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TCV is acquiring a new 1 MW neutral beam and 2 MW additional third-harmonic electron cyclotron resonance heating (ECRH) to expand its operational range. Its existing shaping and ECRH launching versatility was amply exploited in an eclectic 2013 campaign. A new sub-ms real-time equilibrium reconstruction code was used in ECRH control of NTMs and in a prototype shape controller. The detection of visible light from the plasma boundary was also successfully used in a position-control algorithm. A new bang-bang controller improved stability against vertical displacements. The RAPTOR real-time transport simulator was employed to control the current density profile using electron cyclotron current drive. Shot-by-shot internal inductance optimization was demonstrated by iterative learning control of the current reference trace. Systematic studies of suprathermal electrons and ions in the presence of ECRH were performed. The L–H threshold power was measured to be ∼50–75% higher in both H and He than D, to increase with the length of the outer separatrix, and to be independent of the current ramp rate. Core turbulence was found to decrease from positive to negative edge triangularity deep into the core. The geodesic acoustic mode was studied with multiple diagnostics, and its axisymmetry was confirmed by a full toroidal mapping of its magnetic component. A new theory predicting a toroidal rotation component at the plasma edge, driven by inhomogeneous transport and geodesic curvature, was tested successfully. A new high-confinement mode (IN-mode) was found with an edge barrier in density but not in temperature. The edge gradients were found to govern the scaling of confinement with current, power, density and triangularity. The dynamical interplay of confinement and magnetohydrodynamic modes leading to the density limit in TCV was documented. The heat flux profile decay lengths and heat load profile on the wall were documented in limited plasmas. In the snowflake (SF) divertor configuration the heat flux profiles were documented on all four strike points. SF simulations with the EMC3-EIRENE code, including the physics of the secondary separatrix, underestimate the flux to the secondary strike points, possibly resulting from steady-state E × B drifts. With neon injection, radiation in a SF was 15% higher than in a conventional divertor. The novel triple-null and X-divertor configurations were also achieved in TCV. [ABSTRACT FROM AUTHOR]

The dynamics of suprathermal electrons in the presence of magnetohydrodynamics (MHD) activity and the excitation of MHD modes by suprathermal electrons are studied experimentally to improve the understanding of the interaction of fast particles with MHD instabilities in a tokamak. The study focuses on three different aspects of the internal kink mode with poloidal/toroidal mode number : the sawtooth instability, electron fishbones and coupled bursts alternating with sawtooth crashes (CAS), all located where the safety factor profile approaches or takes the value . New quantitative results on suprathermal electron transport and an investigation of electron acceleration during sawtooth crashes are followed by the characterization of initial electron fishbone observations on the Tokamak à configuration variable (TCV). Finally, bursts associated with the sawtooth cycle, coupled to a persisting mode and alternating with sawtooth crashes, are discussed, in particular in view of the fast electron dynamics and their role in confinement degradation and mode excitation. [ABSTRACT FROM AUTHOR]

For a comprehensive comparison with theoretical models and advanced numerical turbulence simulations, a large spectrum of fluctuation parameters was measured on the devices ASDEX Upgrade, TCV, and Tore-Supra. Radial profiles of scale-resolved turbulence levels in H-mode discharges are measured and compared with GENE simulations in the transition range from ion-temperature-gradient to trapped-electron-mode turbulence. Correlation reflectometry is used to study the microscopic structure of turbulence and GAMs in discharges where poloidal flow damping was varied by means of variations of the shape of the poloidal plasma cross-section and collisionality. Full-wave codes and synthetic diagnostics are applied for the interpretation of the data. [ABSTRACT FROM AUTHOR]

Recent experiments have been performed on the Tokamak à configuration variable (TCV) to investigate the confinement properties of high density plasmas and the mechanism behind the density limit. In a limiter configuration with plasma elongation and triangularity the operational density range has been extended up to 0.65 of the Greenwald density at  kA () and even to the Greenwald value at low plasma current  kA (). A transition from the linear to the saturated ohmic confinement regime is observed at high density . A further density increase leads to sawtooth stabilization and is accompanied by a decrease of the energy and particle confinement times. The development of the disruption at the density limit was preceded by sawtooth stabilization. It is shown that electron cyclotron heating leads to the prevention of sawtooth stabilization and then to the increase of the density limit value. [ABSTRACT FROM AUTHOR]

The design of a snowflake (SF) equilibrium requires a strong effort on the poloidal field (PF) currents in terms of MAturns and mechanical loads. This has limited the maximum plasma current in SF configurations on Tokamak à Configuration Variable (TCV) to values well below the intrinsic magnetohydrodynamic limits. In this paper the definition of optimized SF configurations in TCV and their experimental tests are illustrated. The PF current optimization procedure proposed in Albanese et al (2014 Plasma Phys. Control. Fusion56 035008) is adapted and applied to a SF scenario in TCV where the PF currents were close to their operational limits with the aim of reducing the total MAturns in view of higher values of the plasma current. This procedure optimizes the PF currents while fulfilling the machine technological constraints for a given bound on the tolerable plasma shape changes. The method exploits the linearized relation between the plasma–wall gaps and the PF currents. In the investigated TCV scenario the optimization procedure allowed a 20% increase of the plasma current while keeping the plasma shape alignment with respect to the nominal shape within a tolerance of 1 cm. The predicted optimization potential was confirmed in a TCV experiment. [ABSTRACT FROM AUTHOR]

Starting from a standard single null X-point configuration, a second order null divertor (snowflake (SF)) has been successfully created on the Tokamak a Configuration Variable (TCV) tokamak. The magnetic properties of this innovative configuration have been analysed and compared with a standard X-point configuration. For the SF divertor, the connection length and the flux expansion close to the separatrix exceed those of the standard X-point by more than a factor of 2. The magnetic shear in the plasma edge is also larger for the SF configuration. [ABSTRACT FROM AUTHOR]

