Delayed improvement of depression and anxiety after transcatheter aortic valve implantation (TAVI) in stages of extended extra-valvular cardiac damage

Background: Depression and anxiety are frequently occurring and likely to be linked to the severity of cardiac diseases like aortic stenosis (AS). This seems to be of interest since a staging classification of extra-valvular cardiac damage in AS has been introduced and shown to be of prognostic relevance. Objective: The current study aimed to investigate the frequency of depression and anxiety in association to staging and their dynamics after transcatheter aortic valve implantation (TAVI). Methods: A total number of 224 AS patients undergoing TAVI were classified according to the 2017 staging classification into stage 0 to 4 and further dichotomized into group A (stage 0 to 2) and B (stage 3 and 4). Using the Hospital Anxiety and Depression Scale (HADS-D), patients were assigned to depressive versus non-depressive or anxious versus non-anxious per staging group respectively, and analyzed at baseline, 6 weeks, 6 months and 12 months after TAVI. Results: After dichotomization, 158 patients (70.5%) were assigned to group A and 66 patients (29.5%) to group B. The part showing pathologic values for depression was 25.4% (57/224 patients) in the entire collective, 26.6% (42/158 patients) in group A and 22.7% (15/66 patients) in group B (p = n.s.). The proportion showing pathologic values for anxiety was 26.8% (60/224 patients) in the entire collective and did not differ between group A (24.7%, 39/158 patients) and B (31.8%, 21/66 patients) (p = n.s.). In patients revealing pathologic values for depression or anxiety prior to TAVI, there were significant and stable improvements over time observable already in short-term (6 weeks) follow-up in group A, and likewise, but later, in long-term (6/12 months) follow-up in group B. Conclusions: Although of proven prognostic relevance, higher stages of extra-valvular cardiac damage are not associated with higher rates of pre-existing depression or anxiety. The TAVI procedure resulted in a persisting reduction of depression and anxiety in patients showing pathologic values at baseline. Notably, these improvements are timely delayed in higher stage

Artifical compound eyes - Different concepts and their application to ultra flat image acquisition sensors

Two different approaches for ultra flat image acquisition sensors on the basis of artificial compound eyes are examined. In apposition optics the image reconstruction is based on moiré- or static sampling while the superposition eye approach produces an overall image. Both types of sensors are compared with respect to theoretical limitations of resolution, sensitivity and system thickness. Explicit design rules are given. A paraxial 3×3 matrix formalism is used to describe the arrangement of three microlens arrays with different pitches to find first order parameters of artificial superposition eyes. The model is validated by analysis of the system with raytracing software. Measurements of focal length of anamorphic reflow lenses, which are key components of the superposition approach, under oblique incidence are performed. For the second approach, the artificial apposition eye, a first demonstrator system is presented. The monolithic device consists of a UV-replicated reflow microlens array on a thin silica-substrate with a pinhole array in a metal layer on the backside. The pitch of the pinholes differs from the lens array pitch to enable an individual viewing angle for each channel. Imaged test patterns are presented and measurements of the angular sensitivity function are compared to calculations using commercial raytracing software

Rationale and Design of JenaMACS—Acute Hemodynamic Impact of Ventricular Unloading Using the Impella CP Assist Device in Patients with Cardiogenic Shock

Introduction: Cardiogenic shock due to myocardial infarction or heart failure entails a reduction in end organ perfusion. Patients who cannot be stabilized with inotropes and who experience increasing circulatory failure are in need of an extracorporeal mechanical support system. Today, small, percutaneously implantable cardiac assist devices are available and might be a solution to reduce mortality and complications. A temporary, ventricular, continuous flow propeller pump using magnetic levitation (Impella ® ) has been approved for that purpose. Methods and Study Design: JenaMACS (Jena Mechanical Assist Circulatory Support) is a monocenter, proof-of-concept study to determine whether treatment with an Impella CP ® leads to improvement of hemodynamic parameters in patients with cardiogenic shock requiring extracorporeal, hemodynamic support. The primary outcomes of JenaMACS are changes in hemodynamic parameters measured by pulmonary artery catheterization and changes in echocardiographic parameters of left and right heart function before and after Impella ® implantation at different support levels after 24 h of support. Secondary outcome measures are hemodynamic and echocardiographic changes over time as well as clinical endpoints such as mortality or time to hemodynamic stabilization. Further, laboratory and clinical safety endpoints including severe bleeding, stroke, neurological outcome, peripheral ischemic complications and occurrence of sepsis will be assessed. JenaMACS addresses essential questions of extracorporeal, mechanical, cardiac support with an Impella CP ® device in patients with cardiogenic shock. Knowledge of the acute and subacute hemodynamic and echocardiographic effects may help to optimize therapy and improve the outcome in those patients. Conclusion: The JenaMACS study will address essential questions of extracorporeal, mechanical, cardiac support with an Impella CP ® assist device in patients with cardiogenic shock. Knowledge of the acute and subacute hemodynamic and echocardiographic effects may help to optimize therapy and may improve outcome in those patients. Ethics and Dissemination: The protocol was approved by the institutional review board and ethics committee of the University Hospital of Jena. Written informed consent will be obtained from all participants of the study. The results of this study will be published in a renowned international medical journal, irrespective of the outcomes of the study. Strengths and Limitations: JenaMACS is an innovative approach to characterize the effect of additional left ventricular mechanical unloading during cardiogenic shock via a minimally invasive cardiac assist system (Impella CP ® ) 24 h after onset and will provide valuable data for acute interventional strategies or future prospective trials. However, JenaMACS, due to its proof-of-concept design, is limited by its single center protocol, with a small sample size and without a comparison group

