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Background: Heart failure (HF) due to myocarditis might not respond in the same way to standard therapy as HF due to other aetiologies. The aim of this study was to investigate the value of endomyocardial biopsies (EMB) for clinical decision-making and its relation to the outcome of paediatric patients with myocarditis. Methods: Clinical and EMB data of children with myocarditis collected for the MYKKE-registry between 2013 and 2020 from 23 centres were analysed. EMB studies included histology, immunohistology, and molecular pathology. The occurrence of major adverse cardiac events (MACE) including mechanical circulatory support (MCS), heart transplantation, and/or death was defined as a combined endpoint. Results: Myocarditis was diagnosed in 209/260 patients: 64% healing/chronic lymphocytic myocarditis, 23% acute lymphocytic myocarditis (AM), 14% healed myocarditis, no giant cell myocarditis. The median age was 12.8 (1.4-15.9) years. Time from symptom-onset to EMB was 11.0 (4.0-29.0) days. Children with AM and high amounts of mononuclear cell infiltrates were significantly younger with signs of HF compared to those with healing/chronic or healed myocarditis. Myocardial viral DNA/RNA detection had no significant effect on outcome. The worst event-free survival was seen in patients with healing/chronic myocarditis (24%), followed by acute (31%) and healed myocarditis (58%, p=0.294). A weaning rate of 64% from MCS was found in AM. Conclusions: EMB provides important information on the type and stage of myocardial inflammation and supports further decision-making. Children with fulminant clinical presentation, high amounts of mononuclear cell infiltrates or healing/chronic inflammation and young age have the highest risk for MACE.

Thrombus formation is a feared complication following bidirectional cavopulmonary shunt (BCPS). We aimed to investigate the effect of thrombus formation on outcome. BCPS was performed in 525 patients at our center between 1998 and 2018. The impacts of thrombus formation on survival and probability of Fontan completion were analyzed, and risk factors for thrombus formation were examined. Thrombus formation occurred in 30 patients (5.7%). Compared with the remaining 495 patients, there was no significant difference in the median age at BCPS (4.9 vs 4.7 months; P = 0.587). However, unbalanced atrioventricular septal defects (17 vs 5%; P = 0.008) and preoperative ventricular dysfunction (23.3 vs 8%; P = 0.004) were more frequent in patients who developed a thrombus. Thrombolytic therapy was performed in all patients and surgical thrombus removal was required in 13 patients. In-hospital mortality was higher in patients with thrombus (30.0 vs 2.2%; P0.001). Of 505 hospital survivors, an estimated survival at 1 year after hospital discharge following BCPS was 84.4% (95% CI, 76.1-92.7%) in patients with thrombus and 96.8% (95% CI, 96.0-97.6%) in those without (P0.001). Cumulative incidence of Fontan completion at 3 years after BCPS was 52.8% (95% CI, 30.3-75.2%) in patients with thrombus and 90.1% (95% CI, 87.2-92.9%) in those without (P = 0.004). Higher left atrial pressure (OR = 1.165; P = 0.029) and longer cardiopulmonary bypass time (OR = 1.013, P = 0.001) at BCPS were independent risk factors for thrombus formation after BCPS. Thrombus formation after BCPS poses a significant risk for survival and Fontan completion. Preoperative higher left atrial pressure and longer cardiopulmonary bypass time are significant risk factors.