Tokamak plasmas operating at high performance are limited by several MHD instabilities. The sawtooth instability limits the core plasma pressure and can drive the neoclassical tearing mode unstable, but also prevents accumulation of impurities in the core. Electron cyclotron heating and current drive systems can be used to modify the local current profile and therefore tailor the sawtooth period. This paper reports on demonstrations of continuous real time feedback control of the sawtooth period by varying the EC injection angle. [ABSTRACT FROM AUTHOR]

Nowadays the phenomenon of global warming is unequivocal, as confirmed by the latest reports of the IPCC and studies of the climate-change impacts on ecosystems, global economy, and populations. The effect of climate change on groundwater is a very relevant task especially for regions dependent chiefly on groundwater availability, as for the southern Italy. In such a territorial framework, to achieve a detailed hydro-climatological characterization, an Ensemble of 15 RCMs (E15) derived from the EURO-CORDEX project was analyzed considering two IPCC Representative Concentration Pathways (RCP4.5 and RCP8.5). The E15 was calibrated over the period (1950-1996) by a statistical comparison with data observed by the regional meteorological network managed by the former National Hydrological Service (SIMN), Department of Naples. The effects of climate change on air temperature (T), precipitation (P) and, consequently, on actual evapotranspiration (ETR) and effective precipitation Pe (P - ETR) were analyzed until 2100. The latter was considered as a proxy of groundwater recharge of the principal aquifer systems, represented chiefly by the karst aquifers. As a principal result, it was found that the E15 is basically able to reproduce the observed annual precipitation (OBS P ) and mean annual air temperature (OBS T ), being characterized by a very similar frequency distribution. Accordingly, an inferential statistical approach was performed for calibrating E15 precipitation (E15 P ) and air temperature (E15 T ) based on the compensation of the difference with OBS P (+ 7%) and OBS T (- 16%). The E15 projects a reduction in precipitation and an increase in air temperature under both RCPs, with a divergence point between the two scenarios occurring by about 2040. As a principal result, Pe shows declining trends for both RCP scenarios, reaching a decrease of the 11-yrs moving average down to - 20%, for RCP4.5, and - 50%, for RCP8.5, even if characterized by relevant inter-annual fluctuations., (© 2024. The Author(s).)

We report observations of nonlinear two-plasmon decay instabilities (TPDIs) of a high-power microwave beam, a process similar to half-harmonic generation in optics, during electron cyclotron resonance heating in a tokamak. TPDIs are found to occur regularly in the plasma edge due to wave trapping in density fluctuations for various confinement modes, and the frequencies of both observed daughter waves agree with modeling. Emissions from a cascade of subsequent decays, which indicate a generation of ion Bernstein waves, are correlated with fast-ion generation. This emphasizes the limitations of standard linear microwave propagation models and possibly paves the way for novel microwave applications in plasmas.

In this paper, a diagnostic for the measurement of the electron cyclotron emission (ECE) from non-thermal electrons in magnetically confined fusion plasmas is presented. The diagnostic employs a vertical viewing line of sight that allows us to directly infer the energy of the emitting electrons. Previous incarnations of this diagnostic on other machines have been limited by refraction, which can cause stray radiation to enter the line of sight, polluting the signal. By tuning the toroidal magnetic field on the Tokamak à Configuration Variable, TCV, and by carefully selecting the range of frequencies that are used to measure the ECE spectrum, refraction can be mitigated and background radiation power reduced to below the noise power of the instrumentation. A novel technique for calibrating the diagnostic based on plasma measurements and modeling has been developed. The paper will describe the Vertical ECE (V-ECE) diagnostic on TCV, the calibration method, and the first results from the measurements., (© 2023 Author(s). All article content, except where otherwise noted, is licensed under a Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).)

Lower gastrointestinal endoscopy is considered the gold standard for the diagnosis and removal of colonic polyps. Delays in colonoscopy following a positive fecal immunochemical test increase the likelihood of advanced adenomas and colorectal cancer (CRC) occurrence. However, patients may refuse to undergo conventional colonoscopy (CC) due to fear of possible risks and pain or discomfort. In this regard, patients undergoing CC frequently require sedation to better tolerate the procedure, increasing the risk of deep sedation or other complications related to sedation. Accordingly, the use of CC as a first-line screening strategy for CRC is hampered by patients' reluctance due to its invasiveness and anxiety about possible discomfort. To overcome the limitations of CC and improve patients' compliance, several studies have investigated the use of robotic colonoscopy (RC) both in experimental models and in vivo. Self-propelling robotic colonoscopes have proven to be promising thanks to their peculiar dexterity and adaptability to the shape of the lower gastrointestinal tract, allowing a virtually painless examination of the colon. In some instances, when alternatives to CC and RC are required, barium enema (BE), computed tomographic colonography (CTC), and colon capsule endoscopy (CCE) may be options. However, BE and CTC are limited by the need for subsequent investigations whenever suspicious lesions are found. In this narrative review, we discussed the current clinical applications of RC, CTC, and CCE, as well as the advantages and disadvantages of different endoscopic procedures, with a particular focus on RC.

Patients diagnosed with Crohn's disease are increasingly subjected to repeat colonoscopic and radiological examinations to assess the extent of the disease severity and the effects of treatment. Pillcam TM Crohn's video capsule, a modified colon capsule, was developed to generate a minimally invasive mouth to rectum video of the gastrointestinal tract. The capsule provides a wide-angle panoramic mucosal view to assess inflammation, ulceration, stenosis, disease extent, and effect of treatment. This review summarizes the evidence of its utility in both adult and paediatric Crohn's disease and reviews the scoring systems used to quantify findings. The literature survey indicates that the Pillcam TM Crohn's capsule offers high sensitivity and specificity for the detection of inflammatory lesions and the extent and distribution of disease, and it could be considered a reliable imaging modality in both adults and childhood with Crohn's disease.

