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Subclinical hypothyroidism (SCH) is characterized by elevated thyroid-stimulating hormone (TSH) and normal free thyroxine levels. The Korean Thyroid Association recently issued a guideline for managing SCH, which emphasizes Korean-specific TSH diagnostic criteria and highlights the health benefits of levothyroxine (LT4) treatment. A serum TSH level of 6.8 mIU/L is presented as the reference value for diagnosing SCH. SCH can be classified as mild (TSH 6.8 to 10.0 mIU/L) or severe (TSH >10.0 mIU/L), and patients can be categorized as adults (age

Subclinical hypothyroidism (sHypo) is defined as normal serum free thyroid hormone levels coexisting with elevated serum thyroid-stimulating hormone (TSH) levels. sHypo is a common condition observed in clinical practice with several unique features. Its diagnosis should be based on an understanding of geographic and demographic differences in biochemical criteria versus a global reference range for TSH that is based on the 95% confidence interval of a healthy population. During the differential diagnosis, it is important to remember that a considerable proportion of sHypo cases are transient and reversible in nature; the focus is better placed on persistent or progressive forms, which mainly result from chronic autoimmune thyroiditis. Despite significant evidence documenting the health impacts of sHypo, the effects of levothyroxine treatment (LT4-Tx) in patients with sHypo remains controversial, especially in patients with grade 1 sHypo and older adults. Existing evidence suggests that it is reasonable to refrain from immediate LT4-Tx in most patients if they are closely monitored, except in women who are pregnant or in progressive cases. Future research is needed to further characterize the risks and benefits of LT4-Tx in different patient cohorts.

The aggregation of α-synuclein (α-syn) has been implicated in the pathogenesis of many neurodegenerative disorders, including Parkinson’s disease (PD), dementia with Lewy bodies (DLB), and multiple system atrophy (MSA). Postmortem analyses of α-syn pathology, especially that of PD, have suggested that aggregates progressively spread from a few discrete locations to wider brain regions. The neuron-to-neuron propagation of α-syn has been suggested to be the underlying mechanism by which aggregates spread throughout the brain. Many cellular and animal models has been created to study cell-to-cell propagation. Recently, it has been shown that a single injection of preformed fibrils (PFFs) made of recombinant α-syn proteins into various tissues and organs of many different animal species results in widespread α-syn pathology in the central nervous system (CNS). These PFF models have been extensively used to study the mechanism by which aggregates spread throughout the brain. Here, we review what we have learned from PFF models, describe the nature of PFFs and the neuropathological features, neurophysiological characteristics, and behavioral outcomes of the models.

Autoimmune thyroid disease (AITD) includes hyperthyroid Graves disease, hypothyroid autoimmune thyroiditis, and subtle subclinical thyroid dysfunctions. AITD is caused by interactions between genetic and environmental predisposing factors and results in autoimmune deterioration. Data on polymorphisms in the AITD susceptibility genes, related environmental factors, and dysregulation of autoimmune processes have accumulated over time. Over the last decade, there has been progress in the clinical field of AITD with respect to the available diagnostic and therapeutic methods as well as clinical consensus. The updated clinical guidelines allow practitioners to identify the most reasonable and current approaches for proper management. In this review, we focus on recent advances in understanding the genetic and environmental pathogenic mechanisms underlying AITD and introduce the updated set of clinical guidelines for AITD management. We also discuss other aspects of the disease such as management of subclinical thyroid dysfunction, use of levothyroxine plus levotriiodothyronine in the treatment of autoimmune hypothyroidism, risk assessment of long-standing antithyroid drug therapy in recurrent Graves' hyperthyroidism, and future research needs.

ITER will use beryllium as a plasma-facing material in the main chamber, covering a total surface area of about 620 m2. Given the importance of beryllium erosion and co-deposition for tritium retention in ITER, significant efforts have been made to understand the behaviour of beryllium under fusion-relevant conditions with high particle and heat loads. This paper provides a comprehensive report on the state of knowledge of beryllium behaviour under fusion-relevant conditions: the erosion mechanisms and their consequences, beryllium migration in JET, fuel retention and dust generation. The paper reviews basic laboratory studies, advanced computer simulations and experience from laboratory plasma experiments in linear simulators of plasma–wall interactions and in controlled fusion devices using beryllium plasma-facing components. A critical assessment of analytical methods and simulation codes used in beryllium studies is given. The overall objective is to review the existing set of data with a broad literature survey and to identify gaps and research needs to broaden the database for ITER.

