Caracterização e desfecho clínico nos doentes com insuficiência cardíaca crónica, seguidos numa consulta especializada de ICC

Introdução: A Insuficiência Cardíaca (IC) é uma doença frequente e com considerável aumento de prevalência, já designada como sendo a epidemia do século XXI. Os doentes com IC manifestam uma alta taxa de mortalidade cardiovascular, em que as arritmias ventriculares malignas estão envolvidas. A remodelagem estrutural e elétrica nos portadores de IC levam a alterações eletromecânicas que desencadeiam a dissincronia cardíaca e natural agravamento da doença, provocando o aumento da predisposição para o aparecimento de arritmias e consequentemente aumento do risco de morte súbita. Objetivo: Caracterização dos doentes com IC seguidos na consulta de ICC do Centro Hospital Leiria-Pombal (CHLP) e avaliação da ocorrência dos eventos cardiovasculares. Avaliação dos parâmetros de repolarização ventricular e o seu contributo no aumento da suscetibilidade a arritmias malignas e/ou morte súbita. Métodos: Selecionou-se um grupo de 130 indivíduos inscritos na consulta externa de ICC-Avançada do CHLP, avaliando-se durante uma média de 42,15 meses de follow-up. Caracterizou-se a amostra quanto aos dados clínicos (anamnese clinica, analises e exames complementares de diagnóstico) e parâmetros de repolarização ventricular (QT, QTc, Tpeack-Tend). Os indivíduos em FA forem classificados quanto ao risco trombótico CHADS2 e CHA2DS2VAS. Quanto aos eventos hospitalares agrupou-se a amostra em Com MACE e Sem MACE. Resultados: Verificou-se que 76,2% da amostra é do sexo masculino, com uma média de idades de 65,9 ±14,8, a etiologia da IC mais comum nesta amostra foi a HTA e a isquémica (n=41 e n=39, respetivamente); segundo a classificação de NYHA 64,6% encontra-se em grau II; 43,1% da amostra encontra-se em FA. Dos 84 indivíduos com avaliação da FEVE, 42,7% tinham a FEVE bastante diminuída e 40,4% depressão ligeira/moderada da FEVE. 10,8% dos indivíduos da amostra foi tratado com ressincronização cardíaca. Durante o follow-up foram registadas 1.479 admissões hospitalares, das quais 1.039 são no serviço de urgência e 182 no serviço de cardiologia. 12,3% da amostra faleceu durante a recolha de dados. A mortalidade total foi influenciada, com significado estatístico (p<0,05), pela idade, QTc, Tpeack-end, total de internamentos, admissões no serviço de urgência, creatinina, ureia e pela TFG. As determinantes independentes para a mortalidade foram a dislipidémia e o total de internamentos, sendo que a idade se revelou tendencialmente significativa. As variáveis TFG, HTA, os antecedentes familiares cardíacos e a terapêutica sem sinvastatina revelaram-se marginalmente significativos para a variável MACE. Os indivíduos com IC mais idosos, com maior percentagem de peso, com diabetes e com alterações na creatinina e TFG revelaram relação estatística com a admissão num dos serviços de internamento. A duração do QRS, do QTC, do Tpeack-Tend e a terapêutica sem anticoagulantes revelaram-se marginalmente significativos na necessidade de internamento hospitalar. Em relação aos doentes em FA segundo a classificação em CHa2DS2VASC e CHADS2 verificou-se que 76,8% da amostra e 48,2% (respetivamente) encontrava-se num score acima do 3. Verificou-se um aumento tendencialmente exponencial em relação ao risco de morte com o aumento do score de CHADS2, bem como a relação direta com o aumento da probabilidade de eventos cardiovasculares. Conclusões: Os portadores de IC são um grupo de doentes peculiares; em que a remodelagem estrutura e elétrica proporciona modificações que culminam no aumento da predisposição para o surgimento de arritmias e consequente aumento de risco de morte súbita.

