[Intraoperative fluorescence-guided perfusion assessment using indocyanine green-Increased safety in gastrointestinal anastomoses?] / Intraoperative fluoreszenzgestützte Perfusionsmessung mit Indocyaningrün ­ erhöhte Sicherheit bei gastrointestinalen Anastomosen?

Insufficiency of gastrointestinal anastomoses represents a relevant risk of morbidity and mortality for affected patients. The perfusion quality of the ends of the intestine is the decisive parameter for ensuring sufficient healing of an anastomosis. Intraoperative fluorescence-guided perfusion assessment with indocyanine green is increasingly being used in modern visceral surgery to evaluate tissue perfusion prior to the fashioning of gastrointestinal anastomoses. This technique provides the possibility to distinguish between adequately and inadequately perfused tissue in order to place the anastomosis in the region with the best possible perfusion. Thus, surgeons have a measuring instrument that enables an objective assessment of the perfusion quality of the tissue to be undertaken in addition to a purely subjective macroscopic visual assessment, in order to achieve a better functional result for the patients. Currently, however, the value of this technique has not yet been conclusively clarified. The aim of this review article is to characterize the benefits of intraoperative fluorescence-guided perfusion assessment and to classify it with respect to its significance for routine clinical practice.

Quantum Correlations beyond Entanglement and Discord.

Dissimilar notions of quantum correlations have been established, each being motivated through particular applications in quantum information science and each competing for being recognized as the most relevant measure of quantumness. In this contribution, we experimentally realize a form of quantum correlation that exists even in the absence of entanglement and discord. We certify the presence of such quantum correlations via negativities in the regularized two-mode Glauber-Sudarshan function. Our data show compatibility with an incoherent mixture of orthonormal photon-number states, ruling out quantum coherence and other kinds of quantum resources. By construction, the quantumness of our state is robust against dephasing, thus requiring fewer experimental resources to ensure stability. In addition, we theoretically show how multimode entanglement can be activated based on the generated, nonentangled state. Therefore, we implement a robust kind of nonclassical photon-photon correlated state with useful applications in quantum information processing.

Statistical Benchmarking of Scalable Photonic Quantum Systems.

Targeting at the realization of scalable photonic quantum technologies, the generation of many photons, their propagation in large optical networks, and a subsequent detection and analysis of sophisticated quantum correlations are essential for the understanding of macroscopic quantum systems. In this experimental contribution, we explore the joint operation of all mentioned ingredients. We benchmark our time-multiplexing framework that includes a high-performance source of multiphoton states and a large multiplexing network, together with unique detectors with high photon-number resolution, readily available for distributing quantum light and measuring complex quantum correlations. Using an adaptive approach that employs flexible time bins, rather than static ones, we successfully verify high-order nonclassical correlations of many photons distributed over many modes. By exploiting the symmetry of our system and using powerful analysis tools, we can analyze correlations that would be inaccessible by classical means otherwise. In particular, we produce on the order of ten photons and distribute them over 64 modes. Nonclassicality is verified with correlation functions up to the 128th order and statistical significances of up to 20 standard deviations.

Detector-Agnostic Phase-Space Distributions.

The representation of quantum states via phase-space functions constitutes an intuitive technique to characterize light. However, the reconstruction of such distributions is challenging as it demands specific types of detectors and detailed models thereof to account for their particular properties and imperfections. To overcome these obstacles, we derive and implement a measurement scheme that enables a reconstruction of phase-space distributions for arbitrary states whose functionality does not depend on the knowledge of the detectors, thus defining the notion of detector-agnostic phase-space distributions. Our theory presents a generalization of well-known phase-space quasiprobability distributions, such as the Wigner function. We implement our measurement protocol, using state-of-the-art transition-edge sensors without performing a detector characterization. Based on our approach, we reveal the characteristic features of heralded single- and two-photon states in phase space and certify their nonclassicality with high statistical significance.

Mid-term radiological results of a cementless short humeral component in anatomical and reverse shoulder arthroplasty.

