A concept of a broadband inverted geometry spectrometer for the Second Target Station at the Spallation Neutron Source.

BWAVES is an acronym for Broadband Wide-Angle VElocity Selector spectrometer, indicating that a novel WAVES (Wide-Angle VElocity Selector) device will be used to select the velocity/wavelength of the detected neutrons after they are scattered by the sample. We describe a conceptual design of BWAVES, a time-of-flight broadband inverted-geometry neutron spectrometer for the Second Target Station at the Spallation Neutron Source operated by Oak Ridge National Laboratory. Being the first inverted geometry spectrometer where the energy of the detected neutrons can be chosen by a WAVES device mechanically, irrespective of the limitations imposed by the crystal analyzers or filters, BWAVES will feature a uniquely broad, continuous dynamic range of measurable energy transfers, spanning 4.5 decades. This will enable measurements of both vibrational and relaxational excitations within the same, continuous scattering spectra. Novel approaches that are necessary for the implementation of a WAVES device at the BWAVES spectrometer will result in a spectrometer with the design and characteristics much different from those displayed by the neutron spectrometers in existence today.

Results from the Survey of Antibiotic Resistance (SOAR) 2014-16 in Bulgaria, Romania, Serbia and Croatia.

Objectives: To determine antibiotic susceptibility of isolates of Streptococcus pneumoniae (n = 573) and Haemophilus influenzae (n = 345) collected in 2014-16 from Bulgaria, Romania, Serbia and Croatia. Methods: MICs were determined by CLSI broth microdilution and susceptibility was assessed using CLSI, EUCAST and pharmacokinetic/pharmacodynamic (PK/PD) breakpoints. Results: Among S. pneumoniae, susceptibility was generally lowest in Romania and Serbia and highest in Bulgaria. Rates of susceptibility to penicillin (CLSI oral or EUCAST) were 22.3% and 21.8% in Romania and Serbia respectively, 57% in Croatia and 86.6% in Bulgaria. Similarly, macrolide susceptibility using CLSI/EUCAST breakpoints was low in Romania and Serbia (∼28% and 34.5%, respectively), higher in Croatia (55.9%) and highest in Bulgaria (∼75%). Only fluoroquinolones were active against all isolates in all four countries. Susceptibility was higher and variability across countries less pronounced for H. influenzae. Susceptibility by CLSI criteria to amoxicillin/clavulanic acid, azithromycin, cefuroxime, ceftriaxone and fluoroquinolones was ≥98% in all countries. Ampicillin susceptibility ranged from 85.3% in Romania to 100% in Bulgaria. Much greater variability was seen across breakpoints. Susceptibility to azithromycin and cefuroxime using CLSI criteria was ≥98% in all four countries, but was 0%-1% by EUCAST criteria. Conclusions: The variability in antimicrobial susceptibility using different breakpoints makes it difficult for clinicians to interpret antimicrobial resistance data, and efforts should be made to harmonize breakpoints. The variability found across the four neighbouring countries demonstrates the need to monitor and publish national and local resistance patterns. These findings provide information critical for the selection of appropriate antimicrobial agents for the treatment of S. pneumoniae and H. influenzae.

Single crystal to polycrystal neutron transmission simulation.

A collection of routines for calculation of the total cross section that determines the attenuation of neutrons by crystalline solids is presented. The total cross section is calculated semi-empirically as a function of crystal structure, neutron energy, temperature, and crystal orientation. The semi-empirical formula includes the contribution of parasitic Bragg scattering to the total cross section using both the crystal's mosaic spread value and its orientation with respect to the neutron beam direction as parameters. These routines allow users to enter a distribution of crystal orientations for calculation of total cross sections of user defined powder or pseudo powder distributions, which enables simulation of non-uniformities such as texture and strain. The spectra for neutron transmission simulations in the neutron thermal energy range (2 meV-100 meV) are presented for single crystal and polycrystal samples and compared to measurements.

