High-heat flux ball-pen probe head in ASDEX-Upgrade.

A new high heat flux ball-pen probe head installed on the midplane manipulator is currently being used in ASDEX-Upgrade (AUG). The probe was designed to withstand high heat fluxes making possible the investigation of the plasma edge under harsh conditions, such as low power H-mode. Composed of seven pins (four Langmuir probes, mounted in two Mach probe pairs, and three ball-pen probes), the new probe head allows us to measure several plasma parameters simultaneously and with high temporal resolution. A novel method to correct the sheath potential dynamically accounting for the total secondary electron emission is introduced together with applications to obtain the electron temperature and plasma potential profiles. The total secondary electron emission yield is obtained from particle in cell simulations in AUG condition and probe realistic impact angle with respect to the magnetic field. Finally, the probe capability to investigate turbulence around the separatrix of AUG is discussed.

Turbulence level effects on conventional reflectometry using 2D full-wave simulations.

Numerical simulations are critical in improving the capabilities of microwave diagnostics. In this work, the 2D finite-difference time-domain full-wave code REFMUL was applied to broadband turbulent plasmas using the conventional reflectometry setup. Simulations were performed with O-mode waves, fixed frequency probing, and I/Q detection. The plasma density, determining O-mode propagation, was modeled as the sum of a slab background plasma with a fluctuating component following a Kolmogorov-like amplitude k-spectrum. The density turbulence level δn e/n e was scanned over several orders of magnitude for simulated plasma flows of constant plasma velocity in either the radial or the poloidal direction. Simulations show trends, such as spectral broadening of the complex A(t)eiφ(t) signals and increasing fluctuations in A(t) and φ(t) with increasing δn e/n e, that are similar for both plasma flow directions. These together with possibilities to reconstruct a poloidal wavenumber spectrum are discussed in view of extending the measuring capabilities. The onset of non-linear effects associated with phase runaway, as previously observed with other 1D and 2D codes, as well as radial Doppler effects is also observed and discussed.

Correlation electron cyclotron emission diagnostic and improved calculation of turbulent temperature fluctuation levels on ASDEX Upgrade.

A newly upgraded correlation electron cyclotron emission (CECE) diagnostic has been installed on the ASDEX Upgrade tokamak and has begun to perform experimental measurements of electron temperature fluctuations. CECE diagnostics measure small amplitude electron temperature fluctuations by correlating closely spaced heterodyne radiometer channels. This upgrade expanded the system from six channels to thirty, allowing simultaneous measurement of fluctuation level radial profiles without repeat discharges, as well as opening up the possibility of measuring radial turbulent correlation lengths. Newly refined statistical techniques have been developed in order to accurately analyze the fluctuation data collected from the CECE system. This paper presents the hardware upgrades for this system and the analysis techniques used to interpret the raw data, as well as measurements of fluctuation spectra and fluctuation level radial profiles.

1 µs broadband frequency sweeping reflectometry for plasma density and fluctuation profile measurements.

Frequency swept reflectometry has reached the symbolic value of 1 µs sweeping time; this performance has been made possible, thanks to an improved control of the ramp voltage driving the frequency source. In parallel, the memory depth of the acquisition system has been upgraded and can provide up to 200 000 signals during a plasma discharge. Additional improvements regarding the trigger delay determination of the acquisition and the voltage ramp linearity required by this ultra-fast technique have been set. While this diagnostic is traditionally dedicated to the plasma electron density profile measurement, such a fast sweeping rate can provide the study of fast plasma events and turbulence with unprecedented time and radial resolution from the edge to the core. Experimental results obtained on ASDEX Upgrade plasmas are presented to demonstrate the performances of the diagnostic.

The impact of co-existing immune-mediated diseases on phenotype and outcomes in inflammatory bowel diseases.

