The tri-band high spectral resolution spectrometer with gratings in tandem for the charge-exchange recombination spectroscopy diagnostic system on HL-2A tokamak

Charge-exchange(CX) recombination spectroscopy is a powerful tool monitoring ion temperature and plasma rotation with good temporal and spatial resolutions. A compact, new design for a high-throughput, tri-band high spectral resolution spectrometer has been developed for the charge-exchange recombination spectroscopy measurement on the HL-2A tokamak. The simultaneous measurements of He II(468.57 nm), C VI(529.1 nm), and Dα(656.1 nm accompanied by beam emission spectra) with an acquisition frequency up to 400 Hz are achieved by vertically binning the spectrum from each fiber in experiments. Initial results indicate that the system can provide radial profiles of not only ion temperature and rotation velocity,but also concentration of carbon. For the case of helium, the measurements for the ion temperature and rotation velocity are straightforward but the apparent concentration associated with the observed CX intensity is obviously too high. Modeling of the active He II CX feature including plume contributions needs to be carried out to extract the true helium concentration.The spectrometer could become a prototype for the ITER charge-exchange recombination spectroscopy diagnostic and the pilot experiments, as presented here, demonstrate the possibility of impurity concentrations measurements based on the combined measurement of local beam emission and charge-exchange recombination spectroscopy spectra.

Long radial coherence of electron temperature fluctuations in non-local transport in HL-2A plasmas

The dynamics of long-wavelength(kθ<1.4 cm^(-1)),broadband(20 kHz–200 kHz)electron temperature fluctuations(Te/Te)of plasmas in gas-puff experiments are observed for the first time in HL-2A tokamak.In a relatively low density(ne(0)■0.91×10^(19)m^(-3)–1.20×10^(19)m^(-3))scenario,after gas-puffing the core temperature increases and the edge temperature drops.On the contrary,temperature fluctuation drops at the core and increases at the edge.Analyses show the non-local emergence is accompanied with a long radial coherent length of turbulent fluctuations.While in a higher density(ne(0)?1.83×10^(19)m^(-3)–2.02×10^(19)m^(-3))scenario,the phenomena are not observed.Furthermore,compelling evidence indicates that E×B shear serves as a substantial contributor to this extensive radial interaction.This finding offers a direct explanatory link to the intriguing core-heating phenomenon witnessed within the realm of non-local transport.

Gut microbiota in preterm infants receiving breast milk or mixed feeding

BACKGROUND Preterm birth is the leading cause of mortality in newborns,with very-low-birthweight infants usually experiencing several complications.Breast milk is considered the gold standard of nutrition,especially for preterm infants with delayed gut colonization,because it contains beneficial microorganisms,such as Lactobacilli and Bifidobacteria.AIM To analyze the gut microbiota of breastfed preterm infants with a birth weight of 1500 g or less.METHODS An observational study was performed on preterm infants with up to 36.6 wk of gestation and a birth weight of 1500 g or less,born at the University Hospital Dr.JoséEleuterio González at Monterrey,Mexico.A total of 40 preterm neonates were classified into breast milk feeding(BM)and mixed feeding(MF)groups(21 in the BM group and 19 in the MF group),from October 2017 to June 2019.Fecal samples were collected before they were introduced to any feeding type.After full enteral feeding was achieved,the composition of the gut microbiota was analyzed using 16S rRNA gene sequencing.Numerical variables were compared using Student’s t-test or using the Mann–Whitney U test for nonparametric variables.Dominance,evenness,equitability,Margalef’s index,Fisher’s alpha,Chao-1 index,and Shannon’s diversity index were also calculated.RESULTS No significant differences were observed at the genus level between the groups.Class comparison indicated higher counts of Alphaproteobacteria and Betaproteobacteria in the initial compared to the final sample of the BM group(P<0.011).In addition,higher counts of Gammaproteobacteria were detected in the final than in the initial sample(P=0.040).According to the Margalef index,Fisher’s alpha,and Chao-1 index,a decrease in species richness from the initial to the final sample,regardless of the feeding type,was observed(P<0.050).The four predominant phyla were Bacteroidetes,Actinobacteria,Firmicutes,and Proteobacteria,with Proteobacteria being the most abundant.However,no significant differences were observed between the initial and final samples at the phylum level.CONCLUSION Breastfeeding is associated with a decrease in Alphaproteobacteria and Betaproteobacteria and an increase of Gammaproteobacteria,contributing to the literature of the gut microbiota structure of very low-birth-weight,preterm.

