Deep learning for laser beam imprinting.

Methods of ablation imprints in solid targets are widely used to characterize focused X-ray laser beams due to a remarkable dynamic range and resolving power. A detailed description of intense beam profiles is especially important in high-energy-density physics aiming at nonlinear phenomena. Complex interaction experiments require an enormous number of imprints to be created under all desired conditions making the analysis demanding and requiring a huge amount of human work. Here, for the first time, we present ablation imprinting methods assisted by deep learning approaches. Employing a multi-layer convolutional neural network (U-Net) trained on thousands of manually annotated ablation imprints in poly(methyl methacrylate), we characterize a focused beam of beamline FL24/FLASH2 at the Free-electron laser in Hamburg. The performance of the neural network is subject to a thorough benchmark test and comparison with experienced human analysts. Methods presented in this Paper pave the way towards a virtual analyst automatically processing experimental data from start to end.

The added value of cardiac index and pulse pressure variation monitoring to mean arterial pressure-guided volume therapy in moderate-risk abdominal surgery (COGUIDE): a pragmatic multicentre randomised controlled trial.

There is disagreement regarding the benefits of goal-directed therapy in moderate-risk abdominal surgery. Therefore, we tested the hypothesis that the addition of non-invasive cardiac index and pulse pressure variation monitoring to mean arterial pressure-based goal-directed therapy would reduce the incidence of postoperative complications in patients having moderate-risk abdominal surgery. In this pragmatic multicentre randomised controlled trial, we randomly allocated 244 patients by envelope drawing in a 1:1 fashion, stratified per centre. All patients had mean arterial pressure, cardiac index and pulse pressure variation measured continuously. In one group, healthcare professionals were blinded to cardiac index and pulse pressure variation values and were asked to guide haemodynamic therapy only based on mean arterial pressure (control group). In the second group, cardiac index and pulse pressure variation values were displayed and kept within target ranges following a pre-defined algorithm (CI-PPV group). The primary endpoint was the incidence of postoperative complications within 30 days. One hundred and seventy-five patients were eligible for final analysis. Overall complication rates were similar (42/94 (44.7%) vs. 38/81 (46.9%) in the control and CI-PPV groups, respectively; p = 0.95). The CI-PPV group had lower mean (SD) pulse pressure variation values (9.5 (2.0)% vs. 11.9 (4.6)%; p = 0.003) and higher mean (SD) cardiac indices (2.76 (0.62) l min-1 .m-2 vs. 2.53 (0.66) l min-1 .m-2 ; p = 0.004) than the control group. In moderate-risk abdominal surgery, we observed no additional value of cardiac index and pulse pressure variation-guided haemodynamic therapy to mean arterial pressure-guided volume therapy with regard to postoperative complications.

Moving targets, long-lived infrastructure, and increasing needs for integration and adaptation in water management: an illustration from Switzerland.

Switzerland provides an example of successful management of water infrastructure and water resources that was accomplished largely without integration across sectors. Limitations in this approach have become apparent; decisions that were formerly based only on technical and economic feasibility must now incorporate broader objectives such as ecological impact. In addition, current and emerging challenges relate to increasingly complex problems that are likely to demand more integrated approaches. If such integration is to be of benefit, it must be possible to redirect resources across sectors, and the synergies derived from integration must outweigh the additional cost of increased complexity.

Long-term outcome of successful percutaneous transluminal angioplasty of the fibular artery in diabetic foot syndrome and single-vessel calf perfusion depends on doppler wave pattern at the forefoot.

