Cavity ring-down spectroscopy system for the evaluation of negative hydrogen ion density at the ELISE test facility.

The large RF negative hydrogen (deuterium) ion source at the ELISE test facility (half of the ITER-NBI source size) has been equipped with a Cavity Ring-Down Spectroscopy (CRDS) system, in order to measure the negative hydrogen (deuterium) ion density in the region in front of the plasma grid (first grid of the extraction system). The challenge of this diagnostic for ELISE relies on the large size of the source and therefore on the plasma length across which the measurements are performed as well as the long pulses at RF power, which can affect the cavity mirror reliability. A dedicated experiment on the mirror reliability was performed, ensuring the feasibility of measurements for long pulses (several hundred seconds) at high RF power. Two horizontal lines of sight were dedicated to CRDS: the measured density was in the range between 4 × 1016 and 1 × 1017 m-3, with a slightly higher density for the bottom lines of sight, for both the isotope hydrogen and deuterium. Different temporal evolution was observed for the two isotopes, showing a higher instability for the deuterium case: this is in correlation with the extracted negative ion current density and inversely correlated with the coextracted electron current density. The CRDS system allowed performing the first measurements of negative ion density for a long pulse (1000 s) in a large source: the temporal behavior and the effect of the beam extraction will also be discussed.

Beamlet scraping and its influence on the beam divergence at the BATMAN Upgrade test facility.

For the ITER fusion experiment, two neutral beam injectors are required for plasma heating and current drive. Each injector supplies a power of about 17 MW, obtained from neutralization of 40 A (46 A), 1 MeV (0.87 MeV) negative deuterium (hydrogen) ions. The full beam is composed of 1280 beamlets, formed in 16 beamlet groups, and strict requirements apply to the beamlet core divergence (<7 mrad). The test facility BATMAN Upgrade uses an ITER-like grid with one beamlet group, which consists of 70 apertures. In a joint campaign performed by IPP and Consorzio RFX to better assess the beam optics, the divergence of a single beamlet was compared to a group of beamlets at BATMAN Upgrade. The single beamlet is measured with a carbon fiber composite tile calorimeter and by beam emission spectroscopy, whereas the divergence of the group of beamlets is measured by beam emission spectroscopy only. When increasing the RF power at low extraction voltages, the divergence of the beamlet and of the group of beamlets is continuously decreasing and no inflection point toward an overperveant beam is found. At the same time, scraping of the extracted ion beam at the second grid (extraction grid) takes place at higher RF power, supported by the absence of the normally seen linear behavior between the measured negative ion density in the plasma close to the extraction system and the measured extracted ion current. Beside its influence on the divergence, beamlet scraping needs to be considered for the determination of the correct perveance and contributes to the measured coextracted electron current.

European consensus on the concepts and measurement of the pathophysiological neuromuscular responses to passive muscle stretch.

BACKGROUND AND PURPOSE: To support clinical decision-making in central neurological disorders, a physical examination is used to assess responses to passive muscle stretch. However, what exactly is being assessed is expressed and interpreted in different ways. A clear diagnostic framework is lacking. Therefore, the aim was to arrive at unambiguous terminology about the concepts and measurement around pathophysiological neuromuscular response to passive muscle stretch. METHODS: During two consensus meetings, 37 experts from 12 European countries filled online questionnaires based on a Delphi approach, followed by plenary discussion after rounds. Consensus was reached for agreement ≥75%. RESULTS: The term hyper-resistance should be used to describe the phenomenon of impaired neuromuscular response during passive stretch, instead of for example 'spasticity' or 'hypertonia'. From there, it is essential to distinguish non-neural (tissue-related) from neural (central nervous system related) contributions to hyper-resistance. Tissue contributions are elasticity, viscosity and muscle shortening. Neural contributions are velocity dependent stretch hyperreflexia and non-velocity dependent involuntary background activation. The term 'spasticity' should only be used next to stretch hyperreflexia, and 'stiffness' next to passive tissue contributions. When joint angle, moment and electromyography are recorded, components of hyper-resistance within the framework can be quantitatively assessed. CONCLUSIONS: A conceptual framework of pathophysiological responses to passive muscle stretch is defined. This framework can be used in clinical assessment of hyper-resistance and will improve communication between clinicians. Components within the framework are defined by objective parameters from instrumented assessment. These parameters need experimental validation in order to develop treatment algorithms based on the aetiology of the clinical phenomena.