Advanced UV inscribed fibre grating structures and applications in optical sensing and laser systems

This thesis presents detailed investigation of UV inscribed fibre grating based devices and novel developments in the applications of such devices in optical sensing and fibre laser systems. The major contribution of this PhD programme includes the systematic study on fabrication, spectral characteristics and applications of different types of UV written in-fibre gratings such as Type I and IA Fibre Bragg Gratings (FBGs), Chirped Fibre Bragg Gratings (CFBGs) and Tilted Fibre Gratings (TFGs) with small, large and 45º tilted structures inscribed in normal silica fibre. Three fabrication techniques including holographic, phase-mask and blank beam exposure scanning, which were employed to fabricate a range of gratings in standard single mode fibre, are fully discussed. The thesis reports the creation of smart structures with self-sensing capability by embedding FBG-array sensors in Al matrix composite. In another part of this study, we have demonstrated the particular significant improvements made in sensitising standard FBGs to the chemical surrounding medium by inducing microstructure to the grating by femtosecond (fs) patterning assisted chemical etching technique. Also, a major work is presented for the investigation on the structures, inscription methods and spectral Polarisation Dependent Loss (PDL) and thermal characteristics of different angle TFGs. Finally, a very novel application in realising stable single polarisation and multiwavelength switchable Erbium Doped Fibre Lasers (EDFLs) using intracavity polarisation selective filters based on TFG devices with tilted structures at small, large and exact 45° angles forms another important contribution of this thesis.

Characterization of 45º-tilted fiber grating and its polarization function in fiber ring laser

We have proposed and demonstrated a fiber ring laser with single-polarization output using an intracavity 45°-tilted fiber grating (45°-TFG). The properties of the 45°-TFG have been investigated both theoretically and experimentally. The fiber ring laser incorporating the 45°-TFG has been systematically characterized, showing a significant improvement in the polarization extinction ratio (PER) and achieving a PER of >30 dB. The slope efficiencies of the ring laser with and without the 45°-TFG have been measured. This laser shows a very stable polarized output with a PER variation of less than 2 dB for 5 hours at laboratory conditions. In addition, we also demonstrated the tunability of the laser.

Optical fibre sensors with applications in gas and biological sensing

This thesis describes the study of various grating based optical fibre sensors for applications in refractive index sensing. The sensitivity of these sensors has been studied and in some cases enhanced using novel techniques. The major areas of development are as follows. The sensitivity of long period gratings (LPGs) to surrounding medium refractive index (SRI) for various periods was investigated. The most sensitive period of LPG was found to be around 160 µm and this was due to the core mode coupling to a single cladding mode but phase matching at two wavelength locations, creating two attenuation peaks, close to the waveguide dispersion turning point. Large angle tilted fibre gratings (TFGs) have similar behaviour to LPGs, in that they couple to the co-propagating cladding modes. The tilted structure of the index modulation within the core of the fibre gives rise to a polarisation dependency, differing the large angle TFG from a LPG. Since the large angle TFG couple to the cladding mode they are SRI sensitive, the sensitivity to SRI can be further increased through cladding etching using HF acid. The thinning of the cladding layer caused a reordering of the cladding modes and shifted to more SRI sensitive cladding modes as the investigation discovered. In a SRI range of 1.36 to 1.40 a sensitivity of 506.9 nm/URI was achieved for the etched large angle TFG, which is greater than the dual resonance LPG. UV inscribed LPGs were coated with sol-gel materials with high RIs. The high RI of the coating caused an increase in cladding mode effective index which in turn caused an increase in the LPG sensitivity to SRI. LPGs of various periods of LPG were coated with sol-gel TiO2 and the optimal thickness was found to vary for each period. By coating of the already highly SRI sensitive 160µm period LPG (which is a dual resonance) with a sol-gel TiO2, the SRI sensitivity was further increased with a peak value of 1458 nm/URI, which was an almost 3 fold increase compared to the uncoated LPG. LPGs were also inscribed using a femtosecond laser which produced a highly focused index change which was no uniform throughout the core of the optical fibre. The inscription technique gave rise to a large polarisation sensitivity and the ability to couple to multiple azimuthal cladding mode sets, not seen with uniform UV inscribed gratings. Through coupling of the core mode to multiple sets of cladding modes, attenuation peaks with opposite wavelength shifts for increasing SRI was observed. Through combining this opposite wavelength shifts, a SRI sensitivity was achieved greater than any single observed attenuations peak. The maximum SRI achieved was 1680 nm/URI for a femtosecond inscribed LPG of period 400 µm. Three different types of surface plasmon resonance (SPR) sensors with a multilayer metal top coating were investigated in D shape optical fibre. The sensors could be separated into two types, utilized a pre UV inscribed tilted Bragg grating and the other employed a post UV exposure to generate surface relief grating structure. This surface perturbation aided the out coupling of light from the core but also changed the sensing mechanism from SPR to localised surface plasmon resonance (LSPR). This greatly increased the SRI sensitivity, compared to the SPR sensors; with the gold coated top layer surface relief sensor producing the largest SRI sensitivity of 2111.5nm/URI was achieved. While, the platinum and silver coated top layer surface relief sensors also gave high SRI sensitivities but also the ability to produce resonances in air (not previously seen with the SPR sensors). These properties were employed in two applications. The silver and platinum surface relief devices were used as gas sensors and were shown to be capable of detecting the minute RI change of different gases. The calculated maximum sensitivities produced were 1882.1dB/URI and 1493.5nm/URI for silver and platinum, respectively. Using a DFB laser and power meter a cheap alternative approach was investigated which showed the ability of the sensors to distinguish between different gases and flow rates of those gases. The gold surface relief sensor was coated in a with a bio compound called an aptamer and it was able to detect various concentrations of a biological compound called Thrombin, ranging from 1mM to as low as 10fM. A solution of 2M NaCl was found to give the best stripping results for Thrombin from the aptamer and showed the reusability of the sensor. The association and disassociation constants were calculated to be 1.0638×106Ms-1 and 0.2482s-1, respectively, showing the high affinity of the Aptamer to thrombin. This supports existing working stating that aptamers could be alternative to enzymes for chemical detection and also helps to explain the low detection limit of the gold surface relief sensor.