We consider k-Hessian operators $$S_k[u]$$ in bounded domains $$\varOmega $$ in $$\mathbb R^N$$ such that $$\partial \varOmega $$ is $$(k-1)$$ -convex. For so-called k-admissible functions $$u \in \varPhi _0^k$$ one has Sobolev type inequalities of the form $$\begin{aligned} \Vert u\Vert _{L^p(\varOmega )} \le C\, \Vert u\Vert _{\varPhi _0^k} \end{aligned}$$ where $$ \Vert u\Vert _{\varPhi _0^k}^{k+1} = \int _\varOmega (-u) S_k[u]dx$$ , and $$1 \le p \le k^* = \frac{N(k+1)}{N-2k}$$ . The case $$N = 2k$$ is a borderline case of Trudinger–Moser type, and it was recently shown by Tian–Wang that a corresponding inequality of exponential type holds $$\begin{aligned} \sup _{\Vert u\Vert _{\varPhi _0^k \le 1}} \int _\varOmega \left( \mathrm {e}^{\alpha |u|^{\frac{N+2}{N}}} -\sum _{j=0}^{k-1}\frac{\alpha ^{j} |u|^{j\frac{N+2}{N}}}{j!} \right) \mathrm {d}x \le C \end{aligned}$$ for $$\alpha \le \alpha _N = N\left[ \frac{\omega _{N-1}}{k} {N-1\atopwithdelims ()k-1}\right] ^{2/N}$$ . In this article we prove an analogue to the famous result of Carleson–Chang, namely that for $$\varOmega = B_R(0)$$ the above supremum is attained also in the limiting case $$\alpha =\alpha _N$$ .

Background:A Konno operation with a mechanical prosthesis may be applied in patients with complex left ventricular outflow tract obstruction to avoid further operations. We reviewed our 20-year experience with the Konno operation.Methods:All patients who underwent the Konno operation between 1996 and 2015 were evaluated. Study end points were survival and reoperations.Results:Twenty-one consecutive patients were included. The median age at operation was 12 years (5 months to 34 years). Twenty (95%) patients had prior interventions for left-sided heart lesions. Additional mitral valve disease was present in 17 (81%) patients. The preoperative mean pressure gradient over the left ventricular outflow tract was 50 ± 25 mm Hg. The median size of implanted valve prostheses was 21 mm (16-25 mm). Concomitant procedures for left-sided heart lesions were performed in six patients, including two mitral valve replacements. There were two hospital mortalities (9.5%) and four late mortalities (19%). Overall survival was 85% ± 7.8% and 72% ± 11% at 5 and 10 years, respectively. In two patients, mitral valve replacement was performed during the same hospital admission. During a mean follow-up time of 7.6 ± 4.8 years, two patients required late reoperations, one for mitral valve replacement and one for heart transplantation. Freedom from late reoperation at 10 years was 89% ± 7.4%.Conclusions:The Konno operation can be considered as a definitive option with a low probability of reoperation on the left ventricular outflow tract in patients with complex left ventricular heart disease. Subsequent operations focus on the treatment of additional mitral valve disease, which remains the cause of mortality and morbidity.

The Max-Planck-Institut f?r Plasmaphysik test facility ELISE is an important intermediate step towards the in-time realization of the ITER neutral beam injection system (NBI). ELISE is equipped with a large radio-frequency (RF) driven negative hydrogen ion source (1???0.9?m2) of half the size of the ITER NBI source. The paper reports on the main results of the very first operation of the source with caesium, but with low RF power, both for hydrogen and deuterium, with pulse lengths of up to 500?s. The results are rather encouraging for the achievement of the required ITER NBI parameters, especially in hydrogen, where large current densities with respect to the low RF power could be achieved at a ratio of co-extracted electrons to extracted ions of 0.5?0.6 at the relevant source pressure of 0.3?Pa. The required magnetic filter field was significantly lower than expected from the experience with the prototype RF source. Similar large extracted ion currents could be achieved also in deuterium, but with larger amounts of co-extracted electrons. Here, the required ratio of co-extracted electrons to extracted ions of one could be achieved only in short pulses.

