Effect of target material on fast-electron transport and resistive collimation.

The effect of target material on fast-electron transport is investigated using a high-intensity (0.7 ps, 10(20) W/cm2) laser pulse irradiated on multilayered solid Al targets with embedded transport (Au, Mo, Al) and tracer (Cu) layers, backed with millimeter-thick carbon foils to minimize refluxing. We consistently observed a more collimated electron beam (36% average reduction in fast-electron induced Cu Kα spot size) using a high- or mid-Z (Au or Mo) layer compared to Al. All targets showed a similar electron flux level in the central spot of the beam. Two-dimensional collisional particle-in-cell simulations showed formation of strong self-generated resistive magnetic fields in targets with a high-Z transport layer that suppressed the fast-electron beam divergence; the consequent magnetic channels guided the fast electrons to a smaller spot, in good agreement with experiments. These findings indicate that fast-electron transport can be controlled by self-generated resistive magnetic fields and may have important implications to fast ignition.

Hot electron temperature and coupling efficiency scaling with prepulse for cone-guided fast ignition.

The effect of increasing prepulse energy levels on the energy spectrum and coupling into forward-going electrons is evaluated in a cone-guided fast-ignition relevant geometry using cone-wire targets irradiated with a high intensity (10(20) W/cm(2)) laser pulse. Hot electron temperature and flux are inferred from Kα images and yields using hybrid particle-in-cell simulations. A two-temperature distribution of hot electrons was required to fit the full profile, with the ratio of energy in a higher energy (MeV) component increasing with a larger prepulse. As prepulse energies were increased from 8 mJ to 1 J, overall coupling from laser to all hot electrons entering the wire was found to fall from 8.4% to 2.5% while coupling into only the 1-3 MeV electrons dropped from 0.57% to 0.03%.

Dynamics of relativistic laser-plasma interaction on solid targets.

A novel time-resolved diagnostic is used to record the critical surface motion during picosecond-scale relativistic laser interaction with a solid target. Single-shot measurements of the specular light show a redshift decreasing with time during the interaction, corresponding to a slowing-down of the hole boring process into overdense plasma. On-shot full characterization of the laser pulse enables simulations of the experiment without any free parameters. Two-dimensional particle-in-cell simulations yield redshifts that agree with the data, and support a simple explanation of the slowing-down of the critical surface based on momentum conservation between ions and reflected laser light.

Limitation on prepulse level for cone-guided fast-ignition inertial confinement fusion.

The viability of fast-ignition (FI) inertial confinement fusion hinges on the efficient transfer of laser energy to the compressed fuel via multi-MeV electrons. Preformed plasma due to the laser prepulse strongly influences ultraintense laser plasma interactions and hot electron generation in the hollow cone of an FI target. We induced a prepulse and consequent preplasma in copper cone targets and measured the energy deposition zone of the main pulse by imaging the emitted K_{alpha} radiation. Simulation of the radiation hydrodynamics of the preplasma and particle in cell modeling of the main pulse interaction agree well with the measured deposition zones and provide an insight into the energy deposition mechanism and electron distribution. It was demonstrated that a under these conditions a 100 mJ prepulse eliminates the forward going component of approximately 2-4 MeV electrons.

Plasma devices to guide and collimate a high density of MeV electrons.

The development of ultra-intense lasers has facilitated new studies in laboratory astrophysics and high-density nuclear science, including laser fusion. Such research relies on the efficient generation of enormous numbers of high-energy charged particles. For example, laser-matter interactions at petawatt (10(15) W) power levels can create pulses of MeV electrons with current densities as large as 10(12) A cm(-2). However, the divergence of these particle beams usually reduces the current density to a few times 10(6) A cm(-2) at distances of the order of centimetres from the source. The invention of devices that can direct such intense, pulsed energetic beams will revolutionize their applications. Here we report high-conductivity devices consisting of transient plasmas that increase the energy density of MeV electrons generated in laser-matter interactions by more than one order of magnitude. A plasma fibre created on a hollow-cone target guides and collimates electrons in a manner akin to the control of light by an optical fibre and collimator. Such plasma devices hold promise for applications using high energy-density particles and should trigger growth in charged particle optics.

Focussing Protons from a Kilojoule Laser for Intense Beam Heating using Proximal Target Structures.

