First Observation of a Stable Highly Dissipative Divertor Plasma Regime on the Wendelstein 7-X Stellarator.

For the first time, the optimized stellarator Wendelstein 7-X has operated with an island divertor. An operation regime in hydrogen was found in which the total plasma radiation approached the absorbed heating power without noticeable loss of stored energy. The divertor thermography recorded simultaneously a strong reduction of the heat load on all divertor targets, indicating almost complete power detachment. This operation regime was stably sustained over several energy confinement times until the preprogrammed end of the discharge. The plasma radiation is mainly due to oxygen and is located at the plasma edge. This plasma scenario is reproducible and robust at various heating powers, plasma densities, and gas fueling locations. These experimental results show that the island divertor concept actually works and displays good power dissipation potential, producing a promising exhaust concept for the stellarator reactor line.

[''Prepidil versus Propess'': pharmacological induction of labour with dinoprostone]. / ''Prepidil versus Propess'': induzione farmacologica del travaglio di parto con dinoprostone.

AIM: The aim of the study was to evaluate the effectiveness and safety of the two different pharmaceutical preparations of dinoprostone: ''Prepidil vs Propess'', in patients with medical and/or obstetrical indications to pharmaceutical induction of labour. METHODS: A retrospective analysis was carried out on 144 patients (82 with Propess vs 62 with Prepidil). INDICATIONS: post-term pregnancy, premature rupture of membranes (PROM), gestational diabetes, gestational-chronic hypertension, intrauterine growth restriction (IUGR),others (fetal macrosomia, oligohydramnios). RESULTS: The groups were homogenous regarding: age, parity, weeks of amenorrhea, Bishop score and indication to induction. Both pharmaceutical preparations of dinoprostone (Prepidil vs Propess) are effective and safe; there are some differences not statistically significant (P>0.01) regarding the percentage of spontaneous deliveries: 61.5% vs 63%, interval from induction to delivery 24.53 vs 20.45 h, number of inductions 1.35 vs 1.15 and neonatal outcome (Apgar scores at 1 and 5 min). A case of serious hyperstimulation with hysterectomy post-delivery after induction with Prepidi was observed. CONCLUSION: A greater use of Propess, especially in patients with PROM, is suggested; Propess has determined a higher percentage of spontaneous deliveries, a shorter interval from induction to delivery and less risks for the mother. It is in fact possible to remove the device easily and safely in case of complication.

Note: Internal diamagnetic flux measurements on ASDEX Upgrade.

Internal diamagnetic flux measurements, with measurement loops and compensation magnetic probes inside the vacuum vessel, are now available on the ASDEX Upgrade tokamak. The measured diamagnetic flux is compared to that predicted by simulations and calculated from equilibrium reconstruction. The diamagnetic flux measured at 2 positions separated toroidally by 180° in the vacuum vessel is compared.

[Sensitivity, specificity, predictive positive and negative value of the main clinical signs and symptoms of hydatiform mole]. / Sensibilità, specificità, valore predittivo positivo e negativo dei principali segni clinici e sintomi della mola idatidea.

AIM: Especially in the first weeks of pregnancy, complete and partial hydatiform moles are not easily detected by sonography, symptoms and clinical signs. Due to the rarity of moles, it is possible that they may be confused with abortive pregnancies until the pathological examination. The aim of this study is to identify the sensitivity, specificity, predictive positive and negative value of the main symptoms and clinical signs of molar pregnancies. METHODS: Thirteen molar pregnancies have been detected after pathological examination from January 2003 to July 2005 in Perugia. Their main clinical signs and symptoms are compared with those recorded in 288 abortive pregnancies, 56 ectopic pregnancies and 27 Hyperemesis gravidarum, observed in the same period. RESULTS: Vaginal bleeding and pelvic pain are the most sensitive symptoms and have the highest predictive negative values. The size of the uterus greater for date is the most specific sign. Pelvic pain with hyperemesis, and uterus size greater for date have the highest predictive positive values, but the lowest sensitivity. CONCLUSIONS: A mole should be excluded in patients with hyperemesis and pelvic pain, and in patients with uterus size greater for date. In the first case, a hyperemesis gravidarum may be diagnosed and, in the second one, a twin pregnancy may be confirmed with a sonographic scan.