IntroductionAcute kidney injury is a frequent complication after cardiac surgery with cardiopulmonary bypass in infants. Neutrophil gelatinase-associated lipocalin has been suggested to be a promising early biomarker of impending acute kidney injury. On the other hand, neutrophil gelatinase-associated lipocalin has been shown to be elevated in systemic inflammatory diseases without renal impairment. In this secondary analysis of data from our previous study on acute kidney injury after infant cardiac surgery, our hypothesis was that neutrophil gelatinase-associated lipocalin may be associated with surgery-related inflammation.MethodsWe prospectively enrolled 59 neonates and infants undergoing cardiopulmonary bypass surgery for CHD and measured neutrophil gelatinase-associated lipocalin in plasma and urine and interleukin-6 in the plasma. Values were correlated with postoperative acute kidney injury according to the paediatric Renal-Injury-Failure-Loss-Endstage classification.ResultsOverall, 48% (28/59) of patients developed acute kidney injury. Of these, 50% (14/28) were classified as injury and 11% (3/28) received renal replacement therapy. Both plasma and urinary neutrophil gelatinase-associated lipocalin values were not correlated with acute kidney injury occurrence. Plasma neutrophil gelatinase-associated lipocalin showed a strong correlation with interleukin-6. Urinary neutrophil gelatinase-associated lipocalin values correlated with cardiopulmonary bypass time.ConclusionOur results suggest that plasma and urinary neutrophil gelatinase-associated lipocalin values are not reliable indicators of impending acute kidney injury in neonates and infants after cardiac surgery with cardiopulmonary bypass. Inflammation may have a major impact on plasma neutrophil gelatinase-associated lipocalin values in infant cardiac surgery. Urinary neutrophil gelatinase-associated lipocalin may add little prognostic value over cardiopulmonary bypass time.

Acute hepatitis B virus (aHBV) infection can lead to fulminant liver failure, which likely is prevented by early lamivudine therapy. Even nonfulminant but severe acute hepatitis B can lead to significant morbidity and impaired quality of life. Therefore, lamivudine was evaluated in patients with severe aHBV in a placebo-controlled trial. Patients with severe aHBV infection (ALT >10× ULN, bilirubin >85 μm, prothrombin time >50%) were prospectively treated with lamivudine 100 mg/day or with placebo within 8 days after the diagnosis. The primary end point was time to bilirubin

Colonization with Staphylococci is widely distributed among patients with end-stage renal disease who are receiving hemodialysis (HD). In addition to more intensive care and use of artificial devices, the incidence of methicillin-resistant Staphylococcus aureus (MRSA) colonization and infection has increased. Such colonization has recently been associated with a more than doubled mortality rate in HD patients. However, it is not clear whether the (presumably increasing) incidence of methicillin-sensitive Staphylococcus aureus (MSSA) colonization is associated with MRSA and/or morbidity and mortality. We therefore established a screening program in our HD population (n = 156) and followed these patients over 10 years. We discovered eighty-eight MSSA-colonized patients and one MRSA-colonized patient by cross-sectional and admission-related screenings between 2000 and 2010. The morbidity and mortality of the HD patients was not related to MSSA colonization. The MSSA colonization rate decreased slightly during the 10-year observation period. We conclude that the incidence of MRSA colonization in our unit was lower compared to that reported in the literature. The reasons for this finding are complex and require further investigation. The incidence of MSSA colonization was frequent but did not impact morbidity or mortality.

ObjectivesWe aimed to investigate whether early postoperative extubation following the Fontan operation is universally feasible and can be used as a management tool in unstable patients.MethodsAll patients undergoing the Fontan operation in our centre between 2004 and 2013 (n=253) were analysed. Until 2008, patients were extubated according to standard criteria and comprised group 1. Group 2 included all patients presenting after 2009, when early extubation was always aimed regardless of the haemodynamic status. Patients who exceeded the 75th percentiles for volume requirements and inotrope scores for the respective group were defined as unstable. Comparisons of outcomes between groups and subgroups and analysis of the changes in haemodynamic and treatment parameters with extubation in unstable patients after 2009 were performed.ResultsCompared with group 1, patients from group 2 were ventilated for shorter duration (pConclusionsTimely extubation is universally applicable following the Fontan operation. Early postoperative extubation can be valuable for improving Fontan haemodynamics.