BACKGROUND: Inflammatory bowel diseases lead to progressive bowel damage and need for surgery. While the increase in prevalence of other immune-mediated diseases in IBD is well recognised, the impact of this on the natural history of IBD is unknown. AIM: To determine the impact of concomitant immune-mediated diseases on phenotypes and outcomes in IBD. METHODS: Patients with IBD enrolled in a prospective registry were queried about the presence of other immune-mediated diseases, defined as those where immune dysregulation plays a role in pathogenesis. Demographics and disease-related information were obtained. Subjects also completed measures of quality of life. Multivariable regression models compared disease phenotype and outcomes of IBD patients with and without other immune-mediated diseases. RESULTS: The cohort included 2145 IBD patients among whom 458 (21%) had another immune-mediated disease. There was no difference in CD phenotype between the two groups. UC patients were more likely to have pancolitis in the presence of another immune-mediated disease (62%) compared to those without (52%, P = 0.02). IBD patients with another immune-mediated disease had higher rates of needing anti-TNF biologics [Odds ratio (OR) 1.31, 95% CI 1.05-1.63] and surgery (OR 1.26, 95% CI 0.99-1.61). The presence of another immune-mediated disease was also associated with lower disease-specific and general physical quality of life. CONCLUSIONS: The presence of another immune-mediated disease in IBD patients was associated with higher likelihood of pancolonic involvement in UC, and a modest increase in need for IBD-related surgery and anti-TNF biological therapy. Such patients also experienced worse quality of life.

Genetics of mitochondrial dysfunction and infertility.

Increasingly, mitochondria are being recognized as having an important role in fertility. Indeed in assisted reproductive technologies mitochondrial function is a key indicator of sperm and oocyte quality. Here, we review the literature regarding mitochondrial genetics and infertility. In many multisystem disorders caused by mitochondrial dysfunction death occurs prior to sexual maturity, or the clinical features are so severe that infertility may be underreported. Interestingly, many of the genes linked to mitochondrial dysfunction and infertility have roles in the maintenance of mitochondrial DNA or in mitochondrial translation. Studies on populations with genetically uncharacterized infertility have highlighted an association with mitochondrial DNA deletions, whether this is causative or indicative of poor functioning mitochondria requires further examination. Studies on the impact of mitochondrial DNA variants present conflicting data but highlight POLG as a particularly interesting candidate gene for both male and female infertility.

Implementation of the new multichannel X-mode edge density profile reflectometer for the ICRF antenna on ASDEX Upgrade.

A new multichannel frequency modulated continuous-wave reflectometry diagnostic has been successfully installed and commissioned on ASDEX Upgrade to measure the plasma edge electron density profile evolution in front of the Ion Cyclotron Range of Frequencies (ICRF) antenna. The design of the new three-strap ICRF antenna integrates ten pairs (sending and receiving) of microwave reflectometry antennas. The multichannel reflectometer can use three of these to measure the edge electron density profiles up to 2 × 1019 m-3, at different poloidal locations, allowing the direct study of the local plasma layers in front of the ICRF antenna. ICRF power coupling, operational effects, and poloidal variations of the plasma density profile can be consistently studied for the first time. In this work the diagnostic hardware architecture is described and the obtained density profile measurements were used to track outer radial plasma position and plasma shape.

Measurement of turbulent electron temperature fluctuations on the ASDEX Upgrade tokamak using correlated electron cyclotron emission.

Turbulent temperature fluctuations are measured on the ASDEX Upgrade tokamak using pairs of closely spaced, narrow-band heterodyne radiometer channels and a standard correlation technique. The pre-detection spacing and bandwidth of the radiometer channel pairs is chosen such that they are physically separated less than a turbulent correlation length, but do not overlap. The radiometer has 4 fixed filter frequency channels and two tunable filter channels for added flexibility in the measurement position. Relative temperature fluctuation amplitudes are observed in a helium plasma to be δT/T = (0.76 ± 0.02)%, (0.67 ± 0.02)%, and (0.59 ± 0.03)% at normalised toroidal flux radius of ρtor = 0.82, 0.75, and 0.68, respectively.

