Multi-channel Doppler backscattering measurements in the C-2 field reversed configuration

A versatile heterodyne Doppler Backscattering (DBS) system is used to measure density fluctuation levels (in the wavenumber range kρs ≤ 50), and the toroidal E × B flow velocity in the C-2 Field-Reversed Configuration (FRC). Six tunable frequencies in three waveguide bands (26 GHz ≤ f ≤ 90 GHz) are launched using monostatic beam optics, via a quasi-optical beam combiner/polarizer and an adjustable parabolic focusing mirror (inside the vacuum enclosure) achieving Gaussian beam spot sizes of 3-5.5 cm at the X/O-mode cutoff. The DBS system covers plasma densities of 0.8 × 10(13) ≤ ne ≤ 1 × 10(14) cm(-3), and provides access to the FRC core (up to the field null) and across the FRC separatrix into the scrape-off layer plasma.

Two waves of colonization straddling the K-Pg boundary formed the modern reef fish fauna

Living reef fishes are one of the most diverse vertebrate assemblages on Earth. Despite its prominence and ecological importance, the origins and assembly of the reef fish fauna is poorly described. A patchy fossil record suggests that the major colonization of reef habitats must have occurred in the Late Cretaceous and early Palaeogene, with the earliest known modern fossil coral reef fish assemblage dated to 50 Ma. Using a phylogenetic approach, we analysed the early evolutionary dynamics of modern reef fishes. We find that reef lineages successively colonized reef habitats throughout the Late Cretaceous and early Palaeogene. Two waves of invasion were accompanied by increasing morphological convergence: one in the Late Cretaceous from 90 to 72 Ma and the other immediately following the end-Cretaceous mass extinction. The surge in reef invasions after the Cretaceous–Palaeogene boundary continued for 10 Myr, after which the pace of transitions to reef habitats slowed. Combined, these patterns match a classic niche-filling scenario: early transitions to reefs were made rapidly by morphologically distinct lineages and were followed by a decrease in the rate of invasions and eventual saturation of morphospace. Major alterations in reef composition, distribution and abundance, along with shifts in climate and oceanic currents, occurred during the Late Cretaceous and early Palaeogene interval. A causal mechanism between these changes and concurrent episodes of reef invasion remains obscure, but what is clear is that the broad framework of the modern reef fish fauna was in place within 10 Myr of the end-Cretaceous extinction.

Allometry indicates giant eyes of giant squid are not exceptional

Background

The eyes of giant and colossal squid are among the largest eyes in the history of life. It was recently proposed that sperm whale predation is the main driver of eye size evolution in giant squid, on the basis of an optical model that suggested optimal performance in detecting large luminous visual targets such as whales in the deep sea. However, it is poorly understood how the eye size of giant and colossal squid compares to that of other aquatic organisms when scaling effects are considered.

Results

We performed a large-scale comparative study that included 87 squid species and 237 species of acanthomorph fish. While squid have larger eyes than most acanthomorphs, a comparison of relative eye size among squid suggests that giant and colossal squid do not have unusually large eyes. After revising constants used in a previous model we found that large eyes perform equally well in detecting point targets and large luminous targets in the deep sea.

Conclusions

The eyes of giant and colossal squid do not appear exceptionally large when allometric effects are considered. It is probable that the giant eyes of giant squid result from a phylogenetically conserved developmental pattern manifested in very large animals. Whatever the cause of large eyes, they appear to have several advantages for vision in the reduced light of the deep mesopelagic zone.

Observation of a critical gradient threshold for electron temperature fluctuations in the DIII-D Tokamak

A critical gradient threshold has been observed for the first time in a systematic, controlled experiment for a locally measured turbulent quantity in the core of a confined high-temperature plasma. In an experiment in the DIII-D tokamak where L(T(e))(-1) = |∇T(e)|/T(e) and toroidal rotation were varied, long wavelength (k(θ)ρ(s) ≲ 0.4) electron temperature fluctuations exhibit a threshold in L(T(e))(-1): below, they change little; above, they steadily increase. The increase in δT(e)/T(e) is concurrent with increased electron heat flux and transport stiffness. Observations were insensitive to rotation. Accumulated evidence strongly enforces the identification of the experimentally observed threshold with ∇T(e)-driven trapped electron mode turbulence.

Potential enhanced ability of giant squid to detect sperm whales is an exaptation tied to their large body size

It has been hypothesized that sperm whale predation is the driver of eye size evolution in giant squid. Given that the eyes of giant squid have the size expected for a squid this big, it is likely that any enhanced ability of giant squid to detect whales is an exaptation tied to their body size. Future studies should target the mechanism behind the evolution of large body size, not eye size. Reconstructions of the evolutionary history of selective regime, eye size, optical performance, and body size will improve the understanding of the evolution of large eyes in large ocean animals.