Fetal Kidneys Ultrasound Appearance in the First Trimester - Clinical Significance and Limits of Counseling.

OBJECTIVE: The objective of this study was to determine the visualizing rate of fetal kidneys at various gestational ages in late first trimester (FT) and to establish the clinical significance of their two-dimensional ultrasound (2DUS) appearance in the FT. METHODS: In a prospective cross-sectional study, 1456 women from an unselected population underwent a detailed assessment of fetal anatomy at 11+0 -13+4 weeks of gestation with the use of transabdominal sonography. Information on the ultrasound findings, antenatal course and perinatal outcome was obtained in 1331 cases. RESULTS: 44 cases in which a congenital kidney disease was detected by ultrasound in the prenatal period were identified. The renal pathology was suspected in the FT in 8 cases, and confirmed by a standard test (postmortem autopsy or second-trimester scan) in 4 cases. The standard detailed second-trimester scan at 18-22 weeks diagnosed another 23 cases but refuted suspicion in 4 FT positive cases. The third trimester added another 17, all confirmed by the postpartum scan. For FT presence or absence of congenital renal anomalies, sensitivity, specificity, +LRs and -LRs of 2DUS were 9.09%, 99.69%, 29.25, and 0.91. CONCLUSION: FT prenatal kidneys' visualization is critically dependent on the gestational age. FT diagnosis holds uncertainty. An early diagnosis carries a risk of providing a false-positive or a false-negative result, because the differentiation of the renal system is delayed or the diagnosis is not amenable yet to prenatal ultrasound. No FT findings can exclude the mid-trimester follow-up ultrasound scan. Second and third trimester scan are relevant for congenital kidney diseases.

Possibilities and limits in the treatment of congenital diaphragmatic hernia.

AIM: to establish a therapeutic strategy that will improve the prognosis and increase the survival rate in congenital diaphragmatic hernia. MATERIAL AND METHOD: 14 congenital diaphragmatic hernias (incidence 1/1597 live births, 12 boys and 2 girls with a sex ratio of 6/1, 10 term infants and 4 preterm first degree, 11 natural births and 3 by caesarean section) admitted to the Clinic of Pediatric Surgery Craiova, in a 5-year period (2007-2012), were analyzed from the therapeutic point of view. The "tension free" primary suture was the main surgical procedure to repair the diaphragmatic defect in all cases, preceded by a period of preoperative resuscitation and stabilization (2.8 days on average). RESULTS: We registered a survival rate of 64.29% and a postoperative mortality rate of 35.71%. CONCLUSIONS: delayed surgery preceded by a period of the preoperative respiratory resuscitation and stabilization (24-72 hours on average) significantly reduced postoperative mortality and increased the survival rate.

Temperature-dependent elastic anisotropy and mesoscale deformation in a nanostructured ferritic alloy.

Nanostructured ferritic alloys are a new class of ultrafine-grained oxide dispersion-strengthened steels that have promising properties for service in extreme environments in future nuclear reactors. This is due to the remarkable stability of their complex microstructures containing numerous Y-Ti-O nanoclusters within grains and along grain boundaries. Although nanoclusters account primarily for the exceptional resistance to irradiation damage and high-temperature creep, little is known about the mechanical roles of the polycrystalline grains that constitute the ferritic matrix. Here we report an in situ mesoscale characterization of anisotropic responses of ultrafine ferrite grains to stresses using state-of-the-art neutron diffraction. We show the experimental determination of single-crystal elastic constants for a 14YWT alloy, and reveal a strong temperature-dependent elastic anisotropy that leads to elastic softening and instability of the ferrite. We also demonstrate, from anisotropy-induced intergranular strains, that a deformation crossover exists from low-temperature lattice hardening to high-temperature lattice softening in response to extensive plastic deformation.

Enhancing glass-forming ability via frustration of nano-clustering in alloys with a high solvent content.

