Exploring multi-stability in semiconductor ring lasers: theory and experiment

We report the first experimental observation of multi-stable states in a single-longitudinal mode semiconductor ring laser. We show how the operation of the device can be steered to either monostable, bistable or multi-stable dynamical regimes in a controlled way. We observe that the dynamical regimes are organized in well reproducible sequences that match the bifurcation diagrams of a two-dimensional model. By analyzing the phase space in this model, we predict how the stochastic transitions between multi-stable states take place and confirm it experimentally.Comment: 4 pages, 5 figure

Topological insight into the non-Arrhenius mode hopping of semiconductor ring lasers

We investigate both theoretically and experimentally the stochastic switching between two counter-propagating lasing modes of a semiconductor ring laser. Experimentally, the residence time distribution cannot be described by a simple one parameter Arrhenius exponential law and reveals the presence of two different mode-hop scenarios with distinct time scales. In order to elucidate the origin of these two time scales, we propose a topological approach based on a two-dimensional dynamical system.Comment: 4 pages, 3 figure

Impact of nonlocal interactions in dissipative systems: towards minimal-sized localized structures

In order to investigate the size limit on spatial localized structures in a nonlinear system, we explore the impact of linear nonlocality on their domains of existence and stability. Our system of choice is an optical microresonator containing an additional metamaterial layer in the cavity, allowing the nonlocal response of the material to become the dominating spatial process. In that case, our bifurcation analysis shows that this nonlocality imposes a new limit on the width of localized structures going beyond the traditional diffraction limit.Comment: 4 pages, 4 figure

Inflammation and premature aging in advanced chronic kidney disease

Systemic inflammation in end-stage renal disease (ESRD) is an established risk factor for mortality and a catalyst for other complications which are related to a premature aging phenotype, including muscle wasting, vascular calcification and other forms of premature vascular disease, depression, osteoporosis and frailty. Uremic inflammation is also mechanistically related to mechanisms involved in the aging process, such as telomere shortening, mitochondrial dysfunction, and altered nutrient sensing, which can have direct effect on cellular and tissue function. In addition to uremia-specific causes such as abnormalities in the phosphate- Klotho axis, there are remarkable similarities between the pathophysiology of uremic inflammation and so-called "inflammaging" in the general population. Potentially relevant, but still somewhat unexplored in this respect are abnormal or misplaced protein structures as well as abnormalities in tissue homeostasis, which evoke danger signals through damage associated molecular patters (DAMPS) as well as the senescence associated secretory phenotype (SASP). Systemic inflammation, in combination with the loss of kidney function, can impair the resilience of the body to external and internal stressors by reduced functional and structural tissue reserve, and by impairing normal organ crosstalk, thus providing an explanation for the greatly increased risk of homeostatic breakdown in this population. In this review, the relation between uremic inflammation and a premature aging phenotype, as well as potential causes and consequences are discussed

Estimation of Muscle Mass in the Integrated Assessment of Patients on Hemodialysis

Assessment of muscle mass (MM) or its proxies, lean tissue mass (LTM) or fat-free mass (FFM), is an integral part of the diagnosis of protein-energy wasting (PEW) and sarcopenia in patients on hemodialysis (HD). Both sarcopenia and PEW are related to a loss of functionality and also increased morbidity and mortality in this patient population. However, loss of MM is a part of a wider spectrum, including inflammation and fluid overload. As both sarcopenia and PEW are amendable to treatment, estimation of MM regularly is therefore of major clinical relevance. Whereas, computer-assisted tomography (CT) or dual-energy X-ray absorptiometry (DXA) is considered a reference method, it is unsuitable as a method for routine clinical monitoring. In this review, different bedside methods to estimate MM or its proxies in patients on HD will be discussed, with emphasis on biochemical methods, simplified creatinine index (SCI), bioimpedance spectroscopy (BIS), and muscle ultrasound (US). Body composition parameters of all methods are related to the outcome and appear relevant in clinical practice. The US is the only parameter by which muscle dimensions are measured. BIS and SCI are also dependent on either theoretical assumptions or the use of population-specific regression equations. Potential caveats of the methods are that SCI can be influenced by residual renal function, BIS can be influenced by fluid overload, although the latter may be circumvented by the use of a three-compartment model, and that muscle US reflects regional and not whole body MM. In conclusion, both SCI and BIS as well as muscle US are all valuable methods that can be applied for bedside nutritional assessment in patients on HD and appear suitable for routine follow-up. The choice for either method depends on local preferences. However, estimation of MM or its proxies should always be part of a multidimensional assessment of the patient followed by a personalized treatment strategy

Malignant Transformation of Giant Cell Tumor of Bone and the Association with Denosumab Treatment:A Radiology and Pathology Perspective

