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This observational case–control study evaluated the anterior ocular segment parameters of patients with celiac disease with a Scheimpflug imaging system and compared them with those of a healthy controls group, highlighting potential differences related to the underlying pathogenetic mechanisms of the disease. Seventy celiac patients and 70 healthy subjects were assessed with a comprehensive ophthalmological evaluation, including clinical history, Snellen best-corrected visual acuity, axial length (AL) measurements with IOLMaster, and anterior segment tomographic evaluation with Pentacam HR. The measurements of all keratometry values, astigmatism, steep axis, anterior and posterior Q value (asphericity), pupil diameter, pupil center, corneal apex, the thinnest point, corneal volume, anterior chamber depth from the epithelium, anterior chamber depth from endothelium, anterior chamber volume, and iridocorneal angle were also appraised. The two study groups were comparable and similar for gender, age, and AL, with no statistically significant differences regarding all analyzed tomographic parameters. Thus, ocular anterior segment parameters of celiac patients are not significantly different from those of healthy subjects, suggesting no underlying pathogenetic implications of celiac disease affecting the assessed structures. Nevertheless, a routine ophthalmological examination for all celiac patients should be recommended throughout their lifetimes due to the potential ocular manifestations of the disease.

Endoscopic sphincterotomy (ES) is commonly performed during endoscopic retrograde cholangiopancreatography, and bleeding is a severe adverse event. PuraStat is a peptide developed as a hemostatic agent for endoscopy. We report its use as a hemostatic strategy in post-ES bleeding refractory to combined hemostasis. A patient with choledocholithiasis underwent endoscopic retrograde cholangiopancreatography for stone removal. After the ES, severe bleeding refractory to the injection of diluted epinephrine around the bleeding source and metal stent placement occurred. Hemostasis was achieved with the application of the hemostatic gel. We reported the use of novel self-assembling hemostatic gel as an effective therapeutic tool for post-ES refractory bleeding.

Background Psychological stress and anxiety, such those generated by forced quarantine, affect gastrointestinal symptoms course in patients with functional gastrointestinal disorders. Thus, our aim was to assess, in a cohort of patients regularly followed up in a devoted outpatient clinic of Southern Italy, the association between their gastrointestinal symptoms changes, stress, and anxiety reported during the Italian lockdown. Methods We recruited patients from the outpatient clinic of the University of Salerno, devoted to functional gastrointestinal disorders, selecting only patients for whom an evaluation was available in the last 6 months before the lockdown. Gastrointestinal symptoms were evaluated at each visit through standardized questionnaire and pooled in a database. On 45th days from the beginning of the lockdown, patients were re‐assessed by phone with the same questionnaire. Anxiety and stress levels were assessed through a self‐administered online questionnaire based on Generalized Anxiety Disorder 7 test and Perceived Stress Scale 10 test. Key Results The intensity‐frequency scores of several upper gastrointestinal symptoms improved (Wilcoxon test

Background: Coronavirus disease 2019 (COVID-19) causes not only severe illness but also detrimental effects associated with the lockdown measures. The present study aimed to evaluate reported lifestyle changes in a cohort of adults in Italy, including physical exercise, food choices, and psychological wellbeing, after two months of lockdown. Methods: A web survey on social media (Facebook and LinkedIn) of 32 multiple-choice questions aiming to evaluate the impact of the national COVID-19 lockdown in a sample of Italian adults. Results: We received 1378 complete responses (women 68.3%, mean age 39.5 ± 12.5 years). The percentage of participants reporting regular exercise decreased during lockdown (52 vs. 56.5%). The vast majority of people continued to consume the three traditional meals per day, but the consumption of meat, fish, and eggs significantly decreased. Women reported more frequent anxiety, sadness, fear, and feelings of insecurity than men. The factors predicting the worst outcome during the lockdown were being a woman, low education and income, gastrointestinal diseases. Conclusion: The lockdown has had a limited impact on food choices and physical exercise in Italian adults of our series, since most of them made an effort to improve their lifestyle. However, women with gastrointestinal diseases reported more frequent negative feelings and poor adaptation to the lockdown.

