The impact of polydioxanone (PDS) foil thickness on reconstruction of the orbital geometry after isolated orbital floor fractures.

PURPOSE: The orbital floor is frequently involved in head trauma. Current evidence on the use of reconstruction materials for orbital floor repair is inconclusive. Accordingly, this study aimed to compare the impact of polydioxanone (PDS) foil thickness on reconstruction of the orbital geometry after isolated orbital floor fractures. METHODS: Standardized isolated orbital floor fractures were symmetrically created in 11 cadaver heads that provided 22 orbits. PDS foils with thicknesses of 0.25-0.5 mm were inserted. Computed tomography (CT) scans of the native, fractured, and reconstructed orbits were obtained, and orbital volume, orbital height, and foil bending were measured. RESULTS: Orbital volume and height significantly (p < 0.01) increased after the creation of isolated orbital floor fractures and significantly (p = 0.001) decreased with overcorrection of the orbital geometry after orbital floor reconstruction with PDS 0.25 mm or PDS 0.5 mm. The orbital geometry reconstruction rate did not differ significantly with respect to foil thickness. However, compared to PDS 0.5 mm, the use of PDS 0.25 mm resulted in quantitatively higher reconstructive accuracy and a restored orbital volume that did not significantly differ from the initial volume. CONCLUSION: Orbital floors subjected to isolated fractures were successfully reconstructed using PDS regardless of foil thickness, with overcorrection of the orbital geometry. Due to its lower flexural stiffness, PDS 0.25 mm appeared to provide more accurate orbital geometry reconstruction than PDS 0.5 mm, although no significant difference in reconstructive accuracy between PDS 0.25 mm and PDS 0.5 mm was observed in this cadaveric study.

Versatile tabletop setup for picosecond time-resolved resonant soft-x-ray scattering and spectroscopy.

We present a laser-driven, bright, and broadband (50 to 1500 eV) soft-x-ray plasma source with <10 ps pulse duration. This source is employed in two complementary, laboratory-scale beamlines for time-resolved, magnetic resonant scattering and spectroscopy, as well as near-edge x-ray absorption fine-structure (NEXAFS) spectroscopy. In both beamlines, dedicated reflection zone plates (RZPs) are used as single optical elements to capture, disperse, and focus the soft x rays, reaching resolving powers up to E/ΔE > 1000, with hybrid RZPs at the NEXAFS beamline retaining a consistent E/ΔE > 500 throughout the full spectral range, allowing for time-efficient data acquisition. We demonstrate the versatility and performance of our setup by a selection of soft-x-ray spectroscopy and scattering experiments, which so far have not been possible on a laboratory scale. Excellent data quality, combined with experimental flexibility, renders our approach a true alternative to large-scale facilities, such as synchrotron-radiation sources and free-electron lasers.

Carboxylation of Acetylene without Salt Waste: Green Synthesis of C4 Chemicals Enabled by a CO2 -Pressure Induced Acidity Switch.

The inherent formation of salt waste in C-H carboxylations is a key obstacle precluding the utilization of CO2 as C1 building block in the industrial synthesis of base chemicals. This challenge is addressed in a circular process for the production of the C4 base chemical dimethyl succinate from CO2 and acetylene. At moderate CO2 pressures, acetylene is doubly carboxylated in the presence of cesium carbonate. Hydrogenation of the C-C triple bond stabilizes the product against decarboxylation. By increasing the CO2 pressure to 70 bar, the medium is reversibly acidified, allowing an esterification of the succinate salt with methanol. The cesium base and the hydrogenation catalyst are regenerated and can be reused. This provides the proof of concept for a salt-free route to C4 chemicals from biogas (CH4 /CO2 ). The origin of this reversible acidity switch and the critical roles of the cesium base and the NMP/MeOH solvents were elucidated by thermodynamic modeling.

All-Optical Switching on the Nanometer Scale Excited and Probed with Femtosecond Extreme Ultraviolet Pulses.

Ultrafast control of magnetization on the nanometer length scale, in particular all-optical switching, is key to putting ultrafast magnetism on the path toward future technological application in data storage technology. However, magnetization manipulation with light on this length scale is challenging due to the wavelength limitations of optical radiation. Here, we excite transient magnetic gratings in a GdFe alloy with a periodicity of 87 nm by the interference of two coherent femtosecond light pulses in the extreme ultraviolet spectral range. The subsequent ultrafast evolution of the magnetization pattern is probed by diffraction of a third, time-delayed pulse tuned to the Gd N-edge at a wavelength of 8.3 nm. By examining the simultaneously recorded first and second order diffractions and by performing reference real-space measurements with a wide-field magneto-optical microscope with femtosecond time resolution, we can conclusively demonstrate the ultrafast emergence of all-optical switching on the nanometer length scale.