A numerical study of fixed frequency reflectometry measurements of plasma filaments with radial and poloidal velocity components.

A 2D finite-differences time-domain full-wave code is used to simulate the measurements of plasma filaments with fixed frequency O-mode reflectometry. The plasma is modeled by a linear slab plasma plus a Gaussian perturbation propagating in a direction that can vary from poloidal to radial. The plasma background density gradient is chosen in agreement with the steep edge transport barrier of H-modes in the ASDEX Upgrade (AUG) tokamak. Illustrative results are presented and different types of reflectometry responses are observed depending on filament sizes and propagation directions. The reflectometry signatures obtained here with numerical simulations support previous experimental findings on filament measurements.

Relationship between final height and health outcomes in adults with congenital adrenal hyperplasia: United Kingdom congenital adrenal hyperplasia adult study executive (CaHASE).

CONTEXT: Treatment of congenital adrenal hyperplasia (CAH) in childhood focuses on growth and development and adult final height (FH) is a measure of effective treatment. We hypothesized that shorter adults will have more severe underlying disease and worse health outcomes. METHODS: This was a cross-sectional analysis of 199 adults with CAH. FH and quality of life were expressed as z-scores adjusted for midparental target height or UK population height. RESULTS: FH correlated inversely with age (men, r = -0.38; women, r = -0.26, P < .01). Men and women had z-scores adjusted for midparental target height of -2 and -1, respectively, and both groups had UK population height z-scores of -1 below the UK population (P < .01). In women, FH was shorter in non-salt-wasting than salt-wasting classic CAH (P < .05) and in moderately affected genotype group B women than either more severely affected groups null and A (P < .01) or the mildest group C (P < .001). Short stature and a higher prevalence of hypertension were observed in classic CAH patients diagnosed late (after 1 y) compared with those diagnosed early and in women treated with glucocorticoid only compared with those treated with both glucocorticoids and mineralocorticoids (P < .05). FH did not associate with insulin sensitivity, lipid profile, adiposity, or quality of life. CONCLUSIONS: Adult CAH patients remain short, although height prognosis has improved over time. The shortest adults are those diagnosed late with moderate severity CAH and are at increased risk of adult hypertension; we hypothesize that these patients are exposed in childhood to high androgens and/or excessive glucocorticoids with potential programming of hypertension. Another possibility is inadequate mineralocorticoid treatment early in life in the late-diagnosed patient group. Prospective studies are now required to examine these hypotheses.

Glucocorticoid treatment regimen and health outcomes in adults with congenital adrenal hyperplasia.

BACKGROUND: Adults with congenital adrenal hyperplasia (CAH) are treated with a wide variety of glucocorticoid treatment regimens. OBJECTIVE, DESIGN AND METHODS: To test whether drug dose and timing of glucocorticoid treatment regimen impacts on health outcomes. This was a cross-sectional study of 196 adult CAH patients in whom treatment and health outcomes were measured. Glucocorticoid dose was converted to prednisolone dose equivalent (PreDEq) using three published formulae. Associations between the type of glucocorticoid regimen and PreDEq with specific health outcome variables were tested using partial correlation and principal components analysis (PCA). RESULTS: Patients on dexamethasone had lower androgens and ACTH but greater insulin resistance compared with those receiving hydrocortisone or prednisolone. Dexamethasone dose and once daily administration were associated with insulin resistance. Partial correlation analysis adjusted for age and sex showed PreDEq weakly correlated (r < 0·2) with blood pressure and androstenedione. Mutation severity was associated with increased PreDEq (F(3,141)  = 4·4, P < 0·01). In PCA, 3 PCs were identified that explained 62% of the total variance (r(2) ) in observed variables. Regression analysis (age and sex adjusted) confirmed that PC2, reflecting disease control (androstenedione, 17-hydroxypregesterone and testosterone), and PC3, reflecting blood pressure and mutations (systolic and diastolic blood pressure and mutation severity), related directly to PreDEq (r(2)  = 23%, P < 0·001). CONCLUSIONS: In adults with congenital adrenal hyperplasia, dexamethasone use was associated with lower androgens but greater insulin resistance, and increasing glucocorticoid dose associated with increased blood pressure, poor disease control and mutation severity.

