RATES IN DAIRY COWS TREATED WITH INTRAVAGINAL PROGESTERONE DEVICES AND DIFFERENT FIXED-TIME AI PROTOCOLS

Two experiments were designed to evaluate the effect of different treatments for the synchronization of ovulation on pregnancy rates following fixed-time AI (FTAI) of lactating dairy cows. In Experiment 1, 394 Holstein cows that were 61.7 � 13.6 days postpartum (range 35 to 94 days), with a milk yield of 30.7 � 6.8 liters per day (range 12.0 to 52.4 liters) and a body condition score (BCS) between 2.5 to 3.5 out of 5, were used. Cows were blocked by days postpartum and milk yield and randomly assigned to one of four treatment groups. Cows in P4+EB treatment groups received an intravaginal DIB device (1 g P4; Syntex, Argentina) and 2 mg of estradiol benzoate (EB; Syntex) i.m. on Day 0. On Day 8, DIB devices were removed, and cows received PGF (150 �g D+cloprostenol: Ciclase; Syntex), and were subdivided to receive 400 IU eCG (Novormon 5000, Syntex) i.m. or no further treatment at that time. On Day 9, all cows received 1 mg of EB and were FTAI 60 h after DIB removal. Cows in P4-Synch groups received a DIB device and 50 �g of GnRH (Lecirelina, Gonasyn; Syntex) i.m. on Day 0. On Day 7, DIB devices were removed; cows received PGF and were divided to receive 400 IU eCG i.m. or no further treatment. On Day 9, all cows received a second GnRH treatment and were FTAI 60 h after DIB removal. Blood samples were taken on Days -10 and 0 to determine plasma P4 concentrations; 93% of the cows had >1 ng/mL P4 in at least one sample. In Experiment 2, 200 lactating cows from the same farm were treated with the P4+EB+eCG and P4-Synch without eCG treatments with either a DIB or a CIDR-B (1.9 g P4; Pfizer Animal Health, Groton, CT, USA) in a 2 � 2 factorial design. Cows were examined by rectal palpation 50 days after FTAI to determine pregnancy status, and data were analyzed by chi-square Mantel-Haenszel test. There was an EB/GnRH by eCG interaction (P < 0.05) which was attributed to a higher pregnancy rate in the P4+EB+eCG group (44/98; 44.9%) than in the P4+EB without eCG group (30/100; 30.0%) and P4-Synch+eCG group (30/98; 30.6%); the P4-Synch without eCG group had an intermediate pregnancy rate that did not differ from the other treatment groups (37/98; 38.8%). In Experiment 2, no significant differences (P = 0.40) in pregnancy rates were detected between cows treated with DIB (51/100; 51.0%) or CIDR-B (42/100; 42.0%), and there was no difference (P = 0.18) between P4+EB+eCG (52/100; 52.0%) and P4-Synch without eCG (41/100; 41.0%) treated groups. Results suggest that the addition of eCG will improve pregnancy rates following FTAI in lactating dairy cows treated with EB but not in those treated with GnRH at the time of insertion and after removal of a P4 releasing device. Although treatment with P4+EB+eCG resulted in numerically higher pregnancy rates, results were not different from those obtained in the GnRH-based treatment, without the addition of eCG.

[Comparative study on the protective effect of two immunization schemes using a hepatitis B recombinant vaccine in vulnerable health science students]

OBJECTIVE

Demonstrate the protective effect of hepatitis B in vaccine vulnerable health sciences students, under 30 years with three schemes the vaccination, two of them are conventional three doses and another one with two doses.

HYPOTHESIS

Three schedules of vaccination dosage schemes hepatitis B produce antibody response over 10 IU/ml.

DESIGN

Analytical, experimental, longitudinal., prospective and concurrent cohort study.

MATERIALS AND METHOD

100 vulnerable female and male students of the Medical Technology Faculty of the UNMSM Medical School were enrolled at first. 89 students completed the final analysis due to the inclusion and exclusion criteria in accordance with the study purpose. A vaccine dosage of 20 ug of surface antigen in 1 mL through three dosage schemes was administered: month 0, 1, 6; month 0, 1, 2; and month 0, 1. Blood samples were taken before and 1, 2, 6, and 7 months after the first dosage administration to determine the anti-HBs level. Anti-HBs approximately 10 mIU/mL was defined as seroprotective value.