Impact of payment source, referral site, and place of residence on outcomes after allogeneic transplantation in Mexico

BACKGROUND The impact of social determinants of health in allogeneic transplant recipients in low-and middle-income countries is poorly described.This observational study analyzes the impact of place of residence,referring institution,and transplant cost coverage(out-of-pocket vs government-funded vs private insurance)on outcomes after allogeneic hematopoietic stem cell transplantation(alloHSCT)in two of Mexico's largest public and private institutions.AIM To evaluate the impact of social determinants of health and their relationship with outcomes among allogeneic transplant recipients in Mexico.METHODS In this retrospective cohort study,we included adolescents and adults≥16 years who received a matched sibling or haploidentical transplant from 2015-2022.Participants were selected without regard to their diagnosis and were sourced from both a private clinic and a public University Hospital in Mexico.Three payment groups were compared:Out-of-pocket(OOP),private insurance,and a federal Universal healthcare program“Seguro Popular”.Outcomes were compared between referred and institution-diagnosed patients,and between residents of Nuevo Leon and out-of-state.Primary outcomes included overall survival(OS),categorized by residence,referral,and payment source.Secondary outcomes encompassed early mortality,event-free-survival,graft-versus-host-relapse-free survival,and non-relapse-mortality(NRM).Statistical analyses employed appropriate tests,Kaplan-Meier method,and Cox proportional hazard regression modeling.Statistical software included SPSS and R with tidycmprsk library.RESULTS Our primary outcome was overall survival.We included 287 patients,n=164 who lived out of state(57.1%),and n=129 referred from another institution(44.9%).The most frequent payment source was OOP(n=139,48.4%),followed by private insurance(n=75,26.1%)and universal coverage(n=73,25.4%).No differences in OS,event-free-survival,NRM,or graft-versus-host-relapse-free survival were observed for patients diagnosed locally vs in another institution,nor patients who lived in-state vs out-of-state.Patients who covered transplant costs through private insurance had the best outcomes with improved OS(median not reached)and 2-year cumulative incidence of NRM of 14%than patients who covered costs OOP(Median OS and 2-year NRM of 32%)or through a universal healthcare program active during the study period(OS and 2-year NRM of 19%)(P=0.024 and P=0.002,respectively).In a multivariate analysis,payment source and disease risk index were the only factors associated with overall survival.CONCLUSION In this Latin-American multicenter study,the site of residence or referral for alloHSCT did not impact outcomes.However,access to healthcare coverage for alloHSCT was associated with improved OS and reduced NRM.

Realization of T_(e0)>10 keV long pulse operation over 100 s on EAST

In 2021,EAST realized a steady-state long pulse with a duration over 100 s and a core electron temperature over 10 keV.This is an integrated operation that resolves several key issues,including active control of wall conditioning,long-lasting fully noninductive current and divertor heat/particle flux.The fully noninductive current is driven by pure radio frequency(RF)waves with a lower hybrid current drive power of 2.5 MW and electron cyclotron resonance heating of 1.4 MW.This is an excellent experimental platform on the timescale of hundreds of seconds for studying multiscale instabilities,electron-dominant transport and particle recycling(plasma-wall interactions)under weak collisionality.

Gyrokinetic simulation of low-n Alfvénic modes in tokamak HL-2A plasmas

The turbulence characteristics of plasmas with internal transport barriers in the HL-2A tokamak are analyzed by means of linear gyrokinetic simulations. It is found that turbulence is dominated by the ion temperature gradient(ITG)mode together with large-scale modes characterized by high-frequency electromagnetic fluctuation, which are destabilized by the steep ion temperature gradient in the weak magnetic shear regime. Comparison with solutions of analytical dispersion relations shows that their linear features match well with the beta-induced Alfvén eigenmode branch of the shear Alfvénic spectrum. It is further clarified that the large population of fast ions in these plasmas plays a stabilization role through the dilution mechanism in high-n ITG mode regimes.

