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Antibody-Mediated Rejection (AMR) due to donor-specific antibodies (DSA) is associated with poor outcomes after lung transplantation. Currently, there are no guidelines regarding the selection of treatment protocols. We studied how DSA characteristics including titers, C1q, and mean fluorescence intensity (MFI) values in undiluted and diluted sera may predict a response to therapeutic plasma exchange (TPE) and inform patient prognosis after treatment. Among 357 patients consecutively transplanted without detectable pre-existing DSAs between 01/01/16 and 12/31/18, 10 patients were treated with a standardized protocol of five TPE sessions with IVIG. Based on DSA characteristics after treatment, all patients were divided into three groups as responders, partial responders, and nonresponders. Kaplan-Meier Survival analyses showed a statistically significant difference in patient survival between those groups (P = 0.0104). Statistical analyses showed that MFI in pre-TPE 1:16 diluted sera was predictive of a response to standardized protocol (R2 = 0.9182) and patient survival (P = 0.0098). Patients predicted to be nonresponders who underwent treatment with a more aggressive protocol of eight TPE sessions with IVIG and bortezomib showed improvements in treatment response (P = 0.0074) and patient survival (P = 0.0253). Dilutions may guide clinicians as to which patients would be expected to respond to a standards protocol or require more aggressive treatment.

We report the broadband spectral performance of a three-stage, high gain, single mode, high output power (25 W) polarization-maintaining (PM) hybrid Ho-doped and Tm-doped fiber amplifier at signal wavelengths of λs = 2004–2108 nm. The three-stage amplifier consists of a two stage high gain Ho-doped PM single clad preamplifier stage followed by a Tm-doped PM double clad power amplifier. We employ narrow linewidth (

Lung transplantation is an established treatment of select patients with end-stage pulmonary disease. Lung transplantation should be considered for patients with end-stage pulmonary disease who have an expected 2-year survival of less than 50% without lung transplant and an expected 5-year survival of greater than 80% after transplant. This article reviews routine postsurgical intensive care unit management, along with management of complications such as acute kidney injury, atrial arrhythmias, deep vein thrombosis, primary graft dysfunction, hyperammonemia syndrome, and thrombocytopenia. Finally, management of long-term issues, including diabetes mellitus, hypertension, and bronchial stenosis, is discussed.

Background Infection is the most common cause of mortality within the first year after lung transplantation (LTx). The management of perioperative antibiotic therapy is a major issue, but little is known about worldwide practices. Methods We sent by email a survey dealing with 5 daily clinical vignettes concerning perioperative antibiotic therapy to 180 LTx centers around the world. The invitation and a weekly reminder were sent to lung transplant specialists for a single consensus answer per center during a 3-month period. Results We received a total of 99 responses from 24 countries, mostly from Western Europe (n = 46) and the USA (n = 34). Systematic screening for bronchial recipient colonization before LTx was mostly performed with sputum samples (72%), regardless of the underlying lung disease. In recipients without colonization, antibiotics with activity against gram-negative bacteria resistant strains (piperacillin / tazobactam, cefepime, ceftazidime, carbapenems) were reported in 72% of the centers, and antibiotics with activity against methicillin-resistant Staphylococcus aureus (mainly vancomycin) were reported in 38% of the centers. For these recipients, the duration of antibiotics reported was 7 days (33%) or less (26%) or stopped when cultures of donor and recipients were reported negatives (12%). In recipients with previous colonization, antibiotics were adapted to the susceptibility of the most resistant strain and given for at least 14 days (67%). Conclusion Practices vary widely around the world, but resistant bacterial strains are mostly targeted even if no colonization occurs. The antibiotic duration reported was longer for colonized recipients.