Evidence for repeated loss of selective constraint in rhodopsin of amblyopsid cavefishes (Teleostei: Amblyopsidae)

The genetic mechanisms underlying regressive evolution-the degeneration or loss of a derived trait--are largely unknown, particularly for complex structures such as eyes in cave organisms. In several eyeless animals, the visual photoreceptor rhodopsin appears to have retained functional amino acid sequences. Hypotheses to explain apparent maintenance of function include weak selection for retention of light-sensing abilities and its pleiotropic roles in circadian rhythms and thermotaxis. In contrast, we show that there has been repeated loss of functional constraint of rhodopsin in amblyopsid cavefishes, as at least three cave lineages have independently accumulated unique loss-of-function mutations over the last 10.3 Mya. Although several cave lineages still possess functional rhodopsin, they exhibit increased rates of nonsynonymous mutations that have greater effect on the structure and function of rhodopsin compared to those in surface lineages. These results indicate that functionality of rhodopsin has been repeatedly lost in amblyopsid cavefishes. The presence of a functional copy of rhodopsin in some cave lineages is likely explained by stochastic accumulation of mutations following recent subterranean colonization.

2D full wave modeling for a synthetic Doppler backscattering diagnostic

Doppler backscattering (DBS) is a plasma diagnostic used in tokamaks and other magnetic confinement devices to measure the fluctuation level of intermediate wavenumber (k(θ)ρ(s) ~ 1) density fluctuations and the lab frame propagation velocity of turbulence. Here, a synthetic DBS diagnostic is described, which has been used for comparisons between measurements in the DIII-D tokamak and predictions from nonlinear gyrokinetic simulations. To estimate the wavenumber range to which a Gaussian beam would be sensitive, a ray tracing code and a 2D finite difference, time domain full wave code are used. Experimental density profiles and magnetic geometry are used along with the experimental antenna and beam characteristics. An example of the effect of the synthetic diagnostic on the output of a nonlinear gyrokinetic simulation is presented.

Field reversed configuration confinement enhancement through edge biasing and neutral beam injection

Field reversed configurations (FRCs) with high confinement are obtained in the C-2 device by combining plasma gun edge biasing and neutral beam injection. The plasma gun creates an inward radial electric field that counters the usual FRC spin-up. The n = 2 rotational instability is stabilized without applying quadrupole magnetic fields. The FRCs are nearly axisymmetric, which enables fast ion confinement. The plasma gun also produces E × B shear in the FRC edge layer, which may explain the observed improved particle transport. The FRC confinement times are improved by factors 2 to 4, and the plasma lifetimes are extended from 1 to up to 4 ms.

Role of zonal flow predator-prey oscillations in triggering the transition to H-mode confinement

Direct evidence of zonal flow (ZF) predator-prey oscillations and the synergistic roles of ZF- and equilibrium E×B flow shear in triggering the low- to high-confinement (L- to H-mode) transition in the DIII-D tokamak is presented. Periodic turbulence suppression is first observed in a narrow layer at and just inside the separatrix when the shearing rate transiently exceeds the turbulence decorrelation rate. The final transition to H mode with sustained turbulence and transport reduction is controlled by equilibrium E×B shear due to the increasing ion pressure gradient.

Nocturnality constrains morphological and functional diversity in the eyes of reef fishes

Background

Ambient light levels are often considered to drive the evolution of eye form and function. Diel activity pattern is the main mechanism controlling the visual environment of teleost reef fish, with day-active (diurnal) fish active in well-illuminated conditions, whereas night-active (nocturnal) fish cope with dim light. Physiological optics predicts several specific evolutionary responses to dim-light vision that should be reflected in visual performance features of the eye.

Results

We analyzed a large comparative dataset on morphological traits of the eyes in 265 species of teleost reef fish in 43 different families. The eye morphology of nocturnal reef teleosts is characterized by a syndrome that indicates better light sensitivity, including large relative eye size, high optical ratio and large, rounded pupils. Improved dim-light image formation comes at the cost of reduced depth of focus and reduction of potential accommodative lens movement. Diurnal teleost reef fish, released from the stringent functional requirements of dim-light vision have much higher morphological and optical diversity than nocturnal species, with large ranges of optical ratio, depth of focus, and lens accommodation.

Conclusions

Physical characteristics of the environment are an important factor in the evolution and diversification of the vertebrate eye. Both teleost reef fish and terrestrial amniotes meet the functional requirements of dim-light vision with a similar evolutionary response of morphological and optical modifications. The trade-off between improved dim-light vision and reduced optical diversity may be a key factor in explaining the lower trophic diversity of nocturnal reef teleosts.

