Extra-anatomical left common carotid and subclavian artery bypass followed by aortic arch replacement with frozen elephant trunk.

BACKGROUND: Total arch replacement (TAR) using a frozen elephant trunk (FET) allows for simultaneous treatment of the aortic arch and descending aortic pathology via median sternotomy. In addition, an extra-anatomical bypass performed between the left common carotid artery (CCA) and subclavian artery (SCA) prior to TAR allowed further proximalisation of the FET prosthesis, facilitated distal anastomosis of the TAR and spared the demanding left subclavian artery (LSA) anastomosis in the deep thorax. We investigated the efficacy of this debranching-first technique, followed by TAR using a frozen elephant trunk, as a two-stage operation for extensive thoracic aortic aneurysms in high-risk patients. METHODS: Forty-nine consecutive patients with diffuse degenerative aneurysms from the aortic arch to the descending aorta or chronic aortic dissection who underwent left common carotid to subclavian artery bypass followed by TAR using a frozen elephant trunk and subsequent thoracic endovascular aortic repair between 2016 and 2021 were analysed. The baseline characteristics and clinical outcomes were assessed. The estimated overall survival, 5-year aortic event-free survival, and aortic reintervention rates were analysed. RESULTS: The average European System for Cardiac Operative Risk Evaluation (EuroSCORE II) was 4.7 ± 2.5. The operative mortality rate was 4.1%, with no paraplegia events. The estimated 5-year overall survival, cumulative aortic-related mortality rates were 76.8% and 2%, respectively. The estimated 5-year overall cumulative aortic reintervention rate, including the intended intervention, was 31.3%. The estimated 5-year cumulative rate of non-intended reintervention was 4.5%. CONCLUSIONS: The assessed technique enables a less technically demanding surgery with reasonable outcomes. The estimated 5-year aortic event-free survival and reintervention rates were acceptable, suggesting that multiple stages of alternative open and endovascular interventions, such as this technique, may reduce the morbidity and mortality rates of high-risk patients with diffuse thoracic aortic aneurysm. UMIN-CTR (University hospital Medical Information Network-Clinical Trial Registry) https://center6.umin.ac.jp/cgi-open-bin/ctr_e/index.cgi Clinical registration number: UMIN000051531.

Mediastinal perigraft seroma after thoracic aortic surgery.

OBJECTIVES: We investigated pertinent factors associated with mediastinal perigraft seroma (PGS) after thoracic aortic surgery. In addition, we provided a clinical review of this entity, as reports reviewing abundant mediastinal PGS cases are rare. METHODS: Eighty-two patients who underwent either ascending aortic replacement or aortic arch replacement between 2016 and 2022 in our institution were enrolled in the present study. Postoperative computed tomography scans were performed to detect fluid capsules with a diameter ≥3.0 cm and radiodensity ≤25 Hounsfield units. Patients who did and who did not develop PGS formation were compared. Variables with a statistically significant difference between these groups were included in a multiple logistic regression analysis along with other factors associated with PGS in the literature. RESULTS: The incidence rate of PGS was 14.6% (12/82). The average radiodensity of the mass was 16.6 ± 6.3 Hounsfield units. The average onset of PGS was 8.5 months post-surgery. Multivariate logistic regression analysis revealed that ejection fraction [odds ratio (OR): 1.25, 95% confidence interval (CI): 1.03-1.50, P = 0.021], aortic dissection (versus degenerative aortic aneurysm) (OR: 6.61, 95% CI: 1.35-32.4, P = 0.02) and warfarin use (OR: 6.67, 95% CI: 1.19-37.1, P = 0.03) significantly contributed to mediastinal PGS after thoracic aortic surgery. CONCLUSIONS: High ejection fraction, warfarin use and aortic dissection (versus degenerative aortic aneurysm) contributed significantly to mediastinal PGS formation after thoracic aortic surgery. Careful serial postoperative imaging studies and fluid analysis can be used to guide treatment plans. CLINICAL TRIAL REGISTRATION: UMIN-CTR (University hospital Medical Information Network-Clinical Trial Registry) Registration number: UMIN000050764.

Ultrafast Dynamics of Intrinsic Anomalous Hall Effect in the Topological Antiferromagnet Mn_{3}Sn.

We investigate ultrafast dynamics of the anomalous Hall effect (AHE) in the topological antiferromagnet Mn_{3}Sn with sub-100 fs time resolution. Optical pulse excitations largely elevate the electron temperature up to 700 K, and terahertz probe pulses clearly resolve ultrafast suppression of the AHE before demagnetization. The result is well reproduced by microscopic calculation of the intrinsic Berry-curvature mechanism while the extrinsic contribution is clearly excluded. Our work opens a new avenue for the study of nonequilibrium AHE to identify the microscopic origin by drastic control of the electron temperature by light.