Investigation of the boundary layer during the transition from volume to surface dominated H⁻ production at the BATMAN test facility.

BATMAN (Bavarian Test Machine for Negative ions) is a test facility equipped with a 18 scale H(-) source for the ITER heating neutral beam injection. Several diagnostics in the boundary layer close to the plasma grid (first grid of the accelerator system) followed the transition from volume to surface dominated H(-) production starting with a Cs-free, cleaned source and subsequent evaporation of caesium, while the source has been operated at ITER relevant pressure of 0.3 Pa: Langmuir probes are used to determine the plasma potential, optical emission spectroscopy is used to follow the caesiation process, and cavity ring-down spectroscopy allows for the measurement of the H(-) density. The influence on the plasma during the transition from an electron-ion plasma towards an ion-ion plasma, in which negative hydrogen ions become the dominant negatively charged particle species, is seen in a strong increase of the H(-) density combined with a reduction of the plasma potential. A clear correlation of the extracted current densities (j(H(-)), j(e)) exists with the Cs emission.

Negative ion production and beam extraction processes in a large ion source (invited).

Recent research results on negative-ion-rich plasmas in a large negative ion source have been reviewed. Spatial density and flow distributions of negative hydrogen ions (H(-)) and positive hydrogen ions together with those of electrons are investigated with a 4-pin probe and a photodetachment (PD) signal of a Langmuir probe. The PD signal is converted to local H(-) density from signal calibration to a scanning cavity ring down PD measurement. Introduction of Cs changes the slope of plasma potential local distribution depending upon the plasma grid bias. A higher electron density H2 plasma locally shields the bias potential and behaves like a metallic free electron gas. On the other hand, the bias and extraction electric fields penetrate in a Cs-seeded electronegative plasma even when the electron density is similar. Electrons are transported by the penetrated electric fields from the driver region along and across the filter and electron deflection magnetic fields. Plasma ions exhibited a completely different response against the penetration of electric fields.

[Operative treatment of scoliosis : Preoperative planning, intraoperative monitoring, and postoperative management]. / Operative Behandlung von Skoliosen : Präoperative Planung, intraoperatives Monitoring und postoperatives Management.

BACKGROUND: The indication for the surgical treatment of thoracic, lumbar, combined, and thoracolumbar idiopathic and neuropathic scoliosis is a Cobb angle of more than 50° in the thoracic and more than 45° in the lumbar spine. The success of the operation is highly dependent on the pre-operative indication. Standardized medical imaging and close collaboration with anesthetists and pediatricians are necessary in complex cases. METHODS: We developed a screening routine in which pre-operative diagnosis is performed during hospitalization. The concept is individually developed across disciplines. Surgery for childhood scoliosis always presents a particular challenge for anesthetists and surgeons. Close collaboration during surgery is indispensable for guaranteeing success. Risk factors are determined, evaluated and-if necessary-treated before performing surgery. These factors are also strictly monitored and dealt with during surgery. RESULT: Regular post-operative check-ups are required to ensure early determination and adequate treatment of complications. CONCLUSION: Operative treatment of scoliosis should only be performed in medical centers that allow for close collaboration and diagnostic investigation.

Cesium dynamics in long pulse operation of negative hydrogen ion sources for fusion.

