Two phase-matching regimes in high-order harmonic generation.

High-order harmonic generation (HHG) provides scalable sources of coherent extreme ultraviolet radiation with pulse duration down to the attosecond time scale. Efficient HHG requires the constructive interplay between microscopic and macroscopic effects in the generation volume, which can be achieved over a large range of experimental parameters from the driving field properties to those of the generating medium. Here, we present a systematic study of the harmonic yield as a function of gas pressure and medium length. Two regimes for optimum yield are identified, supporting the predictions of a recently proposed analytical model. Our observations are independent on the focusing geometry and, to a large extent, on the pulse duration and laser intensity, providing a versatile approach to HHG optimization.

Quantum Optical Signatures in a Strong Laser Pulse after Interaction with Semiconductors.

Electrodynamical processes induced in complex systems like semiconductors by strong electromagnetic fields have traditionally been described using semiclassical approaches. Although these approaches allowed the investigation of ultrafast dynamics in solids culminating in multipetahertz electronics, they do not provide any access to the quantum-optical nature of the interaction, as they treat the driving field classically and unaffected by the interaction. Here, using a full quantum-optical approach, we demonstrate that the subcycle electronic response in a strongly driven semiconductor crystal is imprinted in the quantum state of the driving field resulting in nonclassical light states carrying the information of the interaction. This vital step towards strong-field ultrafast quantum electrodynamics unravels information inaccessible by conventional approaches and leads to the development of a new class of nonclassical light sources.

[Therapy of cardiogenic shock : A success story of German cardiology]. / Therapie des kardiogenen Schocks : Eine Erfolgsgeschichte der deutschen Kardiologie.

In contrast to the situation in the 1960s and 1970s, the mortality risk for patients with myocardial infarction has been clearly reduced, particularly for those with myocardial infarction with cardiogenic shock (MICS). Approximately 5­10 % of patients with a myocardial infarction are affected by a MICS and the mortality risk is between 30 % and 50 %. The primary percutaneous coronary intervention with stent implantation should be carried out as quickly as possible in order to reduce the mortality to around 20 %. This article gives an overview of the currently available options for conservative and fibrinolytic treatment of MICS, of the interventional treatment of cardiogenic shock in the era of intravenous and intracoronary infarct treatment as well as without thrombolysis. In addition, the currently available mechanical support systems and the possibilities for surveillance and monitoring of patients are presented.

Spatial Properties of High-Order Harmonic Beams from Plasma Mirrors: A Ptychographic Study.

Spatial properties of high-order harmonic beams produced by high-intensity laser-matter interactions carry rich information on the physics of the generation process, and their detailed understanding is essential for applications of these light beams. We present a thorough study of these properties in the case of harmonic generation from plasma mirrors, up to the relativistic interaction regime. In situ ptychographic measurements of the amplitude and phase spatial profiles of the different harmonic orders in the target plane are presented, as a function of the key interaction parameters. These measurements are used to validate analytical models of the harmonic spatial phase in different generation regimes, and to benchmark ultrahigh-order Maxwell solvers of particle-in-cell simulation codes.

Dual spectral-band interferometry for spatio-temporal characterization of high-power femtosecond lasers.

We present and demonstrate a technique called RED-SEA TADPOLE for the spatio-temporal characterization of high peak power femtosecond lasers. It retains the basic principle of an existing method, where a scanning monomode fiber is utilized in an interferometric scheme to measure the spectral amplitude and phase at all points across an ultrashort laser beam. We combine this approach with dual spectral-band interferometry, to correct for all phase errors occurring in this interferometer, thus allowing for the simultaneous measurement of the beam wavefront and pulse front in a collimated beam of large diameter. The generic phase correction procedure implemented here can also be extended to other fiber optic device applications sensitive to phase fluctuations.

Optically controlled solid-density transient plasma gratings.

A general approach for optically controlled spatial structuring of overdense plasmas generated at the surface of initially plain solid targets is presented. We demonstrate it experimentally by creating sinusoidal plasma gratings of adjustable spatial periodicity and depth, and study the interaction of these transient structures with an ultraintense laser pulse to establish their usability at relativistically high intensities. We then show how these gratings can be used as a "spatial ruler" to determine the source size of the high-order harmonic beams produced at the surface of an overdense plasma. These results open new directions both for the metrology of laser-plasma interactions and the emerging field of ultrahigh intensity plasmonics.

