Long distance laser filamentation using Yb:YAG kHz laser.

In the framework of the Laser Lightning Rod project, whose aim is to show that laser-induced filaments can guide lightning discharges over considerable distances, we study over a distance of 140 m the filaments created by a laser system with J-range pulses of 1 ps duration at 1 kHz repetition rate. We investigate the spatial evolution of the multiple filamentation regime using the fundamental beam at 1030 nm or using combination with the second and third harmonics. The measurements were made using both a collimated beam and a loosely focused beam.

Nonlinear pulse compression of a 200 mJ and 1†kW ultrafast thin-disk amplifier.

We present a high-energy laser source consisting of an ultrafast thin-disk amplifier followed by a nonlinear compression stage. At a repetition rate of 5 kHz, the drive laser provides a pulse energy of up to 200 mJ with a pulse duration below 500 fs. Nonlinear broadening is implemented inside a Herriott-type multipass cell purged with noble gas, allowing us to operate under different seeding conditions. Firstly, the nonlinear broadening of 64 mJ pulses is demonstrated in an argon-filled cell, showing a compressibility down to 32 fs. Finally, we employ helium as a nonlinear medium to increase the energy up to 200 mJ while maintaining compressibility below 50 fs. Such high-energy pulses with sub-50 fs duration hold great promise as drivers of secondary sources.

Nonlinear pulse compression of a thin-disk amplifier and contrast enhancement via nonlinear ellipse rotation.

We demonstrate pulse compressibility from 840 fs to 38 fs of 10 mJ pulses from a thin-disk amplifier at a repetition rate of 3 kHz after nonlinear broadening in a multipass cell. In addition, the temporal-intensity contrast is enhanced via nonlinear ellipse rotation of more than a factor 50 with an optical efficiency of 56%. We believe this is the first published experimental combination of multipass cell-based nonlinear compression and nonlinear ellipse rotation-based contrast enhancement preserving both pulse compressibility and beam quality.

Treatment effects of palliative care consultation and patient contentment: A monocentric observational study.

ABSTRACT: Palliative care is a central component of the therapy in terminally ill patients. During treatment in non-palliative departments this can be realized by consultation.To analyze the change in symptom burden during palliative care consultation.In this observational study, we enrolled all cancer cases (n = 163) receiving inpatient treatment for 2015 to 2018 at our institution. We used the MDASI-questionnaire (0 = 'not present' and 10 = "as bad as you can imagine") and the FAMCARE-6 (1 = very satisfied, 5 = very dissatisfied) to analyze the treatment effect and patient satisfaction, respectively.We examined the association of symptom burden and patient satisfaction using Spearman-correlation. Comparing mean values, we applied the Wilcoxon-test and one-way ANOVA.An improvement in MDASI-core-items after treatment completion was significant (P < .05) in 14/18 symptoms. The change in perception of pain showed the strongest improvement (median: 5 to 3). Initially the MDASI-items "activity" (median = 8) and emotional distress (median = 5 and 6) were viewed as especially incriminating. There was no evidence for a correlation between patients' age, the type of diagnosis and time since diagnosis.The analysis of FAMCARE-6 patient contentment was lower or equal to two in all of the six items. There was a weak negative association between the change in symptom burden of psycho-emotional items "distress/feeling upset" (P = .006, rSp = -0,226), "sadness" and patient satisfaction in FAMCARE-6.A considerable improvement of the extensive symptom burden particularly of pain relief was achieved by integrating palliative consultation in clinical practice.

Ultrafast thin-disk multipass amplifier with 720 mJ operating at kilohertz repetition rate for applications in atmospheric research.

We present an ultrafast thin-disk based multipass amplifier operating at a wavelength of 1030 nm, designed for atmospheric research in the framework of the Laser Lightning Rod project. The CPA system delivers a pulse energy of 720 mJ and a pulse duration of 920 fs at a repetition rate of 1 kHz. The 240 mJ seed pulses generated by a regenerative amplifier are amplified to the final energy in a multipass amplifier via four industrial thin-disk laser heads. The beam quality factor remains ∼ 2.1 at the output. First results on horizontal long-range filament generation are presented.