Real-time diamagnetic flux measurements on ASDEX Upgrade.

Real-time diamagnetic flux measurements are now available on ASDEX Upgrade. In contrast to the majority of diamagnetic flux measurements on other tokamaks, no analog summation of signals is necessary for measuring the change in toroidal flux or for removing contributions arising from unwanted coupling to the plasma and poloidal field coil currents. To achieve the highest possible sensitivity, the diamagnetic measurement and compensation coil integrators are triggered shortly before plasma initiation when the toroidal field coil current is close to its maximum. In this way, the integration time can be chosen to measure only the small changes in flux due to the presence of plasma. Two identical plasma discharges with positive and negative magnetic field have shown that the alignment error with respect to the plasma current is negligible. The measured diamagnetic flux is compared to that predicted by TRANSP simulations. The poloidal beta inferred from the diamagnetic flux measurement is compared to the values calculated from magnetic equilibrium reconstruction codes. The diamagnetic flux measurement and TRANSP simulation can be used together to estimate the coupled power in discharges with dominant ion cyclotron resonance heating.

Combination intraventricular chemotherapy for meningeal neoplasia.

Twenty two patients with meningeal neoplasia were treated with biweekly combination intraventricular chemotherapy using methotrexate, cytosine arabinoside, and thiotepa. Patients with the following malignancies were included: breast cancer, ten patients; lung cancer, seven; non-Hodgkin's lymphoma, two; malignant melanoma, one; transitional cell carcinoma of the bladder, one; and malignant glioma, one. Eight of 22 patients (36%) had a Karnofsky performance status of less than 50%. Eleven of 22 patients received radiotherapy to symptomatic areas, and seven received systemic chemotherapy in addition to combination intraventricular therapy. Patients were evaluated for both toxicity and response to therapy. Myelosuppression was the major toxic condition and occurred in 17 of 22 patients (77%). Ten patients (45%) had a nadir WBC count of less than 1000/microL or a platelet count of less than 25,000/microL. No patient achieved a complete response (CR), although nine patients (41%) had partial responses (PRs) lasting 4 to 24 + weeks. Median survival for the entire group was 10 weeks (range, 6 to 24+ weeks). In this small group of patients, simultaneous triple-drug intraventricular chemotherapy caused unacceptable myelosuppression without increasing the response rate, response duration, or survival when compared with single-agent methotrexate and radiotherapy.

High-dose thiotepa with autologous bone marrow transplantation for metastatic malignant melanoma: results of phase I and II studies of the North American Bone Marrow Transplantation Group.

We evaluated thiotepa in escalating dose in a broad phase I and II study using cryopreserved autologous bone marrow transplantation to assure hematopoietic recovery. Thiotepa was administered intravenously (IV) over two hours daily for three consecutive days followed in three to four days by marrow transplantation. The daily dose ranged from 60 to 525 mg/m2 (total dose, 180 to 1,575 mg/m2). A total of 71 patients with malignant melanoma were treated. Forty-three patients (61%) had received prior cytotoxic therapy and 28 were untreated. Sixty-two patients (87%) had melanoma disseminated to at least one visceral site, nine patients had skin and/or lymphatic metastases only. As of January 1, 1988 one patient was too early to be evaluated, 15 patients were inevaluable for tumor response, four patients had a complete response (CR), and 25 patients had a partial response (PR) to treatment. The response rates (95% confidence interval) for the 55 evaluable patients and for all 71 treated patients were 53% (40% to 65%) and 41% (30% to 53%), respectively. The median duration of response was 3 months, with a range of 1 to 31 + months. Three patients were alive and well without evidence of tumor more than 1 year after treatment. Analysis of patient subsets indicated that neither total dose, previous cytotoxic therapy, or sites of metastases influenced response rate. In this study, high-dose thiotepa has demonstrated a high response rate in patients with metastatic malignant melanoma with both PRs and CRs noted. Although most of the responses were not durable, 10% of the responses lasted more than 1 year. Future studies will evaluate additional methods for increasing the response rate and improving the duration of response.

