Heat and Work Along Individual Trajectories of a Quantum Bit

We use a near quantum limited detector to experimentally track individual quantum state trajectories of a driven qubit formed by the hybridization of a waveguide cavity and a transmon circuit. For each measured quantum coherent trajectory, we separately identify energy changes of the qubit as heat and work, and verify the first law of thermodynamics for an open quantum system. We further establish the consistency of these results by comparison with the master equation approach and the two-projective-measurement scheme, both for open and closed dynamics, with the help of a quantum feedback loop that compensates for the exchanged heat and effectively isolates the qubit.

Information Gain and Loss for a Quantum Maxwell's Demon

We use continuous weak measurements of a driven superconducting qubit to experimentally study the information dynamics of a quantum Maxwell's demon. We show how information gained by a demon who can track single quantum trajectories of the qubit can be converted into work using quantum coherent feedback. We verify the validity of a quantum fluctuation theorem with feedback by utilizing information obtained along single trajectories. We demonstrate, in particular, that quantum backaction can lead to a loss of information in imperfect measurements. We furthermore probe the transition between information gain and loss by varying the initial purity of the qubit.

Evaluation and management of chemotherapy-induced cardiotoxicity in breast cancer: a Delphi study

Purpose

While much progress has been made in the treatment of breast cancer, cardiac complications resulting from therapy remain a significant concern. Both anthracyclines and novel targeted agents can inflict cardiac damage. The present study aimed to evaluate the difference between what it is currently done and what standards of care should be used to minimizing and managing cardiac toxicity in breast cancer survivors.

Methods

A two-round multicenter Delphi study was carried out. The panel consisted of 100 oncologists who were asked to define the elected therapies for breast cancer patients, the clinical definition and patterns of cancer drug-derived cardiac toxicity, and those protocols focused on early detection and monitoring of cardiovascular outcomes.

Results

Experts agreed a more recent definition of cardiotoxicity. Around 38 % of patients with early-stage disease, and 51.3 % cases with advanced metastatic breast cancer had preexisting risk factors for cardiotoxicity. Among risk factors, cumulative dose of anthracycline ≥450 mg/m² and its combination with other anticancer drugs, and a preexisting cardiovascular disease were considered the best predictors of cardiotoxicity. Echocardiography and radionuclide ventriculography have been the proposed methods for monitoring changes in cardiac structure and function. Breast cancer is generally treated with anthracyclines (80 %), so that the panel strongly stated about the need to plan a strategy to managing cardiotoxicity. A decline of left ventricular ejection fraction (LVEF) >10 %, to an LVEF value <53 % was suggested as a criterion for changing the dose schedule of anthracyclines, or suspending the treatment of chemotherapy plus trastuzumab until the normalization of the left ventricular function. The use of liposomal anthracyclines was strongly suggested as a treatment option for breast cancer patients.

Conclusions

The present report is the first to produce a set of statements on the prevention, evaluation and monitoring of chemotherapy-induced cardiac toxicity in breast cancer patients.

Effects of intertidal seagrass habitat fragmentation on turbulent diffusion and retention time of solutes

An in-depth knowledge of solutes advection and turbulent diffusion is crucial to estimate dispersion area and retention time (t(R)) of pollutants within seagrass habitats. However, there is little knowledge on the influence of seagrass habitat fragmentation on such mechanisms. A set of dye tracer experiments and acoustic Doppler velocimeter measurements (ADV) were conducted. Solute transport conditions were compared in between fragmented (FM) vs homogeneous (HM) intertidal meadows, and in vertical gradients (canopy vs overlaying flow). Results showed the highest horizontal diffusion coefficient (K(y), c.a. 10(-3)m(2)s(-1)) on FM and at the canopy-water column interface, whereas t(R) (2.6-5.6 min) was not affected by fragmentation. It suggests that (1) FM are more vulnerable to pollution events in terms of dispersion area and (2) at low tide, advection rather than turbulent diffusion determines t(R). Furthermore, Taylor's theorem is revealed as a powerful tool to analyze vertical gradients on K(y) within seagrass canopies.

Clinical and pathological factors related to 18F-FDG-PET positivity in the diagnosis of recurrence and/or metastasis in patients with differentiated thyroid cancer

BACKGROUND

Objectives were to analyze the relationship between a positive (18)F-fluorodeoxyglucose (FDG)-positron emission tomography (PET) result and clinical and tumor factors in patients treated for differentiated thyroid cancer (DTC) and under suspicion of recurrence or metastasis, and to determine the diagnostic validity of PET in DTC patients with elevated serum thyroglobulin (Tg) and negative (131)I whole-body scan ((131)I-WBS).

