Search

Blood flow through left ventricular assist devices (LVAD) may induce activation and dysfunction of platelets. Dysfunctional platelets cause coagulation disturbances and form platelet-neutrophil conjugates (PNC), which contribute to inflammatory tissue damage. This prospective observational cohort study investigated patients, who underwent implantation of a LVAD (either HeartMate II (HM II) (n = 7) or HeartMate 3 (HM 3) (n = 6)) and as control patients undergoing coronary artery bypass grafting (CABG) and/or aortic valve replacement (AVR) (n = 10). We performed platelet and leukocyte flow cytometry, analysis of platelet activation markers, and platelet aggregometry. Platelet CD42b expression was reduced at baseline and perioperatively in HM II/3 compared to CABG/AVR patients. After surgery the platelet activation marker ��-thromboglobulin and platelet microparticles increased in all groups while platelet aggregation decreased. Platelet aggregation was more significantly impaired in LVAD compared to CABG/AVR patients. PNC were higher in HM II compared to HM 3 patients. We conclude that LVAD implantation is associated with platelet dysfunction and proinflammatory platelet-leukocyte binding. These changes are less pronounced in patients treated with the newer generation LVAD HM 3. Future research should identify device-specific LVAD features, which are associated with the least amount of platelet activation to further improve LVAD therapy.

Objective The aim was to evaluate the potential of near infrared spectrometry (NIRS) monitoring enhanced by autoregulation parameters to detect clamp ischaemia during awake carotid endarterectomy (CEA). Methods This was a prospective, hypothesis generating, single centre observational study. Fifty-nine consecutive patients with carotid artery stenosis, of whom 15 (25%) were symptomatic, were enrolled. The patients underwent awake CEA with NIRS monitoring. Regional oxygen saturation (rSO2), relative tissue haemoglobin concentration (rTHb), and mean arterial blood pressure were captured by ICM + software (University of Cambridge Enterprise, Cambridge, UK). The cerebral oxygenation index (COx) and haemoglobin volume index (HVx) were calculated continuously. Two groups were formed depending on neurological symptoms: a symptomatic group with shunt insertion (shunt) and an asymptomatic group (no shunt). Results Eight patients (14%) became symptomatic and needed intra-operative shunting. The decrease in ipsilateral rSO2 was higher in the shunt group (13.5% vs. 5.3%) and rTHB increased on the non-operated side (+0.05 ± 0.01; p = .016). In symptomatic patients no significant change in rTHB was found during clamping, whereas in asymptomatic patients there was a bilateral increase (ipsilateral: + 0.06 [p = .022]; contralateral: + 0.06 [p = .010]). In asymptomatic patients, ipsilateral COx decreased after clamping (−0.06 ± 0.02; p = .024), indicating functional autoregulation. In symptomatic patients, ipsilateral COx increased to 0.32 (+0.19 ± 0.05; p = .048), indicating loss of autoregulation. Accordingly, pooled ipsilateral and contralateral data showed increasing HVx and COx in symptomatic patients (HVx, p Conclusion In addition to a drop in rSO2, the loss of autoregulatory capacity may be useful in identifying clinically significant clamping ischaemia during CEA under general anaesthesia and may allow optimisation of blood pressure management during awake CEA.

Die sonographisch kontrollierte distale Ischiadikusblockade erfolgt ublicherweise durch Platzierung der Ultraschallsonde auf der dorsalen Oberschenkelseite. Dies erfordert die Umlagerung des Patienten (Bauch- oder Seitenlage) sowie zusatzliche Hilfestellung. Um eine solche Umlagerung zu vermeiden, wurde eine Positionierungshilfe mit integrierter Sondenhalterung entwickelt und deren Praxistauglichkeit an Patienten, die an der unteren Extremitat operiert wurden, untersucht. Die Ischiadikusblockade wurde sonographisch kontrolliert in Ruckenlage und Allgemeinanasthesie mithilfe der neuen Lagerungshilfe mit integrierter Ultraschallsondenselbsthalterung durchgefuhrt. Es wurden >100 Patienten, die sich einer elektiven Operation des Unterschenkels, Sprunggelenks oder Fuses mithilfe einer kontinuierlichen Ischiadikusblockade unterzogen, mit einem Katheter fur die postoperative Schmerztherapie behandelt. Der Vorteil dieses Verfahrens ist, dass es einfach durchfuhrbar ist und man die Hande zur Bewegung der Nadel und fur die Positionierung des Katheters frei hat. Mogliche Nachteile sind die Notwendigkeit einer „In-plane“-Katheterpositionierung und ein fixierter Ultraschallwinkel.

