Experimental unconditional preparation and detection of a continuous bound entangled state of light

Among the possibly most intriguing aspects of quantum entanglement is that it comes in free and bound instances. The existence of bound entangled states certifies an intrinsic irreversibility of entanglement in nature and suggests a connection with thermodynamics. In this Letter, we present a first unconditional, continuous-variable preparation and detection of a bound entangled state of light. We use convex optimization to identify regimes rendering its bound character well certifiable, and continuously produce a distributed bound entangled state with an extraordinary and unprecedented significance of more than 10 standard deviations away from both separability and distillability. Our results show that the approach chosen allows for the efficient and precise preparation of multimode entangled states of light with various applications in quantum information, quantum state engineering, and high precision metrology.

Non-Markovian behavior of small and large complex quantum systems

The channel induced by a complex system interacting strongly with a qubit is calculated exactly under the assumption of randomness of its eigenvectors. The resulting channel is represented as an isotropic time-dependent oscillation of the Bloch ball, leading to non-Markovian behavior, even in the limit of infinite environments. Two contributions are identified: one due to the density of states and the other due to correlations in the spectrum. Prototype examples, one for chaotic and the other for regular dynamics are explored.

Utility of a simplified ultrasound assessment to assess interstitial pulmonary fibrosis in connective tissue disorders--preliminary results

INTRODUCTION

Interstitial pulmonary fibrosis (IPF) is a frequent manifestation in patients with connective tissue disorders (CTD). Recently the ultrasound (US) criterion validity for its assessment has been proposed; however, the US scoring systems adopted include the study of several lung intercostal spaces (LIS), which could be time-consuming in daily clinical practice. The aim of this study was to investigate the utility of a simplified US B-lines scoring system compared with both the US comprehensive assessment and the high-resolution computed tomography (HRCT) findings of IPF in CTD patients.

METHODS

Thirty-six patients with a diagnosis of CTD were enrolled. Each patient underwent chest HRCT and lung US by an experienced radiologist and rheumatologist, respectively. Both comprehensive and simplified US B-lines assessments were scanned. The comprehensive US assessment was performed at 50 LIS level, whereas the simplified US assessment included bilaterally 14 LIS; for the anterior chest: the second LIS along the para-sternal lines, the fourth LIS along the mid-clavear, anterior axillary and mid-axillary lines; for the posterior chest: the eighth LIS along the paravertebral, sub-scapular and posterior axillary lines. For criterion validity, HRCT was considered the gold standard. Feasibility, inter and intra-observer reliability was also investigated.

RESULTS

A highly significant correlation between comprehensive and simplified US assessment was found (P = 0.0001). A significant correlation was also found between the simplified US assessment and HRCT findings (P = 0.0006). Kappa values for the inter-observer simplified US assessment were in a range from 0.769 to 0.885, whereas the concordance correlation coefficient values for the intra-observer were from 0.856 to 0.955. There was a relevant difference in time spent on comprehensive (mean 23.3 ± SD 4.5 minutes) with respect to the simplified US assessment (mean 8.6 ± SD 1.4) (P < 0.00001).

CONCLUSIONS

Our results provide a new working hypothesis in favor of the utility of a simplified US B-lines assessment as an adjunct method to assess IPF in patients with CTD.

Joint and tendon subclinical involvement suggestive of gouty arthritis in asymptomatic hyperuricemia: an ultrasound controlled study

Introduction

In this study, we aimed to investigate ultrasonographic (US) changes suggestive of gouty arthritis in the hyaline cartilage, joints and tendons from asymptomatic individuals with hyperuricemia.

Methods

We conducted a cross-sectional, controlled study including US examinations of the knees and first metatarsal-phalangeal joints (first MTPJs), as well as of the tendons and enthesis of the lower limbs. Differences were estimated by χ² or unpaired t-tests as appropriate. Associations were calculated using the Spearman's correlation coefficient rank test.

Results

Fifty asymptomatic individuals with hyperuricemia and 52 normouricemic subjects were included. Hyperechoic enhancement of the superficial margin of the hyaline cartilage (double contour sign) was found in 25% of the first MTPJs from hyperuricemic individuals, in contrast to none in the control group (P < 0.0001). Similar results were found on the femoral cartilage (17% versus 0; P < 0.0001). Patellar enthesopathy (12% versus 2.9%; P = 0.01) and tophi (6% versus 0; P = 0.01) as well as Achilles enthesopathy (15% versus 1.9%; P = 0.0007) were more frequent in hyperuricemic than in normouricemic individuals. Intra-articular tophi were found in eight hyperuricemic individuals but in none of the normouricemic subjects (P = 0.003).