Carolina Ciacci,1 Mario Gagliardi,1 Monica Siniscalchi,1 Monica Ruotolo,1 Antonella Santonicola,1 Najla Hajji,1 Fabiana Zingone2 1Celiac Center at Department of Medicine, Surgery, and Dentistry, Scuola Medica Salernitana, University of Salerno, Salerno, Italy; 2Gastroenterology Unit, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, ItalyCorrespondence: Carolina CiacciCeliac Center at Department of Medicine, Surgery, and Dentistry, Scuola Medica Salernitana, University of Salerno, Baronissi, Salerno, 84081, ItalyEmail cciacci@unisa.itIntroduction: Celiac disease (CeD) diagnosis has worldwide shared protocols. Conversely, follow-up of patients is still an object of study. Gluten immunogenic peptide detection in the urine (GIP) appears to be a new and efficient method for dietary gluten control of patients. The present study aims to assess the clinical usefulness of the GIP point-of-care urine test in the follow-up of symptomatic and asymptomatic patients with CeD before and during the COVID-19 lockdown in Italy.Methods: Thirty adult CeD patients on a gluten-free diet (GFD) were enrolled before and during the COVID-19 lockdown through follow-up visits or remote consultation. Patients underwent anthropometrical evaluation, dietetic interview, and State-Trait Anxiety Inventory (STAI). Then, two groups were formed: symptomatic and worried about gluten contamination. Each patient received 5 GIP point-of-care tests to perform a maximum of 5 times in the following 5 weeks in case of symptoms or anxiety state due to hypothesized gluten contamination.Results: Sixteen symptomatic patients and 14 patients with concerns related to gluten contamination were included. There were no differences in age, BMI, compliance to GFD and GIP positive tests between the two groups. Worried group showed a borderline higher level of anxiety than symptomatic group (p = 0.06), with a significant minor percentage of patients reporting “no or low anxiety” (14.3% vs 50% p = 0.03). The symptomatic patients showed a higher rate of diarrhea than worried group (25% vs 0%, p = 0.04). Gluten in urine samples was globally found in 8 out of 30 cases (26.6%).Conclusion: The GIP test is a tool that can be used as a point of care test to assess adequate compliance with GFD and reassure symptomatic CeD patients from the feeling of anxiety for gluten contamination, especially during the COVID-19 pandemic.Keywords: GIP, POCT gluten contamination, GFD, anxiety, burden, celiac disease

Bariatric surgery (BS) is a pillar for the treatment of morbid obesity and its related comorbidities. However, it might be associated with long-term deficiencies and absorption issues. Adherence to micronutrient supplementation is a crucial aspect in the management of these patients.The aim of the present survey was to evaluate the adherence to micronutrient supplementation in a cohort of Italian patients submitted to BS (BS patients) and to identify predictors of adherence using a self-administered, anonymous, internet-based instrument.Patients who underwent BS over the last decade in a single center were invited to participate to a self-administered, anonymous, internet-based survey consisting of a 23 items structured questionnaire evaluating: a. demographic information b. Bariatric procedures performed; c. Indication to BS; d. Lapse of time since last BS, e. Frequency of follow up visits post-surgery, f. Perception of well-being post BS; g. Adherence to micronutrient supplementation; h. Changes in their quality of life and self-esteem.We received an automatic notification of delivery from 1100 out of 1600 BS patients and 290 (81.4% female, mean age 39.5 ± 10.1 years) completed the questionnaire. The main reported bariatric procedures were: Sleeve Gastrectomy (59%), Roux-en-Y Gastric Bypass (31%) and Adjustable Gastric Banding (7.2%). Only 33.1% of the sample acknowledged to have taken all recommended medication regularly. BS patients who underwent malabsorptive procedures and had their last follow up visit more than 5 years earlier, had a higher risk of being nonadherent to micronutrient supplementation. Conversely, BS patients in their forties seemed more likely to adhere to treatment recommendations. Losing more weight was the only independent risk factors for nonadherence to micronutrient supplementation, independently from patient's perception of wellbeing.After BS, several clinical and psychosocial factors might predict nonadherence to micronutrient supplementation.