BACKGROUND: In the diabetic foot syndrome (DFS) due to peripheral artery disease, the fibular artery is often the only vessel which can be revascularised. Because the fibular artery does not have a direct connection to the plantar arch, the clinical result of fibular artery PTA is dependent upon the extent of collateralization at the ankle. Therefore, successful PTA of the fibular artery with resulting biphasic doppler waves at the ankle can lead to either biphasic or monophasic post-occlusive doppler wave patterns at the forefoot. We evaluated prospectively the association of the forefoot doppler wave form on long-term clinical outcome in patients with DFS after successful PTA of the fibular artery. PATIENTS AND METHODS: 44 patients with occluded calf vessels and DFS Wagner 2-4 underwent primary successful fibular artery PTA resulting in biphasic ankle doppler wave. According to doppler wave form at the forefoot, patients were divided into 1) a biphasic or 2) a monophasic group. Up to 45 months, we documented doppler wave forms, clinical course, restenosis, reinterventions, wound healing, major- and minor amputations. RESULTS: PTA resulted in a biphasic doppler wave at the forefoot in 26 (59 %), in 18 (41 %) in a monophasic wave pattern. Biphasic forefoot doppler wave was strongly correlated with longer event-free survival (35 bi- vs. 5.5 months monophasic, p = 0.0018) and complete wound healing (69 % s bi- vs. 44 % vs. monophasic p = 0.0309). Major amputations: 2 / 26 (8 %) in the biphasic and in 3 / 18 (17 %) in the monophasic group. Second revascularisation procedures were more often necessary in the monophasic group (7 / 18 (39 % vs. 2 / 26 (8 %)). CONCLUSION: After successful PTA of the fibular artery, monophasic doppler wave patterns at the forefoot denote insufficient collateralization and are associated with poor outcome. If successful fibular artery PTA results only in monophasic forefoot doppler, additional crural or pedal bypass should be strongly contemplated.

Ultrasound monitoring of a novel microwave ablation (MWA) device in porcine liver: lessons learned and phenomena observed on ablative effects near major intrahepatic vessels.

BACKGROUND: Microwave ablation (MWA) is postulated to have several advantages over other thermoablative modalities in the treatment of hepatic tumors. Herein, we use an in vivo porcine model to determine the effect of hepatic blood flow on a novel MWA applicator. METHODS: Four 100-kg pigs underwent hepatic MWA (2,450 MHz, 100 W, 4 min) using a 5.7-mm diameter applicator (Microsulis Americas, Sulis V) inserted near large intrahepatic blood vessels. Real-time monitoring was performed using 3, 5, and 12 MHz diagnostic ultrasound transducers. The ablated zones were sectioned for gross and histological processing. RESULTS: Ablation zones were uniform in shape and size (3-4 cm) and related to power deliver only. Gross and microscopic examination revealed direct extension of ablation zones to the margin of major hepatic blood vessels and occasionally beyond the intended target. Of note, a momentary acoustic white-out occurred around the probe at 25 +/- -1 s in every ablation. DISCUSSION: The Sulis V MWA applicator produced uniform zones of ablation that remain unaffected by convective heat loss. The applicator induced a reproducible but temporary event as seen by ultrasound. Further study is warranted to define the physics, benefits, limits, and clinical safety of this new MWA technology.

Use of radiofrequency hepatic parenchymal transection device in hepatic hemangioma resection: early experience and lessons learned.

BACKGROUND: Control of intraoperative hemorrhage represents a significant challenge in hepatic surgery, particularly during resection of large, hypervascular hepatic hemangiomata (HH). Various devices to minimize blood loss from hepatic parenchymal transection are currently under investigation. Herein, we present our experience with a radiofrequency (RF)-powered multiarray for resection of HH. PATIENTS AND METHODS: From September 2005 to January 2006, we conducted a retrospective review of our hepatobiliary database to identify patients with symptomatic giant cavernous HH undergoing resection with a RF multiarray device. The purpose of this review was to assess the technical aspects of using RF energy to assist in the resection of HH. RESULTS: The extent of operation varied depending on the size and location of the tumor. Two patients underwent two atypical subsectionectomies and two underwent trisectionectomies. The Habib sealer provided a safe and effective method for hepatic parenchymal transaction. No patients required blood transfusion, and no injuries to major biliary or vascular strictures were observed at 1 year follow-up. A seroma developed in one patient 6 months postoperatively, but was drained percutaneously. CONCLUSIONS: Hepatic parenchymal transection with the Habib sealer device is a feasible approach to resect HH. Further study is needed to objectively compare the efficacy of RF-assisted parenchymal transection with that of traditional parenchymal transection techniques.

[Acute ischemia of the hand after intra-arterial injection of flunitrazepam. Local combined fibrinolysis therapy in three cases]. / Akute Ischämie der Hand nach intraarterieller Flunitrazepaminjektion. Lokale kombinierte Lysetherapie in drei Fällen.

