Electron density measurement of cesium seeded negative ion source by surface wave probe

Electron density measurements of a large-scaled negative ion source were carried out with a surface wave probe. By comparison of the electron densities determined with the surface wave probe and a Langmuir probe, it was confirmed that the surface wave probe is highly available for diagnostic of the electron density in H(-) ion sources. In addition, it was found that the ratio of the electron density to the H(-) ion density dramatically decreases with increase of a bias voltage and the H(-) ions become dominant negative particles at the bias voltage of more than 6 V.

Spatial distribution of the charged particles and potentials during beam extraction in a negative-ion source

We report on the characteristics of the electronegative plasma in a large-scale hydrogen negative ion (H(-)) source. The measurement has been made with a time-resolved Langmuir probe installed in the beam extraction region. The H(-) density is monitored with a cavity ring-down system to identify the electrons in the negative charges. The electron-saturation current decreases rapidly after starting to seed Cs, and ion-ion plasma is observed in the extraction region. The H(-) density steps down during the beam extraction and the electron density jumps up correspondingly. The time integral of the decreasing H(-) charge density agrees well with the electron charge collected with the probe. The agreement of the charges is interpreted to indicate that the H(-) density decreasing at the beam extraction is compensated by the electrons diffusing from the driver region. In the plasmas with very low electron density, the pre-sheath of the extraction field penetrates deeply inside the plasmas. That is because the shielding length in those plasmas is longer than that in the usual electron-ion plasmas, and furthermore the electrons are suppressed to diffuse to the extraction region due to the strong magnetic field.

Acute generalized exanthematous pustulosis during the puerperal period: a case report

BACKGROUND

Acute generalized exanthematous pustulosis (AGEP) is an uncommon adverse cutaneous reaction, most commonly associated with drugs.

CASE

A 38-year-old primigravida whose labor had been induced developed erythema over her chest and abdomen. She was transferred to our department after a failed vacuum extraction, and delivered a mature infant by forceps. On day three postpartum she developed a 40.4 degrees C fever. Although ceftriaxone was administered, her fever persisted (>38 degreesC). On day six of the puerperium, diffuse non-follicular pustules appeared over her neck and trunk, and AGEP was suspected. Two days after ceftriaxone was withdrawn, the eruptions started to resolve without any medical intervention.

CONCLUSION

Once the diagnosis of AGEP has been made, the antibiotics being administered must be discontinued. If continued treatment is required, pharmacologically distinct antibiotics must be used instead to aid the rapid self-limitation of the disease.

Phase II study of topotecan with cisplatin in Japanese patients with small cell lung cancer

BACKGROUND

We conducted a phase II study of topotecan (Tp) with cisplatin (CDDP) in previously untreated Japanese patients with extensive-disease small cell lung cancer (ED-SCLC).

PATIENTS AND METHODS

In stage 1, a total of 30 patients were allocated to Tp 0.65 mg/m(2) with CDDP 60 mg/m(2) day 1 or Tp 1.00 mg/m(2) with CDDP day 5 following prophylactic granulocyte colony stimulating factor (G-CSF) from day 6. In stage 2, the selective combination in 29 patients was evaluated for response rate, toxicity and overall survival.

RESULTS

In stage 1, Tp 1.00 mg/m(2) with CDDP day 5 was selected this schedule had a better hematological profile. In stage 2, the response rate was 83%, and grade 3/4 adverse events were hematological-toxicities. The median survival time was 17.5 months and the 1 year survival rate was 79%.

CONCLUSION

Combination of Tp and CDDP on day 5 with G-CSF support is safe and effective for previously untreated ED-SCLC Japanese patients.

Clinical characteristics of Japanese lung cancer patients with human immunodeficiency virus infection

BACKGROUND

Lung cancer has emerged as a crucial problem among human immunodeficiency virus (HIV)-infected patients, contributing to significant mortality in Western countries. Japan has an increasing number of newly infected HIV patients, but clinical characteristics of lung cancer have not been well investigated in Asian populations with HIV.

PATIENTS AND METHODS

We retrospectively analyzed patients diagnosed with HIV and lung cancer simultaneously in our institution between 1985 and 2010. Data regarding HIV status, characteristics, treatment, and prognosis of lung cancer were evaluated.

