A sustained high-temperature fusion plasma regime facilitated by fast ions.

Nuclear fusion is one of the most attractive alternatives to carbon-dependent energy sources1. Harnessing energy from nuclear fusion in a large reactor scale, however, still presents many scientific challenges despite the many years of research and steady advances in magnetic confinement approaches. State-of-the-art magnetic fusion devices cannot yet achieve a sustainable fusion performance, which requires a high temperature above 100 million kelvin and sufficient control of instabilities to ensure steady-state operation on the order of tens of seconds2,3. Here we report experiments at the Korea Superconducting Tokamak Advanced Research4 device producing a plasma fusion regime that satisfies most of the above requirements: thanks to abundant fast ions stabilizing the core plasma turbulence, we generate plasmas at a temperature of 100 million kelvin lasting up to 20 seconds without plasma edge instabilities or impurity accumulation. A low plasma density combined with a moderate input power for operation is key to establishing this regime by preserving a high fraction of fast ions. This regime is rarely subject to disruption and can be sustained reliably even without a sophisticated control, and thus represents a promising path towards commercial fusion reactors.

Long Term Vortex Flow Evolution around a Magnetic Island in Tokamaks.

We present a gyrokinetic analysis of the vortex flow evolution in a magnetic island in collisionless tokamak plasmas. In a short term ω[over ¯]_{D}t<1, where ω[over ¯]_{D} is the secular magnetic drift of the orbit center, initial monopolar vortex flow approaches to its residual level determined by the neoclassical enhancement of polarization shielding after collisionless relaxation. The residual level depends on the location inside an island and is higher than the Rosenbluth-Hinton level [M.N. Rosenbluth and F.L. Hinton, Phys. Rev. Lett. 80, 724 (1998)PRLTAO0031-900710.1103/PhysRevLett.80.724] due to finite island width. In a long term ω[over ¯]_{D}t>1, the residual vortex flow evolves to a dipolar zonal-vortex flow mixture due to toroidicity-induced breaking of a helical symmetry. The mixture forms localized flow shear layers near the island separatrix away from X points. The deviation of the streamlines of the mixture flows from magnetic surfaces allows turbulence advection across the island. We expect a small island w≲qρ_{Ti}/s[over ^] provides a favorable condition for this mixture flow formation, while the monopolar vortex flow persists for a larger island.

Effects of plasma turbulence on the nonlinear evolution of magnetic island in tokamak.

Magnetic islands (MIs), resulting from a magnetic field reconnection, are ubiquitous structures in magnetized plasmas. In tokamak plasmas, recent researches suggested that the interaction between an MI and ambient turbulence can be important for the nonlinear MI evolution, but a lack of detailed experimental observations and analyses has prevented further understanding. Here, we provide comprehensive observations such as turbulence spreading into an MI and turbulence enhancement at the reconnection site, elucidating intricate effects of plasma turbulence on the nonlinear MI evolution.

Ultrasound-guided lung sliding sign to confirm optimal depth of tracheal tube insertion in young children.

BACKGROUND: The tip of the tracheal tube should lie at the mid-tracheal level after tracheal intubation in paediatric patients. Auscultation does not guarantee optimal positioning of the tracheal tube. We compared auscultation and the ultrasound-guided lung sliding sign to confirm optimal positioning of the tracheal tube in paediatric patients. METHODS: We studied 74 paediatric patients aged 0-24 months of ASA physical status 1-3 who were scheduled for elective surgery under general anaesthesia. All were randomly assigned to one of two groups: depth of tracheal tube confirmed by auscultation (Group A) or using the ultrasound-guided lung sliding sign (Group S). RESULTS: Optimal positioning of the tracheal tube was observed in 32 of 37 (87%) subjects in Group S and 24 of 37 (65%) subjects in Group A (difference in proportion, 22%; 95% confidence interval, 2-39%; P=0.030). Optimal depth correlated with patient height (adjusted coefficient=0.888, P<0.001). CONCLUSIONS: In paediatric patients younger than 24 months, use of the ultrasound-guided lung sliding sign was more accurate than auscultation for optimal positioning of the tracheal tube. CLINICAL TRIAL REGISTRATION: KCT 0003015.