Direct observation of density-gradient effects in harmonic generation from plasma mirrors.

High-order harmonics and attosecond pulses of light can be generated when ultraintense, ultrashort laser pulses reflect off a solid-density plasma with a sharp vacuum interface, i.e., a plasma mirror. We demonstrate experimentally the key influence of the steepness of the plasma-vacuum interface on the interaction, by measuring the spectral and spatial properties of harmonics generated on a plasma mirror whose initial density gradient scale length L is continuously varied. Time-resolved interferometry is used to separately measure this scale length.

Short intense laser pulse collapse in near-critical plasma.

It is observed that the interaction of an intense ultrashort laser pulse with a near-critical gas jet results in the pulse collapse and the deposition of a significant fraction of the energy. This deposition happens in a small and well-localized volume in the rising part of the gas jet, where the electrons are efficiently accelerated and heated. A collisionless plasma expansion over ~ 150 µm at a subrelativistic velocity (~ c/3) has been optically monitored in time and space, and attributed to the quasistatic field ionization of the gas associated with the hot electron current. Numerical simulations in good agreement with the observations suggest the acceleration in the collapse region of relativistic electrons, along with the excitation of a sizable magnetic dipole that sustains the electron current over several picoseconds.

Anticorrelation between ion acceleration and nonlinear coherent structures from laser-underdense plasma interaction.

In laser-plasma experiments, we observed that ion acceleration from the Coulomb explosion of the plasma channel bored by the laser is prevented when multiple plasma instabilities, such as filamentation and hosing, and nonlinear coherent structures (vortices or postsolitons) appear in the wake of an ultrashort laser pulse. The tailoring of the longitudinal plasma density ramp allows us to control the onset of these instabilities. We deduced that the laser pulse is depleted into these structures in our conditions, when a plasma at about 10% of the critical density exhibits a gradient on the order of 250 µm (Gaussian fit), thus hindering the acceleration. A promising experimental setup with a long pulse is demonstrated enabling the excitation of an isolated coherent structure for polarimetric measurements and, in further perspectives, parametric studies of ion plasma acceleration efficiency.

Superior Photo-thermionic electron Emission from Illuminated Phosphorene Surface.

This work demonstrates that black phosphorene, a two dimensional allotrope of phosphorus, has the potential to be an efficient photo-thermionic emitter. To investigate and understand the novel aspects we use a combined approach in which ab initio quantum simulation tools are utilized along with semiclassical description for the emission process. First by using density functional theory based formalism, we study the band structure of phosphorene. From the locations of electronic bands, and band edges, we estimate the Fermi level and work function. This leads us to define a valid material specific parameter space and establish a formalism for estimating thermionic electron emission current from phosphorene. Finally we demonstrate how the emission current can be enhanced substantially under the effect of photon irradiation. We observe that photoemission flux to strongly dominate over its coexisting counterpart thermionic emission flux. Anisotropy in phosphorene structure plays important role in enhancing the flux. The approach which is valid over a much wider range of parameters is successfully tested against recently performed experiments in a different context. The results open up a new possibility for application of phosphorene based thermionic and photo-thermionic energy converters.

Detailed Experimental Study of Ion Acceleration by Interaction of an Ultra-Short Intense Laser with an Underdense Plasma.

Ion acceleration from intense (Iλ(2) > 10(18) Wcm(-2) µm(2)) laser-plasma interaction is experimentally studied within a wide range of He gas densities. Focusing an ultrashort pulse (duration ion plasma period) on a newly designed submillimetric gas jet system, enabled us to inhibit total evacuation of electrons from the central propagation channel reducing the radial ion acceleration associated with ponderomotive Coulomb explosion, a mechanism predominant in the long pulse scenario. New ion acceleration mechanism have been unveiled in this regime leading to non-Maxwellian quasi monoenergetic features in the ion energy spectra. The emitted nonthermal ion bunches show a new scaling of the ion peak energy with plasma density. The scaling identified in this new regime differs from previously reported studies.

Aortic intramural hemorrhage visualized by transesophageal echocardiography: findings and prognostic implications.