The glass-forming ability (GFA) of alloys with a high-solvent content such as soft magnetic Fe-based and Al-based alloys is usually limited due to strong formation of the solvent-based solid solution phase. Herein, we report that the GFA of soft magnetic Fe-based alloys (with >70 at.% Fe to ensure large saturation magnetization) could be dramatically improved by doping with only 0.3 at.% Cu which has a positive enthalpy of mixing with Fe. It was found that an appropriate Cu addition could enhance the liquid phase stability and crystallization resistance by destabilizing the α-Fe nano-clusters due to the necessity to redistribute the Cu atoms. However, excessive Cu doping would stimulate nucleation of the α-Fe nano-clusters due to the repulsive nature between the Fe and Cu atoms, thus deteriorating the GFA. Our findings provide new insights into understanding of glass formation in general.

Strain incompatibility and residual strains in ferroelectric single crystals.

Residual strains in ferroelectrics are known to adversely affect the material properties by aggravating crack growth and fatigue degradation. The primary cause for residual strains is strain incompatibility between different microstructural entities. For example, it was shown in polycrystalline ferroelectrics that residual strains are caused due to incompatibility between the electric-field-induced strains in grains with different crystallographic orientations. However, similar characterization of cause-effect in multidomain ferroelectric single crystals is lacking. In this article, we report on the development of plastic residual strains in [111]-oriented domain engineered BaTiO(3) single crystals. These internal strains are created due to strain incompatibility across 90° domain walls between the differently oriented domains. The average residual strains over a large crystal volume measured by in situ neutron diffraction is comparable to previous X-ray measurements of localized strains near domain boundaries, but are an order of magnitude lower than electric-field-induced residual strains in polycrystalline ferroelectrics.

Using the galactomannan antigen assay in the diagnosis of invasive aspergillosis after hematopoietic stem cell transplantation.

Invasive aspergillosis (IA) is the most common life-threatening infections after hematopoietic stem cell transplant (HSCT). The serum galactomannan (GM) is recognized as an indirect mycological criteria for an early diagnosis of IA. Starting January 2011, we implementing in Fundeni Clinical Institute, Bucharest, for the first time in Romania, the detection of GM antigen (Platelia Aspergillus EIA, Bio-Rad). In 2011, patients undergoing HSCT were screened with the galactomannan ELISA; we performed a retrospective chart review of 162 SCT patients who underwent galactomannan testing. Thirteen of the patients (8.02%) had at least one positive galactomannan ELISA, and four had multiple positive tests. When calculated in reference to a proved or probable diagnosis of aspergillosis, the galactomannan ELISA had a sensitivity of 0.857 and a specificity of 0.913. The positive predictive value was 0.46, and the negative predictive value was 0.993. The Platelia Aspergillus galactomannan antigenemia assay may assist physicians in making an early diagnosis of IA, in correlation with clinical and radiological criteria. The test has a high sensitivity and specificity and a very good negative predictive value. We found the screening of GM ELISA to be a highly specific diagnostic tool in detecting IA manifested in patients undergoing HSCT.

Elastic moduli inheritance and the weakest link in bulk metallic glasses.

We show that a variety of bulk metallic glasses (BMGs) inherit their Young's modulus and shear modulus from the solvent components. This is attributed to preferential straining of locally solvent-rich configurations among tightly bonded atomic clusters, which constitute the weakest link in an amorphous structure. This aspect of inhomogeneous deformation, also revealed by our in situ neutron diffraction studies of an elastically deformed BMG, suggests a rubberlike viscoelastic behavior due to a hierarchy of atomic bonds in BMGs.

PARASURG hybrid parallel robot for minimally invasive surgery.

