Turbulence Transition in Magnetically Confined Hydrogen and Deuterium Plasmas.

In this study, we discovered a turbulence transition in a large helical device. The turbulence level and turbulence-driven energy transport decrease to a specific transition density and increase above it. The ruling turbulences below and above the transition density were ion-temperature gradient (ITG) and resistive-interchange (RI) turbulences, consistent with the predictions of gyrokinetic theory and two-fluid MHD model, respectively. Isotope experiments on hydrogen (H) and deuterium (D) clarified the role of transitions. In the ITG regime, turbulence levels and energy transport were comparable in the H and D plasmas. In contrast, in the RI regime, they were clearly suppressed in the D plasma. The results provide crucial knowledge for understanding isotope effects and future optimization of stellarator and heliotron devices.

Preceding propagation of turbulence pulses at avalanche events in a magnetically confined plasma.

The preceding propagation of turbulence pulses has been observed for the first time in heat avalanche events during the collapse of the electron internal transport barrier (e-ITB) in the Large Helical Device. The turbulence and heat pulses are generated near the foot of the e-ITB and propagate to the peripheral region within a much shorter time than the diffusion timescale. The propagation speed of the turbulence pulse is approximately 10 km/s, which is faster than that of the heat pulse propagating at a speed of 1.5 km/s. The heat pulse propagates at approximately the same speed as that in the theoretical prediction, whereas the turbulence pulse propagates one order of magnitude faster than that in the prediction, thereby providing important insights into the physics of non-local transport.

Turbulence Spreading into an Edge Stochastic Magnetic Layer Induced by Magnetic Fluctuation and Its Impact on Divertor Heat Load.

Turbulence spreading into the edge stochastic magnetic layer induced by magnetic fluctuation is observed at the sharp boundary region in the large helical device. The density fluctuation excited at the sharp boundary region with a large pressure gradient does not propagate into the boundary region due to the blocking of turbulence spreading by the large second derivative of the pressure gradient. Once the magnetic fluctuation appears at the boundary, the density fluctuation begins to penetrate the edge stochastic layer and the second derivative of the pressure gradient also decreases. The increase of density fluctuation in this layer results in the broadening and reduction of the peak divertor heat load. It is demonstrated that magnetic fluctuation plays a key role in controlling the turbulence spreading at the boundary of plasma which contributes to the reduction of divertor heat load.

Iron lamination and interlaminar insulation for high-frequency pulsed magnets.

In high-frequency pulsed magnets, such as kickers in particle accelerators, it is essential to reduce eddy currents that could be induced in the magnet core during excitation not to distort and attenuate the magnetic field pulse. A novel iron lamination scheme with additional interlaminar insulation is proposed for the magnet core of such pulsed magnets. A laminated steel sheet core is formed by alternately stacking thin steel and insulation sheets. For application to matched kicker magnets for accelerators, test magnets with the new and conventional iron lamination were designed, assembled, and extensively evaluated. The pulsed magnetic field waveforms of two test magnets with the new lamination successfully matched to below 0.1% over the entire pulse duration, which was significantly better than those with the conventional lamination. Among the applications of the developed high-frequency pulsed magnets, beam injection kickers for the coming next generation light sources and future colliders, where suppression of the transient stored-beam oscillation during beam injection is crucial, are considered to be promising.

Suppression of Trapped Energetic Ions Driven Resistive Interchange Modes with Electron Cyclotron Heating in a Helical Plasma.

The resistive interchange mode destabilized by the resonant interaction with the trapped energetic ions is fully suppressed when the injected power of electron cyclotron heating exceeds a certain threshold. It is shown for the first time that the complete stabilization of the energetic-particle-driven mode without relaxing the energetic particle (EP) pressure gradient is possible by reducing the radial width of the eigenmodes δ_{w}, especially when δ_{w} narrows to a small enough value relative to the finite orbit width of EP.

Coupling of transient near infrared photonic with magnetic nanoparticle for potential dissipation-free biomedical application in brain.