Frontal penetrating arrow injury:A case report

BACKGROUND Penetrating arrow injuries of the head and neck are exceedingly rare in pediatric patients.This pathology has high morbidity and mortality because of the presence of vital organs,the airway,and large vessels.Therefore,the treatment and removal of an arrow is a challenge that requires multidisciplinary management.CASE SUMMARY A 13-year-old boy was brought to the emergency room after an arrow injury to the frontal region.The arrowhead was lodged in the oropharynx.Imaging studies showed a lesion of the paranasal sinuses without compromising vital structures.The arrow was successfully removed by retrograde nasoendoscopy without complications,and the patient was discharged.CONCLUSION Although rare,maxillofacial arrow injuries have high morbidity and mortality and require multidisciplinary management to preserve function and aesthetics.

Gallbladder plication as a rare complication of endoscopic sleeve gastroplasty:A case report

Endoscopic sleeve gastroplasty(ESG)is a minimally invasive procedure used in the treatment of obesity,with a complication rate of less than 2%of cases.There have been only two reported cases worldwide of gallbladder injuries as a major complication of ESG.CASE SUMMARY We present the case of a 34-year-old patient who developed a complication after ESG.The patient experienced epigastric and right hypochondrium pain 12 h after the procedure,and a positive Murphy’s sign was identified on physical examination.Laboratory results showed a leukocyte count of 17×10^(3)/μL,and computed tomography indicated the presence of free fluid in the pelvic cavity and perihepatic recesses as well as a possible suture in the wall of the Hartmann’s pouch toward the anterior surface of the stomach.A diagnostic laparoscopy was performed,revealing plication of the Hartmann’s pouch wall to the anterior stomach wall.Laparoscopic cholecystectomy and lavage were carried out.The patient had a stable recovery and was discharged 72 h after surgery,tolerating oral intake.CONCLUSION Gallbladder plication should be suspected if signs and symptoms consistent with acute cholecystitis occur after ESG.

Comparison of methods for turbulence Doppler frequency shift calculation in Doppler reflectometer

The Doppler reflectometer(DR),a powerful diagnostic for the plasma perpendicular velocity(u⊥)and turbulence measurement,has been widely used in various fusion devices.Many efforts have been put into extracting the Doppler shift from the DR signal.There are several commonly used methods for Doppler shift extraction,such as the phase derivative,the center of gravity,and symmetric fitting(SFIT).However,the strong zero-order reflection component around 0 kHz may interfere with the calculation of the Doppler shift.To avoid the influence of the zerofrequency peak,the asymmetric fitting(AFIT)method was designed to calculate the Doppler shift.Nevertheless,the AFIT method may lead to an unacceptable error when the Doppler shift is relatively small compared to the half width at half maximum(HWHM).Therefore,an improved method,which can remove the zero-frequency peak and fit the remaining Doppler peak with a Gaussian function,is devised to extract the Doppler shift.This method can still work reliably whether the HWHM is larger than the Doppler shift or not.

Optimization of X-mode electron cyclotron current drive in high-electron-temperature plasma in the EAST tokamak

A discharge with electron temperature up to 14 keV has been achieved in EAST.Analysis of the electron cyclotron current drive(ECCD)efficiency at high electron temperature under EAST parameters is presented using C3PO/LUKE code.Simulation results show that the ECCD efficiency of X-mode increases with central electron temperature up to 10 keV and then starts to decrease above 10 keV,at a specific magnetic field and toroidal angle.The efficiency degradation is due to the presence of the third harmonic extraordinary(X3)downshifted absorption at the low field side(LFS);even the cold resonance of X3 mode is located outside the plasma.As the electron temperature increases from 5 to 20 ke V,the X3 absorption increases from 0.9%to 96.4%.The trapping electron effect at the LFS produces a reverse Ohkawa current.The competition between the Fisch–Boozer current drive and the Ohkawa current drive results in a decrease in ECCD efficiency.ECCD efficiency optimization is achieved through two methods.One is to increase the toroidal angle,leading to X2 mode predominating again over X3 mode and the electron resonance domain of X2 mode moving far from the trapped/passing boundary.The second one is to increase the magnetic field to move away the X3 resonance layer from the plasma,hence less EC power absorbed by X3 mode.

