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Research on the National Spherical Torus Experiment, NSTX, targets physics understanding needed for extrapolation to a steady-state ST Fusion Nuclear Science Facility, pilot plant, or DEMO. The unique ST operational space is leveraged to test physics theories for next-step tokamak operation, including ITER. Present research also examines implications for the coming device upgrade, NSTX-U. An energy confinement time, τE, scaling unified for varied wall conditions exhibits a strong improvement of BTτE with decreased electron collisionality, accentuated by lithium (Li) wall conditioning. This result is consistent with nonlinear microtearing simulations that match the experimental electron diffusivity quantitatively and predict reduced electron heat transport at lower collisionality. Beam-emission spectroscopy measurements in the steep gradient region of the pedestal indicate the poloidal correlation length of turbulence of about ten ion gyroradii increases at higher electron density gradient and lower Ti gradient, consistent with turbulence caused by trapped electron instabilities. Density fluctuations in the pedestal top region indicate ion-scale microturbulence compatible with ion temperature gradient and/or kinetic ballooning mode instabilities. Plasma characteristics change nearly continuously with increasing Li evaporation and edge localized modes (ELMs) stabilize due to edge density gradient alteration. Global mode stability studies show stabilizing resonant kinetic effects are enhanced at lower collisionality, but in stark contrast have almost no dependence on collisionality when the plasma is off-resonance. Combined resistive wall mode radial and poloidal field sensor feedback was used to control n = 1 perturbations and improve stability. The disruption probability due to unstable resistive wall modes (RWMs) was surprisingly reduced at very high βN/li > 10 consistent with low frequency magnetohydrodynamic spectroscopy measurements of mode stability. Greater instability seen at intermediate βN is consistent with decreased kinetic RWM stabilization. A model-based RWM state-space controller produced long-pulse discharges exceeding βN = 6.4 and βN/li = 13. Precursor analysis shows 96.3% of disruptions can be predicted with 10 ms warning and a false positive rate of only 2.8%. Disruption halo currents rotate toroidally and can have significant toroidal asymmetry. Global kinks cause measured fast ion redistribution, with full-orbit calculations showing redistribution from the core outward and towards V∥/V = 1 where destabilizing compressional Alfvén eigenmode resonances are expected. Applied 3D fields altered global Alfvén eigenmode characteristics. High-harmonic fast-wave (HHFW) power couples to field lines across the entire width of the scrape-off layer, showing the importance of the inclusion of this phenomenon in designing future RF systems. The snowflake divertor configuration enhanced by radiative detachment showed large reductions in both steady-state and ELM heat fluxes (ELMing peak values down from 19 MW m-2 to less than 1.5 MW m-2). Toroidal asymmetry of heat deposition was observed during ELMs or by 3D fields. The heating power required for accessing H-mode decreased by 30% as the triangularity was decreased by moving the X-point to larger radius, consistent with calculations of the dependence of E × B shear in the edge region on ion heat flux and X-point radius. Co-axial helicity injection reduced the inductive start-up flux, with plasmas ramped to 1 MA requiring 35% less inductive flux. Non-inductive current fraction (NICF) up to 65% is reached experimentally with neutral beam injection at plasma current Ip = 0.7 MA and between 70-100% with HHFW application at Ip = 0.3 MA. NSTX-U scenario development calculations project 100% NICF for a large range of 0.6 < Ip (MA) < 1.35. © 2013 IAEA, Vienna.