Optical emission spectroscopy has been widely used in low-temperature argon plasma diagnostics. A coronal model is usually used to analyze the measured line ratios for diagnostics with a single temperature and density. However, many plasma processing conditions deviate from single temperature and density, optically thin conditions, or even coronal plasma conditions due to cascades from high-lying states. In this paper, we present a collisional-radiative model to investigate the validity of coronal approximations over a range of plasma conditions of Te = 1–4 eV and Ne = 108–1013 cm−3. The commonly used line ratios are found to change from a coronal limit where they are independent of Ne to a collisional-radiative regime where they are not. The effects of multiple-temperature plasma, radiation trapping, wall neutralization, and quenching on the line ratios are investigated to identify the plasma conditions under which these effects are significant. This study demonstrates the importance of the completeness of atomic datasets in applying a collisional-radiative model to low-temperature plasma diagnostics.

Context: Because subclinical hyperthyroidism increases the risk of osteoporosis and fractures, concerns are growing about the long-term skeletal safety of TSH suppression therapy after total thyroidectomy in patients with differentiated thyroid cancer (DTC).Objective: We aimed to determine the effect of TSH suppression therapy on bone mineral density (BMD) in DTC patients.Methods: We searched PubMed, Embase, the Cochrane library, and other sources. Eligible observational studies included DTC patients who underwent TSH suppression therapy and BMD measurement. Two independent reviewers extracted data on the studies' characteristics and outcomes and determined their risk of bias. Data were extracted from each study for postmenopausal/premenopausal women's and men's lumbar spine (LS), femoral neck (FN), and total hip (TH) BMD and summed using a random-effects meta-analysis model. The weighted mean differences with 95% CIs are expressed for the differences in outcome measurements between groups.Results: Seventeen studies (739 patients and 1085 controls) were included for quantitative analysis. In postmenopausal women, TSH suppression therapy showed a significant decrease in LS BMD (-0.03; -0.05, -0.02), and a similar trend was seen in TH. In premenopausal women, TSH suppression therapy significantly increased LS BMD (0.04; 0.02, 0.06) and FN BMD (0.02; 0.01, 0.04). In men, there was no significant association between TSH suppression therapy and BMD at any site compared with the controls.Conclusion: Evidence from observational studies suggests that postmenopausal women treated with TSH suppression therapy are at risk for lower BMD. Attention should be paid to long-term skeletal safety in DTC survivors. [ABSTRACT FROM AUTHOR]

Background:A major problem with antithyroid drug (ATD) therapy in Graves'' disease is the high relapse rate. Therefore, clinicians have sought prognostic indicators of permanent remission. Suppression of serum thyrotropin (TSH) when ATD therapy is stopped carries a poor prognosis, but little is known regarding the significance of elevated serum TSH concentrations in the course of ATD therapy. The objective of this study was to determine if elevated serum TSH concentrations during methimazole (MMI) therapy is associated with a favorable long-term prognosis.Methods:We retrospectively studied patients with Graves'' disease who were initially on MMI, in whom this drug was stopped because they had undetectable thyroid-stimulating antibodies (TSAbs) or were euthyroid after at least 24 months on MMI treatment. A strategy of high MMI doses plus T4 was not used in these patients. We identified 40 patients with elevated serum TSH concentration (>10 μIU/mL) during MMI therapy (H-TSH group). Eighty-five percent of the H-TSH group had negative tests for TSAb. The H-TSH group was sex- and age-matched with 37 patients who had similar selection criteria, but did not have elevated serum TSH concentration during MMI therapy (N-TSH group). The H-TSH and N-TSH groups were similar in gross thyroid size, percentage of patients with exophthalmos, serum free thyroxine, duration of MMI treatment, TSAb status, duration that their TSAb tests remained negative, and thyroid peroxidase antibody titers. The patients were followed for 24 months after stopping MMI.Results:In the H-TSH group, MMI-associated hypothyroidism typically occurred after 7–8 months of treatment with daily doses of 10–15 mg MMI. No patient had severe symptoms of hypothyroidism. The percentage of patients in remission at 6, 12, and 24 months after discontinuation of MMI was 90.0, 87.5, and 85.0, respectively, in the H-TSH group and 70.3, 67.6, and 54.1, respectively, in the N-TSH group (p< 0.05 for the comparison of groups at 6 and 12 months and p< 0.001 for comparison of the groups at 24 months).Conclusions:In patients with Graves'' disease who are treated with MMI for at least 2 years and become euthyroid, the occurrence of elevated serum TSH concentrations during MMI treatment is a favorable indicator for long-term remission and is independent of multiple other factors including TSAb status, duration of MMI treatment, and gross parameters of goiter size. [ABSTRACT FROM AUTHOR]

