Measurement of four-photon absorption in GaP and ZnTe semiconductors.

Intensity-dependent effective four-photon absorption (4PA) coefficients in GaP and ZnTe semiconductors were measured by the z-scan method using pump pulses of 1.75 µm wavelength, 135 fs duration, and up to 500 GWcm-2 intensity. A nonlinear pulse propagation model, including linear dispersion and 4PA was used to obtain the 4PA coefficients from measurements. The intensity-dependent effective 4PA coefficients vary from 2.6 × 10-4 to 65 × 10-4 cm5GW-3 in GaP, and from 3.5 × 10-4 to 9.1 × 10-4 cm5GW-3 in ZnTe. The anisotropy in 4PA was shown in GaP. The knowledge of 4PA coefficients is important for the design of semiconductor photonics devices.

110-mJ 225-fs cryogenically cooled Yb:CaF2 multipass amplifier.

We report on a diode-pumped cryogenically cooled bulk Yb:CaF2 12-pass amplifier delivering 110-mJ, 1030-nm pulses at a 50-Hz repetition rate. The pulses have a spectral bandwidth of 13 nm and are compressed to 225 fs pulse duration in a double reflection grating based compressor having a transmission efficiency of >90%. The measured output beam quality is M2<1.1. A key feature of the amplifier design is the 4f relay imaging onto the gain medium with progressive beam magnification for the mitigation of the spatial gain narrowing effect. The number of passes in the amplifier is scalable by increasing the size of imaging mirrors. In order to prevent accumulation of nonlinear phase due to self-phase modulation in air, the amplifier is enclosed into a low-vacuum case.

High-energy terahertz pulses from semiconductors pumped beyond the three-photon absorption edge.

A new route to efficient generation of THz pulses with high-energy was demonstrated using semiconductor materials pumped at an infrared wavelength sufficiently long to suppress both two- and three-photon absorption and associated free-carrier absorption at THz frequencies. For pumping beyond the three-photon absorption edge, the THz generation efficiency for optical rectification of femtosecond laser pulses with tilted intensity front in ZnTe was shown to increase 3.5 times, as compared to pumping below the absorption edge. The four-photon absorption coefficient of ZnTe was estimated to be ß4=(4±1)×10-5 cm5/GW3. THz pulses with 14 µJ energy were generated with as high as 0.7% efficiency in ZnTe pumped at 1.7 µm. It is shown that scaling the THz pulse energy to the mJ level by increasing the pump spot size and pump pulse energy is feasible.

800-fs, 330-µJ pulses from a 100-W regenerative Yb:YAG thin-disk amplifier at 300 kHz and THz generation in LiNbO3.

Yb:YAG thin-disk lasers offer extraordinary output power, but systems delivering femtosecond pulses at a repetition rate of hundreds of kilohertz are scarce, even though this regime is ideal for ultrafast electron diffraction, coincidence imaging, attosecond science, and terahertz (THz) spectroscopy. Here we describe a regenerative Yb:YAG amplifier based on thin-disk technology, producing 800-fs pulses at a repetition rate adjustable between 50 and 400 kHz. The key design elements are a short regenerative cavity and fast-switching Pockels cell. The average output power is 130 W before the compressor and 100 W after compression, which at 300 kHz corresponds to pulse energies of 430 and 330 µJ, respectively. This is sufficient for a wide range of nonlinear conversions and broadening/compression schemes. As a first application, we use optical rectification in LiNbO3 to produce 30-nJ single-cycle THz pulses with 6 W pump power. The electric field exceeds 10 kV/cm at a central frequency of 0.3 THz, suitable for driving structural dynamics or controlling electron beams.

Efficient generation of THz pulses with 0.4 mJ energy.

Efficient generation of THz pulses with high energy was demonstrated by optical rectification of 785-fs laser pulses in lithium niobate using tilted-pulse-front pumping. The enhancement of conversion efficiency by a factor of 2.4 to 2.7 was demonstrated up to 186 µJ THz energy by cryogenic cooling of the generating crystal and using up to 18.5 mJ/cm2 pump fluence. Generation of THz pulses with more than 0.4 mJ energy and 0.77% efficiency was demonstrated even at room temperature by increasing the pump fluence to 186 mJ/cm2. The spectral peak is at about 0.2 THz, suitable for charged-particle manipulation.

Proposal for carrier-envelope-phase stable single-cycle attosecond pulse generation in the extreme-ultraviolet range.

A robust method for producing half-cycle-few-cycle attosecond pulses in the extreme ultraviolet spectral range is proposed. It is based on coherent undulator radiation of relativistic ultrathin electron layers (nanobunches), which are produced by nanobunching of ultrashort electron bunches by a 10-TW power laser in a modulator undulator. Our numerical calculations predict the generation of nanobunches shorter than 10 nm. By using these electron nanobunches the production of carrier-envelope-phase stable attosecond pulses with up to a few tens of nJ energy and down to 10 nm wavelength and 35 as duration is predicted.