METHODS

We studied 50 DTC patients with elevated serum Tg and negative WBS treated with total thyroidectomy and (131)I ablation. Thyroxin treatment was withdrawn and patients were on iodine-free diet before WBS. Tg, anti-Tg antibodies, and thyroid-stimulating hormone (TSH) were determined. Patients with negative WBS and elevated Tg underwent PET study 1 week later. PET findings were verified by pathology findings or other imaging techniques [computed tomography (CT), magnetic resonance imaging (MRI), ultrasound (US)] and/or 12-month follow-up. The relationship between PET findings and tumor (histological type, size, multifocality, thyroid capsular invasion, lymph-node and/or metastatic involvement) and clinical (age at diagnosis, sex, Tg, accumulated iodine dose, and recurrence time) variables was analyzed.

RESULTS

PET was positive in 32/39 patients with confirmed disease (82% sensitivity) and negative in 7/11 of disease-free cases (64% specificity), a positive predictive value (PPV) of 89%. Tumor size (P < 0.05) and thyroid capsular invasion (P < 0.05) were significantly associated with positive PET study. The relationship of PET findings with Tg levels and age at diagnosis was close to significance.

CONCLUSION

(18)F-FDG-PET study offers a high sensitivity and positive predictive value (PPV) in patients with negative WBS and Tg positive. The use of FDG-PET is strongly recommended in DTC patients with large tumors, thyroid capsule invasion or poor-prognosis variants.

Metabolic syndrome in patients with systemic lupus erythematosus from Southern Spain

The aim of this cross-sectional study was to establish the frequency, phenotype and characteristics of metabolic syndrome (MS), as defined by the Adult Treatment Panel III, in a cohort of patients with systemic lupus erythematosus (SLE) and its possible association with cardiovascular diseases (CVD). A total of 160 patients with SLE and 245 age, sex, educational level and ethnically matched controls were included. Association with cardiovascular risk factors, SLE features, treatment of SLE and history of CVD were assessed in patients with SLE and controls with and without MS. MS was non-significantly increased in patients with SLE (20%) compared with controls (13%; P = 0.083). It was more commonly observed in patients with SLE ≤40 years old (15.8%) than in controls of the same age group (4.2%; P < 0.001). The mean number of MS criteria was significantly higher among patients with SLE than in controls. The frequency of CVD was also 28-fold higher among patients with SLE (11.3%) than in controls (0.4%). SLE with MS presented higher levels of inflammatory markers than SLE without MS. In a multivariate analysis, educational level, serum triglycerides, HDL-cholesterol and C3 serum levels and hydroxychloroquine use were independently associated with MS.

Bone Fractures After Cardiac Transplantation

OBJECTIVE

Bone loss and bone fractures are disabling complications after heart transplantation. Severe bone loss happens mainly during the first year posttransplantation. Steroids and cyclosporine alter bone metabolism in several ways. To counterbalance these effects, antiresorptive therapy is provided to these patients. The objective of this study was to assess the frequency of bone fractures after heart transplantation, considering previous comorbidities, immunosuppressive therapy, and osteoprotective treatment.

METHODS

From 1993 to 2005, 443 consecutive heart transplant recipients were followed for the occurrence of bone fractures, immunosuppressive therapy, clinical conditions, and antiresorptive treatment.

RESULTS

There were 41 fractures in 34 patients (7.6%, group I). The remainder of patients formed group II. Fractures commonly involved the lumbar spine. Postmenopausal women had more fractures than other patients (20.6% vs 7.8%, P = .02). When the initial immunosuppressive regimen included tacrolimus, fractures did not happen (P = .01, vs other regimens). Osteoprotective therapy was administered to 91.2% of patients in group I and 79% in group II (P = .08). Mean interval from transplantation to the first fracture was 1131.5 days. Overweight patients had a 61.8% incidence of fracture.

CONCLUSIONS

Our series showed a low frequency of bone fractures. Postmenopausal women and overweight patients had more fractures. An initial immunosuppressive regimen using tacrolimus was associated with lower fracture rates.

Magnetic long-range order induced by quantum relaxation in single-molecule magnets

Can magnetic interactions between single-molecule magnets (SMMs) in a crystal establish long-range magnetic order at low temperatures deep in the quantum regime, where the only electron spin fluctuations are due to incoherent magnetic quantum tunneling (MQT)? Put inversely: can MQT provide the temperature dependent fluctuations needed to destroy the ordered state above some finite T(c), although it should basically itself be a T-independent process? Our experiments on two novel Mn4 SMMs provide a positive answer to the above, showing at the same time that MQT in the SMMs has to involve spin-lattice coupling at a relaxation rate equaling that predicted and observed recently for nuclear-spin-mediated quantum relaxation.

