Distal Radiation Access as an Alternative to Conventional Radial Access for Coronary Angiography and Percutaneous Coronary Interventions (According to TENDERA Trial).

The aim of this study was to assess the immediate and medium-term (3 months) results of the safety and efficacy of distal radial access (DRA) in coronary interventions compared with conventional transradial radial access (TRA). TRA is the recommended access for coronary procedures because of increased safety: fewer local complications, large and small bleeding. Recently, DRA has emerged as a promising alternative access to minimize radial artery occlusion (RAO) risk, as well as other complications. A large-scale, international, randomized trial comparing medium-term results with TRA and DRA is lacking. An analysis of 776 patients of the prospective randomized TENDERA trial was carried out: the distal artery access group (DRA) - 391, the transradial access group (TRA) - 385. Statistically more often the crossover access was in the DRA group (5.1% and 0.8%, P < 0.001). The primary endpoint was early or late thrombosis/occlusion of the radial artery (RA). Secondary endpoints: (1) composite complications from access vessels; (2) access parameters. Statistically significant differences were obtained for the primary endpoint: DRA 2.7% (n = 10), TRA 6.8% (n = 26), P = 0.008. Occlusion of the distal radial artery (DRAt), with patent RA: DRA 1.3% (n = 5), TRA 0 (0), P = 0.023. At the secondary composite endpoint, statistically significant differences were obtained for the following groups of complications: BARC type I bleeding (DRA: 3.8% (n = 14), TRA: 21.7% (n = 83), P < 0.001); hematoma larger than 5 cm on day 1 (DRA: 10% [n = 37], TRA: 25.9% [n = 98], P < 0.001); hematoma larger than 5 cm on day 7 (DRA: 12.4% [n = 45], TRA: 34.6% [n = 132], P < 0.001). Of the access parameters, the following statistically significantly differed: puncture time DRA 19.0 (8.0; 50), TRA 13.5 (5.0; 29), P < 0.001; insertion of introducer DRA 42.0 (26.0; 84.0), TRA 35.0 (23.0; 55.0), P < 0.001, access artery hemostasis duration (min.) DRA 180.0 (120.0; 480.0), TRA 155.0 (115.0; 195.0), P < 0.001. The duration of the procedure and fluoroscopy, radiation dose, RA spasm in both groups had no statistically significant differences. In the TENDERA trail, DRA demonstrated efficacy and safety in interventional coronary interventions compared with TRA in the medium-term follow-up period: a statistically significant lower incidence of RA occlusion and local complications.

Ray-tracing simulation of the radiation dose distribution on the surface of the spherical phantom of the MATROSHKA-R experiment onboard the ISS.

Space radiation is one of the main concerns for human space flights. The prediction of the radiation dose for the actual spacecraft geometry is very important for the planning of long-duration missions. We present a numerical method for the fast calculation of the radiation dose rate during a space flight. We demonstrate its application for dose calculations during the first and the second sessions of the MATROSHKA-R space experiment with a spherical tissue-equivalent phantom. The main advantage of the method is the short simulation time, so it can be applied for urgent radiation dose calculations for low-Earth orbit space missions. The method uses depth-dose curve and shield-and-composition distribution functions to calculate a radiation dose at the point of interest. The spacecraft geometry is processed into a shield-and-composition distribution function using a ray-tracing method. Depth-dose curves are calculated using the GEANT4 Monte-Carlo code (version 10.00.P02) for a double-layer aluminum-water shielding. Aluminum-water shielding is a good approximation of the real geometry, as water is a good equivalent for biological tissues, and aluminum is the major material of spacecraft bodies. The method is applied to model the dose distribution on the surface of the spherical phantom in the MATROSHKA-R space experiment. The experiment has been carried out onboard the ISS from 2004 to the present. The absorbed dose was determined in 32 points on the phantom's surface. We find a good agreement between the data obtained in the experiment and our calculation results. The simulation method is thus applicable for future radiation dose predictions for low-Earth orbit missions and experiments.