Background Obese patients (Ob) with a binge eating disorders (BED) behavior pattern have a higher prevalence of postprandial distress syndrome (PDS) compared to Ob without a BED behavior pattern, while an increase of PDS has been described in Ob after sleeve gastrectomy (SG). Hedonic response to a meal is dissociable from satiation in healthy subjects. Anhedonia is the lowered ability to experience pleasure. There are no studies investigating the presence of anhedonia in Ob with and without SG and its relationship to PDS symptoms. Aim To assess the relationship among anhedonia, BED and upper gastrointestinal symptoms in two group of morbidly Ob with and without SG. Methods Eighty-one Ob without SG, 45 Ob with SG and 55 healthy controls (HC) were studied. All subjects fulfilled the binge eating scale (BES) to investigate BED, the validated 14 items Snaith-Hamilton pleasure scale (SHAPS) to assess Anhedonia as well as the Beck Depression Inventory-II (BDI II) and State Trait Anxiety Inventory (STAI) questionnaires to screen for depression and anxiety. All patients underwent a standardized questionnaire investigating the intensity-frequency scores (0-6) of upper gastrointestinal symptoms and were diagnosed for the presence of functional dyspepsia (FD) and its subtypes according to ROME IV criteria. Results Ob without SG who were positive for BED had a 4.7 higher risk of FD compared to Ob without SG who were negative for BED (OR: 4.7; 95.0%CI 1.23-18.24; P = 0.02). STAI-Y2 scores were significantly higher in Ob without SG positive for BED (42.2 ± 1.5 vs Ob negative for BED: 39.6 ± 1 .0, P = 0.04), while SHAPS scores and BDI II did not differ in the two groups (1.16 ± 1.30 vs 0.89 ± 1.02, P = 0.49). A lower prevalence of BED (BES > 17: 11.4% vs 40.7%, P = 0.001) and BDI-II (6.8 ± 1.2 vs 13.8 ± 1.9, P = 0.005) was reported in Ob with SG than Ob without SG, on the contrary total mean scores of STAI-Y1 and STAI-Y2 were significantly higher in Ob with SG than Ob without SG. Thirty-five percent of Ob with SG fulfilled the diagnosis of FD. SHAPS mean scores and the prevalence of anhedonia did not differ among the two groups (18.2 vs 8.1%, P = 0.2). Fifty-four percent of Ob with SG achieved surgical success excess weight loss > 50%. Excess weight loss was negatively related to SHAPS total mean scores [adjusted B: -7. 099 (95%CI: -13.91 to -0.29), P = 0.04]. Conclusion Ob without SG showed a higher prevalence of PDS, mood disorders and anxiety when positive for BE behavior compared to those negative for BE behavior, whereas no differences were found in SHAPS score. Ob with SG showed a higher prevalence of PDS compared to Ob without SG. Concerning psychological aspect, BED and depression are less frequent in the Ob with SG, while both state and trait anxiety are significantly higher. Moreover, the more an Ob with SG is anhedonic, less surgical success was achieved.