This paper presents the parallel hybrid robot, PARASURG 9M, for robotically assisted surgery, a robot which was entirely designed and produced in Romania. It is a versatile robot, being composed of a positioning and orientation module, PARASURG 5M with five degrees of freedom, having the possibility of attaching at its end either a laparoscope or an active surgical instrument for cutting/grasping, PARASIM, with four degrees of freedom. Based on its mathematical modelling, the first low-cost experimental model of the surgical robot has been built. The robot is part of the surgical robotic system, PARAMIS, with three arms, one used as a laparoscope holder, and other two for manipulating active instruments. When it is used as a manipulator of the camera, the user has the possibility to give commands in a large area for the positioning of the laparoscope using different interfaces: joystick, microphone, keyboard & mouse and haptic device. If the active surgical instrument, PARASIM, is attached, the robot commands are given through a haptic device. The main features that make the PARASURG 9M surgical robot suited for minimally invasive surgery are: precision, the elimination of the natural tremor of the surgeon, direct control over a smooth, precise, stable view of the internal surgical field for the surgeon. It also eliminates the need of a second surgeon to be present for the entire procedure (in the case of using the robot as a camera holder). In addition, there is improvement of surgeon dexterity in the case of using the PARASIM active instrument and better ergonomics in using the robot (in the case of the classic laparoscopy, the surgeon must adopt a difficult position for a long period of time, while the robot never gets tired). Having a relatively easy to understand, intuitive commanding system, the surgeons can rapidly adapt to the use of the PARASURG 9M robot in surgical procedures.

[Video-assisted thoracoscopic extended thymectomy (VATET) with cervical approach for myasthenia gravis--initial experience]. / Timectomia extinsa prin abord toracoscopic bilateral si timp cervical pentru miastenia gravis--experienta initiala.

Complete thymectomy plays an important role in the myasthenia gravis (MG) pacient's treatment. Many different surgical techniques have been developed to achieve thymectomy. Of these, thoracoscopic technique is the most recent. There still are many controversies about the most suitable approach for thymectomy. The paper presents in detail the video-assisted thoracoscopic extended thymectomy--VATET-technique, and initial results with this procedure. Prospective data was obtain according to the Myasthenia Gravis Foundation of America (MGFA) recommendations. From Mai 2007 to December 2009, 15 patients with MG underwent the VATET procedure with cervical access. There was no conversion to sternotomic approach. Mean operating time for complete VATET was 215 min (150-280 min), with the cervical procedure requiring 44 min (25-60 min). There was no mortality or intraoperative complications. It was a single case with a thoracoscopic second look for hemothorax from intercostals bleeding. At this time, due to the reduced number of cases, we can't evaluate the therapeutic effectiveness of the VATET. We consider VATET as a valuable surgical option to treat myasthenic patients, with an optimal report between radicality and invasiveness.

Deformation crossover: from nano- to mesoscale.

In situ synchrotron and neutron diffraction were used to study deformation mechanisms in Ni over a broad range of grain sizes. The experimental data show that unlike in coarse-grained metals, where the deformation is dominated by dislocation slip, plastic deformation in nanocrystalline Ni is mediated by grain-boundary activities, as evidenced by the lack of intergranular strain and texture development. For ultrafine-grained Ni, although dislocation slip is an active deformation mechanism, deformation twinning also plays an important role, whose propensity increases with the grain size.

Power-law scaling and fractal nature of medium-range order in metallic glasses.

The atomic structure of metallic glasses has been a long-standing scientific problem. Unlike crystalline metals, where long-range ordering is established by periodic stacking of fundamental building blocks known as unit cells, a metallic glass has no long-range translational or orientational order, although some degrees of short- and medium-range order do exist. Previous studies have identified solute- (minority atom)-centred clusters as the fundamental building blocks or short-range order in metallic glasses. Idealized cluster packing schemes, such as efficient cluster packing on a cubic lattice and icosahedral packing as in a quasicrystal, have been proposed and provided first insights on the medium-range order in metallic glasses. However, these packing schemes break down beyond a length scale of a few clusters. Here, on the basis of neutron and X-ray diffraction experiments, we propose a new packing scheme-self-similar packing of atomic clusters. We show that the medium-range order has the characteristics of a fractal network with a dimension of 2.31, and is described by a power-law correlation function over the medium-range length scale. Our finding provides a new perspective of order in disordered materials and has broad implications for understanding their structure-property relationship, particularly those involving a change in length scales.