New plasma measurements with a multichannel millimeter-wave fluctuation diagnostic system in the DIII-D tokamak (invited)

A novel multichannel, tunable Doppler backscattering (DBS)/reflectometry system has recently been developed and applied to a variety of DIII-D plasmas. Either DBS or reflectometry can be easily configured for use in a wide range of plasma conditions using a flexible quasi-optical antenna system. The multiple closely spaced channels, when combined with other fluctuation diagnostic systems, have opened up new measurements of plasma properties. For example, the toroidal and fine-scale radial structure of coherent plasma oscillations, such as geodesic acoustic modes, have been probed simultaneously in the core of high temperature plasmas by applying correlation analysis between two toroidally separated DBS systems, as well as within the multichannel array. When configured as a reflectometer, cross-correlation with electron cyclotron emission radiometry has uncovered detailed information regarding the crossphase relationship between density and temperature fluctuations. The density-temperature crossphase measurement yields insight into the physics of tokamak turbulence at a fundamental level that can be directly compared with predictions from nonlinear gyrokinetic simulations.

Quasioptical design of integrated Doppler backscattering and correlation electron cyclotron emission systems on the DIII-D tokamak

The quasioptical design of a new integrated Doppler backscattering (DBS) and correlation electron cyclotron emission (CECE) system is presented. The design provides for simultaneous measurements of intermediate wavenumber density and long wavelength electron temperature turbulence behavior. The Doppler backscattering technique is sensitive to plasma turbulence flow and has been utilized to determine radial electric field, geodesic acoustic modes, zonal flows, and intermediate scale (k∼1-6 cm(-1)) density turbulence. The correlation ECE system measures a second turbulent field, electron temperature fluctuations, and is sensitive to long poloidal wavelength (k≤1.8 cm(-1)). The integrated system utilizes a newly installed in-vessel focusing mirror that produces a beam waist diameter of 3.5-5 cm in the plasma depending on the frequency. A single antenna (i.e., monostatic operation) is used for both launch and receive. The DBS wavenumber is selected via an adjustable launch angle and variable probing frequency. Due to the unique system design both positive and negative wavenumbers can be obtained, with a range of low to intermediate wavenumbers possible (approximately -3 to 10 cm(-1)). A unique feature of the design is the ability to place the DBS and CECE measurements at the same radial and poloidal locations allowing for cross correlation studies (e.g., measurement of nT cross-phase).

Dynamic formation of a hot field reversed configuration with improved confinement by supersonic merging of two colliding high-β compact toroids

A hot stable field-reversed configuration (FRC) has been produced in the C-2 experiment by colliding and merging two high-β plasmoids preformed by the dynamic version of field-reversed θ-pinch technology. The merging process exhibits the highest poloidal flux amplification obtained in a magnetic confinement system (over tenfold increase). Most of the kinetic energy is converted into thermal energy with total temperature (T{i}+T{e}) exceeding 0.5 keV. The final FRC state exhibits a record FRC lifetime with flux confinement approaching classical values. These findings should have significant implications for fusion research and the physics of magnetic reconnection.

A multichannel, frequency-modulated, tunable Doppler backscattering and reflectometry system

A novel multichannel Doppler backscattering system has been designed and tested for application on the DIII-D [J. L. Luxon, Fusion Sci. Technol. 48, 828 (2005)] and National Spherical Torus Experiment (NSTX) [M. Ono et al., Nucl. Fusion 40, 557 (2000)] fusion plasma devices. Doppler backscattering measures localized intermediate wavenumber (k(perpendicular)rho(i) approximately 1-4,k(perpendicular) approximately 2-15 cm(-1)) density fluctuations and the propagation velocity of turbulent structures. Microwave radiation is launched at a frequency that approaches a cutoff layer in the plasma and at an angle that is oblique to the cutoff layer. Bragg backscattering occurs near the cutoff layer for fluctuations with k(perpendicular) approximately -2k(i), where k(i) is the incident probe wave vector at the scattering location. The turbulence propagation velocity can be determined from the Doppler shift in the return signal together with knowledge of the scattering wavenumber. Ray tracing simulations are used to determine k(perpendicular) and the scattering location. Frequency modulation of a voltage-controlled solid state microwave source followed by frequency multiplication is used to create an array of finely spaced (Delta f=350 MHz) frequencies spanning 1.4 GHz. The center of the array bandwidth is tunable within the range of approximately 53-78 GHz. This article details the system design, laboratory tests, and presents initial data from DIII-D plasmas.

