Melanoma of the gallbladder

An 80-year-old man, with no medical history, was referred to the gastroenterologist due to cholestasis and altered general condition. Physical examination revealed mild abdominal tenderness in the right hypochondrium, with no other clinical signs. Laboratory examinations showed a cholestasis (gamma-glutamyl transferase: 160 U/L and alkaline phosphatase: 120 U/L) and an elevated CRP level of 25 mg/L. Abdominal MRI was performed (Fig 1, Fig 2A). Subsequently, a PET-CT and brain MRI for seizures (Fig. 2B) were realized.

FRI0551 PERFORMANCE OF THE 2019 AMERICAN COLLEGE OF RHEUMATOLOGY/EUROPEAN LEAGUE AGAINST RHEUMATISM SYSTEMIC LUPUS ERYTHEMATOSUS CLASSIFICATION CRITERIA

Background:

Systemic lupus erythematosus (SLE) is a heterogenous autoimmune disease, with increased morbidity and mortality, often diagnosed in advanced stages. The recently published 2019 American College Of Rheumatology/European League Against Rheumatism (ACR/EULAR) classification criteria for SLE are weighted, hierarchically clustered criteria developed to increase reliability and the identification of early SLE.

Objectives:

To compare the sensitivity and specificity of the 2019 ACR/EULAR criteria with the 2012 SLICC criteria in a large single-centre cohort of patients with SLE, diagnosed according to expert oppinion.

Methods:

Data of SLE patients evaluated in our centre between 1996-2019 have been retrospectively analyzed. The control cohort included patients with positive antinuclear antibodies of other ethiology than SLE, evaluated between 2001-2019. The sensitivity and specificity of the 2019 ACR/EULAR and 2012 SLICC criteria were tested using the McNemar test for correlated proportions.

Results:

Four hundred and forty-six patients with SLE (413 women, mean±SD age 40.5±12.7 years, disease duration 10.1±9.2 years) and 67 controls (63 women, mean±SD age 50.4±12.6 years, disease duration 7.6±6.9 years; 29 systemic sclerosis (SSc), 18 mixed connective tissue dissease (MCTD), 15 undifferentiated CTD, 2 rheumatoid arthritis (RA), 2 SSc – RA overlaps and 1 dermatomyositis) were included. The sensitivity of the 2019 ACR/EULAR and 2012 SLICC criteria were similar 85.4% and 83.6 %, respectively (p=0.3). The specificity of the 2019 ACR/EULAR and 2012 SLICC criteria were 70.2 % and 86.6%, respectively (p=0.007). In the SLE group, patients missclassified according to the new 2019 ACR/EULAR criteria were 65, whereas according to the 2012 SLICC criteria were 73; of them, 44 patients did not fulfill any criteria. In the control group, patients misclassified had mainly MCTD (13/20 patients according to the new 2019 ACR/EULAR, and 8/9 according to the 2012 SLICC criteria).

Conclusion:

In this real-life cohort, the 2019 ACR/EULAR criteria have a similar sensitivity and lower specificity than the 2012 SLICC criteria, misclassifying especially MCTD patients. These results might be due to the long disease duration in our cohort.

References:

[1] Aringer M, Costenbader K, Daikh D, et al. 2019 European League Against Rheumatism/American College of Rheumatology Classification Criteria for Systemic Lupus Erythematosus. Arthritis Rheumatol. 2019;71(9):1400–1412. doi:10.1002/art.40930

Disclosure of Interests:

None declared

Reversible state transfer between light and a single trapped atom

We demonstrate the reversible mapping of a coherent state of light with a mean photon number (-)n approximately equal to 1.1 to and from the hyperfine states of an atom trapped within the mode of a high-finesse optical cavity. The coherence of the basic processes is verified by mapping the atomic state back onto a field state in a way that depends on the phase of the original coherent state. Our experiment represents an important step toward the realization of cavity QED-based quantum networks, wherein coherent transfer of quantum states enables the distribution of quantum information across the network.

Cooling to the ground state of axial motion for one atom strongly coupled to an optical cavity

Localization to the ground state of axial motion is demonstrated for a single, trapped atom strongly coupled to the field of a high finesse optical resonator. The axial atomic motion is cooled by way of coherent Raman transitions on the red vibrational sideband. An efficient state detection scheme enabled by strong coupling in cavity QED is used to record the Raman spectrum, from which the state of atomic motion is inferred. We find that the lowest vibrational level of the axial potential with zero-point energy variant Planck's over 2 h omega a/2kB = 13 microK is occupied with probability P0 approximately 0.95.