Background: The management of acromioclavicular (AC) joint dislocation remains controversial. Recently, anatomic coracoclavicular (CC) fixation with a double clavicular tunnel and three flip-buttons has shown promising results. This study aimed to evaluate functional and radiological outcomes in patients with high-grade AC joint dislocation treated with anatomic CC fixation using double clavicular tunnels and three flip-buttons., Methods: A retrospective, unicentric study was performed. The study included patients with high-grade AC joint dislocation who underwent surgery with anatomic CC fixation using double clavicular tunnels and three flip-buttons. Demographic data were obtained from medical records. A functional evaluation using subjective shoulder value (SSV), visual analog scale (VAS), and disabilities of the arm, shoulder, and hand (DASH) questionnaires was performed, and an evaluation of preoperative and postoperative comparative Zanca view images was performed. Factors associated with functional outcomes and radiological AC reduction were analyzed., Results: A total of 83 patients completed follow-up and were included in the analysis. The mean SSV, VAS, and DASH scores were 92.8, 0.8, and 6.4, respectively. Patients who had complications experienced significantly worse functional outcomes (DASH: P=0.037). Suboptimal final AC reduction was observed in nine patients (11.1%), and significantly more frequently in patients older than 40 years (P=0.031) and in surgeries performed more than 7 days after injury (P=0.034). There were two reoperations (2.4%)., Conclusions: Anatomic CC fixation with a double clavicular tunnel and three flip-buttons leads to good functional outcomes, low complication rates, and high rates of optimal AC reduction. Level of Evidence: Level IV; Case series.

Objectives: The EndoRings device is a distal attachment consisting of two layers of circular flexible rings that evert mucosal folds. The aim of this study was to investigate whether EndoRing assisted colonoscopy (ER) improves polyp and adenoma detection compared to standard colonoscopy (SC)., Methods: Multicenter, parallel group, randomized controlled trial., Results: Total of 556 patients randomized to ER (n = 275) or SC (n = 281). Colonoscopy completed in 532/556 (96%) cases. EndoRings removed in 74/275 (27%) patients. Total number of polyps in ER limb 582 vs. 515 in SC limb, P = 0.04. Total number of adenomas in ER limb 361 vs. 343 for SC limb, P = 0.49. A statistically significant difference in the mean number of polyps per patient in both the intention to treat (1.84 SC vs. 2.10 ER, P = 0.027) and per protocol (PP) (1.84 SC vs. 2.25 ER, P = 0.004)., Conclusions: Our study shows promise for the EndoRings device to improve polyp detection., (© 2022 Japan Gastroenterological Endoscopy Society.)

Introduction: in patients with anterior glenohumeral (GH) instability together with an off-track or engaging Hill-Sachs (HS) defect, Bankart-remplissage (B-R) surgery reduces the recurrence rate when compared to Bankart (B) surgery alone. There is controversy regarding whether the recurrence rate also decreases in patients with on-track or non-engaging Hill-Sachs defects., Objective: to compare the recurrence rate and clinical evolution of patients with anterior glenohumeral instability with 'on-track' Hill-Sachs defect treated with either B or B-R surgery., Material and Methods: non-randomized, retrospective, single-center cohort study of patients with anterior glenohumeral instability and on-track Hill-Sachs defect, operated between January 2010 and December 2018. Patients operated with B versus B-R were compared. Recurrence, complications and re-operation were recorded. In addition, VAS, SSV, WOSI and qDASH scores were obtained and compared in both groups., Results: of the 105 patients who met the inclusion criteria, 78 (74.3%) patients had a complete follow-up (52 B and 26 B-R, 4.3 years median follow-up). There was a higher recurrence rate in group B compared to B-R, with this difference not reaching statistical significance (17.3% vs 7.7%, p = 0.21). There were no significant differences in residual pain, feeling of instability, complications or VAS, qDASH, SSV or WOSI scores between both groups. In the subgroup analysis, patients who practiced contact sports and were operated with B showed higher recurrence rates (24.1% vs 0%, p = 0.08) and complications (41.4% vs 18.2%, p = 0.16) when compared to B + R, although these differences were not significant., Conclusion: there were no significant differences in recurrence rates and functional evolution between patients with anterior glenohumeral instability operated with B or B-R surgery. Comparative, prospective studies should be performed to establish definitive recommendations.

The usefulness of virtual chromoendoscopy (VC) in capsule endoscopy (CE) isa controversial issue, with conflicting studies regarding its efficacy. FICE and a blue filter were embedded in the PillCam TM software, with the aim to assist readers in identifying the source of obscure gastrointestinal (GI) bleeding (OGIB), coeliac disease mucosal changes and other small and large bowel lesions, including polyps and tumors. This review aims to summarize the existing evidence on the value of VC in the visualization and identification of different types of pathology. Overall, VC in CE with FICE 1 and 2 can be a useful adjunctive tool and may increase the visibility of pigmented lesions, such as angiectasias and ulcers. However, it does not appear to improve the detection of polyps or tumors. On the other hand, the role of FICE 3 and the blue filter appears to be limited. FICE may also be helpful in differentiating hyperplastic and adenomatous colonic polyps during colon capsule endoscopy, although more evidence is needed.

