Soluble NKG2DLs Are Elevated in Breast Cancer Patients and Associate with Disease Outcome

Ligands of the natural killer group 2D (NKG2DL) family are expressed on malignant cells and are usually absent from healthy tissues. Recognition of NKG2DLs such as MICA/B and ULBP1-3 by the activating immunoreceptor NKG2D, expressed by NK and cytotoxic T cells, stimulates anti-tumor immunity in breast cancer. Upregulation of membrane-bound NKG2DLs in breast cancer has been demonstrated by immunohistochemistry. Tumor cells release NKG2DLs via proteolytic cleavage as soluble (s)NKG2DLs, which allows for effective immune escape and is associated with poor prognosis. In this study, we collected serum from 140 breast cancer (BC) and 20 ductal carcinoma in situ (DCIS) patients at the time of initial diagnosis and 20 healthy volunteers (HVs). Serum levels of sNKG2DLs were quantified through the use of ELISA and correlated with clinical data. The analyzed sNKG2DLs were low to absent in HVs and significantly higher in BC patients. For some of the ligands analyzed, higher sNKG2DLs serum levels were associated with the classification of malignant tumor (TNM) stage and grading. Low sMICA serum levels were associated with significantly longer progression-free (PFS) and overall survival (OS). In conclusion, we provide the first insights into sNKG2DLs in BC patients and suggest their potential role in tumor immune escape in breast cancer. Furthermore, our observations suggest that serum sMICA levels may serve as a prognostic parameter in the patients analyzed in this study.

Measured optical losses of Sc doped AlN waveguides

Although Sc doped AlN (ScAlN) has been used extensively in micro-electro-mechanical systems (MEMS) devices and more recently in optical devices, there have not been thorough studies of its intrinsic optical losses. Here we explore the optical losses of the Sc0.30Al0.70N waveguide system by observing racetrack resonator waveguide quality factors. Using a partial physical etch, we fabricate waveguides and extract propagation losses as low as 1.6 ± 0.3 dB/cm at wavelengths around 1550 nm, mostly dominated by intrinsic material absorption from the Sc0.30Al0.70N thin film layer. The highest quality factor of the resonators was greater than 87,000. The propagation loss value is lower than any value previously published and shows that this material can be broadly used in optical modulators without significant loss.

Ultrashort pulse written fiber Bragg gratings as narrowband filters in multicore fibers

We present the inscription of narrow-linewidth fiber Bragg gratings (FBGs) into different types of multicore fibers (MCFs) using ultrashort laser pulses and the phase mask technique, which can act as notch filters. Such filters are required, e.g., to suppress light emitted by hydroxyl in the Earth's upper atmosphere, which disturbs ground-based observation of extraterrestrial objects in the near infrared. However, the inscription into a commercially available seven-core fiber showed a quite large core-to-core deviation of the resonance wavelength of up to 0.45 nm. Two options are presented to overcome this: first, we present the photo-treatment of the FBGs to tune the resonance wavelength, which allows for sufficient resonance shifts. Second, adapted MCFs containing 12 cores, arranged on a circle, are fabricated. For this, two different fabrication procedures were investigated, namely, the mechanical drilling of the preform for a rod-in-tube version as well as a stack-and-draw approach. Both adapted MCFs yielded significant improvements with core-to-core wavelength variations of the FBGs of only about 0.18 nm and 0.11 nm, respectively, sufficient to fulfill the requirements for astronomical filter applications as discussed above.

Results from a real-time dosimetry study during left atrial ablations performed with ultra-low dose radiation settings

Background

Three-dimensional mapping systems and the use of ultra-low dose radiation protocols have supported minimization of radiation dose during left atrial ablation procedures. By using optimal shielding, scattered radiation reaching the operator can be further reduced. This prospective study was designed to determine the remaining operator radiation exposure during left atrial catheter ablations using real-time dosimetry.