Background Infection with the novel severe acute respiratory syndrome coronavirus 2 has been associated with a hypercoagulable state. Emerging data from China and Europe have consistently shown an increased incidence of venous thromboembolism (VTE). We aimed to identify the VTE incidence and early predictors of VTE at our high-volume tertiary care center. Methods We performed a retrospective cohort study of 147 patients who had been admitted to Temple University Hospital with coronavirus disease 2019 (COVID-19) from April 1, 2020 to April 27, 2020. We first identified the VTE (pulmonary embolism [PE] and deep vein thrombosis [DVT]) incidence in our cohort. The VTE and no-VTE groups were compared by univariable analysis for demographics, comorbidities, laboratory data, and treatment outcomes. Subsequently, multivariable logistic regression analysis was performed to identify the early predictors of VTE. Results The 147 patients (20.9% of all admissions) admitted to a designated COVID-19 unit at Temple University Hospital with a high clinical suspicion of acute VTE had undergone testing for VTE using computed tomography pulmonary angiography and/or extremity venous duplex ultrasonography. The overall incidence of VTE was 17% (25 of 147). Of the 25 patients, 16 had had acute PE, 14 had had acute DVT, and 5 had had both PE and DVT. The need for invasive mechanical ventilation (adjusted odds ratio, 3.19; 95% confidence interval, 1.07-9.55) and the admission D-dimer level ≥1500 ng/mL (adjusted odds ratio, 3.55; 95% confidence interval, 1.29-9.78) were independent markers associated with VTE. The all-cause mortality in the VTE group was greater than that in the non-VTE group (48% vs 22%; P = .007). Conclusions Our study represents one of the earliest reported from the United States on the incidence rate of VTE in patients with COVID-19. Patients with a high clinical suspicion and the identified risk factors (invasive mechanical ventilation, admission D-dimer level ≥1500 ng/mL) should be considered for early VTE testing. We did not screen all patients admitted for VTE; therefore, the true incidence of VTE could have been underestimated. Our findings require confirmation in future prospective studies.

A discrete-mode laser diode, fabricated in the In0.6Ga0.4P/AlGaInP multiple quantum well system, emitting a single mode at $\lambda =689$ nm is reported. The laser has an ex-facet output power >10 mW at 30 °C and operates mode hop free in the temperature range 0 °C to 50 °C.

Compact monolithic single-mode red emitting diode lasers are still not readily available for many wavelengths in the visible spectrum. Strontium lattice and Calcium clocks are some of the most widely investigated optical clocks worldwide and the pertinent transitions wavelengths required are in the red and blue wavelength spectral region. The current state of the art in laser technology employs external cavity laser diodes and frequency doubling crystals in order to hit the desired wavelength with external amplifiers used to meet the power requirements. Compact rugged monolithic narrow linewidth laser sources operating in the red and blue wavelengths have been identified by the European Space Agency as a key technology that could be used to replace all of these costly, energy inefficient and vibration sensitive components and to one day facilitate the optical clock leaving the laboratory and to eventually end up on a satellite in space.

The quality and pulse compression of the 60 GHz millimeter wave signals generated by 750 μm long InAlGaAs Multi Quantum Well (MQW) passively mode locked laser under free running and optical self injection locked conditions are experimentally characterized in terms of longitudinal modes under certain bias currents that range from 24 mA to 90 mA. Initially, the MQW laser is characterized in free running condition with no external injection. The measurements reflect that the free spectral range of laser under test is around 61 GHz and exhibit more than 22 lasing modes. The laser is then integrated into low phase noise self injection locking oscillator by feeding a part of output RF signal back into the laser cavity to enhance passive mode locking. By doing so the microwave line width of our laser is reduced from 900 kHz to 24 kHz with significant increase in output of resultant beat tones which exhibits strong passive mode locking. This is the first time that the free running microwave line width of MQW laser is reduced up to this level. It is evident from our experimental investigation that as we increase the power and phase correlation between different longitudinal modes inside laser cavity through optical self injection, the strength of the passively mode locked mechanism is significantly increased and the phase noise of radio frequency signal is drastically reduced.

We report on a 2.051 μm InxGaAs/InP-based discrete mode laser diode monolithically integrated with a curved tapered semiconductor optical amplifier for CO2 sensing applications. At a heat-sink temperature of 0°C, the laser emits a record InP value of more than 35 mW continuous-wave output power in a single longitudinal mode.