Large scale negative hydrogen ion sources operating stable for 1 h (cw mode) are required for the neutral beam heating system of the fusion experiment ITER. The formation of negative hydrogen ions relies on the surface effect for which cesium is evaporated into the source. In order to monitor the cesium dynamics the laser absorption spectroscopy technique is applied to the long pulse test facility MANITU. In the vacuum phase, without plasma operation the evaporation of cesium and the built-up of the cesium in the source are measured. Typical neutral cesium densities are 10(15) m(-3). During plasma operation and after the plasma phase a high cesium dynamics is observed, showing also depletion of cesium during long pulses with low cesium amount. The co-extracted electron current decreases with the cesium amount to a certain level whereas the ion current indicates an optimum density range.

Evaluating the Effect of Style in Information Visualization.

This paper reports on a between-subject, comparative online study of three information visualization demonstrators that each displayed the same dataset by way of an identical scatterplot technique, yet were different in style in terms of visual and interactive embellishment. We validated stylistic adherence and integrity through a separate experiment in which a small cohort of participants assigned our three demonstrators to predefined groups of stylistic examples, after which they described the styles with their own words. From the online study, we discovered significant differences in how participants execute specific interaction operations, and the types of insights that followed from them. However, in spite of significant differences in apparent usability, enjoyability and usefulness between the style demonstrators, no variation was found on the self-reported depth, expert-rated depth, confidence or difficulty of the resulting insights. Three different methods of insight analysis have been applied, revealing how style impacts the creation of insights, ranging from higher-level pattern seeking to a more reflective and interpretative engagement with content, which is what underlies the patterns. As this study only forms the first step in determining how the impact of style in information visualization could be best evaluated, we propose several guidelines and tips on how to gather, compare and categorize insights through an online evaluation study, particularly in terms of analyzing the concise, yet wide variety of insights and observations in a trustworthy and reproducable manner.

Work function measurements during plasma exposition at conditions relevant in negative ion sources for the ITER neutral beam injection.

Cesium seeded sources for surface generated negative hydrogen ions are major components of neutral beam injection systems in future large-scale fusion experiments such as ITER. The stability and delivered current density depend highly on the work function during vacuum and plasma phases of the ion source. One of the most important quantities that affect the source performance is the work function. A modified photocurrent method was developed to measure the temporal behavior of the work function during and after cesium evaporation. The investigation of cesium exposed Mo and MoLa samples under ITER negative hydrogen ion based neutral beam injection relevant surface and plasma conditions showed the influence of impurities which result in a fast degradation when the plasma exposure or the cesium flux onto the sample is stopped. A minimum work function close to that of bulk cesium was obtained under the influence of the plasma exposition, while a significantly higher work function was observed under ITER-like vacuum conditions.

[Indications for deformity correction with minimally invasive spondylodesis]. / Indikationen für eine Formkorrektur mittels minimalinvasiver Spondylodese.

The indications for surgical treatment of thoracic, lumbar, combined and thoracolumbar scoliosis are given for a curvature of the thoracic spine with a Cobb angle more than 50° and more than 45° in the lumbar spine. The maximum Cobb angle is 90°. The aim is the correction of more than 50% in the frontal plane and correction of scoliosis is possible in flexible curvatures up to 90%. By the minimally invasive surgical technique the muscular damage is completely avoided on the convex side but on the concave side this is only partly possible. This is the first report of a muscle preserving minimally invasive surgical technique for the convex side of scoliosis.

Biomimetic analogs for collagen biomineralization.

Inability of chemical phosphorylation of sodium trimetaphosphate to induce intrafibrillar mineralization of type I collagen may be due to the failure to incorporate a biomimetic analog to stabilize amorphous calcium phosphates (ACP) as nanoprecursors. This study investigated adsorption/desorption characteristics of hydrolyzed and pH-adjusted sodium trimetaphosphate (HPA-Na(3)P(3)O(9)) to collagen. Based on those results, a 5-minute treatment time with 2.8 wt% HPA-Na(3)P(3)O(9) was used in a single-layer reconstituted collagen model to confirm that both the ACP-stabilization analog and matrix phosphoprotein analog must be present for intrafibrillar mineralization. The results of that model were further validated by complete remineralization of phosphoric-acid-etched dentin treated with the matrix phosphoprotein analog and lined with a remineralizing lining composite, and with the ACP-stabilization analog supplied in simulated body fluid. An understanding of the basic processes involved in intrafibrillar mineralization of reconstituted collagen fibrils facilitates the design of novel tissue engineering materials for hard tissue repair and regeneration.