HISTORY AND ADMISSION FINDINGS: Three drug addicts presented as emergencies with severe pain in one hand. 1 to 3 hours previously they had accidentally injected dissolved flunitrazepam tablets intra-arterially. The affected hands were pale and cold. Two of the patients had injected into the brachial artery, one into the radial artery. DIAGNOSTICS: The brachial and radial arteries were palpable in all three patients, but immediate angiography showed complete occlusion of all arteries to the hand and fingers. TREATMENT AND COURSE: Initial local treatment with intra-arterial infusion of prostanoids (PGE(1)) did not improve hand perfusion. Subsequently, a combination of PGE(1) and local fibrinolytic therapy with rt-PA was given intra-arterially over 12 to 22 hours. In two of the patients complete reperfusion was achieved, but one, in whom the delay between injection and treatment had been the longest, lost the distal phalanges of digits 1, 2 and 3. No bleeding complications were observed. CONCLUSION: Peripheral ischemia as a result of an accidental intra-arterial injection of dissolved tablets in drug addicts is an emergency which requires immediate action. The combined administration of prostanoids and rt-PA-lysis is a promising therapeutic option that should be employed in such patients.

arrA is a reliable marker for As(V) respiration.

Arsenate [As(V)]-respiring bacteria affect the speciation and mobilization of arsenic in the environment. This can lead to arsenic contamination of drinking water supplies and deleterious consequences for human health. Using molecular genetics, we show that the functional gene for As(V) respiration, arrA, is highly conserved; that it is required for As(V) reduction to arsenite when arsenic is sorbed onto iron minerals; and that it can be used to identify the presence and activity of As(V)-respiring bacteria in arsenic-contaminated iron-rich sediments. The expression of arrA thus can be used to monitor sites in which As(V)-respiring bacteria may be controlling arsenic geochemistry.

Thrombin-antithrombin complex and the prothrombin fragment in arterial and venous blood of patients with peripheral arterial disease.

BACKGROUND: Thrombin generation has recently been recognized as an important factor in the development of arterial occlusive disease in all vascular provinces. Several reports concerning markers of thrombin generation have been published with however, conflicting results. It has been demonstrated in vitro that accelerated blood flow velocity causes increased thrombin generation via higher shear rates. In recent articles TAT and F1 + F2 concentrations are reported significantly higher in arterial than in venous blood. A correlation with the severity of atherosclerosis or specially with the stage of PAD was expected. In the present investigation we additionally collected blood from the femoral vein. PATIENTS AND METHODS: In 11 patients with Fontaine stages IIb to IV and two healthy subjects TAT and F1 + F2 concentrations were determined in blood samples from the femoral artery, the femoral vein (diseased leg) and cubital vein. In all cases and at all puncture sites exactly the same atraumatic technique of venipuncture was used. RESULTS: The concentrations of TAT and F1 + F2 were significantly elevated in patients with PAD. There was no significant difference between the concentrations of TAT and F1 + F2 in arterial (femoral artery) and venous (femoral vein and cubital vein) blood. CONCLUSION: The results from previous investigations have been confirmed only partially. Differences in the puncture techniques to collect arterial or venous blood result in an increased scattering of the data and a systematic error.

Deposition and fate of arsenic in iron- and arsenic-enriched reservoir sediments.

Deposition of arsenic to the sediments of Haiwee Reservoir (Olancha, CA) has dramatically increased since March 1996 as a result of an interim strategy for arsenic management in the Los Angeles Aqueduct (LAA) water supply. Ferric chloride and cationic polymer are introduced into the Aqueduct at the Cottonwood treatment plant, 27 km north of the Haiwee Reservoir. This treatment decreases the average arsenic concentration from 25 microg/L above Cottonwood to 8.3 microg/L below Haiwee. Iron- and arsenic-rich flocculated solids are removed by deposition to the reservoir sediments. Analysis of sediments shows a pronounced signature of this deposition with elevated sediment concentrations of iron, arsenic, and manganese relative to a control site. Sediment concentrations of these elements remain elevated throughout the core length sampled (ca. 4% iron and 600 and 200 microg/g of manganese and arsenic, respectively, on a dry weight basis). A pore water profile revealed a strong redox gradient in the sediment. Manganese in the pore waters increased below 5 cm; iron and arsenic increased below 10 cm and were strongly correlated, consistent with reductive dissolution of iron oxyhydroxides and concurrent release of associated arsenic to solution. X-ray absorption near-edge spectroscopy revealed inorganic As(V) present only in the uppermost sediment (0-2.5 cm) in addition to inorganic As(III). In the deeper sediments (to 44 cm), only oxygen-coordinated As(III) was detected. Analysis of the extended X-ray absorption fine structure spectrum indicates that the As(III) at depth remains associated with iron oxyhydroxide. We hypothesize that this phase persists in the recently deposited sediment despite reducing conditions due to slow dissolution kinetics.