Pure red cell aplasia associated with administration of sustained-release procainamide.

Pure red cell aplasia developed in a patient with small-cell lung cancer who was also taking sustained-release procainamide. Shortly after discontinuation of the procainamide preparation, a reticulocytosis and increasing hemoglobin level were observed.

High-dose N,N',N"-triethylenethiophosphoramide (thiotepa) with autologous bone marrow transplantation: phase I studies.

N,N',N''-triethylenethiophosphoramide (thiotepa) is a polyfunctional alkylating agent similar in structure to nitrogen mustard. Thiotepa (synthesized by American Cyanamid Company, Wayne, NJ) underwent clinical trials in the 1960s that showed that it was active against a wide variety of tumors. At a standard dose level (10 to 30 mg/m2), the dose-limiting toxicity is myelosuppression; other toxicities are infrequent. Therefore, high-dose phase I evaluation was encouraged by these observations. Approximately 217 patients have been treated with single-agent high-dose thiotepa administered intravenously daily over 2 hours for 3 days followed by hematopoietic stem cell rescue to prevent prolonged myelotoxicity. The total doses administered ranged from 135 to 1,575 mg/m2. As anticipated, myelotoxicity was substantial, with 180 mg/m2 being the highest dose not requiring stem cell rescue to ensure hematopoietic recovery. Extramedullary toxicities consisted of stomatitis, dermatitis, hepatoxicity, and central nervous system (CNS) toxicity. CNS toxicity was dose-limiting; other toxicities were problematic, ie, dose-dependent but not truly dose-limiting. The maximal tolerated dose of thiotepa is 900 to 1,125 mg/m2, with the lower dose being the maximal dose for evaluation in combination chemotherapy. In high-dose phase I evaluation, the overall response rate was approximately 50% with responses seen in a wide variety of solid tumors, lymphomas, and pediatric tumors. High-dose thiotepa appears to be an alkylating agent with broad-spectrum antitumor efficacy, which should add to the cytoreductive regimens for both solid and hematopoietic tumors.

Use of the BCR probe to demonstrate extramedullary recurrence of CGL with a T cell lymphoid phenotype following bone marrow transplantation.

A case of Philadelphia chromosome (Ph1) positive chronic granulocytic leukemia (CGL) is described in which the patient underwent successful treatment with supralethal chemoradiotherapy and allogeneic bone marrow transplantation (BMT) after transformation to blast crisis. Supraclavicular adenopathy developed 5 months after BMT and biopsy revealed a hematopoietic lymphoid neoplasm with an early T cell phenotype. A concurrent bone marrow was microscopically and cytogenetically normal. A metaphase chromosome preparation could not be obtained from nodal tissue. Lymph node DNA, however, was easily extracted and a rearrangement of BCR identical to that in the bone marrow prior to BMT was demonstrated indicating recurrent CGL rather than a de novo lymphoproliferative process. Appropriate therapy for lymphoid blast crisis resulted in a marked regression of measurable disease. The BCR probe may prove to be a useful tool for the diagnosis of CGL when standard cytogenetic techniques cannot be applied.

Validity of simple approach to scoring and standard setting for standardized-patient cases in an examination of clinical competence.