Combined treatment strategies based on magnetic nanoparticles (MNPs) with near infrared ray (NIR) biophotonic possess tremendous potential for non-invasive therapeutic approach. Nonetheless, investigations in this direction have been limited to peripheral body region and little is known about the potential biomedical application of this approach for brain. Here we report that transient NIR exposure is dissipation-free and has no adverse effect on the viability and plasticity of major brain cells in the presence or absence superparamagnetic nanoparticles. The 808 nm NIR laser module with thermocouple was employed for functional studies upon NIR exposure to brain cells. Magnetic nanoparticles were characterized using transmission electron microscopy (TEM), X-ray diffraction (XRD), dynamic laser scattering (DLS), and vibrating sample magnetometer (VSM). Brain cells viability and plasticity were analyzed using electric cell-substrate impedance sensing system, cytotoxicity evaluation, and confocal microscopy. When efficacious non-invasive photobiomodulation and neuro-therapeutical targeting and monitoring to brain remain a formidable task, the discovery of this dissipation-free, transient NIR photonic approach for brain cells possesses remarkable potential to add new dimension.

'Transfer out' tuberculosis patients: treatment outcomes after cross-checking registers, 2012-2013, Lusaka, Zambia.

SETTING: Lusaka, Zambia. OBJECTIVE: To assess the actual treatment outcomes of 'transfer out' (TO) cases at a diagnostic centre in Lusaka, in the third and fourth quarters of 2012, and to see the impact of this cross-check in treatment success rates (TSR) in 2013 and early 2014. DESIGN AND METHOD: In this retrospective cohort study, treatment outcomes for new bacteriologically positive tuberculosis (TB) cases referred from the diagnostic centre were reviewed and compared with those at the receiving treatment units. RESULTS: Of 49 (58%) cases referred to three treatment units, the treatment outcomes of nine had to be updated at the diagnostic centre, which reduced the proportion of TO cases from 17.6% to 11.8% and increased the TSR to 70.6% from 64.7%. CONCLUSION: The review and cross-checking of the TB registers at the diagnostic and treatment units led to a significant reduction in non-assessed cases, suggesting that the TB registers in the diagnostic and treatment units should be cross-checked regularly. There is also need for a complementary intervention to reduce the proportion of TOs associated with high loss to follow-up and non-evaluated TO rates.

Contexte : Lusaka, Zambie.Objectif : Evaluer les vrais résultats du traitement des cas « transférés hors zone ¼ (TO) dans un centre de diagnostic, à Lusaka, pendant les troisième et quatrième trimestres de 2012, et voir l'impact du croisement des informations dans le taux de succès du traitement (TSR) en 2013 et au début de 2014.Schéma et méthode : Dans cette étude rétrospective de cohorte, les résultats du traitement de nouveaux cas de tuberculose (TB) à bactériologie positive qui avaient été référés du centre de diagnostic ont été revus et comparés à ceux de l'unité de traitement.Résultats : Sur 49 cas (58%) qui ont été référés à trois unités de traitement, les résultats du traitement de neuf cas ont dû être mis à jour au centre de diagnostic, ce qui a abouti à la réduction de la proportion de cas « TO ¼ de 17,6% à 11,8% et à l'augmentation du TSR de 64,7% à 70,6%.Conclusion : La revue et le croisement des registres TB des unités des centres de diagnostic et de traitement a abouti à une réduction significative des cas non évalués, ce qui suggère que les registres TB des unités de diagnostic et de traitement devraient être fréquemment croisés. Il y a également un besoin d'interventions complémentaires afin de réduire la proportion de TO, qui est associée à un taux élevé de perdus de vue et de cas non évalués.

