Renal Perfusion in Scleroderma Patients Assessed by Microbubble-Based Contrast-Enhanced Ultrasound

OBJECTIVES: Renal damage is common in scleroderma. It can occur acutely or chronically. Renal reserve might already be impaired before it can be detected by laboratory findings. Microbubble-based contrast-enhanced ultrasound has been demonstrated to improve blood perfusion imaging in organs. Therefore, we conducted a study to assess renal perfusion in scleroderma patients utilizing this novel technique. MATERIALS AND METHODOLOGY: Microbubble-based contrast agent was infused and destroyed by using high mechanical index by Siemens Sequoia (curved array, 4.5 MHz). Replenishment was recorded for 8 seconds. Regions of interests (ROI) were analyzed in renal parenchyma, interlobular artery and renal pyramid with quantitative contrast software (CUSQ 1.4, Siemens Acuson, Mountain View, California). Time to maximal Enhancement (TmE), maximal enhancement (mE) and maximal enhancement relative to maximal enhancement of the interlobular artery (mE%A) were calculated for different ROIs. RESULTS: There was a linear correlation between the time to maximal enhancement in the parenchyma and the glomerular filtration rate. However, the other parameters did not reveal significant differences between scleroderma patients and healthy controls. CONCLUSION: Renal perfusion of scleroderma patients including the glomerular filtration rate can be assessed using microbubble-based contrast media

Time-bin entanglement at telecom wavelengths from a hybrid photonic integrated circuit

Mass-deployable implementations for quantum communication require compact, reliable, and low-cost hardware solutions for photon generation, control and analysis. We present a fiber-pigtailed hybrid photonic circuit comprising nonlinear waveguides for photon-pair generation and a polymer interposer reaching 68dB of pump suppression and photon separation with >25dB polarization extinction ratio. The optical stability of the hybrid assembly enhances the quality of the entanglement, and the efficient background suppression and photon routing further reduce accidental coincidences. We thus achieve a 96(-8,+3)% concurrence and a 96(-5,+2)% fidelity to a Bell state. The generated telecom-wavelength, time-bin entangled photon pairs are ideally suited for distributing Bell pairs over fiber networks with low dispersion

Topological quenching of the tunnel splitting for a particle in a double-well potential on a planar loop

The motion of a particle along a one-dimensional closed curve in a plane is considered. The only restriction on the shape of the loop is that it must be invariant under a twofold rotation about an axis perpendicular to the plane of motion. Along the curve a symmetric double-well potential is present leading to a twofold degeneracy of the classical ground state. In quantum mechanics, this degeneracy is lifted: the energies of the ground state and the first excited state are separated from each other by a slight difference ¿E, the tunnel splitting. Although a magnetic field perpendicular to the plane of the loop does not influence the classical motion of the charged particle, the quantum-mechanical separation of levels turns out to be a function of its strength B. The dependence of ¿E on the field B is oscillatory: for specific discrete values Bn the splitting drops to zero, indicating a twofold degeneracy of the ground state. This result is obtained within the path-integral formulation of quantum mechanics; in particular, the semiclassical instanton method is used. The origin of the quenched splitting is intuitively obvious: it is due to the fact that the configuration space of the system is not simply connected, thus allowing for destructive interference of quantum-mechanical amplitudes. From an abstract point of view this phenomenon can be traced back to the existence of a topological term in the Lagrangian and a nonsimply connected configuration space. In principle, it should be possible to observe the splitting in appropriately fabricated mesoscopic rings consisting of normally conducting metal

Solvable three-state model of a driven double-well potential and coherent destruction of tunneling

A simple model for a particle in a double well is derived from discretizing its configuration space. The model contains as many free parameters as the original system and it respects all the existing symmetries. In the presence of an external periodic force both the continuous system and the discrete model are shown to possess a generalized time-reversal symmetry in addition to the known generalized parity. The impact of the driving force on the spectrum of the Floquet operator is studied. In particular, the occurrence of degenerate quasienergies causing coherent destruction of tunneling is discussed—to a large extent analytically—for arbitrary driving frequencies and barrier heights

Machine learning-based improvement of an online rheumatology referral and triage system