The aim of this study was to evaluate if there is a correlation between the use of intraoperative transesophageal echocardiography and an increased rate of extubation failure and to find other risk factors for severe upper airway obstructions after pediatric cardiac surgery.Retrospective analysis.Cardiac PICU.Patients 24 months old or younger who underwent surgery for congenital heart disease with cardiopulmonary bypass were retrospectively enrolled and divided into two groups depending on whether they received an intraoperative transesophageal echocardiography or not. We analyzed all cases of early reintubations within 12 hours after extubation due to a documented upper airway obstruction.None.From a total of 424 patients, 12 patients (2.8%) met our criteria of early reintubation due to upper airway obstruction. Ten of 207 children in the transesophageal echocardiography group had to be reintubated, whereas only two of the 217 children in the control group had to be reintubated (4.8% vs 0.9%; p = 0.018). Logistic regression analysis showed a significant correlation between use of intraoperative transesophageal echocardiography and extubation failure (odds ratio, 5.64; 95% CI, 1.18-27.05; p = 0.030). There was no significant relationship among sex (odds ratio, 4.53; 95% CI, 0.93-22.05; p = 0.061), weight (odds ratio, 1.07; 95% CI, 0.82-1.40; p = 0.601), duration of surgery (odds ratio, 1.04; 95% CI, 0.74-1.44; p = 0.834), duration of mechanical ventilation (odds ratio, 1.00; 95% CI, 0.99-1.00; p = 0.998), and occurrence of trisomy 21 (odds ratio, 3.47; 95% CI, 0.83-14.56; p = 0.089).Although the benefits of intraoperative transesophageal echocardiography during pediatric cardiac surgery are undisputed, it may be one factor which could increase the rate of severe upper airway obstruction after extubation with the need for reintubation. We suggest to take precautions before extubating high-risk patients, especially in young male children with genetic abnormalities after cardiac surgery with cardiopulmonary bypass.

ZusammenfassungDie juvenile idiopathische Arthritis (JIA), als häufigste rheumatische Erkrankung im Kindesalter, ist vielfach durch eine mögliche Kiefergelenkbeteiligung für das Fachgebiet der Kieferorthopädie relevant. Eine Kiefergelenkarthritis kann – wie nachfolgend ausgeführt – mitunter negativen Einfluss auf die orofaziale Entwicklung und Ausbildung von kraniofazialen Anomalien haben. Eine frühzeitige Erstdiagnose kann die Qualität des Behandlungsergebnisses deutlich begünstigen. Die in diesem Update zur JIA im Weiteren vorgestellten Empfehlungen fassen die interdisziplinären Arbeiten der internationalen Expertengruppe euroTMjoint der letzten Jahre zusammen. Im Vordergrund steht dabei auch die erstmalige internationale und interdisziplinäre Konsensusempfehlung für die orofaziale Untersuchung und Überwachung von Patienten mit JIA zur Vereinheitlichung klinischer und wissenschaftlicher Parameter sowie Früherkennung einer Kiefergelenkbeteiligung.Neben der Kieferorthopädie umfasst die Therapie der JIA weitere Säulen, wie die medikamentöse Therapie durch Kinderrheumatologen, Physiotherapie, psychosoziale Begleitung sowie weitere Therapieverfahren. Eine enge interdisziplinäre Zusammenarbeit ist hier notwendig.

