Sonographic Indices in Patients with Severe Acute Tubular Necrosis during Early Post-Kidney Transplantation Period.

BACKGROUND: Kidney transplantation is the most effective and optimal treatment for end-stage renal disease. OBJECTIVE: To investigate the association between serially measured ultrasound indices during the early post-operative period to determine severe acute tubular necrosis (ATN) in kidney allografts. METHODS: In a prospective study, we assessed sonographic renal indices including interlobar arteries peak systolic velocity (PSV), end-diastolic velocity (EDV), resistance index (RI), pulsatility index (PI), power doppler grading (PDG), acceleration time (AT), and renal volume on the 3rd and 9th days after kidney transplantation in 46 adult recipients who had no other significant complications except ATN. Biopsies were performed in patients with prolonged delayed graft function (DGF) to exclude other pathologies, especially acute rejection. RESULTS: 12 (20%) recipients experienced biopsy-proven severe ATN. The differences in the ultrasound indices and their measured discrepancies on the 1st and 2nd examinations between the groups were not statistically significant except for the 1st examined RI (p=0.029) and PI (p=0.04). No patient had PDG of >2. The first RI, with a cut-off value of 0.66, had a sensitivity of 91.7% and a specificity of 50% for predicting severe ATN (area under the ROC curve = 0.71). To compensate for the low specificity of this index, we suggest using the first PDG scale of equal to 2 with a specificity of 85.3%. Overall sensitivity, specificity, and positive and negative predictive values in established severe ATN throughout early post-operative days for a 3rd day RI >0.66 and PDG = 2, were 38%, 92.5%, 64.1%, and 80.9%, respectively. CONCLUSIONS: The RI and the PDG measured on the 3rd day after renal transplantation are useful indices for the diagnosis of established severe ATN in kidney allografts. Furthermore, donor characteristics, post-harvesting organ preservation status, main renal vascular anastomosis, and early post-operative recipient's clinical situations may also influence the incidence of severe ATN. Although the 1st ultrasound examination on the 3rd day in early post-transplantation provides important diagnostic and prognostic information, repeated assessment about one week later provides no more valuable information.

Evaluation of the effect of locally administered amitriptyline gel as adjunct to local anesthetics in irreversible pulpitis pain.

BACKGROUND: Amitriptyline is one of the most common tricyclic antidepressants, which binds to pain sensory nerve fibers close to the sodium channel; hence, it could interact to some degree with receptors of local anesthetics. This study was designed to assess the additional analgesic effects of 2% Amitriptyline local gel administration in irreversible pulpitis pain of the molars. MATERIALS AND METHODS: This study was a randomized, double-blind clinical trial that was performed on 56 consented adult patients who did not receive enough analgesia after a lidocaine nerve block for their tooth pulpitis pain. Patients were treated with 0.2 ml of either 2% amitriptyline or placebo, which was directly injected into their mandibular molar pulp chamber after they had received two routine lidocaine injections. Patients were asked to score their pain as a mark on a 10-cm Visual Analogue Scale (VAS) at different timepoints: 0 (just before gel administration), 1, 3, 5, 7, and 9 minutes after the treatments. RESULTS: There was a 92.5% decrease in VAS scores of patients 9 minutes after amitriptyline administration compared to Time 0, while in the placebo group this difference was only 13.5%. Further, in the amitriptyline group, the VAS score at all timepoints was statistically different from Time 0 (P < 0.01). The overall pain reduction and its trend was significantly higher in the amitriptyline group compared with the placebo group (P < 0.001). CONCLUSION: Inter-pulp space administration of amitriptyline 2% gel for completing analgesia in irreversible pulpitis pain could be effective and useful as a conjunctive therapy to injections of local anesthetics.

Correlative capacity of composite quantum states.

We characterize the optimal correlative capacity of entangled, separable, and classically correlated states. Introducing the notions of the infimum and supremum within majorization theory, we construct the least disordered separable state compatible with a set of marginals. The maximum separable correlation information supportable by the marginals of a multiqubit pure state is shown to be a local operations and classical communication monotone. The least disordered composite of a pair of qubits is found for the above classes, with classically correlated states defined as diagonal in the product of marginal bases.

Entanglement versus Stosszahlansatz: disappearance of the thermodynamic arrow in a high-correlation environment.

The crucial role of ambient correlations in determining thermodynamic behavior is established. A class of entangled states of two macroscopic systems is constructed such that each component is in a state of thermal equilibrium at a given temperature, and when the two are allowed to interact heat can flow from the colder to the hotter system. A dilute gas model exhibiting this behavior is presented. This reversal of the thermodynamic arrow is a consequence of the entanglement between the two systems, a condition that is opposite to molecular chaos and shown to be unlikely in a low-entropy environment. By contrast, the second law is established by proving Clausius' inequality in a low-entropy environment. These general results strongly support the expectation, first expressed by Boltzmann and subsequently elaborated by others, that the second law is an emergent phenomenon which requires a low-entropy cosmological environment, one that can effectively function as an ideal information sink.

Universal measure of entanglement.

A general framework is developed for separating classical and quantum correlations in a multipartite system. Entanglement is defined as the difference in the correlation information encoded by the state of a system and a suitably defined separable state with the same marginals. A generalization of the Schmidt decomposition is developed to implement the separation of correlations for any pure, multipartite state. The measure based on this decomposition is a generalization of the entanglement of formation to multipartite systems, provides an upper bound for the relative entropy of entanglement, and is directly computable on pure states. The example of pure three-qubit states is analyzed in detail, and a classification based on minimal, four-term decompositions is developed.

Hamilton-Jacobi formulation of Kolmogorov-Sinai entropy for classical and quantum dynamics.

A Hamilton-Jacobi formulation of the Lyapunov spectrum and Kolmogorov-Sinai (KS) entropy is developed. It is numerically efficient and reveals a close relation between the KS invariant and the classical action. This formulation is extended to the quantum domain using the Madelung-Bohm orbits associated with the Schroedinger equation. The resulting quantum KS invariant for a given orbit equals the mean decay rate of the probability density along the orbit, while its ensemble average measures the mean growth rate of configuration-space information for the quantum system.