IntroductionRheport is an online rheumatology referral system allowing automatic appointment triaging of new rheumatology patient referrals according to the respective probability of an inflammatory rheumatic disease (IRD). Previous research reported that Rheport was well accepted among IRD patients. Its accuracy was, however, limited, currently being based on an expert-based weighted sum score. This study aimed to evaluate whether machine learning (ML) models could improve this limited accuracy.Materials and methodsData from a national rheumatology registry (RHADAR) was used to train and test nine different ML models to correctly classify IRD patients. Diagnostic performance was compared of ML models and the current algorithm was compared using the area under the receiver operating curve (AUROC). Feature importance was investigated using shapley additive explanation (SHAP).ResultsA complete data set of 2265 patients was used to train and test ML models. 30.5% of patients were diagnosed with an IRD, 69.3% were female. The diagnostic accuracy of the current Rheport algorithm (AUROC of 0.534) could be improved with all ML models, (AUROC ranging between 0.630 and 0.737). Targeting a sensitivity of 90%, the logistic regression model could double current specificity (17% vs. 33%). Finger joint pain, inflammatory marker levels, psoriasis, symptom duration and female sex were the five most important features of the best performing logistic regression model for IRD classification.ConclusionIn summary, ML could improve the accuracy of a currently used rheumatology online referral system. Including further laboratory parameters and enabling individual feature importance adaption could increase accuracy and lead to broader usage

Categorizing Different Approaches to the Cosmological Constant Problem

We have found that proposals addressing the old cosmological constant problem come in various categories. The aim of this paper is to identify as many different, credible mechanisms as possible and to provide them with a code for future reference. We find that they all can be classified into five different schemes of which we indicate the advantages and drawbacks. Besides, we add a new approach based on a symmetry principle mapping real to imaginary spacetime.Comment: updated version, accepted for publicatio

P67-phox (NCF2) Lacking Exons 11 and 12 Is Functionally Active and Leads to an Extremely Late Diagnosis of Chronic Granulomatous Disease (CGD)

Two brothers in their fifties presented with a medical history of suspected fungal allergy, allergic bronchopulmonary aspergillosis, alveolitis, and invasive aspergillosis and pulmonary fistula, respectively. Eventually, after a delay of 50 years, chronic granulomatous disease (CGD) was diagnosed in the index patient. We found a new splice mutation in the NCF2 (p67-phox) gene, c.1000+2T→G, that led to several splice products one of which lacked exons 11 and 12. This deletion was in frame and allowed for remarkable residual NADPH oxidase activity as determined by transduction experiments using a retroviral vector. We conclude that p67-phox which lacks the 34 amino acids encoded by the two exons can still exert considerable functional activity. This activity can partially explain the long-term survival of the patients without adequate diagnosis and treatment, but could not prevent progressing lung damage

New insights into the prevalence of depressive symptoms and depression in rheumatoid arthritis – Implications from the prospective multicenter VADERA II study

Objectives To investigate the prevalence of depressive symptoms in rheumatoid arthritis (RA) patients using two previously validated questionnaires in a large patient sample, and to evaluate depressive symptoms in the context of clinical characteristics (e.g. remission of disease) and patient-reported impact of disease. Methods In this cross-sectional study, the previously validated Patient Health Questionnaire (PHQ-9) and Beck-Depression Inventory II (BDI-II) were used to assess the extent of depressive symptoms in RA patients. Demographic background, RA disease activity score (DAS28), RA impact of disease (RAID) score, comorbidities, anti-rheumatic therapy and antidepressive treatment, were recorded. Cut-off values for depressive symptomatology were PHQ-9 ≥5 or BDI-II ≥14 for mild depressive symptoms or worse and PHQ-9 ≥ 10 or BDI-II ≥ 20 for moderate depressive symptoms or worse. Prevalence of depressive symptomatology was derived by frequency analysis while factors independently associated with depressive symptomatology were investigated by using multiple logistic regression analyses. Ethics committee approval was obtained, and all patients provided written informed consent before participation. Results In 1004 RA-patients (75.1% female, mean±SD age: 61.0±12.9 years, mean disease duration: 12.2±9.9 years, DAS28 (ESR): 2.5±1.2), the prevalence of depressive symptoms was 55.4% (mild or worse) and 22.8% (moderate or worse). Characteristics independently associated with depressive symptomatology were: age 2 (OR = 10.54) and presence of chronic pain (OR = 3.25). Of patients classified as having depressive symptoms, only 11.7% were receiving anti-depressive therapy. Conclusions Mild and moderate depressive symptoms were common in RA patients according to validated tools. In routine clinical practice, screening for depression with corresponding follow-up procedures is as relevant as incorporating these results with patient-reported outcomes (e.g. symptom state), because the mere assessment of clinical disease activity does not sufficiently reflect the prevalence of depressive symptoms. Clinical trial registration number This study is registered in the Deutsches Register Klinischer Studien (DRKS00003231) and ClinicalTrials.gov (NCT02485483)