In the last two experimental campaigns, the low aspect ratio NSTX has explored physics issues critical to both toroidal confinement physics and ITER. Experiments have made extensive use of lithium coatings for wall conditioning, correction of non-axisymmetric field errors and control of n = 1 resistive wall modes (RWMs) to produce high-performance neutral-beam heated discharges extending to 1.7 s in duration with non-inductive current fractions up to 0.7. The RWM control coils have been used to trigger repetitive ELMs with high reliability, and they have also contributed to an improved understanding of both neoclassical tearing mode and RWM stabilization physics, including the interplay between rotation and kinetic effects on stability. High harmonic fast wave (HHFW) heating has produced plasmas with central electron temperatures exceeding 6 keV. The HHFW heating was used to show that there was a 20-40% higher power threshold for the L-H transition for helium than for deuterium plasmas. A new diagnostic showed a depletion of the fast-ion density profile over a broad spatial region as a result of toroidicity-induced Alfvén eigenmodes (TAEs) and energetic-particle modes (EPMs) bursts. In addition, it was observed that other modes (e.g. global Alfvén eigenmodes) can trigger TAE and EPM bursts, suggesting that fast ions are redistributed by high-frequency AEs. The momentum pinch velocity determined by a perturbative technique decreased as the collisionality was reduced, although the pinch to diffusion ratio, Vpinch/χ, remained approximately constant. The mechanisms of deuterium retention by graphite and lithium-coated graphite plasma-facing components have been investigated. To reduce divertor heat flux, a novel divertor configuration, the 'snowflake' divertor, was tested in NSTX and many beneficial aspects were found. A reduction in the required central solenoid flux has been realized in NSTX when discharges initiated by coaxial helicity injection were ramped in current using induction. The resulting plasmas have characteristics needed to meet the objectives of the non-inductive start-up and ramp-up program of NSTX. © 2011 IAEA, Vienna.

The mission of the National Spherical Torus Experiment (NSTX) is the demonstration of the physics basis required to extrapolate to the next steps for the spherical torus (ST), such as a plasma facing component test facility (NHTX) or an ST based component test facility (ST-CTF), and to support ITER. Key issues for the ST are transport, and steady state high β operation. To better understand electron transport, a new high-k scattering diagnostic was used extensively to investigate electron gyro-scale fluctuations with varying electron temperature gradient scale length. Results from n = 3 braking studies are consistent with the flow shear dependence of ion transport. New results from electron Bernstein wave emission measurements from plasmas with lithium wall coating applied indicate transmission efficiencies near 70% in H-mode as a result of reduced collisionality. Improved coupling of high harmonic fast-waves has been achieved by reducing the edge density relative to the critical density for surface wave coupling. In order to achieve high bootstrap current fraction, future ST designs envision running at very high elongation. Plasmas have been maintained on NSTX at very low internal inductance li ∼ 0.4 with strong shaping (κ ∼ 2.7, δ ∼ 0.8) with βN approaching the with-wall β-limit for several energy confinement times. By operating at lower collisionality in this regime, NSTX has achieved record non-inductive current drive fraction fNI ∼ 71%. Instabilities driven by super-Alfvénic ions will be an important issue for all burning plasmas, including ITER. Fast ions from NBI on NSTX are super-Alfvénic. Linear toroidal Alfvén eigenmode thresholds and appreciable fast ion loss during multi-mode bursts are measured and these results are compared with theory. The impact of n > 1 error fields on stability is an important result for ITER. Resistive wall mode/resonant field amplification feedback combined with n = 3 error field control was used on NSTX to maintain plasma rotation with β above the no-wall limit. Other highlights are results of lithium coating experiments, momentum confinement studies, scrape-off layer width scaling, demonstration of divertor heat load mitigation in strongly shaped plasmas and coupling of coaxial helicity injection plasmas to ohmic heating ramp-up. These results advance the ST towards next step fusion energy devices such as NHTX and ST-CTF. © 2009 IAEA, Vienna.

Optical diagnostics will be critical for the operation and performance assessment of burning plasma experiments, such as ITER. At the same time, extracting light for these diagnostics with reflective mirrors becomes difficult in the burning plasma environment due to the deleterious effects of the prolonged exposure on plasma and nuclear radiations. As an alternative, we explore the possibility to use freestanding diffractive optical elements, such as transmission gratings and zone plates, as light extractors. Since in diffractive systems, light is deflected by periodic slits rather than by a surface, these may withstand plasma exposure with less degradation of their optical properties. To investigate this possibility, we developed freestanding transmission gratings for the visible range and exposed them to conditions resembling (or even exceeding) those expected for the ITER “first mirrors.” The results of this study indicate that the gratings can withstand high heat fluxes and plasma and energetic radiation bombardment. Additionally, in contrast to the reflective elements, the extraction efficiency of diffractive elements may even improve with plasma exposure, which is possibly due to the shaping and thinning of the grating bars by plasma erosion. Moreover, in tightly collimated configurations, even very thin gratings can be used to extract light from hot fusion plasmas, as demonstrated by our tests of an extreme ultraviolet extractor at the National Spherical Torus Experiment. [ABSTRACT FROM AUTHOR]