Methods

Radiation dose was recorded using real-time digital dosimetry badges outside the lead apron during 201 consecutive left atrial fibrillation ablation procedures. All procedures were performed using the same X‑ray system (Siemens Healthineers Artis dBc; Siemens Healthcare AG, Erlangen, Germany) programmed with ultra-low dose radiation settings including a low frame rate (two frames per second), maximum copper filtration, and an optimized detector dose. To reduce scattered radiation to the operators, table-suspended lead curtains, ceiling-suspended leaded plastic shields, and radiation-absorbing shields on the patient were positioned in an overlapping configuration.

Results

The 201 procedures included 139 (69%) pulmonary vein isolations (PVI) (20 cryoballoon ablations, 119 radiofrequency ablations, with 35 cases receiving additional ablation of the cavotricuspid isthmus) and 62 (31%) PVI plus further left atrial substrate ablation.

Mean radiation dose measured as dose area product for all procedures was 128.09 ± 187.87 cGy ∙ cm² with a mean fluoroscopy duration of 9.4 ± 8.7 min. Real-time dosimetry showed very low average operator doses of 0.52 ± 0.10 µSv. A subanalysis of 51 (25%) procedures showed that the radiation burden for the operator was highest during pulmonary vein angiography.

Conclusion

The use of ultra-low dose radiation protocols in combination with optimized shielding results in extremely low scattered radiation reaching the operator.

[Young Respiratory Physicians in Germany - Current Situation and Future Perspectives]

BACKGROUND

 Demographic changes in the society and among doctors, as well as changing attitudes towards and norms of how living should be structured are creating challenges regarding the organization of work environment in the hospital. In addition, organization of medical training is increasingly being influenced by economic considerations as well as a high level of medical specialization. We asked young respiratory physicians how they assessed their current situation with respect to quality of medical training and organization of their work environment.

METHODS

 From September to November 2019, we performed an online survey adressing young respiratory physicians in Germany. Participants were recruited via three emails (baseline and reminders after 2 and 6 weeks) sent by the German Respiratory Society (DGP) and the German Union of Pulmonologists (BdP). The questionnaire consisted of a maximum of 62 questions. Apart from own questions that had been aligned with other questionnaires from similar surveys in other medical specialties, we also assessed the effort-reward ratio (ER ratio) based on the short version of the effort-reward imbalance questionnaire (16 questions).

RESULTS

 We recuited n = 224 participants (33.8 ± 4.5 years, 5.4 ± 2.9 years of medical training, 54.4 % female , 86.8 % with German nationality). A little under half of the interviewees (n = 103, 46 %) reported to be very or generally satisfied with their working conditions, while n = 60 (27 %) were unsure. The main reasons for not being satisfied were long working hours and high work-load, as well as a lack of streamlining the work environment in the hospital to the specific needs of doctors. Despite the fact that many participants were satisfied, a large majority (n = 166, 88.2 %) depicted an unfavorable effort-reward ratio imbalance (adjusted mean 1.89 ± 2.18).

CONCLUSION

 Compared to many other European countries and internationally, the German healthcare system offers high-quality patient care and a well-equipped work environment. Increasing demands in the health care sector, however, are leading to a gratification crisis that not only harms the health and work performance of doctors but is also leading to reduced attractiveness of the job that might possibly lead to the search for new fields of activity or migration. Respiratory medicine is a discipline of growing interest and motivating young doctors to secure the promotion of this discipline is increasingly important. Factors harming the growth of this discipline should be immediately addressed. The results of this survey might help leaders in the field to restructure the work environment and medical education according to the actual needs.

Influence of pedestal diameter on mode instabilities in Yb/Ce/Al-doped fibers

In this paper we present numerical and experimental results revealing that the mode instability threshold of highly Yb-doped, Ce/Al co-doped pedestal fibers is affected by the size of the index-increased pedestal structure surrounding the core. An alternative preparation technology for the realization of large mode area fibers with very large Al-doped silica pedestals is introduced. Three different pedestal fiber design iterations characterized by low photodarkening were manufactured and tested in counter-pumped amplifier setups. Up to 1.9 kW continuous-wave output power of near-diffraction-limited beam quality (M² = 1.26) was achieved with an 18/200/420 µm fiber of very low NA = 0.042, limited only by the occurrence of mode instabilities.