Prolonged inspiratory time produces better gas exchange in patients undergoing laparoscopic surgery: A randomised trial.

BACKGROUND: Laparoscopic surgery performed with a patient in the Trendelenburg position is known to have adverse effects on pulmonary gas exchange and respiratory mechanics. We supposed that prolonged inspiratory time can improve gas exchange at lower airway pressure. METHODS: One hundred patients undergoing gynaecologic laparoscopic surgery were randomly assigned to one of four groups: conventional inspiratory-to-expiratory (I : E) ratio (Group 1 : 2), I : E ratio of 1 : 1 (Group 1 : 1), 2 : 1 (Group 2 : 1), or 1 : 2 with external positive end-expiratory pressure (PEEP) of 5 cmH2 O (Group 1 : 2 PEEP). Tidal volume was set to 6 ml/kg, and I : E ratio was adjusted at the onset of pneumoperitoneum. Arterial blood gas analysis with measurements of partial pressure of arterial oxygen/fraction of inspired oxygen (PaO2 /FiO2 ), and physiologic dead space-to-tidal volume ratio (VD /VT ) was performed 15 min after anaesthetic induction (T1), and 30 (T2) and 60 min (T3) after onset of CO2 insufflation. RESULTS: PaO2 /FiO2 at T3 in Groups 1 : 1, 2 : 1, and 1 : 2 PEEP were higher than Group 1 : 2. The partial pressure of arterial carbon dioxide at T3 in Group 2 : 1 was lower than the other groups. The VD /VT at T2 and T3 were lower in Groups 1 : 1 and 2 : 1 than Groups 1 : 2 and 1 : 2 PEEP. Peak or plateau airway pressure was higher in Group 1 : 2 PEEP than the other groups. CONCLUSIONS: A prolonged inspiratory time demonstrated a beneficial effect on oxygenation. Furthermore, it showed better CO2 elimination without elevating the peak or plateau airway pressure compared with applying external PEEP. In terms of gas exchange and respiratory mechanics, a prolonged inspiratory time appears to be superior to applying external PEEP in patients undergoing laparoscopic surgery in the Trendelenburg position.

Combined carbamazepine and pregabalin therapy in a rat model of neuropathic pain.

BACKGROUND: Carbamazepine and pregabalin have proven effects against neuropathic pain. Carbamazepine blocks voltage-dependent Na(+) channels, whereas pregabalin blocks voltage-dependent Ca(2+) channels. The authors hypothesized that the co-administration of these drugs would synergistically reduce neuropathic pain. METHODS: Neuropathic pain was induced by L5 nerve ligation in Sprague-Dawley rats. To determine their ED(50) values, carbamazepine and pregabalin were orally administered at 0.3, 3, 10, or 30 mg kg(-1). The drugs were then co-administered at 0, 1/4×ED(50), 1/2×ED(50), 1.5×ED(50), and 2×ED(50) to determine the ED(50) and ED(75) values of the drugs in combination. Allodynia was determined using the von Frey hair test and dose-effect curves and isobolograms were used to investigate drug interactions. Levels of the acute reactive protein c-Fos in the dorsal horn were evaluated as an indicator of pathological nerve excitation. RESULTS: At ED(50) levels, carbamazepine and pregabalin did not exhibit synergism, but doses higher than ED(75) were found to be synergistic. The combination index was 0.18 (strong synergy) and dose reductions were 35.7-fold for carbamazepine and 6.8-fold for pregabalin when co-administered when compared with a single administration at ED(75). The percentage allodynia relief was only 60% for carbamazepine and 80% for pregabalin by single administration, whereas their co-administration relieved allodynia by 100%. Furthermore, treatment decreased c-Fos expression in the dorsal horn, but expressional differences between animals treated with carbamazepine plus pregabalin were not significantly different from those treated with single drug. CONCLUSIONS: Carbamazepine and pregabalin ameliorate neuropathic pain synergistically at higher doses.

Edge temperature gradient as intrinsic rotation drive in Alcator C-Mod tokamak plasmas.