Conclusions

These data demonstrate that morphostructural changes suggestive of gouty arthritis induced by chronic hyperuricemia frequently occur in both intra- and extra-articular structures of clinically asymptomatic individuals.

Validity of ultrasonography and measures of adult shoulder function and reliability of ultrasonography in detecting shoulder synovitis in patients with rheumatoid arthritis using magnetic resonance imaging as a gold standard

OBJECTIVE

To assess the intra- and interobserver reproducibility of musculoskeletal ultrasonography (US) in detecting inflammatory shoulder changes in patients with rheumatoid arthritis, and to determine the agreement between US and the Shoulder Pain and Disability Index (SPADI) and the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, using magnetic resonance imaging (MRI) as a gold standard.

METHODS

Eleven rheumatologists investigated 10 patients in 2 rounds independently and blindly of each other by US. US results were compared with shoulder function tests and MRI.

RESULTS

The positive and negative predictive values (NPVs) for axillary recess synovitis (ARS) were 0.88 and 0.43, respectively, for posterior recess synovitis (PRS) were 0.36 and 0.97, respectively, for subacromial/subdeltoid bursitis (SASB) were 0.85 and 0.28, respectively, and the NPV for biceps tenosynovitis (BT) was 1.00. The intraobserver kappa was 0.62 for ARS, 0.59 for PRS, 0.51 for BT, and 0.70 for SASB. The intraobserver kappa for power Doppler US (PDUS) signal was 0.91 for PRS, 0.77 for ARS, 0.94 for SASB, and 0.53 for BT. The interobserver maximum kappa was 0.46 for BT, 0.95 for ARS, 0.52 for PRS, and 0.61 for SASB. The interobserver reliability of PDUS was 1.0 for PRS, 0.1 for ARS, 0.5 for BT, and 1.0 for SASB. P values for the SPADI and DASH versus cuff tear on US were 0.02 and 0.01, respectively; all other relationships were not significant.

CONCLUSION

Overall agreements between gray-scale US and MRI regarding synovitis of the shoulder varied considerably, but excellent results were seen for PDUS. Measures of shoulder function have a poor relationship with US and MRI. Improved standardization of US scanning technique could further reliability of shoulder US.

Self-directed learning of basic musculoskeletal ultrasound among rheumatologists in the United States

OBJECTIVE

Because musculoskeletal ultrasound (MSUS) is highly user dependent, we aimed to establish whether non-mentored learning of MSUS is sufficient to achieve the same level of diagnostic accuracy and scanning reliability as has been achieved by rheumatologists recognized as international experts in MSUS.

METHODS

A group of 8 rheumatologists with more experience in MSUS and 8 rheumatologists with less experience in MSUS participated in an MSUS exercise to assess patients with musculoskeletal abnormalities commonly seen in a rheumatology practice. Patients' established diagnoses were obtained from chart review (gout, osteoarthritis, rotator cuff syndrome, rheumatoid arthritis, and seronegative arthritis). Two examining groups were formed, each composed of 4 less experienced and 4 more experienced examiners. Each group scanned 1 predefined body region (hand, wrist, elbow, shoulder, knee, or ankle) in each of 8 patients, blinded to medical history and physical examination. Structural abnormalities were noted with dichotomous answers, and an open-ended answer was used for the final diagnosis.

RESULTS

Less experienced and more experienced examiners achieved the same diagnostic accuracy (US-established diagnosis versus chart review diagnosis). The interrater reliability for tissue pathology was slightly higher for more experienced versus less experienced examiners (kappa = 0.43 versus kappa = 0.34; P = 0.001).

CONCLUSION

Non-mentored training in MSUS can lead to the achievement of diagnostic accuracy in MSUS comparable to that achieved by highly experienced international experts. Reliability may increase slightly with additional experience. Further study is needed to determine the minimal training requirement to achieve proficiency in MSUS.

Bicuspid aortic valve: a synergistic factor for aortic dilation and dissection in Marfan syndrome?