Opinion Statement: Gastroenteropancreatic neuroendocrine neoplasms (GEP NENs) comprise a heterogeneous group of slow growing tumors arising from the neuroendocrine cells of the gastrointestinal (GI) tract. Although they are considered relatively rare, their incidence is rising and it is believed that the more frequent use of endoscopy and imaging studies have at least in part contributed to the increased diagnosis especially of localized neoplasms. The management of these neoplasms should be guided by a multidisciplinary NEN team following appropriate staging investigations. Localized neoplasms of the GI tract may be suitable for endoscopic therapy, while patients with pancreatic NENs, unsuitable for surgery, should be considered for endoscopic ultrasound (EUS)-guided ablation. In this review, we discuss the evidence regarding endoscopic resection of luminal NENs and EUS-guided therapy of pancreatic NENs. The efficacy, safety, and other longer-term outcomes of these techniques are summarized. In conclusion, this review of endoscopic therapies for localized NENs may be a useful guide for NEN clinicians and endoscopists who are considering these therapeutic options for the management of focal GEP NENs., (© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Nuclear fusion using magnetic confinement, in particular in the tokamak configuration, is a promising path towards sustainable energy. A core challenge is to shape and maintain a high-temperature plasma within the tokamak vessel. This requires high-dimensional, high-frequency, closed-loop control using magnetic actuator coils, further complicated by the diverse requirements across a wide range of plasma configurations. In this work, we introduce a previously undescribed architecture for tokamak magnetic controller design that autonomously learns to command the full set of control coils. This architecture meets control objectives specified at a high level, at the same time satisfying physical and operational constraints. This approach has unprecedented flexibility and generality in problem specification and yields a notable reduction in design effort to produce new plasma configurations. We successfully produce and control a diverse set of plasma configurations on the Tokamak à Configuration Variable 1,2 , including elongated, conventional shapes, as well as advanced configurations, such as negative triangularity and 'snowflake' configurations. Our approach achieves accurate tracking of the location, current and shape for these configurations. We also demonstrate sustained 'droplets' on TCV, in which two separate plasmas are maintained simultaneously within the vessel. This represents a notable advance for tokamak feedback control, showing the potential of reinforcement learning to accelerate research in the fusion domain, and is one of the most challenging real-world systems to which reinforcement learning has been applied., (© 2022. The Author(s).)

The COVID-19 pandemic has caused considerable disruption in healthcare services and has had a substantial impact on the care of patients with chronic diseases, such as inflammatory bowel disease. Endoscopy services were significantly restricted, resulting in long waiting lists. There has been a growing interest in the use of capsule endoscopy in the diagnostic pathway and management of these patients. This review explores the published literature on the role of colon capsule endoscopy in ulcerative colitis and Crohn's disease as a method for mucosal assessment of extent, severity, and response to treatment. Colon capsule preparation regimens and scoring systems are reported. The studies indicate that, despite inherent limitations of minimally invasive capsule endoscopy, there is increasing evidence to support the use of the second-generation colon capsule in inflammatory bowel disease evaluation, providing an additional pathway to expedite investigation of appropriate patients especially during and after the pandemic.

Many areas around the world are affected by Groundwater Level rising (GWLr). One of the most severe consequences of this phenomenon is Groundwater Flooding (GF), with serious impacts for the human and natural environment. In Europe, GF has recently received specific attention with Directive 2007/60/EC, which requires Member States to map GF hazard and propose measures for risk mitigation. In this paper a methodology has been developed for Groundwater Flooding Susceptibility (GFS) assessment, using for the first time Spatial Distribution Models. These Machine Learning techniques connect occurrence data to predisposing factors (PFs) to estimate their distributions. The implemented methodology employs aquifer type, depth of piezometric level, thickness and hydraulic conductivity of unsaturated zone, drainage density and land-use as PFs, and a GF observations inventory as occurrences. The algorithms adopted to perform the analysis are Generalized Boosting Model, Artificial Neural Network and Maximum Entropy. Ensemble Models are carried out to reduce the uncertainty associated with each algorithm and increase its reliability. GFS is mapped by choosing the ensemble model with the best predictivity performance and dividing occurrence probability values into five classes, from very low to very high susceptibility, using Natural Breaks classification. The methodology has been tested and statistically validated in an area of 14,3 km 2 located in the Metropolitan City of Naples (Italy), affected by GWLr since 1990 and GF in buildings and agricultural soils since 2007. The results of modeling show that about 93% of the inventoried points fall in the high and very high GFS classes, and piezometric level depth, thickness of unsaturated zone and drainage density are the most influencing PFs, in accordance with field observations and the triggering mechanism of GF. The outcomes provide a first step in the assessment of GF hazard and a decision support tool to local authorities for GF risk management., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Introduction: Significant Hill-Sachs lesions are associated with recurrent shoulder instability. Bankart-Remplissage (B+R) and Latarjet (L) are valid treatments for these injuries. Few studies compare both techniques., Objective: To compare functional outcome, complications and recurrent instability rate between B+R and L in patients operated for anterior shoulder instability (ASI) with significant Hill-Sachs (HS) lesions and non critical glenoid bone loss (NC-GBL)., Material and Methods: Retrospective cohort study with patients operated between 2010 and 2018 for ASI. 107 met inclusion criteria. Demographic data, complications, recurrence rate and subsequent procedures were obtained from their medical records. CT scan imaging was used to assess humeral and glenoid bone loss. Online questionnaires were sent for assesing functional outcomes with SSV, WOSI, VAS and qDASH. 48 patients completed the online assessment (26 B+R, 22 L). The mean follow-up was 3.8 years., Results: Comparing both groups, there were no differences in WOSI, SSV, EVA and qDASH. There was no difference in complication rate (B+R: 13 [18.8%], L: 5 [13.2%], p = 0.16), revisions (B+R: 4 [5.7%], L: 1 [2.6%], p = 0.41) and recurrent instability (B+R: 4 [5.7%], L: 1 [2.6%], p = 0.41). L in subgroup who practiced collision sports had better SSV (92.5 vs 72.5 p = 0.048) and WOSI (98.3 vs 67.3 p = 0.043). B+R in dominant extremity had worst complication rate (50 vs 9.1% p = 0.038). Association was not found between complications and recurrent instabillity according to glenoid bone defect or previous dislocation episodes., Conclusion: Significant Hill-Sachs lesions with NC-GBL, both Bankart-Remplissage and Latarjet achieve satisfactory results, with similar recurrent instability and functional outcomes. Latarjet has better subjetive funtional results in collision sports and less complication in dominant extremity compared to Bankart-Remplissage.