The ITER ECRH system consists of 24 gyrotrons with up to 24 MW installed millimeter wave heating power at 170 GHz, power supplies, control system, transmission lines, one Equatorial and the four Upper Launchers. With its high frequency and small beam focus the ECRH has the unique capability of driving locally current. While the Equatorial Launcher mainly acts for central heating and current profile shaping, the Upper Launchers aim on suppressing MHD instabilities, especially neoclassical tearing modes (NTM) triggering plasma disruptions. The Upper Launchers inject millimeter waves through a quasi-optical section consisting of three fixed and the front steering mirror set. The eight overlapping beams have focal points optimized for suppression of the q = 3/2 and q = 2/1 NTMs., Several project change requests required the redesign of the Upper Launchers and the connected ex-vessel system. This redesign includes a new boundary geometry of the launchers as well as a newly designed cooling system for the Blanket Shield Module (BSM), a modified flange of the BSM to the structural main frame and a refined optical design. Additionally shield blocks with integrated in-vessel waveguides were added and the closure plate with waveguide and supply line feedthroughs was adapted. Further changes, not all caused by PCRs, include newly designed ex-vessel waveguide components with a reduced aperture and redesigned ultra low-loss CVD diamond windows. Finally several components originally foreseen as off-the-shelf components have become part of the design scope. The new launcher design status is presented with selected results on numerical design validation.

International audience; The safety classification of Structures, Systems and Components (SSCs) used in nuclear power plants provided in various IAEA guides and other international standards is mostly aimed at the fission applications. For fusion the main safety functions are related to the confinement of radioactive materials and the limitation of personnel radiation exposure and not with heat removal or reactivity control. Similarly, various plant states and events with their severity levels specific to a fusion plant are different. Ranking SSCs according to their significance to safety helps to determine the design, quality and manufacturing requirements to be applied to individual SSCs. Classification is a top down process that begins with a basic understanding of the plant design, its safety analysis and how the main safety functions will be achieved. On the basis of the classification, a complete set of engineering rules must be specified which then dictate the codes and standards that are used by the designers. Guidelines for identification and classification of SSCs that are important to safety for Fusion applications have been provided considering the current practice and highlight the differences in the approaches used to identify and classify SSCs that are important to safety. © 2018

The torus window unit is a very particular component of the ITER EC HC this structure is then integrated into a metallic housing by welding. The compliance with the requirements shall be assured by applying the ASME Section III – Subsection NC code and a dedicated experimental qualification program. This paper reports the way in which the design of the unit, already optimized by FEM analyses against the ITER loading conditions, was further improved by the application of the ASME III-NC code, leading to a more feasible and simpler manufacturing and assembling sequence. In addition, the impact of the ITER project decision to change the inner diameter of the waveguide from 63.5 to 50 mm, to improve the beams’ mode purity, was assessed and it is also discussed. Different materials for the metallic housing and in particular for the millimeter-wave inserts of the unit were compared using appropriate engineering criteria to mitigate the significant increase of the millimeter-wave thermal loads on the waveguides when the diameter is decreased.

Four EC H&CD (Electron Cyclotron Heating and Current Drive) launchers will be installed into the upper ports #12, #13, #15 and #16 in ITER. Beside plasma heating their main purpose is to counteract plasma instabilities by injecting up to 20 MW of microwave power at a frequency of 170 GHz at dedicated positions into the plasma. The microwave power is generated in 24 Gyrotrons outside the Tokamak and transmitted into the dedicated ports by 8 waveguide lines per launcher. After passing a CVD (Chemical Vapor Deposition) diamond window and another section of circular waveguides, the microwaves are quasi-optically guided into the plasma by an adjusted set of mirrors. These mirrors and also the foremost segments of the waveguides are mounted into the Upper Port Plug, which is a massive steel structure capable to dissipate up to 800 kW heat and to withstand heavy mechanical loads induced mainly from plasma disruptions. This paper presents the most recent status of the design of the EC H&CD Upper Port Plug (UPP), featuring the construction of the supporting structure and the BSM (Blanket Shield Module) with its plasma facing First Wall, the PHTS (Primary Heat Transfer System) water cooling layout, the shielding components engineering, the microwave system integration and comprehensive manufacturing strategies. Also correlated computational analyses to prove the final design of the launcheŕs structural system are given.