The aim of this registry is to provide data on age-related clinical features of suspected myocarditis and to create a study platform allowing for deriving diagnostic criteria and, at a later stage, testing therapeutic interventions in patients with myocarditis.After an initial 6-month pilot phase, MYKKE was opened in June 2014 as a prospective multicenter registry for patients from pediatric heart centers, university hospitals, and community hospitals with pediatric cardiology wards in Germany. Inclusion criteria consisted of age18 years and hospitalization for suspected myocarditis as leading diagnosis at the discretion of the treating physician. By December 31, 2015, fifteen centers across Germany were actively participating and had enrolled 149 patients. Baseline data reveal 2 age peaks (2 years,12 years), show higher proportions of males, and document a high prevalence of severe disease courses in pediatric patients with suspected myocarditis. Severe clinical courses and early adverse events were more prevalent in younger patients and were related to severely impaired leftventricular ejection fraction at initial presentation.MYKKE represents a multicenter registry and research platform for children and adolescents with suspected myocarditis that achieve steady recruitment and generate a wide range of real-world data on clinical course, diagnostic workup, and treatment of this group of patients. The baseline data reveal the presence of 2 age peaks and provide important insights into the severity of disease in children with suspected myocarditis. In the future, MYKKE might facilitate interventional substudies by providing an established collaborating network using common diagnostic approaches.

Patienten, die eine fruhzeitige partielle cavopulmonale Anastomose (PCPA) im Alter von unter drei Monaten erhielten, wiesen sowohl kurz vor der partiellen als auch kurz vor der totalen cavopulmonalen Anastomose kleinere Pulmonalarterien auf, als die zum Zeitpunkt der PCPA alteren Patienten. Dennoch konnte ein Wachstum der rechten Pulmonalarterien zwischen den beiden Operationen beobachtet werden. Es zeigte sich kein komplikationsreicherer postoperativer Verlauf nach fruhzeitiger PCPA und keine erhohte Mortalitat bei einem medianen Beobachtungszeitraum von zwei Jahren.

The usefulness of intensive chemotherapy with the MACOP-B protocol was evaluated in 8 patients with AIDS-related non-Hodgkin's lymphoma (NHL). Four patients had a prior AIDS diagnosis. The median CD4+ lymphocyte count was 0.079 cells x 10(9)/l (range 0.016-0.330). All patients responded to treatment. Four patients finished chemotherapy, all with complete remission, while another 3 patients deteriorated prior to finishing treatment and died. The median survival was 4 months (range 1 to 86 months). Major causes of the poor outcome were AIDS-related opportunistic infections and meningeal CNS involvement by NHL developing during or after chemotherapy. Patients with AIDS-related NHL usually do not appear to benefit from treatment with MACOP-B protocol. Advanced immunodeficiency is associated with poor tolerance to treatment and inability to finish this chemotherapy protocol. MACOP-B chemotherapy does not prevent meningeal spread of lymphoma in spite of using repeatedly systemic methotrexate crossing the blood-brain barrier. CNS prophylaxis with repeated application of intrathecal methotrexate may lower the risk of meningeal spread of lymphoma, which developed in 1 of 5 patients given CNS prophylaxis as compared to 2 of 3 patients without CNS prophylaxis.

Forty-nine episodes of Pneumocystis carinii pneumonia, treated with trimethoprim-sulfamethoxazole among 46 patients with AIDS were analysed retrospectively for any side effects. For only two were there insufficient data. There were 39 toxic reactions, 15 of them serious: leukopenia (n = 23), abnormal liver functions (n = 14), skin changes (n = 12), gastrointestinal complaints (n = 10) and thrombocytopenia (n = 9). In nine patients the treatment had to be discontinued, in six of them so early that a switch to pentamidine was necessary. Gastrointestinal symptoms occurred as early as the sixth day of treatment, while leukopenia and thrombocytopenia were first observed after 12-13 days. Despite the high rate of side effects trimethoprim-sulfamethoxazole remains the drugs of choice, other regimens not having been found to be any better.