HV discharges triggered by dual- and triple-frequency laser filaments.

We study the use of frequency upconversion schemes of near-IR picosecond laser pulses and compare their ability to guide and trigger electric discharges through filamentation in air. Upconversion, such as Second Harmonic Generation, is favorable for triggering electric discharges for given amount of available laser energy, even taking into account the losses inherent to frequency conversion. We focus on the practical question of optimizing the use of energy from a given available laser system and the potential advantage to use frequency conversion schemes.

Maternal progesterone levels are modulated by maternal BMI and predict birth weight sex-specifically in human pregnancies.

OBJECTIVE: Successful pregnancy outcome is the result of a tailored adaptation of the maternal endocrine and immune system throughout gestation. We aimed to investigate if maternal endocrine, anthropometric and life style factors assessed longitudinally throughout pregnancy allow prediction of birth weight. STUDY DESIGN: Data on maternal factors and obstetrical characteristics from 220 pregnancies from a German prospective pregnancy cohort were analyzed using univariate and multivariate regression models. The association between maternal progesterone levels at the end of the 1st (gw 12-14), the 2nd (gw 22-24) and the 3rd trimester (gw 34-36) and birth weight of children born at term was examined. Interaction terms were included to identify possible sex-specific associations. Furthermore, associations between maternal and obstetric characteristics and progesterone levels were tested. RESULTS: After controlling for possible confounders, progesterone in the 2nd trimester emerged as an independent predictor for birth weight in pregnancies with female (p=0.01), but not male fetuses (p=0.6). In female fetuses each increase of progesterone by 1ng/ml in the 2nd trimester was associated with an increase of birth weight by 6.8g (95%-CI=1.44-12.24). Maternal 1st trimester BMI showed a significant inverse correlation to progesterone levels throughout gestation (p<0.0001 in the 1st and 2nd, p=0.01 in the 3rd trimester). This inverse association between maternal BMI and progesterone levels was confined to overweight women. CONCLUSION: Our data support that maternal progesterone levels have the potential to serve as early biomarker for reduced birth weight and underpins the importance of normal weight when entering the reproductive phase.

Regenerative thin-disk amplifier for 300 mJ pulse energy.

A regenerative amplifier based on thin-disk technology has been upgraded and optimized. Within a CPA laser system chirped 1 ns pulses are amplified to more than 300 mJ pulse energy. In addition to the high pulse energy the amplifier shows a very good energy stability with 0.25% (rms) fluctuation as well as an excellent beam quality of M(2) = 1.04. The regenerative amplifier is equipped with an Yb:YAG thin-disk of 17 mm in diameter pumped with 1.75 kW peak power. It is operated at a repetition rate of 100 Hz. The optical-to-optical efficiency is better than 18%. The laser pulses are compressed to 1.8 ps pulse duration.

Thin-disk ring amplifier for high pulse energy.

A CPA laser system for high pulse energy at high average power has been developed. The system is based on Yb:YAG thin-disk technology. It provides two laser beams with more than 500 mJ pulse energy each at 100 Hz repetition rate and 2 ps pulse duration. The system consists of a common oscillator, a grating stretcher and compressor and two identical amplifier chains that are both equipped with a regenerative amplifier and a ring amplifier. The compressor supports an individual alignment of the dispersion for the two laser channels.

High average power, highly brilliant laser-produced plasma source for soft X-ray spectroscopy.

In this work, a novel laser-produced plasma source is presented which delivers pulsed broadband soft X-radiation in the range between 100 and 1200 eV. The source was designed in view of long operating hours, high stability, and cost effectiveness. It relies on a rotating and translating metal target and achieves high stability through an on-line monitoring device using a four quadrant extreme ultraviolet diode in a pinhole camera arrangement. The source can be operated with three different laser pulse durations and various target materials and is equipped with two beamlines for simultaneous experiments. Characterization measurements are presented with special emphasis on the source position and emission stability of the source. As a first application, a near edge X-ray absorption fine structure measurement on a thin polyimide foil shows the potential of the source for soft X-ray spectroscopy.