Probing electron and hole colocalization by resonant four-wave mixing spectroscopy in the extreme ultraviolet.

Extending nonlinear spectroscopic techniques into the x-ray domain promises unique insight into photoexcited charge dynamics, which are of fundamental and applied interest. We report on the observation of a third-order nonlinear process in lithium fluoride (LiF) at a free-electron laser. Exploring the yield of four-wave mixing (FWM) in resonance with transitions to strongly localized core exciton states versus delocalized Bloch states, we find resonant FWM to be a sensitive probe for the degree of charge localization: Substantial sum- and difference-frequency generation is observed exclusively when in a one- or three-photon resonance with a LiF core exciton, with a dipole forbidden transition affecting details of the nonlinear response. Our reflective geometry-based approach to detect FWM signals enables the study of a wide variety of condensed matter sample systems, provides atomic selectivity via resonant transitions, and can be easily scaled to shorter wavelengths at free-electron x-ray lasers.

Toward ultrafast magnetic depth profiling using time-resolved x-ray resonant magnetic reflectivity.

During the last two decades, a variety of models have been developed to explain the ultrafast quenching of magnetization following femtosecond optical excitation. These models can be classified into two broad categories, relying either on a local or a non-local transfer of angular momentum. The acquisition of the magnetic depth profiles with femtosecond resolution, using time-resolved x-ray resonant magnetic reflectivity, can distinguish local and non-local effects. Here, we demonstrate the feasibility of this technique in a pump-probe geometry using a custom-built reflectometer at the FLASH2 free-electron laser (FEL). Although FLASH2 is limited to the production of photons with a fundamental wavelength of 4 nm ( ≃ 310 eV ), we were able to probe close to the Fe L 3 edge ( 706.8 eV ) of a magnetic thin film employing the third harmonic of the FEL. Our approach allows us to extract structural and magnetic asymmetry signals revealing two dynamics on different time scales which underpin a non-homogeneous loss of magnetization and a significant dilation of 2 Å of the layer thickness followed by oscillations. Future analysis of the data will pave the way to a full quantitative description of the transient magnetic depth profile combining femtosecond with nanometer resolution, which will provide further insight into the microscopic mechanisms underlying ultrafast demagnetization.

Impact of quality certification of multidisciplinary head and neck tumor centers.

BACKGROUND: Certification of multidisciplinary tumor centers is nowadays seen as the gold standard in modern oncological therapy for optimization and realization of guideline-based therapy and better outcomes. Single cases are reimbursed based on diagnosis-related groups (DRG). We aimed to review efficiency, cost analysis, and profitability following a certification. METHODS: Tumor board certification at the university hospital Aachen was implemented in 2013. We compared 1251 cases of oropharyngeal cancer treated from 2008 to 2017 before and after certification. For this purpose, several patient characteristics, surgery, and stay-related constants, as well as expenses and reimbursement heights were analyzed statistically. RESULTS: Following certification, the total case and patient number, surgery duration, hours of mechanical ventilation, case mix index points, DRG reimbursements as well as the costs increased significantly, whereas days of intensive care unit, amount of blood transfusions, patient clinical complexity level (PCCL) and the overall stay were significantly lowered. No changes were observed for the patient's age and gender distribution. Also, the predetermined stay duration stayed constant. CONCLUSIONS: Certification of head-neck tumor centers causes a concentration of more complex cases requiring higher surgical efforts, which can be processed more efficiently due to a higher level of professionalism. Despite their benefits in cancer care, without compensation, centers may be struggling to cover their expenses in a system, which continuously underestimates them.

A tabletop setup for ultrafast helicity-dependent and element-specific absorption spectroscopy and scattering in the extreme ultraviolet spectral range.

Further advances in the field of ultrafast magnetization dynamics require experimental tools to measure the spin and electron dynamics with element-specificity and femtosecond temporal resolution. We present a new laboratory setup for two complementary experiments with light in the extreme ultraviolet (XUV) spectral range. One experiment is designed for polarization-dependent transient spectroscopy, particularly for simultaneous measurements of magnetic circular dichroism (MCD) at the 3p resonances of the 3d transition metals Fe, Co, and Ni. The second instrument is designed for resonant small-angle scattering experiments with monochromatic light allowing us to monitor spin dynamics with spatial information on the nanometer scale. We combine a high harmonic generation (HHG) source with a phase shifter to obtain XUV pulses with variable polarization and a flux of about (3 ± 1) × 1010 photons/s/harmonic at 60 eV at the source. A dedicated reference spectrometer effectively reduces the intensity fluctuations of the HHG spectrum to below 0.12% rms. We demonstrate the capabilities of the setup by capturing the energy- and polarization-dependent absorption of a thin Co film as well as the time-resolved small-angle scattering in a magnetic-domain network of a Co/Pt multilayer. The new laboratory setup allows systematic studies of optically induced spin and electron dynamics with element-specificity, particularly with MCD as the contrast mechanism with femtosecond temporal resolution and an unprecedented signal-to-noise ratio.