Intrinsic rotation has been observed in I-mode plasmas from the C-Mod tokamak, and is found to be similar to that in H mode, both in its edge origin and in the scaling with global pressure. Since both plasmas have similar edge ∇T, but completely different edge ∇n, it may be concluded that the drive of the intrinsic rotation is the edge ∇T rather than ∇P. Evidence suggests that the connection between gradients and rotation is the residual stress, and a scaling for the rotation from conversion of free energy to macroscopic flow is calculated.

Trapped electron mode turbulence driven intrinsic rotation in Tokamak plasmas.

Progress from global gyrokinetic simulations in understanding the origin of intrinsic rotation in toroidal plasmas is reported. The turbulence-driven intrinsic torque associated with nonlinear residual stress generation due to zonal flow shear induced asymmetry in the parallel wave number spectrum is shown to scale close to linearly with plasma gradients and the inverse of the plasma current, qualitatively reproducing experimental empirical scalings of intrinsic rotation. The origin of current scaling is found to be enhanced k(∥) symmetry breaking induced by the increased radial variation of the safety factor as the current decreases. The intrinsic torque is proportional to the pressure gradient because both turbulence intensity and zonal flow shear, which are two key ingredients for driving residual stress, increase with turbulence drive, which is R/L(T(e)) and R/L(n(e)) for the trapped electron mode.

Comparison of the prophylactic anti-emetic efficacy of ramosetron and ondansetron in patients at high-risk for postoperative nausea and vomiting after total knee replacement.

We compared the prophylactic anti-emetic efficacy of ramosetron, a newly developed 5-HT(3) antagonist, and ondansetron in patients at high-risk for postoperative nausea and vomiting after total knee replacement. Eighty-four patients with three risk factors for postoperative nausea and vomiting (female, non-smoking and use of postoperative opioid use (ropivacaine and hydromorphone patient controlled epidural analgesia)) undergoing unilateral total knee replacement were randomly allocated to ramosetron 0.3 mg (n = 42) or ondansetron 4 mg (n = 42) groups. A complete response (no postoperative nausea and vomiting and no rescue anti-emetic) and the incidence of postoperative nausea and vomiting were assessed for 48 h after surgery at 0-2 h, 2-6 h, 6-24 h, and 24-48 h. More patients in the ramosetron group had a complete response between 2 and 48 h. The incidence of nausea between 2 and 24 h and the severity of nausea between 2 and 48 h were also less in the ramosetron group. Ramosetron was more effective than ondansetron in preventing postoperative nausea and vomiting in patients at high risk undergoing unilateral total knee replacement.

Recovery of nicotine-free proteins from tobacco leaves using phosphate buffer system under controlled conditions.

Establishment of an effective, high-throughput processing system to recover protein from tobacco with no nicotine contamination is essential and vital to the development of value-added, alternative applications for tobacco farmers. We have successfully developed a mechanism capable of processing up to 60 kg of tobacco leaves per hour with phosphate buffer (Na(2)HPO(4)-KH(2)PO(4)) simultaneously added to stabilize the protein as the plant was being disintegrated. The optimal processing parameters were identified, including the ratio of buffer to leaf (BLR) at 4.75 (w/w), buffer pH 7.85, and buffer concentration 0.085 mol/L, achieving a maximum yield of soluble protein at 12.85 mg/g fresh leaf. Acetone at -20 degrees C was the most effective among all methods investigated to remove nicotine from protein; however, it also drastically reduced the recovery rate of protein (63.3%). Ultrafiltration was only able to remove about 50% of the residual nicotine, although the protein recovery rate was high (94.7%). The residual nicotine content inherent in the recovered protein was completely removed by rinsing the protein with 85% phosphoric acid at pH 3.5 for three times with a protein recovery of 94.5%. The pilot-scale operation provides a solid foundation for further scale-up to industrial production of nicotine-free tobacco protein that could bring added value to tobacco for nonsmoking applications.

Gyrokinetic studies on turbulence-driven and neoclassical nondiffusive toroidal-momentum transport and the effect of residual fluctuations in strong E x B shear.

A significant inward flux of toroidal momentum is found in global gyrokinetic simulations of ion temperature gradient turbulence, leading to core plasma rotation spin-up. The underlying mechanism is identified to be the generation of residual stress due to the k parallel symmetry breaking induced by global quasistationary zonal flow shear. Simulations also show a significant off-diagonal element associated with the ion temperature gradient in the neoclassical momentum flux, while the overall neoclassical flux is small. In addition, the residual turbulence found in the presence of strong E x B flow shear may account for neoclassical-level ion heat and anomalous momentum transport widely observed in experiments.

