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Juliane Schürmann,1 Frank Noack,2,3 Steffi Bethge,4 Viktoria Heinze,4 Axel Schlitt4,5 1Department of Cardiology and Pulmonology AMEOS Clinic Bernburg, Bernburg, Germany; 2Department of Emergency Medicine, University Clinic Halle-Saale, Halle, Germany; 3Department of Medicine I, University Clinic Halle-Saale, Halle, Germany; 4Paracelsus-Harz-Clinic Bad Suderode, Quedlinburg, Germany; 5Medical Faculty, Martin-Luther-University Halle-Wittenberg, Halle, GermanyCorrespondence: Juliane SchürmannDepartment of Cardiology and Pulmonology AMEOS Clinic, Bernburg, 06406, GermanyTel +49 3471 341504Fax +49 3471 342053Email jsch.med@bernburg.ameos.deBackground: Heart failure is the third most fatal disease in Germany and generates considerable treatment costs. The multimodal program of inpatient rehabilitation can improve the symptoms and prognosis of these patients. At the present time, however, only few data are available on the effectiveness of rehabilitation for heart failure patients.Methods: After receiving study approval from the ethics committee of the Saxony–Anhalt Medical Association, 200 patients with a primary or secondary diagnosis of heart failure were prospectively included in the study at Paracelsus-Harz-Clinic Bad Suderode, Quedlinburg, Germany. Baseline parameters such as age, gender, and BMI were documented. Outcome variables included NYHA classifications, quality of life, and mortality. For follow-up, the patients were contacted again by mail or phone after three and 12 months and, data on symptoms and serious events were recorded.Results: The proportion of patients with a highly reduced ejection fraction (HFrEF) was 13.5%, with a midrange reduced ejection fraction (HFmrEF) 33%, and with preserved ejection fraction (HFpEF) 53.5%. The mean age was 64 ± 11.9 years, the proportion of women 24.1%. The effects of rehabilitation were documented by low overall mortality (no patient died during the stay, only 4% of the patients died in the 12-month follow-up) and an improvement in NYHA classification during and after the inpatient rehabilitation.Conclusion: This monocentric study showed effects both for symptoms (improvement in NYHA classifications) and prognosis (overall mortality) after rehabilitation. These data reflect the effectiveness of multimodal rehabilitation and underscore the need for rehabilitation in patients diagnosed with heart failure after an acute event and hospital stay or who present with chronic deterioration.Keywords: heart failure, cardiac rehabilitation, inpatient rehabilitation

Stephan Waßmuth,1 Katharina Rohe,1 Frank Noack,2 Michel Noutsias,1 Hendrik Treede,3 Axel Schlitt4,5 1Department of Medicine III, University Clinic, Halle, Germany; 2Emergency Department and Department of Medicine II, University Clinic, Halle, Germany; 3Department of Cardiac Surgery, University Clinic, Halle, Germany; 4Paracelsus Harz-Clinic Bad Suderode, Quedlinburg, Germany; 5Medical Faculty, Martin Luther-University Halle-Wittenberg, Halle, GermanyCorrespondence: Stephan WaßmuthDepartment of Internal Medicine, St. Josefs Hospital Wiesbaden, Beethovenstraße 20, Wiesbaden 65189, GermanyTel +49 1726619946Fax +49 6452 5350Email s.wassmuth@joho.deObjectives: Treatment with lipid-lowering therapy (LLT) such as statins, cholesterol absorption inhibitors, or PCSK9 inhibitors is of major importance for the survival of patients with atherosclerotic diseases, and adherence to LLT is essential for treatment success. The intention of this study was to investigate adherence to LLT in patients with coronary heart disease (CHD) in a 12-month follow-up period in Saxony-Anhalt, the state with the highest incidence and mortality for CHD in Germany.Patients and methods: Data were taken from 542 hospitalized patients with angiographically documented CHD who were prospectively included in this study conducted in the Department of Medicine III of the University Clinics (Halle). We collected data concerning medication at discharge and after 3 and 12 months.Results: A total of 542 patients were included in this study. Mean age was 69.2 ± 11.8 years. In all, 68.8% were males, 165 (30.4%) were smokers, 39.7% suffered from diabetes, and 86.9% had arterial hypertension. The follow-up time of this study was 12 months. At discharge, 463 patients (85.4%) were being treated with a statin. After 3 months 409 (75.5%) and after 12 months, 395 patients (72.9%) were still on statin therapy, respectively. In total treatment, adherence for the statin medication decreased by 15.7% in 12 months. Kaplan–Meier analyses showed that survival, taken as freedom of death from any cause, decreased significantly if statin treatment was stopped (p=0.001). This was confirmed by multivariate Cox regression (HR 1.78, p=0.012). Ezetemibe was prescribed for 56 patients at discharge (10.3%). After 3 months, 40 patients (7.4%) were still taking ezetemibe. After 12 months, adherence to ezetemibe treatment decreased to 4.1% (22 patients).Conclusion: During follow-up for 3 and 12 months, adherence for statin therapy decreased by 15.7% and for ezetemibe by 46.6%. Here, low adherence to statin therapy was associated with fatal outcome.Keywords: coronary heart disease, lipid-lowering drugs, adherence