[Clinical characteristics of patients with essential hypertension regarding salt intake]

A number of epidemiologic and experimental studies have revealed the close relationship between salt intake and blood pressure. The objective of this study was to know the salt intake among 293 not previously treated hypertensive patients and to identify their clinical characteristics that would allow us to define the profile of patients with high sodium intake. Hypertensive patients who first attended a specialized high blood pressure (HBP) clinic not previously treated with drugs, at least for the last month were selected. Sodium 24 h urinary excretion was determined on two occasions, as sodium intake index. Thirteen percent of patients had a salt intake lower than 100 mEq/24 h and 35% of patients higher than 200 mEq/24 h. Sodium intake was higher among men, younger patients, those with a higher Quetelet index, smokers, higher socioeconomic status, and less years with IBP. No differences were observed between salt intake among hypertensive patients with associated diabetes or hyperlipidemia. The Quetelet index, sex, age and smoking were identified as independent variables for salt intake by the multiple linear regression analysis. No correlation was found between salt intake and blood pressure. In conclusion, a high sodium intake was observed in our setting among hypertensive patients who had previously been advised to moderate salt intake. The highest salt intake was observed among men, youths, obese and smokers.

Tunnel window's imprint on dipolar field distributions

We have performed Monte Carlo simulations of interacting dipoles that relax through quantum tunneling. We aim to mimic tunneling experiments on crystals of magnetic clusters, such as Fe(8), at very low temperatures. Accordingly, we allow spin flips only if the corresponding energy change is less than some 2 delta h(hf). Time evolutions of the dipolar field distribution P(t)(H) are studied. As in experiments, a "hole" develops in P(t)(H). The half-width W of incipient holes of weakly polarized systems are, under certain conditions, simply related to delta h(hf). For k(B)T less than approximately 0.5 delta h(hf) and delta h(hf) smaller than approximately 1/10 of the half-width of the dipolar field distributions of disordered systems, W approximately equal to 0.75 delta h(hf).

Gas chromatographic analysis of total fatty acids in cider

This paper reports the composition of total fatty acids in an apple beverage, cider. Fatty acids are present in the free or esterified form and contribute to both the flavor and foam properties of cider. Fatty acids were separated and identified as methyl esters by GC-MS, and 12 of these were subsequently determined by GC-FID. The major fatty acids found in cider were caproic, caprylic, capric, and palmitic acid, the saturated acids predominating over the unsaturated ones. The proposed method was applied to 59 ciders from three consecutive harvests (1996, 1997, and 1998), which were made by 19 cider-makers from the region of Asturias (Spain). Linear discriminant analysis of fatty acids in these samples allowed selection of palmitoleic, pentadecanoic, linoleic, myristic, and linolenic acid as the most predictive variables to differentiate ciders made from apples grown in the Asturias region (1997 harvest) and ciders made from apples grown outside this region (1996 and 1998 harvests).

[The practical clinical guidelines of the Sociedad Española de Cardiología on interventional cardiology: coronary angioplasty and other technics]

Interventional cardiology has had an extraordinary expansion in last years. This clinical guideline is a review of the scientific evidence of the techniques in relation to clinical and anatomic findings. The review includes: 1. Coronary arteriography. 2. Coronary balloon angioplasty. 3. Coronary stents. 4. Other techniques: directional atherectomy, rotational atherectomy, transluminal extraction atherectomy, cutting balloon, laser angioplasty and transmyocardial laser and endovascular radiotherapy. 5. Platelet glycoprotein IIb/IIIa inhibitors. 6. New diagnostic techniques: intravascular ultrasound, coronary angioscopy, Doppler and pressure wire. For the recommendations we have used the classification system: class I, IIa, IIb, III like in the guidelines of the American College of Cardiology and the American Heart Association.