RESULTS

We identified 13 consecutive patients (all men; mean age, 59.0 ± 10.2 years) since 1985, 7 of whom had been diagnosed since 2008. Mean CD4 cell count was 332 ± 159 cells/μL, and HIV viral loads were undetectable in 8 patients (61.5%) at the time of lung cancer diagnosis. The mean latency from HIV diagnosis to detection of lung cancer was 4.0 years. Histological examination demonstrated adenocarcinoma in 9 patients (69.2%), followed by squamous cell carcinoma (23.1%), and small cell carcinoma (7.7%). Among the 7 patients available for examination, 2 patients (28.6%) harbored EGFR mutation. Six patients had stage IA-IIIA, and 7 patients had stage IIIB/IV. Among 6 patients treated with chemotherapy for unresectable stages, 5 (83.3%) achieved a partial response. Median overall survival was 17 months for all stages and 14 months for advanced stages. Toxicities for treatment modalities were largely acceptable.

CONCLUSIONS

Clinical characteristics of Japanese HIV-infected patients with lung cancer resemble those of Western populations. The prognosis for patients in the metastatic stage was better than previously reported.

[A case of pulmonary MALT lymphoma with multiple nodules and ground-glass opacities]

An asymptomatic 77-year-old woman was referred in 2000 because multiple nodular shadows were found on chest X-ray films on a medical checkup. Chest computed tomography (CT) showed bilateral multiple ground-glass opacities and ill-defined nodules. A transbronchial lung biopsy was performed via bronchoscopy, but the specimens did not yield any specific findings. She was then monitored without therapy as an outpatient. In November 2005, chest CT imaging showed that the size and density of the ground-glass opacities and nodules had increased. In January, 2006 video-assisted thoracic surgery (VATS) was performed to obtain a definitive diagnosis. Based on histological and immunohistochemical examinations, primary pulmonary mucosa-associated lymphoid tissue (MALT) lymphoma was diagnosed. She has been followed up without any additional treatment since.

CONCLUSION

Multiple ground glass opacities and nodules are rare chest CT findings in pulmonary MALT lymphoma.

An Early MRI Change following Reversible Hypoxic Brain Injury

We describe a patient who suffered reversible hypoxic brain injury. The initial MRI taken 3.5 hours after asphyxiation showed an abnormal lesion on DWI, but he recovered completely from coma. The presence of cytotoxic edema in the acute stage may not necessarily indicate a poor prognosis.

Effect of elevated left ventricular diastolic filling pressure on the frequency of left atrial appendage thrombus in patients with nonvalvular atrial fibrillation

We investigated the relation between left ventricular diastolic dysfunction and left atrial appendage (LAA) thrombus in patients with atrial fibrillation (AF). We performed transesophageal echocardiography to examine LAA thrombus or spontaneous echo contrast (SEC) and to measure LAA emptying flow velocity in consecutive 376 patients with AF. We estimated diastolic filling pressure as the ratio of early transmitral flow velocity (E) to mitral annular velocity (e') on transthoracic echocardiogram. E/e' ratio in 28 patients (7.4%) with LAA thrombi was higher than that in patients without thrombus (18.3 ± 9.3 vs 11.4 ± 5.9, p <0.0001). The fourth quartile of E/e' (>13.6) consisted of 19 patients with thrombi and had a higher prevalence of thrombi than the others (p <0.0001). Multivariate regression analysis selected E/e' ≥13 as an independent predictor of LAA thrombus with an odds ratio of 3.50 (1.22 to 10.61) in addition to LA dimension and ejection fraction. Increased quartile of E/e' was negatively associated with LAA flow velocity and positively with rate of SEC. In conclusion, increased diastolic filling pressure is associated with a higher rate of LAA thrombus in AF, partly through blood stasis or impaired LAA function.

Stevens-Johnson syndrome and toxic epidermal necrolysis due to anticonvulsants share certain clinical and laboratory features with drug-induced hypersensitivity syndrome, despite differences in cutaneous presentations

BACKGROUND

Drug-induced hypersensitivity syndrome (DIHS)/drug rash with eosinophilia and systemic symptoms (DRESS) syndrome is characterized by late disease onset, fever, rash, hepatic dysfunction, haematological abnormalities, lymphadenopathy and often, human herpesvirus (HHV) reactivation. The diagnosis of DIHS is based on the combined presence of these findings. Anticonvulsants are a major cause of DIHS and may also cause Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). We examined whether SJS/TEN due to anticonvulsants display similar clinical and laboratory features seen in DIHS.

METHODS

Patients diagnosed with SJS or TEN due to anticonvulsants (n = 8) were examined and their clinical features and laboratory findings were compared with patients with anticonvulsant-related DIHS (n = 6).