Robotic low anterior resection of rectal metastasis from small bowel adenocarcinoma: A case report.

A 69-year-old female underwent laparoscopic ileal partial resection for ileal adenocarcinoma. Pathological diagnosis was moderately differentiated tubular adenocarcinoma (UICC 8th; T4N0M0 StageIIB). The patient received adjuvant chemotherapy with modified 5-fluorouracil/leucovorin/oxaliplatin. Fourteen months after surgery, computed tomography revealed a mass in the upper rectum. Colonoscopy detected a submucosal protruding mass and a biopsy specimen showed moderately differentiated tubular adenocarcinoma. Robotic low anterior resection was performed. The tumor was located in the upper rectum and there was no macroscopic invasion or peritoneal dissemination. Pathologically, the tumor was moderately differentiated tubular adenocarcinoma located within the rectal wall with little evidence of a carcinoma component in the mucosal lining. Immunohistochemistry showed the same pattern as the previous ileal adenocarcinoma: negativity for cytokeratin 7 and positivity for cytokeratin 20 and caudal-type homeobox 2. In combination with the rectum showing no abnormalities in colonoscopy performed 15 mo previously, the mass was considered hematogenous metastasis from small bowel adenocarcinoma.

Switchable generation of azimuthally- and radially-polarized terahertz beams from a spintronic terahertz emitter.

We propose and demonstrate a method of generating two fundamental terahertz cylindrical vector beams (THz-CVBs), namely the azimuthally- and radially-polarized THz pulses, from a spintronic THz emitter. We begin by presenting that the spintronic emitter generates the HE21 mode, a quadrupole like polarization distribution, when placed between two magnets with opposing polarity. By providing an appropriate mode conversion using a triangular Si prism, we show both from experiment and numerical calculation that we obtain azimuthal and radial THz vector beams. The proposed method facilitates the access of CVBs and paves the way toward sophisticated polarization control in the THz regime.

Nonreciprocal Terahertz Second-Harmonic Generation in Superconducting NbN under Supercurrent Injection.

Giant second-harmonic generation in the terahertz (THz) frequency range is observed in a thin film of an s-wave superconductor NbN, where the time-reversal (T) and space-inversion (P) symmetries are simultaneously broken by supercurrent injection. We demonstrate that the phase of the second-harmonic signal flips when the direction of supercurrent is inverted; i.e., the signal is ascribed to the nonreciprocal response that occurs under broken P and T symmetries. The temperature dependence of the SH signal exhibits a sharp resonance, which is accounted for by the vortex motion driven by the THz electric field in an anharmonic pinning potential. The maximum conversion ratio η_{SHG} reaches ≈10^{-2} in a thin film NbN with the thickness of 25 nm after the field cooling with a very small magnetic field of ≈1 Oe, for a relatively weak incident THz electric field of 2.8 kV/cm at 0.48 THz.

Phase-resolved Higgs response in superconducting cuprates.

In high-energy physics, the Higgs field couples to gauge bosons and fermions and gives mass to their elementary excitations. Experimentally, such couplings can be inferred from the decay product of the Higgs boson, i.e., the scalar (amplitude) excitation of the Higgs field. In superconductors, Cooper pairs bear a close analogy to the Higgs field. Interaction between the Cooper pairs and other degrees of freedom provides dissipation channels for the amplitude mode, which may reveal important information about the microscopic pairing mechanism. To this end, we investigate the Higgs (amplitude) mode of several cuprate thin films using phase-resolved terahertz third harmonic generation (THG). In addition to the heavily damped Higgs mode itself, we observe a universal jump in the phase of the driven Higgs oscillation as well as a non-vanishing THG above Tc. These findings indicate coupling of the Higgs mode to other collective modes and potentially a nonzero pairing amplitude above Tc.

Light-Driven Electron-Hole Bardeen-Cooper-Schrieffer-Like State in Bulk GaAs.

We investigate the photon-dressed state of excitons in bulk GaAs by optical pump-probe spectroscopy. We reveal that the high-energy branch of the dressed states continuously evolves into a singular enhancement at the absorption edge in the high-density region where the exciton picture is no longer valid. Comparing the experimental result with a simulation based on semiconductor Bloch equations, we show that the dressed state in such a high-density region is better viewed as a Bardeen-Cooper-Schrieffer-like state, which has been theoretically anticipated to exist over decades. Having seen that the dressed state can be regarded as a macroscopic coherent state driven by an external light field, we also discuss the decoherence from the dressed state to an incoherent state after the photoexcitation in view of the Coulomb enhancement in the transient absorption.