Chirp-controlled filamentation and formation of light bullets in the mid-IR.

Formation of light bullets-tightly localized in space and time light packets, retaining their spatiotemporal shape during propagation-is, for the first time, experimentally observed and investigated in a new regime of mid-infrared filamentation in ambient air. It is suggested that the light bullets generated in ambient air by multi-mJ, positively chirped 3.9-µm pulses originate from a dynamic interplay between the anomalous dispersion in the vicinity of CO2 resonance and positive chirp, both intrinsic, carried by the driver pulse, and accumulated, originating from nonlinear propagation in air. By adjusting the initial chirp of the driving pulses, one can control the spatial beam profile, energy losses, and spectral-temporal dynamics of filamenting pulses and deliver sub-3-cycle mid-IR pulses in high-quality beam on a remote target.

Filamentation of mid-IR pulses in ambient air in the vicinity of molecular resonances.

Properties of filaments ignited by multi-millijoule, 90 fs mid-infrared pulses centered at 3.9 µm are examined experimentally by monitoring plasma density, losses, spectral dynamics and beam profile evolution at different focusing strengths. By changing from strong (f=0.25 m) to loose (f=7 m) focusing, we observe a shift from plasma-assisted filamentation to filaments with low plasma density. In the latter case, filamentation manifests itself by beam self-symmetrization and spatial self-channeling. Spectral dynamics in the case of loose focusing is dominated by the nonlinear Raman frequency downshift, which leads to the overlap with the CO2 resonance in the vicinity of 4.2 µm. The dynamic CO2 absorption in the case of 3.9 µm filaments with their low plasma content is the main mechanism of energy losses and, either alone or together with other nonlinear processes, contributes to the arrest of intensity.

Multi-millijoule few-cycle mid-infrared pulses through nonlinear self-compression in bulk.

The physics of strong-field applications requires driver laser pulses that are both energetic and extremely short. Whereas optical amplifiers, laser and parametric, boost the energy, their gain bandwidth restricts the attainable pulse duration, requiring additional nonlinear spectral broadening to enable few or even single cycle compression and a corresponding peak power increase. Here we demonstrate, in the mid-infrared wavelength range that is important for scaling the ponderomotive energy in strong-field interactions, a simple energy-efficient and scalable soliton-like pulse compression in a mm-long yttrium aluminium garnet crystal with no additional dispersion management. Sub-three-cycle pulses with >0.44 TW peak power are compressed and extracted before the onset of modulation instability and multiple filamentation as a result of a favourable interplay between strong anomalous dispersion and optical nonlinearity around the wavelength of 3.9 µm. As a manifestation of the increased peak power, we show the evidence of mid-infrared pulse filamentation in atmospheric air.

[Coronary Angioplasty and Stenting in Patients Older Than 80 Years: Immediate and Long-Term Results].

AIM: to assess immediate and long-term results of coronary angioplasty and stenting in patients older than 80 years - a high risk group in view of the severity of concomitant pathology and extent of coronary atherosclerosis. MATERIAL AND METHODS: We conducted retrospective analysis of data from 167 patients older than 80 years (mean age 81.43+/-2.14 years) subjected to percutaneous coronary intervention from 2006 to 2013 (3.2% from total number of patients). Multivessel involvement was present in 128 patients (76.6%) including 20 (12.4%) with stenosis in left main coronary artery. In 215 out of 270 stenotic lesions complicated stenoses type B2, C were detected . Number of chronic occlusions was 31 (10.3%) out of 301 treated lesions. There were 46 patients (27.5%) with diabetes, 16 (9.6%) with chronic anemia, 35 (21%) with chronic renal failure. Concomitant multifocal lesions in other arterial beds were found in 67 patients (40.1%). Radial, femoral, and combined femoral-radial accesses was used in 157 (94%), 5 (3%), and 5 (3%) patients, respectively. Results were studied with the help of automated system of digital computer angiography and intracoronary ultrasound. Long-term results were assessed with the help of questioning, control angiography, and echocardiography. RESULTS: Immediate angiographic and clinical success was achieved in 97 and 94% of cases, respectively. Revascularization was complete in 62.2% of cases. Hospital mortality was 0.7%. Major adverse cardiac events (MACE) were registered in 4.6 and 22.4% of patients during periods of 30 days and >24 months, respectively. Stent thrombosis was diagnosed in 3 cases (1.79%) in 6-18 months after intervention. Repeat revascularization in remote period was performed in 20 patients (12.8%), in 8 of them because of appearance of new lesion. Survival after 40 months was 91%, survival without MACE after 60 months was 74.8%. Complications related to access artery was 4.2% (1.9% in 157 transradial Interventions). According of logistic regression analysis, the following predictors of MACE in remote period were determined: initial depressed left ventricular function, diabetes mellitus, and lesion length >35 mm. CONCLUSION: Coronary angioplasty and stenting is an effective method of treatment of coronary atherosclerosis in patients older than 80 years with acceptable rate of MACE. Radial access lowers rate of access related vascular complications.