AIMS: Shoulder arthroplasty using short humeral components is becoming increasingly popular. Some such components have been associated with relatively high rates of adverse radiological findings. The aim of this retrospective review was to evaluate the radiological humeral bone changes and mechanical failure rates with implantation of a short cementless humeral component in anatomical (TSA) and reverse shoulder arthroplasty (RSA). PATIENTS AND METHODS: A total of 100 shoulder arthroplasties (35 TSA and 65 RSA) were evaluated at a mean of 3.8 years (3 to 8.3). The mean age at the time of surgery was 68 years (31 to 90). The mean body mass index was 32.7 kg/m2 (17.3 to 66.4). RESULTS: Greater tuberosity stress shielding was noted in 14 shoulders (two TSA and 12 RSA) and was graded as mild in nine, moderate in two, and severe in three. Medial calcar resorption was noted in 23 shoulders (seven TSA and 16 RSA), and was graded as mild in 21 and moderate in two. No humeral components were revised for loosening or considered to be loose radiologically. Nine shoulders underwent reoperation for infection (n = 3), fracture of the humeral tray (n = 2), aseptic glenoid loosening (n = 1), and instability (n = 3). No periprosthetic fractures occurred. CONCLUSION: Implantation of this particular short cementless humeral component at the time of TSA or RSA was associated with a low rate of adverse radiological findings on the humeral side at mid-term follow-up. Our data do not raise any concerns regarding the use of a short stem in TSA or RSA. Cite this article: Bone Joint J 2019;101-B:610-614.

Experimental Reconstruction of Entanglement Quasiprobabilities.

We report on the first experimental reconstruction of an entanglement quasiprobability. In contrast to related techniques, the negativities in our distributions are a necessary and sufficient identifier of separability and entanglement and enable a full characterization of the quantum state. A reconstruction algorithm is developed, a polarization Bell state is prepared, and its entanglement is certified based on the reconstructed entanglement quasiprobabilities, with a high significance and without correcting for imperfections.

Can a reverse shoulder arthroplasty be used to revise a failed primary reverse shoulder arthroplasty?: Revision reverse shoulder arthroplasty for failed reverse prosthesis.

AIMS: Patients with a failed reverse shoulder arthroplasty (RSA) have limited salvage options. The aim of this study was to determine the outcome of revision RSA when used as a salvage procedure for a failed primary RSA. PATIENTS AND METHODS: We reviewed all revision RSAs performed for a failed primary RSA between 2006 and 2012, excluding patients with a follow-up of less than two years. A total of 27 revision RSAs were included in the study. The mean age of the patients at the time of revision was 70 years (58 to 82). Of the 27 patients, 14 (52% were female). The mean follow-up was 4.4 years (2 to 10). RESULTS: Six patients (22%) developed complications requiring further revision surgery, at a mean of 1.7 years (0.1 to 5.3) postoperatively. The indication for further revision was dislocation in two, glenoid loosening in one, fracture of the humeral component in one, disassociation of the glenosphere in one, and infection in one. The five-year survival free of further revision was 85%. Five additional RSAs developed complications that did not need surgery, including dislocation in three and periprosthetic fracture in two. Overall, patients who did not require further revision had excellent pain relief, and significant improvements in elevation and external rotation of the shoulder (p < 0.01). The mean postoperative American Shoulder and Elbow Surgeons (ASES), and simple shoulder test (SST) scores were 66 and 7, respectively. Radiological results were available in 26 patients (96.3%) at a mean of 4.3 years (1.5 to 9.5). At the most recent follow-up, six patients (23%) had glenoid lucency, which were classified as grade III or higher in three (12%). Smokers had a significantly increased risk of glenoid lucency (p < 0.01). CONCLUSION: Revision RSA, when used to salvage a failed primary RSA, can be a successful procedure. At intermediate follow-up, survival rates are reasonable, but dislocation and glenoid lucency remain a concern, particularly in smokers. Cite this article: Bone Joint J 2018;100-B:1493-98.

Incomplete Detection of Nonclassical Phase-Space Distributions.

We implement the direct sampling of negative phase-space functions via unbalanced homodyne measurement using click-counting detectors. The negativities significantly certify nonclassical light in the high-loss regime using a small number of detectors which cannot resolve individual photons. We apply our method to heralded single-photon states and experimentally demonstrate the most significant certification of nonclassicality for only two detection bins. By contrast, the frequently applied Wigner function fails to directly indicate such quantum characteristics for the quantum efficiencies present in our setup without applying additional reconstruction algorithms. Therefore, we realize a robust and reliable approach to characterize nonclassical light in phase space under realistic conditions.

Separable and Inseparable Quantum Trajectories.

The dynamical behavior of interacting systems plays a fundamental role for determining quantum correlations, such as entanglement. In this Letter, we describe temporal quantum effects of the inseparable evolution of composite quantum states by comparing the trajectories to their classically correlated counterparts. For this reason, we introduce equations of motions describing the separable propagation of any interacting quantum system, which are derived by requiring separability for all times. The resulting Schrödinger-type equations allow for comparing the trajectories in a separable configuration with the actual behavior of the system and, thereby, identifying inseparable and time-dependent quantum properties. As an example, we study bipartite discrete- and continuous-variable interacting systems. The generalization of our developed technique to multipartite scenarios is also provided.

Detector-Independent Verification of Quantum Light.