Echocardiographic parameters as predictors of in-hospital mortality in patients with acute coronary syndrome undergoing percutaneous coronary intervention.

Different ways have been used to stratify risk in acute coronary syndrome (ACS) patients. The aim of the study was to examine the usefulness of echocardiographic parameters as predictors of in-hospital outcome in patients with ACS after percutaneous coronary intervention (PCI). A data of 2030 patients with diagnosis of ACS hospitalized from December 2008 to December 2011 was used to develop a risk model based on echocardiographic parameters using the binary logistic regression. This model was independently evaluated in validation cohort prospectively (954 patients admitted during 2012). In-hospital mortality in derivation cohort was 7.73%, and 6.28% in validation cohort. Developed model has been designed with 4 independent echocardiographic predictors of in-hospital mortality: left ventricular ejection fraction (LVEF RR = 0.892; 95%CI = 0.854-0.932, P < 0.0005), aortic leaflet separation diameter (AOvs RR = 0.131; 95%CI = 0.027-0.627, P = 0.011), right ventricle diameter (RV RR = 2.675; 95%CI = 1.109-6.448, P = 0.028) and right ventricle systolic pressure (RVSP RR = 1.036; 95%CI = 1.000-1.074, P = 0.048). Model has good prognostic accuracy (AUROC = 0.84) and it retains good (AUROC = 0.78) when testing on the validation cohort. Risks for in-hospital mortality after PCI in ACS patients using echocardiographic measurements could be accurately predicted in contemporary practice. Incorporation of such developed model should facilitate research, clinical decisions, and optimizing treatment strategy in selected high risk ACS patients.

Double heart rupture after acute myocardial infarction: a case report.

INTRODUCTION: Double heart rupture is a rare complication of acute myocardial infarction with high mortality. CASE REPORT: We presented a 67-year-old female patient with symptoms and signs of myocardial infarction, diagnosed with echocardiography, rupture of the septum, the presence of a thrombus and a small pericardial effusion. Soon after admission the patient died. Autopsy revealed tamponade and double myocardial rupture, free wall rupture and ventricular septal rupture, as a cause of death. CONCLUSION: This case highlights the need to evaluate patients with myocardial infarction, recurrent chest pain, echocardiographic signs of effusion and the presence of thrombus in the pericardium in terms of double rupture of the heart.

Myopericarditis--diagnostic dilemmas in relation to acute myocardial infarction.

INTRODUCTION: Myopericarditis with clinical presentation of chest pain, electrocardiographic changes and positive cardio specific enzymes is often a differential diagnostic dilemma in relation to acute myocardial infarction. Literature data are very scarce and only case reports or small series of patients can be found in the literature so each case is a significant contribution to this issue. CASE REPORT: A 19-year-old patient was admitted to the intensive care unit, with chest pain, electrocardiographic signs of suspected myocardial lesion and highly positive cardio specific enzymes. Since echocardiography revealed segmental hypocinesia of the left ventricle, urgent coronary angiography was done, which diagnosed normal luminogram of coronary arteries. Having received the adequate therapy, the patient was subjectively asymptomatic, hemodynamically stable, sub-febrile at the beginning of hospitalization. Two weeks after admission, the patient was discharged in good condition with diagnosis of myopericarditis. CONCLUSION: This case shows that it is sometimes difficult to differentiate acute miopericarditis from acute myocardial infarction only according to anamnesis, clinical, electrocardiographic sings and echocardiography.

The variable Jung as a predictor of mortality in patients with pulmonary edema.