Patients with either Marfan syndrome or bicuspid aortic valve are at increased risk for aortic dilation and dissection, but occurrence of both conditions has barely been reported. Whether bicuspid aortic valve adversely impacts the cardiovascular outcome in Marfan syndrome patients is unknown. The objective was to investigate the prevalence of bicuspid aortic valve and to define whether its combined presence would adversely impact cardiovascular outcome in patients with Marfan syndrome. We performed a retrospective review on a Marfan syndrome database from a single center. Comparisons between patients with or without bicuspid aortic valve were performed by chi2 or Student t test as appropriate. Bicuspid aortic valve was found in 4 of 89 Marfan syndrome patients (two males; mean age 21.5 +/- 13 years) for 4.5% prevalence; in contrast, 1.5% prevalence was found in 200 control subjects (p = 0.1). Each patient with bicuspid aortic valve is separately discussed. Presence of bicuspid aortic valve shows trends for association with aortic dilation (Odds ratio [OR] 4.2; 95% Confidence interval [95% CI] 0.2-81), and aortic dissection (OR 5.5; 95% CI 0.7-42), while negative association with the Walker-Murdoch sign (OR 0.07; 95% CI 0.006-0.73) was found. Prevalence of bicuspid aortic valve in patients with Marfan syndrome patients is 4.5%. While it is intriguing and even intuitive that the concurrence of both conditions would lead to more aggressive aortic disease, a true synergistic role for aortic wall weakening cannot be supported.

An elevated level of physical activity is associated with normal lipoprotein(a) levels in individuals from Maracaibo, Venezuela

Coronary artery disease is the main cause of death worldwide. Lipoprotein(a) [Lp(a)], is an independent risk factor for coronary artery disease in which concentrations are genetically regulated. Contradictory results have been published about physical activity influence on Lp(a) concentration. This research aimed to determine associations between different physical activity levels and Lp(a) concentration. A descriptive and cross-sectional study was made in 1340 randomly selected subjects (males = 598; females = 712) to whom a complete clinical history, the International Physical Activity Questionnaire, and Lp(a) level determination were made. Statistical analysis was carried out to assess qualitative variables relationship by chi2 and differences between means by one-way analysis of variance considering a P value <0.05 as statistically significant. Results are shown as absolute frequencies, percentages, and mean +/- standard deviation according to case. Physical activity levels were ordinal classified as follows: low activity with 24.3% (n = 318), moderate activity with 35.0% (n = 458), and high physical activity with 40.8% (n = 534). Lp(a) concentration in the studied sample was 26.28 +/- 12.64 (IC: 25.59-26.96) mg/dL. Lp(a) concentration according to low, moderate, and high physical activity levels were 29.22 +/- 13.74, 26.27 +/- 12.91, and 24.53 +/- 11.35 mg/dL, respectively, observing statistically significant differences between low and moderate level (P = 0.004) and low and high level (P < 0.001). A strong association (chi2 = 9.771; P = 0.002) was observed among a high physical activity level and a normal concentration of Lp(a) (less than 30 mg/dL). A lifestyle characterized by high physical activity is associated with normal Lp(a) levels.

Distribution of metastases in NSCLC: Economic impact of imaging

e19036

Background: Purpose: to investigate the usefulness and cost-effectiveness of routine pelvic CT scans in patients with NSCLC. Given that many patients have metastases to several organs, one important question is - “what is the frequency of metastases in the chest, the abdomen, the pelvis, elsewhere?” Methods: We retrospectively reviewed the CT data of 184 patients with Stage 4 NSCLC. The results are shown in Table 1 . Results: We found that there were 690 metastases to the chest, 205 to the abdomen, 80 to the bones, 18 to the pelvis, 13 to the brain and 23 others, not specified. These represent a relative incidence of 67%, 20%, 8%, 2%, 1% and 2%, respectively. These results are a strong indicator of the main areas that require imaging in NSCLC. If we consider the actual incidence of metastases, we find the following absolute statistics: 16 patients had pelvic involvement. This compares with 42 patients with adrenal metastases, 81 with liver metastases, 80 with bone metastases, 112 with hilar adenopathy, and 159 with mediastinal adenopathy. (See Table ) Conclusions: The cost of a CT of the pelvis varies, but is estimated at approximately $2000[Fred, Herbert L., MD, MACP. Drawbacks and Limitations of Computed Tomography: Views from a Medical Educator. Texas Heart Institute Journal 31 (2004): 345.]. The incidence of NSCLC is approximately 172,000 in 2008[Ries, LAG, et al (eds). SEER Cancer Statistics Review, 1975–2005. Surveillance Epidemiology and End Results. 2007. National Cancer Institute. 03JAN2009. http://seer.cancer.gov/csr/1975_2005/ .]. Hence, the potential annual savings accrued by not performing CT of the pelvis is approximately $344 million. These costs can be justified in a Research setting, but it is more difficult to do so in the clinical arena.