Photon blockade in an optical cavity with one trapped atom

At low temperatures, sufficiently small metallic and semiconductor devices exhibit the 'Coulomb blockade' effect, in which charge transport through the device occurs on an electron-by-electron basis. For example, a single electron on a metallic island can block the flow of another electron if the charging energy of the island greatly exceeds the thermal energy. The analogous effect of 'photon blockade' has been proposed for the transport of light through an optical system; this involves photon-photon interactions in a nonlinear optical cavity. Here we report observations of photon blockade for the light transmitted by an optical cavity containing one trapped atom, in the regime of strong atom-cavity coupling. Excitation of the atom-cavity system by a first photon blocks the transmission of a second photon, thereby converting an incident poissonian stream of photons into a sub-poissonian, anti-bunched stream. This is confirmed by measurements of the photon statistics of the transmitted field. Our observations of photon blockade represent an advance over traditional nonlinear optics and laser physics, into a regime with dynamical processes involving atoms and photons taken one-by-one.

Observation of the vacuum Rabi spectrum for one trapped atom

The transmission spectrum for one atom strongly coupled to the field of a high finesse optical resonator is observed to exhibit a clearly resolved vacuum Rabi splitting characteristic of the normal modes in the eigenvalue spectrum of the atom-cavity system. A new Raman scheme for cooling atomic motion along the cavity axis enables a complete spectrum to be recorded for an individual atom trapped within the cavity mode, in contrast to all previous measurements in cavity QED that have required averaging over 10(3)-10(5) atoms.

Deterministic Generation of Single Photons from One Atom Trapped in a Cavity

A single cesium atom trapped within the mode of an optical cavity is used to generate single photons on demand. The photon wave packets are emitted as a Gaussian beam with temporal profile and repetition rate controlled by external driving fields. Each generation attempt is inferred to succeed with a probability near unity, whereas the efficiency for creating an unpolarized photon in the total cavity output is 0.69 +/- 0.10, as limited by passive cavity losses. An average of 1.4 x 10(4) photons are produced by each trapped atom. These results constitute an important step in quantum information science, for example, toward the realization of distributed quantum networking.

Experimental realization of a one-atom laser in the regime of strong coupling

Conventional lasers (from table-top systems to microscopic devices) typically operate in the so-called weak-coupling regime, involving large numbers of atoms and photons; individual quanta have a negligible impact on the system dynamics. However, this is no longer the case when the system approaches the regime of strong coupling for which the number of atoms and photons can become quite small. Indeed, the lasing properties of a single atom in a resonant cavity have been extensively investigated theoretically. Here we report the experimental realization of a one-atom laser operated in the regime of strong coupling. We exploit recent advances in cavity quantum electrodynamics that allow one atom to be isolated in an optical cavity in a regime for which one photon is sufficient to saturate the atomic transition. The observed characteristics of the atom-cavity system are qualitatively different from those of the familiar many-atom case. Specifically, our measurements of the intracavity photon number versus pump intensity indicate that there is no threshold for lasing, and we infer that the output flux from the cavity mode exceeds that from atomic fluorescence by more than tenfold. Observations of the second-order intensity correlation function demonstrate that our one-atom laser generates manifestly quantum (nonclassical) light, typified by photon anti-bunching and sub-poissonian photon statistics.

Generation of nonclassical photon pairs for scalable quantum communication with atomic ensembles

Quantum information science attempts to exploit capabilities from the quantum realm to accomplish tasks that are otherwise impossible in the classical domain. Although sufficient conditions have been formulated for the physical resources required to achieve quantum computation and communication, there is a growing understanding of the power of quantum measurement combined with the conditional evolution of quantum states for accomplishing diverse tasks in quantum information science. For example, a protocol has recently been developed for the realization of scalable long-distance quantum communication and the distribution of entanglement over quantum networks. Here we report the first enabling step in the realization of this protocol, namely the observation of quantum correlations for photon pairs generated in the collective emission from an atomic ensemble. The nonclassical character of the fields is demonstrated by the violation of an inequality involving their normalized correlation functions. Compared to previous investigations of non-classical correlations for photon pairs produced in atomic cascades and in parametric down-conversion, our experiment is distinct in that the correlated photons are separated by a programmable time interval (of about 400 nanoseconds in our initial experiments).