BACKGROUND/AIM: In our Intensive Coronary Care Unit (CCU) a specific scoring system named the AMIS_NS was developed both for prediction of mortality in patients with acute myocardial infarction and for evaluation of the quality of work. One of the most important variables of the AMIS_NS system is the variable Jung which stands for the interrelationship unified mortality predictors. The variable includes all the values of systolic blood pressure, heart rate and age, without limiting values for any of these. The cutoff value is 2.08. The patients with the lower variable value account for a significantly higher mortality. Data on the actual infarction are not necessitated now for this variable. The aim of this study was to assess the significance of the variable Jung in non-infarction patients with acute pulmonary edema. METHODS: In a 24-month period out of 2,223 patients there were 1,087 and 1,136 patients with and without acute myocardial infarction, respectively. There was the subgroup without myocardial infarction of 312 (84.1%) patients admitted with the diagnosis of pulmonary edema. The subgroup with myocardial infarction consisted of 59 (15.9%) patients who were admitted for acute myocardial infarction and pulmonary edema which developed immediately after admission or during hospitalization in the CCU. For all the patients a uniform questionnaire was fulfilled on admission. Data were put into the personal computer. The variable "Jung" was used: (systolic bloog pressure/heart rate x age) x 100. RESULTS. Regarding sex, there was no difference in mortality, so that males and females were regarded as a whole. Previous myocardial infarction was equally registered in both groups. The investigated persons had less percent of mortality and a significantly higher systemic pressure as well as higher value of the variable Jung. There was no statistically significant difference in the heart rate between the two groups. In both groups of deceased patients the variable Jung (1.5 vs 1.6) was significantly lower in respect to the survived patients (2.3 vs 2.1). CONCLUSION. The variable Jung is simple, highly reliable and can absolutely be used as a significant indicator of clinical status also in noninfarction patients with the acute pulmonary edema, no matter if it is caused by acute myocardial infarction or not.

CABG mortality is not influenced by prior PCI in low risk patients.

BACKGROUND AND AIMS: An increasing number of patients referred for coronary artery bypass grafting (CABG) have had prior percutaneous coronary intervention (PCI). We sought to determine whether a relationship exists between increased postoperative mortality and morbidity following CABG procedure in patients with prior PCI. METHODS: Over an 18-month period, 950 patients having first-time isolated CABG were divided into two groups based on absence (Group A, 819 patients--86.21%) or presence of a prior PCI (Group B, 131 patients--13.79%). RESULTS: In the prior PCI population, 74 patients (56.4%) had only one stent, and only 6.8% had multiple admissions for PCI. The overall incidence of three vessel disease in the entire patient population was only 65% and the average ejection fraction was 52%. Multivariate analysis demonstrated age (OR 1.080; 95% CI: 1.020 to 1.145; p = 0.009), left ventricular ejection fraction (OR 0.939; 95% CI: 0.901 to 0.978; p = 0.002), and emergency surgery (OR 0.138; 95% CI: 0.0.045 to 0.424; p = 0.001) as risk factors for 30-day mortality, while age (OR 1.059; 95% CI: 1.016 to 1.104; p = 0.007) and emergency surgery (OR 0.205; 95% CI: 0.078 to 0.537; p = 0.001) predicted major adverse cardiac events (MACE). Prior PCI did not influence mortality or MACE at 30 days. CONCLUSION: In this study involving low risk patients, a PCI prior to CABG did not increase morbidity or mortality.

The pharmacokinetics of Biolimus A9 after elution from the BioMatrix II stent in patients with coronary artery disease: the Stealth PK Study.