Proton beams driven by chirped pulse amplified lasers have multi-picosecond duration and can isochorically and volumetrically heat material samples, potentially providing an approach for creating samples of warm dense matter with conditions not present on Earth. Envisioned on a larger scale, they could heat fusion fuel to achieve ignition. We have shown in an experiment that a kilojoule-class, multi-picosecond short pulse laser is particularly effective for heating materials. The proton beam can be focussed via target design to achieve exceptionally high flux, important for the applications mentioned. The laser irradiated spherically curved diamond-like-carbon targets with intensity 4 × 1018 W/cm2, producing proton beams with 3 MeV slope temperature. A Cu witness foil was positioned behind the curved target, and the gap between was either empty or spanned with a structure. With a structured target, the total emission of Cu Kα fluorescence was increased 18 fold and the emission profile was consistent with a tightly focussed beam. Transverse proton radiography probed the target with ps order temporal and 10 µm spatial resolution, revealing the fast-acting focussing electric field. Complementary particle-in-cell simulations show how the structures funnel protons to the tight focus. The beam of protons and neutralizing electrons induce the bright Kα emission observed and heat the Cu to 100 eV.

Conservative management resulting in complete resolution of a double intussusception in an adult haemophiliac.

Acute abdominal pain in haemophiliacs should be approached as haemorrhage until proven otherwise. With advancements in factor repletion and coagulopathic management a conservative approach should be considered. We describe a case of double colo-colonic intussusception lead by an intramural haematoma occurring spontaneously and resolving with conservative management in a young haemophiliac. This demonstrates that intussusception in these cases may be transient, and does not require surgical intervention.

Anomalous material-dependent transport of focused, laser-driven proton beams.

Intense lasers can accelerate protons in sufficient numbers and energy that the resulting beam can heat materials to exotic warm (10 s of eV temperature) states. Here we show with experimental data that a laser-driven proton beam focused onto a target heated it in a localized spot with size strongly dependent upon material and as small as 35 µm radius. Simulations indicate that cold stopping power values cannot model the intense proton beam transport in solid targets well enough to match the large differences observed. In the experiment a 74 J, 670 fs laser drove a focusing proton beam that transported through different thicknesses of solid Mylar, Al, Cu or Au, eventually heating a rear, thin, Au witness layer. The XUV emission seen from the rear of the Au indicated a clear dependence of proton beam transport upon atomic number, Z, of the transport layer: a larger and brighter emission spot was measured after proton transport through the lower Z foils even with equal mass density for supposed equivalent proton stopping range. Beam transport dynamics pertaining to the observed heated spot were investigated numerically with a particle-in-cell (PIC) code. In simulations protons moving through an Al transport layer result in higher Au temperature responsible for higher Au radiant emittance compared to a Cu transport case. The inferred finding that proton stopping varies with temperature in different materials, considerably changing the beam heating profile, can guide applications seeking to controllably heat targets with intense proton beams.

Calibration and characterization of a highly efficient spectrometer in von Hamos geometry for 7-10 keV x-rays.

We have built an absolutely calibrated, highly efficient, Bragg crystal spectrometer in von Hamos geometry. This zinc von Hamos spectrometer uses a crystal made from highly oriented pyrolytic graphite that is cylindrically bent along the non-dispersive axis. It is tuned to measure x-ray spectra in the 7-10 keV range and has been designed to be used on a Ten Inch Manipulator for the Omega and OmegaEP target chambers at the Laboratory for Laser Energetics in Rochester, USA. Significant shielding strategies and fluorescence mitigation have been implemented in addition to an imaging plate detector making it well suited for experiments in high-intensity environments. Here we present the design and absolute calibration as well as mosaicity and integrated reflectivity measurements.

Pathological and molecular predictors of the response of rectal cancer to neoadjuvant radiochemotherapy.

AIMS: The prediction of sensitivity and resistance to neoadjuvant therapy has great potential value for many tumour sites. A neoadjuvant regimen is increasingly the gold standard in rectal cancer management and the aim of this review was to highlight predictive markers currently assessed and evaluate their clinical utility. METHODS: A systematic search of Medline was conducted using the following keywords 'colorectal', 'neoadjuvant', 'molecular', 'predict' and 'radiotherapy'. Original manuscripts from all relevant listings were sourced. These were hand searched for further articles of relevance. RESULTS: Conventional indices including tumour stage and grade were unable to predict histological response. Immunohistochemical assessment of P53 gene, Bcl 2, Bax and microsatellite instability are of no predictive value. Studies utilising molecular response predictors from archival pre-treatment tumour tissues have identified several promising predictive markers including p21, spontaneous apoptosis and direct sequencing of the p53 gene. Global gene expression from fresh pre-treatment tissue using cDNA microarray has only recently been assessed but identified expression differences between 54 genes and was able to predict response with 78% sensitivity and 86% specificity. CONCLUSIONS: Currently there are no clinically useful predictors of response based on standard pathological assessment and immunocytochemistry. Direct gene sequencing of p53, studies of apoptosis and global gene sequencing may hold promise.

Ingrowing toenails: improving treatment.