Digestive histochemical reactions in rats after space flight of different duration

Different histochemical reactions were searched in the digestive tract of rats that flighted on Soviet biosatellites, 5, 7, 13, 14 and 18 1/2 days (2). Space flight decreased glycoprotein (GP) content of sublingual glands and of gastric and intestinal mucosa, and increased reactions for leucin-aminopeptidase (LAP) and acid phosphatase (ACP) of the small intestine. These responses were in relation with the duration of the flight. For searching some possible mechanism by which they occurred, same investigations were done in rats submitted at soil level to a contention hypokinesia (HK), for mimicking space flight. After HK, similar histochemical responses were founded as after the true flight. The evolution of histochemical responses paralleled the corticosterone hypersecretion, suggesting a causal correlation, but they were also the same in adrenalectomised rats. Effectory hormonal pathways are thus further to be searched, as well as a correlation with the intermediary metabolism, as a similar evolution was founded in pancreatic, insulin secreting, B cells.

Histochemical alterations in the digestive tract of rats after 13 days of flight in the "Cosmos 1887" biosatellite

In rats recovered after 13 days of cosmic flight a diminution of acid and neutral glycoproteins was observed in the gastric mucosa and proximal segments of the small intestine: the decrease was less evident in the sublingual glands and colon. Leucine aminopeptidase and acid phosphatase in the small intestine were intensified. No significant changes were observed in the other enzymes investigated. Acid phosphatase showed a more intense activity in the endocrine pancreas B cells. The alterations observed after 13 days of flight in the "Cosmos 1887" biosatellite are significant but less marked than after 18 days of flight, and more accentuated than after 5-7 days of flight.

The digestive tract of rat after flight in the biosatellite Cosmos 1667

From the histochemical investigation carried out on the digestive tract of rats after 7 days space flight in the soviet biosatellite Cosmos 1667 it resulted that neutral and acid glycoproteins diminished slightly in the sublingual gland, stomach, small intestine and the colon. Some intestinal enzymes augmented (leucineaminopeptidase, acid phosphatase, adenosinetriphosphatase and glucose-6-phosphatase). The changes observed after this flight were less marked than after an 18 day flight (in the Soviet biosatellite Cosmos 936 and 1129) and similar to those revealed after 7 days of hypokinesia. The glycoprotein changes were close to those observed after a 5-day flight (Cosmos 1514) but in which there were pregnant rats; after these last flights, the enzymes were not studied.

Histochemical changes in the digestive tract in irradiated rats

Wistar rats (110-125 g) were irradiated with a single dose of 500 R. Histochemical studies were done concerning the glycoproteins (GP) of sublingual glands, gastric, small intestine and colon mucosa, and some intestinal enzymes: acid and alkaline phosphatase (ACP, ALP) leucineaminopeptidase (LAP), Mg-dependent ATP-ase, NADH-diaphorase, lactic dehydrogenase (LDH). After irradiation all these reactions were diminished, with a maximal effect between 3-5 days. This impairment is in accord with the maximal lethality in this interval after such a degree of irradiation that produced the gastrointestinal syndrome. Cocarboxylase, a radioprotector, improved these changes regarding the structures of the small intestine and also the GP of sublingual glands, stomach, small intestine and colon, demonstrating there its efficiency.

Effects of a seven-day hypokinesia on the digestive tract of nonpregnant and pregnant rats

Hypokinesia (HK) produced by a 7-day contention of pregnant rats in small cages is followed by a discrete decrease of PAS reaction for glycoproteins in the submandibular and sublingual glands, in the mucosa of the stomach, duodenum, small intestine and colon, and also by a small but evident increase of that for leucineaminopeptidase and acid phosphatase in the duodenum and in the intestine. The moderation of these reactions may be explained by the small interval of contention, and not by pregnancy, because the changes are similar in male rats after the same interval. After a longer interval, these reactions change in the same manner but they are more evident, as results from our previous studies. They are not connected with a corticosterone hypersecretion (the principal glucocorticoid in rat) because adrenalectomy does not influence them as results from our previous research. HK increases the 4 and 5 isoenzymes of lactic dehydrogenase (LDH) in the stomach. In the small intestine appeared only the LDH 4 and 5 isoenzymes, HK increases LDH5 isoenzyme. Adrenalectomy increases all LDH isoenzymes of gastric mucosa, and in the small intestine all five fractions appeared, but with a slight activity of LDH 1 and 2. This relation between adrenal hormones and these isoenzymes must be further studied, especially after HK. After a 7-day HK, nonpregnant female rats present an augmented total gastric acid output (TAO), as previously found by us in males. After adrenalectomy this acid hypersecretion disappeared. Even smaller values for TAO were found. Pregnancy considerably increased TAO which may be due, as we have already found, to a blood pH decrease. After HK this hypersecretion decreased remaining nevertheless great. Progeni born of rats submitted to HK have, after 30 days of life, an augmented TAO. Parts of this research were carried out in order to reproduce by HK, at ground level, the 5-day orbital flight conditions of the soviet Cosmos 1514 biosatellite containing pregnant rats in which we studied some identical parameters.