OBJECTIVES: This prospective, open-label multicenter study was conducted to assess the pharmacokinetics of Biolimus A9 after elution from BioMatrix II coronary stents. Recent clinical trials have demonstrated the efficacy and safety of Biolimus A9 eluted from different stent platforms. To date, the pharmacokinetics of Biolimus A9 in patients following the deployment of BioMatrix II stents has not yet been studied METHODS: BioMatrix II stents were implanted into 27 patients with coronary artery disease. The primary endpoints of the study were the systemic concentrations of Biolimus A9 after 28 days and 6 months as measured using a sensitive validated liquid chromatography-tandem mass spectrometry assay. RESULTS: The highest measured blood concentration at any time point was 394 pg/mL. At 28 days and 6 months following stent placement, 51.8 and 100% of patients, respectively, had Biolimus A9 concentrations <10 pg/mL. After 9 months, 100% of the patients were free of major cardiac adverse events (MACE). There was no Biolimus A9 toxicity, no cardiac or non-cardiac deaths, no myocardial infarctions, nor target vessel or target lesion revascularizations during the 9 months of follow-up. No case of acute, subacute, or late stent thrombosis was detected. CONCLUSIONS: Compared to other drug-eluting stents, such as Cypher, BioMatrix II results in relatively low systemic exposure, which may be explained by the ablominal coating of the Biomatrix II stent in combination with Biolimus A9's high lipophilicity.

Influence of intracoronary injections of bone-marrow-derived mononuclear cells on large myocardial infarction outcome: quantum of initial necrosis is the key.

BACKGROUND/AIM: Autologous bone-marrow-derived intra= coronary injection of mononuclear cells (MNC) modestly improved left ventricular ejection fraction (LVEF) in the selected patients after acute ST elevation myocardial infarction (STEMI). Major determinants of stem cell therapy outcome in the subacute phase of STEMI still remain unknown. Therefore, the aim of this study was to determine modifying factors for the outcome of stem cell therapy after STEMI. METHODS: Eighteen patients in the stem cell therapy group and 24 patients in the control group with the successfully reperfused first large STEMI (LVEF < or = 40%) were enrolled in the study. The stem cell group was submitted to autologous bone-marrow-derived MNC injection between 7-12 days after MI. Left ventricular ejection fraction and infarction size at baseline and after 4 months were determined by echocardiography and scintigraphy examination. Age, pain onset to reperfusion time, admission glycemia, maximum lactate dehydrogenase (LDH) activity and C-reactive protein level, baseline LVEF and infarction size, and the number of MNC injected were compared between patients with and without significant improvement of LVEF and decrease of myocardial infarct size after 4 months. RESULTS: In the stem cell group, patients with the improvement of LVEF for more than 5.1% had significantly lower levels of LDH than patients without such improvement (1689 +/- 139 vs 2133 +/- 215 IU/L, p < 0.001) and lower baseline infarction size on scintigraphy (26.7 +/- 5.2 vs 34.9 +/- 3.7%, p < 0.001). Such dependence was not found in the control group. CONCLUSION: In the patients with first large STEMI intracoronary injection of autologous bone-marrow-derived MNC leads to the significant decrease of myocardial infarction size but not the significant improvement of LVEF after four months. Higher serum LDH levels after STEMI and very large baseline infarction size are predictors of failure of stem cell therapy in our group of STEMI patients.

The pharmacokinetics of Biolimus A9 after elution from the Nobori stent in patients with coronary artery disease: the NOBORI PK study.

OBJECTIVES: The aim of this study was to assess the pharmacokinetics and tolerability of Biolimus A9 eluted from Nobori coronary stents. BACKGROUND: : The release kinetics and pharmacokinetics of drugs delivered via coronary stents have been shown to play an essential role in the efficacy and safety of drug eluting stents. METHODS: Twenty patients with coronary artery disease were treated with single 14-mm (10 patients) or 28-mm long stent (10 patients). Blood samples were drawn at 16 time points to determine the pharmacokinetics of Biolimus A9. At seven time points, complete laboratory and toxicology panels were assessed to screen for potential Biolimus A9 toxicity. The primary endpoint of the study was the systemic blood concentrations of Biolimus A9 after 28 days and 6 months as measured using highly specific and sensitive liquid chromatography- tandem mass spectrometry assay. RESULTS: At 28 days, 6 patients (30%) had quantifiable Biolimus A9 concentrations in blood. The highest Biolimus A9 blood concentration measured in any sample was 32.2 pg/mL. The median time to maximum concentration was 2 hr, ranging from 0.05 hr to 3 months. Six months after stent implantation, only 1 of 20 patients had measurable Biolimus A9 concentrations at the lowest level of quantification, while at 9 months no sample had quantifiable Biolimus A9 concentrations. Laboratory and toxicology assessments did not indicate any impact of Biolimus A9 on the evaluated parameters. CONCLUSION: Results of this study suggest that systemic exposure to Biolimus A9 was very low and that Biolimus A9 was well tolerated.