[Intrauterine treatment of incomplete fetal heart block in a mother with Sjögren syndrome]

BACKGROUND

Isolated fetal heart block is considered as an immunological disorder in the majority of cases. Mothers of affected fetuses often suffer from connective tissue disease (Sjögren syndrome or Lupus erythematodes). All of them test positive for anti-SS-A (anti Ro) and/or anti-SS-B (anti La) antibodies. Once established, third-degree congenital heart block is permanent and often requires a pacemaker.

CASE

We report on a pregnancy in a mother with Sjögren syndrome which was complicated by the development of incomplete fetal heart block, diagnosed by pulsed wave Doppler echocardiography. We started oral dexamethasone treatment to reduce immune-mediated fetal cardiac damage and to prevent complications like hydrops fetalis.

CONCLUSION

Detection of isolated fetal heart block is possible with pulsed Doppler sonography, but there are no clear recommendations for treatment.

A correlation electron cyclotron emission diagnostic and the importance of multifield fluctuation measurements for testing nonlinear gyrokinetic turbulence simulations

A correlation electron cyclotron emission (CECE) diagnostic has been used to measure local, turbulent fluctuations of the electron temperature in the core of DIII-D plasmas. This paper describes the hardware and testing of the CECE diagnostic and highlights the importance of measurements of multifield fluctuation profiles for the testing and validation of nonlinear gyrokinetic codes. The process of testing and validating such codes is critical for extrapolation to next-step fusion devices. For the first time, the radial profiles of electron temperature and density fluctuations are compared to nonlinear gyrokinetic simulations. The CECE diagnostic at DIII-D uses correlation radiometry to measure the rms amplitude and spectrum of the electron temperature fluctuations. Gaussian optics are used to produce a poloidal spot size with w(o) approximately 1.75 cm in the plasma. The intermediate frequency filters and the natural linewidth of the EC emission determine the radial resolution of the CECE diagnostic, which can be less than 1 cm. Wavenumbers resolved by the CECE diagnostic are k(theta) < or = 1.8 cm(-1) and k(r) < or = 4 cm(-1), relevant for studies of long-wavelength turbulence associated with the trapped electron mode and the ion temperature gradient mode. In neutral beam heated L-mode plasmas, core electron temperature fluctuations in the region 0.5 < r/a < 0.9, increase with radius from approximately 0.5% to approximately 2%, similar to density fluctuations that are measured simultaneously with beam emission spectroscopy. After incorporating "synthetic diagnostics" to effectively filter the code output, the simulations reproduce the characteristics of the turbulence and transport at one radial location r/a = 0.5, but not at a second location, r/a = 0.75. These results illustrate that measurements of the profiles of multiple fluctuating fields can provide a significant constraint on the turbulence models employed by the code.

Detection of zonal flow spectra in DIII-D by a dual-channel Doppler backscattering system

Doppler backscattering (DBS) has been successfully used to measure the E x B flow velocity and local intermediate wavenumber density fluctuation levels in the DIII-D tokamak. Depending on the launch angle and the frequency of the probing beam, the signal backscattered from the plasma cut-off layer is sensitive to density fluctuations at a specific perpendicular wavenumber (1 < or = k(perpendicular rho(s)) < or = 4). Due to the localization and high time resolution for poloidal flow measurements, DBS is well suited to detect stationary and time-dependent shear flows [zonal flows (ZFs)]. We present a novel scheme to measure ZF spectra using a dual-channel DBS system capable of simultaneously probing two minor radii separated by a distance of 0.2 cm < Delta r < 3 cm. Frequency spectra of geodesic acoustic modes and low frequency ZFs (f or = 10 kHz) have been obtained for 0.6 < r/a < 0.95.

Observation of reduced electron-temperature fluctuations in the core of H-mode plasmas

Core electron-temperature fluctuations [0.5%< or =T[over ]_(e)/T_(e)< or =2%, k_(theta)rho_(s)< or =0.3 in neutral-beam-heated low confinement-mode (L-mode) plasmas] are observed to decrease by at least a factor of 4 in standard and quiescent high-confinement-mode (H-mode and QH-mode) regimes in the DIII-D tokamak (r/a=0.7). These fluctuations are attributed to ion temperature gradient (ITG) modes stabilized by rotational shear at the H-mode transition. The simultaneous reduction in electron heat diffusivity (chi_(e)(QH)/chi_(e)(L)<0.25) suggests that T[over ]_(e) fluctuations can contribute significantly to L-mode electron heat transport.

