Quasicontinuous Exhaust Scenario for a Fusion Reactor: The Renaissance of Small Edge Localized Modes.

Tokamak operational regimes with small edge localized modes (ELMs) could be a solution to the problem of large transient heat loads in fusion reactors. A ballooning mode near the last closed flux surface governed by the pressure gradient and the magnetic shear there has been proposed for small ELMs. In this Letter, we experimentally investigate several stabilizing effects near the last closed flux surface and present linear ideal simulations that indeed develop ballooninglike fluctuations there and connect them with nonlinear resistive simulations. The dimensionless parameters of the small ELM regime in the region of interest are very similar to those in a reactor, making this regime the ideal exhaust scenario for a future device.

High-dose busulfan, melphalan and thiotepa followed by autologous peripheral blood stem cell (PBSC) rescue in patients with advanced stage III/IV ovarian cancer.

The purpose of this study was to evaluate the efficacy of high-dose chemotherapy (HDC) with busulfan, melphalan and thiotepa (BUMELTT) followed by autologous PBSC infusion in treating patients with advanced ovarian cancer. Thirty-one patients, 18 with stage III/IIIc and 13 with stage IV ovarian cancer, were treated with BU (12 mg/kg), MEL (100 mg/m2) and TT (500 mg/m2) and autologous PBSC rescue. Fifteen patients were in clinical complete remission (CR) at treatment; 11 had platinum-sensitive disease. Sixteen patients were not in CR; two had platinum-sensitive disease. The probabilities of overall survival (OS), event-free survival (EFS) and relapse (R) for all patients at 18 months were 0.57, 0.30 and 0.63; for patients in CR, the rates were 0.87, 0.44 and 0.49 and for patients not in CR, 0.38, 0.13 and 0.81. Two patients (6.5%) died of treatment-related causes. Among the 13 patients with platinum-sensitive disease, all are still alive, with seven having relapsed 129-1021 days after PBSC infusion. OS, EFS and R were 1.00, 0.52 and 0.48. Of the 18 patients with platinum-resistant disease, four remain alive (two in remission). Six patients did not respond and eight relapsed from days 104-429. The OS, EFS and R were 0.33, 0.11 and 0.78. We conclude that BUMELTT is well tolerated in patients with advanced ovarian cancer and results are equivalent to other published HDC regimens.

Transient global amnesia as a manifestation of Epstein-Barr virus encephalitis.

A 43-year-old man developed severe global amnesia with uncinate fits and a single generalised convulsion 10 days after a febrile infection. CSF pleocytosis and serological findings indicated an acute Epstein-Barr virus encephalitis. All of the symptoms cleared within 2 weeks except for occasional generalised seizures. This seems to be the first observation of Epstein-Barr virus encephalitis presenting predominantly as transient global amnesia.

Clinical investigation of the antidepressant effectiveness of hypericum.

To date, 25 controlled therapy studies have investigated the antidepressive effectiveness of hypericum extracts. A total of 1592 treatment cases have been included. The dosage was typically 300 to 900 mg total extract daily; the therapy duration was 2 to 6 weeks. Fifteen studies were performed comparing hypericum extracts with placebo, 10 studies as comparative studies. This paper presents an overview of their results.

Placebo-controlled double-blind study examining the effectiveness of an hypericum preparation in 105 mildly depressed patients.

One hundred and five outpatients with mild depressions of short duration were treated in a double-blind study with either 3 x 300 mg hypericum extract or placebo. The therapy phase was 4 weeks. The effectiveness was judged according to the Hamilton Depression Scale after 2 and 4 weeks. The values of the mean basic score in these periods fell from 15.8 to 9.6 or 7.2 in the active group, and in the placebo group, from 15.8 to 12.3 and 11.3. The differences between active and placebo groups were statistically significant with P < .05 and P < .01 achieved after 2 and 4 weeks, respectively. In the active group, 28 of 42 patients (67%) and, in the placebo group, 13 of 47 patients (28%) responded to treatment. Notable side effects were not found.

Effectiveness and tolerance of the hypericum extract LI 160 compared to maprotiline: a multicenter double-blind study.

A randomized, double-blind study examining the effectiveness and tolerance of a standardized hypericum preparation when compared to maprotiline was performed in a group of 102 patients with depression, in accordance with ICD-10, F 32.1. The study was conducted in the offices of neurology and psychiatry specialists. The patients received, over a period of 4 weeks, either 3 x 300 mg of the hypericum extract or 3 x 25 mg maprotiline pills of identical appearance. Effectiveness was determined using the Hamilton Depression Scale (HAMD), the Depression Scale according to von Zerssen (D-S), and the Clinical Global Impression Scale (CGI). The total score of the HAMD scale dropped during the 4 weeks of therapy in both treatment groups by about 50%. The mean values of the D-S scale and the CGI scale showed similar results, and after 4 weeks of therapy, no significant differences in either treatment group were noticed. The onset of the effects occurred up to the second week of treatment, but were observed earlier with maprotiline than with the hypericum extract. On the other hand, maprotiline treatment resulted in more cases of tiredness, mouth dryness, and heart complaints.