Investigation of phase modulation and propagation-route effect from unmatched large-scale structures for Doppler reflectometry measurement through 2D full-wave modeling

To interpret the common symmetric peaks caused by the large-scale structure in the complex S(f)spectrum from the heterodyne Doppler reflectometry(DR)measurement in EAST,a 2D circular-shaped O-mode full-wave model based on the finite-difference time-domain method is built.The scattering characteristics and the influences on the DR signal from various scales are investigated.When the structure is located around the cutoff layer,a moving radial or poloidal large-scale structure k_(θ)k_(θ),match(k_(θ),match is the theoretic wavenumber of Bragg scattering)could both generate an oscillation phase term called‘phase modulation’,and symmetrical peaks in the complex S(f)spectrum.It was found that the image-rejection ratio A_(−1)/A_(+1)(A_(±1)represents the amplitudes of±1 order modulation peaks)could be a feasible indicator for experiment comparison.In the case when the structure is near the cutoff layer with the same arrangement as the experiment for the edge DR channel,the curve of A_(−1)/A_(+1)versus kθcan be divided into three regions,weak asymmetrical range with k_(θ)/k_(0)0.15(k_(0)is the vacuum wavenumber),harmonics range with 0.15k_(θ)/k_(0)0.4,and Bragg scattering range of 0.4k_(θ)/k_(0)0.7.In the case when the structure is located away from the cutoff layer,the final complex S(f)spectrum is the simple superimposing of modulation and Bragg scattering,and the modulation peaks have an amplitude response nearly proportional to the local density fluctuation,called the‘propagationroute effect’.Under the H-mode experiment arrangement for the core DR,a critical fluctuation amplitude Amp(n_(e,Mod.@route))/Amp(n_(e,Tur.@MSA)∼1.3–4.1(Amp(n_(e,Mod.@route))refers to the pedestal large-scale structure amplitude and Amp(ne,Tur.@MSA)refers to turbulence amplitude at the main scattering area)is needed for the structure in the pedestal to be observed by the core DR measurement.The simulations are well consistent with the experimental results.These effects need to be carefully considered during the DR signal analyses as the injecting beam passes through the plasma region with large-scale structures.

化学气相沉积法制备SiC/SiO2梯度复合涂层的热力学分析

SiC/SiO2复合涂层是显著改善先进高温气冷用石墨抗氧化性能的一个理想涂层体系，但目前其优化的化学气相沉积工艺还未见诸报道。本研究利用HSC-CHEMISTRY 4.1分析了化学气相沉积工艺对制备的SiC/SiO2复合涂层的影响。分析结果表明：载气中加入足够的氢气对制备不含杂质的SiC/SiO2复合涂层很有必要；合适的沉积温度为1100-1200℃；最佳反应物浓度为：SiCl4摩尔分数为1%-2%，沉积SiC涂层时CH4与SiCl4的摩尔比为1，沉积SiO2涂层时水蒸气与SiCl4摩尔比为2，通过逐渐改变CVD气氛中的水蒸气与CH4的比例来沉积SiC/SiO2梯度过渡层。

ITER氦冷固态增殖剂试验包层模块中子学设计与优化

针对ITER中国氦冷固态增殖剂试验包层模块(HCCB TBM)的概念设计方案进行了初步中子学设计和优化。在铍球床填充率从80%降为62%的情况下,通过调整TBM内部结构的材料和布置,提出了一种中子学性能更好且满足安全要求的设计方案。计算结果表明,优化后HCCB TBM的产氚率比概念设计值提高的满功率运行一天后的产氚量为0.42mg,但总核热和最大功率密度有了一定降低。

Hepatogenous diabetes: Is it a neglected condition in chronic liver disease?