We introduce a method for the verification of nonclassical light which is independent of the complex interaction between the generated light and the material of the detectors. This is accomplished by means of a multiplexing arrangement. Its theoretical description yields that the coincidence statistics of this measurement layout is a mixture of multinomial distributions for any classical light field and any type of detector. This allows us to formulate bounds on the statistical properties of classical states. We apply our directly accessible method to heralded multiphoton states which are detected with a single multiplexing step only and two detectors, which are in our work superconducting transition-edge sensors. The nonclassicality of the generated light is verified and characterized through the violation of the classical bounds without the need for characterizing the used detectors.

Long-term outcomes of cemented versus cementless humeral components in arthroplasty of the shoulder: a propensity score-matched analysis.

AIMS: In the initial development of total shoulder arthroplasty (TSA), the humeral component was usually fixed with cement. Cementless components were subsequently introduced. The aim of this study was to compare the long-term outcome of cemented and cementless humeral components in arthroplasty of the shoulder. PATIENTS AND METHODS: All patients who underwent primary arthroplasty of the shoulder at our institution between 1970 and 2012 were included in the study. There were 4636 patients with 1167 cemented humeral components and 3469 cementless components. Patients with the two types of fixation were matched for nine different covariates using a propensity score analysis. A total of 551 well-balanced pairs of patients with cemented and cementless components were available after matching for comparison of the outcomes. The clinical outcomes which were analysed included loosening of the humeral component determined at revision surgery, periprosthetic fractures, post-operative infection and operating time. RESULTS: The overall five-, ten-, 15- and 20-year rates of survival were 98.9%, 97.2%, 95.5%, and 94.4%, respectively. Survival without loosening at 20 years was 98% for cemented components and 92.4% for cementless components. After propensity score matching including fixation as determined by the design of the component, humeral loosening was also found to be significantly higher in the cementless group. Survival without humeral loosening at 20 years was 98.7% for cemented components and 91.0% for cementless components. There was no significant difference in the risk of intra- or post-operative fracture. The rate of survival without deep infection and the mean operating time were significantly higher in the cemented group. CONCLUSION: Both types of fixation give rates of long-term survival of > 90%. Cemented components have better rates of survival without loosening but this should be weighed against increased operating time and the risk of bony destruction of the proximal humerus at the time of revision of a cemented humeral component. Cite this article: Bone Joint J 2017;99-B:666-73.

Identification of nonclassical properties of light with multiplexing layouts.

In Sperling et al. [Phys. Rev. Lett. 118, 163602 (2017)], we introduced and applied a detector-independent method to uncover nonclassicality. Here, we extend those techniques and give more details on the performed analysis. We derive a general theory of the positive-operator-valued measure that describes multiplexing layouts with arbitrary detectors. From the resulting quantum version of a multinomial statistics, we infer nonclassicality probes based on a matrix of normally ordered moments. We discuss these criteria and apply the theory to our data which are measured with superconducting transition-edge sensors. Our experiment produces heralded multiphoton states from a parametric down-conversion light source. We show that the known notions of sub-Poisson and sub-binomial light can be deduced from our general approach, and we establish the concept of sub-multinomial light, which is shown to outperform the former two concepts of nonclassicality for our data.

Conditional Hybrid Nonclassicality.

We derive and implement a general method to characterize the nonclassicality in compound discrete- and continuous-variable systems. For this purpose, we introduce the operational notion of conditional hybrid nonclassicality which relates to the ability to produce a nonclassical continuous-variable state by projecting onto a general superposition of discrete-variable subsystem. We discuss the importance of this form of quantumness in connection with interfaces for quantum communication. To verify the conditional hybrid nonclassicality, a matrix version of a nonclassicality quasiprobability is derived and its sampling approach is formulated. We experimentally generate an entangled, hybrid Schrödinger cat state, using a coherent photon-addition process acting on two temporal modes, and we directly sample its nonclassicality quasiprobability matrix. The introduced conditional quantum effects are certified with high statistical significance.

[Intraoperative multidimensional visualization]. / Intraoperative mehrdimensionale Visualisierung.

Modern intraoperative techniques of visualization are increasingly being applied in general and visceral surgery. The combination of diverse techniques provides the possibility of multidimensional intraoperative visualization of specific anatomical structures. Thus, it is possible to differentiate between normal tissue and tumor tissue and therefore exactly define tumor margins. The aim of intraoperative visualization of tissue that is to be resected and tissue that should be spared is to lead to a rational balance between oncological and functional results. Moreover, these techniques help to analyze the physiology and integrity of tissues. Using these methods surgeons are able to analyze tissue perfusion and oxygenation. However, to date it is not clear to what extent these imaging techniques are relevant in the clinical routine. The present manuscript reviews the relevant modern visualization techniques focusing on intraoperative computed tomography and magnetic resonance imaging as well as augmented reality, fluorescence imaging and optoacoustic imaging.