Mroawan Amoury,1 Frank Noack,1,2 Kathleen Kleeberg,3 Dietrich Stoevesandt,4 Burghart Lehnigk,5 Steffi Bethge,5 Viktoria Heinze,5 Axel Schlitt3,5 1Department of Emergency Medicine, University Clinic Halle-Saale, Halle, Germany; 2Department of Medicine I, University Clinic Halle-Saale, Halle, Germany; 3Medical Faculty, Martin Luther-University Halle-Wittenberg, Halle, Germany; 4Department of Diagnostic Radiology, University Clinic Halle-Saale, Halle, Germany; 5Department of Cardiology and Pulmology, Paracelsus-Harz Clinic Bad Suderode, Quedlinburg, Germany Introduction: Pulmonary embolism (PE) is a life-threatening disease; in Germany, therefore, rehabilitation after PE is recommended in patients with intermediate- and high-risk PE. However, no prospective data on PE after inpatient rehabilitation have been published so far. Patients and methods: For this monocentric study, 70 patients with PE were prospectively recruited between November 2013 and November 2014 after giving written informed consent. This study was approved by the ethics committee of the Medical Association of Saxony-Anhalt. Inclusion criteria were as follows: age ≥18 years and a stay at the Paracelsus-Harz Clinic in Bad Suderode, Germany, with the main indication of PE. During the hospital stay, history-relevant medical data and diagnostic findings were collected and documented. Furthermore, we recorded whether patients were rehospitalized or died during the treatment period in the rehabilitation clinic or during the 12-month follow-up. Results: The mean age was 64.5 ± 13.0 years, the mean body mass index (BMI) was 30.4 ± 6.0 kg/m2, and 54.3% were women. During rehabilitation, two patients (3.9%) were transferred to a primary care hospital; no patient died. However, four patients died (5.7%) in the 12-month follow-up period. A total of 20 patients were hospitalized in the 12-month follow-up period (hospitalization rate during the 12-month follow-up period: 28.6%). Of these 20 patients, one patient was rehospitalized with a newly diagnosed PE (1.4%) and two patients were rehospitalized for bleeding events (2.8%). Conclusion: PE is a life-threatening disease, and therefore it seems reasonable to recommend rehabilitation at least in patients with an intermediate- or high-risk PE. In this study, death and other serious event rates were low during the in-hospital rehabilitation and in the 12-month follow-up period, which underlined the safety and importance of a standardized rehabilitation program after survived PE. Keywords: pulmonary embolism, rehabilitation, prognosis