RESULTS

89 students under 30 years (average age: 23.5 years). 46 (51.7%) male individuals, and 43 (48.3%) female individuals.12.4% of students reached protection within 30 days from the first dosage; 98.8% reached protection within 30 days from the second dosage; and 100% reached protection 180 days later. After the second dosage, the three groups reached protection values, and at the end of the study, the average antibody levels were between 532.7 mIU/mL and 1237.2 mIU/mL.

CONCLUSIONS

This study showed an equivalent protective effect 7 months after the first dosage. An equivalent protective effect for hepatitis B was reached through three different vaccination schemes: conventional three dose scheme (month 0, 1, 6); two dose brief scheme (month 0, 1); and three dose brief scheme (month 0, 1, 2). A two dose scheme is suggested for individuals under 30 years, which would imply a higher compliance rate, lower cost, and a similar protection benefit.

Severe lung involvement in systemic scleromyxoedema: a highly unusual finding

Scleromyxoedema is a rare systemic disorder characterized by a lichenoid papular rash. Although scleromyxoedema can involve any organ, very few cases of pulmonary involvement have been reported. Moreover, there are no reports in the literature on treatment of this condition, especially with lung transplantation. The authors report a case of scleromyxoedema in a young man with neurological, skin and respiratory involvement, the latter being mainly characterized by pulmonary emphysema. Due to the serious respiratory compromise, and to the stability of the systemic lesions, a bilateral lung transplantation was performed with successful results at 4.5 yrs. In conclusion, lung transplantation may be required in patients with severe respiratory failure caused by scleromyxoedema.

A randomized, double-blind, parallel-group, duration-finding study of oral terbinafine and open-label, high-dose griseofulvin in children with tinea capitis due to Microsporum species

BACKGROUND

Tinea capitis, a common clinical pattern of dermatophyte infection in children is becoming a public health hazard in some countries. Several studies have reported terbinafine to be a safe and well-tolerated fungicidal drug for the treatment of this infection. However, the optimal treatment duration for its use in the treatment of tinea capitis caused by Microsporum species has not yet been determined.

OBJECTIVE

(i) To establish the optimal duration for terbinafine treatment to bring about complete cure of tinea capitis due to Microsporum infection in a large paediatric population, and (ii) to obtain information on the maximum therapeutic effect of the existing therapy.

PATIENTS AND METHODS

This parallel-group, double-blind, multicentre study was conducted in Europe and South America. Patients were randomized to one of four oral terbinafine treatment arms (6, 8, 10 or 12 weeks treatment) or to an open label, 12-week, high-dose griseofulvin (20 mg x kg(-1) x day(-1)) arm at a 1 : 1 : 1 : 1 : 1 ratio. All patients were followed up for 4 weeks after the end of the treatment phase.

RESULTS

In this group of 134 intention-to-treat patients, effective treatment was observed at the end of study in 62% of patients treated with terbinafine for 6 weeks and in 63% treated for 8 weeks. Mycological cure was obtained in 59% and 57%, respectively, and clinical cure in 76% and 80%. In the griseofulvin group, effective treatment was 88%, mycological cure was 76% and clinical cure 96%. However, these high rates were believed to be due to the high dosage of this drug and the prolonged course of treatment. Complete cure was observed at the end of study in 62% patients treated with terbinafine for 6 weeks, in 60% treated for 8 weeks and in 84% patients treated with griseofulvin for 12 weeks.

CONCLUSIONS

Although there was no statistical trend between the duration of terbinafine treatment within the groups for complete cure at the end of study, there was a positive correlation between the daily dose of terbinafine (mg x kg(-1)) and complete cure. Terbinafine therapy for 6 weeks could represent an alternative to griseofulvin for the treatment of Microsporum tinea capitis. However, further clinical trials are required in order to optimize the dose regimen to allow higher cure rates to be reached.