The diamond window is part of the ex-vessel waveguide system of the ITER ECRH Upper Launcher and consists of an ultra-low loss CVD diamond disk mounted in a system of metallic parts. On the one hand the window has to fulfil adequate transmission capability for high power mm-waves and on the other hand it serves, together with an isolation valve, as primary vacuum boundary of the ITER vacuum vessel, and has the function of tritium confinement. Therefore it is classified as Protection Important Component and high requirements for quality and safety apply. The window assembly cannot be entirely covered by codes and standards and thus an ad-hoc qualification program is required, including prototyping activities. The mm-wave transmission capability of the window, which is mainly defined by the dielectric loss of the diamond disk, has to be demonstrated as well as its structural integrity. For previous and current window prototypes, diamond disks with low dielectric losses have been chosen with a diameter of 80 mm and a thickness of 1.11 mm. This thickness satisfies the resonance condition (d = n*λeff/2) for the 170 GHz beam, ensuring a high transmission, but it also needs to be validated with respect to the mechanical loads, especially the expected pressure loads. Investigations on the flexural strength of diamond disks (D = 30 mm, d = 1.11 mm) have been performed using a ring-on-ring set-up and the results lead to an estimation of the failure behavior. In addition, pressure tests of a mock-up consisting of a diamond disk (D = 80 mm, d = 1.11 mm) brazed to a copper cuff are under examination. The dedicated test program includes cyclic tests at lower pressures and high pressure tests (up to 2 bar) allowing a simulation of the expected events. This paper will give an overview on the qualification activities for the ITER torus window with a focus on the qualification of the diamond disk and with respect to its mechanical properties. Respective parts of the test program, which need F4E and IO review and approval, will be described and first results will be presented.

Mitigating edge localized modes (ELMs) with resonant magnetic perturbations (RMPs) can increase energetic particle losses and resulting wall loads, which have previously been studied in the vacuum approximation. This paper presents recent results of fusion alpha and NBI ion losses in the ITER baseline scenario modelled with the Monte Carlo orbit following code ASCOT in a realistic magnetic field including the effect of the plasma response. The response was found to reduce alpha particle losses but increase NBI losses, with up to 4.2% of the injected power being lost. Additionally, some of the load in the divertor was found to be shifted away from the target plates toward the divertor dome.

The diamond window is part of the electron cyclotron heating upper launcher system for ITER. Together with the isolation valve it constitutes the primary vacuum boundary and it also acts as first tritium barrier. Therefore the window is classified as Safety/Protection Important Component (SIC/PIC) with the nuclear safety function “confinement”. As the diamond window unit is not entirely covered by standard codes, an ad-hoc qualification program needs to be defined, including analysis, prototyping and testing. In the framework of a contract with F4E, the test program for a diamond window prototype is being developed with the aim to prove its operability for normal, accidental and incidental conditions as identified in the ITER load specifications. Tests range from dielectric loss measurements for the bare Chemical Vapour Deposition (CVD) diamond disk up to mechanical and vacuum tests for the complete window assembly. Finally mm-wave properties have to be characterized for the complete window. A clear definition of the testing requirements and of the acceptance criteria is necessary as well as a complete documentation of the process. This paper will present the development of the test plan for a window prototype, which is currently under manufacturing. First tests are directed to the characterization of the bare diamond disk with a focus on its dielectric properties.