Diabetes mellitus(DM) that occurs because of chronic liver disease(CLD) is known as hepatogenous diabetes(HD). Although the association of diabetes and liver cirrhosis was described forty years ago, it was scarcely studied for long time. Patients suffering from this condition have low frequency of risk factors of type 2 DM. Its incidence is higher in CLD of viral, alcoholic and cryptogenic etiology. Its pathophysiology relates to liver damage, pancreatic dysfunction, interactions between hepatitis C virus(HCV) and glucose metabolism mechanisms and genetic susceptibility. It associates with increased rate of liver complications and hepatocellular carcinoma, and decreased 5-year survival rate. It reduces sustained virological response in HCV infected patients. In spite of these evidences, the American Diabetes Association does not recognize HD. In addition, the impact of glucose control on clinical outcomes of patients has not been evaluated. Treatment of diabetes may be difficult due to liver insufficiency and hepatotoxicity of antidiabetic drugs. Notwithstanding, no therapeutic guidelines have been implemented up to date. In this editorial, authors discuss the reasons why they think that HD may be a neglected pathological condition and call attention to the necessity for more clinical research on different fields of this disease.

Steroid hyperglycemia: Prevalence, early detection and therapeutic recommendations: A narrative review

Steroids are drugs that have been used extensively in a variety of conditions. Although widely prescribed for their anti-inflammatory and immunosuppressive properties, glucocorticoids have several side effects, being hyperglycemia one of the most common and representative. In the present review, we discuss the main epidemiologic characteristics associated with steroid use, with emphasis on the identification of high risk populations. Additionally we present the pathophysiology of corticosteroid induced hyperglycemia as well as the pharmacokinetics and pharmacodynamics associated with steroid use. We propose a treatment strategy based on previous reports and the understanding of the mechanism of action of both, the different types of glucocorticoids and the treatment options, in both the ambulatory and the hospital setting. Finally, we present some of the recent scientific advances as well as some options for future use of glucocorticoids.

Gastrointestinal disorders associated with migraine: A comprehensive review

Migraine is a recurrent and commonly disabling primary headache disorder that affects over 17% of women and 5%-8% of men. Migraine susceptibility is multifactorial with genetic, hormonal and environmental factors all playing an important role. The physiopathology of migraine is complex and still not fully understood. Many different neuropeptides, neurotransmitters and brain pathways have been implicated. In connection with the myriad mechanisms and pathways implicated in migraine, a variety of multisystemic comorbidities(e.g., cardiovascular, psychiatric and other neurological conditions) have been found to be closely associated with migraine. Recent reports demonstrate an increased frequency of gastrointestinal(GI) disorders in patients with migraine compared with the general population. Helicobacter pylori infection, irritable bowel syndrome, gastroparesis, hepatobiliary disorders, celiac disease and alterations in the microbiota have been linked to the occurrence of migraine. Several mechanisms involving the gut-brain axis, such as a chronic inflammatory response with inflammatory and vasoactive mediators passing to the circulatory system, intestinal microbiota modulation of the enteric immunological milieu and dysfunction of the autonomic and enteric nervous system, have been postulated to explain these associations. However, the precise mechanisms and pathways related to the gut-brain axis in migraine need to be fully elucidated. In this review, we survey the available literature linking migraine with GI disorders. We discuss the possible physiopathological mechanisms, and clinical implications as well as several future areas of interest for research.

Diagnostic and therapeutic challenges of gastrointestinal angiodysplasias: A critical review and view points

Gastrointestinal angiodysplasias (GIADs), also called angioectasias, are the most frequent vascular lesions. Its precise prevalence is unknown since most of them are asymptomatic. However, the incidence may be increasing since GIADs affect individuals aged more than 60 years and population life expectancy is globally increasing worldwide. They are responsible of about 5% to 10% of all gastrointestinal bleeding (GIB) cases. Most GIADs are placed in small bowel, where are the cause of 50 to 60% of obscure GIB diagnosed with video capsule endoscopy. They may be the cause of fatal severe bleeding episodes;nevertheless, recurrent overt or occult bleeding episodes requiring repeated expensive treatments and disturbing patient’s quality-of-life are more frequently observed. Diagnosis and treatment of GIADs (particularly those placed in small bowel) are a great challenge due to insidious disease behavior, inaccessibility to affected sites and limitations of available diagnostic procedures. Hemorrhagic causality out of the actively bleeding lesions detected by diagnostic procedures may be difficult to establish. No treatment guidelines are currently available, so there is a high variability in the management of these patients. In this review, the epidemiology and pathophysiology of GIADs and the status in the diagnosis and treatment, with special emphasis on small bowel angiodysplasias based on multiple publications, are critically discussed. In addition, a classification of GIADs based on their endoscopic characteristics is proposed. Finally, some aspects that need to be clarified in future research studies are highlighted.