The development of a radio frequency (RF) driven source for negative hydrogen ions for the neutral beam heating devices of fusion experiments has been successfully carried out at IPP since 1996 on the test facility BATMAN. The required ITER parameters have been achieved with the prototype source consisting of a cylindrical driver on the back side of a racetrack like expansion chamber. The extraction system, called “Large Area Grid” (LAG) was derived from a positive ion accelerator from ASDEX Upgrade (AUG) using its aperture size (o 8 mm) and pattern but replacing the first two electrodes and masking down the extraction area to 70 cm2. BATMAN is a well diagnosed and highly flexible test facility which will be kept operational in parallel to the half size ITER source test facility ELISE for further developments to improve the RF efficiency and the beam properties. It is therefore planned to upgrade BATMAN with a new ITER-like grid system (ILG) representing almost one ITER beamlet group, namely 5 × 14 apertures (o 14 mm). Additionally to the standard three grid extraction system a repeller electrode upstream of the grounded grid can optionally be installed which is positively charged against it by 2 kV. This is designated to affect the onset of the space charge compensation downstream of the grounded grid and to reduce the backstreaming of positive ions from the drift space backwards into the ion source. For magnetic filter field studies a plasma grid current up to 3 kA will be available as well as permanent magnets embedded into a diagnostic flange or in an external magnet frame. Furthermore different source vessels and source configurations are under discussion for BATMAN, e.g. using the AUG type racetrack RF source as driver instead of the circular one or modifying the expansion chamber for a more flexible position of the external magnet frame.

The ITER project requires additional heating provided by two injectors of neutral beams resulting from the neutralisation of accelerated negative ions. To study and optimise negative ion production, the SPIDER test facility (particle energy 100keV; beam current 50A) is under construction in Padova, with the aim of testing beam characteristics and to verify the source proper operation. The SPIDER beam will be characterised by the instrumented calorimeter STRIKE, whose main components are one-directional carbon fibre carbon composite tiles. Some prototype tiles have been employed in 2012 as a small-scale version (mini-STRIKE) of the entire system to investigate the features of the beam from BATMAN at IPP-Garching. As the BATMAN beamlets are superposed at the measurement position, about 1m from the grounded grid, an actively cooled copper mask is located in front of the tiles; holes in the mask create an artificial beamlet structure. Recently the mini-STRIKE has been updated, taking into account the results obtained in the first campaign. In particular the spatial resolution of the system has been improved by increasing the number of the copper mask holes. Moreover a custom measurement system has been realized for the thermocouple signals and employed in BATMAN in view of its use in SPIDER. The present contribution gives a description of the new design of the system as well as of the thermocouple measurements system and its field test. A new series of measurements has been carried out in BATMAN. The BATMAN beam characterisation in different experimental conditions is presented.

The negative ion source test facility ELISE (Extraction from a Large Ion Source Experiment) is in operation since beginning of 2013 at the Max-Planck-Institut fur Plasmaphysik (IPP) in Garching bei Munchen. The large radio frequency driven ion source of ELISE is about 1x1 m(2) in size (1/2 the ITER source) and can produce a plasma for up to 1 h. Negative ions can be extracted and accelerated by an ITER-like extraction system made of 3 grids with an area of 0.1 m(2), for 10 s every 3 minutes. A total accelerating voltage of up to 60 kV is available, i.e. a maximum ion beam power of about 1.2 MW can be produced. ELISE is equipped with several beam diagnostic tools for the evaluation of the beam characteristics. In order to evaluate the beam properties with a high level of detail, a sophisticated diagnostic calorimeter has been installed in the test facility at the end of 2013, starting operation in January 2014. The diagnostic calorimeter is split into 4 copper plates with separate water calorimetry for each of the plates. Each calorimeter plate is made of 15x15 copper blocks, which act as many separate inertial calorimeters and are attached to a copper plate with an embedded cooling circuit. The block geometry and the connection with the cooling plate are optimized to accurately measure the time-averaged power of the 10 s ion beam. The surface of the blocks is covered with a black coating that allows infrared (IR) thermography which provides a 2D profile of the beam power density. In order to calibrate the IR thermography, 48 thermocouples are installed in as many blocks, arranged in two vertical and two horizontal rows. The paper describes the beam calorimetry in ELISE, including the methods used for the IR thermography, the water calorimetry and the analytical methods for beam profile evaluation. It is shown how the maximum beam inhomogeneity amounts to 13% in average. The beam divergence derived by IR thermography ranges between 1 degrees and 4 degrees and correlates relatively well with the values measured by beam emission spectroscopy with up to 30% difference. It has also been observed that the beam inhomogeneity decreases with lower beam divergence.