Prenatal Diagnosis of Isolated Foramen ovale Obstruction

Premature obstruction of the foramen ovale is a rare but serious clinical entity. Obstruction can be associated with right ventricular failure, fetal hydrops, tricuspid regurgitation, left heart obstructive defects and supraventricular tachycardia. In most cases, the diagnosis is made at the postmortem examination. The etiology is unknown. We discuss 2 prenatal cases with the sole diagnosis of ventricular asymmetry. The right ventricle was dilated and hypertrophic, and the foramen ovale ballooned into the left atrium without color Doppler detection of right-to-left flow. After delivery, the infants had no hydrops or symptoms of cardiac or respiratory distress. Echocardiography demonstrated a structurally normal heart with increased right ventricle dimensions until the 7th day of life. Delivery should be induced if possible in cases of foramen ovale obstruction with signs of cardiac decompensation.

Doppler flow parameters of left ventricular filling in infants: how long does it take for the maturation of the diastolic function in a normal left ventricle to occur?

OBJECTIVE

To study the impact of the maturational process of diastolic left ventricular function on trans-mitral Doppler flow parameters.

METHODS AND PARTICIPANTS

In a survey we examined pulsed-wave Doppler signals and diastolic time intervals from 238 healthy neonates and infants. Using multiple linear regression analysis, we evaluated the impact of physiological determinants on parameter expression.

RESULTS

Early-filling and atrial-filling peak velocities, early-filling acceleration and deceleration rates, and the atrial-filling time velocity integral reached a climax within 2 months after birth, while early-filling time velocity integral followed increasing throughout the study period. The isovolumic relaxation time was found to be significantly longer for neonates than for infants older than 2 months. The observed parameter movements could be attributed to changes of stroke volume and mitral valve area for early filling-time velocity integral (R2 = 0.93), and of heart rate, stroke volume, and mitral valve area for early filling peak velocity (R2 = 0.84), and atrial-filling time velocity integral (R2 = 0.65). Isovolumic relaxation time and atrial-filling peak velocity became heart rate dependent not before 3 months after birth.

CONCLUSIONS

The observed parameter changes are powerful indicators for the maturational process in diastolic function. This process is mainly completed by 3 months of age.

[Doppler echocardiographic investigation of left ventricular diastolic function in preterm infants with and without a patent ductus arteriosus]

We studied the influence of preload augmentation on Doppler-derived left ventricular diastolic function parameters in infants with a birth weight <1500 g. In 44 neonates with a closed duct and 29 neonates with an open ductus arteriosus a complete echocardiographic study including Doppler investigations of the mitral inflow signals and analysis of diastolic time intervals was performed. Neonates with an open duct had a lower median gestational age (27.1 vs. 29, P<0.01), a higher cardiac index (425 vs. 260 ml/min/kg, P<0.001), and a different M-mode left atrial to aortic diameter ratio (1.36 vs. 0.79, P<0.001), but birth weight, age at examination (6.6 vs. 7.9 days), and heart rate were similar compared to the neonates with a closed duct. Main differences in diastolic indexes existed in early and atrial filling integrals and peak velocities, early filling acceleration time, and isovolumic relaxation time. Most informative in neonates with an open ductus peak early filling velocity (41.2 vs. 30.4 cm, P<0.01) and peak atrial filling velocity (49.2 vs. 35.9, P<0.001) are higher, and isovolumic relaxation time is shorter (45 vs. 53 ms, P<0.001) than in closed duct peers. Isovolumic relaxation time is inversely correlated with the cardiac index (R = -0.78). These parameter changes can be interpreted as incipient left ventricular diastolic failure in extremely low birth weight infants in the presence of a preload challenge. The coincidence of higher peak velocities with a shortened isovolumic relaxation time is very likely a result of left atrial pressure elevation. Preload mismatch has to be considered in preterm infants with a persistent ductus arteriosus. The results of this study can be helpful to find the indication for PDA-closure and to adjust volume replacement therapy, and catecholamine medication to a level appropriate for the individual cardiac performance.

[Left ventricular diastolic function in pregnancy in patients with arterial hypertension. A prospective study with M-mode echocardiography and Doppler echocardiography]

INTRODUCTION

During pregnancy eminent cardiovascular changes occur. The aim of the following study was to investigate the course of hemodynamic parameters under increased volume load during pregnancy in women suffering from mild arterial hypertension.

METHODS

Altogether 47 women (age: 25 +/- 4 years) with mild arterial hypertension detected during pregnancy underwent echocardiography at the 9th, 24th and 33rd week of gestation. Furthermore echocardiography was performed postpartum at weeks 1 and 8. The control group comprised 45 healthy pregnant women. In all patients left ventricular muscle mass index and systolic shortening fraction were measured. The following Doppler echocardiographic parameters were ascertained: peak early diastolic and peak late diastolic flow, VE/VA ratio, acceleration time, deceleration time and isovolumetric relaxation time.