Background CT scan measures of emphysema and airway disease have been correlated with lung function in cohorts of subjects with a range of COPD severity. The contribution of CT scan-assessed airway disease to objective measures of lung function and respiratory symptoms such as dyspnea in severe emphysema is less clear. Methods Using data from 338 subjects in the National Emphysema Treatment Trial (NETT) Genetics Ancillary Study, densitometric measures of emphysema using a threshold of −950 Hounsfield units (%LAA-950) and airway wall phenotypes of the wall thickness (WT) and the square root of wall area (SRWA) of a 10-mm luminal perimeter airway were calculated for each subject. Linear regression analysis was performed for outcome variables FEV 1 and percent predicted value of FEV 1 with CT scan measures of emphysema and airway disease. Results In univariate analysis, there were significant negative correlations between %LAA-950 and both the WT ( r = −0.28, p = 0.0001) and SRWA ( r = −0.19, p = 0.0008). Airway wall thickness was weakly but significantly correlated with postbronchodilator FEV 1 % predicted (R = −0.12, p = 0.02). Multivariate analysis showed significant associations between either WT or SRWA (β = −5.2, p = 0.009; β = −2.6, p = 0.008, respectively) and %LAA-950 (β = −10.6, p = 0.03) with the postbronchodilator FEV 1 % predicted. Male subjects exhibited significantly thicker airway wall phenotypes (p = 0.007 for WT and p = 0.0006 for SRWA). Conclusions Airway disease and emphysema detected by CT scanning are inversely related in patients with severe COPD. Airway wall phenotypes were influenced by gender and associated with lung function in subjects with severe emphysema.

Donor blood transfusion has been identified as a potential risk factor for primary graft dysfunction and by extension early mortality. We sought to define the contributing risk of donor transfusion on early mortality for lung transplant.Donor and recipient data were abstracted from the Organ Procurement and Transplantation Network database updated through June 30, 2014, which included 86,398 potential donors and 16,255 transplants. Using the United Network for Organ Sharing 4-level designation of transfusion (no blood, 1-5 units, 6-10 units, and10 units, massive), we analyzed all-cause mortality at 30-days with the use of logistic regression adjusted for confounders (ischemic time, donor age, recipient diagnosis, lung allocation score and recipient age, and recipient body mass index). Secondary analyses assessed 90-day and 1-year mortality and hospital length of stay.Of the 16,255 recipients transplanted, 8835 (54.35%) donors received at least one transfusion. Among those transfused, 1016 (6.25%) received a massive transfusion, defined as10 units. Those donors with massive transfusion were most commonly young trauma patients. After adjustment for confounding variables, donor massive transfusion was associated significantly with an increased risk in 30-day (P = .03) and 90-day recipient mortality (P = .01) but not 1-year mortality (P = .09). There was no significant difference in recipient length of stay or hospital-free days with respect to donor transfusion.Massive donor blood transfusion (10 units) was associated with early recipient mortality after lung transplantation. Conversely, submassive donor transfusion was not associated with increased recipient mortality. The mechanism of increased early mortality in recipients of lungs from massively transfused donors is unclear and needs further study but is consistent with excess mortality seen with primary graft dysfunction in the first 90 days posttransplant.

The quality and pulse compression of the 60 GHz millimeter wave signals generated by 750 m long InAlGaAs Multi Quantum Well (MQW) passively mode locked laser under free running and optical self-injection locked conditions are experimentally characterized in terms of longitudinal modes under certain bias currents that range from 24 mA to 90 mA. Initially, the MQW laser is characterized in free running condition with no external injection. The measurements reflect that the free spectral range of laser under test is around 61 GHz and exhibit more than 22 lasing modes. The laser is then integrated into low phase noise self-injection locking oscillator by feeding a part of output RF signal back into the laser cavity to enhance passive mode locking. By doing so the microwave line width of our laser is reduced from 900 kHz to 24 kHz with significant increase in output of resultant beat tones which exhibits strong passive mode locking. This is the first time that the free running microwave line width of MQW laser is reduced up to this level. It is evident from our experimental investigation that as we increase the power and phase correlation between different longitudinal modes inside laser cavity through optical self-injection, the strength of the passively mode locked mechanism is significantly increased and the phase noise of radio frequency signal is drastically reduced.