Frank Noack,1,2 Bernd Schmidt,1 Mroawan Amoury,2 Dietrich Stoevesandt,3 Stephan Gielen,4 Birgit Pflaumbaum,5 Christiane Girschick,5 Heinz Völler,6 Axel Schlitt5,7 1Department of Medicine I, 2Department of Emergency Medicine, 3Department of Diagnostic Radiology, 4Department of Medicine III, University Clinic Halle (Saale), Halle, Germany; 5Department of Cardiology and Pulmology, Paracelsus-Harz-Clinic Bad Suderode, Quedlinburg, Germany; 6Klinik am See, Rüdersdorf, Germany; 7Medical Faculty, Martin Luther University Halle, Wittenberg, Germany Background: Venous thromboembolism is a life-threatening disease. In survivors, different degrees of functional complaints need to be restored or prevented (eg, post-thrombotic syndrome, pulmonary hypertension). Therefore, rehabilitation after venous thromboembolism is recommended in Germany. However, a structured rehabilitation program has not been defined for this indication. Here, we present the experience of a single rehabilitation center. Methods: Data from consecutive pulmonary embolism (PE) patients who were referred for a 3-week inpatient rehabilitation program from 2006 to 2014 were retrospectively evaluated. Results: In all, 422 patients were identified. The mean age was 63.9±13.5 years, the mean body mass index (BMI) was 30.6±6.2 kg/m2, and 51.9% were female. Deep vein thrombosis according to PE was known for 55.5% of all patients. We applied a wide range of therapeutic interventions such as bicycle training with monitored heart rate in 86.7%, respiratory training in 82.5%, aquatic therapy/swimming in 40.1%, and medical training therapy in 14.9% of all patients. Adverse events (AEs) occurred in 57 patients during the 3-week rehabilitation period. The most common AEs were cold (n=6), diarrhea (n=5), and infection of the upper or lower respiratory tract that was treated with antibiotics (n=5). However, three patients under anticoagulation therapy suffered from bleeding, which was clinically relevant in one. Four patients (0.9%) had to be transferred to a primary care hospital for non-PE-associated reasons (acute coronary syndrome, pharyngeal abscess, and acute abdominal problems). No influence of any of the physical activity interventions on the incidence of any AE was found. Conclusion: Since PE is a life-threatening disease, it seems reasonable to recommend rehabilitation at least in PE patients with an intermediate or high risk. It is shown for the first time in this study that a standard rehabilitation program after PE is safe. However, efficacy and safety in the long term need to be studied prospectively. Keywords: venous thromboembolism, pulmonary embolism, rehabilitation

We present data on the linear (transmission, index of refraction) and nonlinear (second-order susceptibility) optical properties of the quaternary semiconductor AgGa[Ge.sub.5][Se.sub.12] with orthorhombic symmetry--a solid solution in the [Ag.sub.x][Ga.sub.x][Ge.sub.1-x][Se.sub.2] system with x = 0.17. The nonlinear coefficients are estimated from phase-matched second-harmonic generation near 3 [micro]m. After numerical analysis of the phase-matching configurations for three-wave nonlinear interactions, the first experimental results on difference-frequency mixing, producing tunable (4-7.5-[micro]m) femtosecond pulses at a 1-kHz repetition rate, are described. The pulses of only five optical cycles (FWHM = 84 fs) are generated near 5 [micro]m with energy of 0.5 [micro]J. Because of its higher damage threshold, larger birefringence and bandgap, and greater variety of phase-matching schemes, AgGa[Ge.sub.5][Se.sub.12] could become an alternative to AgGa[S.sub.2] and AgGa[Se.sub.2], more widely used in high-power and specific applications. OCIS codes: 190.2620, 160.4330, 190.7110.

A newly developed nonlinear crystal belonging to the borate family, lithium tetraborate Li2B4O7 (LB4), has excellent properties below 180 nm and allows the generation of wavelengths down to 170 nm with an all-solid state laser system. This was gleaned from a characterization of the newly grown crystal by the Czochralski method. A comparison with a lithium triborate sample showed that it performs better in the vacuum ultraviolet spectral region below 180 nm. Its effective nonlinearity is maximized under the conditions of 90 degree-phase matching.

The nuclear magnetic resonance relaxation of solvent nuclei in non-viscous paramagnetic solutions has been investigated. The study focused on the situation in which the electronic spin of the paramagnetic species is not free, but is submitted to a hyperfine field, Hhyp, due to a nuclear spin K of the radical molecule. A theoretical model which accounts for the intermolecular longitudinal relaxation rate due to dipolar magnetic coupling has been developed.