RESULTS

During pregnancy all patients had an increase of left ventricular muscle mass index and a decrease of fractional shortening. All patients developed a relevant diastolic dysfunction. While the control group developed signs of disturbed relaxation as reduction of peak early diastolic flow (0.89 +/- 0.07 versus 0.82 +/- 0.08 m/s*), VE/VA ratio and an increase of isovolumetric relaxation time (72 +/- 12 versus 123 +/- 7*) at the 33rd week of gestation (* p < 0.01), all pregnant women with mild arterial hypertension developed a diastolic dysfunction with signs of delayed relaxation already at the beginning of gestation. 26 pregnant women with arterial hypertension developed a restrictive diastolic filling pattern at 24 weeks of gestation. The other 21 pregnant women only showed restriction for a short time at the end of gestation. In healthy pregnant women, volume load results in a reversible physiologic left ventricular hypertrophia, a significant alteration of diastolic left ventricular function in terms of a disturbed relaxation pattern and a temporary decrease of systolic function. In comparison hypertensive pregnant women show a delayed relaxation at the beginning of pregnancy and 50% developed early signs of restrictive cardiomyopathy. These changes may predispose to critical complications during pregnancy.

Prenatal diagnosis of familial absent pulmonary valve syndrome: case report and review of the literature

We report on a case of absent pulmonary valve syndrome in a woman with a history of one healthy child and one child with tetralogy of Fallot with absent pulmonary valve. The diagnosis was missed at the first ultrasound examination performed at 13 + 5 weeks of gestation and correctly diagnosed at 21 + 5 weeks. Re-evaluation of the ultrasound examination recorded at 13 + 5 weeks exhibited severe insufficiency of the pulmonary valve at this time. However, neither dilatation of the right and left pulmonary arteries nor asymmetry of the ventricles were present at that time. The pregnancy was terminated at 22 + 1 weeks of gestation when autopsy confirmed the diagnosis of absent pulmonary valve syndrome. Karyotyping of the fetus after termination of pregnancy revealed normal chromosomes. Echocardiography of the parents and the healthy sibling revealed normal results.

[Sonographic course of systemic echinococcosis in a 10 year old girl (with cardiac, hepatic, renal and muscular involvement)]

PURPOSE

To present the predominantly ultrasonographic (initial and follow-up) imaging in a disease that is rare among the Central European paediatric population--and to evaluate the role of ultrasound for initial staging and follow-up under antihelmintic therapy.

METHOD

The imaging documents as well as the clinical record of a 10-year old Armenian girl with systemic hydatid disease (cystic echinococcosis) were analysed retrospectively.

RESULTS

By means of ultrasound, the complete initial systemic spread of the disease with at least 11 cysts within the liver, 1 cyst in the left kidney, 1 peri-/2 intracardiac cysts, and 1 cyst in the dorsal musculature was detected. Repeated sonographic examinations allowed the estimation of successful medical treatment by the following criteria: size reduction of all cysts with changing internal structures from an initially echo-free to an increasingly homogeneous echodense character; no developing new cysts. In addition, CT and MRI enabled a more complete demonstration of especially the intra- and pericardiac lesions (preoperatively) and the exclusion of further intracranial cysts.

CONCLUSION

In paediatric hydatid disease, ultrasonography yields important information not only with regard to the initial staging, but also to the antihelmintic therapeutic effects and thus helps to determine when to discontinue medical treatment.

Left ventricular diastolic function in infants, children, and adolescents. Reference values and analysis of morphologic and physiologic determinants of echocardiographic Doppler flow signals during growth and maturation

OBJECTIVES

The aim of this study was to set up reference values for Doppler flow-derived left ventricular filling parameters and to evaluate physiologic determinants of changes in signal expression related to maturation.

BACKGROUND

In left ventricular diastolic function studies, age-related modulations in signal expression are observed. Assuming degenerative myocardial changes to be absent during childhood and adolescence, the determinants of these modulations must be different from those suspected in adults.

METHODS

Pulsed wave Doppler signals from the mitral valve tip region were recorded in 329 healthy subjects aged 2 months to 39 years. Multiple linear regression was used to evaluate statistical relations between Doppler flow signals and stroke volume in the mitral valve area.

RESULTS

Increasing early filling time velocity integral throughout maturation caused a decrease in atrial filling fraction from 0.34+/-0.06 to 0.24+/-0.04 (p < 0.005). Peak flow velocities during atrial systole decreased from infancy to adolescence (66+/-15 to 41+/-10 cm/s). Main effects on signal modulation were caused by heart rate, stroke volume and mitral ring area with a linear model fit (R2) of 0.79 for early filling phase (E)-time velocity integral, 0.6 for atrial filling phase peak velocity 0.84 for total E duration and 0.73 for E deceleration time. Atrial filling phase-time velocity integral, albeit significantly dependent on heart rate, was stable throughout growth.