Capsule endoscopy (CE) has been increasingly utilised in recent years as a minimally invasive tool to investigate the whole gastrointestinal (GI) tract and a range of capsules are currently available for evaluation of upper GI, small bowel, and lower GI pathology. Although CE is undoubtedly an invaluable test for the investigation of small bowel pathology, it presents considerable challenges and limitations, such as long and laborious reading times, risk of missing lesions, lack of bowel cleansing score and lack of locomotion. Artificial intelligence (AI) seems to be a promising tool that may help improve the performance metrics of CE, and consequently translate to better patient care. In the last decade, significant progress has been made to apply AI in the field of endoscopy, including CE. Although it is certain that AI will find soon its place in day-to-day endoscopy clinical practice, there are still some open questions and barriers limiting its widespread application. In this review, we provide some general information about AI, and outline recent advances in AI and CE, issues around implementation of AI in medical practice and potential future applications of AI-aided CE.

This article describes the realization of a novel approach to short pulse (∼1 ns) reflectometry (SPR) recently implemented in the tokamak configuration variable tokamak. Taking advantage of a fast arbitrary waveform generator and vector-network-analyzer extension modules, the design offers flexibility regarding pulse output frequency, duration, and repetition rate. Such flexibility allows the instrument to overcome traditional SPR spatial sampling limitations while reducing hardware complexity. In order to measure the group-delay of nanosecond-scale pulses, both traditional analog and novel digital sampling techniques have been explored. A group-delay range resolution of 17 ps (2.6 mm) in average over the V-band has been achieved with both timing techniques against a waveguide mirror featuring 10 dB power fluctuations. Direct pulse sampling during L-mode plasmas shows that reflected pulse widths increase only by 4% in average. However, pulse width dispersion does occur in L-mode plasmas and leads to an increase in the group-delay uncertainty up to 40 ps (6 mm). Raw histograms of group-delay data show interesting qualitative changes from the L mode to the H-mode. Frequency spectra of group-delay data allow the identification of macroscopic density fluctuations as well as edge quasicoherent modes during edge-localized mode-free H-modes. Finally, fast changes to the density profile have been measured with microsecond time resolution and subcentimeter spatial resolution in both O and X-mode polarizations.

Gastric adenocarcinoma carries a poor prognosis, in part due to the late stage of diagnosis. Risk factors include Helicobacter pylori infection, family history of gastric cancer-in particular, hereditary diffuse gastric cancer and pernicious anaemia. The stages in the progression to cancer include chronic gastritis, gastric atrophy (GA), gastric intestinal metaplasia (GIM) and dysplasia. The key to early detection of cancer and improved survival is to non-invasively identify those at risk before endoscopy. However, although biomarkers may help in the detection of patients with chronic atrophic gastritis, there is insufficient evidence to support their use for population screening. High-quality endoscopy with full mucosal visualisation is an important part of improving early detection. Image-enhanced endoscopy combined with biopsy sampling for histopathology is the best approach to detect and accurately risk-stratify GA and GIM. Biopsies following the Sydney protocol from the antrum, incisura, lesser and greater curvature allow both diagnostic confirmation and risk stratification for progression to cancer. Ideally biopsies should be directed to areas of GA or GIM visualised by high-quality endoscopy. There is insufficient evidence to support screening in a low-risk population (undergoing routine diagnostic oesophagogastroduodenoscopy) such as the UK, but endoscopic surveillance every 3 years should be offered to patients with extensive GA or GIM. Endoscopic mucosal resection or endoscopic submucosal dissection of visible gastric dysplasia and early cancer has been shown to be efficacious with a high success rate and low rate of recurrence, providing that specific quality criteria are met., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Introduction: Colonoscopy reduces the risk of colorectal cancer, by interrupting the adenoma-carcinoma sequence enabling the detection and removal of adenomas before they turn into colorectal cancer. Colonoscopy has its limitations as adenoma miss rates as high as 25% have been reported. The reasons for missed pathology are complicated and multi-factorial. The recent drive to improve adenoma detection rates has led to a plethora of new technologies. Areas covered: An increasing number of advanced endoscopes and distal attachment devices have appeared in the market. Advanced endoscopes aim to improve mucosal visualization by widening the field of view. Distal attachment devices aim to increase adenoma detection behind folds by flattening folds on withdrawal. In this review article, we discuss the three following distal attachment devices: the transparent cap, the Endocuff, and the Endoring. Expert commentary: The authors believe that the distal attachment devices will have a greater benefit for endoscopists with low baseline adenoma detection rates.

A variable configuration V-band heterodyne Doppler back-scattering diagnostic has been recently made operational in the tokamak a ̀ configuration variable. This article describes the hardware setup options, flexible quasi-optical launcher antenna, data-analysis techniques, and first data. The diagnostic uses a fast arbitrary waveform generator as the main oscillator and commercial vector network analyzer extension modules as the main mm-wave hardware. It allows sweepable single or multi-frequency operation. A flexible quasi-optical launcher antenna allows 3D poloidal (10°-58°) and toroidal (-180° to 180°) steering of the beam with 0.2° accuracy. A pair of fast HE 11 miter-bend polarizers allow flexible coupling to either O or X mode and programmable polarization changes during the shot. These have been used to measure the magnetic-field pitch angle in the edge of the plasma by monitoring the backscattered signal power. Ray-tracing simulations reveal an available k ⊥ range between 3 and 16 cm -1 with a resolution of 2-4 cm -1 . Perpendicular rotation velocity estimates compare well against ExB plasma poloidal rotation estimates from charge exchange recombination spectroscopy.