Pump pulse width and temperature effects in lithium niobate for efficient THz generation.

We present a study on THz generation in lithium niobate pumped by a powerful and versatile Yb:CaF(2) laser. The unique laser system delivers transform-limited pulses of variable duration (0.38-0.65 ps) with pulse energies up to 15 mJ and center wavelength of 1030 nm. From previous theoretical investigations, it is expected that such laser parameters are ideally suited for efficient THz generation. Here, we present experimental results on both the conversion efficiency and the THz spectral shape for variable pump pulse durations and for different crystal temperatures, down to 25 K. We experimentally verify the optimum pump parameters for the most efficient and broadband THz generation.

F-18-fluoro-2-deoxyglucose positron emission tomography (PET) and PET/computed tomography imaging in primary staging of patients with malignant melanoma: a systematic review.

PURPOSE: The aim of this systematic review was to systematically assess the potential patient-relevant benefit (primary aim) and diagnostic and prognostic accuracy (secondary aim) of positron emission tomography (PET) and PET/computed tomography (CT) in primary staging of malignant melanoma. This systematic review updates the previous evidence for PET(/CT) in malignant melanoma. MATERIALS AND METHODS: For the first aim, randomized controlled trials (RCTs) investigating patient-relevant outcomes and comparing PET and PET(/CT) with each other or with conventional imaging were considered. For the secondary aim, a review of reviews was conducted, which was amended by an update search for primary studies. MEDLINE, EMBASE and four databases of the Cochrane Library were searched. The risk of bias was assessed using a modified QUADAS tool. RESULTS: No RCTs investigating the patient-relevant benefit of PET(/CT) and no prognostic accuracy studies were found. Seventeen diagnostic accuracy studies of varying quality were identified. For patients with American Joint Committee on Cancer (AJCC) stages I and II, sensitivity mostly ranged from 0 to 67%. Specificity ranged from 77 to 100%. For AJCC stages III and IV, sensitivity ranged from 68 to 87% and specificity from 92 to 98%. CONCLUSION: There is currently no evidence of a patient-relevant benefit of PET(/CT) in the primary staging of malignant melanoma. RCTs investigating patient-relevant outcomes are therefore required. The diagnostic accuracy of PET(/CT) appears to increase with higher AJCC stages.

Generation of sub-mJ terahertz pulses by optical rectification.

Recent theoretical calculations predicted an order-of-magnitude increase in the efficiency of terahertz pulse generation by optical rectification in lithium niobate when 500 fs long pump pulses are used, rather than the commonly used ~100 fs pulses. Even by using longer than optimal pump pulses of 1.3 ps duration, 2.5× higher THz pulse energy (125 µJ) was measured with 2.5× higher pump-to-THz energy conversion efficiency (0.25%) than reported previously with shorter pulses. These results verify the advantage of longer pump pulses and support the expectation that mJ-level THz pulses will be available by cooling the crystal and using large pumped area.

Design of high-energy terahertz sources based on optical rectification.

Detailed analysis of the tilted-pulse-front pumping scheme used for ultrashort THz pulse generation by optical rectification of femtosecond laser pulses is presented. It is shown that imaging errors in a pulse-front-tilting setup consisting of a grating and a lens can lead to a THz beam with strongly asymmetric intensity profile and strong divergence, thereby limiting applications. Optimized setup parameters are given to reduce such distortions. We also show that semiconductors can offer a promising alternative to LiNbO(3) in high-energy THz pulse generation when pumped at longer wavelengths. This requires tilted-pulse-front pumping, however the small tilt angles allow semiconductors to be easily used in such schemes. Semiconductors can be advantageous for generating THz pulses with high spectral intensity at higher THz frequencies, while LiNbO(3) is better suited to generate THz pulses with very large relative spectral width. By using optimized schemes the upscaling of the energy of ultrashort THz pulses is foreseen.

Comparison of dispersive mirrors based on the time-domain and conventional approaches, for sub-5-fs pulses.

Dispersive mirrors based on time-domain approach are compared with mirrors resulting from conventional phase target designs. Phase targets have been applied to complementary-pair dispersive mirrors, used for sub-5-fs pulse compression. While the phase approach has hither to afforded the best performance for the shortest pulses, our new approach, based on time-domain targets and tailored for a specific input spectrum, appears to provide comparable performance for pulse compression for a pulse duration 4.6 fs. Experimental studies using dispersive mirrors made to both designs are described.

Doppler echocardiography assessment of prosthetic heart valves.