This is the case of a severe Pseudomonas aeruginosa biological vascular graft infection, completely involving the perianastomotic tract of a femoro - femoral crossover bypass and resulting in repeated bleeding from the offended vessel wall. After the failure of a sartorious rotational muscle flap transposition into the infected groin wound, this 'high-grade' vascular graft infection was finally treated successfully by wrapping a great saphenous vein patch reinforcement circumferentially around the damaged biological vascular conduit and filling the infected wound with a rectus abdominis myocutaneous muscle flap transposition. The aim of this report is to illustrate this novel, to our knowledge, 'perivascular venous banding' technique and to evaluate the prospective of future testing of this surgical procedure. Starting from this singular case, we will also review the role of the rotational muscle flaps in the conservative management of major vascular graft infections. [ABSTRACT FROM AUTHOR]

Background and Aim: Few studies have specifically addressed interobserver agreement in describing lesions identified during capsule endoscopy. The aim of our study is to evaluate interobserver agreement in the description of capsule endoscopy findings., Materials and Methods: Consecutive short segments of capsule endoscopy were prospectively observed by 8 investigators. Seventy-five videos were prepared by an external investigator (gold standard). The description of the findings was reported by the investigators using the same validated and standardized capsule endoscopy structured terminology. The agreement was assessed using Cohen's kappa statistic., Results: As concerns the ability to detect a lesion, the agreement with the gold standard was moderate (kappa 0.48), as well as the agreement relating to the final diagnosis (κ 0.45). The best agreement was observed in identifying the presence of active bleeding (κ 0.72), whereas the poorest agreement concerned the lesion size (κ 0.32). The agreement with the GS was significantly better in endoscopists with higher case/volume of capsule endoscopy per year. Diagnostic concordance was better in the presence of angiectasia than in the presence of polyps or ulcers/erosions., Conclusions: Correct lesion identification and diagnosis seem more likely to occur in presence of angiectasia, and for readers with more experience in capsule endoscopy reading., (Published by Elsevier Ltd.)

Background: Gastric juice is usually discarded during upper-GI endoscopy., Objective: By using a novel device, the Mt 21-42, we evaluated the potential of this important organic fluid in clinical practice, exploring its contribution to the diagnosis of Helicobacter pylori infection and atrophic gastritis of the oxyntic mucosa (AGOM)., Design and Patients: A multicenter study (17,907 patients; 10 endoscopy units) estimated the frequency of diagnosis of AGOM and H pylori infection in routine endoscopic practice. A prospective study (216 patients) at 1 of these units aimed to determine the real prevalence of these conditions and the possible benefits of gastric juice analysis. We considered gastric juice pH and ammonium concentration, endoscopic and histologic features, serologic parameters for atrophy and H pylori, gastric acid secretion, and costs., Results: We found that H pylori infection and, even more markedly, AGOM were greatly underdiagnosed in routine endoscopic practice (20.1% and 0.8% vs 49.1% and 12.5% in the prospective study, respectively), because of the intrinsic limitations of the conventional tests and lack/inappropriateness of biopsy planning. Gastric-juice analysis proved to be a cheap, simple, and effective way to prevent such underdiagnosis and allowed detection of atrophic gastritis and H pylori in 96% and 98% of cases, and saved costs (cost-effectiveness ratio 209 vs 274-5047)., Conclusions: Gastric juice provided a valuable source of clinicopathologic information that, properly analyzed, allowed detection of the main risk factors for gastric cancer (H pylori and atrophic gastritis), overcoming the diagnostic limitations associated with these conditions and also producing time and cost savings.