A tangential viewing phase contrast imaging system is being designed for the JT-60SA tokamak to investigate microturbulence. In order to obtain localized information on the turbulence, a spatial-filtering technique is applied, based on magnetic shearing. The tangential viewing geometry enhances the radial localization. The probing laser beam is injected tangentially and traverses the entire plasma region including both low and high field sides. The spatial resolution for an Internal Transport Barrier discharge is estimated at 30%-70% of the minor radius at k = 5 cm -1 , which is the typical expected wave number of ion scale turbulence such as ion temperature gradient/trapped electron mode.

Background: This study evaluated the timing and location of radiologic bone adaptations related to shoulder arthroplasty using a single type of cementless short-stem shoulder prosthesis., Methods: Uncemented short-stem shoulder arthroplasties were evaluated in 52 patients at a mean age of 71.6 years (range, 58.1-86.6) with a minimum clinical and radiologic follow-up of 2 years (mean, 32 months; range, 23-52 months). All radiographs were analyzed for inclination of the stem, filling ratio of metaphysis and diaphysis, bone remodeling around the stem, radiolucent lines around the glenoid, and subsidence of the humeral stem. Finally, the radiographic and clinical findings were compared between patients with low and high bone adaptations., Results: At final follow-up, no loosening, subsidence, or osteolysis was seen. High bone adaptations were present in 27 patients (51.9%). Cortical thinning and osteopenia in the medial cortex (82.7%) and spot welds in the lateral cortex (78.6%) were the most frequently occurring bone adaptations. Patients with high bone adaptations had significantly higher metaphyseal (0.60 ± 0.05 vs. 0.56 ± 0.06; P = .024) and diaphyseal filling ratio (0.66 ± 0.04 vs. 0.61 ± 0.06; P = .019) at 2-year follow-up than patients with low bone adaptations. Clinical outcome was not influenced by the radiographic changes., Conclusion: The clinical and radiologic results of the short-stem shoulder arthroplasty are comparable to those with the third and fourth generations of standard stem arthroplasty. Higher filling ratios in the metaphysis and the diaphysis were significantly associated with the occurrence of high bone adaptations., (Copyright © 2016 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.)

Detection, characterization, and staging constitute the fundamental elements in the endoscopic diagnosis of gastrointestinal diseases, but histology still remains the diagnostic gold standard. New developments in endoscopic techniques may challenge histopathology in the near future. An ideal endoscopic technique should combine a wide-field, "red flag" screening technique with an optical contrast or microscopy method for characterization and staging, all simultaneously available during the procedure. In theory, biophotonic advances have the potential to unite these elements to allow in vivo "optical biopsy." These techniques may ultimately offer the potential to increase the rates of detection of high risk lesions and the ability to target biopsies and resections, and so reduce the need for biopsy, costs, and uncertainty for patients. However, their utility and sensitivity in clinical practice must be evaluated against those of conventional histopathology. This review describes some of the most recent applications of biophotonics in endoscopic optical imaging and metrology, along with their fundamental principles and the clinical experience that has been acquired in their deployment as tools for the endoscopist. Particular emphasis has been placed on translational label-free optical techniques, such as fluorescence spectroscopy, fluorescence lifetime imaging microscopy (FLIM), two-photon and multi-photon microscopy, second harmonic generation (SHG) and third harmonic generation (THG) imaging, optical coherence tomography (OCT), diffuse reflectance, Raman spectroscopy, and molecular imaging.

Objective: Conscious sedation is widely used in endoscopic practice but is not without risk. We aimed to determine the frequency of sedation complications requiring reversal, and to identify potential patient and procedural risk factors., Design: A retrospective study of all gastrointestinal endoscopic procedures performed under conscious sedation, in a large three-campus tertiary referral endoscopic centre, between 12 October 2007 and 31 December 2012 (n=52 553). Flumazenil or naloxone administration was used as a marker of sedation complications requiring reversal. Reversal cases were analysed for associations with sedation dose, patient American Society of Anesthesiologists (ASA) grade, age and type of procedure undertaken., Results: In total, 149 sedation reversals occurred, representing 0.28% of all sedated endoscopic procedures carried out. Endoscopic Retrograde Cholangiopancreatography (ERCP) and increasing patient ASA grade were positively associated with sedation reversal (p<0.05). Mean midazolam dose was highest for ERCP (4.9±2.9 mg) and lowest for flexible sigmoidoscopy (1.7±0.6 mg; p<0.01). Mean opioid dose (calculated as pethidine equivalent) was highest for ERCP (62.9±38.7 mg) and lowest for gastroscopy (6.9±13.5 mg; p<0.01). Maximum doses of midazolam or opioid recommended by the British Society of Gastroenterology were exceeded in 7.4% and 14.1% of reversals, respectively., Conclusions: ERCP procedures and higher patient ASA grade were associated with an increased risk of conscious sedation-related complications requiring reversal. In these high-risk groups, alternative sedation strategies should be considered and tested. Prospective studies are needed to further explore risk factors that may help predict adverse sedation outcomes.

Purpose: Uncemented short stem shoulder arthroplasty combines the advantages of a bone-saving implantation with a straightforward revision option. Uncemented humeral long stems can be associated with stress shielding and loosening. Therefore, we analysed the clinical and radiological outcome of a short stem shoulder prosthesis with metaphyseal fixation., Methods: This two-centre study included 82 total shoulder arthroplasties in 80 patients with short stem shoulder prosthesis and a cemented polyethylene glenoid performed between 2010 and 2012. Sixty-eight shoulders had primary osteoarthritis, eight shoulders had post traumatic sequelae and six had other diagnoses. Minimum follow-up was two years. Outcome data included the Constant Score (CS), Subjective Shoulder Value (SSV), Pain Scale (0-15) and range of motion. Radiographic evaluation was done in shoulders with primary osteoarthritis in a standard view., Results: The mean clinical and radiological follow-up was 31.2 ± 7.2 months (20-52). CS improved from 36.7 ± 15.2 % to 90.4 ± 16.4% and SSV improved from 39.4 ± 15.5 points to 85.5 ± 13.2 points (p < 0.0001). Pain was rated as mild or none in 76 shoulders (92.7%) with a mean value of 13.2 ± 2.6. The mean active flexion was 157.0 ± 24.7°, abduction was 152.6 ± 29.1° and the active external rotation was 38.2 ± 14.8° at recent follow-up. Radiographic assessment was done in 44 shoulders. Six shoulders (13.6%) showed features of slight stress shielding at the medial cortex and no stem with subsidence was found. Three glenoids (6.8%) had minor radiolucent lines., Conclusions: Uncemented short stem shoulder arthroplasty with a cemented polyethylene glenoid can yield a stable fixation with a good clinical outcome at minimum follow-up of two years.