[CALCULATION OF RADIATION LOADS ON THE ANTHROPOMORPHIC PHANTOM ONBOARD THE SPACE STATION IN THE CASE OF ADDITIONAL SHIELDING].

The paper presents the results of calculating doses from space ionizing radiation for a modeled orbital station cabin outfitted with an additional shield aimed to reduce radiation loads on cosmonaut. The shield is a layer with the mass thickness of -6 g/cm2 (mean density = 0.62 g/cm3) that covers the outer cabin wall and consists of wet tissues and towels used by cosmonauts for hygienic purposes. A tissue-equivalent anthropomorphic phantom imitates human body. Doses were calculated for the standard orbit of the International space station (ISS) with consideration of the longitudinal and transverse phantom orientation relative to the wall with or without the additional shield. Calculation of dose distribution in the human body improves prediction of radiation loads. The additional shield reduces radiation exposure of human critical organs by -20% depending on their depth and body spatial orientation in the ISS compartment.

Stimulated Raman gas sensing by backward UV lasing from a femtosecond filament.

We perform a proof-of-principle demonstration of chemically specific standoff gas sensing, in which a coherent stimulated Raman signal is detected in the direction anticollinear to a two-color laser excitation beam traversing the target volume. The proposed geometry is intrinsically free space as it does not involve back-scattering (reflection) of the signal or excitation beams at or behind the target. A beam carrying an intense mid-IR femtosecond (fs) pulse and a parametrically generated picosecond (ps) UV Stokes pulse is fired in the forward direction. A fs filament, produced by the intense mid-IR pulse, emits a backward-propagating narrowband ps laser pulse at the 337 and 357 nm transitions of excited molecular nitrogen, thus supplying a counter-propagating Raman pump pulse. The scheme is linearly sensitive to species concentration and provides both transverse and longitudinal spatial resolution.

[Cytokines level in patients with drug-induced jaw necrosis].

The study included 15 patients with purulent inflammatory diseases of maxillofacial area and 25 patients with facial bone necrosis induced by synthetic drugs. Pro- and anti-inflammatory cytokines levels in saliva and wound fluid were analyzed in two groups. The results proved cytokines to play important role in jaw necrosis induced by drugs containing red phosphorus.

[Defensins level in patients with inflammatory diseases of maxillofacial area].

Molecular study of congenital immune factors was conducted in 45 patients with inflammatory diseases of maxillofacial area. The study focused on expression of cationic low-molecular peptides α- and Β-defensines in oral mucosa. These peptides are involved in antibacterial activity and regulation of immune reactions. The results showed 20-fold increase in defensines expression in oral mucosa of patients with inflammatory diseases of maxillofacial area when compared to control group (12 healthy individuals) thus proving an important role they play in the development of the disease. Therapy with cytokines may be indicated in these cases.

Mid-infrared laser filamentation in molecular gases.