Micro-fluorescence lifetime and spectral imaging of ytterbium doped laser materials

We present the application of a confocal fluorescence microscope to the analysis of Yb-doped solid-state laser materials, with examples of Yb-doped crystals, photonic crystal fibers and fiber preforms made with different manufacturing processes. Beside the fluorescence lifetime image itself, a microscopic spectral fluorescence emission analysis is presented and spatially resolved emission cross sections are obtained. Doping concentration and its distributions and other laser optical parameters are measured, which help to analyze manufacturing steps. Further properties like photodarkening and saturation are addressed.

Coherently combined 16-channel multicore fiber laser system

We present a coherently combined laser amplifier with 16 channels from a multicore fiber in a proof-of-principle demonstration. Filled-aperture beam splitting and combination, together with temporal phasing, is realized in a compact and low-component-count setup. Combined average power of up to 70 W with 40 ps pulses is achieved with combination efficiencies around 80%.

Single mode 4.3 kW output power from a diode-pumped Yb-doped fiber amplifier

We investigate the average power scaling of two diode-pumped Yb-doped fiber amplifiers emitting a diffraction-limited beam. The first fiber under investigation with a core diameter of 30 µm was able to amplify a 10 W narrow linewidth seed laser up to 2.8 kW average output power before the onset of transverse mode instabilities (TMI). A further power scaling was achieved using a second fiber with a smaller core size (23µm), which allowed for a narrow linewidth output power of 3.5 kW limited by stimulated Brillouin scattering (SBS). We mitigated SBS using a spectral broadening mechanism, which allowed us to further increase the output power to 4.3 kW only limited by the available pump power. Up to this power level, a high slope efficiency of 90% with diffraction-limited beam quality and without any sign of TMI or stimulated Raman scattering for a spectral dynamic range of higher than -80 dB was obtained.

Modal content measurements (S2) of negative curvature hollow-core photonic crystal fibers

We present modal content measurements (S²) of two different negative curvature hollow-core photonic crystal fibers: a kagome fiber and an ice cream cone fiber. Their sensitivity towards mode matching, bending and polarization is analyzed. For the kagome fiber, a higher order mode suppression of 17dB under optimal conditions was achieved, and for the ice cream cone fiber there was a suppression of up to 42dB. Polarization turned out to be a critical parameter for good higher order mode suppression in both fibers.

Libraries of Synthetic TALE-Activated Promoters: Methods and Applications

The discovery of proteins with programmable DNA-binding specificities triggered a whole array of applications in synthetic biology, including genome editing, regulation of transcription, and epigenetic modifications. Among those, transcription activator-like effectors (TALEs) due to their natural function as transcription regulators, are especially well-suited for the development of orthogonal systems for the control of gene expression. We describe here the construction and testing of libraries of synthetic TALE-activated promoters which are under the control of a single TALE with a given DNA-binding specificity. These libraries consist of a fixed DNA-binding element for the TALE, a TATA box, and variable sequences of 19 bases upstream and 43 bases downstream of the DNA-binding element. These libraries were cloned using a Golden Gate cloning strategy making them usable as standard parts in a modular cloning system. The broad range of promoter activities detected and the versatility of these promoter libraries make them valuable tools for applications in the fine-tuning of expression in metabolic engineering projects or in the design and implementation of regulatory circuits.

Narrow linewidth, single mode 3 kW average power from a directly diode pumped ytterbium-doped low NA fiber amplifier

We report on a newly designed and fabricated ytterbium-doped large mode area fiber with an extremely low NA (~0.04) and related systematic investigations on fiber parameters that crucially influence the mode instability threshold. The fiber is used to demonstrate a narrow linewidth, continuous wave, single mode fiber laser amplifier emitting a maximum output power of 3 kW at a wavelength of 1070 nm without reaching the mode-instability threshold. A high slope efficiency of 90 %, excellent beam quality, high temporal stability, and an ASE suppression of 70 dB could be reached with a signal linewidth of only 170 pm.