Transthoracic Doppler echocardiography is an accurate noninvasive method for the evaluation of prosthetic valve function. The flow characteristics and pressure gradients of normally functioning mechanical and bioprosthetic valves have been, in general established. Normal functioning mitral valve prostheses have a valve area greater than 1.8 cm 2 with the St. Jude valve having the largest effective valve area and normally functioning aortic prosthetic valves have a peak instantaneous gradient of less than 45 mmHg, with the Starr-Edwards valves (Starr-Edwards, Irvine CA) showing the highest gradients. The incidence of minimal or mild regurgitation is approximately 15% to 30% in the mitral position and 25% to 50% in the aortic position, with the higher incidence of regurgitation seen with mechanical compared to bioprosthetic valves. Transthoracic Doppler echocardiography can accurately detect patients with prosthetic valvular stenosis. The presence of prosthetic aortic regurgitation can also generally be accurately assessed, except in the presence of both prosthetic aortic and mitral valves. Assessment of prosthetic mitral regurgitation remains limited due to significant attenuation of the ultrasound beam by the prosthesis and the frequent underestimation of severity of regurgitation. Other limitations of transthoracic studies include assessment of leaflet morphology, detection of vegetations and valve abscesses, and differentiation between valvular and paravalvular regurgitation.

Aortic regurgitation: a common complication after surgery for hypertrophic obstructive cardiomyopathy.

Surgical ventriculomyectomy and ventriculomyotomy by the aortic approach are safe and effective methods of relieving symptoms and obstruction to left ventricular outflow in patients with hypertrophic obstructive cardiomyopathy. With the addition of Doppler ultrasound to the routine follow-up assessment of these patients an unexpectedly high occurrence of aortic regurgitation was found in the postoperative patients. Because aortic regurgitation has been reported to rarely accompany this condition, 67 patients with hypertrophic obstructive cardiomyopathy were studied clinically and with Doppler echocardiography for the presence and severity of aortic regurgitation. Severity of the regurgitation was quantitated by pulsed or color Doppler echocardiography according to the length and width of the regurgitant jet in at least two views. In 37 patients with hypertrophic obstructive cardiomyopathy who did not undergo surgery, aortic regurgitation was detected in only 1 (3%) by Doppler ultrasound and in none clinically. In 52 patients who did undergo surgery and were studied a mean of 7.8 years postoperatively, aortic regurgitation of trivial to moderate degree was common, being detected in 28 (54%) by Doppler ultrasound and in 6 (12%) clinically. In a subgroup of 22 patients who were studied preoperatively and again early postoperatively (mean 6 weeks), new aortic regurgitation was found in 8 (36%) and was graded as trivial in all. Aortic regurgitation is a common complication related to ventriculomyectomy and ventriculomyotomy in patients with hypertrophic obstructive cardiomyopathy. Although initially trivial, the regurgitation may progress in severity over time. The regurgitation has been well tolerated in all patients studied to date.

Five-year follow-up of Hancock pericardial valves: management of premature failure.

The durability and function of bovine pericardial valves are dependent upon design, preservation, patient factors (age, sex), and site of valve implantation. In 1983, a shelf recall of all Hancock bovine pericardial valves (HPV) was instituted by the manufacturer. This report represents the results of an organized 5-year follow-up in a hospital Prosthetic Valve Registry of 129 HPV implanted in 122 patients (79 males, 43 females) between May 1982 and April 1985 using echo Doppler and careful clinical evaluation. Mean age was 56 +/- 15 years. There were 81 AVR, 33 MVR, 7 DVR, and 1 TVR. Concomitant coronary bypass was performed in 38 patients (31%). Surgery was on a redo basis in 25 patients (20%), urgent in 14 (11%), and for SBE in 8 patients (7%). There were seven hospital deaths (5.7%). Mean follow-up was 44 months (maximum 66 months) for 114 patients (99% complete), representing 417 patient years. There have been 20 late deaths (18%), of which 7 were directly valve related. Linearized frequency of major events (per pt-yr) was: thromboembolism, 1.6%; anticoagulant related hemorrhage, 0.8% (1 late death); prosthetic valve endocarditis 1.3%; primary tissue failure, 5.8%. Patient symptomatology was a more accurate predictor of bioprosthetic failure requiring reoperation than echo Doppler studies, which were completed in 74 of 97 patients examined during scheduled follow-up visits. Twenty-four of the 96 patients (25%) have required re-replacement at a mean interval of 44 months (27-59 months) from initial implantation. This was due to vertical shear starting at the top of the strut anchoring commissural attachments in every case.(ABSTRACT TRUNCATED AT 250 WORDS)

Aortic valve replacement with a small prosthesis.