Impact of Wound Closure on the Corrosion Rate of Biodegradable Mg-Ca-Zn Alloys in the Oral Environment.

Magnesium alloys have exhibited a rapid rate of corrosion and thus early implant failure, so this study was designed to investigate the longer-term effects and in particular on wound closure. The aim of the study is to evaluate Mg-Ca-Zn Alloys as promising biodegradable implants in the field of maxillofacial surgery, which have so far never been evaluated for the changing conditions from a saliva to a serum-like environment after wound closure. Magnesium-0.6/calcium-0.8 wt.% zinc alloys were either immersed for 10 days in artificial saliva or 10 days in Hank's salt solution as control groups. The test group was transferred from artificial saliva to Hank's salt solution after 5 days in order to simulate wound closure. Corrosion rates were determined by immersion testing. Additional electron microscopy and energy dispersive X-ray spectroscopy (EDX) were performed. Prior artificial saliva exposure led to significantly decreased (p = 0.0272) corrosion rates after transfer to Hank's solution in comparison to sole Hank's solution exposure (0.1703 vs. 0.6675 mg/(cm2·day)) and sole artificial saliva exposure (0.3180 mg/(cm2·day)), which both exhibit a strong increase after 5 days. The results were in accordance with the scanning electron microscopy and EDX pictures. Prior saliva exposure could protect from increasing corrosion rates after wound closure. Thus Mg-Ca-Zn Alloys are promising future implant alloys in oral surgery, whereas other surgical fields without saliva exposure have to deal with accelerated corrosion rates after 5 days.

Evaluation of SPECT/CT in the assessment of inflammatory jaw pathologies.

PURPOSE: Since accurate diagnosis of inflammatory jaw diseases is still challenging, this study investigated the performance of three phase bone scintigraphy including SPECT/CT in the assessment of correct diagnosis and size of the affected bone tissue. METHOD: This retrospective study contained 31 patients with suspected jaw-related osteoradionecrosis, osteomyelitis or medication-related osteonecrosis of the jaw, which underwent 3-phase bone scintigraphy including SPECT/CT. Results were reviewed by two nuclear medicine physicians. Positive cases received surgery; negative ones were followed-up for six months. Both served as reference standard. Inflamed bone length was measured in the SPECT/CT images and postoperatively by a pathologist. RESULTS: 19 out of 20 positive cases and 10 out of 11 negative ones were classified correctly by SPECT/CT (sensitivity 95 %, specificity 91 %, accuracy 94 %, positive predictive value 95 %, negative predictive value 91 %). Regarding the length of affected bone, no significant difference (p = 0.23) could be observed between SPECT/CT and postoperative obtained values. Both correlated significantly (r = 0.86, p = 0.0001). CONCLUSION: SPECT/CT can safely detect different kinds of inflammatory jaw pathologies compared to other conventional imaging modalities. Lack of specificity of conventional scintigraphy ranging from 17 % to 71 % in earlier studies could be improved by adding CT-analysis. Additionally, SPECT/CT assists the surgeon in determining the expansion of the process (with focus on the length) preoperatively and thereby optimizing surgery planning.

Optical inter-site spin transfer probed by energy and spin-resolved transient absorption spectroscopy.

Optically driven spin transport is the fastest and most efficient process to manipulate macroscopic magnetization as it does not rely on secondary mechanisms to dissipate angular momentum. In the present work, we show that such an optical inter-site spin transfer (OISTR) from Pt to Co emerges as a dominant mechanism governing the ultrafast magnetization dynamics of a CoPt alloy. To demonstrate this, we perform a joint theoretical and experimental investigation to determine the transient changes of the helicity dependent absorption in the extreme ultraviolet spectral range. We show that the helicity dependent absorption is directly related to changes of the transient spin-split density of states, allowing us to link the origin of OISTR to the available minority states above the Fermi level. This makes OISTR a general phenomenon in optical manipulation of multi-component magnetic systems.

Elevated expression of the metalloproteinase ADAM8 associates with vascular diseases in mice and humans.