Growth hormone effects on cortical bone dimensions in young adults with childhood-onset growth hormone deficiency.

UNLABELLED: Growth hormone (GH) treatment in young adults with childhood-onset GH deficiency has beneficial effects on bone mass. The present study shows that cortical bone dimensions also benefit from GH treatment, with endosteal expansion and increased cortical thickness leading to improved bone strength. INTRODUCTION: In young adults with childhood-onset growth hormone deficiency (CO GHD), GH treatment after final height is reached has been shown to have beneficial effects on spine and hip bone mineral density. The objective of the study was to evaluate the influence of GH on cortical bone dimensions. METHODS: Patients (n = 160; mean age, 21.2 years; 63% males) with CO GHD were randomised 2:1 to GH or no treatment for 24 months. Cortical bone dimensions were evaluated by digital x-ray radiogrammetry of the metacarpal bones every 6 months. RESULTS: After 24 months, cortical thickness was increased compared with the controls (6.43%, CI 3.34 to 9.61%; p = 0.0001) and metacarpal index (MCI) (6.14%, CI 3.95 to 8.38%; p < 0.0001), while the endosteal diameter decreased (-4.64%, CI -7.15 to -2.05; p < 0.001). Total bone width did not change significantly (0.68%, CI -1.17 to 2.57%; not significant (NS)). A gender effect was seen on bone width (p < 0.0001), endosteal diameter (p < 0.01) and cortical thickness (p < 0.01), but not with MCI (NS). CONCLUSIONS: Cortical bone reacts promptly to reinstitution of GH beyond the attainment of final height by increasing the cortical thickness through endosteal bone growth. This leads to a higher peak bone mass and may reduce the risk of cortical bone fragility later in life.

Mean and oscillating plasma flows and turbulence interactions across the L-H confinement transition.

A complex interaction between turbulence driven E × B zonal flow oscillations, i.e., geodesic acoustic modes (GAMs), the turbulence, and mean equilibrium flows is observed during the low to high (L-H) plasma confinement mode transition in the ASDEX Upgrade tokamak. Below the L-H threshold at low densities a limit-cycle oscillation forms with competition between the turbulence level and the GAM flow shearing. At higher densities the cycle is diminished, while in the H mode the cycle duration becomes too short to sustain the GAM, which is replaced by large amplitude broadband flow perturbations. Initially GAM amplitude increases as the H-mode transition is approached, but is then suppressed in the H mode by enhanced mean flow shear.

Androgen-dependent measurements of female genitalia in women with complete androgen insensitivity syndrome.

Measurements of clitoral length and clitoral to urethral distance were made and analysed for a relationship in a group of 19 women with complete androgen insensitivity syndrome (CAIS)attending a specialist clinic for adult women with disorders of sexual development. These were compared with a control group of 50 women attending hospital for a gynaecological procedure.There was a positive correlation between clitoral length and clitoral to urethral distance for women with CAIS. In contrast, a negative correlation was seen between clitoral length and clitoral to urethral distance for women in the control group. Women with CAIS had a reduced mean clitoral length compared with controls(P = 0.001), but no difference was observed for the clitoral to urethral distance between the two groups (P = 0.116).

Improved time-frequency analysis of ASDEX Upgrade reflectometry data using the reassigned spectrogram technique.