CONCLUSIONS

During infancy and childhood, the stroke volume crossing the mitral valve is a main modulator for early filling phase (E)-time velocity integral and diastolic time intervals during early filling, whereas atrial filling phase parameters are mainly dependent on heart rate. This results in a more pronounced atrial filling during infancy and childhood.

Genetic and immunological parameters governing in vivo susceptibility/resistance to retrovirally induced murine malignant histiocytosis

Malignant histiocytosis sarcoma virus (MHSV) arose as a recombinant of c-Harvey-ras murine sarcoma virus (Ha-MuSV) and Friend mink cell focus-forming virus (F-MCFV). It is a defective acute transforming retrovirus that, along with Friend murine leukemia helper virus (F-MuLV), induces malignant histiocytosis (MH) in susceptible adult mice. We have assessed the in vivo susceptibility to MHSV in inbred homozygous, F1 hybrid, congenic, and recombinant inbred (RI) mice. We have shown that: (1) in vivo resistance to MHSV is multigenic, regulated by MHC and non-MHC genes in a different fashion than with F-MCFV, F-MuLV, or Ha-MuSV; (2) using BXD RI mice, the resistance phenotype is linked with 95.8% probability to two linked loci, Pmv-9 and Iapls3-14, on chromosome 13 (homologous to the area of human chromosome 5 for which a chromosomal break point at position 5q35 is associated with human MH); and (3) CD4+ T cells are critical for MHSV resistance.

Nosology and pathology of Langerhans cell histiocytosis

The pathology of LCH is continuing to be defined and diagnostic features clarified as unprecedented research is done. Although the etiology of LCH remains unknown, new information on cytokines, viruses, immunologic dysfunction, cell surface antigen expression, and clonality in the disease are providing essential pieces of the puzzle.

X-chromosomal (p21) muscular dystrophy and left ventricular diastolic and systolic function

In order to screen for cardiac abnormalities, we prospectively studied 15 patients (age 8-25 years, mean 15.5 years) with Duchenne's (DMD) (n = 9) and Becker's (BMD) (n = 6) muscular dystrophy using the echocardiogram. Data were compared to a control group of 92 healthy individuals (age 7.9-25 years, mean 14.3 years). Left ventricular filling in diastole showed a different pattern when comparing echocardiographic Doppler results in patients and controls: Patients had lower peak velocity of early left ventricular diastolic filling (E-vmax)(P < 0.0001) and smaller time velocity integral of the E-wave (E-tvi)(P < 0.0001). In contrast, the atrial component (A-vmax, A-tvi) of diastolic filling in DMD/ BMD showed no significant difference to controls. The mean area of the mitral valve orifice was significantly larger in patients (P < 0.0001) without presence of mitral regurgitation. Systolic left ventricular function was significantly impaired in the DMD/BMD group; we found lower heart rate corrected fiber shortening velocity VCFc (P < 0.001) and higher peak systolic wall stress (P < 0.001) in DMD/BMD. In 8 of 15 patients, peak systolic wall stress was above 95th percentile of controls. In 6 of 15 patients, VCFc was lower than the 5th percentile of controls. Systolic and diastolic myocardial impairment was found even in young patients and at low stages of disability--equally among patients with DMD or BMD. Diastolic left ventricular impairment predominantly affected the early diastolic filling, but atrial compensation was poor. Peak systolic wall stress measurements were particularly useful in patients with CMP, reflecting the left ventricular afterload.

High-pass-filtered magnetocardiogram and cardiomyopathy in patients with type 1 diabetes mellitus