Background and Aims: The province of Ferrara has one of the highest incidences of colorectal cancer (CRC) in Italy. In January 2000, we set up a colonoscopy screening program focussing on first-degree relatives of CRC patients. We now report the results 5 years after the beginning of the project. SCREENEES AND METHODS: In October 1999, we started a campaign stressing the usefulness of colonoscopy for the first-degree relatives of CRC patients. Subjects included in the screening program were aged between 45 and 75 years with at least one first-degree relative affected by CRC. They were invited to an interview where a physician suggested colonoscopy as a screening option., Results: In 5 years, 776 subjects were interviewed and 733 (94.4%) agreed to an endoscopic examination (M/F:375/401; mean age 55 years): 562 colonoscopies were performed. Adenomas and cancers were found in 122 (21.7%) and 12 (2.1%) subjects, respectively. Histological examination in 181 persons with lesions (32.8%) showed (most serious lesion quoted) 47 hyperplastic polyps (26% of all lesions), 2 serrated adenomas (1.1%), 68 tubular adenomas (48%), 24 tubulovillous adenomas (13.3%), 9 adenomas with high grade dysplasia (5%) and 12 adenocarcinomas (6.6%). The majority of the cancers were at an early stage (8 Dukes A and 3 Dukes B). Sedation was used in only 42 colonoscopies (7.5%)., Conclusions: A colonoscopy-based screening in this selected high-risk population is feasible. Even without sedation subjects readily agreed to the endoscopic procedure. We identified a significant number of advanced neoplasms and cancers at an early stage suggesting that this could be a useful tool in early identification of CRC.

The higher sensitivity to low-energy scattered photons of radiographic film compared to water can lead to significant dosimetric error when the beam quality varies significantly within a field. Correcting for this artifact will provide greater accuracy for intensity modulated radiation therapy (IMRT) verification dosimetry. A procedure is developed for correction of the film energy-dependent response by creating a pencil beam kernel within our treatment planning system to model the film response specifically. Film kernels are obtained from EGSnrc Monte Carlo simulations of the dose distribution from a 1 mm diameter narrow beam in a model of the film placed at six depths from 1.5 to 40 cm in polystyrene and solid water phantoms. Kernels for different area phantoms (50 x 50 cm2 and 25 x 25 cm2 polystyrene and 30 x 30 cm2 solid water) are produced. The Monte Carlo calculated kernel is experimentally verified with film, ion chamber and thermoluminescent dosimetry (TLD) measurements in polystyrene irradiated by a narrow beam. The kernel is then used in convolution calculations to, predict the film response in open and IMRT fields. A 6 MV photon beam and Kodak XV2 film in a polystyrene phantom are selected to test the method as they are often used in practice and can result in large energy-dependent artifacts. The difference in dose distributions calculated with the film kernel and the water kernel is subtracted from film measurements to obtain a practically film artifact free IMRT dose distribution for the Kodak XV2 film. For the points with dose exceeding 5 cGy (11% of the peak dose) in a large modulated field and a film measurement inside a large polystyrene phantom at depth of 10 cm, the correction reduces the fraction of pixels for which the film dose deviates from dose to water by more than 5% of the mean film dose from 44% to 6%.

Aim of the study is to report our preliminar experience with MCA Coupler System in mechanical microanastomoses performed in head and neck reconstructive surgery. During almost 7 months we performed 7 end-to-end venous anastomoses: 3 of them regarding the cephalic district. We had no vascular thrombosis, vascular congestion or flap loss. Mean time of execution of anastomosis with MCA Coupler System was 10 minutes. In our experence it is essential the choice of the appropriate size of the device and a good dissection of recipient vessels. In our opinion the Coupler System is an easy applicable device, and an efficient alternative to manual micro-anastomoses.

Breast reconstruction as now to be consider as a complementary treatment of breast cancer surgery. Between 1998-1999 we developed a project of collaboration with Polytech-Silimed Europe Gmbh for a new textured tissue expander. This new system allows expansion of the middle and lower quadrant of the breast acting a physiologic ptosis of the breast. Authors report their experience on the first 130 patients.

Aim of the study is to provide high-level results in terms of functionality and softness of the tissues achieved with different reconstructive techniques performed in oncological surgery of the head and neck. Test group was composed of 528 patients recovered with a diagnosis of head and neck cancer. We performed 569 flaps: myocutaneous, cutaneous and fasciocutaneous, and free flaps. The clinical outcome and the morpho-functional evaluation show that free flaps can ensure excellent results, especially in defined anatomical areas such as the cervical-esophageal region, jaw and tongue. As to myocutaneous and cutaneous/fasciocutaneous flaps, they are still the first reconstructive choice, according to their minimal or no functional implications.