RESULTS

Seven of the eight patients with SJS/TEN developed symptoms > 3 weeks after starting anticonvulsants. Hepatic dysfunction was present in six patients with SJS/TEN and five patients with DIHS. Leucocytosis and/or eosinophilia was noted in seven patients with SJS/TEN and four patients with DIHS. Only one patient in the SJS/TEN group had atypical lymphocytosis; this was present in four patients with DIHS. Reactivation of HHV-6 was detected in one of the four patients tested in the SJS/TEN group, although it was seen in five of the six patients with DIHS.

CONCLUSIONS

TSJS/TEN due to anticonvulsants may exhibit some clinical and laboratory features of DIHS. The nature of the cutaneous involvement should be emphasized in the diagnosis of DIHS.

[Re-treatment with epidermal growth factor receptor tyrosine kinase inhibitor(EGFR-TKI)for lung adenocarcinoma]

BACKGROUND

EGFR-TKI yields a long survival period in cases of non-small cell lung cancer (NSCLC), especially those with EGFR gene mutations, but the effect is limited. The later treatment strategy is still a large problem. Efficacy by re-treatment with EGFR-TKI is sometimes reported, but its clinical significance is not clear.

METHODS

We reviewed retrospectively 22 cases (gefitinib 11 cases and erlotinib 11 cases) of NSCLC re-treated with EGFR-TKI in our hospital from August 2004 to August 2009.

RESULTS

After re-treatment with gefitinib, four cases showed disease control. Efficacy of erlotinib was recognized in the cases in which disease control was obtained by initial treatment with gefitinib. The disease control rate was 36% (4/11) in the gefitinib group and 45% (5/11) in the erlotinib group. Median survival time was 212 days and 292 days from re-treatment with EGFR-TKI, respectively.

CONCLUSION

Re-administration of EGFR-TKI was effective, and therefore is considered one of the treatment options for patients who once respond to gefitinib, until new anti-cancer drugs are available.

Automated assessment of myocardial viability after acute myocardial infarction by global longitudinal peak strain on low-dose dobutamine stress echocardiography

BACKGROUND

Low-dose dobutamine stress echocardiography (DSE) assesses myocardial viability at the early stage of acute myocardial infarction (AMI), but its assessment is subjective and variable. Automated function image (AFI) determines global longitudinal peak strain (GLPS) based on tissue tracking technique. The ability of GLPS obtained by AFI during dobutamine stress to assess myocardial viability after AMI was investigated.

METHODS AND RESULTS

Low-dose DSE at day 3 in 23 consecutive patients with AMI was performed using Vivid 7 (GE Healthcare). Segmental longitudinal peak strain with AFI and obtained GLPS was analyzed. Wall motion score index (WMSI) by echocardiography 1 month later was determined. In 18 patients, left ventriculography was also performed at 3.2±1.5 months later to obtain left ventricular ejection fraction (LVEF) and regional wall motion (RWM, SD/chord). GLPS was improved during dobutamine infusion at 10 µg · kg(-1) · min(-1) (-12.9 ± 3.5% to -15.2 ± 3.6%, P=0.0004). GLPS during dobutamine stress showed good correlations with follow-up WMSI (R=0.47, P=0.02), with peak CK-MB (R = 0.52, P=0.01), with RWM (R = -0.48, P=0.04), and with LVEF (R = -0.54, P=0.02), whereas GLPS at baseline showed no correlations with them. Averaged segmental peak strain at baseline and during stress were correlated with follow-up WMSI (R = 0.50 and 0.43, respectively), but not with LVEF.

CONCLUSIONS

GLPS during dobutamine stress determined by AFI is a promising, objective index to assess myocardial viability on the early stage of AMI.

Characteristics of 80 keV positive ion source for Large Helical Device

An additional beamline, BL5, equipped with four positive ion sources will be installed on Large Helical Device (LHD) in 2010. The performance of an ion source which generates 80 keV deuterium and 60 keV hydrogen beams was investigated. The structure of the ion source is based on that of a BL4 ion source on LHD. The main differences between the ion sources for the BL4 and BL5 are the acceleration voltages and the materials of plasma electrodes: copper and molybdenum, respectively. The molybdenum plasma electrode for BL5 has better performance than the copper plasma electrode of BL4. The integrated performance of the ion source for BL5 reached a value equivalent to approximately 58 A in the beam current of hydrogen positive ion at 60 keV in the beam energy.

Beamlet characteristics in the accelerator with multislot grounded grid

Characteristics of multibeamlets are investigated by means of beamlet monitoring technique. The beamlets are extracted from an accelerator with multislot grounded grid and the profiles are observed as infrared images of temperature distributions on a cold isostatic pressed graphite plate exposed by H-beamlets. The optimal horizontal and vertical divergence angles of single beamlet are estimated at 4.1 and 6.1 mrad, respectively.