BACKGROUND AND AIMS: Members of the family of a disintegrin and metalloproteinases (ADAMs) and their substrates have been previously shown to modulate the inflammatory response in cardiac diseases, but studies investigating the relevance of ADAM8 are still rare. Our aim is to provide evidence for the inflammatory dysregulation of ADAM8 in vascular diseases and its association with disease severity. METHODS: Western-type diet fed Apoe-/- and Ldlr-/- mice and artery ligation served as murine model for atherosclerosis and myocardial infarction, respectively. Human bypass grafts were used to study the association with coronary artery disease (CAD), with the simplified acute physiology score II (SAPS II) as a measure of postoperative organ dysfunction. Human primary vascular and blood cells were analyzed under basal and inflammatory conditions. mRNA levels were determined by RT-qPCR, ADAM8 protein levels by ELISA, immunohistochemistry or flow cytometry. RESULTS: ADAM8/ADAM8 expression is associated with atherosclerosis and CAD such as myocardial infarction in both mice and humans, especially in endothelial cells and leukocytes. We observed a strong in vivo and in vitro correlation of ADAM8 with the vascular disease markers VCAM-1, ICAM-1, TNF, IL-6, and CCL-2. Serum analysis revealed a significant elevation of soluble ADAM8 serum levels correlating with soluble CXCL16 levels and SAPS II. CONCLUSIONS: We demonstrate a general association of ADAM8 with cardiovascular diseases in mice and humans predominantly acting in endothelial cells and leukocytes. The correlation with postoperative organ dysfunctions in CAD patients highlights the value of further studies investigating the specific function of ADAM8 in cardiovascular diseases.

Ultrafast and Energy-Efficient Quenching of Spin Order: Antiferromagnetism Beats Ferromagnetism.

By comparing femtosecond laser pulse induced ferro- and antiferromagnetic dynamics in one and the same material-metallic dysprosium-we show both to behave fundamentally different. Antiferromagnetic order is considerably faster and much more efficiently reduced by optical excitation than its ferromagnetic counterpart. We assign the fast and extremely efficient process in the antiferromagnet to an interatomic transfer of angular momentum within the spin system. Our findings imply that this angular momentum transfer channel is effective in other magnetic metals with nonparallel spin alignment. They also point out a possible route towards energy-efficient spin manipulation for magnetic devices.

Time-resolved soft X-ray absorption spectroscopy in transmission mode on liquids at MHz repetition rates.

We present a setup combining a liquid flatjet sample delivery and a MHz laser system for time-resolved soft X-ray absorption measurements of liquid samples at the high brilliance undulator beamline UE52-SGM at Bessy II yielding unprecedented statistics in this spectral range. We demonstrate that the efficient detection of transient absorption changes in transmission mode enables the identification of photoexcited species in dilute samples. With iron(II)-trisbipyridine in aqueous solution as a benchmark system, we present absorption measurements at various edges in the soft X-ray regime. In combination with the wavelength tunability of the laser system, the set-up opens up opportunities to study the photochemistry of many systems at low concentrations, relevant to materials sciences, chemistry, and biology.

Versatile soft X-ray-optical cross-correlator for ultrafast applications.

We present an X-ray-optical cross-correlator for the soft ([Formula: see text]) up to the hard X-ray regime based on a molybdenum-silicon superlattice. The cross-correlation is done by probing intensity and position changes of superlattice Bragg peaks caused by photoexcitation of coherent phonons. This approach is applicable for a wide range of X-ray photon energies as well as for a broad range of excitation wavelengths and requires no external fields or changes of temperature. Moreover, the cross-correlator can be employed on a 10 ps or 100 fs time scale featuring up to 50% total X-ray reflectivity and transient signal changes of more than 20%.

Analysis of the halo background in femtosecond slicing experiments.

The slicing facility FemtoSpeX at BESSY II offers unique opportunities to study photo-induced dynamics on femtosecond time scales by means of X-ray magnetic circular dichroism, resonant and non-resonant X-ray diffraction, and X-ray absorption spectroscopy experiments in the soft X-ray regime. Besides femtosecond X-ray pulses, slicing sources inherently also produce a so-called `halo' background with a different time structure, polarization and pointing. Here a detailed experimental characterization of the halo radiation is presented, and a method is demonstrated for its correct and unambiguous removal from femtosecond time-resolved data using a special laser triggering scheme as well as analytical models. Examples are given for time-resolved measurements with corresponding halo correction, and errors of the relevant physical quantities caused by either neglecting or by applying a simplified model to describe this background are estimated.

Monte Carlo Modeling of Computed Tomography Ceiling Scatter for Shielding Calculations.