1009 nm continuous-wave ytterbium-doped fiber amplifier emitting 146 W

In this Letter, we demonstrate a single-mode continuous-wave fiber laser amplifier emitting 146 W of average output power at a wavelength of 1009 nm. The wavelength and bandwidth of the seed oscillator are defined by a pair of fiber Bragg gratings. The seed is amplified in a two-stage ytterbium-doped rod-type amplifier to 146 W with a high slope efficiency of 64%, showing excellent beam quality and stability throughout the experiment. The ASE suppression is as high as 63 dB.

On the mode-locking mechanism of a dissipative- soliton fiber oscillator

We report on the generation of high-energy pulses in an all normal dispersion photonic-crystal fiber laser. Two mode-locking techniques with and without passive spectral filtering are studied both numerically and experimentally to address a roadmap for energy scaling. It is found that high-contrast passive modulation is a very promising mode-locking technique for energy scaling in dissipative-soliton laser. Moreover, this technique does not need any additional spectral filtering than the limited gain bandwidth to stabilize high-energy ultrashort pulses. The presented laser generates 110 nJ chirped pulses at 57 MHz repetition rate for an average power of 6.2 W. The output pulses could be dechirped close to the transform-limited duration of 100 fs.

High power narrow-band fiber-based ASE source

In this paper we describe a high power narrow-band amplified spontaneous emission (ASE) light source at 1030 nm center wavelength generated in an Yb-doped fiber-based experimental setup. By cutting a small region out of a broadband ASE spectrum using two fiber Bragg gratings a strongly constrained bandwidth of 12±2 pm (3.5±0.6 GHz) is formed. A two-stage high power fiber amplifier system is used to boost the output power up to 697 W with a measured beam quality of M2≤1.34. In an additional experiment we demonstrate a stimulated Brillouin scattering (SBS) suppression of at least 17 dB (theoretically predicted ~20 dB), which is only limited by the dynamic range of the measurement and not by the onset of SBS when using the described light source. The presented narrow-band ASE source could be of great interest for brightness scaling applications by beam combination, where SBS is known as a limiting factor.

Spectral beam combination of fiber amplified ns-pulses by means of interference filters

In this paper we introduce a simple scheme to spectrally combine four single beams using three low-cost dielectric interference filters as combining elements. 25 ns pulses from four independent and actively Q-switched fiber seed-sources are amplified in a single stage fiber-amplifier. Temporally and spatially combined 208 W of average power and 6.3 mJ of pulse energy are obtained at two different repetition frequencies. A detailed analysis of beam quality as well as the thermal behavior of the combining elements is carried out and reveals mutual dependency.

Average power of 1.1 kW from spectrally combined, fiber-amplified, nanosecond-pulsed sources

We report on spectral combination of four high repetition rate 5 ns pulsed Yb-doped fiber amplifiers at 1 microm wavelength. The output beam is spatially and temporally superposed by use of an all-reflective diffraction grating. 1.1 kW average power and 220 microJ pulse energy were extracted with a combining efficiency of 99%.

2 kW incoherent beam combining of four narrow-linewidth photonic crystal fiber amplifiers

We report on beam combining of four narrow-linewidth fiber amplifier chains, running at different wavelengths and each delivering 500 W optical output power. The main amplifier stage consists of a large mode area photonic crystal fiber. The four output beams of the amplifier chains are spectrally (incoherent) combined using a polarization-independent dielectric reflective diffraction grating to form an output beam of 2 kW continuous-wave optical power with good beam quality (M(2)x = 2.0, M(2)y = 1.8).

Effects of Arginine Vasopressin on Oxygenation and Haemodynamics during One-Lung Ventilation in an Animal Model