A small aortic prosthesis can be inserted in selected patients with excellent symptomatic improvement. A prospective evaluation was performed on 321 consecutive patients undergoing isolated aortic valve replacement between January 1982 and December 1984. Smaller prostheses (19 or 21 mm, predominantly pericardial valves, 132 patients) were inserted in older patients (p = .0001), women (p = .0001), smaller patients (body surface area: p = .0001), and patients with aortic stenosis (p = .0001). Twelve patients died in-hospital (3.7%) and 33 died during the follow-up period, producing an actuarial survival of 80% +/- 4% at 48 months. Survival was independently predicted by advancing age (p = .009), the preoperative NYHA functional class (p = .04) but not valve size (p = .28). Eighty-nine percent of patients were NYHA class I or II postoperatively compared with 22% preoperatively. Symptomatic recovery was similar for those with smaller size valves. Postoperative Doppler echocardiography in 57 patients revealed significant differences in aortic valve areas and gradients between the valve sizes. The 19 mm pericardial valves had the smallest areas (1.0 +/- 0.3 cm2) and the highest gradients (34 +/- 20 mm Hg). The aortic valve gradient was significantly related to cardiac output and valve size (p = .0001 by analysis of covariance). Linear regression analyses were used to estimate the aortic valve gradient during exercise (a 50% increase in cardiac output). The estimated exercise gradient was disturbingly high for the 19 mm valves (55 +/- 16 mm Hg), but the estimated exercise gradients for the 21, 23, and 25 mm valves were similar, all below 30 mm Hg. Aortic valve replacement with a small prosthesis resulted in excellent symptomatic improvement and acceptable resting valve gradients. However, a 19 mm prosthesis may produce prohibitive gradients during exercise, which may limit symptomatic recovery and should be avoided in active patients.

Cardiac presentation of non-Hodgkin's lymphoma.

We present a case of non-Hodgkin's lymphoma with massive cardiac involvement in a previously well 65-year-old man, presenting with pericardial tamponade and heart failure of recent onset. Results of echocardiography and of pericardial and pleural fluid cytology suggested the diagnosis. Within two weeks the patient's condition progressed to complete heart block and he died. Primary cardiac tumors are rare when compared with metastatic involvement of the heart. Their presentation includes congestive heart failure, cardiomegaly, pericardial effusion, and sudden death. The clinical diagnosis has seldom been made.

Persistent ventricular adaptations in postoperative coarctation of the aorta.

To evaluate ventricular performance and myocardial contractility after surgical correction of congenital coarctation of the aorta, we studied 25 patients (16 men and 9 women, mean age 26.1 years [range 19 to 34]), an average of 10.6 years (range 2 to 25) after repair. Radionuclide ventriculography at rest and exercise and digitized, quantitative two-dimensional echocardiography were performed. Data from derived, high resolution time-activity curves by radionuclide ventriculography, combined with noninvasive hemodynamic/ventricular volume data, were compared with values in an age- and sex-matched normal population. Despite essentially identical baseline and exercise hemodynamics, postoperative coarctation subjects demonstrated enhanced ventricular contraction, as determined by the peak ejection rate at rest (-3.79 versus -3.20 stroke volume/s, p less than 0.01) and exercise (-3.00 versus -2.90 stroke volume/s, p = NS), and overall ejection fraction at rest (56.4 versus 48.0%, p less than 0.01) and exercise (70.8 versus 59.3%, p less than 0.01). An intrinsic activation-contraction delay was observed, as illustrated by a prolonged time to peak ejection rate at rest (27.7 versus 21.5% of the RR interval, p less than 0.01) and exercise (28.4 versus 21.2% of the RR interval, p less than 0.01), and total systolic time at rest (50.2 versus 43.4% of the RR interval, p less than 0.01) and exercise (56.8 versus 50.4% of the RR interval, p less than 0.01). Although left ventricular meridinal wall stress was statistically indistinguishable (62 versus 74 mm Hg/mm2, p = NS), intrinsic myocardial contractility, as assessed by the peak systolic pressure/volume ratio, was increased in the postoperative coarctation group (1.88 versus 2.87 mm Hg/ml, p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

The role of echocardiography in the assessment of hypertrophic cardiomyopathy.

Echocardiography has greatly simplified the diagnosis of hypertrophic cardiomyopathy and routine haemodynamic studies are usually only required in patients being considered for myectomy or the assessment of coexistent coronary disease. A complete echo Doppler study should be performed in all patients with hypertrophic cardiomyopathy to define the degree of obstruction, the degree of asymmetric hypertrophy and abnormalities of diastolic function. In this manner the patient can be classified according to haemodynamic subgroup, thus influencing the choice of treatment and helping to determine prognosis. These studies also provide a simple quantitative method of assessing the beneficial effects of medical or surgical therapy.