The electron cyclotron (EC) heating and current drive (H&CD) system developed for the ITER is made of 12 sets of high-voltage power supplies feeding 24 gyrotrons connected through 24 transmission lines (TL), to five launchers, four located in upper ports and one at the equatorial level. Nearly all procurements are in-kind, following general ITER philosophy, and will come from Europe, India, Japan, Russia and the USA. The full system is designed to couple to the plasma 20 MW among the 24 MW generated power, at the frequency of 170 GHz, for various physics applications such as plasma start-up, central H&CD and magnetohydrodynamic (MHD) activity control. The design takes present day technology and extends toward high-power continuous operation, which represents a large step forward as compared to the present state of the art. The ITER EC system will be a stepping stone to future EC systems for DEMO and beyond. The development of the EC system is facing significant challenges, which includes not only an advanced microwave system but also compliance with stringent requirements associated with nuclear safety as ITER became the first fusion device licensed as basic nuclear installations as of 9 November 2012. Since the conceptual design of the EC system was established in 2007, the EC system has progressed to a preliminary design stage in 2012 and is now moving forward toward a final design.

We assess the effect of the European design of the pebble-bed helium-cooled test blanket modules (TBM) on fast ion power loads on ITER material surfaces. For this purpose, the effect of not only the TBMs but also the ferritic inserts (FI), used for mitigating the toroidal field ripple, were included in unprecedented detail in the reconstruction of the 3-dimensional magnetic field. This is important because, due to their low collisionality, fast ions follow the magnetic geometry much more faithfully than the thermal plasma. The Monte Carlo orbit-following code ASCOT was used to simulate all the foreseen operating scenarios of ITER: the baseline 15 MA standard H-mode operation, the 12.5 MA hybrid scenario, the 9 MA advanced scenario, and the half-field scenario with helium plasma that will be ITER’s initial operating scenario. The effect of TBMs was assessed by carrying out the simulations in pairs: one including only the effect of ferritic inserts, and the other including also the perturbation due to TBMs. Both thermonuclear fusion alphas and NBI ions from ITER heating beams were addressed. The TBMs are found to increase the power loads, but the absolute values remain small. Neither do they produce any additional hot spots.

The magnetic perturbation due to the ferromagnetic test blanket modules (TBMs) may deteriorate fast ion confinement in ITER. This effect must be quantified by numerical studies in 3D. We have implemented a combined finite element method (FEM) -- Biot-Savart law integrator method (BSLIM) to calculate the ITER 3D magnetic field and vector potential in detail. Unavoidable geometry simplifications changed the mass of the TBMs and ferritic inserts (FIs) up to 26%. This has been compensated for by modifying the nonlinear ferromagnetic material properties accordingly. Despite the simplifications, the computation geometry and the calculated fields are highly detailed. The combination of careful FEM mesh design and using BSLIM enables the use of the fields unsmoothed for particle orbit-following simulations. The magnetic field was found to agree with earlier calculations and revealed finer details. The vector potential is intended to serve as input for plasma shielding calculations., In proceedings of the 28th Symposium on Fusion Technology

A 24 MW Electron Cyclotron (EC) system operating at 170 GHz and 3600 s pulse length is to be installed on ITER. The EC plant shall deliver 20 MW of this power to the plasma for Heating and Current Drive (H&CD) applications. The EC system is designed for plasma initiation, central heating, current drive, current profile tailoring, and Magneto-hydrodynamic control (in particular, sawteeth and Neo-classical Tearing Mode) in the flat-top phase of the plasma. A preliminary design review was performed in 2012, which identified a need for extended application of the EC system to the plasma ramp-up, flattop, and ramp down phases of ITER plasma pulse. The various functionalities are prioritized based on those applications, which can be uniquely addressed with the EC system in contrast to other H&CD systems. An initial attempt has been developed at prioritizing the allocated H&CD applications for the three scenarios envisioned: ELMy H-mode (15 MA), Hybrid (similar to 12 MA), and Advanced (similar to 9 MA) scenarios. This leads to the finalization of the design requirements for the EC sub-systems.