Recently, a fully magnetically levitated left ventricular assist device (LVAD) system (HeartMate 3, Thoratec, Pleasanton, California) has become clinically available [(1)][1]. The centrifugal rotor of the pump head in this system allows large flow gaps around it. Due to an artificial pulse algorithm

Background Successful percutaneous mitral valve repair (PMVR) in patients with severe mitral regurgitation (MR) causes changes in hemodynamics. Echocardiographic calculation of cardiac output (CO) has not been evaluated in the setting of PMVR, so far. Here we evaluated hemodynamics before and after PMVR with the MitraClip system using pulmonary artery catheterization, transthoracic (TTE) and transesophageal (TEE) echocardiography. Methods 101 patients with severe MR not eligible for conventional surgery underwent PMVR. Hemodynamic parameters were determined during and after the intervention. We evaluated changes in CO and pulmonary artery systolic pressure before and after PMVR. CO was determined with invasive parameters using the Fick method (COi) and by a combination of TTE and TEE (COe). Results All patients had successful clip implantation, which was associated with increased COi (from 4.6±1.4l/min to 5.4±1.6l/min, p p =0.01). In accordance with invasive measurements, COe increased significantly (COe from 4.3±1.7l/min to 4.8±1.7l/min, p =0.003). Comparing both methods to calculate CO, we observed good agreement between COi and COe using Bland Altman plots. Conclusions CO increased significantly after PMVR as determined by echocardiography based and invasive calculation of hemodynamics during PMVR. COe shows good agreement with COi before and after the intervention and, thus, represents a potential non-invasive method to determine CO in patients with MR not accessible by conventional surgery.

The early diagnosis and treatment of right ventricular (RV) dysfunction are of critical importance in cardiac surgery patients and impact clinical outcome. Two-dimensional (2D) transesophageal echocardiography (TEE) can be used to evaluate RV function using surrogate parameters due to complex RV geometry. The aim of this study was to evaluate whether the commonly used visual evaluation of RV function and size using 2D TEE correlated with the calculated three-dimensional (3D) volumetric models of RV function.Retrospective study, single center, University Hospital.Seventy complete datasets were studied consisting of 2D 4-chamber view loops (2-3 beats) and the corresponding 4-chamber view 3D full-volume loop of the right ventricle. RV function and RV size of the 2D loops then were assessed retrospectively purely qualitatively individually by 4 clinician echocardiographers certified in perioperative TEE. Corresponding 3D volumetric models calculating RV ejection fraction and RV end-diastolic volumes then were established and compared with the 2D assessments.2D assessment of RV function correlated with 3D volumetric calculations (Spearman's rho -0.5; p0.0001). No correlation could be established between 2D estimates of RV size and actual 3D volumetric end-diastolic volumes (Spearman's rho 0.15; p = 0.25).The 2D assessment of right ventricular function based on visual estimation as frequently used in clinical practice appeared to be a reliable method of RV functional evaluation. However, 2D assessment of RV size seemed unreliable and should be used with caution.

New surgical techniques aim for less-invasive implantation of left ventricular assist devices (LVADs) via small surgical incision sites. Echocardiography plays an important role during patient selection and guidance of the procedure. The surgical incision site can be identified preoperatively by transthoracic echocardiography. Intraoperative identification of left ventricular apex, de-airing, and monitoring heart function is performed by transesophageal echocardiography. This article highlights special echocardiographic considerations during less-invasive LVAD implantation surgeries.