We observed the filamentation of mid-infrared ultrashort laser pulses (3.9 µm, 80 fs) in molecular gases. It efficiently generates a broadband supercontinuum over two octaves in the 2.5-6 µm spectral range, with a red-shift up to 500 nm due to the Raman effect, which dominates over the blue shift induced by self-steepening and the gas ionization. As a result, the conversion efficiency into the Stokes region (4.3-6 µm) 65% is demonstrated.

[Multistage endovascular treatment of multifocal atherosclerosis].

We present a report of a clinical case of multistage endovascular treatment of multifocal atherosclerosis with involvement of coronary arteries, left renal artery, and arteries of lower extremities. A 54 year old patient with type 2 diabetes, impaired renal function, vasorenal hypertension, and lowered left ventricular contractility had history of stroke and myocardial infarction. Endovascular treatment was carried out in 6 stages with sequential angioplasty and stenting of coronary arteries, arteries of lower extremities, and left renal artery. Overall 20 stents were implanted (17 with drug covering): 10 in coronary vascular bed, 9 in arteries of lower extremities, 1 in renal artery. Control examination in 9 months showed good remote angiographic and clinical result.

[Calculation of radiation loads in a space station compartment with a secondary shielding].

Doses from space ionizing radiation were estimated using a model of ISS cosmonaut's quarters (CQ) outfitted with secondary shielding ("Protective shutter" (PS) as part of experiment MATRYOSHKA-R). Protective shutter is a "blanket" of water-containing material with mass thickness of - 6 g/cm2 covering the CQ exterior wall. Calculation was performed specifically for locations of experimental dosimetry assemblies. Agreement of calculations and experimental data reaching accuracy - 15% proves model applicability to estimating protective effectiveness of secondary shielding in the present-day and future space vehicles. This shielding may reduce radiation loading onto crewmembers as an equivalent dose by more than 40% within a broad range of orbit altitudes equally during the solar minimum and maximum.

Ultrafast-laser-induced backward stimulated Raman scattering for tracing atmospheric gases.

By combining tunable broadband pulse generation with the technique of nonlinear spectral compression we demonstrate a prototype scheme for highly selective detection of air molecules by backward stimulated Raman scattering. The experimental results allow to extrapolate the laser parameters required for standoff sensing based on the recently demonstrated backward atmospheric lasing.

Third- and fifth-harmonic generation by mid-infrared ultrashort pulses: beyond the fifth-order nonlinearity.

Third- and fifth-harmonic generation by ultrashort laser pulses in the mid-infrared (mid-IR) reveals nonlinear-optical effects beyond the fifth-order nonlinearity and enables, because of an extraordinarily long coherence length, efficient multiplex frequency upconversion of ultrashort mid-IR pulses. We show that harmonic generation by mid-IR pulses provides an access to the key optical constants of gas media, allowing metrology of linear and nonlinear-optical susceptibilities in the mid-IR and offering a tool for the remote sensing of the atmosphere.

[A new approach to shielding function calculation: radiation dose estimation for a phantome inside space station compartment].

The article presents a new procedure of calculating the shielding functions for irregular objects formed from a set of nonintersecting (adjacent) triangles covering completely the surface of each object. Calculated and experimentally derived distributions of space ionizing radiation doses in the spherical tissue-equivalent phantom (experiment MATRYOSHKA-R) inside the International space station were in good agreement in the mass of phantom depths with allowance for measurement error (-10%). The procedure can be applied in modeling radiation loads on cosmonauts, calculating effectiveness of secondary protection in spacecraft, and design review of radiation protection for future space exploration missions.

Hollow-fiber compression of 6 mJ pulses from a continuous-wave diode-pumped single-stage Yb,Na:CaF2 chirped pulse amplifier.

Here, 200 fs 6 mJ pulses from a cw diode-pumped Yb,Na:CaF(2) amplifier are spectrally broadened in an Ar- or Ne-filled hollow-core fiber and recompressed to 20 fs (Ar) and 35 fs (Ne) using a prism pair. The results of spectral broadening and phase measurement are in excellent agreement with numerical modeling based on the generalized nonlinear Schrödinger equation. The longer laser wavelength of 1030 nm permits favorable energy scaling for the hollow-fiber technique compared to ultrafast amplifiers operating at 800 nm.