The present paper reports numerical and experimental investigation of noise figure of a multi-section semiconductor optical amplifier. The designed amplifier shows a 3.8dB noise figure, which seems to be the lowest figure reported.

Summary form only given. As the frequency spectrum below 10GHz becomes saturated, it will become increasingly difficult to maintain adequate bandwidth provision for the growing customer demand. For this reason, the possibility of utilizing the unlicensed 57GHz-64GHz band for services such as WPAN is an attractive prospect [1]. Furthermore, the advantages of an optical system to realize this prospect are numerous. Extremely low phase noise can be obtained from laser systems used for millimetre-wave applications, relative to the equivalent electronic components. In addition to this, the costs of such a system are much lower and the footprint smaller, not to mention the additional benefits of low loss and easy switching of carrier frequency. In this paper, a multimode quantum well Fabry-Perot laser with potential application as a carrier signal generator for WPAN is characterized. The laser is passively mode-locked, with no saturable absorber, and exhibits pulsed operation at 60GHz with only d.c. bias applied. The InP-based laser is 700μm long and exhibits multimode emission between 1555nm and 1565nm. A typical output spectrum at 70mA bias current is shown in Fig. 1. Also indicated on the graph are the measured values for optical linewidth for each mode. These values were measured using an optical self-heterodyne setup.The linewidth of the beat tone generated at a photodiode was also measured for various values of bias current. In free-running conditions, a linewidth of 1.7MHz is measured at 61.92GHz. A circulator and an optical delay line are then placed after the laser in the setup, in place of the isolator, thus creating an optical feedback loop. A filter is used to isolate two consecutive modes. The linewidth measured for the beat signal is reduced by a factor of 100, to nearly 10kHz, with lower linewidths being for longitudinal modes near to the centre of the optical spectrum. These results indicate that this laser has potential for application in RoF and WPAN areas, due to its low linewidth, cost and the fact that it exhibits 60GHz operation using only d.c. bias.

An experimental characterisation of a multi-contact semiconductor optical amplifier using ultrashort optical pulses is presented. The SOA in question allows the injection of bias current through multiple independent electrical contacts, allowing the direct control of the carrier density. Picosecond-scale optical pulses are transmitted through the SOA. The non-linear effects on the pulse shape and spectrum after transmission are determined. It is found that the bias current distribution in the SOA is a significant factor in determining the extent of the non-linearities affecting the pulses. Additionally, amplification of negatively chirped pulses in the saturated SOA is found to reduce the spectral width of the pulses.

We present an experimental investigation of a multi-contact semiconductor optical amplifier. This first-generation device allows for direct control of the carrier density profile along the length of the waveguide. This is used to control the device noise figure, with a minimum value of 5 dB observed at a gain of 15 dB for an optimum carrier density profile. The opposite carrier density profile results in an increase of the power saturation by 3 dB.

Experimental characterisation of a novel noise-controlled semiconductor optical amplifier (NCSOA) is presented. The design utilises grooves etched parallel to the active waveguide, at the output sections of the NCSOA, so as to induce lasing laterally to the propagation axis. This clamps the carrier density in a relevant region, allowing for the engineering of a specific longitudinal carrier density profile, corresponding to an improved noise figure performance. Results have demonstrated the effectiveness of carrier density profile engineering as a means of reducing the noise figure in semiconductor optical amplifiers.

A bulk semiconductor optical amplifier (SOA) utilizing a multi-contact biasing method is characterized as a function of the bias current supplied to each section Firstly, amplified spontaneous emission spectra and characteristic light-current profiles are analyzed. Single-pass gain and noise figure of the SOA are then assessed by injecting a continuous wave input beam. Finally, the amplification of a 10 Gb/s (215-1) long pseudo random bit sequence signal is analysed. The obtained results, particularly at a bias condition of 90mA-50mA-10mA, reveal the potential of this device as a low noise figure in-line amplifier.