Sixty-six patients with ingrowing toenails were randomly assigned to one of two treatment groups and followed up for 16 to 30 months after surgery. In group A 39 nail edges in 32 patients were treated by excision of the nail edge and chemical ablation of germinal matrix edge with 70% aqueous phenol. There were 34 patients in group B, in whom 46 nail edges and germinal matrix edges were surgically excised. In group A recurring symptoms developed in four (10%) nail edges, necessitating further surgery, and asymptomatic spicules developed in seven (18%) nail edges. Two (4%) nails in group B required reoperation and spicules developed in 10 (22%). Both procedures were performed as outpatient surgery, relieved pain and infection, and were acceptable to patients. At an average 2-year follow-up, both procedures yielded comparable results that were superior to those of simple avulsion.

A prospective randomized trial of laparoscopic versus open appendectomy.

BACKGROUND: Laparoscopic appendectomy is feasible, but whether it confers any advantage to patients with acute appendicitis is not known. We performed a randomized controlled trial to compare results of laparoscopic and open appendectomy in patients with signs and symptoms suggesting acute appendicitis who were seen by one surgical team. METHODS: Sixty-two consecutive patients were randomized, 30 to laparoscopy and 32 to a classical open appendectomy. Postoperative recovery, complications, and return to normal activities were compared in the two groups. RESULTS: The laparoscopy group were discharged earlier (2.5 vs 3.8 days, p less than 0.01). Postoperative complications were more frequent after open appendectomy. Follow-up showed less pain, shorter bed stay at home, and faster return to work and sport after laparoscopic appendectomy. CONCLUSIONS: This prospective randomized study shows that laparoscopic appendectomy is superior to open appendectomy in terms of hospital stay, postoperative complications, and return to normal activities and is recommended as the approach of choice in the management of acute appendicitis.

Effect of a betadine connection shield on central venous catheter sepsis.

The effect on the rate of central venous catheter sepsis of incorporating the catheter hub in a povidone-iodine (Betadine) connection shield was evaluated in a randomized controlled clinical trial involving 47 Silastic catheters inserted in 35 patients solely for the administration of parenteral nutrition. All catheters were tunneled subcutaneously and once inserted were randomized to one of two subsequent management groups. Group 1 (n = 25) were managed in a standard fashion whereas Group 2 catheters (n = 22) in addition were managed by incorporating the catheter hub in a Betadine connection shield (Connection Shield 3; Travenol/Baxter). The catheter lifespans in the two groups were similar (Group 1 mean 10.8 days; range 3-28: Group 2 mean 13.3 days: range 5-31). There was a significant difference in the rates of both clinical sepsis (Group 1, 8 cases; 32%; Group 2, 1 case; 4.5%; p less than 0.05) and bacteriologic sepsis (Group 1, 6 cases; 24%; Group 2, 0 cases; p less than 0.05) in the two groups. Incorporating the catheter hub in a Betadine connection shield confers significant benefit in terms of reducing the incidence of catheter sepsis in patients receiving total parenteral nutrition.

Experimental measurements of deep directional columnar heating by laser-generated relativistic electrons at near-solid density.

In our experiments, we irradiated solid CH targets with a 400 J, 5 ps, 3 x 10(19) W/cm(2) laser, and we used x-ray imaging and spectroscopic diagnostics to monitor the keV x-ray emission from thin Al or Au tracer layers buried within the targets. The experiments were designed to quantify the spatial distribution of the thermal electron temperature and density as a function of buried layer depth; these data provide insights into the behavior of relativistic electron currents which flow within the solid target and are directly and indirectly responsible for the heating. We measured approximately 200-350 eV temperatures and near-solid densities at depths ranging from 5 to 100 microm beneath the target surface. Time-resolved x-ray spectra from Al tracers indicate that the tracers emit thermal x rays and cool slowly compared to the time scale of the laser pulse. Most intriguingly, we consistently observe annular x-ray images in all buried tracer-layer experiments, and these data show that the temperature distribution is columnar, with enhanced heating along the edges of the column. The ring diameters are much greater than the laser focal spot diameter and do not vary significantly with the depth of the tracer layer for depths greater than 30 microm. The local temperatures are 200-350 eV for all tracer depths. We discuss recent simulations of the evolution of electron currents deep within solid targets irradiated by ultra-high-intensity lasers, and we discuss how modeling and analytical results suggest that the annular patterns we observe may be related to locally strong growth of the Weibel instability. We also suggest avenues for future research in order to further illuminate the complex physics of relativistic electron transport and energy deposition inside ultra-high-intensity laser-irradiated solid targets.

Ion acceleration from the shock front induced by hole boring in ultraintense laser-plasma interactions.