The spectrogram is one of the best-known time-frequency distributions suitable to analyze signals whose energy varies both in time and frequency. In reflectometry, it has been used to obtain the frequency content of FM-CW signals for density profile inversion and also to study plasma density fluctuations from swept and fixed frequency data. Being implemented via the short-time Fourier transform, the spectrogram is limited in resolution, and for that reason several methods have been developed to overcome this problem. Among those, we focus on the reassigned spectrogram technique that is both easily automated and computationally efficient requiring only the calculation of two additional spectrograms. In each time-frequency window, the technique reallocates the spectrogram coordinates to the region that most contributes to the signal energy. The application to ASDEX Upgrade reflectometry data results in better energy concentration and improved localization of the spectral content of the reflected signals. When combined with the automatic (data driven) window length spectrogram, this technique provides improved profile accuracy, in particular, in regions where frequency content varies most rapidly such as the edge pedestal shoulder.

Simulation of reflectometry Bragg backscattering spectral responses in the absence of a cutoff layer.

Experimental reflectometry signals obtained in the absence of a cutoff layer, with the possibility of interferometric operation excluded, show a coherent and recurrent frequency spectrum signature similar to an Alfvén cascade signature. A possible explanation resides in the modulation of a resonant Bragg backscattering response by an Alfvén mode structure located at the center of the plasma whose frequency of oscillation modulates the backscattered signal in a conformable way. This situation is modeled and simulated using an O-mode full-wave Maxwell finite-difference time-domain code and the resulting signatures are discussed.

Spironolactone interference in the immunoassay of androstenedione.

BACKGROUND: In an evaluation of androstenedione results from patient serum samples using the Siemens Immulite 2500 analyser and manual Coat-A-Count (CAC) methods, three outliers were evident with grossly elevated results in the CAC assay. METHODS: The clinic notes of three patients with apparently high serum androstenedione concentrations by the CAC assay were checked for medications. The samples were all from patients with polycystic ovary syndrome taking 100-200 mg/d of a steroidal antiandrogen (spironolactone). Two other patients on 50 mg spironolactone per day had less markedly higher androstendione results with the CAC assay. In a further five patients who were selected since they were on spironolactone and had high androstenedione results by the CAC method, spironolactone was temporarily withdrawn and fresh blood samples obtained for analysis. RESULTS: Spironolactone treatment was associated with higher androstenedione concentrations measured by the CAC assay that reverted to normal on treatment withdrawal. Based on a single test with spironolactone at 1000 ng/mL, the manufacturer reported only 0.109% interference in the CAC assay. CONCLUSIONS: Spironolactone (and/or its metabolites) may interfere in the Siemens CAC assay for androstenedione but not in the Immulite 2500 assay. This experience highlights the need for information from clinicians on drug treatment when laboratory investigations are requested. Drug interferences in immunoassay are common and need evaluation beyond tests performed to certify laboratory reagents.

Analysis of X chromosome genomic DNA sequence copy number variation associated with premature ovarian failure (POF).

BACKGROUND: Premature ovarian failure (POF) is a heterogeneous disease defined as amenorrhoea for >6 months before age 40, with an FSH serum level >40 mIU/ml (menopausal levels). While there is a strong genetic association with POF, familial studies have also indicated that idiopathic POF may also be genetically linked. Conventional cytogenetic analyses have identified regions of the X chromosome that are strongly associated with ovarian function, as well as several POF candidate genes. Cryptic chromosome abnormalities that have been missed might be detected by array comparative genomic hybridization. METHODS: In this study, samples from 42 idiopathic POF patients were subjected to a complete end-to-end X/Y chromosome tiling path array to achieve a detailed copy number variation (CNV) analysis of X chromosome involvement in POF. The arrays also contained a 1 Mb autosomal tiling path as a reference control. Quantitative PCR for selected genes contained within the CNVs was used to confirm the majority of the changes detected. The expression pattern of some of these genes in human tissue RNA was examined by reverse transcription (RT)-PCR. RESULTS: A number of CNVs were identified on both Xp and Xq, with several being shared among the POF cases. Some CNVs fall within known polymorphic CNV regions, and others span previously identified POF candidate regions and genes. CONCLUSIONS: The new data reported in this study reveal further discrete X chromosome intervals not previously associated with the disease and therefore implicate new clusters of candidate genes. Further studies will be required to elucidate their involvement in POF.