49,XXXXY syndrome is a rare sex chromosome aneuploidy and characterized by mental retardation, skeletal defects, craniofacial anomalies and hypogonadism. The increased frequency of diabetes mellitus in patients with Klinefelter syndrome and other types of X-chromosome polysomy has been reported, but no cases of diabetes mellitus in adult with 49,XXXXY syndrome have been reported so far. We report an 18-year-old patient with 49,XXXXY syndrome accompanying diabetes mellitus. Copyright © 2006 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

The article comments on a study which examines the association between cardiac autonomic neuropathy (CAN) and carotid atherosclerosis in type 2 diabetes patients. The significance of the CAN evaluation process and the score of the five CAN tests are described. Further study to assess the clinical significance of CAN evaluation and the development of more cost-effective methods of CAN evaluation is suggested.

Abstract The advent of x-ray free-electron lasers has enabled a range of new experimental investigations into the properties of matter driven to extreme conditions via intense x-ray-matter interactions. The femtosecond timescales of these interactions lead to the creation of transient high-energy-density plasmas, where both the electrons and the ions may be far from local thermodynamic equilibrium. Predictive modelling of such systems remains challenging because of the different timescales at which electrons and ions thermalize, and because of the vast number of atomic configurations required to describe highly-ionized plasmas. Here we present CCFLY, a code designed to model the time-dependent evolution of both electron distributions and ion states interacting with intense x-ray fields on ultra-short timescales, far from local thermodynamic equilibrium. We explore how the plasma relaxes to local thermodynamic equilibrium on femtosecond timescales in terms of the charge state distribution, electron density, and temperature.

In a post-thermal-quench plasma, mitigated or unmitigated, the plasma power balance is mostly between collisional or Ohmic heating and plasma radiative cooling. In a plasma of atomic mixture $\{n_\alpha\}$ with α labeling the atomic species, the power balance sets the plasma temperature, ion charge state distribution $\{n_\alpha^i\}$ with i the charge number, and through the electron temperature $T_\mathrm{e}$ and ion charge state distribution $\{n_\alpha^i\},$ the parallel electric field $E_\parallel.$ Since the threshold electric field for runaway avalanche growth $E_\mathrm{av}$ is also set by the atomic mixture, ion charge state distribution and its derived quantity, the electron density $n_\mathrm{e},$ the plasma power balance between Ohmic heating and radiative cooling imposes a stringent constraint on the plasma regime for avoiding and minimizing runaways when a fusion-grade tokamak plasma is rapidly terminated.