Multipartite Entanglement of a Two-Separable State.

We consider a six-partite, continuous-variable quantum state that we have effectively generated by the parametric down-conversion of a femtosecond frequency comb. We show that, though this state is two-separable, i.e., it does not exhibit "genuine entanglement," it is undoubtedly multipartite entangled. The consideration of not only the entanglement of individual mode decompositions, but also of combinations of those, solves the puzzle and exemplifies the importance of studying different categories of multipartite entanglement.

Quantum Correlations from the Conditional Statistics of Incomplete Data.

We study, in theory and experiment, the quantum properties of correlated light fields measured with click-counting detectors providing incomplete information on the photon statistics. We establish a correlation parameter for the conditional statistics, and we derive the corresponding nonclassicality criteria for detecting conditional quantum correlations. Classical bounds for Pearson's correlation parameter are formulated that allow us, once they are violated, to determine nonclassical correlations via the joint statistics. On the one hand, we demonstrate nonclassical correlations in terms of the joint click statistics of light produced by a parametric down-conversion source. On the other hand, we verify quantum correlations of a heralded, split single-photon state via the conditional click statistics together with a generalization to higher-order moments. We discuss the performance of the presented nonclassicality criteria to successfully discern joint and conditional quantum correlations. Remarkably, our results are obtained without making any assumptions on the response function, quantum efficiency, and dark-count rate of photodetectors.

Uncovering Quantum Correlations with Time-Multiplexed Click Detection.

We report on the implementation of a time-multiplexed click detection scheme to probe quantum correlations between different spatial optical modes. We demonstrate that such measurement setups can uncover nonclassical correlations in multimode light fields even if the single mode reductions are purely classical. The nonclassical character of correlated photon pairs, generated by a parametric down-conversion, is immediately measurable employing the theory of click counting instead of low-intensity approximations with photoelectric detection models. The analysis is based on second- and higher-order moments, which are directly retrieved from the measured click statistics, for relatively high mean photon numbers. No data postprocessing is required to demonstrate the effects of interest with high significance, despite low efficiencies and experimental imperfections. Our approach shows that such novel detection schemes are a reliable and robust way to characterize quantum-correlated light fields for practical applications in quantum communications.

Full multipartite entanglement of frequency-comb Gaussian states.

An analysis is conducted of the multipartite entanglement for Gaussian states generated by the parametric down-conversion of a femtosecond frequency comb. Using a recently introduced method for constructing optimal entanglement criteria, a family of tests is formulated for mode decompositions that extends beyond the traditional bipartition analyses. A numerical optimization over this family is performed to achieve maximal significance of entanglement verification. For experimentally prepared 4-, 6-, and 10-mode states, full entanglement is certified for all of the 14, 202, and 115 974 possible nontrivial partitions, respectively.

An electronic alert for HIV screening in the emergency department increases screening but not the diagnosis of HIV.

OBJECTIVE: Based on US. Centers for Disease Control and Prevention recommendations, New York State enacted legislation in 2010 requiring healthcare providers to offer non-targeted human immunodeficiency virus (HIV) testing to all patients aged 13-64. Three New York City adult emergency departments implemented an electronic alert that required clinicians to document whether an HIV test was offered before discharging a patient. The purpose of this study was to assess the impact of the electronic alert on HIV testing rates and diagnosis of HIV positive individuals. METHODS: During the pre-intervention period (2.5-4 months), an electronic "HIV Testing" order set was available for clinicians to order a test or document a reason for not offering the test (e.g., patient is not conscious). An electronic alert was then added to enforce completion of the order set, effectively preventing ED discharge until an HIV test was offered to the patient. We analyzed data from 79,786 visits, measuring HIV testing and detection rates during the pre-intervention period and during the six months following the implementation of the alert. RESULTS: The percentage of visits where an HIV test was performed increased from 5.4% in the preintervention period to 8.7% (p<0.001) after the electronic alert. After the implementation of the electronic alert, there was a 61% increase in HIV tests performed per visit. However, the percentage of patients testing positive per total patients-tested was slightly lower in the post-intervention group than the pre-intervention group (0.48% vs. 0.55%), but this was not significant. The number of patients-testing positive per total-patient visit was higher in the post-intervention group (0.04% vs. 0.03%). CONCLUSIONS: An electronic alert which enforced non-targeted screening was effective at increasing HIV testing rates but did not significantly increase the detection of persons living with HIV. The impact of this electronic alert on healthcare costs and quality of care merits further examination.