Paper No S16.2. See-through multiaperture near-to-eye display with waveguide

We describe design and manufacturing of a multiaperture near-to-eye (N2E) display, establish design rules, and discuss relevant properties in comparison with traditional single-aperture devices. A grating-coupled waveguide shifts the image laterally toward the eve-motion box and enables see-through functionality using the zeroth diffraction order of the outcoupling grating

Array projection optics. Multi-channel design for ultra slim projectors

Common projection optics use a single aperture approach to create a magnified image on a screen. The transmitted flux of such systems always scales with their system dimensions thus preventing the realization of ultra compact devices along with a high lumen output. We introduce a new multi-channel approach that breaks this rule and enables the realization of ultra slim, laterally extended projection devices with high flux and integrated homogenization. Array projection optics consists of a regular two-dimensional arrangement of projective microlenses superposing their images on the screen. First we derive the scaling laws of such a multi-channel projector in contrast to common single aperture optics and analyze the system parameters of a single projection channel by Seidel aberration theory. Based on the application of these results to a variable array size the array projection optics are specified. The technological realization of a sample system with still image projection is shown and characterized with respect to modulation transfer and flux

Realization of a vertical integration scheme for polymer waveguides by a novel stacking technology

The rapid growth of communication continuously demands an increasing number of data transport channels. We present an approach towards a substantial growth of channel numbers within the integrated optical waveguide chip. This is accomplished by introducing a vertical integration scheme, which is implemented with stacked polymer waveguides. To meet the requirements of stacked optical waveguide devices concerning index distributions, cross-sections and alignment precision, a novel fabrication technology has been developed. During the stacking process several fundamental problems, e.g., index inhomogenities caused by diffusion effects and distortion of the desired waveguide structures with increasing stack height, have to be avoided. In addition, the non-linear index change of the polymer materials during polymerization has to be carefully considered to come to well defined index distributions, which are the same in all layers. A solution meeting these requirements is presented using st andard processes like UV patterning in combination with thermal curing steps

Evaluation of lenslet fabrication technologies for micro-optical array projectors

Micro-optical array projectors are discussed as replacement for structured illumination in applications with critical space requirements. The concept bases on the fly’s eye condenser principle and a well-defined buried array of micro-dia. Their optical performance benefits from etendue conservation and the large depth of field of applied short focal lenses. As an established technique to generate microlens profiles, thermal reflow of binary patterned photoresist is known for more than three decades. This approach leads to lens arrays with filling factors up to ~90% when used in hexagonal arrangement. Further increment requires direct writing methods such as grayscale lithography. Recently a LED based projection stepper-like lithography system became competitive, because it allows structure depths beyond 50 microns. It utilizes an LCoS micro-imager as variable 8-bit reticle and a high dynamic dosage controlled illumination. This paper represents the evaluation of the technique for the generation of refractive lens profiles by means of metrology and optical performance of micro-optical array projectors. Micro-array projectors based on circular lenslets will be compared, followed by the analysis of closely packed square-shaped lenslets. The aim is to understand the impact of lens shape deviation, conical constant or statistical distribution of lens properties like sag height, radius of curvature on the projection. A correlation of imperfections and quality loss due to scattering, aberrations, and mismatch of images in the overlay of different projectorlets will be given. The work concludes with an outlook on further developments in mastering micro-optical profiles for illumination application