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

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

Role of lymph node dissection for intrahepatic cholangiocarcinoma

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Background: The prognosis of intrahepatic cholangiocarcinoma (ICC) with lymph node metastases is dismal. Recent studies have highlighted the importance of lymph node retrieval from disease staging and therapeutic standpoints. To define the role of lymph node dissection for ICC, this study aimed to evaluate the patterns of lymph node metastases and their prognostic implication. Methods: A retrospective cohort analysis was conducted for 56 consecutive patients who underwent R0/R1 resection for ICC between 1990 and 2015. In principle, lymph nodes in the hepatic hilum and around the pancreas head were systematically removed. For left-sided tumors, lymph nodes in the lesser curvature of the stomach and the root of left gastric artery were also dissected. Clinicopathologic predictors of 3-year survival were identified by Cox multivariate analyses. Lymph node mapping was performed and positive nodes were classified into 3 compartments based on metastatic rates and prognoses. Results: Median tumor size, 4.5 (1.5–16.0) cm; Mass-forming and its dominant type, 42 (75%); R0 resection, 47 (84%). Nineteen (34%) patients had lymph node metastases. After excluding 4 in-hospital deaths, the overall and recurrence-free survival rates at 3 years were 66% and 33%, respectively (median follow-up, 36 months). Cox multivariate analysis revealed lymph node metastases [hazard ratio (HR) 6.3, 95% confidence interval (CI) 1.9-21.7, P = 0.003] and R1 resection (HR 7.8, 95% CI 1.6-38.3, P = 0.01) as independent negative predictors of overall survival. Patients with ≥ 4 positive nodes ( n = 7) had significantly decreased survival compared with those with 1–3 positive nodes ( n = 10, P= 0.005). Metastatic lymph nodes were classified into compartments I (metastatic rates ≥ 10% and longest survival ≥ 3 years), II (5%–10% and 1-year survival ≥ 50%), and III ( < 5% and 1-year survival < 50%). Lymph nodes in the suprapyloric area, celiac trunk, and paraaorta belonged to compartment III and appeared less important to be dissected. Conclusions: Systematic lymph node dissection for ICC based on tumor location provides accurate staging and may prolong survival in patients with limited number of positive nodes. Compartment classification is useful to determine the extent of dissection.

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

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

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

SETTING

Lusaka, Zambia.

OBJECTIVE

To assess the actual treatment outcomes of 'transfer out' (TO) cases at a diagnostic centre in Lusaka, in the third and fourth quarters of 2012, and to see the impact of this cross-check in treatment success rates (TSR) in 2013 and early 2014.

DESIGN AND METHOD

In this retrospective cohort study, treatment outcomes for new bacteriologically positive tuberculosis (TB) cases referred from the diagnostic centre were reviewed and compared with those at the receiving treatment units.

RESULTS

Of 49 (58%) cases referred to three treatment units, the treatment outcomes of nine had to be updated at the diagnostic centre, which reduced the proportion of TO cases from 17.6% to 11.8% and increased the TSR to 70.6% from 64.7%.

CONCLUSION

The review and cross-checking of the TB registers at the diagnostic and treatment units led to a significant reduction in non-assessed cases, suggesting that the TB registers in the diagnostic and treatment units should be cross-checked regularly. There is also need for a complementary intervention to reduce the proportion of TOs associated with high loss to follow-up and non-evaluated TO rates.

Arthrodesis of the ankle using an anterior sliding tibial graft for osteoarthritis secondary to osteonecrosis of the talus

Aims

This retrospective cohort study compared the results of vascularised and non-vascularised anterior sliding tibial grafts for the treatment of osteoarthritis (OA)of the ankle secondary to osteonecrosis of the talus.

Patients and Methods

We reviewed the clinical and radiological outcomes of 27 patients who underwent arthrodesis with either vascularised or non-vascularised (conventional) grafts, comparing the outcomes (clinical scores, proportion with successful union and time to union) between the two groups. The clinical outcome was assessed using the Mazur and American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scores. The mean follow-up was 35 months (24 to 68).

Results

The mean outcome scores increased significantly in both groups. In the vascularised graft group, the mean Mazur score improved from 36.9 to 74.6 and the mean AOFAS scale improved from 49.6 to 80.1. In the conventional arthrodesis group, the mean Mazur score improved from 35.5 to 65 and the mean AOFAS scale from 49.2 to 67.6. Complete fusion was achieved in 13 patients (76%) in the vascularised group, but only four (40%) in the conventional group. The clinical outcomes and proportion achieving union were significantly better in the vascularised group compared with the conventional arthrodesis group, although time to union was similar in the two groups. Take home message: Vascularised sliding tibial grafts may be used to achieve arthrodesis in patients with OA of the ankle secondary to osteonecrosis of the talus. Cite this article: Bone Joint J 2016;98-B:359–64.

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

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

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

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

Comparison of microscopic and endoscopic approaches to the cerebellopontine angle

OBJECTIVE

To examine the efficacy of the endoscope as an adjunct to the operating microscope in defining the surgical anatomy of the cerebellopontine angle (CPA).

METHODS

The surgical anatomy of the CPA was examined in cadaveric CPAs through a retrosigmoid approach. The upper, middle, and lower neurovascular complexes and the individual segments of the cerebellar arteries in the CPA were examined with the surgical microscope and 0° and 45° rigid endoscopes.