[Table: see text]

No significant financial relationships to disclose.

Radiographic imaging in osteomyelitis: the role of plain radiography, computed tomography, ultrasonography, magnetic resonance imaging, and scintigraphy

The diagnostic imaging of osteomyelitis can require the combination of diverse imaging techniques for an accurate diagnosis. Conventional radiography should always be the first imaging modality to start with, as it provides an overview of the anatomy and the pathologic conditions of the bone and soft tissues of the region of interest. Sonography is most useful in the diagnosis of fluid collections, periosteal involvement, and surrounding soft tissue abnormalities and may provide guidance for diagnostic or therapeutic aspiration, drainage, or tissue biopsy. Computed tomography scan can be a useful method to detect early osseous erosion and to document the presence of sequestrum, foreign body, or gas formation but generally is less sensitive than other modalities for the detection of bone infection. Magnetic resonance imaging is the most sensitive and most specific imaging modality for the detection of osteomyelitis and provides superb anatomic detail and more accurate information of the extent of the infectious process and soft tissues involved. Nuclear medicine imaging is particularly useful in identifying multifocal osseous involvement.

[Guidelines in RA treatment: concepts on safety and recommendations using anti-TNF-alpha inhibitors. Grupo de Estudio de Nuevas Terapias de Enfermedades reumáticas (GENTE)]

Recommendations for the use of Disease-Modifying Antirheumatic Drugs (DMARD) with both conventional and biological agents in Rheumatoid Arthritis (RA) must be based on their safety profile, adverse effects, risks, and advantages. With the purpose of presenting the most updated information about the safety of tumor necrosis factor alpha (TNFalpha) antagonists, in this article we summarize the literature published during the last three years about this sort of biological agents in specific clinical situations, such as risk of developing infections, cancer, cardiovascular diseases, and autoimmunity; as well as their administration to patients who will undergo surgical procedures, pregnant and/or breast-feeding women, and patients who need immunizations. Likewise, in this analysis we offer specific recommendations, based on evidence, for the best anti-TNF-alfa management.

Radiographic imaging in osteomyelitis: the role of plain radiography, computed tomography, ultrasonography, magnetic resonance imaging, and scintigraphy

The diagnostic imaging of osteomyelitis can require the combination of diverse imaging techniques for an accurate diagnosis. Conventional radiography should always be the first imaging modality to start with, as it provides an overview of the anatomy and the pathologic conditions of the bone and soft tissues of the region of interest. Sonography is most useful in the diagnosis of fluid collections, periosteal involvement, and surrounding soft tissue abnormalities and may provide guidance for diagnostic or therapeutic aspiration, drainage, or tissue biopsy. Computed tomography scan can be a useful method to detect early osseous erosion and to document the presence of sequestrum, foreign body, or gas formation but generally is less sensitive than other modalities for the detection of bone infection. Magnetic resonance imaging is the most sensitive and most specific imaging modality for the detection of osteomyelitis and provides superb anatomic detail and more accurate information of the extent of the infectious process and soft tissues involved. Nuclear medicine imaging is particularly useful in identifying multifocal osseous involvement.

[Basic physical principles of ultrasonography, anatomy of the musculoskeletal system and ecographic artifacts]

Ultrasound is a simple, non invasive and accessible imaging technique that allows the evaluation of the musculoskeletal system in real time, with the advantage of examining the joints in a dynamic way and with the aid of Doppler power, local inflammatory phenomena can be evaluated, without submitting the patient to radiation. It has the disadvantage of being operator dependant, which has to have a wide knowledge of the physical principles of ultrasonography, has to be familiar with the sonographic anatomy and musculoskeletal anatomy, but even more it is important that he has the ability to recognize the sonographic phenomena that can present as decoys, nominated artifacts. This knowledge is desirable to the specialist in musculoskeletal conditions, so that ecographic studies can be interpreted and recognizing artifacts and avoiding wrong diagnosis and unnecessary procedures. In the present review, the basic principles of ecography are analyzed, the normal sonographic anatomy of the musculoskeletal system ant the more common artifacts encountered in ecography.