BACKGROUND Chronic inflammatory processes contribute to the pathogenesis of bronchopulmonary dysplasia (BPD). We hypothesized colonisation with Ureaplasma urealyticum (Uu) as a possible reason for an increased risk of developing prolonged oxygen dependency > 28 days in very low birth weight (VLBW) infants. PATIENTS AND METHODS From January 1998 to November 1999 pharyngeal swabs were prospectively obtained and tested for Uu at birth and then weekly in VLBW infants. The following variables were compared between Uu-positive and Uu-negative infants: prenatal corticosteroids, maternal infections, mode of delivery, gestational age, birth weight, gender distribution, RDS, surfactant therapy, maximum inspiratory oxygen concentration during the first 24 and 48 hours, duration of oxygen supplementation beyond day 28, PDA, and weight differences during the first week of life. RESULTS Of a total of 74 infants, 17 were found to be Uu-positive. The latter group showed a lower mean gestational age (29; 25 - 37 vs. 28; 24 - 34 WOG; p = 0.02) and a longer duration of oxygen supplementation after day 28 (0; 0 - 121 vs. 5; 0 - 134 d; p = 0.02). All other variables did not differ significantly between both groups. Multivariate analyses identified the variables birth weight and colonisation with Uu as risk factors for a longer period of oxygen dependency after day 28 (p 28 days.

The safety and efficacy of a fixed 25 mg pyrimethamine-500 mg sulfadoxine combination supplemented with 15 mg folinic acid twice a week as primary prophylaxis of Pneumocystis carinii pneumonia (PCP) and toxoplasmic encephalitis was evaluated in 106 patients infected with the human immunodeficiency virus. All patients had a CD4+ T-lymphocyte count of less than 100 cells/microl at study entry. Efficacy in this single-arm open-label prospective study was analyzed on an as-treated basis. No patient received highly active antiretroviral treatment, including protease inhibitors or non-nucleoside reverse transcriptase inhibitors, while on study medication. PCP developed in four patients, one of whom had been noncompliant. No PCP episode occurred in the first year. Probabilities of freedom from PCP were 0.97 (95%CI, 0.92-1) after 24 months and 0.93 (95%CI, 0.84-1) after 36 months. Of 74 (69.8%) patients positive for anti-toxoplasma IgG antibodies, one noncompliant patient developed toxoplasmic encephalitis after 24 months. Allergic reactions were observed in 18 (17%) patients and resulted in permanent discontinuation in 7 (6.6%) patients. One (0.9%) patient who had continued prophylaxis despite progressive hypersensitivity reactions developed a serious adverse reaction (Stevens-Johnson syndrome). The median survival of study participants was 29 months, with relentless progression of AIDS accounting for most deaths. The prophylaxis regimen studied appeared safe and effective for primary prophylaxis of PCP and toxoplasmic encephalitis. Severe adverse events can likely be prevented by discontinuation of prophylaxis at the time allergic reactions are noted. Rechallenge frequently results in tolerance. Efficacy and safety compare favorably with previously studied regimens. This simple prophylactic regimen may provide a convenient alternative for patients failing or intolerant to approved regimens.

The ITER neutral beam injection system is being designed to provide 33 MW of heating from two injectors, with an upgrade to 50 MW possible with a third injector; such heating power will be provided by accelerating negative ions to high energies, 1 MeV, and neutralizing them. These neutrals are then injected into the tokamak where they impart their energy by collisions. To study and optimize negative ion production, the SPIDER prototype is under construction in Padova, Italy, whose beam has an energy of 100 keV and a current of 48 A. The instrumented calorimeter Short-Time Retractable Instrumented Kalorimeter Experiment (STRIKE) has been designed with the main purpose of characterizing the SPIDER negative ion beam in terms of beam uniformity and beam divergence during short operations (several seconds). STRIKE is made of 16 1-D carbon fiber composite (CFC) tiles, intercepting the whole beam and observed from the rear side by infrared (IR) cameras. With two identical samples of the CFC material and the IR camera under assessment, a reduced version of the entire calorimeter has been built, with the purpose of characterizing its diagnostic properties. This mini-STRIKE was used in the BATMAN experiment at Max Planck Institut fu?r Plasmaphysik (Garching, Germany). As the beamlet divergence in BATMAN is large, the beamlets overlap each other in the measurement position; therefore, the mini-STRIKE for BATMAN includes a copper mask, facing the beam and featuring eight apertures. Thus, eight different portions of the beam can be simultaneously sampled, with minimal overlapping of the power coming from adjacent apertures. The copper mask was actively cooled, and calorimetry was carried out. The temperature in the center of the mask and some positions along the CFC tiles was also measured. In this paper, the design of the system is presented. The calorimetry system is presented in detail as well as the procedure adopted for calorimetrical data analysis. The results of - alorimetry are presented together with preliminary correlations with the BATMAN beam features.