The use of semiconductor optical amplifiers (SOA) in optical communications networks has so far been limited due to their inherent large noise figure (NF) compared to Erbium Doped Fibre Amplifiers. Therefore improvement of the noise performance of SOAs is critical to their widespread adoption in future networks. We propose to reduce the NF of the SOA by introducing a lasing cavity lateral to the axis of amplification of the device. The carrier density within the cavity is clamped at the lasing threshold. It is thus possible to engineer the carrier density distribution along the active waveguide by controlling the cavity design. According to our simulations, some of the cavity designs lead to a reduction of the noise figure in this novel SOA.

In this paper, Cassidy's method is presented and is applied to measure the linewidth enhancement factor (LEF) of a 370 GHz self-pulsating Fabry-Perot laser. The importance of the LEF is addressed, the method is detailed, and the device under test is presented. It exhibits a self-modulation at 370 GHz even though it is DC biased. The measured LEFs vary according to the wavelength, values of 4 have been measured at threshold current, which is typical in the case of multi-quantum well lasers. In this paper we propose to present measurement of the linewidth enhancement factor (LEF) in semiconductor laser based, 370 GHz source generator. First we explain the origin of LEF in semiconductor material, then we present several techniques to measure it. We present a computational simulation using modelled ASE spectra, and in part 4, we detail our device and experimental set-up and provide some results. The linewidth enhancement factor (LEF) or alpha parameter is a distinguishing feature of semiconductor devices. Semiconductor devices generally have a larger linewidth than other solid state lasers. This broadened linewidth leads to effects such as mode instability, filementation in broad area devices and frequency chirping under modulation. This last effect is of particular interest, especially in the field of optical communications. It can be suppressed if the LEF is reduced. Therefore in the design of semiconductor lasers or semiconductor amplifiers (SOA), a number of factors have to be taken into consideration, but one of the most important of these is the linewidth enhancement factor. For instance, when the gain of an SOA is affected by the injection of a pulsed source, refractive index changes caused by changes in carrier density will lead to an instantaneous variation of the frequency. This effect is exacerbated as the gain is saturated.

The consequences of tailoring the longitudinal carrier density along the active layer of a multi-contact bulk semiconductor optical amplifier (SOA) are investigated using a rate equation model. It is shown that both the noise figure and output power saturation can be optimized for a fixed total injected bias current. The simulation results are validated by comparison with experiment using a multi-contact SOA. The inter-contact resistance is increased using a focused ion beam in order to optimize the carrier density control. A chip noise figure of 3.8 dB and a saturation output power of 9 dBm are measured experimentally for a total bias current of 150 mA.

An all-optical heterodyne approach based on a room-temperature controlled semiconductor optical amplifier (SOA) for measuring the frequency and linewidth of the terahertz beat-tone signal from a passively mode-locked laser is proposed. Under the injection of two external cavity lasers, the SOA acts as a local oscillator at their detuning frequency and also as an optical frequency mixer whose inputs are the self-modulated spectrum of the device under test and the two laser beams. Frequency and linewidth of the intermediate frequency signal (and therefore, the beat-tone signal) are resolved by using a photodiode and an electrical spectrum analyzer.

The RAD52 gene is required for much of the recombination that occurs in Saccharomyces cerevisiae. One of the two commonly utilized mutant alleles, rad52-2, increases rather than reduces mitotic recombination, yet in other respects appears to be a typical rad52 mutant allele. This raises the question as to whether RAD52 is really necessary for mitotic recombination. Analysis of a deletion/insertion allele created in vitro indicates that the null mutant phenotype is indeed a deficiency in mitotic recombination, especially in gene conversion. The data also indicate that RAD52 is required for crossing-over between at least some chromosomes. Finally, examination of the behavior of a replicating plasmid in rad52-1 strains indicates that the frequency of plasmid integration is substantially reduced from that in wild type, a conclusion consistent with a role for RAD52 in reciprocal crossing-over. Analysis of recombinants arising in rad52-2 strains suggests that this allele may result in the increased activity of a RAD52-independent recombinational pathway.