Extracorporeal Cardiac Shock Wave Therapy Ameliorates Clinical Symptoms and Improves Regional Myocardial Blood Flow in a Patient with Severe Coronary Artery Disease and Refractory Angina

Different therapeutic options are being used for chronic coronary artery disease (CAD). We report about a 51-year-old female with CAD and refractory angina pectoris despite maximally tolerated medical therapy and after both percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG). The patient received cardiac shock wave therapy (CSWT) over a period of 6 month. There was no arrhythmia during or after treatment; enzyme levels were normal at all times. PET imaging showed a substantial improvement of myocardial stress perfusion. Since the patient reported that she now was fully capable to deal with her everyday life, further treatment options were postponed. Our case report suggests that ultrasound-guided CSWT is able to improve symptoms and perfusion in ischemic myocardium

A comparative co-simulation analysis to improve the sustainability of cogeneration-based district multi-energy systems using photovoltaics, power-to-heat, and heat storage

For an extensive decarbonization of district multi-energy systems, efforts are needed that go beyond today\u27s cogeneration of heat and power in district multi-energy systems. The multitude of existing technical possibilities are confronted with a large variety of existing multi-energy system configurations. The variety impedes the development of universal decarbonization pathways. In order to tackle the decarbonization challenge in existing and distinct districts, this paper calculates a wide range of urban district configurations in an extensive co-simulation based on domain specific submodels. A district multi-energy system comprising a district heating network, a power grid, and cogeneration is simulated for two locations in Germany with locally captured weather data, and for a whole year with variable parameters to configure a power-to-heat operation, building insolation/refurbishment, rooftop photovoltaic orientation, future energy demand scenarios, and district sizes with a temporal resolution of 60 seconds, in total 3840 variants. The interdependencies and synergies between the electrical low-voltage distribution grid and the district heating network are analysed in terms of efficiency and compliance with network restrictions. Thus, important sector-specific simulations of the heat and the electricity sector are combined in a holistic district multi-energy system co-simulation. The clearly most important impact on emission reduction and fuel consumption is a low heat demand, which can be achieved through thermal refurbishment of buildings. Up to \SI{46}{\percent} reduction in $CO_2$ emissions are possible using the surplus electricity from photovoltaics for power-to-heat in combination with central heat storage in the district\u27s combined heat and power plant. Domestic hot water heated by district heating network in combination with power-to-heat conversion distributed in the district reduces the load on the distribution power grid. Even though the investigated measures already improve the sustainability significantly, providing the energy needed for the production of synthetic fuels remains the crucial challenge on the further path towards net-zero