An electron cyclotron system is one of the four auxiliary plasma heating systems to be installed on the ITER tokamak. The ITER EC system consists of 24 gyrotrons with associated 12 high voltage power supplies, a set of evacuated transmission lines and two types of launchers. The whole system is designed to inject 20 MW of microwave power at 170 GHz into the plasma. The primary functions of the system include plasma start-up, central heating and current drive, and magneto-hydrodynamic instabilities control. The design takes present day technology and extends towards high power CW operation, which represents a large step forward as compared to the present state of the art. The ITER EC system will be a stepping stone to future EC systems for DEMO and beyond. The EC system is faced with significant challenges, which not only includes an advanced microwave system for plasma heating and current drive applications but also has to comply with stringent requirements associated with nuclear safety as ITER became the first fusion device licensed as basic nuclear installations as of 9 November 2012. Since conceptual design of the EC system established in 2007, the EC system has progressed to a preliminary design stage in 2012, and is now moving forward towards a final design. The majority of the subsystems have completed the detailed design and now advancing towards the final design completion. (C) 2014 Elsevier B.V. All rights reserved.

The ITER electron cyclotron upper launcher (EC UL) is used to direct high power microwave beams generated by the gyrotrons into the plasma for magneto-hydrodynamic (MHD) control and heating and current drive (H&CD) applications. The UL consists of an assembly of ex-vessel waveguides (WGs) and an in-vessel port plug. The diamond window units form vacuum and tritium confinement boundaries between the torus volume and the transmission lines (TLs) which guide beams between 1 and 2 MW from the gyrotrons to the launcher.

estibular evoked myogenic potentials (VEMPs) represent a relatively recent subject Vestibular evoked myogenic potentials (VEMPs) represent a relatively recent subject of investigation in regard to diagnosing specific vestibular disorders. Numerous experimental animal models 1-3 and clinical studies 4-9 suggest that VEMPs are a vestibularcolic reflex, the afferent branch of which originates in the acoustic cells of the saccule, conducting signals through the inferior vestibular nerve. These studies have proposed hypotheses based on the possibility of VEMPs originating in the saccule but have provided no definitive proof to that effect.

The purpose of this study was to determine the effectiveness of a new physical maneuver in the treatment of the apogeotropic variant of horizontal canal benign paroxysmal positional vertigo.Case review.Outpatient clinic.The diagnosis of apogeotropic horizontal canal benign paroxysmal positional vertigo was based on the history of recurrent sudden crisis of vertigo associated with bursts of horizontal apogeotropic paroxysmal nystagmus provoked by turning the head from the supine to either lateral position. The patients were three men and five women ranging in age from 31 to 73 years (average, 49.2 yr).All patients were treated with a repositioning maneuver based on the hypothesis that the syndrome is caused by the presence of free-floating dense particles inside the endolymph of the anterior arm of the horizontal canal. The maneuver favors their shifting into the posterior arm of the canal. Patients were reexamined immediately after the treatment and underwent Gufoni's liberatory maneuver for the geotropic variant of horizontal canal benign paroxysmal positional vertigo.The treatment outcome was considered as responsive when, after one repositioning maneuver, nystagmus shifted from apogeotropic to geotropic.The repositioning maneuver resulted in a transformation from the apogeotropic variant into a geotropic variant of horizontal canal benign paroxysmal positional vertigo in all patients.This maneuver represents a simple and effective approach to the treatment of the apogeotropic variant of horizontal canal benign paroxysmal positional vertigo. It favors the shifting of the canaliths from the anterior into the posterior arm of the horizontal canal from where they can migrate into the utricle with Gufoni's maneuver.