Single- and dual-wavelength switchable erbium-doped fiber ring laser based on intracavity polarization selective tilted fiber gratings

We propose and demonstrate a single- and dual-wavelength switchable erbium-doped fiber laser (EDFL) by utilizing intracavity polarization selective filters based on tilted fiber gratings (TFGs). In the cavity, one 45° TFG functions as an in-fiber polarizer and the other 77° TFG is used as a fiber polarization dependent loss (PDL) filter. The combined polarization effect from these two TFGs enables the laser to switch between the single- and the dual-wavelength operation with a single-polarization state at room temperature. The laser output at each wavelength shows an optical signal-to-noise ratio (OSNR) of >60 dB, a side mode suppression ratio (SMSR) of >50 dB, and a polarization extinction ratio of ~35 dB. The proposed EDFL can give stable output under laboratory conditions.

Novel glucose sensor based on enzymeimmobilized 81° tilted fiber grating

We demonstrate a novel glucose sensor based on an optical fiber grating with an excessively tilted index fringe structure and its surface modified by glucose oxidase (GOD). The aminopropyltriethoxysilane (APTES) was utilized as binding site for the subsequent GOD immobilization. Confocal microscopy and fluorescence microscope were used to provide the assessment of the effectiveness in modifying the fiber surface. The resonance wavelength of the sensor exhibited red-shift after the binding of the APTES and GOD to the fiber surface and also in the glucose detection process. The red-shift of the resonance wavelength showed a good linear response to the glucose concentration with a sensitivity of 0.298nm(mg/ml)-1 in the very low concentration range of 0.0∼3.0mg/ml. Compared to the previously reported glucose sensor based on the GOD-immobilized long period grating (LPG), the 81° tilted fiber grating (81°-TFG) based sensor has shown a lower thermal cross-talk effect, better linearity and higher Q-factor in sensing response. In addition, its sensitivity for glucose concentration can be further improved by increasing the grating length and/or choosing a higher-order cladding mode for detection. Potentially, the proposed techniques based on 81°-TFG can be developed as sensitive, label free and micro-structural sensors for applications in food safety, disease diagnosis, clinical analysis and environmental monitoring.

Advanced fibre gratings fabricated in standard and infrared glass fibres by ultraviolet and near-infrared-femtosecond lasers

In this thesis, I describe studies on fabrication, spectral characteristics and applications of tilted fibre gratings (TFGs) with small, large and 45° tilted structures and novel developments in fabrication of fibre Bragg gratings (FBGs) and long period gratings (LPGs) in normal silica and mid-infrared (mid-IR) glass fibres using near-IR femtosecond laser. One of the major contributions presented in this thesis is the systematic investigation of structures, inscription methods and spectral, polarisation dependent loss (PDL) and thermal characteristics of TFGs with small (<45°), large (>45°) and 45° tilted structures. I have experimentally characterised TFGs, obtaining relationships between the radiation angle, central wavelength of the radiation profile, Bragg resonance and the tilt angle, which are consistent with theoretical simulation based on the mode-coupling theory. Furthermore, thermal responses have been measured for these three types of TFGs, showing the transmission spectra of large and 45° TFGs are insensitive to the temperature change, unlike the normal and small angle tilted FBGs. Based on the distinctive optical properties, TFGs have been developed into interrogation system and sensors, which form the other significant contributions of the work presented in this thesis. The 10°-TFG based 800nm WDM interrogation system can function not just as an in-fibre spectrum analyser but also possess refractive index sensing capability. By utilising the unique polarisation properties, the 81 °-TFG based sensors are capable of sensing the transverse loading and twisting with sensitivities of 2.04pW/(kg/m) and 145.90pW/rad, repectively. The final but the most important contribution from the research work presented in this thesis is the development of novel grating inscription techniques using near-IR femtosecond laser. A number of LPGs and FBGs were successfully fabricated in normal silica and mid-IR glass fibres using point-by-point and phase-mask techniques. LPGs and 1st and 2nd order FBGs have been fabricated in these mid-IR glass fibres showing resonances covering the wavelength range from 1200 to 1700nm with the strengths up to 13dB. In addition, the thermal and strain sensitivities of these gratings have been systematically investigated. All the results from these initial but systematic works will provide useful function characteristics information for future fibre grating based devices and applications in mid-IR range.