Ion-acceleration processes have been studied in ultraintense laser plasma interactions for normal incidence irradiation of solid deuterated targets via neutron spectroscopy. The experimental neutron spectra strongly suggest that the ions are preferentially accelerated radially, rather than into the bulk of the material from three-dimensional Monte Carlo fitting of the neutron spectra. Although the laser system has a 10(-7) contrast ratio, a two-dimensional magnetic hydrodynamics simulation shows that the laser pedestal generates a 10 mum scale length in the coronal plasma with a 3 mum scale-length plasma near the critical density. Two-dimensional particle-in-cell simulations, incorporating this realistic density profile, indicate that the acceleration of the ions is caused by a collisionless shock formation. This has implications for modeling energy transport in solid density plasmas as well as cone-focused fast ignition using the next generation PW lasers currently under construction.

K(alpha) fluorescence measurement of relativistic electron transport in the context of fast ignition.

Electron transport within solid targets, irradiated by a high-intensity short-pulse laser, has been measured by imaging K(alpha) radiation from high- Z layers (Cu, Ti) buried in low- Z (CH, Al) foils. Although the laser spot is approximately 10 microm [full width at half maximum (FWHM)], the electron beam spreads to > or =70 microm FWHM within <20 microm of penetration into an Al target then, at depths >100 microm, diverges with a 40 degree spreading angle. Monte Carlo and analytic models are compared to our data. We find that a Monte Carlo model with a heuristic model for the electron injection gives a reasonable fit with our data.

Review of 210 autogenous vein by-pass operations.

This is a retrospective review, using the life table method, of 210 vein by-pass operations. Sixtythree percent of the operations were performed for limb salvage. Eightyeight percent of the operations were performed with the distal anastomosis below the knee joint. The longerm patency rates for those grafts with good run-off was significantly better (p = .036) than for those with poor run-off and the addition of a lumbar sympathectomy was found not to significantly alter the longterm patency rates. Re-operation for graft failure in the first 448 hours after operation was found to be worthwhile procedure giving a cumulative patency rate of 59.9% at five years. A five year cumulative patency rate of 57% is reported and autogenous vein bypass is considered a worthwhile procedure for limb salvage and some selected claudicants with femoro-popliteal arterial disease.

A prospective comparison of laparoscopic versus open cholecystectomy.

In one surgical unit, 115 patients undergoing cholecystectomy were studied to compare patient recovery, subjective and objective pain experienced and complications after laparoscopic and open cholecystectomy. The data were collected prospectively where allocation to open or laparoscopic cholecystectomy was by consecutive attendance. Laparoscopic cholecystectomy was feasible in 90% of patients presenting with symptomatic gallstones. Compared with the open operation, laparoscopic cholecystectomy was safe with less peroperative and postoperative morbidity, was more cost-effective and was associated with faster patient recovery as documented by less postoperative pain, earlier return to diet, earlier full mobilisation and discharge home. Laparoscopic cholecystectomy is superior to open cholecystectomy and should be available to all patients requiring elective cholecystectomy.

Diagnosis of significant abdominal trauma after road traffic accidents: preliminary results of a multicentre clinical trial comparing minilaparoscopy with peritoneal lavage.

A prospective multicentre study comparing the value of the recently introduced minilaparoscopy with peritoneal lavage in patients with abdominal trauma is in progress. To date 55 patients with blunt abdominal trauma have been entered into the study. Following initial resuscitation, 26 were randomised to peritoneal lavage and 29 to minilaparoscopy performed under intravenous sedation and local anaesthesia. The two groups were comparable with respect to age, sex, incidence of multiple injuries and mortality (2 patients in the lavage group and 1 in the minilaparoscopy group). A negative test was obtained in 15 patients subjected to lavage and 12 patients who underwent minilaparoscopy. A further four patients in the minilaparoscopy group were found to have a minimal static haemoperitoneum. All these patients were treated conservatively and none required surgical intervention on the abdomen. Thus neither investigation carried a false negative rate. A positive test was obtained in 11 patients in the lavage group and significant findings were observed in 13 patients assessed by minilaparoscopy. All these patients were subjected to emergency laparotomy. Absence of significant bleeding or trauma was observed at laparotomy in 3/11 (27%) and 1/13 (8%) in the lavage and minilaparoscopy groups respectively. Although both procedures were highly sensitive for the detection of significant intra-abdominal injury (100%), the specificity was 83% for peritoneal lavage and 94% for minilaparoscopy. The predictive value of a positive minilaparoscopic examination was 92% as opposed to a positive predictive value of 72% for peritoneal lavage.

Laparoscopy appendicectomy is feasible and safe in acute appendicitis.

Our initial experience of using laparoscopy to perform appendicectomy for appendicitis has shown that the operation is feasible, safe and as effective as open surgery in early appendicitis. The precise role of laparoscopic appendicectomy will need to be defined by a prospective randomised trial.