Prolonged and/or fractionated depolarization due to tissue degeneration of the ventricular myocardium is a feature of cardiomyopathy. Signal averaged electrocardiography uses high-pass filters of the Butterworth type to quantify, noninvasively, fractionated high-frequency components at the end of the QRS complex. In this study a finite impulse response high-pass filter of the 90th order (cutoff at 37 Hz) was applied to magnetocardiograms (MCGs) and high-resolution electrocardiograms (ECGs) order to quantify high-frequency components throughout the myocardial depolarization. Additionally, late-potential analysis on the signal-averaged ECG was performed. A prospective investigation was made of 23 cardiologically asymptomatic patients, 11 females and 12 males, with type I diabetes mellitus. Their mean age was 21.7 years (range, 13-34 years). The mean duration of diabetes was 14 years (range, 1-27 years). Data were compared with those of 22 control subjects (12 females, 10 males) of mean age, 23.2 years (range, 11-35 years). The ECGs and MCGs were simultaneously recorded and signal-averaged, digitally filtered, and quantified by a score obtained by multiplying the amplitude variation of the signal by the number of maximal/minimal in the QRS complex. Echocardiograms were used to calculate the left ventricular mass and to document the presence of cardiomyopathy. Scores were higher in the MCGs of with type I diabetes mellitus than in the control subjects (P < .001). High scores correlated with an increased left ventricular muscular mass index (P < .05) and duration of the diabetes (P < .05). The high-resolution ECG, processed analogously, showed similar results in relation to left ventricular mass (P = .06) and duration of diabetes (P = .07), respectively (nonsignificant). No late potentials were found. These findings suggest that using a linear-phase high-pass finite impulse response filter may be useful for the noninvasive identification of patients with cardiomyopathy who exhibit possible disturbances of intraventricular depolarization. Our findings also suggest that analysis using the total QRS complex, rather than the final part of the QRS complex only, may improve identification of patients at risk.

Effect of mechanical ventilation strategy on dissemination of intratracheally instilled Escherichia coli in dogs

OBJECTIVE

To test the effect of different mechanical ventilation strategies on dissemination of intratracheally instilled Escherichia coli in dogs and to determine the extent and distribution of lung damage.

DESIGN

Prospective, randomized study.

SETTING

Experimental animal laboratory.

SUBJECTS

Eighteen anesthetized and paralyzed dogs.

INTERVENTIONS

We studied the effect of three ventilatory strategies based on two variables: transpulmonary pressure and positive end-expiratory pressure (PEEP). Group 1 animals (n = 6) were ventilated with a PEEP of 3 cm H2O and a tidal volume of 15 mL/kg, which generated an end-inspiratory transpulmonary pressure of < or = 15 cm H2O. In group 2(n = 6), tidal volume was adjusted to generate a transpulmonary pressure of 35 cm H2O and PEEP was set to 3 cm H2O. In group 3(n = 6), tidal volume was also adjusted to yield a transpulmonary pressure of 35 cm H2O but PEEP was set to 10 cm H2O. In each group, we instilled approximately 10(8) colony-forming units of E. coli into the trachea of the dogs and ventilated them with the chosen tidal volume and PEEP for 6 hrs afterward.

MEASUREMENTS AND MAIN RESULTS

We measured the pressure-volume relationship (pressure-volume curve) of the respiratory system before and 6 hrs after bacterial instillation. We obtained blood cultures before and 0.5, 1,2,3,4,5, and 6 hrs after bacterial instillation. After 6 hrs, the lungs were removed for histologic (histologic score) and gravimetric (wet-to-dry weight ratio, WW/DW) analysis. During the experiment 0, 5, and 1 dogs developed positive blood cultures in groups 1, 2, and 3, respectively. The number of dogs that developed bacteremia in group 2 was significantly greater than in the other two groups (p < .05). In group 1, pressure-volume curves demonstrated a lower inflection point which was greater than the end-inspiratory transpulmonary pressure suggesting that low transpulmonary pressure/low PEEP strategy ventilated aerated regions without expanding atelectatic areas. In group 2, pressure-volume curves demonstrated both a lower inflection point and an upper deflection point which were spanned by the tidal volume, suggesting that high transpulmonary pressure/low PEEP strategy might have caused both overdistention and cyclic closure and reopening. In group 3, pressure-volume curves demonstrated only a upper deflection point which was less than the maximal alveolar tidal pressure. At the end of the experimental protocol, group 2 manifested the most lung injury as assessed by gravimetric and histologic indices of lung injury. WW/DW of group 2(13.1 +/- 1.0 (SD); p < .05) was greater than groups 1 and 3(7.5 +/- 1.2 and 8.6 +/- 1.0, respectively). Similarly, the overall weighted histologic injury score for group 2 (1.19 +/- 0.26; p < .02) was greater than for groups 1 and 3 (0.82 +/- 0.20 and 0.88 +/- 0.22, respectively). For groups 2 and 3, the overall weighted histologic injury scores of the dependent regions were greater than the nondependent regions (p < .004).

CONCLUSIONS

We conclude that the ventilatory strategy most likely to overdistend the lungs while allowing repetitive opening and closure of alveoli (group 2) facilitated bacterial translocation from the alveoli to the bloodstream and increased lung injury, as determined by histologic and gravimetric analysis. PEEP ameliorated these effects, despite lung overdistention, but increased histologic and gravimetric indices of lung injury in dependent as compared with the nondependent regions.