Toroidal rotation driven by the polarization drift.

Starting from a phase space conserving gyrokinetic formulation, a systematic derivation of parallel momentum conservation uncovers a novel mechanism by which microturbulence may drive intrinsic rotation. This mechanism, which appears in the gyrokinetic formulation through the parallel nonlinearity, emerges due to charge separation induced by the polarization drift. The derivation and physical discussion of this mechanism will be pursued throughout this Letter.

Turbulent equipartition and homogenization of plasma angular momentum.

A physical model of turbulent equipartition (TEP) of plasma angular momentum is developed. We show that using a simple, model insensitive ansatz of conservation of total angular momentum, a TEP pinch of angular momentum can be obtained. We note that this term corresponds to a part of the pinch velocity previously calculated using quasilinear gyrokinetic theory. We observe that the nondiffusive TEP flux is inward, and therefore may explain the peakedness of the rotation profiles observed in certain experiments. Similar expressions for linear toroidal momentum and flow are computed and it is noted that there is an additional effect due the radial profile of moment of inertia density.

Comparison of surgical conditions during propofol or sevoflurane anaesthesia for endoscopic sinus surgery.

BACKGROUND: Endoscopic sinus surgery (ESS) is often affected by intra-nasal bleeding, which can be influenced by various anaesthetics and preoperative conditions. This study compared the surgical condition and the amount of intra-nasal bleeding between patients given sevoflurane/remifentanil (SR) and propofol/remifentanil (PR) anaesthesia. METHODS: ASA I or II patients undergoing ESS were randomly assigned to group SR (n=20) or group PR (n=20). The extent of the preoperative surgical lesion was classified as high (> 12) and low Lund-Mackay (LM) (< or = 12) scores according to the computed tomography findings. The amount of intraoperative blood loss was calculated from the patients' haemoglobin (Hb) and the amount of blood in the suction canister. The surgeons rated the visibility of the surgical field on a numeric rating scale (NRS). RESULTS: In the high-LM score patients, the median (1st/3rd quartiles) blood loss for the SR and PR groups was 135 (121/222) and 19 (8/71) ml h(-1), respectively (P<0.01), and the mean (SD) of NRS was 5.8 (2.3) and 2.3 (1.0), respectively (P<0.05). However, in patients with low-LM score, both blood loss and NRS scores were not different between groups SR and PR. CONCLUSIONS: In the high-LM score patients, PR anaesthesia results in less blood loss and a better surgical conditions for ESS than SR anaesthesia.

Comparison of femoral arterial blood pressure with radial arterial blood pressure and noninvasive upper arm blood pressure in the reperfusion period during liver transplantation.

PURPOSE: The reperfusion period during liver transplantation is hemodynamically unstable. Accurate blood pressure measurements are the mainstay for the efficient management of abrupt cardiovascular changes. We sought to compare femoral arterial blood pressure (FABP) with radial arterial blood pressure (RABP) and noninvasive upper arm blood pressure (NIBP) in the reperfusion period. METHODS: Thirty-six adult living donor liver recipients were enrolled in this prospective study. Blood pressures in 3 locations were simultaneously recorded from 1 minute before reperfusion to 15 minutes after reperfusion. We evaluated agreements between FABP and RABP and between FABP and NIBP using intraclass correlation coefficients. Also, we investigated the rates of postreperfusion syndrome (PRS) based on the measurements from 3 locations. RESULTS: After reperfusion, the mean and diastolic RABP agreed more with the corresponding FABP than NIBP. However, systolic NIBP showed high agreement with FABP from 3 to 10 minutes after reperfusion in contrast with the moderate agreement between systolic RABP with FABP, and systolic values of NIBP than RABP were closer to FABP. The rates of PRS based on FABP, RABP, and NIBP measurements were 50.0% (18/36), 80.6% (29/36), and 50.0% (18/36), respectively. CONCLUSIONS: We believe that NIBP in addition to RABP may be considered to be a reliable alternative when FABP is not available to evaluate hemodynamic instability in the reperfusion period during liver transplantation.