The results are disappointing, providing little support for the validity of the case-passing decisions based on this simple approach to scoring and standard setting. The case-passing decisions predicted what the case author intended for about only 73% or 74% of the students on average and, with agreement expected by chance removed, predicted what the case author intended for about only 25% of the students. Even with the use of the optimal pass/fail cutoffs and the dropping of students with ambiguous borderline global ratings, the case-passing decisions failed to agree with the case authors' global ratings for 15% to 30% of the students. The findings might be dismissed as simply due to low reliabilities of passing decisions and global ratings based on a single case. Although this concern would apply to intercase reliabilities, which would be subject to case specificity, the appropriate reliabilities here would seem to be intracase (i.e., intrarater), which should be fairly high (if they could be computed). Nevertheless, it seems reasonable to expect much better agreement between results of case scoring and of standard setting developed by the case author and the case author's global ratings of performance on that case, given that the case author might recall the checklist, assign a weight to each item, and so forth. Also, case-passing decisions would possibly agree more with global ratings of live or videotaped performances than with ratings of written summaries of performance; however, that question remains a challenge for further research. In conclusion, the study provides only weak evidence, at best, for the validity of the scoring and standard setting commonly used with SP assessment. The results do not undermine claims about the realism of the SP approach, however, nor do they call into question the standardization afforded by this method of assessing clinical competence. The results do raise serious concerns about this simple approach to scoring and standard setting for SP-based assessments and suggest that we should focus more on the observation and evaluation of actual student performance on SP cases in the development of valid scoring and standard setting.

Recent progress in the treatment of seminoma.

Effective treatment for seminoma of the testicle has improved markedly since the initial reports utilizing orthovoltage radiotherapy. Contributing to this progress have been the use of chemotherapy in advanced disease and the development of a staging system to predict outcome for patients treated with radiation therapy alone. Those groups of patients manifesting poor survival with radiation have benefited from cisplatin-based chemotherapy. At the present time, 80-100% of patients with limited disease and 60-80% of patients with more advanced disease will become long-term survivors. Areas requiring further investigation include the significance of elevated HCG, extragonadal primaries, residual radiographic abnormalities following chemotherapy, and the treatment of relapse after chemotherapy.

Disseminated Merkel cell tumor. Treatment with systemic chemotherapy.

Four patients with disseminated Merkel cell tumors were treated with cyclophosphamide (C), doxorubicin (A), and vincristine (V). Two partial responses (PR) were noted and in one case disease remained stable. One of the patients who achieved a PR achieved a second PR when treated with VP-16 (E) and cis-platin (P) after progressive disease developed. Systemic chemotherapy appears capable of inducing objective responses in some patients with disseminated Merkel cell tumors.

[Hypohidrotic ectodermal dysplasia]. / Displasia ectodermica ipoidrotica.

The authors report a case of Hypohidrotic ectodermal dysplasia (Christ-Siemens-Touraine syndrome). Diagnosed at the age of 2 months.

Post-traumatic amenorrhea: the role of diagnostic and operative hysteroscopy in the prevention, diagnosis, differential diagnosis and treatment.

AIM: The aim of the study was to evaluate the clinical usefulness of the selective removal of residual intrauterine trophoblastic tissue by using a hysteroscopic procedure, especially in the prevention of the Intra-Uterine Adhesion's Syndrome. METHODS: Seventy-six patients had an Asherman's Syndrome: 5 cases after laparotomic myomectomy, 1 after caesarean section, 2 after hysteroscopic myomectomy, 10 after VIP, 1 with a severe vaginal endometriosis, 1 after conisation, 4 after a post-partum hemorrhage due to coagulopathy or uterine atony, 20 cases after D&C because of PPH due to placental retention, 26 after repetitive D&Cs because of AUB due to post abortion chorial residues' retention, 6 cases after D&C for post menopausal AUB. Thirty-six patients presented AUB due to chorioplacental residues retention: 14 cases after a vaginal delivery or a caesarean section, 4 after VIP, 18 cases after repetitive D&Cs for incomplete or internal spontaneous abortion. Complete physical examination, transvaginal ultrasonography and operative hysteroscopy was offered as first treatment to all patients. Surgical treatment of IUA depends on the type (I-IV) and is based on the section of synechiae, liberation of the uterine cavity and tubal recesses, recovery of the residual endometrium to restore the physiology of the reproductive tract. Our technique to remove the chorioplacental residues is based on: correct use of loops and electric currents, enucleation by cold loops of the base of the placental implant, and to single out the level of miometrial infiltration. RESULTS: After treatment we have noticed: two hysterectomies (for persistent AUB after myomectomy and for severe bleeding after dehiscence of a C. section), restoration of regular menstruations in 94.6% of patients (6 women in menopause), disappearance of pelvic pain and dysmenorrhea in all cases (100%), 8 pregnancies of the 9 women who were wanting child after hysteroscopic synechiolysis (88.9%). CONCLUSION: According to the present study, the best way to prevent IUA is to make D&C for abortion, avoiding waiting longer than 24 hours, perform a D&C and then a diagnostic hysteroscopy after PPH in symptomatic women, reserve D&Cs only for a PPH, or an incomplete abortion, limit to only one D&C, always make a diagnostic hysteroscopy after D&C and uterine plugging for PPH.