Histochemistry of the gastrointestinal tract in pregnant rats subjected to cosmic flight and in their progeny (Cosmos 1514)

Investigations were carried out in the digestive tract of pregnant rats submitted to 5 days orbital flight, as well as in rats aged 30 and 100 days, to which the pregnant experimental rats had given birth. The flight produces, in pregnant rats, a mild reduction of the glycoproteins of the salivary glands, of the gastric mucosa and the goblet cells of the small intestine, as well as an augmented activity of some intestinal enzymes. The progeny born after flight presents at 30 days a mild decrease of the glycoproteins in the sublingual gland and stomach and a slight increase in the activity of some enzymes in the small intestine. In 100-day-old rats, the differences between control and experimental group are not significant.

Modifications of the digestive tract in rats submitted to an orbital flight aboard the Soviet satellite Cosmos 1129

Investigations carried out on the digestive tract of rats submitted to an 18 1/2-day orbital flight aboard the Soviet biosatellite Cosmos 1129 revealed that flight produces a reduction of the glycoproteins (GP) of the submaxillary glands, gastric mucosa and the goblet cells of the small and large intestine, the last being the most nonreactive, as well as an augmented staining for leucine-aminopeptidase (LAP) and acid phosphatase (AP). In lamina propria an accumulation of eosinophils was noticed. These changes were more intense than those produced in the groups of rats maintained "synchronous" under environmental conditions similar to flight. On the basis of previous data obtained by various authors and by ourselves on hypokinetic rats from the biosatellite Cosmos 936, it can be concluded that these reactions have a nonspecific, stress character. A stress of restraint applied daily for 2 1/2 hours during a period of 6 days to the animals immediately after landing produced modifications similar to those following flight but more intense, thus underlying the hypothesis of a stress reaction.

The action of simulated and true weightlessness on the digestive tract of rats

Rats on board the Soviet Cosmos 936 satellite for l8 1/2 days showed a decreased glycoprotein secretion from the salivary mucous glands, stomach and intestine, and an increased leucine aminopeptidase and acid phosphatase content from the small intestine. Grimelius positive cells were activated. One group of rats were centrifuged at 1 g during the flight to simulate terrestrial gravity. Some investigations have suggested that under these conditions muscular and cardiac disorders diminished. In the digestive tract the benefits of centrifugation at 1 g are minimal and limited to a few glycoprotein components. The digestive changes are probably the expression of a stress response, unrelated to weightlessness. Similar changes, concomitant with a glycocorticoid hypersecretion, were found in rats after 15 days of hypokinesia on Earth. These digestive changes persisted even in adrenalectomized rats.

The digestive tract after 7 days of restraining conditions in normal and adrenalectomized rats

Hypokinesia produced specific reactions in tissues related to motion (bones, skeletal muscles and myocardium) and nonspecific in others, as that of the digestive tract after 7 days of hypokinesia. A decreased content of glycoproteins from mucous salivary glands, stomach, small intestine and colon, and an increased intestinal content of leucine-aminopeptidase and acid and alkaline phosphatase were found as a result of histochemical reactions. An important plasmatic corticosterone increase was also found. The same histochemical modifications appeared in adrenalectomized rats in which the plasma corticosterone was substantially diminished. Therefore these glycoproteins and enzymatic secretions are not dependent on the glucocorticoid response.

Digestive tract of rats after hypokinesia and hypergravitation

We found in rats submitted to a 7 days interval of hypokinesia a decreased glycoprotein content in salivary mucous glands, gastric and intestinal mucosa, an increased glycoprotein content and an increased content of leucine-aminopeptidase, acid and alkaline phosphatase. Similar changes were found after a short interval of centrifugation (+6 Gz, 10 min). These nonspecific responses were more accentuated if the hypergravitation was performed after 7 days of hypokinesia. We reproduced this way this events that occurred in space flight and deacceleration before landing.

Digestive structural modifications in rats submitted to 15 days of hypokinetical conditions

Restraining rats for 14 days in special cages in order to determine a hypokinetical state decreased mucopolysaccharide secretion in submaxillary glands and gastric mucosa. In the small intestine and in the colon, concomitantly with an enzymatic (leucine-aminopeptidase and acid phosphatase) hypersecretion as results from specific histochemical reactions. These modifications show maximum intensity at the end of the interval. The corticosterone plasmatic level determined in the same interval also increased, suggesting this way to a causal relation. The histomorphological changes presented delayed reaction. This material is in accord with our previous investigations as well as with some literature data.