Fundamental experiments on evaporation of cesium in ion sources.

Basic experiments are carried out to study the cesium evaporation and desorption from surfaces at different temperatures in an environment, which is very close to the conditions of negative hydrogen ion sources for fusion applications: in a vacuum base pressure of 10(-5) mbar and in a hydrogen plasma in the Pa-range. Several diagnostic techniques such as emission and absorption spectroscopy, a surface ionization detector, and a quartz-microbalance have been utilized to determine the cesium densities, evaporation and desorption rates. The work function of a cesiated surface measured by the photoelectric effect degrades with increasing plasma-off time. Impurities and cesium compounds are detected by a residual mass analyzer.

The janus face of immunosuppression - de novo malignancy after renal transplantation: the experience of the Transplantation Center Munich.

After decades of successful organ transplantation clinicians continue to be troubled by the increasing incidence of cancers under maintenance immunosuppression. In this study, we examined rates of malignancies in 2419 renal transplant recipients transplanted in our institution between 1978 and 2005. In renal transplant recipients the cumulative incidence of cancer after 25 years was 49.3% for all tumors and 39.7% excluding non-melanoma skin cancers, compared with 21% for a normal sex- and age-matched population. The most frequent tumors observed were non-melanoma skin cancers (20.5%), kidney cancers (12.0%), and cancers of the pharynx, larynx, or oral cavity (8.2%). The general increase of cancer risk was 4.3-fold. Independent risk factors for the development of a tumor were male gender, older recipient age, the presence of preformed antibodies before transplantation, and the time on immunosuppression. Interestingly, the use of IL-2-receptor antagonists significantly reduced the tumor risk of transplant recipients. The tumor risk between immunosuppressive drugs typically used for maintenance immunosuppression was not significantly different. However, mammalian target of rapamycin (mTOR) inhibitor-based immunosuppressive protocols showed a clear tendency for lower malignancy rates. De novo malignancies following renal transplantation represent a serious problem endangering the prognosis of otherwise successfully transplanted patients. Future studies will have to address whether optimized immunosuppressive regimens including mTOR-inhibitors are capable of reducing the incidence or preventing the development of posttransplant malignancies.

Partial photoionization cross sections and angular distributions for double excitation of helium up to the N = 13 threshold.

Partial photoionization cross sections sigmaN(Egamma) and photoelectron angular distributions betaN(Egamma) were measured for the final ionic states He+ (N > 4) in the region between the N = 8 and N = 13 thresholds (Egamma > 78.155 eV) using the cold target recoil ion momentum spectroscopy technique (COLTRIMS). Comparison of the experimental data with two independent sets of theoretical predictions reveals disagreement for the branching ratios to the various HeN(+) states. The angular distributions just below the double ionization threshold suggest an excitation process for highly excited N states similar to the Wannier mechanism for double ionization.

Mean xenograft survival of 14.6 days in a small group of hDAF-transgenic pig hearts transplanted orthotopically into baboons.