Introduction Right ventricular (RV) strain analysis proved to be prognostically relevant in various cardiac diseases. However, data regarding outcome prediction by RV strain analysis during surgical coronary revascularization are limited. Three-dimensional (3D) transesophageal echocardiography-based (TEE) methods dedicated to the RV might be advantageous over established measures of cardiac function. Methods 87 patients undergoing coronary artery bypass grafting with (CABG, n=49) or without cardiopulmonary bypass (off-pump coronary artery bypass grafting, OPCAB, n=38) were enrolled retrospectively if suitable 3D-TEE was performed after anesthesia induction. Post-hoc offline analysis using 3D-STE software (4D RV-Function 2.0, Tomtec) was used to generate RV meshes. Regional and RV global longitudinal and circumferential strain analysis on the surface of the meshes was performed using a custom-made software algorithm based on the Visualization Toolkit (www.vtk.org). Global RV and left ventricular (LV) ejection fraction (EF) as well as LV global longitudinal strain (LV-GLS) were assessed using commercially available 3D-STE software packages (4D RV-Function 2.0 and 4D LV-Analysis, Tomtec). Prolonged (>48 hours) post-operative mechanical ventilation was used as the primary end-point. Results RV strain analysis was feasible in all patients (100%). Mean RV global longitudinal strain (RV-GLS) and mean RV global circumferential strain (RV-GCS) was -14.1±4.6% and -15.7±4.7% respectively. Between CABG and OPCAB patients, neither RV-GLS (-14.3±4.6% vs. 13.8±4.7%, p=0.62) nor RV-GCS (-15.9±4.4% vs. -15.4±5.1%, p=0.60) was significantly different. In univariate regression models, septal longitudinal RV strains (p Discussion In patients undergoing coronary artery bypass surgery, right ventricular global longitudinal strain analysis on meshes derived from transesophageal 3D-STE is superior in predicting short-term ICU outcomes compared to conventional parameters of right or left ventricular function and might be helpful to identify patients at higher risks for post-operative complications.

Optimierungspotenziale Im OP stehen Betriebswirtschaft und Medizin teilweise in einem Spannungsfeld zueinander. Dass das nicht sein muss, belegen Projekte, die von der Unternehmensberatung Roland Berger begleitet wurden: Durch strukturierte Analysen und die Identifizierung von Optimierungspotenzialen ist es gelungen, gleichzeitig okonomische und medizinische Verbesserungen herbeizufuhren – zum Beispiel durch ein OP-Management-Team, eine bedarfsorientierte Kapazitatssteuerung und einen flexiblen Personaleinsatz.

Vorgeschichte: Nach unauffälliger Neugeborenen-Periode (40. SSW, eutrophes weibliches Neugeborenes) fielen mit 9 Monaten druckdolente, knotige Effloreszenzen an den Streckseiten der Extremitäten sowie gluteal auf. Entzündungswerte, Infektionsserologie, Abdomen-Sonografie und Röntgen-Thorax[zum vollständigen Text gelangen Sie über die oben angegebene URL], 47. Kongress der Deutschen Gesellschaft für Rheumatologie (DGRh), 33. Jahrestagung der Deutschen Gesellschaft für Orthopädische Rheumatologie (DGORh), 29. Jahrestagung der Gesellschaft für Kinder- und Jugendrheumatologie (GKJR)

Sonographically controlled blockade of the distal sciatic nerve is usually performed by placing the ultrasound probe on the dorsal side of the thigh. This requires positioning maneuvers (prone or side positioning) of the patient as well as additional assistance. In order to avoid these positioning maneuvers, a positioning aid with integrated ultrasound probe holder has been developed and its practicability was examined on patients with lower limb surgery. The sonographically controlled block of the sciatic nerve was performed with the patient under general anesthesia and in a supine position with the help of the new positioning aid with an integrated ultrasound probe holder. A total of100 patients were treated, who underwent elective lower leg, ankle or foot surgery with a continuous blockade of the distal sciatic nerve using catheters for postoperative analgesia. The advantages are easy performance, hands-free needle movement and catheter placement. The disadvantages might be the need for in-plane catheter placement and a fixed ultrasound angle.