Infrared Activation of the Higgs Mode by Supercurrent Injection in Superconducting NbN.

The Higgs mode in superconductors, i.e., the collective amplitude mode of the order parameter, does not associate with charge nor spin fluctuations, therefore it does not couple to the electromagnetic field in the linear response regime. Contrary to this common understanding, here, we demonstrate that if the dc supercurrent is introduced into the superconductor, the Higgs mode becomes infrared active and is directly observed in the linear optical conductivity measurement. We observed a sharp resonant peak at ω=2Δ in the optical conductivity spectrum of a thin-film NbN in the presence of dc supercurrent, showing a reasonable agreement with the recent theoretical prediction. The method as proven by this work opens a new pathway to study the Higgs mode in a wide variety of superconductors.

Ultrafast Terahertz Nonlinear Optics of Landau Level Transitions in a Monolayer Graphene.

We investigated the ultrafast terahertz (THz) nonlinearity in a monolayer graphene under the strong magnetic field using THz pump-THz probe spectroscopy. An ultrafast suppression of the Faraday rotation associated with inter-Landau level (LL) transitions is observed, reflecting the Dirac electron character of nonequidistant LLs with large transition dipole moments. A drastic modulation of electron distribution in LLs is induced by far off-resonant THz pulse excitation in the transparent region. Numerical simulation based on the density matrix formalism without rotating-wave approximation reproduces the experimental results. Our results indicate that the strong light-matter coupling regime is realized in graphene, with the Rabi frequency exceeding the carrier wave frequency and even the relevant energy scale of the inter-LL transition.

Higgs Mode in the d-Wave Superconductor Bi_{2}Sr_{2}CaCu_{2}O_{8+x} Driven by an Intense Terahertz Pulse.

We investigate the terahertz (THz)-pulse-driven nonlinear response in the d-wave cuprate superconductor Bi_{2}Sr_{2}CaCu_{2}O_{8+x} (Bi2212) using a THz pump near-infrared probe scheme in the time domain. We observe an oscillatory behavior of the optical reflectivity that follows the THz electric field squared and is markedly enhanced below T_{c}. The corresponding third-order nonlinear effect exhibits both A_{1g} and B_{1g} symmetry components, which are decomposed from polarization-resolved measurements. A comparison with a BCS calculation of the nonlinear susceptibility indicates that the A_{1g} component is associated with the Higgs mode of the d-wave order parameter.

Anomalous Metal Phase Emergent on the Verge of an Exciton Mott Transition.

We investigate the exciton Mott transition (EMT) by using optical pump-terahertz probe spectroscopy on GaAs, with realizing the condition of Mott's gedanken experiment by the resonant excitation of 1s excitons. We show that an anomalous metallic phase emerges on the verge of the EMT as manifested by a peculiar enhancement of the quasiparticle mass and scattering rate. From the temperature and density dependence, the observed anomaly is shown to originate from the electron-hole (e-h) correlation which becomes prominent at low temperatures, possibly suggesting a precursor of e-h Cooper pairing.

Light-induced collective pseudospin precession resonating with Higgs mode in a superconductor.

Superconductors host collective modes that can be manipulated with light. We show that a strong terahertz light field can induce oscillations of the superconducting order parameter in NbN with twice the frequency of the terahertz field. The result can be captured as a collective precession of Anderson's pseudospins in ac driving fields. A resonance between the field and the Higgs amplitude mode of the superconductor then results in large terahertz third-harmonic generation. The method we present here paves a way toward nonlinear quantum optics in superconductors with driving the pseudospins collectively and can be potentially extended to exotic superconductors for shedding light on the character of order parameters and their coupling to other degrees of freedom.

Higgs amplitude mode in the BCS superconductors Nb1-xTi(x)N induced by terahertz pulse excitation.

Ultrafast responses of BCS superconductor Nb(1-x)Ti(x)N films in a nonadiabatic excitation regime were investigated by using terahertz (THz) pump-THz probe spectroscopy. After an instantaneous excitation with the monocycle THz pump pulse, a transient oscillation emerges in the electromagnetic response in the BCS gap energy region. The oscillation frequency coincides with the asymptotic value of the BCS gap energy, indicating the appearance of the theoretically anticipated collective amplitude mode of the order parameter, namely the Higgs amplitude mode. Our result opens a new pathway to the ultrafast manipulation of the superconducting order parameter by optical means.

Nonequilibrium BCS state dynamics induced by intense terahertz pulses in a superconducting NbN film.