[Evolutive particularities of appendicular plastron in children]. / Particularitati evolutive ale blocului apendicular la copil.

This paper analyses the experience of the Paediatric Surgery Department from the Emergency Hospital in Craiova regarding the clinical and therapeutical evaluation of 55 cases with appendicular plastron admitted in our department between 1997-2006. We analyse both the evolution and the complications in managing these cases, together with particular aspects of differential diagnosis related to this group of age. These 55 cases were children aged between 2 and 15 years with a 15 days average hospitalization period. Applying a standard treatment we had favorable results in 85% of cases with 15% cases underwent surgical treatment from the first admission. Comparative to a study realised in our dept. between 1975-1996, which registered 30 cases with a mortality of 6.70%, the present one revealed in the latest years an important increase of the number of appendicular plastron with a significant low mortality.

[Visceral leishmaniasis--surgical aspects]. / Leishmanioza viscerala--aspecte chirurgicale.

Visceral Leishmaniasis is a multi-organic parasitic disease caused by an intracellular protozoon named Leishmania Donovani; the mean signs are: weight loss, cough, fever, hepatosplenomegaly, adenopathy and cutaneous lesions; death without treatment is the rule. The main treatment is a conservative one. Surgical treatment is necessary for complications, especially for those intra-abdominally. We wish to present a young female patient who underwent two subsequent interventions due to an unclear diagnosis. We emphasize the difficulties in achieving a certain diagnostic, because of the rarity of disease in Romania; there are also revealed surgical aspects, which are important because of very few available data in the literature.

[The gastroschisis: clinical and therapeutic considerations]. / Laparoschizisul: consideratii clinico-terapeutice.

Gastroschisis is a severe congenital malformation of the abdominal wall, with relative low incidence. The authors are analysing different therapeutic methods, in a group of 17 cases, hospitalised and operated in Department of Pediatric Surgery, Emergency Hospital of Craiova. They are underlining the importance of the ultrasound prenatal diagnosis of the malformation, close related to different therapeutic methods applied in this period of time and also are advising secondary closure of the abdominal wall, using a synthetic material (Silo-bag) for temporary coverage of the intestine developed outside the peritoneal cavity. This method helped with the decreasing of mortality in gastroschisis but with high costs of treatment.

[Update in diagnosis and treatment of esophageal atresia]. / Actualitfati în diagnosticul si tratamentul atreziei de esofag.

The paper present a number of 17 cases of esophageal atresia, hospitalised and operated in a period of 4 years (2001-2004). The authors are underlining the importance of the prenatal diagnosis, preoperative and postoperative care, the chance for primary anastomosis for type III A of the disease, complications and prognosis related to the type of atresia. Esophageal atresia is a success of a complex team where the role of the neonatologist and anesthesiologist, next to the surgeon, is very important.

[Ambulatory treatment of anal fissure]. / Tratamentul ambulatoriu al fisurii anale.

Not a long time ago, the standard treatment for anal fissure was surgical, inpatient care; this concept failed in the last years, ambulatory treatment becoming the rule and the inpatient care the exception. We wish to present here our results in 125 ambulatory patients, who were referred to our proctologic office with anal fissure. We used two methods: a conservative one, by applying topical 0.2% nitroglycerine, similar to other proctology practitioners, and one method of our own which is a minimal surgical procedure consisting of sphincterotomy. The average follow-up period was 6 months. Symptom-free and anatomic-free states were obtained in 61.2% for conservative treated patients and in 91.4% for operated patients, respectively. We had no postoperative complications, rebounds or sequelae. We consider the results at least equal in effectiveness to those of standard surgical treatment. This is why we underline that ambulatory treatment for anal fissure reaches the goal to be of a first line option.