Marco de referencia: La ciudad de Lusaka en Zambia.Objetivo: Evaluar los desenlaces terapéuticos reales de los pacientes con tuberculosis (TB) 'transferidos a otro centro' (TO), en una unidad de diagnóstico de Lusaka durante el tercero y cuarto trimestres del 2012 y examinar el efecto de la verificación cruzada de las tasas de éxito terapéutico (TSR) en el 2013 y comienzos del 2014.Método: En el presente estudio retrospectivo de cohortes, se analizaron los desenlaces terapéuticos de los casos nuevos de TB con confirmación bacteriológica de una unidad diagnóstica que se remitieron a otros centros y se compararon con los resultados obtenidos en las unidades de tratamiento que los recibieron.Resultados: Se remitieron 49 pacientes (58%) del centro diagnóstico a tres unidades de tratamiento. Faltaba la actualización del desenlace terapéutico de nueve de estos pacientes en el centro de diagnóstico y tras la verificación cruzada, disminuyó la proporción de casos TO de 17,6% a 11,8% y la TSR aumentó de 64,7% a 70,6%.Conclusión: La revisión y la verificación cruzada de los registros de TB de las unidades de diagnóstico y las unidades de tratamiento dio lugar a una disminución considerable de los casos clasificados como no evaluados, lo cual destaca la necesidad de cotejar con frecuencia los registros de tuberculosis de las diferentes unidades. Se precisan intervenciones complementarias encaminadas a disminuir la proporción de TO, las cuales se asocian con una alta tasa de pérdida durante el seguimiento y de casos TO no evaluados.

Arthrodesis of the ankle using an anterior sliding tibial graft for osteoarthritis secondary to osteonecrosis of the talus: A comparison of vascularised non-vascularised grafts.

AIMS: This retrospective cohort study compared the results of vascularised and non-vascularised anterior sliding tibial grafts for the treatment of osteoarthritis (OA)of the ankle secondary to osteonecrosis of the talus. PATIENTS AND METHODS: We reviewed the clinical and radiological outcomes of 27 patients who underwent arthrodesis with either vascularised or non-vascularised (conventional) grafts, comparing the outcomes (clinical scores, proportion with successful union and time to union) between the two groups. The clinical outcome was assessed using the Mazur and American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scores. The mean follow-up was 35 months (24 to 68). RESULTS: The mean outcome scores increased significantly in both groups. In the vascularised graft group, the mean Mazur score improved from 36.9 to 74.6 and the mean AOFAS scale improved from 49.6 to 80.1. In the conventional arthrodesis group, the mean Mazur score improved from 35.5 to 65 and the mean AOFAS scale from 49.2 to 67.6. Complete fusion was achieved in 13 patients (76%) in the vascularised group, but only four (40%) in the conventional group. The clinical outcomes and proportion achieving union were significantly better in the vascularised group compared with the conventional arthrodesis group, although time to union was similar in the two groups. TAKE HOME MESSAGE: Vascularised sliding tibial grafts may be used to achieve arthrodesis in patients with OA of the ankle secondary to osteonecrosis of the talus.

A new form of surgical treatment for patients with avascular necrosis of the talus and secondary osteoarthritis of the ankle.

A new method of vascularised tibial grafting has been developed for the treatment of avascular necrosis (AVN) of the talus and secondary osteoarthritis (OA) of the ankle. We used 40 cadavers to identify the vascular anatomy of the distal tibia in order to establish how to elevate a vascularised tibial graft safely. Between 2008 and 2012, eight patients (three male, five female, mean age 50 years; 26 to 68) with isolated AVN of the talus and 12 patients (four male, eight female, mean age 58 years; 23 to 76) with secondary OA underwent vascularised bone grafting from the distal tibia either to revascularise the talus or for arthrodesis. The radiological and clinical outcomes were evaluated at a mean follow-up of 31 months (24 to 62). The peri-malleolar arterial arch was confirmed in the cadaveric study. A vascularised bone graft could be elevated safely using the peri-malleolar pedicle. The clinical outcomes for the group with AVN of the talus assessed with the mean Mazur ankle grading scores, improved significantly from 39 points (21 to 48) pre-operatively to 81 points (73 to 90) at the final follow-up (p = 0.01). In all eight revascularisations, bone healing was obtained without progression to talar collapse, and union was established in 11 of 12 vascularised arthrodeses at a mean follow-up of 34 months (24 to 58). MRI showed revascularisation of the talus in all patients. We conclude that a vascularised tibial graft can be used both for revascularisation of the talus and for the arthrodesis of the ankle in patients with OA secondary to AVN of the talus.

Development of 2D soft X-ray measurement system in the large helical device.