OBJECTIVES: This study describes the transesophageal echocardiographic and follow-up findings in patients with aortic intramural hemorrhage. BACKGROUND: Localized aortic intramural hemorrhage resulting in layered thickening of the aortic wall seems to represent a variant of acute aortic dissection without communication or a typical moving intimal flap. In autopsy studies this variant, attributed to a rupture of the vasa vasorum, has been described in 5% to 10% of patients with dissection. METHODS: In a prospective transesophageal echocardiographic study in patients with aortic dissection performed between 1986 and 1991, the diagnosis of intramural hemorrhage was established in 15 of 114 patients and either confirmed anatomically (7 patients) with an additional diagnostic imaging technique or on the basis of clear follow-up changes (8 patients). RESULTS: Elderly patients (mean age 70 years) with a history of hypertension were affected by this variant of dissection. The ascending aorta was involved in 3 patients and the descending aorta in 12. The longitudinal extent varied between 3 and 20 cm, and wall thickness varied between 0.7 and 3 cm. Classic aortic dissection developed in five patients (33%) and rupture in four (27%). Regression of aortic wall thickening was noted in two patients, whereas three patients became asymptomatic without apparent wall changes (33%). Surgery was performed in 5 patients, whereas medical therapy was continued in 10. During a mean follow-up period of 11 months, eight patients (53%) died because of complications of the aortic disease. CONCLUSIONS: Intramural hemorrhage represents a variant of aortic dissection and may be an early finding in patients who develop classic aortic dissection or rupture. Transesophageal echocardiography is an excellent method for the detection of intramural hemorrhage and for monitoring these patients.

The presence of infection-related antiphospholipid antibodies in infective endocarditis determines a major risk factor for embolic events.

OBJECTIVES: The impact of infection-associated antiphospholipid antibodies (APA) on endothelial cell activation, blood coagulation and fibrinolysis was evaluated in patients with infective endocarditis with and without major embolic events. BACKGROUND: An embolic event is a common and severe complication of infective endocarditis. Despite the fact that APAs are known to be associated with infectious diseases, their pathogenic role in infective endocarditis has not been clearly defined. METHODS: The relationship among the occurrence of major embolic events, echocardiographic vegetation size, endothelial cell activation, thrombin generation, fibrinolysis and APA was examined in 91 patients with definite infective endocarditis, including 26 patients with embolic events and 65 control subjects without embolic events. RESULTS: Overall, 14.3% of patients exhibited elevated APA levels. Embolic events occurred more frequently in patients with elevated levels of APA than in patients without (61.5% vs. 23.1%; p = 0.008). Patients with elevated levels of APA showed higher levels of prothrombin-fragment F1 +2 (p = 0.005), plasminogen-activator inhibitor 1 (p = 0.0002), von Willebrand factor (p = 0.002) and lower levels of activated protein C (p = 0.001) than patients with normal levels of APA. Thrombin generation and endothelial cell activation were both positively correlated with levels of APA. The occurrence of elevated APA levels was frequently associated with structural valve abnormalities (p = 0.01) and vegetations >1.3 cm (p = 0.002). CONCLUSIONS: Infection-associated elevated APA levels in patients with infective endocarditis are related to endothelial cell activation, thrombin generation and impairment of fibrinolysis. This may contribute to the increased risk for major embolic events in these patients.

Exercise echocardiography for the evaluation of patients after nonsurgical coronary artery revascularization.

OBJECTIVES: The purpose of this study was to demonstrate the accuracy of stress echocardiography for detecting the progression of coronary artery disease after nonsurgical revascularization. BACKGROUND: The expanding role of nonsurgical coronary revascularization procedures mandates the development of sensitive noninvasive techniques for the detection of recurrent ischemia. METHODS: Bicycle stress echocardiography was performed in a series of 86 patients 6.5 +/- 1.3 months after a revascularization procedure. Seven patients were excluded from analysis because of poor echocardiographic image quality. RESULTS: Digital analysis achieved a sensitivity of 83% for the entire group and a specificity of 85% for stress echocardiographic detection of significant coronary artery disease. Sensitivity was greater in patients with (88%) than in those without (75%) prior myocardial infarction, but this difference did not reach statistical significance. Additional analysis using an increase in end-systolic volume index or a decrease in ejection fraction during stress as an additional marker for ischemia tended to enhance sensitivity (90% for the entire group and 93% for the subgroup with prior myocardial infarction). CONCLUSIONS: Stress echocardiography is a useful and sensitive method for the follow-up of patients undergoing nonsurgical revascularization procedures. The addition of volume determination to routine wall motion analysis may be helpful in patients with prior infarction who have scar tissue that may be difficult to distinguish from an adjacent exercise-induced wall motion abnormality.