In a case of arterial hypotension during one-lung ventilation, haemodynamic support may be required to maintain adequate mean arterial pressure. Arginine vasopressin, a potent systemic vasoconstrictor with limited effects on the pulmonary artery pressure, has not been studied in this setting. Twelve female pigs were anaesthetised and ventilated and arterial, central venous and pulmonary artery catheters were inserted. A left-sided double lumen tube was placed via tracheostomy and one-lung ventilation was initiated. The animals were in the left lateral position, with the left lung ventilated and right lung collapsed. Respiratory and haemodynamic values were recorded before and during a continuous infusion of arginine vasopressin sufficient to double the mean arterial pressure. The arginine vasopressin caused a decrease in cardiac output (3.8±1.1 vs. 2.7±0.7 l/min, P <0.001) and mixed-venous oxygen tension (39.1±5.8 vs. 34.4±5 mmHg, P=0.003). Pulmonary artery pressure was unchanged (24±2 vs. 24±3 mmHg, P=0.682). There was no effect of the arginine vasopressin on arterial oxygen tension (226±106 vs. 231±118 mmHg, P=0.745). However, there was a significant decrease in shunt fraction (28.3±6.2 vs. 24.3±7.8%, P=0.043) and a significant proportional increase in perfusion of the ventilated lung (78.8±9.5 vs. 85.5±7.9%, P=0.036). In our animal model of one-lung ventilation, doubling mean arterial pressure by infusion of arginine vasopressin significantly affected global haemodynamics, but had no influence on systemic arterial oxygen tension.

Passively mode-locked single-polarization microstructure fiber laser

The generation of high-power and stable ultra-short pulses from a passively mode-locked purely normal dispersion fiber laser is reported using the unique combination of a photonic crystal fiber featuring single-polarization, single-mode, and low nonlinearity with a high modulation depth semiconductor saturable absorber mirror. The environmentally-stable, self-starting fiber laser generates 1.6 W of average power at a repetition rate of 63 MHz, corresponding to a pulse energy of 25 nJ. The emitted pulses are positively chirped with a pulse duration of 3.7 ps. They are compressible down to a near transform-limited duration of 750 fs. Numerical simulations are in good agreement with the experimental results.

Experimental and numerical study of pulse dynamics in positive net-cavity dispersion modelocked Yb-doped fiber lasers

We report on environmentally stable mode-locked Yb-doped all-fiber lasers operating in the wave-breaking-free and stretched-pulse regime. The compact linear cavity is constructed with saturable absorber mirror directly glued to the fibers end-facet as nonlinear mode-locking mechanism and chirped fiber Bragg grating for dispersion management, thus, without any free-space optics. In the wave-breaking-free regime the laser generates positively-chirped pulses with a pulse duration of 15.4 ps. These pulses are compressed to 218 fs in a hollow-core photonic bandgap fiber spliced to the output port. Adaptation of dispersion management has led to operation in the stretched-pulse regime, where a parabolic spectral profile is obtained as well. In this regime pulses are compressible to 213 fs. Numerical simulations are presented which confirm the wave-breaking-free and stretched-pulse evolution inside the fiber laser cavity. Both regimes are compared in terms of pulse quality.

High-energy femtosecond Yb-doped dispersion compensation free fiber laser

We report on a mode-locked high energy fiber laser operating in the dispersion compensation free regime. The sigma cavity is constructed with a saturable absorber mirror and short-length large-mode-area photonic crystal fiber. The laser generates positively-chirped pulses with an energy of 265 nJ at a repetition rate of 10.18 MHz in a stable and self-starting operation. The pulses are compressible down to 400 fs leading to a peak power of 500 kW. Numerical simulations accurately reflect the experimental results and reveal the mechanisms for self consistent intracavity pulse evolution. With this performance mode-locked fiber lasers can compete with state-of-the-art bulk femtosecond oscillators for the first time and pulse energy scaling beyond the muJ-level appears to be feasible.

Präklinische transtracheale Notfallventilation

INTRODUCTION

Prehospital transtracheal ventilation via a needle cricothyroidotomy may be lifesaving in cannot-intubate-cannot-ventilate situations. A self-made device consisting of a three-way stopcock placed between a transtracheal airway catheter and an oxygen supply was constructed and the effectiveness of the device was compared with a hand-triggered emergency jet generator in animal experiments.

MATERIALS AND METHODS

An emergency transtracheal airway catheter was inserted into the trachea of 10 anesthetized pigs (18-35 kgbw) and a situation of partial expiratory airway obstruction was established. All pigs were ventilated in a randomized order via the transtracheal airway catheter with the hand-triggered emergency jet injector and the self-made device for 15 min each.

RESULTS

With both devices satisfactory oxygenation and ventilation was achieved in all animals.

CONCLUSIONS

The efficacy of the self-made device during the experiment was comparable with the efficacy of the hand-triggered emergency jet injector.