We report on the experimental observation of strong-field dressing of an autoionizing two-electron state in helium with intense extreme-ultraviolet laser pulses from a free-electron laser. The asymmetric Fano line shape of this transition is spectrally resolved, and we observe modifications of the resonance asymmetry structure for increasing free-electron-laser pulse energy on the order of few tens of $\mu$J. A quantum-mechanical calculation of the time-dependent dipole response of this autoionizing state, driven by classical extreme-ultraviolet (XUV) electric fields, reveals a direct link between strong-field-induced energy and phase shifts of the doubly excited state and the Fano line-shape asymmetry. The experimental results obtained at the Free-Electron Laser in Hamburg (FLASH) thus correspond to transient energy shifts on the order of few meV, induced by strong XUV fields. These results open up a new way of performing non-perturbative XUV nonlinear optics for the light-matter interaction of resonant electronic transitions in atoms at short wavelengths., Comment: 16 pages, 3 figures

OBJECTIVES The transition from single-ventricle lesions with surgically placed systemic-to-pulmonary artery shunt to the circulation following a bidirectional cavopulmonary connection results in higher pressure in the superior vena cava when compared with the preceding circulation. The aim of this study was to evaluate the impact of this transition on the perioperative cerebral oxygen metabolism. DESIGN Prospective observational cohort study. SETTING Pediatric critical care unit of a tertiary referral center. PATIENTS Sixteen infants after bidirectional cavopulmonary connection. INTERVENTION Cardiac surgery (bidirectional cavopulmonary connection). MEASUREMENTS AND MAIN RESULTS We measured regional cerebral oxygen saturation, amount of hemoglobin, blood flow velocity, and microperfusion immediately before, 12-24 hours, and 36-48 hours following bidirectional cavopulmonary connection. Based on these measurements, we calculated cerebral fractional tissue oxygen extraction and approximated cerebral metabolic rate of oxygen. Mean pressure in the superior vena cava increased significantly (8 vs 17 mm Hg; p < 0.001) following bidirectional cavopulmonary connection. Mean cerebral oxygen saturation increased from 49.0% (27.4-61.0) to 56.9% (39.5-64.0) (p = 0.008), whereas mean cerebral blood flow velocity decreased from 80.0 arbitrary units (61.9-93.0) to 67.3 arbitrary units (59.0-83.3) (p < 0.001). No change was found in the cerebral amount of hemoglobin and in the cerebral microperfusion. Mean cerebral fractional tissue oxygen extraction (0.48 [0.17-0.63] vs 0.30 [0.19-0.56]; p = 0.006) and approximated cerebral metabolic rate of oxygen (5.82 arbitrary units [2.70-8.78] vs 2.27 arbitrary units [1.19-7.35]; p < 0.001) decreased significantly. CONCLUSIONS Establishment of bidirectional cavopulmonary connection is associated with postoperative improvement in cerebral oxygen metabolism. Cerebral amount of hemoglobin did not increase, although creation of the bidirectional cavopulmonary connection results in significant elevation in superior vena cava pressure. Improvement in cerebral oxygen metabolism was due to lower cerebral blood flow velocity and stable microperfusion, which may indicate intact cerebral autoregulation.

Perioperative bleeding disorders leading to major blood losses have a severe impact on patient morbidity and mortality. Despite efficient communication with the surgical team, a profound knowledge concerning the underlying mechanisms, diagnostic possibilities and available therapeutic strategies is essential for the anesthesiologist in charge. This clinical review summarizes the preoperative assessment of the most common preexisting bleeding disorders, as well as intraoperative diagnostics and management. A special focus is set on novel point-of-care tests, such as viscoelastic coagulation assays that allow rapid and precise bedside analysis of different blood clotting components. As anticoagulants and antiplatelet drugs are broadly established in everyday clinical practice, pharmacological profiles of the most common substances are highly relevant in order to provide the patient with a safe perioperative setting - including novel oral anticoagulants. Structured checklists, as introduced in this article, may help to facilitate clinical decision making during perioperative bleedings.Die Behandlung von Blutungen im Rahmen einer Operation ist eine der Kernaufgaben des Anästhesisten. Neben der ständigen Kommunikation mit dem Operateur ist hierfür ein fundiertes Verständnis der vielfältigen Ursachen essenziell, um einen schnellstmöglichen Behandlungserfolg zu erzielen. Der Beitrag stellt die wichtigsten Zusammenhänge zur Diagnostik und Therapie perioperativer Blutungen dar.