Stress echocardiography in hyperthyroidism.

Exertion symptoms occur frequently in subjects with hyperthyroidism. Using stress echocardiography, exercise capacity and global left ventricular function can be assessed noninvasively. To evaluate stress-induced changes in cardiovascular function, 42 patients with untreated thyrotoxicosis were examined using exercise echocardiography. Studies were performed during hyperthyroidism, after treatment with propranolol, and after restoration of euthyroidism. Twenty-two healthy subjects served as controls. Ergometry was performed with patients in a semisupine position using a continuous ramp protocol starting at 20 watts/min. In contrast to control and euthyroidism, the change in end-systolic volume index from rest to maximal exercise was lower in hyperthyroidism. At rest, the stroke volume index, ejection fraction, and cardiac index were significantly increased in hyperthyroidism, but exhibited a blunted response to exercise, which normalized after restoration of euthyroidism. Propranolol treatment also led to a significant increase of delta (delta) stroke volume index. Maximal work load and delta heart rate were markedly lower in hyper- vs. euthyroidism. Compared to the control value, systemic vascular resistance was lowered by 36% in hyperthyroidism at rest, but no further decline was noted at maximal exercise. The delta stroke volume index, delta ejection fraction, delta heart rate, and maximal work load were significantly reduced in severe hyperthyroidism. Negative correlations between free T3 and diastolic blood pressure, maximal work load, delta heart rate, and delta ejection fraction were noted. Thus, in hyperthyroidism, stress echocardiography revealed impaired chronotropic, contractile, and vasodilatatory cardiovascular reserves, which were reversible when euthyroidism was restored.

Ineffective cardiorespiratory function in hyperthyroidism.

Dyspnea on exertion is a common complaint in hyperthyroidism, and this thyroid dysfunction has been implicated as a primary cause of impaired effort tolerance. Using spirometry and spiroergometry, 42 patients with untreated hyperthyroidism were examined, and the condition was controlled 7 days later under propranolol monotherapy, as well as after 6 months in euthyroidism. While hyperthyroid, reduced forced vital capacity and tidal volume at the anaerobic threshold (AT) were observed in comparison to euthyroidism. Decreased oxygen (O2) pulse at AT (7 +/- 0.4 vs. 9.1 +/- 0.4 mL/beat, P = 0.0012) and at maximal exercise was noted in hyperthyroidism and was enhanced under propranolol (8.9 +/- 0.4 mL/beat, P = 0.0001). During exercise, the increment of minute ventilation (16.1 +/- 0.7 vs. 20.2 +/- 1.0 L/min, P = 0.0015), O2 uptake (9 +/- 0.5 vs. 11.4 +/- 0.5 mL/min/kg, P = 0.0022), O2 pulse (4.0 +/- 0.3 vs. 5.6 +/- 0.3 mL/beat, P = 0.0001), and heart rate (53 +/- 2 vs. 65 +/- 3 beat/min, P = 0.0004) was markedly lower in hyper- vs. euthyroidism. Work rate at AT and at maximum was reduced in hyper- vs. euthyroidism (107.4 +/- 3 vs. 141.1 +/- 4 watt, P = 0.0001). Negative correlations between free T3 and O2 pulse at AT (r = -0.59, P = 0.0005), delta O2 uptake (r = -0.54, P = 0.0007), delta minute ventilation (r = -0.48, P = 0.0007), and maximal work rate (r = -0.62, P = 0.0001) were noted. In hyperthyroidism, analysis of respiratory gas exchange showed low efficiency of cardiopulmonary function, respiratory muscle weakness, and impaired exercise capacity, which were reversible in euthyroidism.

Prevalence of myxomatous mitral valve prolapse in patients with lymphocytic thyroiditis.