INTRODUCTION: In a discordant orthotopic xenotransplantation model (pig-to-baboon) donor pigs expressing human decay accelerating factor (hDAF) as a regulator of complement activity were used to prevent hyperacute xenograft rejection (HXR). We investigated a modified immunosuppressive therapy consisting of ERL080 (Novartis Pharma AG, Base, Switzerland), cyclosporin A (Neoral), steroids, and a cyclophosphamide (CyP) induction protocol with several reduced doses to prevent acute vascular rejection (AVR). METHODS: Donor hearts were harvested from hDAF-transgenic pigs (18.8 +/- 2.6 kg, Imutran Ltd., a Novartis Pharma AG Company). Four adult baboons (25.6 +/- 2.7 kg) with high titers of xenoreactive antibodies (XAb) served as recipients. Serological and hemodynamic parameters were measured. Finally, myocardial tissue was sampled for histological and immunohistochemical examinations. RESULTS: In the first baboon, an acute graft failure occurred after 1 hour due to preservation injury. The second succumbed after 11.1 day due to an acute renal failure. The third died after 13.1 days of an ileus. The fourth baboon had continuously excellent cardiac function (mean echocardiographic ejection fraction, 69.2%), but succumbed on day 20 due to anemia. Corrected mean xenograft survival (excluding the first baboon because of a technical failure) was 14.6 +/- 2.6 days. XAb decreased after day 3 to constantly low levels (<1:64 titer) after CyP induction. White blood cell count decreased from 10.3 +/- 0.8 to 0.9 +/- 0.3 G/L after day 3. Macroscopically and histologically no typical signs of HXR or severe AVR could be detected. CONCLUSIONS: These results confirm that hDAF transgen blocks HXR in this life-supporting model. AVR was prevented by using a modified quadruple immunosuppressive drug combination (Neoral, ERL080, steroids, and several small single doses of CyP). An optimum "fine-tuning" of immunosuppression is required to achieve the best risk-benefit ratio.

Combination of hDAF-transgenic pig hearts and immunoadsorption in heterotopic xenotransplantation of immunosuppressed baboons.

INTRODUCTION: Hyperacute xenograft rejection (HXR) and acute vascular rejection (AVR) after xenotransplantation are triggered by xenoreactive antibodies (XAb) and an activated complement cascade. In a heterotopic (abdominal) xenotransplantation model we combined immunoadsorption (IA, Ig-Therasorb column) and a quadruple immunosuppressive drug therapy in recipient baboons with donor pig hearts transgenic for human decay accelerating factor (hDAF). METHODS: According to XAb titers between 6 and 14 cycles of IA were performed preoperatively in 4 recipient baboons (18.6 +/- 2.5 kg). Hearts of hDAF-transgenic donor pigs (6.1 +/- 1.1 kg, Imutran Ltd., a Novartis Pharma AG Company, Basel, Switzerland) were heterotopically transplanted using the abdominal technique in baboons. Immunosuppression consisted of cyclophosphamide (CyP) induction therapy, ERL080 (Novartis Pharma AG), cyclosporin A (CyA, Neoral), and steroids. Blood levels of mycophenolate, CyA, immunoglobulins (Ig), anti-pig-antibodies, complement factors, and cardiac enzymes were determined. Abdominal electrocardiography (ECG), echocardiography, and palpation were used for monitoring of the pig hearts. Myocardial tissue specimens were examined using immunohistochemistry, light microscope (LM), and electron microscope (EM). RESULTS: Ten cycles of IA alone removed 78% of XAb and accordingly IgM, IgG, IgA, complement C3, and C4. None of the xenografts was hyperacutely rejected, but xenograft failure occurred after 5.0 +/- 1.3 days (range, 2.4-8.0 days) because of an AVR associated with a rapid XAb increase within 24 hours. White blood cell count (10.3 +/- 2.2 G/L) showed a maximum of 13.1 +/- 2.1 (day 1) and constant levels (1.4 +/- 0.3-2.1 +/- 1.3 G/L) between day 3 and 6. Histology (LM/EM) showed massive hemorrhage, necrosis, and vascular thrombi as signs of AVR. CONCLUSION: Although HXR was prevented by using IA and hDAF-transgenic donor hearts, AVR was not avoided due to insufficient immunosuppressive regimen used and a missed postoperative IA treatment as a result of an inefficient control of XAb production.

Experimental observation of interatomic coulombic decay in neon dimers.