Introduction: In this study, we evaluated right ventricular (RV) function before and after percutaneous mitral valve repair (PMVR) using conventional echocardiographic parameters and novel 3DE data sets acquired prior to and directly after the procedure. Patients and methods: Observational study on 45 patients undergoing PMVR at an university hospital. Results: In the overall collective, the 3D RV-EF before and after PMVR showed no significant change (p = 0.16). While there was a significant increase of the fractional area change (FAC, from 23 [19–29] % to 28 [24–33] %, p = 0.001), no significant change of the tricuspid annular plane systolic excursion (TAPSE, from 17 ± 6 mm to 18 ± 5 mm (standard deviation), p = 0.33) was observed. Regarding patients with a reduced RV-EF (< 35%), a significant RV-EF improvement was observed (from 27 [23–34] % to 32.5 [30–39] % (p = 0.001). 71.4% of patients had an improved clinical outcome (improvement in 6-minute walk test and/or improvement in NYHA class of more than one grade), whereas clinical outcome did not improve in 28.6% of patients. Using univariate logistic regression analysis, the post-PMVR RV-EF (OR 1.15: 95% CI 1.02–1.29; p = 0.02) and the change in RV-EF (OR 1.13: 95% CI 1.02–1.25; p = 0.02) were significant predictors for improved clinical outcome at 6 months follow up. Conclusion: Thus, RV function may be an important non-invasive parameter to add to the predictive parameters indicating a potential clinical benefit from treatment of severe mitral regurgitation using PMVR. Keywords: Mitral regurgitation, Percutaneous mitral valve repair, Echocardiography, 3D-echocardiography, RV function, Outcome

Longitudinal right ventricular (RV) function is substantial and might be reflected by free wall longitudinal strain (FWLS). Software solutions for FWLS analysis by two-dimensional (2D) and three-dimensional (3D) transesophageal echocardiography (TEE) are available, but data on validation are sparse. In this study, a novel method for FWLS analysis on 3D meshes (“mesh surface”, MS-FWLS,) was tested for feasibility and compared to available parameters. 80 patients undergoing left-sided cardiac valve surgery with intraoperative TEE were included retrospectively. 2D-FWLS, 3D-derived (3Dd)-FWLS (assessed in optimized four-chamber views after volume analysis) and MS-FWLS were measured and compared to conventional parameters (3Dd-TAPSE, FAC and RVEF). The mean FWLS values did not differ significantly between methods (− 19.0 ± 6.1%, − 20.0 ± 7.3%, − 19.5 ± 7.3% for 2D-, 3Dd- and MS-FWLS, respectively). No significant differences in the mean FWLS between patients with normal or increased pulmonary artery pressures as well as normal or reduced left ventricular ejection fraction were observed. Agreement was best between 3Dd- and MS-FWLS (r = 0.89, bias = − 1.0%, LOA ± 6.9%). Conventional echocardiographic parameters yielded poorer intermodality agreement. In patients with discrepant results between 2D- and 3Dd-FWLS, 3Dd-FWLS and MS-FWLS yielded similar results (r = 0.82, bias = − 0.3%, LOA ± 8.6%), while 2D-FWLS and MS-FWLS did not. Intra- and interobserver variabilities of strain analyses were low. MS-FWLS might represent a promising method to overcome artefacts associated with 2D analysis. Its prognostic relevance needs to be investigated in prospective studies.