[The practical clinical guidelines of the Sociedad Española de Cardiología on coronary surgery]

Surgery in coronary disease, including myocardial revascularization and the surgery of mechanical complications of acute myocardial infarction, has shown to improve the symptoms, quality of life and/or prognosis in certain groups of patients. The expected benefit in each patient depend on many well-known factors among which the appropriateness of the indication for surgery is fundamental. The objective of these guidelines is to review current indications for cardiac surgery in patients with coronary heart disease through an evaluation of the degree of evidence of effectiveness in the light of current knowledge (systematic review of bibliography) and expert opinion gathered from various reports. Indications and the degree of recommendation for conventional coronary artery bypass grafting have been established for each of the most frequent anatomo-clinical situations defined by clinical symptoms (stable angina, unstable angina and acute myocardial infarction) as well as by left ventricular function and extend of coronary disease. Furthermore, the subgroups with the greatest surgical risk and stratification models are described to aid the decision making process. Also we analyse the rational basis and indication for the new surgical techniques such as minimally invasive coronary surgery and total arterial revascularization. Finally, the indication and timing of surgery in patients with mechanical complications of acute myocardial infarction are considered.

[The clinical management guidelines of the Sociedad Española de Cardiología in acute myocardial infarct]

In the recent years, new possibilities have emerged in the diagnosis and management of acute myocardial infarction with ST segment elevation and its complications. Moreover, a deep transformation has taken place in the health care system organization, particularly in aspects related to care of patients presenting non-traumatic chest pain, both in pre-hospital and hospital areas. All these issues warrant a consensus document in Spain dealing with the role that these important changes should play in the whole management of myocardial infarction patients. This document revises and updates all the main clinical issues of acute myocardial infarction patients from the moment they contact with the health care system outside the hospital until they return home, after staying at the coronary care unit and the general hospitalization ward. All those aspects are considered not only in the uncomplicated myocardial infarction but also in the complicated one. This review also includes a set of recommendations on structural and organisational aspects, mainly referred to the prehospital and emergency levels.

[Angioplasty for acute coronary syndromes in the era of the stent]

Pharmacological treatment frequently stabilizes symptoms of patients with acute myocardial ischemia. However, significant quiescent residual stenosis normally persists and leads to rethrombosis. Since rethrombosis produces reischemia and has a deleterious impact on initial and long-term prognosis in these patients, definitive normalisation of local flow assured through deactivation treatments and complete passivation of quiescent residual stenosis in an inert plaque should be a main priority in modern treatment of acute coronary ischemia. Considering the negative influence of significant stenosis on rethrombosis, and that the normalization has a clear antithrombotic effect of flow, routine elimination of residual stenosis by means of angioplasty should prevent rethrombosis and its side effects. Nevertheless, according to trials carried out previous to the most relevant progresses in the field of interventional cardiology, the advantage of this strategy over the conservative treatment has not been clearly demonstrated. Coronary stenting produces a real normalisation of flow and lumen which prevents local thrombosis. In concordance with these facts, recent evidence indicates a substancial clinical benefit of stenting in very thrombogenic acute settings, such as primary angioplasty or refractory acute coronary angina. Presumably, routine stenting also benefits initial and long-term prognosis of other subsets of unstable patients, especially those with thrombolysed myocardial infarction and stabilized patients with acute ischemia without ST-segment elevation. To demonstrate this new trials are needed to compare the efficacy of conservative and interventional approaches that incorporate the advances of each strategys. Until new data are available on these studies, the treatment of acute coronary ischemia should be tailored to each patient and no out-dated recommendation should be given or accepted.

[The prognostic value of dobutamine echocardiography after an uncomplicated acute myocardial infarct]

BACKGROUND AND PURPOSE

The identification of patients at risk for future events after an infarction is mandatory. The aim of this study was to assess the prognostic value of dobutamine stress echocardiography after an uncomplicated myocardial infarction.

METHODS

One hundred and twenty five patients (mean age 65 +/- 11 years, males 82%) underwent dobutamine-echo within ten days after an uncomplicated myocardial infarction. Four myocardial responses were identified: a) negative; b) sustained improvement of myocardial contractility; c) initial improvement followed by worsening, and d) worsening at a distance or in the infarcted zone.

RESULTS

Mean follow-up was 7.4 +/- 4.6 months. An adverse outcome occurred in 47 patients: non cardiac death in 3, cardiac death in 6, myocardial infarction in 5, angina in 21, congestive heart failure in 2, and in 10 patients revascularization. Cox regression analysis showed that worsening of contractility was the best predictor for adverse events (p < 0.0001, relative risk 2.8; 95% confidence interval: 1.7-4.5). Non-smoking and previous angina were also predictors of adverse events (p = 0.003 and p = 0.04, respectively). Similar results were obtained after excluding the revascularized patients.

CONCLUSIONS

Sustained improvement of contractility in the infarcted region is not a predictor of adverse events. Asynergy at a distance or in the infarcted region during dobutamine echocardiography within ten days after an uncomplicated myocardial infarction predicts adverse cardiac events during follow-up. Therefore, dobutamine echocardiography could be used for risk stratification after acute myocardial infarction.