Millijoule pulse energy Q-switched short-length fiber laser

We report on a Q-switched short-length fiber laser producing 100 W of average output power at 100 kHz repetition rate and pulse durations as short as 17 ns. Up to 2 mJ of energy and sub-10-ns pulse duration are extracted at lower repetition rates. This performance is obtained by employing a rod-type ytterbium-doped photonic crystal fiber with a 70 microm core as gain medium, allowing for very short pulse durations, high energy storage, and emission of a single-transverse-mode beam.

Parametric amplification and compression to ultrashort pulse duration of resonant linear waves

We report on an optical parametric amplification system which is pumped and seeded by fiber generated laser radiation. Due to its low broadening threshold, high spatial beam quality and high stability, the fiber based broad bandwidth signal generation is a promising alternative to white light generation in bulky glass or sapphire plates. We demonstrate a novel and successful signal engineering implemented in a setup for parametric amplification and subsequent recompression of resonant linear waves resulting from soliton fission in a highly nonlinear photonic crystal fiber. The applied pump source is a high repetition rate ytterbium-doped fiber chirped pulse amplification system. The presented approach results in the generation of ~50 fs pulses at MHz repetition rate. The potential of generating even shorter pulse duration and higher pulse energies will be discussed.

Thermo-optical behavior of rare-earth-doped low-NA fibers in high power operation

The influence of the internal temperature gradient in rare-earth-doped low-numerical-aperture fibers on modal properties is analyzed for step-index and photonic crystal fibers. We provide guidelines when a single-mode fiber turns into a multimode fiber and how the mode-field-diameter is affected.

Extended single-mode photonic crystal fiber lasers

We report on an ytterbium-doped photonic crystal fiber with a core diameter of 60 microm and mode-field-area of ~2000 microm(2) of the emitted fundamental mode. Together with the short absorption length of 0.5 m this fiber possesses a record low nonlinearity which makes this fiber predestinated for the amplification of short laser pulses to very high peak powers. In a first continuous-wave experiment a power of 320 W has been extracted corresponding to 550 W per meter. To our knowledge this represents the highest power per unit length ever reported for fiber lasers. Furthermore, the robust single-transverse-mode propagation in a passive 100 microm core fiber with a similar design reveals the potential of extended large-mode-area photonic crystal fibers.

Self-starting self-similar all-polarization maintaining Yb-doped fiber laser

We report on the generation of self-similar pulses from an self-starting saturable absorber mirror (SAM) based environmentally stable fiber laser comprising only polarization maintaining (PM) fibers. Pulse energies of 1 nJ at a repetition rate of 17 MHz were obtained, which could be externally compressed to an autocorrelation width of 280 fs.

Supercontinuum generation by femtosecond single and dual wavelength pumping in photonic crystal fibers with two zero dispersion wavelengths

We investigate supercontinuum generation in photonic crystal fibers under femtosecond single and dual wavelength pumping experimentally and by numerical simulations. Details about the expansion of the blue but also the red side of the continuum due to cross-phase modulation (XPM) and transfer of energy to dispersive waves are revealed and experimentally confirmed. Additionally, simple guidelines are given to predicte the maximum bandwidth of supercontinuum generation only by the use of the dispersion curve of the fiber.

131 W 220 fs fiber laser system

We report on an ytterbium-doped photonic-crystal-fiber-based chirped-pulse amplification system delivering 131 W average power 220 fs pulses at 1040 nm center wavelength in a diffraction-limited beam. The pulse repetition rate is 73 MHz, corresponding to a pulse energy of 1.8 microJ and a peak power as high as 8.2 MW.

Stress-induced single-polarization single-transverse mode photonic crystal fiber with low nonlinearity

We report on the design of a single-polarization single-transverse mode large mode area photonic crystal fiber. By including index-matched stress applying elements in the photonic cladding an ultra-broadband single polarization window is obtained while a large mode field area of ~700 microm(2) is maintained. Based on that design, an Yb-doped double-clad photonic crystal fiber is realized that combines low nonlinearity and single polarization properties. A first result of the high power operation using this fiber is demonstrated.