A fast two-dimensional soft X-ray camera using silicon photo diode array is being developed in order to investigate high frequency MHD instability with high mode number. The advantage of the adopted diode is a large sensor area of 10 mm × 10 mm and small diode capacitance which enable us to measure signals with the short response time. The characteristic of the prototype is summarized as follows: Channel number is 6 × 8 = 48, detection range 1∼10 keV, the spatial resolution 128 mm at the plasma location, and frequency range DC∼100 kHz. Synthetic image of the prototype in the Large Helical Device is estimated by using perturbation model of MHD mode.

A case of renal-coloboma syndrome associated with mental developmental delay exhibiting a novel PAX2 gene mutation.

A case of an adolescent male with renal-coloboma syndrome (RCS) showing developmental delay is described. Birth and perinatal histories were typical. Proteinuria was initially observed at the age of 7 years during an annual mass screening program for school children. His urine was checked periodically at a local hospital. Because of an increase in proteinuria, he was referred to our hospital for further clinical evaluation. Proteinuria was moderate, ranging from 1.0 to 1.5 g/day, and was coupled with mild renal dysfunction. At that time, he was found to have myopia associated with astigmatism. He exhibited mild developmental delay, assessed by a WISC-III test. A renal biopsy sample showed marked glomerular enlargement, collapse of glomerular capillaries, mesangial matrix expansion, and tubulointerstitial change, demonstrating typical histologic features of RCS. Approximately five years after starting follow-up, the patient had severe renal dysfunction. Furthermore, optic nerve coloboma was also evident. Genetic analysis of the patient revealed a novel heterozygous mutation in exon 3 of the PAX2 gene (P130H).

Post-operative oral contraceptive use reduces the risk of ovarian endometrioma recurrence after laparoscopic excision.

BACKGROUND: The aim of this study was to evaluate the impact of post-operative oral contraceptives (OCs) use on the rate of recurrence after laparoscopic excision of ovarian endometrioma. METHODS: In May 2005, we introduced a 'post-operative OC recommendation' for patients treated with laparoscopic excision of endometrioma. That is, at the time of the operation, we provided each patient with information about OC, known and possible benefits and risks and let her decide whether to take OC. A retrospective cohort study included 87 patients who underwent a laparoscopy after May 2005. The endometrioma recurrence rate at 24 months was compared between those who used OC for the entire follow-up period OC (n = 34) and all of the others (n = 53). We also performed logistic regression analysis to identify variables associated with recurrence. A before-after study included another 224 patients who underwent a laparoscopy before May 2005 and compared the recurrence rate before and after introduction of the 'post-operative OC recommendation'. RESULTS: The recurrence rate in those who used OC for the entire period was significantly lower than in the 'others' group (2.9 versus 35.8%, relative risk 0.082, 95% CI 0.012-0.58, P < 0.001). Post-operative OC was determined as an independent variable associated with lower recurrence (OR 0.054, 95% CI 0.007-0.429, P < 0.001). The overall recurrence rate in patients who underwent laparoscopy after the introduction of the 'post-operative OC recommendation' was significantly lower than that in patients who received laparoscopy before the introduction (18.6 versus 33.1%, relative risk 0.56, 95% CI 0.32-0.97, P < 0.05). CONCLUSIONS: Post-operative OC use reduces the risk of ovarian endometrioma recurrence after laparoscopic excision. This information will help in appropriate planning of pre- and post-operative management.

Ageing is associated with diminished apoptotic cell clearance in vivo.

Ageing leads to immune system dysfunction and the accumulation of autoantibodies. Because the rapid phagocytic clearance of apoptotic cells is required to prevent the development of autoimmunity, we examined the relative clearance of apoptotic material in young and aged mice using two independent assays. First, 2-year-old mice were found to be impaired in their ability to clear apoptotic keratinocytes following ultraviolet irradiation of the skin. Secondly, peritoneal macrophages exposed to apoptotic Jurkat T cells in vivo displayed diminished phagocytic activity in aged mice compared with 8-week-old mice. Consistent with these findings, aged mice exhibited signs of autoimmunity with the appearance of anti-nuclear antibodies and increased kidney glomerular size as well as complement deposits within the glomeruli. In vitro assays revealed that the pretreatment of macrophages with the serum from aged mice led to a reduction in their ability to phagocytose apoptotic bodies compared with macrophages treated with serum from young mice. These data show that the ageing process is accompanied by a diminished ability to clear apoptotic debris. This accumulation of apoptotic debris could contribute to immune system dysfunction that occurs in aged organisms.

