Massive hemorrhage caused by a perforating Gianturco-Z stent resulting in an aortoesophageal fistula

Squamous cell carcinoma of the tonsil has a relatively poor prognosis. Aggressive surgery, radiation therapy and combinations of irradiation and surgery have been employed but there exists some controversy about the efficacy of these treatment modalities. The purpose of this paper is to compare the efficacy of treatment between the surgery followed by radiation therapy and the preoperative radiation therapy followed by surgical resection. The medical records of 33 patients treated for squamous cell carcinoma of the tonsil at the Department of Otolaryngology-Head and Neck Surgery, Korea University Hospital between 1989-1993 were reviewed retrospectively. None of the patients were stage I, but stage II, III, and IV were four, five, and 24 patients, respectively. There were 30 males and three females. The most common histopathology was moderately differentiated squamous cell carcinoma (20/33). The 13 patients treated initially with surgery had an overall three-year survival rate of 38.5%, and the rate for the 20 patients treated initially with radiation was 40%. The main pattern of treatment failure was a local recurrence and neck metastases, and pathologic differentiation thought to be an important prognostic factor. Complications are fewer in patients treated initially with surgery (23.1%) than patients initially treated with radiation (50.0%). There is no difference in the efficacy between the two therapeutic groups.     

Glutathione modulates ryanodine receptor from skeletal muscle sarcoplasmic reticulum. Evidence for redox regulation of the Ca2+ release mechanism

In this report, we demonstrate the ability of the cellular thiol glutathione to modulate the ryanodine receptor from skeletal muscle sarcoplasmic reticulum. Reduced glutathione (GSH) inhibited Ca2+-stimulated [3H]ryanodine binding to the sarcoplasmic reticulum and inhibited the single-channel gating activity of the reconstituted Ca2+ release channel. The effects of GSH on both the [3H]ryanodine binding and single-channel measurements were dose-dependent, exhibiting an IC50 of approximately 2.4 mM in binding experiments. Scatchard analysis demonstrated that GSH decreased the binding affinity of ryanodine for its receptor (increased Kd) and lowered the maximal binding occupancy (Bmax). In addition, GSH did not modify the Ca2+ dependence of [3H]ryanodine binding. In single-channel experiments, GSH (5-10 mM), added to the cis side of the bilayer lipid membrane, lowered the open probability (Po) of a Ca2+ (50 microM)-stimulated Ca2+ channel without modifying the single-channel conductance. Subsequent perfusion of the cis chamber with an identical buffer, containing 50 microM Ca2+ without GSH, re-established Ca2+-stimulated channel gating. GSH did not inhibit channel activity when added to the trans side of the bilayer lipid membrane. Similar to GSH, the thiol-reducing agents dithiothreitol and beta-mercaptoethanol also inhibited high affinity [3H]ryanodine binding to sarcoplasmic reticulum membranes. In contrast to GSH, glutathione disulfide (GSSG) was a potent stimulator of high affinity [3H]ryanodine binding and it also stimulated the activity of the reconstituted single Ca2+ release channel. These results provide direct evidence that glutathione interacts with reactive thiols associated with the Ca2+ release channel/ryanodine receptor complex, which are located on the cytoplasmic face of the SR, and support previous observations (Liu, G, Abramson, J. J., Zable, A. C., and Pessah, I. N. (1994) Mol. Pharmacol. 45, 189-200) that reactive thiols may be involved in the gating of the Ca2+ release channel.     

Surface‐Enhanced Raman Scattering Using Microstructured Optical Fiber Substrates

Microstructured optical fibers (MOFs) represent a promising platform technology for fully integrated next generation surface enhanced Raman scattering (SERS) sensors and plasmonic devices. In this paper we demonstrate silver nanoparticle substrates for SERS detection within MOF templates with exceptional temporal and mechanical stability, using organometallic precursors and a high‐pressure chemical deposition technique. These 3D substrates offer significant benefits over conventional planar detection geometries, with the long electromagnetic interaction lengths of the optical guided fiber modes exciting multiple plasmon resonances along the fiber. The large Raman response detected when analyte molecules are infiltrated within the structures can be directly related to the deposition profile of the nanoparticles within the MOFs via electrical characterization.     

Design and technological solutions for the plasma facing components of WENDELSTEIN 7-X

The operation of W7-X stellarator for pulse length up to 30 min with 10 MW input power requires a full set of actively water-cooled plasma facing components. From the lower thermally loaded area of the wall protection system designed for an averaged load of 100 kW/m² to the higher loaded area of the divertor up to 10 MW/m², various design and technological solutions have been developed meeting the high load requirements and coping with the restricted available space and the particular 3D-shaped geometry of the plasma vessel. 80 ports are dedicated alone to the water-cooling of plasma facing components and a complex networking of kilometers of pipework will be installed in the plasma vessel to connect all components to the cooling system. An advanced technology was developed in collaboration with industry for the target elements of the high heat flux (HHF) divertor, the so-called “bi-layer” technology for the bonding of flat tiles made from CFC NB31 onto the CuCrZr cooling structure. The design, R&D and the adopted technological solutions of plasma facing components are presented. At present, except the HHF divertor, most of plasma facing components has been already manufactured.     