Ideally, endoscopists should be able to detect, characterize, and confirm the nature of a lesion at the bedside, minimizing uncertainties and targeting biopsies and resections only where necessary. However, under conventional white-light inspection - at present, the sole established technique available to most of humanity - premalignant conditions and early cancers can frequently escape detection. In recent years, a range of innovative techniques have entered the endoscopic arena due to their ability to enhance the contrast of diseased tissue regions beyond what is inherently possible with standard white-light endoscopy equipment. The aim of this review is to provide an overview of the state-of-the-art advanced endoscopic imaging techniques available for clinical use that are impacting the way precancerous and neoplastic lesions of the gastrointestinal tract are currently detected and characterized at endoscopy. The basic instrumentation and the physics behind each method, followed by the most influential clinical experience, are described. High-definition endoscopy, with or without optical magnification, has contributed to higher detection rates compared with white-light endoscopy alone and has now replaced ordinary equipment in daily practice. Contrast-enhancement techniques, whether dye-based or computed, have been combined with white-light endoscopy to further improve its accuracy, but histology is still required to clarify the diagnosis. Optical microscopy techniques such as confocal laser endomicroscopy and endocytoscopy enable in vivo histology during endoscopy; however, although of invaluable assistance for tissue characterization, they have not yet made transition between research and clinical use. It is still unknown which approach or combination of techniques offers the best potential. The optimal method will entail the ability to survey wide areas of tissue in concert with the ability to obtain the degree of detailed information provided by microscopic techniques. In this respect, the challenging combination of autofluorescence imaging and confocal endomicroscopy seems promising, and further research is awaited.

We present an ex vivo study of temporally and spectrally resolved autofluorescence in a total of 47 endoscopic excision biopsy/resection specimens from colon, using pulsed excitation laser sources operating at wavelengths of 375 nm and 435 nm. A paired analysis of normal and neoplastic (adenomatous polyp) tissue specimens obtained from the same patient yielded a significant difference in the mean spectrally averaged autofluorescence lifetime -570 ± 740 ps (p = 0.021, n = 12). We also investigated the fluorescence signature of non-neoplastic polyps (n = 6) and inflammatory bowel disease (n = 4) compared to normal tissue in a small number of specimens.

The risk of esophageal perforation following endoscopic balloon dilation for achalasia is in the range of 1%-5%, with a mortality rate of 1%-20%. Perforations need to be recognized early, and, if reasonable, an immediate endoscopic repair should be pursued quickly. Herein, we report a case of successful endoscopic closure by clipping of a large iatrogenic perforation in a patient with achalasia. An 80-year-old woman with achalasia was admitted to our institution to undergo pneumatic dilation. A 40-mm balloon dilator with inflation pressure of 20 psi was used for 2 minutes as usual. During the procedure, the patient had a transient bradycardia. Endoscopic control showed a 2-cm rupture of the distal esophagus. Prompt endoscopic repair of the perforation by endoclips (n=6) was then attempted, followed by conservative management by total parenteral nutrition and intravenous antibiotics. Endoscopic clipping completely closed the esophageal perforation. The patient was given oral nutrition 10 days later without any complications. Six months after discharge from the hospital, the patient was healthy and free of dysphagia. Endoscopy showed complete healing of the esophageal mucosa without luminal stenosis. This report highlights that prompt endoscopic clipping is a useful means to close a large esophageal perforation caused by pneumatic dilation.

Virtually collisionless magnetic mirror-trapped energetic ion populations often partially stabilize internally driven magnetohydrodynamic disturbances in the magnetosphere and in toroidal laboratory plasma devices such as the tokamak. This results in less frequent but dangerously enlarged plasma reorganization. Unique to the toroidal magnetic configuration are confined 'circulating' energetic particles that are not mirror trapped. Here we show that a newly discovered effect from hybrid kinetic-magnetohydrodynamic theory has been exploited in sophisticated phase space engineering techniques for controlling stability in the tokamak. These theoretical predictions have been confirmed, and the technique successfully applied in the Joint European Torus. Manipulation of auxiliary ion heating systems can create an asymmetry in the distribution of energetic circulating ions in the velocity orientated along magnetic field lines. We show the first experiments in which large sawtooth collapses have been controlled by this technique, and neoclassical tearing modes avoided, in high-performance reactor-relevant plasmas.

Endoscopic submucosal dissection (ESD) has gained worldwide acceptance as a treatment for early gastrointestinal cancers (EGICs). However, the management of these tumors in the Western world is still mainly surgical. Our aim was to evaluate the safety and feasibility of ESD at a European center. Based on the knowledge transferred by one of the most experienced Japanese institutions, we conducted a pilot study on 25 consecutive patients with EGICs located in the esophagus (n = 3), stomach (n = 7), duodenum (n = 1), and colon (n = 14) at our tertiary center over a 2-year-period. The main outcome measurements were complete (R0) resection, as well as en-bloc resection and the management of complications. The R0 and en-bloc resection rates were 100% and 84%, respectively. There were three cases of bleeding and five cases of perforation. With a median follow up of 18 months, two recurrences were observed. We conclude that ESD for early esophageal and gastric cancers is feasible and effective, while colonic ESD requires more expertise.