All-fibre twist sensor system based on 45 and 81 tilted fibre gratings

We experimentally demonstrated a highly sensitive twist sensor system based on a 45° and an 81° tilted fibre grating (TFG). The 81°-TFG has a set of dual-peaks that are due to the birefringence induced by its extremely tilted structure. When the 81°-TFG subjected to twist, the coupling to the two peaks would interchange from each other, providing a mechanism to measure and monitor the twist. We have investigated the performance of the sensor system by three interrogation methods (spectral, power-measurement and voltage-measurement). The experimental results clearly show that the 81°-TFG and the 45°-TFG could be combined forming a full fibre twist sensor system capable of not just measuring the magnitude but also recognising the direction of the applied twist.

UV-inscription, polarization-dependant loss characteristics and applications of 45° tilted fiber gratings

We have UV-inscribed and theoretically and experimentally analyzed fiber gratings with the structure tilted at 45° and implemented this type of devices as an in-fiber polarizer. A systematic investigation has been carried out on the characterization of 45° tilted fiber gratings (45° TFGs) in terms of the polarization-dependant loss (PDL) and thermal response. The detailed theoretical modeling has revealed a linear correlation between the grating length and the PDL, which has been proved by the experimental results. For the first time, we have examined the UV beam diffraction from a tilted phase mask and designed the UV-inscription system to suit the 45° TFG fabrication. Experimentally, a 24 mm long 45° TFG UV-inscribed in standard telecom single-mode fiber exhibited around 25 dB PDL at 1530 nm and an over ~300 nm bandwidth of PDL spectrum. By the concatenation method, a 44 mm long grating showed a PDL as high as 40 dB that is close to the high polarization extinction ratio of commercial products. Moreover, we have revealed that the PDL of 45° TFGs has low thermal influence, which is desirable for real application devices. Finally, we experimentally demonstrated an all-fiber twist sensor system based on a 45° and an 81° TFG.

2 μm mode-locked thulium doped fiber laser using tilted fiber grating

A nonlinear polarization rotation based all-fiber passively mode-locked Tm3+-doped fiber laser is demonstrated by using a 45° tilted fiber grating (TFG) as an in-line polarizer. Stable soliton pulses centered at 1992.7 nm with 2.02 nm FWHM bandwidth were produced at a repetition rate of 1.902 MHz with pulse duration of 2.2 ps and pulse energy of 74.6 pJ. With the increased pump power, the laser also can operate at noise-like regime with 18.1 nm FWHM bandwidth and pulse energy of up to 250.1 nJ. Using the same 45° TFG, both stable soliton and noise-like mode-locking centered at ∼1970 nm and ∼2050 nm, were also achieved by shortening and extending the length of Tm3+-doped fiber, respectively, exhibiting advantages of broadband and low insertion loss at 2 μm band.

In-fiber linear polarizer based on UV-inscribed 45° tilted grating in polarization maintaining fiber

We report an in-fiber linear polarizer structured by UV-inscribing a 45° tilted fiber grating (TFG) into polarization maintaining (PM) fiber along its principal axis. The polarization extinction ratio (PER) achieved by a 48 mm long 45° TFG has reached 46 dB at 1550 nm and the overall PER is >40 dB over a 50 nm wavelength range. Such 45° TFG based polarizers have many advantages over conventional products, including low loss, low cost, simple fabrication process, and no physical modification to the fiber, thus offering high stability and capable of handling high power.