[Diagnostic significance of myocardial perfusion scintigraphy in identification and localisation of culprit lesions in patients undergoing elective PTCA].

BACKGROUND/AIM: The coronary angiography provides information on the anatomical state of the coronary tree, while myocardial perfusion scintigraphy (MPI) facilitates the evaluation of the grade of ischaemia that a particular stenosis produces. The purpose of MPI is to detect the coronary stenosis that provokes the ischaemia and is termed the "culprit lesion". The aim of this study was to evaluate the accuracy of 1-day DypEX 99mTc-tetrofosmin tomography in the identification and localization of culprit lesion in the patients with known coronary artery disease (CAD). METHODS: Ninety-one (91) patients with known CAD were studied. In all of them significant coronary narowing (> 75% luminal stenosis) was angiographically detected. All the patients were submitted to 2 i.v. injections of 99mTc-tetrofosmin, one in a peak of pharmacologic dipyridamole stress protocol with concomitant low level bicycle exercise 50W (DypEX) and the other 3 h after exercise. Quantification of regional tetrofosmin uptake was performed using short-axis myocardial tomogram that was divided on 17 segments for each study. Reversibility score (RS) > or =3 determinated culprit lesion. Two of segments with scor 5 (index of reversibility scor--IRS) in the territory of coronary artery stenoses determinated culprit lesion. RESULTS: A total of 273 vascular territories (4641 segments) were analyzed before percutaneous coronary intervention (PCI). Overall sensivity, specificit, and accuracy using RS > or =3 and IRS were 90.1%, 87.1%, 89.4%, with positive predictive value 95.8%, and 94.1%, 93.3%, 94%, with positive predictive value 98%, respectively. CONCLUSION: RS and IRS significantly improve sensitivity, specificity, and accuracy for determination of culprit lesion in patients undergoing PCI.

[Adenosine stress protocols for myocardial perfusion imaging].

BACKGROUND/AIM: Treadmill test combined with myocardial perfusion scintigraphy (MPS) is a commonly used technique in the assessment of coronary artery disease. There are many patients, however, who may not be able to undergo treadmill test. Such patients would benefit from pharmacological stress procedures combined with MPS. The most commonly used pharmacological agents for cardiac stress are coronary vasodilatators (adenosine, dipyridamol) and catecholamines. Concomitant low-level treadmill exercise with adenosine pharma cologic stress (AdenoEX) during MPS has become commonly used in recent years. A number of studies have demonstrated a beneficial impact of AdenoEX protocol. The aim of the study was, besides introducing into practice the two types of protocols of pharmatological stress test with adenosine, as a preparation for MPS, to compare and monitor the frequency of their side effects to quality, acquisition, as well as to standardize the onset time of acquisition (diagnostic imaging) for both protocols. METHODS: A total of 130 patients underwent pharmacological stress test with adenosine (vasodilatator). In 108 of the patients we performed concomitant exercise (AdenoEX) of low level (50W) by a bicycle ergometar. In 28 of the patients we performed Adenosine ab breviated protocol (AdenoSCAN). Side effects of adenosine were followed and compared between the two kinds of protocols AdenoEX and AdenoSCAN. Also compared were image quality and suggested time of acquisition after the stress test. RESULTS: Numerous side effects were found, but being short lived they did not require any active interventions. The benefit of AdenoEX versus AdenoSCAN included decreased side effects (62% vs 87%), improved safety and patients tolerance, improved target-to-background ratios because of less subdiaphragmatic activity, earlier acquisition, and improved sensitivity. CONCLUSION: The safety and efficacy of adenosine pharmacological stress is even better with concomitant exercise. In the light of these benefits we recommend AdenoEX whenever possible.