Background: General anesthesia induction with the initiation of positive pressure ventilation creates a vulnerable phase for patients. The impact of positive intrathoracic pressure on cardiac performance has been studied but remains controversial. 3D echocardiography is a valid and MRI-validated bed-side tool to evaluate the right ventricle (RV). The aim of this study was to assess the impact of anesthesia induction (using midazolam, sufentanil and rocuronium, followed by sevoflurane) with positive pressure ventilation (PEEP 5, tidal volume 6 – 8 ml/kg) on 2D and 3D echocardiography derived parameters of RV function. Methods: A prospective observational study on fifty-three patients undergoing elective cardiac surgery in a tertiary care university hospital was designed. Transthoracic echocardiography exams were performed before and immediately after anesthesia induction and were recorded together with hemodynamic parameters and ventilator settings. Results: TAPSE as a parameter reflecting the movement of the lateral tricuspid annulus was significantly reduced (mean difference -1.6mm (95% CI -2.6mm to -0.7mm; p=0.0013). Tissue Doppler derived tricuspid annulus peak velocity was also significantly reduced (mean difference -1.9% (95% CI: -2.6 to -1.2; pConclusions: This data shows a preserved right ventricular ejection fraction and right ventricular stroke volume despite reduced baso-apical right ventricular function after anesthesia induction and initiation of positive pressure ventilation. Because only small changes were seen the clinical impact has yet to be determined. Trial Registration: Retrospecitvely registered, 6th June 2016, ClinicalTrials.gov Identifier NCT02820727. Keywords: Right ventricular function; positive-pressure respiration; anesthesiology; echocardiography, three-dimensional.

Physical review letters 123(10), 103001 (2019). doi:10.1103/PhysRevLett.123.103001, We demonstrate time-resolved nonlinear extreme-ultraviolet absorption spectroscopy on multiply charged ions, here applied to the doubly charged neon ion, driven by a phase-locked sequence of two intense free-electron laser pulses. Absorption signatures of resonance lines due to $2p-3d$ bound–bound transitions between the spin-orbit multiplets $^3P_{0,1,2}$ and $^3D_{1,2,3}$ of the transiently produced doubly charged Ne$^{2+}$ ion are revealed, with time-dependent spectral changes over a time-delay range of (2.4±0.3) fs. Furthermore, we observe 10-meV-scale spectral shifts of these resonances owing to the ac Stark effect. We use a time-dependent quantum model to explain the observations by an enhanced coupling of the ionic quantum states with the partially coherent free-electron laser radiation when the phase-locked pump and probe pulses precisely overlap in time., Published by APS, College Park, Md.

Within this work, electron dynamics of autoionizing, doubly excited states in helium are investigated. Therefore, strong field couplings of these states are studied in two spectral regimes: in the infrared and in the extreme ultraviolet. A laser system capable of tuning its output-pulses' central wavelength within the infrared spectral regime is installed and characterized by a FROG setup. Furthermore, high harmonics of these output pulses are generated and discussed. First intensity dependent and time resolved experiments in helium with this laser system are presented and supported by numerical calculations. The transition from an unperturbed light induced state, which is generated from the 2p4p state, to a resonant Autler-Townes splitting of the sp2;3+ state is observed. Furthermore, strong field couplings between the ground and a doubly-excited state are studied in the extreme ultraviolet only regime. With the help of simulations Rabi-like couplings and Stark shifts for ultrashort pulses leading to a manipulated absorption line shape are investigated. The same study is carried out for autoionizing states. This theory part is used to explain experimentally measured line-shape changes of the 2s2p resonance in helium interacting with FEL pulses.

Die meisten Rettungskrafte empfinden eine Wasserrettung als besonders anspruchsvoll. Dafur gibt es haufig zwei Grunde: Weder haben sie darin Einsatzroutine noch konnen sie sich auf einen geltenden Handlungsstandard berufen. Erfahren Sie in diesem Beitrag, wie Sie am besten vorgehen – ohne sich selbst in Gefahr zu bringen.

Die extrakorporale Membranoxygenierung (ECMO) ist heute ein sicheres und etabliertes Verfahren zur Unterstutzung der Lunge. Ist auch das Herz betroffen, wird sie zum extrakorporalen Life Support (ECLS) erweitert. Bei Intensivverlegungen und Reanimationen kommt auch der Rettungsdienst zunehmend mit ECMO und ECLS in Beruhrung.