Wave-particle decorrelation and transport of anisotropic turbulence in collisionless plasmas.

Comprehensive analysis of the largest first-principles simulations to date shows that stochastic wave-particle decorrelation is the dominant mechanism responsible for electron heat transport driven by electron temperature gradient turbulence with extended radial streamers. The transport is proportional to the local fluctuation intensity, and phase-space island overlap leads to a diffusive process with a time scale comparable to the wave-particle decorrelation time, determined by the fluctuation spectral width. This kinetic time scale is much shorter than the fluid time scale of eddy mixing.

Nonlinear triad interactions and the mechanism of spreading in drift-wave turbulence.

We present the results of a derivation of the fluctuation energy transport matrix for the two-field Hasegawa-Wakatani model of drift wave turbulence. The energy transport matrix is derived from a two-scale direct interaction approximation assuming weak turbulence. We examine different classes of triad interactions and show that radially extended eddies, as occurs in penetrative convection, are the most effective in turbulence spreading. We show that in the near-adiabatic limit internal energy spreads faster than the kinetic energy. Previous theories of spreading results are discussed in the context of weak turbulence theory.

Measurement of turbulence decorrelation during transport barrier evolution in a high-temperature fusion plasma.

A low power polychromatic beam of microwaves is used to diagnose the behavior of turbulent fluctuations in the core of the JT-60U tokamak during the evolution of the internal transport barrier. A continuous reduction in the size of turbulent structures is observed concomitant with the reduction of the density scale length during the evolution of the internal transport barrier. The density correlation length decreases to the order of the ion gyroradius, in contrast with the much longer scale lengths observed earlier in the discharge, while the density fluctuation level remain similar to the level before transport barrier formation.

Size scaling of turbulent transport in magnetically confined plasmas.

Transport scaling with respect to device size in magnetically confined plasmas is critically examined for electrostatic ion-temperature-gradient turbulence using global gyrokinetic particle simulations. It is found, by varying device size normalized by ion gyroradius while keeping other dimensionless plasma parameters fixed, that fluctuation scale length is microscopic in the presence of zonal flows. The local transport coefficient exhibits a gradual transition from a Bohm-like scaling for device sizes corresponding to present-day experiments to a gyro-Bohm scaling for future larger devices.

Plasma levels of interleukin-6 and interleukin-10 are affected by ketorolac as an adjunct to patient-controlled morphine after abdominal hysterectomy.

OBJECTIVE: Because morphine affects various immune functions, patient-controlled analgesia with morphine may further deteriorate the immune mechanisms after surgery. Therefore, the purpose of this study was to determine differences between morphine patient-controlled analgesia and a combination of morphine and ketorolac in interleukin-6 and interleukin-10 responses, and in analgesia and morphine-related side effects. DESIGN: Prospective study. PATIENTS: Twenty-two patients who underwent abdominal hysterectomy were classified randomly into two groups: (1) patient-controlled analgesia with morphine; and (2) patient-controlled analgesia with a combination of morphine and ketorolac. Blood samples to measure cytokines were collected at preoperatively, immediately postoperatively, and 2 hours, 4 hours, and 24 hours postoperatively. OUTCOME MEASURES: Plasma was separated and frozen until the analysis of cytokines using enzyme-linked immunosorbent assays. Postoperative pain was assessed using a visual analog score. Sedation was checked based on a protocol developed at the Samsung Medical Center. RESULTS: In the two groups, interleukin-6 increased immediately postoperatively, and it remained consistent for 24 hours. Interleukin-10 concentrations peaked at 2 hours postoperatively and progressively decreased. Cytokine concentrations between the two groups were significantly different for interleukin-6 24 hours postoperatively (p = 0.026) and for interleukin-10 4 hours postoperatively (p = 0.045). Total analgesic use was not different, but morphine consumption was significantly different (p = 0.037 at 4 hours postoperatively, p = 0.015 at 24 hours postoperatively). Pain scores, sedation, and side effects were unaffected by the patient-controlled analgesia regimen. CONCLUSIONS: The authors conclude that supplementation using ketorolac plus administration of morphine modifies cytokine responses and may contribute to immune augmentations during postoperative periods.