Radiation protection for clinical staff and members of the public is of paramount importance, particularly in occupied areas adjacent to computed tomography scanner suites. Increased patient workloads and the adoption of multi-slice scanning systems may make unshielded secondary scatter from ceiling surfaces a significant contributor to dose. The present paper expands upon an existing analytical model for calculating ceiling scatter accounting for variable room geometries and provides calibration data for a range of clinical beam qualities. The practical effect of gantry, false ceiling, and wall attenuation in limiting ceiling scatter is also explored and incorporated into the model. Monte Carlo simulations were used to calibrate the model for scatter from both concrete and lead surfaces. Gantry attenuation experimental data showed an effective blocking of scatter directed toward the ceiling at angles up to 20-30° from the vertical for the scanners examined. The contribution of ceiling scatter from computed tomography operation to the effective dose of individuals in areas surrounding the scanner suite could be significant and therefore should be considered in shielding design according to the proposed analytical model.

Radiation dose efficiency of dual-energy CT benchmarked against single-source, kilovoltage-optimized scans.

OBJECTIVE: This study evaluated the radiation dose and image quality implications of dual-energy CT (DECT) use, compared with kilovoltage-optimized single-source/single-energy CT (SECT) on a dual-source Siemens Somatom(®) Definition Flash CT scanner (Siemens Healthcare, Forcheim, Germany). METHODS: With equalized radiation dose (volumetric CT dose index), image noise (standard deviation of CT number) and signal-difference-to-noise ratio (SDNR) were measured and compared across three techniques: 100, 120 and 100/140 kVp (dual energy). Noise in a 30-cm-diameter water phantom and SDNR within unenhanced soft-tissue regions of a small adult (50 kg/165 cm) anthropomorphic phantom were utilized for the assessment. RESULTS: Water phantom image noise decreased with DECT compared with the lower noise SECT setting of 120 kVp (p = 0.046). A decrease in SDNR within the anthropomorphic phantom was demonstrated at 120 kVp compared with the SECT kilovoltage-optimized setting of 100 kVp (p = 0.001). A further decrease in SDNR was observed for the DECT technique when compared with 120 kVp (p = 0.01). CONCLUSION: On the Siemens Somatom Definition Flash system (Siemens Healthcare), and for equalized radiation dose conditions, image quality expressed as SDNR of unenhanced soft tissue may be compromised for DECT when compared with kilovoltage-optimized SECT, particularly for smaller patients. ADVANCES IN KNOWLEDGE: DECT on a dual-source CT scanner may require a radiation dose increase to maintain unenhanced soft-tissue contrast detectability, particularly for smaller patients.

Radiation protection methods for the interventionalist's hands: use of an extension tube.

PURPOSE: Cumulative radiation exposure to the hands during certain interventional procedures may be high. It is important to decrease the amount of radiation to the operator due to the possibility of deterministic effects. We performed a pilot study to demonstrate a significant decrease in operator dose when using extension tubing (ET) in combination with shielding and collimation during a simulated percutaneous transhepatic cholangiogram (PTC) procedure. METHODS: A whole body, anthropomorphic phantom was used to simulate the patient. A Unfors-Xi Survey detector (to measure scatter) supported by a retort stand and trolley was placed in various positions to simulate the position of hands and eyes/thyroid of an interventionalist. Radiation dose was measured simulating left and right-sided PTC punctures with and without a lead shield, and with and without ET. RESULTS: Regarding the radiation dose to the hands; the use of an ET reduces dose by 54 % in right-sided PTC punctures without a shield and by 91 % if used in combination with a shield. For left-sided PTC punctures, ET reduces hand dose by 75 %. The use of collimation decreases hand dose by approximately 60 %. The use of shielding reduces dose to the eyes/thyroid by 98 %. CONCLUSIONS: The dose to the hands can be significantly reduced with the appropriate use of a shield, ET, and tight collimation. The use of a shield is paramount to reduce dose to the eyes/thyroid. It is important for interventionalists to adhere to radiation protective practice considering the potential deterministic effects during a lifelong career.

Localized excited charge carriers generate ultrafast inhomogeneous strain in the multiferroic BiFeO3.

We apply ultrafast x-ray diffraction with femtosecond temporal resolution to monitor the lattice dynamics in a thin film of multiferroic BiFeO3 after above-band-gap photoexcitation. The sound-velocity limited evolution of the observed lattice strains indicates a quasi-instantaneous photoinduced stress which decays on a nanosecond time scale. This stress exhibits an inhomogeneous spatial profile evidenced by the broadening of the Bragg peak. These new data require substantial modification of existing models of photogenerated stresses in BiFeO3: the relevant excited charge carriers must remain localized to be consistent with the data.