Objectives/Hypothesis: The objective was to evaluate dizziness as the first symptom of endolymphatic hydrops, which could provide valuable information on the initial stages of endolymphatic hydrops development. Study Design: The present investigation was specifically designed to establish whether a combination of the traditional glycerol test and the vestibular evoked myogenic potential (VEMP) glycerol test is capable of diagnosing endolymphatic hydrops early and to identify potential Meniere's disease. The study was limited to patients who complained of dizziness as their only vestibular symptom. Methods: Thirty-eight consecutive patients with dizziness who had received no treatment were investigated. Each patient underwent glycerol testing measured with both conventional pure-tone audiometry and vestibular evoked myogenic potential testing. For the vestibular evoked myogenic potential glycerol test, an increase of more than 20% in both latency and amplitude after glycerol intake was considered an improvement. Results: In one patient, the reappearance of the vestibular evoked myogenic potentials was observed. In another six patients, there was an increase in the vestibular evoked myogenic potential amplitudes, unilaterally in four cases and bilaterally in two. One patient showed a bilateral improvement in amplitude and an unilateral amelioration in latency. Conclusion: The assumption of saccular dilation as a sign of early Meniere's disease was not supported by the literature, which considered saccular hydrops as the final progression of the dilation of the endolymphatic compartments into the cochlea. These data seem to indicate that in our patients a saccular dysfunction rather than an early saccular hydrops has been documented, confirming vestibular evoked myogenic potential testing as an intriguing diagnostic option for a lesion of this structure. The vestibular evoked myogenic potential glycerol test proved capable of identifying dysfunctions of the saccule that were not otherwise detectable by the routine methods. Therefore, the vestibular evoked myogenic potential glycerol test should be considered as an additional method of diagnosis in patients with vertigo or dizziness.

Objective The purpose of this study was to determine the effectiveness of a new liberatory maneuver in the management of the geotropic variant of horizontal canal paroxysmal positional vertigo (HC-PPV). Study design Case review. Setting Outpatient clinic. Patients The diagnosis of HC-PPV was based on the history of recurrent sudden crisis of vertigo associated with bursts of horizontal geotropic paroxysmal nystagmus provoked by turning the head from the supine to either lateral position. The patients were 11 men and 21 women ranging in age from 30 to 85 years (average 55.43 years), and the average duration of symptoms was 7.68 days. Interventions All patients were treated with a liberatory maneuver based on the hypothesis that the syndrome is caused by the presence of free-floating dense particles inside the endolymph of the posterior arm of the semicircular horizontal canal. The maneuver favors their outmigration into the utricle. Patients were reexamined immediately after the treatment and again 2 days later. Main outcome measure The treatment outcome was considered as responsive when, after one or more liberatory maneuvers, the clinical signs of PPV disappeared at the end of physical therapy. Results The liberatory maneuver resulted in a complete remission of the positioning vertigo and nystagmus in all patients after the first session. Conclusions This approach represents a simple and effective approach to the management of the geotropic form of HC-PPV.

Nuclear fusion power plants require electron cyclotron (EC) heating and current drive (H&CD) systems for plasma heating and stabilization. High-power microwave beams between 1 and 2 MW generated by gyrotrons propagate in a dedicated waveguide transmission system to reach the plasma at specific locations. Key components in this transmission system are the chemical vapor deposition diamond windows on both the torus and gyrotron sides of the reactor as they allow transmission of high-power beams while acting as confinement and/or vacuum boundaries. Diamond windows consist of a polycrystalline diamond disk integrated in a metallic housing. In the conventional configuration, there is one disk perpendicular to the beam propagation direction. A steering mechanism is then used to deploy the fixed frequency beam at different locations in the plasma. This is, for instance, the configuration used in the ITER EC H&CD system. Movable parts close to the plasma will be problematic for the lifetime of launchers in future fusion reactors like the DEMOnstration nuclear fusion reactor (DEMO) because of the higher heat loads and neutron fluxes. Therefore, one of the alternative concepts is to deploy the beams directly at the desired resonant magnetic flux surface by frequency tuning gyrotrons. In this case, diamond windows able to work in a given frequency range, like the diamond Brewster-angle window, are required. It is an elegant and compact broadband window solution with the disk inclined at the Brewster angle with respect to the beam direction. This paper shows the development and the current state of different diamond window concepts including the design, the numerical analyses, and application of standard construction nuclear codes and of a specific qualification program.