Recently Cederbaum et al. [Phys. Rev. Lett. 79, 4778 (1997)]] predicted a new decay channel of excited atoms and molecules termed interatomic Coulombic decay (ICD). In ICD the deexcitation energy is transferred via virtual photon exchange to a neighboring atom, which releases it by electron emission. We report on an experimental observation of ICD in 2s ionized neon dimers. The process is unambiguously identified by detecting the energy of two Ne1+ fragments and the ICD electron in coincidence, yielding a clean, background free experimental spectral distribution of the ICD electrons.

Comparison of conventional versus minimally invasive extraperitoneal approach for anterior lumbar interbody fusion.

The purpose of the study was to compare conventional versus minimally invasive extraperitoneal approach for anterior lumbar interbody fusion (ALIF). Fifty-six consecutive patients with spondylolisthesis, lumbar instability, or failed back syndrome were treated with ALIF between 1991 and 2001. The patients were retrospectively evaluated and divided in two groups: Group 1, consisting 33 patients, was treated with ALIF using the conventional retroperitoneal approach, and Group 2, consisting of 23 patients, was operated with the minimally invasive muscle-splitting approach for ALIF. The groups were comparable as regards age, indication of fusion, and diagnosis. All patients in both groups had fusion with autologous iliac crest grafts and posterior instrumentation with posterolateral fusion in the same sitting. Clinical evaluation was done by two questionnaires: the North American Spine Society (NASS) Lumbar Spine Outcome Assessment Instrument and the Nottingham Health Profile (NHP). Fusion rate was evaluated radiologically. Mean clinical follow-up was 5.5 years. There was no statistical difference in the occurrence of complications with both approaches nor with the fusion rates of 92% in group 1 and 84% in group 2 respectively. The minimally invasive extraperitoneal approach for ALIF was associated with significantly less intraoperative blood loss, operation time, and length of the skin incision. In addition, this approach showed significant improvement in postoperative back pain in comparison to the conventional approach for ALIF.

Infection of a total hip arthroplasty with Prevotella loeschii.

Infection is a serious complication of total hip replacement. It has been proposed that 6% of all infections after total hip arthroplasty may be of dental origin through hematogenous spread. However, no conclusive evidence that the mouth is a definitive source for infection of a total hip replacement has been reported. In the current case, Prevotella loeschii, a pigmented bacteroides species was identified in a total hip replacement. Prevotella loeschii is an organism which exclusively inhabits the dental region. Hematogenous spread of Prevotella loeschii may occur after penetration of the mucosal barrier in cases of endodontic or periodontic lesions, pericoronitis, or complications of tooth extraction. The involvement of Prevotella loescheii in an infection in a patient who had a total hip arthroplasty is strong evidence for the mechanism of a hematogenous infection from a dental source.

Contamination during removal of cement in revision hip arthroplasty. A cadaver study using ultrasound and high-speed cutters.

Instruments used in surgery which rotate or vibrate at a high frequency can produce potentially contaminated aerosols. Such tools are in use in cemented hip revision arthroplasties. We aimed to measure the extent of the environmental and body contamination caused by an ultrasound device and a high-speed cutter. On a human cadaver we carried out a complete surgical procedure including draping and simulated blood flow contaminated with Staphylococcus aureus (ATCC 12600). After cemented total hip arthroplasty, we undertook repeated extractions of cement using either an ultrasound device or a high-speed cutter. Surveillance cultures detected any environmental and body contamination of the surgical team. Environmental contamination was present in an area of 6 x 8 m for both devices. The concentration of contamination was lower for the ultrasound device. Both the ultrasound and the high-speed cutter contaminated all members of the surgical team. The devices tested produced aerosols which covered the whole operating theatre and all personnel present during the procedure. In contaminated and infected patients, infectious agents may be present in these aerosols. We therefore recommend the introduction of effective measures to control infection and thorough disinfection of the operating theatre after such procedures.