Subacute occlusion, bleeding complications, hospital stay and restenosis after Palmaz-Schatz coronary stenting under a new antithrombotic regimen

OBJECTIVES

This study was designed to evaluate the effect of an antithrombotic regimen without full early anticoagulation on subacute occlusion, bleeding, hospital stay and restenosis after elective coronary stenting.

BACKGROUND

Subacute occlusion is a major limitation of stenting. Aggressive antithrombotic therapy is not fully prophylactic against this complication, carries risk of bleeding, prolongs hospital stay and reduces cost-effectiveness.

METHODS

We studied 110 consecutive patients (121 lesions) who underwent elective Palmaz-Schatz stenting. Intravenous heparin was given only during the procedure. After stenting, patients took aspirin, dipyridamole, dextran, warfarin and low molecular weight heparin (enoxaparin, 40 mg subcutaneously daily, stopped when an international normalized ratio of 2 to 3 was achieved). The first 52 patients (group A) underwent coronary angiography 24 h after stenting, and hospital stay was extended until an international normalized ratio of 2 to 3.5 was achieved. The remaining 58 patients (group B) were discharged 24 h after stenting. Clinical and angiographic follow-up were performed 1 and 6 months after stenting for all patients.

RESULTS

In group A the activated partial thromboplastin time remained normal (30 +/- 6.2 s [mean +/- SD]) during enoxaparin administration, and hospital stay was 9.1 +/- 4.3 days. In group B hospital stay was 27 +/- 8 h. No major cardiac events occurred within the first month in patients from both groups. At 1 and 30 days all stented lesions remained patent. Only two patients (1.8%, 95% confidence interval [CI] 0.32% to 7%) developed bleeding. At 6 months, the restenosis rate was 22% (95% CI 15% to 30%).

CONCLUSIONS

After coronary stenting with optimal angiographic results, this new antithrombotic regimen prevented subacute stent occlusion and bleeding, with a brief hospital stay. No detrimental effect on the previously reported restenosis rate was observed.

Activity of the gamma-glutamyltransferase, leucine aminopeptidase and alkaline phosphatase enzymes in human tear fluid

In this work the presence of gamma-glutamyltransferase (GGT), leucine amino-peptidase (LAP) and alkaline phosphatase (AP) is shown in human tear fluid. We studied these levels according to sex, age and some eye refraction defects. The differences between the levels for both sexes are not significant. LAP and AP do not show any differences in either age groups or individuals with some refraction defects. The average level of GGT is higher from 40 years of age upwards (p less than 0.005). In individuals with refraction defects, the enzymatic activity is significantly higher (p less than 0.05) than the activities found in normal subjects. The levels of the three enzymes in serum and tear fluid do not show a significant correlation nor are they significantly modified after the samples have been frozen for a month at -20 degrees C.

[Serum enzyme alterations during diabetic ketoacidosis. Prospective study of the behaviour of AP, AsAT, AIAT, and GGPT in 24 cases (author's transl)]

Because of the scarcity of data on the changes of serum enzymes during diabetic ketoacidosis, the authors have prospectively studied the alterations of gamma-glutamyl transpeptidase (GGTP), alkaline phosphatase (AP), aspartate aminotransferase (AsAT), and alanine aminotransferase (AIAT) in this metabolic disturbance. The most significant finding was the frequent increase of AP activity on admission, with a systematic fall of the serum levels within the first 24 hours (p less than 0.001). This phenomenon was negatively correlated with patients' age (p less than 0.05), and the same occurred with the bone isoenzyme of AP (p less than 0.01). The remaining enzymes studies were always normal, thus suggesting that any increase of the serum levels of GGTP, AsAT, and AIAT found in a patient with diabetic ketoacidosis must arise the suspicion of an associated disturbance.

[Candidiasic granuloma associated to hypothyroidism (author's transl)]

Chronic mucocutaneous candidiasis is a rare cellular immunodeficiency disease, characterized by persistent infections of the mucous membranes, nails, skin and scalp. Candidal granuloma is an uncommon form of mucocutaneous candidiasis of early onset which may ne associated with hypothyroidism. It is difficult to manage as so far no truly effective treatment has been found. We present a 13-year old boy with candidal granuloma associated with primary hypothyroidism who had a favorable response to treatment with thyroid hormone and miconazole. The fungicide was given in tablet form, a single dose per day and patient kept it in his mouth and in contact with his lips for 15 minutes. One and a half year later clinical evolution is good and no side effects related to the miconazole have been observed.