An inventive method was applied to determine the minimum major radius, R0, and the optimum build of a tokamak fusion reactor that simultaneously meets all physics, engineering, and neutronics constraints. With a simple cost model, tokamak systems analyses were carried out over ranges of system parameters to find an optimum build of a tokamak fusion reactor at minimum cost. The impact of a wide range of physics parameters and advanced engineering elements on costs were also addressed. When a central solenoid was used to ramp up a plasma current, design solutions with a cost of electricity (COE) between 109 and 140 mills/kWh, direct capital cost between 5000 and 6000 M/USD, and net electric power, Pe between 1000 and 1600 MW could be found with a minimum R0 between 6.0 and 7.0 m, and fusion power, Pfusion between 2000 and 2800 MW. When the plasma current was driven by a non-inductive external system, the system size and costs could be reduced further; a COE between 98 and 130 mills/kWh, direct capital cost between 4000 and 5000 M$, and Pe between 1000 and 1420 MW could be found with a minimum R0 between 5.1 and 6.7 m, and Pfusion between 2000 and 2650 MW.

The generation of solid-density plasmas in a controlled manner using an X-ray free electron laser (XFEL) has opened up the possibility of diagnosing the atomic properties of hot, strongly coupled systems in novel ways. Previous work has concentrated on K-shell emission spectroscopy of low Z (Z(=32) element Germanium, where the XFEL creates copious L-shell holes, and the plasma conditions are interrogated by recording of the associated L-shell X-ray emission spectra. Given the desirability of generating as uniform a plasma as possible, we present here a study of the effects of the FEL photon energy on the temperatures and electron densities created, and their uniformity in the FEL beam propagation direction. We show that good uniformity can be achieved by tuning the photon energy of the XFEL such that it does not overlap significantly with L-shell to M-shell bound-bound transitions, and lies below the L-edges of the ions formed during the heating process. Reasonable agreement between experiment and simulations is found for the emitted X-ray spectra, demonstrating that for these higher Z elements, the selection of appropriate XFEL parameters is important for achieving uniformity in the plasma conditions.

Line-shape analysis is one of the most important tools for diagnostics of both laboratory and space plasmas. Its reliable implementation requires sufficiently accurate calculations, which imply the use of analytic methods and computer codes of varying complexity, and, necessarily, varying limits of applicability and accuracy. However, studies comparing different computational and analytic methods are almost non-existent. The Spectral Line Shapes in Plasma (SLSP) code comparison workshop series [1] was established to fill this gap. Numerous computational cases considered in the two workshops organized to date (in April 2012 and August 2013 in Vienna, Austria) not only serve the purpose of code comparison, but also have applications in research of magnetic fusion, astrophysical, laser-produced plasmas, and so on. Therefore, although the first workshop was briefly reviewed elsewhere [2], and will likely be followed by a review of the second one, it was unanimously decided by the participants that a volume devoted to results of the workshops was desired. It is the main purpose of this special issue.

The Spectral Line Shapes in Plasmas (SLSP) code comparison workshop series [...]

Atomic structure and transition probabilities are fundamental physical data required in many fields of science and technology. Atomic physics codes are freely available to other community users to generate atomic data for their interest, but the quality of these data is rarely verified. This special issue addresses estimation of uncertainties in atomic structure and transition probability calculations, and discusses methods and strategies to assess and ensure the quality of theoretical atomic data.

Ultrafast optical excitation of matter leads to highly excited states that are far from equilibrium. In this study, femtosecond x-ray absorption spectroscopy was used to visualize the ultrafast dynamics in photoexcited warm dense Cu. The rich dynamical features related to d vacancies are observed on femtosecond timescales. Despite the success in explaining x-ray absorption data in the picosecond regime, the new femtosecond data are poorly understood through the traditional two-temperature model based on the fast thermalization concept and the static electronic structure for high-temperature metals. An improved understanding can be achieved by including the recombination dynamics of nonthermal electrons and changes in the screening of the excited d block. The population balance between the 4sp and 3d bands is mainly determined by the recombination rate of nonthermal electrons, and the underpopulated 3d block is initially strongly downshifted and recovered in several hundreds of femtoseconds. [ABSTRACT FROM AUTHOR]

There exist several codes in the atomic physics community to generate atomic structure and transition probabilities freely and readily distributed to researchers outside atomic physics community, in plasma, astrophysical or nuclear physics communities. Users take these atomic physics codes to generate the necessary atomic data or modify the codes for their own applications. However, there has been very little effort to validate and verify the data sets generated by non-expert users. [...]