Ultrasound in rheumatology. The Mexican experience

Over the last few years, a growing number of rheumatologists has taken great interest in ultrasonography for its well known advantages and wide spectrum of validated applications in daily rheumatological practice. Most rheumatologists actively performing ultrasonography have had a training experience mainly based on attendance in sonographic courses and/or in radiological or rheumatological units. At present, in Mexico ultrasonography has a still limited diffusion among rheumatologists even if it may play a key role as a first line imaging technique also because of the restricted availability for rheumatic patients for other imaging modalities. This report describes the Mexican experience in education and training on musculoskeletal ultrasound. In 2003, the Mexican School of Musculoskeletal Ultrasound of the Mexican College of Rheumatology (ECOMER) was founded with the intention of joining efforts to launch musculoskeletal ultrasound in Mexico. Essential requirements shared by all the members of ECOMER include: to own an ultrasound machine, to incorporate ultrasonography into clinical daily practice and to keep up-to-date in musculoskeletal ultrasound. The motto of ECOMER is una clara imagen de la reumatologia which means a clear picture of rheumatology. The statute of ECOMER can be read in its web site: www.ecomer.org.mx. This web site also provides a forum for case discussion, consultation and image review.

Surprising relations between parametric level correlations and fidelity decay

Relations among fidelity, cross-form-factor (i.e., parametric level correlations), and level velocity correlations are found both by deriving a Ward identity in a two-matrix model and by comparing exact results, using supersymmetry techniques, in the framework of random matrix theory. A power law decay near Heisenberg time, as a function of the relevant parameter, is shown to be at the root of revivals recently discovered for fidelity decay. For cross-form-factors the revivals are illustrated by a numerical study of a multiply kicked Ising spin chain.

Reliability of ultrasonography in detecting shoulder disease in patients with rheumatoid arthritis

Objective:

To assess the intra and interobserver reproducibility of musculoskeletal ultrasonography (US) among rheumatologists in detecting destructive and inflammatory shoulder abnormalities in patients with rheumatoid arthritis (RA) and to determine the overall agreement between US and MRI.

Methods:

A total of 14 observers examined 5 patients in 2 rounds independently and blindly of each other. US results were compared with MRI. Overall agreement of all findings, of positive findings on MRI, as well as intra and interobserver reliabilities, were calculated.

Results:

Overall agreement between US and MRI was seen in 79% with regard to humeral head erosions (HHE), in 64% with regard to posterior recess synovitis (PRS), in 31% with regard to axillary recess synovitis (ARS), in 64% with regard to bursitis, in 50% with regard to biceps tenosynovitis (BT), and in 84% for complete cuff tear (CCT). Intraobserver and interobserver κ was 0.69 and 0.43 for HHE, 0.29 and 0.49 for PRS, 0.57 and 1.00 for ARS, −0.17 and 0.51 for bursitis, 0.17 and 0.46 for BT and 0.52 and 0.6 for CCT, respectively. The intraobserver and interobserver κ for power Doppler (PD) was 0.90 and 0.70 for glenohumeral signals and 0.60 and 0.51 for bursal signals, respectively.

Conclusions:

US is a reliable imaging technique for most shoulder pathology in RA especially with regard to PD. Standardisation of scanning technique and definitions of particular lesions may further enhance the reliability of US investigation of the shoulder.

Exposure of gnotobiotic Artemia franciscana larvae to abiotic stress promotes heat shock protein 70 synthesis and enhances resistance to pathogenic Vibrio campbellii

Larvae of the brine shrimp Artemia franciscana serve as important feed in fish and shellfish larviculture; however, they are subject to bacterial diseases that devastate entire populations and consequently hinder their use in aquaculture. Exposure to abiotic stress was shown previously to shield Artemia larvae against infection by pathogenic Vibrio, with the results suggesting a mechanistic role for heat shock protein 70. In the current report, combined hypothermic/hyperthermic shock followed by recovery at ambient temperature induced Hsp70 synthesis in Artemia larvae. Thermotolerance was also increased as was protection against infection by Vibrio campbellii, the latter indicated by reduced mortality and lower bacterial load in challenge tests. Resistance to Vibrio improved in the face of declining body mass as demonstrated by measurement of ash-free dry weight. Hypothermic stress only and acute osmotic insult did not promote Hsp70 expression and thermotolerance in Artemia larvae nor was resistance to Vibrio challenge augmented. The data support a causal link between Hsp70 accumulation induced by abiotic stress and enhanced resistance to infection by V. campbellii, perhaps via stimulation of the Artemia immune system. This possibility is now under investigation, and the work may reveal fundamental properties of crustacean immunity. Additionally, the findings are important in aquaculture where development of procedures to prevent bacterial infection of feed stock such as Artemia larvae is a priority.