Management of acute and chronic aortic disease during the COVID-19 pandemic\u2014Results from a web-based ad hoc platform

Background: To share the results of a web-based expert panel discussion focusing on the management of acute and chronic aortic disease during the coronavirus (COVID-19) pandemic. Methods: A web-based expert panel discussion on April 18, 2020, where eight experts were invited to share their experience with COVID-19 disease touching several aspects of aortic medicine. After each talk, specific questions were asked by the online audience, and results were immediately evaluated and shared with faculty and participants. Results: As of April 18, 73.3% answered that more than 200 patients have been treated at their respective settings. Sixty-four percent were reported that their hospital was well prepared for the pandemic. In 57.7%, the percentage of infected healthcare professionals was below 5% whereas 19.2% reported the percentage to be between 10% and 20%. Sixty-seven percent reported the application of extracorporeal membrane oxygenation in less than 2% of COVID-19 patients whereas 11.8% reported application in 5%\u201310% of COVID-19 patients. Thirty percent of participants reported the occurrence of pulmonary embolism in COVID-19 patients. Three percent reported to have seen aortic ruptures in primarily elective patients having been postponed because of the anticipated need to provide sufficient ICU capacity because of the pandemic. Nearly 70% reported a decrease in acute aortic syndrome referrals since the start of the pandemic. Conclusion: The current COVID-19 pandemic has\u2014besides the stoppage of elective referrals\u2014also led to a decrease of referrals of acute aortic syndromes in many settings. The reluctance of patients seeking medical help seems to be a major driver. The number of patients, who have been postponed due to the provisioning of ICU resources but having experienced aortic rupture in the waiting period, is still low. Further, studies are needed to learn more about the influence that the COVID-19 pandemic has on the treatment of patients with acute and chronic aortic disease

Coherent Imaging of Biological Samples with Femtosecond Pulses at the Free Electron Laser FLASH

Coherent x-ray imaging represents a new window to imaging noncrystalline, biological specimens at unprecedented resolutions. The advent offree-electron lasers (FEL) allows extremely high flux densities to be delivered to a specimen resulting in stronger scattered signal from these samples to be measured. In the best case scenario, the diffraction pattern is measured before the sample is destroyed by these intense pulses, as the processes involved in radiation damage may be substantially slower than the pulse duration. In this case, the scattered signal can be interpreted and reconstructed to yield a faithful image of the sample at a resolution beyond the conventional radiation damage limit. We employ coherent x-ray diffraction imaging (CXDI) using the free-electron LASer in Hamburg (FLASH) in a non-destructive regime to compare images ofa biological sample reconstructed using different, single, femtosecond pulses of FEL radiation. Furthermore, for the first time, we demonstrate CXDI, in-line holography and Fourier transform holography (FTH) of the same unicellular marine organism using an FEL and present diffraction data collected using the third harmonic of FLASH, reaching into the water window. We provide quantitative results for the resolution of the CXDI images as a function of pulse intensity, and compare this with the resolutions achieved with in-line holography and FTH

Validation of transpulmonary thermodilution variables in hemodynamically stable patients with heart diseases

BACKGROUND Transpulmonary thermodilution is recommended in the treatment of critically ill patients presenting with complex shock. However, so far it has not been validated in hemodynamically stable patients with heart disease. METHODS We assessed the validity of cardiac output, global end-diastolic volume index (GEDVI), an established marker of preload thought to reflect the volume of all four heart chambers, global ejection fraction (GEF) and cardiac function index (CFI) as variables of cardiac function, and extravascular lung water index (EVLWI) as indicator of pulmonary edema in 29 patients undergoing elective left and right heart catheterization including left ventricular angiography with stable coronary heart disease and normal cardiac function (controls, n = 11), moderate-to-severe aortic valve stenosis (AS, n = 10), or dilated cardiomyopathy (DCM, n = 8). RESULTS Cardiac output was similar in controls, AS, and DCM, with good correlation between transpulmonary thermodilution and pulmonary artery catheter using the Fick method (r = 0.69, p < 0.0001). Left ventricular end-diastolic volume was normal in controls and AS, but significantly higher in DCM (104 ± 37 vs 135 ± 63 vs 234 ± 24 ml, p < 0.01). GEDVI did not differentiate between patients with normal and patients with enlarged left ventricular end-diastolic volume (848 ± 128 vs 882 ± 213 ml m-2, p = 0.60). No difference in GEF and CFI was found between patients with normal and patients with reduced left ventricular ejection fraction. Patients with AS but not DCM had higher EVLWI than controls (9 ± 2 vs 12 ± 4 vs 11 ± 3 ml kg-1, p = 0.04), while there was only a trend in pulmonary artery occlusion pressure (8 ± 3 vs 10 ± 5 vs 14 ± 7 mmHg, p = 0.05). CONCLUSIONS Cardiac output measurement by transpulmonary thermodilution is unaffected by differences in ventricular size and outflow obstruction. However, GEDVI did not identify markedly enlarged left ventricular end-diastolic volumes, and neither GEF nor CFI reflected the increased heart chamber volumes and markedly impaired left ventricular function in patients with DCM. In contrast, EVLWI is probably a sensitive marker of subclinical pulmonary edema particularly in patients with elevated left-ventricular-filling pressure irrespective of differences in left ventricular function

Digital In-line Holography with femtosecond VUV radiation provided by the Free-electron laser FLASH

Femtosecond vacuum ultraviolet (VUV) radiation provided by the free-electron laser FLASH was used for digital in-line holographic microscopy and applied to image particles, diatoms and critical point dried fibroblast cells. To realize the classical in-line Gabor geometry, a 1 microm pinhole was used as spatial filter to generate a divergent light cone with excellent pointing stability. At a fundamental wavelength of 8 nm test objects such as particles and diatoms were imaged at a spatial resolution of 620 nm. In order to demonstrate the applicability to biologically relevant systems, critical point dried rat embryonic fibroblast cells were for the first time imaged with free-electron laser radiation

Resonant Magnetic Scattering with Soft X-ray Pulses from a Free-Electron Laser Operating at 1.59 nm.

We report on a resonant magnetic scattering experiment using soft x-ray pulses generated from a free-electron laser (FEL). The free-electron laser was operated at a fundamental wavelength of 7.97 nm and radiation at the fifth harmonic originating from self-amplified stimulated emission at 1.59 nm with an average energy of 4 nJ per pulse was detected. We demonstrate the feasibility of resonant magnetic scattering at FEL sources by using a Co/Pd multilayer as prototype sample that was illuminated with 20-fs-long soft x-ray pulses tuned to the Co L3 absorption edge at 778.1 eV (1.59 nm)