Alveolar macrophage activation and an emphysema-like phenotype in adiponectin-deficient mice.

Adiponectin is an adipocyte-derived collectin that acts on a wide range of tissues including liver, brain, heart, and vascular endothelium. To date, little is known about the actions of adiponectin in the lung. Herein, we demonstrate that adiponectin is present in lung lining fluid and that adiponectin deficiency leads to increases in proinflammatory mediators and an emphysema-like phenotype in the mouse lung. Alveolar macrophages from adiponectin-deficient mice spontaneously display increased production of tumor necrosis factor-alpha (TNF-alpha) and matrix metalloproteinase (MMP-12) activity. Consistent with these observations, we found that pretreatment of alveolar macrophages with adiponectin leads to TNF-alpha and MMP-12 suppression. Together, our findings show that adiponectin leads to macrophage suppression in the lung and suggest that adiponectin-deficient states may contribute to the pathogenesis of inflammatory lung conditions such as emphysema.

Implant hyperthermia resonant circuit produces heat in response to MRI unit radiofrequency pulses.

A small resonant circuit was investigated for its potential for producing hyperthermia to treat cancer. Implant hyperthermia has been performed using tiny elements implanted inside the body that are heated by an external energy source. We assessed the effect on heat generation of a resonant circuit used as an implant hyperthermia device by MRI unit radiofrequency (RF) pulses with different imaging sequences. The resonant circuit used as a heating device consisted of a closed connection between a coil and a capacitor. The resonant frequency was set to 63.9 MHz so that the circuit would react and generate heat in response to the RF pulses of a 1.5 T MRI unit. The resonant circuit was placed in the MRI unit with an optical thermometer enclosed by insulating material, and the temperature rise was monitored during imaging sequences. Standard imaging MRI sequences--fast low angle shot gradient echo (FLASH), T1 weighted spin echo image (T1WI) and rapid acquisition with refocused echoes (RARE)--were used to produce RF pulses that affected the resonant circuit. This circuit was gradually heated during all MRI sequences. The temperature rise ranged from 7.2 degrees C to 12.6 degrees C. The highest temperature rise was obtained with RARE, followed by FLASH and T1WI. Thus, this apparatus may have potential for implant hyperthermia, which could provide minimally invasive anticancer therapy.

Aspirin: recent developments.

Aspirin exerts anti-thrombotic action by acetylating and inactivating cyclooxygenase-1, preventing the production of thromboxane A2 in platelets. Through this inhibition of platelet function, aspirin is considered as a preventative of ischemic diseases such as coronary and cerebral infarction. However, many studies have revealed that aspirin has other beneficial actions in addition to its anti-platelet activity. For example, aspirin may confer some benefit against colorectal cancer. Here, we discuss the involvement of inflammation in atherosclerosis and how aspirin exerts its beneficial actions in atherosclerotic diseases and cancer.

Recurrence of ovarian endometrioma after laparoscopic excision.

BACKGROUND: To analyse risk factors that influence the recurrence of endometrioma after laparoscopic excision. METHODS: A total of 224 patients who had a minimum of 2 years of post-operative follow-up after laparoscopic ovarian endometrioma excision were studied retrospectively. Recurrence was defined as the presence of endometrioma more than 2 cm in size, detected by ultrasonography within 2 years of surgery. Fourteen variables (age, presence of infertility, pain, uterine myoma, adenomyosis, previous medical treatment of endometriosis, previous surgery for ovarian endometriosis, single or multiple cysts, the size of the largest cyst at laparoscopy, unilateral or bilateral involvement, co-existence of deep endometriosis, revised American Society for Reproductive Medicine (ASRM) score, post-operative medical treatment and post-operative pregnancy) were evaluated to assess their independent effects on the recurrence using logistic regression analysis. RESULTS: The overall rate of recurrence was 30.4% (68/224). Significant factors that were independently associated with higher recurrence were previous medical treatment of endometriosis [odds ratio (OR) = 2.324, 95% confidence interval (95% CI) = 1.232-4.383, P = 0.0092) and larger diameter of the largest cyst (OR = 1.182, 95% CI = 1.004-1.391, P = 0.0442). Post-operative pregnancy was associated with lower recurrence (OR = 0.292, 95% CI = 0.028-0.317, P = 0.0181). CONCLUSIONS: Previous medical treatment of endometriosis or large cyst size was a significant factor that was associated with higher recurrence of the disease. Post-operative pregnancy is a favourable prognostic factor.