The development of a large area (Asource,ITER = 0.9 × 2 m2) hydrogen negative ion (NI) source constitutes a crucial step in construction of the neutral beam injectors of the international fusion reactor ITER. To understand the plasma behaviour in the boundary layer close to the extraction system the 3D PIC MCC code ONIX is exploited. Direct cross checked analysis of the simulation and experimental results from the ITER-relevant BATMAN source testbed with a smaller area (Asource,BATMAN ≈ 0.32 × 0.59 m2) has been conducted for a low perveance beam, but for a full set of plasma parameters available. ONIX has been partially benchmarked by comparison to the results obtained using the commercial particle tracing code for positive ion extraction KOBRA3D. Very good agreement has been found in terms of meniscus position and its shape for simulations of different plasma densities. The influence of the initial plasma composition on the final meniscus structure was then investigated for NIs. As expected from the Child–Langmuir law, the results show that not only does the extraction potential play a crucial role on the meniscus formation, but also the initial plasma density and its electronegativity. For the given parameters, the calculated meniscus locates a few mm downstream of the plasma grid aperture provoking a direct NI extraction. Most of the surface produced NIs do not reach the plasma bulk, but move directly towards the extraction grid guided by the extraction field. Even for artificially increased electronegativity of the bulk plasma the extracted NI current from this region is low. This observation indicates a high relevance of the direct NI extraction. These calculations show that the extracted NI current from the bulk region is low even if a complete ion–ion plasma is assumed, meaning that direct extraction from surface produced ions should be present in order to obtain sufficiently high extracted NI current density. The calculated extracted currents, both ions and electrons, agree rather well with the experiment.

The Source for Production of Ion of Deuterium Extracted from Rf plasma (SPIDER) test facility is under construction in Padova to optimise the operation of the beam source of ITER neutral beam injectors. The SPIDER beam will be characterised by the instrumented calorimeter STRIKE, whose main components are one-directional carbon-fibre-carbon-composite tiles. A small-scale version of the entire system has been employed in the BAvarian Test MAchine for Negative ions (BATMAN) testbed by arranging two prototype tiles in the vertical direction. The paper presents a description of the mini-STRIKE system and of the data analysis procedures, as well as some results concerning the BATMAN beam under varying operating conditions.

BACKGROUND Clostridium difficile is of growing importance as a hospital-acquired pathogen. Pseudomembraneous colitis is the main clinical disease. Transmission and epidemiological features are not yet fully understood. PATIENTS AND METHODS Stool samples from 1164 individuals (571 women and 593 men) attending were examined for the presence of C. difficile. Follow-up examinations and molecular typing methods were used for the detection nosocomial transmissions. Additionally, hospital-borne environmental samples as well as staff samples were tested. RESULTS Incidence of C. difficile infection was 8.4%. Nearly all patients (92.9%) had antibiotics given. Using molecular typing nosocomial transmission was evident. Though, environmental samples in general had a low positivity, toilet chairs were contaminated in 15.4% and may be a potential source of transmission. Staff was positive in only one case. CONCLUSIONS Prevention of infections with C. difficile becomes to be a major threat for the clinical and hygienic management.

The simultaneous occurrence of a pregnancy after in-vitro-fertilisation (IVF-ET) and an active tuberculosis can have massive and life-threatening consequences. We are showing in our case-report the symptoms, diagnostic investigations and the therapy of a patient with exacerbated tuberculosis after an IVF-pregnancy. As a conclusion preventive measures should be taken; varios options will be discussed.