Time scales for sorption-desorption and surface precipitation of uranyl on goethite.

The sorption of uranium on mineral surfaces can significantly influence the fate and transport of uranium contamination in soils and groundwater. The rates of uranium adsorption and desorption on a synthetic goethite have been evaluated in batch experiments conducted at constant pH of 6 and ionic strength of 0.1 M. Adsorption and desorption reactions following the perturbation of initial states were complete within minutes to hours. Surface-solution exchange rates as measured by an isotope exchange method occur on an even shorter time scale. Although the uranium desorption rate was unaffected by the aging of uranium-goethite suspensions, the aging process appears to remove a portion of adsorbed uranium from a readily exchangeable pool. The distinction between sorption control and precipitation control of the dissolved uranium concentration was also investigated. In heterogeneous nucleation experiments, the dissolved uranium concentration was ultimately controlled by the solubility of a precipitated uranyl oxide hydrate. The X-ray diffraction pattern of the precipitate is characteristic of the mineral schoepite. Precipitation is kinetically hindered at low degrees of supersaturation. In one experiment, metastable sorption controlled dissolved uranium concentrations in excess of the solubility limit for more than 30 d.

Myocardial extraction of bupivacaine in anaesthetized sheep and by hearts of sheep and rats in vitro.

We observed the in vivo kinetics of bupivacaine in the cardiopulmonary system, particularly in the pulmonary artery, the upper part of the descending aorta and the coronary sinus of anaesthetized sheep, each of which received a high dose infusion into the central vein. In some experiments dilution curves were monitored for the non-extracted dye, indocyanine green. Concentrations of bupivacaine were approximately 20% lower in the aorta than in the pulmonary artery. This gradient of bupivacaine was present across the lung for 5-10 min. Concentrations of bupivacaine in the coronary venous plasma were also markedly lower than at the arterial site. Initially more than 50% of the amount of bupivacaine at the arterial site was removed by the heart. Later, the myocardial extraction ratio decreased and plateaued at a value of 0.30-0.40. At this time, concentrations of bupivacaine in the pulmonary artery were approximately 12 micrograms ml-1. Therefore, approximately 0.3-0.6 mg of bupivacaine were extracted per minute by the sheep heart in vivo. On the other hand, isolated perfused rat hearts did not substantially remove bupivacaine (2 micrograms ml-1) from the medium. Approximately one-third of 14C-bupivacaine was retained in slices of rat and sheep myocardial tissue. However, there was no evidence that metabolism played a substantial role in the cardiac kinetics of bupivacaine.

Pulmonary and left ventricular decompression by artificial pulmonary valve incompetence during percutaneous cardiopulmonary bypass support in cardiac arrest.

BACKGROUND: In cardiac arrest, use of percutaneous cardiopulmonary bypass support (PCPS) may lead to left ventricular loading, with deleterious effects on the myocardium, and is often accompanied by an increase in pulmonary artery pressure. The present study was designed to assess the potential of artificially induced pulmonary valve incompetency to retrogradely decompress the left ventricle during PCPS in ventricular fibrillation. METHODS AND RESULTS: Studies were performed using a standardized experimental animal model in sheep (n = 12; body weight, 77 to 112 kg). When PCPS was used during fibrillation, an increase in left ventricular pressure (from 21.4 +/- 5.0 mm Hg after 1 minute to 28.4 +/- 9.5 mm Hg after 10 minutes of fibrillation) was observed in all animals, with a simultaneous increase in pulmonary artery pressure in 6 animals, from 15.5 +/- 3.8 to 24.3 +/- 5.4 mm Hg (group A). In these animals, artificial pulmonary valve incompetency, which was induced by a special "pulmonary valve spreading catheter," led to effective decompression of both the pulmonary circulation (decrease in pulmonary artery pressure from 24.3 to 11.3 mm Hg) and the left ventricle (decrease in left ventricular pressure from 30.5 to 17.7 mm Hg). We simultaneously measured a decrease in the myocardial release of lactate (increase in arterial coronaryvenous difference in lactate content from -0.01 to 0.14 mmol/L), demonstrating the myocardial protective effect of the procedure. In contrast, in 6 animals without an increase in pulmonary artery pressure during PCPS (group B), artificial pulmonary valve incompetency did not reduce left ventricular loading, which was probably because of competent mitral valves in these animals. CONCLUSIONS: In case of increasing pulmonary artery pressure during PCPS in cardiac arrest, artificial pulmonary valve incompetency might be a useful tool for effective pulmonary and retrograde left ventricular decompression.