An edge-localized mode (ELM) H-mode regime, supported by electron cyclotron heating, has been successfully established in a "snowflake" (second-order null) divertor configuration for the first time in the TCV tokamak. This regime exhibits 2 to 3 times lower ELM frequency and 20%-30% increased normalized ELM energy (ΔWELM/Wp) compared to an identically shaped, conventional single-null diverted H mode. Enhanced stability of mid- to high-toroidal-mode-number ideal modes is consistent with the different snowflake ELM phenomenology. The capability of the snowflake to redistribute the edge power on the additional strike points has been confirmed experimentally.

We report a case of acute relapsing pancreatitis associated with pancreas divisum, who underwent major papilla sphincterotomy after failed minor papilla cannulation. Long-term results were satisfactory. The possible explanations of the efficacy of major papilla endoscopic resection in this particular case are discussed.

Purpose: To determine whether the use of platelet-rich plasma gel (PRPG) affects magnetic resonance imaging (MRI) findings in the anterior cruciate ligament (ACL) graft during the first year after reconstruction., Methods: A prospective single-blinded study of 50 ACL reconstructions in 50 patients was performed. In group A (study group) PRPG was added to the graft with a standardized technique, and in group B (control group) no PRPG was added. An MRI study was performed postoperatively between 3 and 9 months in group A and between 3 and 12 months in group B. The imaging analysis was performed in a blind protocol by the same radiologist., Results: The mean heterogeneity score value at the time of MRI, assigned by the radiologist, was 1.14 in group A and 3.25 in group B. Both groups were comparable in terms of sex and age (P < .05). The mean time to obtain a completely homogeneous intra-articular segment in group A (PRPG added) was 177 days after surgery, and it was 369 days in group B. Using the quadratic predictive model, these findings show that group A (PRPG added) needed only 48% of the time group B required to achieve the same MRI image (P < .001)., Conclusions: ACL reconstruction with the use of PRPG achieves complete homogeneous grafts assessed by MRI, in 179 days compared with 369 days for ACL reconstruction without PRPG. This represents a time shortening of 48% with respect to ACL reconstruction without PRPG., ((c) 2010 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.)

Background and Study Aims: Bleeding and perforation are major complications of endoscopic submucosal dissection (ESD) for early gastric cancer (EGC), but post-ESD stenosis represents a severe delayed complication that can result in clinical symptoms such as dysphagia and nausea. The aims of this study were to determine the risk factors and evaluate the clinical treatment for post-ESD stenosis., Methods: A total of 2011 EGCs resected by ESD at our institution between 2000 and 2005 were reviewed retrospectively. Resection was defined as cardiac when any mucosal defect was located in the squamocolumnar junction, and as pyloric when any mucosal defect was located < 1 cm from the pylorus ring. Post-ESD stenosis was defined when a standard endoscope could not be passed through the stenosis. We examined the incidence of post-ESD stenosis, its relationship with relevant factors, and the clinical course of post-ESD stenosis patients., Results: Post-ESD stenosis occurred with seven of 41 cardiac resections (17 %) and eight of 115 pyloric resections (7 %). Circumferential extent of the mucosal defect of > 3/4 and longitudinal extent > 5 cm were each significantly related to occurrence of post-ESD stenosis with both cardiac and pyloric resections. All 15 affected patients were successfully treated by endoscopic balloon dilation., Conclusions: A circumferential extent of the mucosal defect of > 3/4 or longitudinal extent of > 5 cm in length were both demonstrated to be risk factors for post-ESD stenosis, in both cardiac and pyloric resections, and endoscopic balloon dilation was shown to be effective in treating post-ESD stenosis.

The sawtooth control mechanism in plasmas employing off-axis toroidally propagating ion cyclotron resonance waves in tokamaks is reinvestigated. The radial drift excursion of energetic passing ions distributed asymmetrically in the velocity parallel to the magnetic field determines stability when the rational q=1 surface resides within a narrow region centered about the shifted fundamental cyclotron resonance.

Electron cyclotron resonance heating and electron cyclotron current drive, disruptive events, and sawtooth activity are all known to produce suprathermal electrons in fusion devices, motivating increasingly detailed studies of the generation and dynamics of this suprathermal population. Measurements have been performed in the past years in the tokamak a configuration variable (TCV) tokamak using a single pinhole hard-x-ray (HXR) camera and electron-cyclotron-emission radiometers, leading, in particular, to the identification of the crucial role of spatial transport in the physics of ECCD. The observation of a poloidal asymmetry in the emitted suprathermal bremsstrahlung radiation motivates the design of a proposed new tomographic HXR spectrometer reported in this paper. The design, which is based on a compact modified Soller collimator concept, is being aided by simulations of tomographic reconstruction. Quantitative criteria have been developed to optimize the design for the greatly variable shapes and positions of TCV plasmas.

Plasmas, both in the laboratory and in space, are often not in thermodynamic equilibrium, and the plasma electron distribution function is accordingly non-Maxwellian. Suprathermal electron tails can be generated by external drives, such as rf waves and electric fields, or internal ones, such as instabilities and magnetic reconnection. The variety and importance of the phenomena in which suprathermal electrons play a significant role explains an enduring interest in diagnostic techniques to investigate their properties and dynamics. X-ray bremsstrahlung emission has been studied in hot magnetized plasmas for well over two decades, flanked progressively by electron-cyclotron emission in geometries favoring the high-energy end of the distribution function (high-field-side, vertical, oblique emission), by electron-cyclotron absorption, by spectroscopic techniques, and at lower temperatures, by Langmuir probes and electrostatic analyzers. Continuous progress in detector technology and in measurement and analysis techniques, increasingly sophisticated layouts (multichannel and tomographic systems, imaging geometries), and highly controlled suprathermal generation methods (e.g., perturbative rf modulation) have all been brought to bear in recent years on an increasingly detailed, although far from complete, understanding of suprathermal electron dynamics.