RESULTS

The microscope provided satisfactory views of the posterior surface of the neural and vascular structures in the central part of the CPA cistern. The endoscope provided superior views of the nerves' junction with the brainstem, their dural exit, and their vascular relationships. The endoscope also provided superior views of the individual segments of the cerebellar arteries.

CONCLUSION

The combination of endoscopic and microsurgical techniques aids in achieving optimal exposure in CPA surgery.

Advances in Self-Limiting Growth of Wide Bandgap II–VI Semiconductors

Recent advances in understanding the ALE (atomic layer epitaxy) growth of ZnSe, ZnS and ZnTe are reviewed. The Ideal ALE growth is obtained in the substrate temperature range of 250–350°C for ZnSe. In the ALE growth of ZnSe and ZnTe, a unique self-limiting mechanism is observed, in which the deposition rate saturates at 0.5 monolayer per cycle. Furthermore, applications of ALE of II–VI compounds to the growth of strained layer superlattices are also reviewed.

Histopathologic characteristics of a saccular aneurysm arising in the non-branching segment of the distal middle cerebral artery

Currently, the characteristics of aneurysms arising in the distal middle cerebral artery (dMCA) are not well understood. Here, we report the case of a 56-year-old woman with a ruptured saccular aneurysm in the M2 segment of the middle cerebral artery (MCA). The patient presented with a disturbance of consciousness, and computed tomography revealed a subarachnoid hemorrhage that angiography disclosed as a result of a saccular-type aneurysmal dilatation in the M2 segment of the left MCA. We excluded infection, inflammation, trauma, and neoplasia as causes of the aneurysm. Pathologic examination confirmed a ruptured saccular aneurysm of the dMCA that was unrelated to a branching zone. The aneurysmal wall was composed primarily of alphaSMA-positive and calponin/desmin-negative spindle cells and lacked internal elastic lamina, which was completely disrupted at the neck of the aneurysm. There was a strong positive immunoreactivity for matrix metalloproteinases (MMPs) 1, 2, and 9 in the spindle cells of the aneurysmal wall. In contrast, tests for MMP-8 were negative. The parent artery showed thickening of both the intima and media, with preservation of the internal elastic lamina. Atherosclerosis was not detected in either the parent artery or aneurysm. These findings suggest that an overexpression of MMPs may contribute to the development of saccular aneurysms in regions of the arterial trunk unrelated to branching zones.

Triphenyltin chloride induces glucose intolerance by the suppression of insulin release from hamster pancreatic beta-cells

We performed an intravenous glucose tolerance test (IVGTT) after the administration of triphenyltin chloride (TPTCl-Ad) in hamsters in order to confirm the presence of glucose intolerance and to clarify the pathogenesis of TPTCl-induced glucose intolerance. On the 1st, 2nd, 3rd, 4th and 7th days after TPTCl-Ad or the administration of sesame oil alone as a control, glucose was injected at a dose of 0.05 g glucose/100 g B.W., and then PG, IRI and TG were measured on 0, 1, 2, 3, 5 and 10 min after IVGTT. The TPT concentration in the pancreas was measured by gaschromatography and the morphological findings with a transmission electron microscope were compared between the TPTCl-Ad and the control hamsters. FPG on the 1st and the 2nd days after TPTCl-Ad were significantly higher than those in control, but those on the 4th and the 7th day recovered up to the control level. In contrast, basal IRI levels showed reciprocal results compared to the FPG levels. delta IRI/ delta PG on the 1st day after TPTCl-Ad was significantly reduced compared to the control. Fasting TG on the 1st day after TPTCl-Ad was much higher than the control. TPT-concentration on the 1st day after TPTCl-Ad showed peak values and its concentration gradually decreased. Electron microscopic findings in the pancreas after TPTCl-Ad indicated neither destruction nor lymphocyte infiltration of the pancreas.

CONCLUSIONS

The present data suggest that the administration of TPTCl in hamsters induces a functional transient damage on islet cells but not a morphological disorder, which shows an essentially different nature from the change in the pancreas induced by viral infection or by a large amount of streptozotocin.

Ruptured tectal arteriovenous malformation demonstrated angiographically after removal of an unruptured occipital lobe arteriovenous malformation

We report a case of ruptured tectal arteriovenous malformation (AVM) that was demonstrated angiographically only after removal of an unruptured occipital AVM. A 57-year-old man presented with sudden onset of diplopia and tinnitus. Computed tomography revealed a small hemorrhage in the right tectum mesencephali with intraventricular hemorrhage. Magnetic resonance imaging and angiography disclosed AVM in the right occipital lobe which was separate from the hemorrhagic lesion. Angiography demonstrated that the right occipital AVM was fed by the parieto-occipital artery and drained into the superior sagittal sinus and vein of Galen. However, no abnormal vascular lesion was detected near the tectum mesencephali. As venous hypertension was considered the reason for hemorrhage, the occipital AVM was completely resected. Postoperative angiography demonstrated disappearance of the occipital AVM, but it also disclosed a small tectal AVM fed by branches from the superior cerebellar artery, which had not been detected on preoperative angiography. This was considered the true cause of hemorrhage, and gamma knife surgery was accordingly performed. Even if an AVM is demonstrated, if the lesion does not correspond to the hemorrhage we recommend serial angiographical evaluation so that a small AVM is not missed.

Ageing is associated with diminished apoptotic cell clearance in vivo

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