[Concomitant hemodynamic effects of intracoronary injections of a new transpulmonary contrast medium]. / Hämodynamische Begleiterscheinungen intrakoronarer Injektionen eines neuen lungengängigen Ultraschallkontrastmittels.

AIM: A new transpulmonary echo contrast agent (SH U 508) was injected intracoronally to six anaesthetised sheep to examine its possible direct cardiac effects. METHOD: SH U 508 was injected in randomised order in three different volumes (2, 4 and 8 ml; n = 12, 10, 9) with the same drug concentration of 200 mg/ml. RESULTS: The 2 ml and 4 ml injections had no relevant effect on the arterial, pulmonary-arterial and ventricular pressures, on the left ventricular contraction velocity and on the myocardial blood flow (less than +/- 10% of the control value). The left ventricular relaxation velocity decreased by 20%. The disturbance of the left ventricular relaxation at a volume of 8 ml was pronounced (about 40% decrease). Slight left ventricular dysfunction further manifested itself in a decreased systolic pressure (-15%) and increased left ventricular enddiastolic pressure (20%). CONCLUSION: In summary the overall effect of the intracoronary injections of SH U 508 exhibited only minor cardiac side effects. If the current results are extrapolated to peripheral-venous application, the clinically required central-venous 8 ml injection of a 400 mg/ml suspension is not expected to produce any coronary haemodynamic side effects, due to drug dilution in the pulmonary circulation and resulting low intra-coronary concentrations.

Peripheral and cardiac effects of a new phosphodiesterase inhibitor in comparison with enoximone.

The effect of the new phosphodiesterse inhibitor R80122 (E)-N-cyclohexyl-N-methyl-2-[[[phenyl(1,2,3,5-tetrahydro-2-oxoimidazo [2,1-b]-quinazolin-7-yl)methylene] amino]oxy]acetamide, (CAS 133718-29-3) on haemodynamic parameters and myocardial oxygen consumption were intraindividually compared with those of enoximone, a clinically established phosphodiesterase inhibitor. In 12 anaesthetised sheep the drugs were given in randomized order as i. v. infusions for 6 min at each setting (10, 20 and 30 micrograms.kg-1.min-1 (R80122) and 32, 64 and 96 micrograms.kg-1.min-1 (enoximone)). R 80122 as well as enoximone caused a significant increase in cardiac inotropism with a simultaneous increase of myocardial oxygen consumption. The peripheral resistance was significantly decreased by both drugs. The haemodynamic effects elicited by the application of equieffective doses of R80122 and enoximone did not show any differences.

Dopamine-dependent diastolic dysfunction in moderate hypothermia.

We designed an experimental animal study to study the effects of dopamine (DA) on diastolic function in hypothermia. DA was applied at five incremental infusion rates in 6 sheep during normothermia and moderate hypothermia (29 degrees C). Left ventricular end-diastolic pressure (LVEDP) was increased during hypothermia as compared with normothermia at all doses of DA. Contraction and relaxation velocity were changed only slightly during hypothermia; during normothermia, both velocities were markedly increased. The pronounced hemodynamic effect observed during hypothermia was further intensified by occurrence of aftercontractions, which disappeared at very high DA doses. These paradoxic results were considered the result of hypothermia-induced reduction in active transport mechanisms responsible for regulation of the cytoplasmic CA2+ concentration. The generally reduced inotropic effect of DA, the risk of paradoxic reactions, and the occurrence of aftercontractions must be taken into account when emergency drugs are administered clinically during hypothermia.