Fabrication and characterisation of 45º and Ex 45º:tilted fibre gratings and their applications in fibre lasers and sensors

In this thesis, I present the studies on fabrication, spectral and polarisation characterisation of fibre gratings with tilted structures at 45º and > 45º (namely 45º- TFGs and ex 45º-TFGs throughout this thesis) and a range of novel applications with these two types of grating. One of the major contributions made in this thesis is the systematic investigation of the grating structures, inscription analysis and spectral and polarisation properties of both types of TFGs. I have inscribed 45º-TFGs in standard telecom and polarisation maintaining (PM) fibres. Two wavelength regions of interest have been explored including 1.55 µm and 1.06 µm. Detailed analysis on fabrication and characterisation of 45º-TFGs on PM fibres have also been carried out for the first time. For ex 45º- TFGs, fabrication has been investigated only on low-cost standard telecom fibre. Furthermore, thermal responses have been measured and analysed showing that both types of TFG have low responsivity to temperature change. More importantly, their refractive index (RI) responses have been characterised to verify the high responsivity to surrounding medium. Based on the unique polarisation properties, both types of TFG have been applied in fibre laser systems to improve the laser performance, which forms another major contribution of the research presented in this thesis. The integration of a 45º-TFG to the Erbium doped fibre laser (EDFL) enables single polarisation laser output at a single wavelength. When combing with ex 45º-TFGs, the EDFL can be transformed to a multi-wavelength switchable laser with single polarisation output. Furthermore, by utilising the polarisation property of the TFGs, a 45º-TFG based mode locked fibre laser is implemented. This laser can produce laser pulses at femtosecond scale and is the first application of TFG in the field of nonlinear optics. Another important contribution from the studies is the development of TFG based passive and active optical sensor systems. An ex 45º-TFG has been successfully developed into a liquid level sensor showing high sensitivity to water based solvents. Strain and twist sensors have been demonstrated via a fibre laser system using both 45°- and ex 45º-TFG with capability identifying not just the twist rate but also the direction. The sensor systems have shown the added advantage of low cost signal demodulation. In addition, load sensor applications have been demonstrated using the 45º-TFG based single polarisation EDFL and the experimental results show good agreement with the theoretical simulation.

All-fiber normal-dispersion single-polarization passively mode-locked laser based on a 45°-tilted fiber grating

An all-fiber normal-dispersion Yb-doped fiber laser with 45- tilted fiber grating (TFG) isto the best of our knowledgeexperimentally demonstrated for the first time. Stable linearly-chirped pulses with the duration of 4 ps and the bandwidth of 9 nm can be directly generated from the laser cavity. By employing the 45 TFG with the polarization-dependent loss of 33 dBoutput pulses with high polarization extinction ratio of 26 dB are implemented in the experiment. Our result shows that the 45 TFG can work effectively as a polarizerwhich could be exploited to singlepolarization all-fiber lasers.

UV-inscription, polarization-dependant loss characteristics and applications of 45° tilted fiber gratings

We have UV-inscribed and theoretically and experimentally analyzed fiber gratings with the structure tilted at 45° and implemented this type of devices as an in-fiber polarizer. A systematic investigation has been carried out on the characterization of 45° tilted fiber gratings (45° TFGs) in terms of the polarization-dependant loss (PDL) and thermal response. The detailed theoretical modeling has revealed a linear correlation between the grating length and the PDL, which has been proved by the experimental results. For the first time, we have examined the UV beam diffraction from a tilted phase mask and designed the UV-inscription system to suit the 45° TFG fabrication. Experimentally, a 24 mm long 45° TFG UV-inscribed in standard telecom single-mode fiber exhibited around 25 dB PDL at 1530 nm and an over ~300 nm bandwidth of PDL spectrum. By the concatenation method, a 44 mm long grating showed a PDL as high as 40 dB that is close to the high polarization extinction ratio of commercial products. Moreover, we have revealed that the PDL of 45° TFGs has low thermal influence, which is desirable for real application devices. Finally, we experimentally demonstrated an all-fiber twist sensor system based on a 45° and an 81° TFG.

All-fiber normal-dispersion single-polarization passively mode-locked laser based on a 45°-tilted fiber grating

An all-fiber normal-dispersion Yb-doped fiber laser with 45- tilted fiber grating (TFG) isto the best of our knowledgeexperimentally demonstrated for the first time. Stable linearly-chirped pulses with the duration of 4 ps and the bandwidth of 9 nm can be directly generated from the laser cavity. By employing the 45 TFG with the polarization-dependent loss of 33 dBoutput pulses with high polarization extinction ratio of 26 dB are implemented in the experiment. Our result shows that the 45 TFG can work effectively as a polarizerwhich could be exploited to singlepolarization all-fiber lasers.