Using terahertz (THz) pump-THz probe spectroscopy, we have investigated the dynamics of the nonequilibrium BCS state in a superconducting NbN film after the impulsive photoinjection of high-density Bogoliubov quasiparticles. The superconducting state rapidly changes within the duration of the monocycle THz pump pulse (1.6 ps). The complex optical conductivity spectrum in the nonequilibrium BCS state significantly deviates from that in the equilibrium state. The observed spectral features are qualitatively well described by the effective medium theory that assumes the formation of normal state patches embedded in a superconducting matrix.

Exciton Mott transition in Si revealed by terahertz spectroscopy.

We investigate the exciton Mott transition in Si by using optical pump and terahertz probe spectroscopy. The density-dependent exciton ionization ratio α is quantitatively evaluated from the analysis of dielectric function and conductivity spectra. The Mott density is clearly determined by the rapid increase in α as a function of electron-hole (e-h) pair density, which agrees well with the value expected from the random phase approximation theory. However, exciton is sustained in the high-density metallic region above the Mott density as manifested by the 1s-2p excitonic resonance that remains intact across the Mott density. Moreover, the charge carrier scattering rate is strongly enhanced slightly above the Mott density due to nonvanishing excitons, indicating the emergence of highly correlated metallic phase in the photoexcited e-h system. Concomitantly, the loss function spectra exhibit the signature of plasmon-exciton coupling, i.e., the existence of a new collective mode of charge density excitation combined with the excitonic polarization at the proximity of Mott density.

Intense terahertz pulse induced exciton generation in carbon nanotubes.

We have investigated the highly nonlinear terahertz (THz) light-matter interaction in single-walled carbon nanotubes (SWNTs). The high-peak THz electric-field (∼0.7 MV/cm) and the low effective mass of carriers result in their ponderomotive energy exceeding the bandgap energy of semiconducting SWNTs. Under such an intense THz pulse irradiation, the interband excitation that results in the generation of excitons occurs, although the THz photon energy (∼4 meV) is much smaller than the gap energy of SWNTs (∼1 eV). The ultrafast dynamics of this exciton generation process is investigated by THz pump and optical probe spectroscopy. The exciton generation mechanism is described by impact excitation process induced by the strong THz E-field. Such intense THz pulse excitation provides a powerful tool to study nonlinear terahertz optics in non-perturbative regime as well as nonlinear transport phenomena in solids with ultrafast temporal resolution.

Above-room-temperature ferroelectricity in a single-component molecular crystal.

Ferroelectrics are electro-active materials that can store and switch their polarity (ferroelectricity), sense temperature changes (pyroelectricity), interchange electric and mechanical functions (piezoelectricity), and manipulate light (through optical nonlinearities and the electro-optic effect): all of these functions have practical applications. Topological switching of pi-conjugation in organic molecules, such as the keto-enol transformation, has long been anticipated as a means of realizing these phenomena in molecular assemblies and crystals. Croconic acid, an ingredient of black dyes, was recently found to have a hydrogen-bonded polar structure in a crystalline state. Here we demonstrate that application of an electric field can coherently align the molecular polarities in crystalline croconic acid, as indicated by an increase of optical second harmonic generation, and produce a well-defined polarization hysteresis at room temperature. To make this simple pentagonal molecule ferroelectric, we switched the pi-bond topology using synchronized proton transfer instead of rigid-body rotation. Of the organic ferroelectrics, this molecular crystal exhibits the highest spontaneous polarization ( approximately 20 muC cm(-2)) in spite of its small molecular size, which is in accord with first-principles electronic-structure calculations. Such high polarization, which persists up to 400 K, may find application in active capacitor and nonlinear optics elements in future organic electronics.

Time-resolved formation of excitons and electron-hole droplets in si studied using terahertz spectroscopy.

We investigated the formation dynamics of excitons and electron-hole (e-h) droplets (EHDs) in Si by using broadband terahertz time-domain spectroscopy. The formation of indirect excitons in Si was studied by observing their 1S-2P transition. Changes in surface plasmon resonance of the EHDs showed a gradual condensation from homogeneous e-h plasma at e-h densities above the exciton-Mott transition. Excitonic correlations were shown to exist prior to EHD condensation even above the Mott density.

Compact terahertz time domain spectroscopy system with diffraction-limited spatial resolution.

A compact and rigid terahertz time domain spectroscopy system is presented. The size of the device is 20 mm diameter times 61 mm length with four parabolic-shaped concave mirrors dug in it to effectively focus a terahertz beam on a sample. The device has no chromatic aberration over the whole bandwidth of the beam (0.3-2 THz), and an effective numerical aperture of about 0.45 is achieved, which has a capability to image the structure whose size is almost the same as the wavelength. Frequency resolved images clearly show this performance. We also show that quantitative retrieval of the complex refractive index of the structure as small as twice of the wavelength is possible.