In conclusion, given the cardiac (mitral regurgitation, endocarditis, thromboembolic complications, arrhythmic sudden death) and neurologic (cerebral embolic event) complications of the pathologic forms of MVP, physicians should look carefully for myxomatous involvement of the mitral valve and prolapse in patients with autoimmune thyroid diseases. Patients should be monitored and prophylactic antibiotic treatment recommended when appropriate.

Measurement of intracardiac dimensions and structures in normal young adult subjects by transesophageal echocardiography.

Transesophageal echocardiography (TEE) has proven to be an excellent diagnostic means of diagnosing different cardiac diseases. To distinguish between normal and pathologic findings, standardized measurements of well-defined cross-sectional planes are necessary. Therefore, the 2-dimensional echocardiographic data of 25 healthy volunteers were obtained. In 13 men and 12 women, aged 19 to 30 years, recordings of the left ventricular short-axis view, the 2- or 4-chamber view with the left and right atria, the long axes of the left and right ventricles, the mitral and tricuspid valve ring and the atrial septum were analyzed. Furthermore, the aortic valve plane and the ascending and descending aorta were also measured. All data are given as mean values +/- 2 times the standard deviation. End-diastolic and end-systolic left ventricular anterior-to-posterior diameter of the left ventricular short axis was 2.5 +/- 0.3 cm/m2 and 1.7 +/- 0.3 cm/m2, with the fractional shortening ranging from 27 to 42%. The end-systolic lateral diameter was 2.4 +/- 0.5 cm/m2 for the left atrium and 2.4 +/- 0.4 cm/m2 for the right atrium, and the end-systolic anterior-to-posterior diameter was 1.5 +/- 0.6 cm/m2 for the left atrium and 2.1 +/- 0.6 cm/m2 for the right atrium. End-diastolic diameters of 3.4 +/- 0.6 cm/m2 and 2.8 +/- 0.4 cm/m2 were obtained for the long axis of the left ventricle and for the right ventricle. Measurements ranged from 1.5 to 2.2 cm/m2 for the end-diastolic diameter of the mitral ring and from 1.3 to 2.0 cm/m2 for the tricuspid ring.(ABSTRACT TRUNCATED AT 250 WORDS)

Cardiac arrhythmias and heart rate in hyperthyroidism.

The arrhythmia profile and heart rate (HR) were analyzed by 24-hour Holter monitoring in 37 hyperthyroid patients before (triiodothyronine [T3] hormone level = 331 +/- 108 ng/dl), during (T3 level = 202 +/- 98 ng/dl) and after an antihyperthyroid therapy of 8 to 89 weeks' duration (T3 level = 149 +/- 41 ng/dl). The data were compared with those of 50 control subjects free from cardiac disease. Only 12 hyperthyroid patients (32%) had complex ventricular arrhythmias (Lown grade 3 or 4) as compared with 6 normal subjects (12%, p greater than 0.05). Three patients (8%) had repetitive ventricular arrhythmias (Lown grade 4A/B) as compared with 4 normal subjects (8%, p greater than 0.05). Supraventricular premature complexes occurred more often in hyperthyroid patients than in normal subjects before and after therapy (p less than 0.001). The prevalence of supraventricular tachycardia decreased from 8 patients to 1 during therapy (p less than 0.002). The HR decreased from 95 +/- 13 to 79 +/- 9 beats/min after therapy, but was still increased as compared with the normal subjects (72 +/- 8 beats/min, p less than 0.001). A day/night difference in HR greater than 10% was found in 32 patients (86%) and was more pronounced than in the normal group (p less than 0.001). Compared with the normal HR profile, the HR curve of hyperthyroid patients was shifted to a higher level (about 20 beats/min). Serum T3 level correlated best with HR at night in hyperthyroid patients (r = 0.74, p less than 0.001). Thus, hyperthyroid patients show frequent supraventricular arrhythmias that might be reversible during therapy.(ABSTRACT TRUNCATED AT 250 WORDS)

Detection of strands in native aortic valves by transesophageal echocardiography.

Prevalence and echocardiographic characteristics of strands on the leaflets of native aortic valves were examined. According to our data, the strands we found in 39% of patients are most likely Lambl's excrescences.