Contingent negative variation (CNV) differences between cerebrovascular patients with and without dementia.

This study investigated the clinical usefulness of the contingent negative variation (CNV) as a neurophysiological index of cognitive dysfunction associated with cerebrovascular disease. A total of 31 patients ranging in age from 45 to 88 years with the diagnosis of a stroke were included. Nineteen patients were classified as demented according to clinical assessment and the Mental Deterioration Index (MDI) based on the WAIS, the other 12 patients as non-demented. In a discriminative CNV-paradigm two different tones served as warning stimuli for a flash of light presented 1.5 s later that could be turned off by a press on a button only after the relevant tone. According to our hypothesis, CNV amplitudes of demented patients were significantly smaller than those of the non-demented group. Moreover, a significant relationship was observed between severity of dementia (MDI) and degree of amplitude reduction. Thus, it was concluded that the CNV method could make an important clinical contribution to the assessment and course of dementia.

A multidimensional approach in testing nootropic drug effects (Cerebrolysin).

In an attempt to improve indicators of validity for the therapeutic efficacy of nootropics, the effects of Cerebrolysin(R) were compared across three different dimensions of variables in a randomized placebo-controlled double-blind study. A group of 27 geriatric patients suffering from an organic brain syndrome with moderate cognitive impairment of a vascular or/and degenerative nature received a series of ten Cerebrolysin + multivitamin infusions. They were compared to a second group with 14 clinically comparable patients, who received multivitamin infusions alone. Pre-posttreatment differences from (1) clinical scales (SCAG, Plutchik Geriatric Rating Scale and a self-evaluation scale); (2) psychometric test performance (trail-making and maze subtests from the Nürnberg Age Inventory); and (3) event-related brain activity (contingent negative variation (CNV) amplitude) were in favor of the Cerebrolysin-treated group. A high degree of association as well as high classification rates (95% joint correct classification) underlined their clinical significance. It was concluded that the multidimensional measurement approach could increase the clinical validity of nootropic drug effects.

[Sarcoidosis of the nervous system. Clinical and neuropathological findings in three cases (author's transl)]. / Zur Sarkoidose des Nervensystems.

Three cases of neurosarcoidosis are reported, which demonstrate almost the complete spectrum of known neurological symptoms in this disease. Furthermore, extensive neuropathological findings are reported in one case. It is emphasized that recognition of neurosarcoidosis presents almost insuperable difficulties in those cases in which sarcoidosis is not obvious in other organs.

[Forensic psychiatry problems in depression]. / Forensisch-psychiatrische Probleme bei Depressionen.

Forensic complications involving criminal or civil law are generally rare in depressive disorders, but are of varied nature and of great consequence to the person concerned. Suicide, which is the problem of greatest practical importance may have far-reaching consequences with regard to legal insurance, apart from the medical responsibility or liability. From the point of view of civil law, moreover, the effects of depression on thought and action, as well as on free will with respect to legal capacity, testifiability, marriageability, actionability and potential considerations of interdiction ought to be examined. Last, but not least, consequences of a socio-legal nature may ensue. The spectrum of possible crimes by depressed subjects essentially comprises disease-characteristic offences, amongst which the desperate deed of extended suicide is foremost, as well as other criminal acts with a less direct connection to the depressive syndrome. Additional factors such as alcohol and medication may further complicate the relationship and also the assessment of culpability. In the forensic judgment of depressed subjects diagnostic classification is not alone decisive, but depends to a greater extent on the nature and severity of the psychopathological state and its influence on motivational aspects.

[Autonomic dysfunction in multiple sclerosis (respiratory and cardiac disturbances) (author's transl)]. / Störungen autonomer Funktionen bei multipler Sklerose (Atem- und Herztätigkeit).

Except for rectal, vesical and sexual disorders almost nothing is known about disturbances of autonomic functions in multiple sclerosis. MS plaques, however, do not spare vegetative centres and spinal tracts. Therefore autonomic disorders are to be expected in other functional ranges as well. We could not confirm the study of Neubauer and Gundersen (1978) who found the short time variability and the long time variability of pulse rate to be significantly diminished in patients suffering from multiple sclerosis. Our investigation, however, revealed frequent occurrence of rigid, paradoxical and atactic courses of the patients' graphs obtained by "averaging" the pulse rate alterations dependent on respiration. We consider this to be an indication of cardio-respiratory hyposynergia in precision regulations. As compared with the normal control group the patients' respiratory rate was significantly raised, and this was almost exclusively due to an abbreviated time of inspiration. Concerning the pulse rate and the pulse-breathing quotient the patients did not differ significantly from the healthy controls. The findings in 40 MS patients (definite diagnosis) and in 40 healthy persons point to the fact that cardio-respiratory disorders are no rare occurrence.