Antibiotic selection patterns in acutely febrile new outpatients with or without immediate testing for C reactive protein and leucocyte count.

BACKGROUND: Excessive use of broad spectrum antibiotics is related to the spread of drug resistant bacterial strains in the community. AIM/METHODS: The effects of immediate testing for C reactive protein (CRP) and white blood cell count (WBC) on physicians' choices of antibiotic was investigated in patients with acute infection. Acutely febrile new outpatients were randomised into two groups: group 1 (147 patients) underwent CRP and WBC testing before initial consultation (advance testing). Prescriptions were compared with those in group 2 (no advance testing; 154 patients). RESULTS: In non-pneumonic acute respiratory tract infections, 61 (58%) and 122 (91%) of group 1 and 2 patients were prescribed antibiotics, respectively. Cefcapene pivoxil (third generation cephalosporin) and amoxicillin were the most frequently chosen drugs for group 1 and 2, respectively. Total prescriptions of newer, extended spectrum antibiotics (cefcapene pivoxil and clarithromycin (advanced macrolide)) were reduced by 25% in group 1, although they increased in rate (41 (67%) v 55 (45%) prescriptions) because of the decreased prescription of amoxicillin. In group 1, cefcapene pivoxil was preferentially selected when WBC values were greater than 9 x 10(9)/litre. Prescription shifted to macrolides (mainly clarithromycin) in patients without leucocytosis. Patient treatment outcome did not significantly differ between the two groups. CONCLUSIONS: The availability of CRP and WBC data during initial consultation greatly reduced prescription of amoxicillin, but had a lesser effect on newer, potent, broad spectrum antibiotics.

[Bentall operation for a 90-year-old man with root aneurysm; report of a case].

Open heart surgery in nonagenarians is not common. We reported a successful Bentall operation in a 90-year-old man with aortic root aneurysm and aortic regurgitation. He has lived healthfully and independently without a big problem. He was referred to our hospital for acute heart failure. The aortic root enlarged as a diameter of 60 mm and moderate aortic regurgitation were recognized by echocardiography and aortogram. We excised the aneurysm, implanted a composite graft, directly attached the coronary arteries to the aortic graft (Carrel patch technique), and made the distal anastomosis to the divided aorta. Postoperative course was uneventful. To our knowledge, this is the first successful case of Bentall operation for nonagenarians in Japan. If selective criteria identifying risks and benefits for individual patients is applied, the nonagenarian can safely undergo cardiac surgery.

Relationship between sympathetic skin response and power spectral analysis of heart rate variation in patients with type 2 diabetes.

We measured sympathetic skin response (SSR), a measure of sympathetic sudomotor function, and compared SSR with other quantitative neurological tests including power spectral analysis (PSA) of heart rate variations in 60 type 2 diabetic subjects. SSR was detected in all 20 age-matched healthy subjects but was absent in 17 patients with type 2 diabetes (28%) (P<.01). Even after exclusion of diabetic patients with absent SSR, the SSR amplitude in diabetic patients was significantly lower than in healthy subjects (P<.05). Both the low frequency power of R-R intervals, which reflects both cardiac sympathetic and parasympathetic function, and the postural fall in systolic blood pressure were significantly lower in the diabetic patients with absent SSR than in those with present SSR (P<.05 and.001, respectively). However, we found no significant difference in the high frequency power of R-R intervals, which reflects accurately cardiac parasympathetic function, between the diabetic patients with absent SSR and those with present SSR. In the diabetic patients with present SSR, SSR amplitude was also positively correlated with the postural fall in systolic blood pressure, low-frequency (LF) power, and high-frequency (HF) power. These results suggest that SSR is a useful and sensitive method for evaluating diabetic autonomic neuropathy, and that sympathetic sudomotor neuropathy may be preceded by cardiac parasympathetic neuropathy in patients with type 2 diabetes.