Application of AXUV diode detectors at ASDEX Upgrade.

In the ASDEX Upgrade tokamak, a radiation measurement for a wide spectral range, based on semiconductor detectors, with 256 lines of sight and a time resolution of 5 µs was recently installed. In combination with the foil based bolometry, it is now possible to estimate the absolutely calibrated radiated power of the plasma on fast timescales. This work introduces this diagnostic based on AXUV (Absolute eXtended UltraViolet) n-on-p diodes made by International Radiation Detectors, Inc. The measurement and the degradation of the diodes in a tokamak environment is shown. Even though the AXUV diodes are developed to have a constant sensitivity for all photon energies (1 eV-8 keV), degradation leads to a photon energy dependence of the sensitivity. The foil bolometry, which is restricted to a time resolution of less than 1 kHz, offers a basis for a time dependent calibration of the diodes. The measurements of the quasi-calibrated diodes are compared with the foil bolometry and found to be accurate on the kHz time scale. Therefore, it is assumed, that the corrected values are also valid for the highest time resolution (200 kHz). With this improved diagnostic setup, the radiation induced by edge localized modes is analyzed on fast timescales.

Optimization of a bolometer detector for ITER based on Pt absorber on SiN membrane.

Any plasma diagnostic in ITER must be able to operate at temperatures in excess of 200 °C and neutron loads corresponding to 0.1 dpa over its lifetime. To achieve this aim for the bolometer diagnostic, a miniaturized metal resistor bolometer detector based on Pt absorbers galvanically deposited on SiN membranes is being developed. The first two generations of detectors featured up to 4.5 µm thick absorbers. Results from laboratory tests are presented characterizing the dependence of their calibration constants under thermal loads up to 450 °C. Several detectors have been tested in ASDEX Upgrade providing reliable data but also pointing out the need for further optimization. A laser trimming procedure has been implemented to reduce the mismatch in meander resistances below 1% for one detector and the thermal drifts from this mismatch.

Design criteria of the bolometer diagnostic for steady-state operation of the W7-X stellarator.

A bolometric diagnostic system with features necessary for steady-state operation in the superconducting stellarator W7-X was designed. During a pulse length of 1800 s with an ECRH (electron cyclotron resonance heating) power of 10 MW, the components suffer not only from a large thermal load but also from stray radiation of the nonabsorbed isotropic microwaves. This paper gives an overview of the technical problems encountered during the design work and the solutions to individual problems to meet the special requirements in W7-X, e.g., component thermal protection, detector offset thermal drift suppression, as well as a microwave shielding technique.

The ITER bolometer diagnostic: status and plans.

A consortium consisting of four EURATOM Associations has been set up to develop the project plan for the full development of the ITER bolometer diagnostic and to continue urgent R&D activities. An overview of the current status is given, including detector development, line-of-sight optimization, performance analysis as well as the design of the diagnostic components and their integration in ITER. This is complemented by the presentation of plans for future activities required to successfully implement the bolometer diagnostic, ranging from the detector development over diagnostic design and prototype testing to RH tools for calibration.