Performance and statistical quality assessment of CFC tile bonding on the pre-series elements of the Wendelstein 7-X divertor

Extensive high heat flux (HHF) testing of pre-series IV targets was performed to establish the industrial process for the ongoing production of the actively water-cooled target elements which will be needed for the installation of the Wendelstein 7-X (W7-X) divertor. Finally, 890 components covered with about 18,000 CFC tiles will be installed.The examinations of the elements with 10 MW/m² cycling up to 10,000 pulses, 16 MW/m² cycling and screening tests up to 32 MW/m², confirm the robustness of the design and in particular of the applied CFC bonding technology. The results of the IR examination of the initial tests have been assessed statistically. The paper presents a detailed statistical analysis based on the Six-Sigma method of the surface temperature increase of the CFC tiles tested for 100 cycles at 10 MW/m². Assuming that the series elements will behave in a similar fashion to the pre-series elements this statistical assessment can also be performed for the series elements.     

Design analysis and manufacturing of the cooling lines of the in vessel components of WENDELSTEIN 7-X

All in vessel components (IVCs) of W7-X are actively cooled. Inside the plasma vessel about 4 km of pipes will be installed, supplying water to the IVC. 226 cooling circuits with 78 variants are necessary. The cooling circuits enter the cryostat and the plasma vessel through ad hoc flanged penetrations called “plug-ins”, which provide for the vacuum boundary between the plasma chamber and the torus hall atmosphere. The plug-ins are installed inside the W7-X ports. Some of the plug-ins are also used for the diagnostic cables. In total eighty plug-ins will be produced and installed. The inlet/outlet cooling lines are connected to the plug-ins using a welded hydraulic connector. The layout of the cooling lines is rather complex in consideration of the limited space and the routing between many component parts. Additionally the differential thermal expansion of the lines with respect to the supporting structures during the different operation scenarios had to be compensated by ad hoc supports and adjustments in the flexibility of the lines.     

Mechanical and thermo-physical characterization of three-directional carbon fiber composites for W-7X and ITER

Carbon fiber composites (CFCs) are the first choice as plasma facing materials for the strike points of divertor targets for future nuclear fusion devices like WENDELSTEIN 7-X and ITER. For the application in these facilities several potential European 3D-CFCs were compared and qualified: (1) four material batches of NB31 produced by Snecma Propulsion Solide (SNECMA); (2) NB41, SNECMA, the upgraded version of NB31; (3) N31, SNECMA, which is densified by chemical vapor infiltration (CVI) instead of a final liquid pitch infiltration characteristic for NB31; (4) a new developmental 3D-CFC produced by DUNLOP.The characterization of the composites is comprised of thermo-physical measurements and tensile tests. The results are correlated to density and microstructure and summarized as follows: (1) NB41 provides the highest thermal conductivity in the ex-pitch direction of 375 W/(m K) at room temperature; (2) all material grades are, due to their heterogeneity, characterized by a relatively large scatter of mechanical properties; (3) the different densification process for N31 in comparison to NB31 has no influence on the material properties; (4) NB41 provides in all three directions a comparably high tensile strength with an average in the ex-pitch direction of 220 MPa; (5) the 3D-CFC from DUNLOP is comparable to NB41 but yet does not meet the specifications in the needling direction.     

Towards assembly completion and preparation of experimental campaigns of Wendelstein 7-X in the perspective of a path to a stellarator fusion power plant

The superconducting stellarator device Wendelstein 7-X, currently under construction, is the key device for the proof of stellarator optimization principles. To establish the optimized stellarator as a serious candidate for a fusion reactor, reactor-relevant dimensionless plasma parameters must be achieved in fully integrated steady-state scenarios. After more than 10 years of construction time, the completion of the device is now approaching rapidly (mid-2014). We discuss the most important lessons learned during the device assembly and first experiences with coming major work packages. Those are (a) assembly of about 2500 large, water-cooled, 3d-shaped in-vessel component elements; (b) assembly of in total 14 superconducting current leads, one pair for each coil type; and (c) assembly of the device periphery including diagnostics and heating systems. In the second part we report on the present status of planning for the first operation phase (5–10 s discharge duration at 8 MW heating power), the completion and hardening of the device for full power steady-state operation, and the second operation phase (up to 30 min discharge duration at 10 MW heating power). It is the ultimate goal of operation phase one to develop credible and robust discharge scenarios for the high-power steady-state operation phase two. Beyond the improved equilibrium, confinement, and stability properties owing to stellarator optimization, this requires density control, impurity control, edge iota control as well as high density microwave heating. Of paramount importance is the operation of the island divertor, which is realized in the first operation phase as an inertially cooled conventional graphite target divertor. It will be replaced later on by the steady-state capable island divertor with its water-cooled carbon fiber reinforced carbon target elements.     

PCR-restriction fragment length polymorphism (RFLP) analyses reveal both extensive clonality and local genetic differences in Candida albicans

Using a polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method to obtain genotypes for the diploid pathogenic yeast, Candida albicans, we analysed 204 C. albicans isolates from three populations of the Duke University community: two from clinical sources [one from patients infected with human immunodeficiency virus (HIV) and the other from patients without HIV infection], and the third from healthy student volunteers. The results indicated: (i) extensive evidence for clonality within and between populations of C. albicans; and (ii) greater genotypic and gene diversities in the nonclinical population than those derived from clinical specimens, regardless of HIV status. The two clinical populations were genetically more similar to each other than either was to the population consisting of isolates from healthy people. Within each population sample there was a general lack of heterozygotes, and random associations of alleles within and between loci were found in less than 50% of the loci or pairs of loci. These findings were consistent between the two sets of samples analysed: those including all isolates and those including only clone-corrected isolates. Possible mechanisms are presented to explain the observed patterns of genetic variation within and between C. albicans populations.