Objective. Malignancy in giant cell tumor of bone (mGCTB) is categorized as primary (concomitantly with conventional GCTB) or secondary (after radiotherapy or other treatment). Denosumab therapy has been suggested to play a role in the etiology of secondary mGCTB. In this case series from a tertiary referral sarcoma center, we aimed to find distinctive features for malignant transformation in GCTB on different imaging modalities. Furthermore, we assessed the duration of denosumab treatment and lag time to the development of malignancy. Methods. From a histopathology database search, 6 patients were pathologically confirmed as having initial conventional GCTB and subsequently with secondary mGCTB. Results. At the time of mGCTB diagnosis, 2 cases were treated with denosumab only, 2 with denosumab and surgery, 1 with multiple curettages and radiotherapy, and 1 with surgery only. In the 4 denosumab treated patients, the mean lag time to malignant transformation was 7 months (range 2-11 months). Imaging findings suspicious of malignant transformation related to denosumab therapy are the absence of fibro-osseous matrix formation and absent neocortex formation on CT, and stable or even increased size of the soft tissue component. Conclusion. In 4 patients treated with denosumab, secondary mGCTB occurred within the first year after initiation of treatment. Radiotherapy-associated mGCTB has a longer lag time than denosumab-associated mGCTB. Close clinical and imaging follow-up during the first months of denosumab therapy is key, as mGCTB tends to have rapid aggressive behavior, similar to other high-grade sarcomas. Nonresponders should be (re) evaluated for their primary diagnosis of conventional GCTB

Нарративное интервью в исследовании катамнеза внутренней картины болезни при шизофрении (клинико-психологический аспект)

Представлены особенности проведения клинического нарративного интервью как значимого метода в психодиагностике внутренней картины болезни (ВКБ) в катамнезе у больных шизофренией. Проведено комплексное психоанамнестическое, психодиагностическое, патоперсонологическое обследование больных параноидной шизофренией. Сформулированы стратегии и тактики проведения нарративного интервью с целью выявления особенностей их ВКБ.Наведено особливості проведення клінічного наративного інтерв'ю як визначального методу в психодіагностиці внутрішньої картини хвороби (ВКХ) у катамнезі у хворих на шизофренію. Проведено комплексне психоанамнестичне, психодіагностичне, патоперсонологічне обстеження хворих на параноїдну шизофренію. Сформульовано стратегії і тактики проведення наративного інтерв'ю з метою виявлення особливостей їх ВКХ.The peculiarities of clinical narrative interview as a significant method in psychodagnosis of the disease inner picture (DIP) in the history of patients with schizophrenia are presented. Complex psychoanamnestic, psychodiagnostic, pathopersonological investigation of patients with paranoid schizophrenia was performed. The strategies and tactics of narrative interview with the purpose to reveal DIP peculiarities were formulated

Encouraging survival rates in patients with acute myocardial infarction treated with an intra-aortic balloon pump

Objective To evaluate a 30-day and long-term outcome of patients with acute myocardial infarction (AMI) treated with intra-aortic balloon pump (IABP) counterpulsation and to identify predictors of a 30-day and long-term all-cause mortality. Methods Retrospective cohort study of 437 consecutive AMI patients treated with IABP between January 1990 and June 2004. A Cox proportional hazards model was used to identify predictors of a 30-day and long-term all-cause mortality. Results Mean age of the study population was 61±11 years, 80% of the patients were male, and 68% had cardiogenic shock. Survival until IABP removal after successful haemodynamic stabilisation was 78% (n=341). Cumulative 30-day survival was 68%. Median follow-up was 2.9 years (range, 6 months to 15 years). In patients who survived until IABP removal, cumulative 1-, 5-, and 10-year survival was 75%

Lipid levels are inversely associated with infectious and all-cause mortality: international MONDO study results.

Cardiovascular (CV) events are increased 36-fold in patients with end-stage renal disease. However, randomized controlled trials to lower LDL cholesterol (LDL-C) and serum total cholesterol (TC) have not shown significant mortality improvements. An inverse association of TC and LDL-C with all-cause and CV mortality has been observed in patients on chronic dialysis. Lipoproteins also may protect against infectious diseases. We used data from 37,250 patients in the international Monitoring Dialysis Outcomes (MONDO) database to evaluate the association between lipids and infection-related or CV mortality. The study began on the first day of lipid measurement and continued for up to 4 years. We applied Cox proportional models with time-varying covariates to study associations of LDL-C, HDL cholesterol (HDL-C), and triglycerides (TGs) with all-cause, CV, infectious, and other causes of death. Overall, 6,147 patients died (19.2% from CV, 13.2% from infection, and 67.6% from other causes). After multivariable adjustment, higher LDL-C, HDL-C, and TGs were independently associated with lower all-cause death risk. Neither LDL-C nor TGs were associated with CV death, and HDL-C was associated with lower CV risk. Higher LDL-C and HDL-C were associated with a lower risk of death from infection or other non-CV causes. LDL-C was associated with reduced all-cause and infectious, but not CV mortality, which resulted in the inverse association with all-cause mortality