[Space radiation doses in the anthropomorphous phantom in space experiment "Matryeshka-R" and spacesuit "Orlan-M" during extravehicular activity].

Russian space experiment "Matryeshka-R" was conducted in 2004-2005 to study dose distribution in the body of anthropomorphous phantom inserted in a spacesuit imitating container mounted on outer surface of the ISS Service module (experiment "Matryeshka"). The objective was to compare doses inside the phantom in the container to human body donned in spacesuit "Orlan-M" during extravehicular activity (EVA). The shielding function was calculated using the geometric model, specification of the phantom shielded by the container, "Orlan-M" description, and results of ground-based estimation of shielding effectiveness by gamma-raying. Doses were calculated from the dose attenuation curves obtained for galactic cosmic rays, and the AE-8/AP-8 models of electron and proton flows in Earth's radiation belt. Calculated ratios of equivalent doses in representative points of the body critical organs to analogous doses in phantom "Matryeshka" H(ORLAN-M)/H(Matryeshka) for identical radiation conditions vary with organs and solar activity in the range from 0.1 to 1.8 with organs and solar activity. These observations should be taken into account when applying Matryeshka data to the EVA conditions.

Following a chemical reaction using high-harmonic interferometry.

The study of chemical reactions on the molecular (femtosecond) timescale typically uses pump laser pulses to excite molecules and subsequent probe pulses to interrogate them. The ultrashort pump pulse can excite only a small fraction of molecules, and the probe wavelength must be carefully chosen to discriminate between excited and unexcited molecules. The past decade has seen the emergence of new methods that are also aimed at imaging chemical reactions as they occur, based on X-ray diffraction, electron diffraction or laser-induced recollision--with spectral selection not available for any of these new methods. Here we show that in the case of high-harmonic spectroscopy based on recollision, this apparent limitation becomes a major advantage owing to the coherent nature of the attosecond high-harmonic pulse generation. The coherence allows the unexcited molecules to act as local oscillators against which the dynamics are observed, so a transient grating technique can be used to reconstruct the amplitude and phase of emission from the excited molecules. We then extract structural information from the amplitude, which encodes the internuclear separation, by quantum interference at short times and by scattering of the recollision electron at longer times. The phase records the attosecond dynamics of the electrons, giving access to the evolving ionization potentials and the electronic structure of the transient molecule. In our experiment, we are able to document a temporal shift of the high-harmonic field of less than an attosecond (1 as = 10(-18) s) between the stretched and compressed geometry of weakly vibrationally excited Br(2) in the electronic ground state. The ability to probe structural and electronic features, combined with high time resolution, make high-harmonic spectroscopy ideally suited to measuring coupled electronic and nuclear dynamics occurring in photochemical reactions and to characterizing the electronic structure of transition states.

[Role of Toll-like receptors and defensins in antimicrobial protection of urogenital tract in females].

Levels of expression of hBD-1 gene (beta-defensin 1) and Toll-like receptors (TLR1, TLR2, TLR6) in cells of cervical mucosa in healthy nonpregnant and healthy pregnant women as well as in pregnant women with urogenital infection was measured by developed RT-PCR systems. During normal pregnancy compared with nonpregnant women, increase of TLRs genes expression which was correlated with increase of hBD-1 gene expression was observed. During urogenital infection in pregnant women compared with healthy pregnant, 10- fold and 50-fold increase of TLR1 and TLR2 genes expression respectively was associated with 2.5-fold decrease of hBD-1 gene expression in cervical mucosa. In group of women with untrauterine infection more marked increase of TLRs genes expression was observed. Thus significant changes (TLRs, antimicrobial peptides, cytokines etc.) in cells of cervical mucosa can be used as prognostic criteria for development of intrauterine infection.