A review of Helicobacter pylori diagnosis, treatment, and methods to detect eradication

Helicobacter pylori(H. pylori) affects nearly half of the world's population and, thus, is one of the most frequent and persistent bacterial infections worldwide. H. pylori is associated with peptic ulcer disease, gastric ulcers, mucosa-associated lymphoid tissue lymphoma, and gastric cancer. Various diagnostic methods exist to detect infection, and the choice of one method or another depends on several factors, such as accessibility, advantages and disadvantages of each method, cost, and the age of patients. Once H. pylori infection is diagnosed, the clinician decides whether treatment is necessity, according to the patient's clinical condition. Typically, eradication of H. pylori is recommended for treatment and prevention of the infection. Cure rates with the standard triple therapy are acceptable, and effective quadruple therapies, sequential therapies, and concomitant therapies have been introduced as key alternatives to treat H. pylori infection. In this work, we review the main diagnostic methods used to identify H. pylori infection and to confirm eradication of infection. In addition, key factors related to treatment are reviewed.

Different patterns of intestinal response to injury after arterial,venous or arteriovenous occlusion in rats

AIM:To investigate the differences in injury patterns caused by arterial, venous or arteriovenous mesenteric occlusion.METHODS: Male Wistar rats were separated equally into four groups. Occlusion was performed by clamping the superior mesenteric artery (A), the mesenteric vein (V) or both (AV) for 30 min, followed by 60 min of reperfusion. A control group received sham surgery only. Intestinal sections were examined for histological damage and serum tumor necrosis factor-α (TNF-α), endothelin-1 (ET-1), P-selectin, antithrombin (AT) and soluble intracellular adhesion molecule-1(ICAM-1) concentrations were measured. RESULTS: All groups showed signif icant mucosal injury compared to controls. Furthermore, mucosal injury was significantly more severe in the V and AV groupscompared to the A group (3.6±0.55, 3.4±0.55 and 2±0.71, respectively, P=0.01). ICAM-1 was similarly elevated in all groups, with no significant differences between the groups. P-selectin levels were significantly elevated in the V and AV groups but not the A group (1.4±0.5 ng/mL, 2.52±0.9 ng/mL and 0.02±0.01 ng/mL, respectively, P=0.01) and ET-1 was significantly elevated in the A and V groups but not the AV group (0.32±0.04 pg/mL, 0.36±0.05 pg/mL and 0.29±0.03 pg/mL, respectively, P=0.01) compared to sham controls. AT CONCLUSION:Different patterns of response to ischemia/reperfusion are associated with venous, arterial or arteriovenous occlusion. Venous and arteriovenous occlusion was associated with the most severe alterations.

Subclinical abnormal glucose tolerance is a predictor of death in liver cirrhosis

AIM:To determine if subclinical abnormal glucose tolerance(SAGT)has influence on survival of non-diabetic patients with liver cirrhosis.METHODS:In total,100 patients with compensatedliver cirrhosis and normal fasting plasma glucose were included.Fasting plasma insulin(FPI)levels were measured,and oral glucose tolerance test(OGTT)was performed.According to OGTT results two groups of patients were formed:those with normal glucose tolerance(NGT)and those with SAGT.Patients were followed every three months.The mean follow-up was932 d(range of 180-1925).Survival was analyzed by the Kaplan-Meyer method,and predictive factors of death were analyzed using the Cox proportional hazard regression model.RESULTS:Of the included patients,30 showed NGT and70 SAGT.Groups were significantly different only in age,INR,FPI and HOMA2-IR.Patients with SAGT showed lower 5-year cumulated survival than NGT patients(31.7%vs 71.6%,P=0.02).Differences in survival were significant only after 3 years of follow-up.SAGT,Child-Pugh B,and high Child-Pugh and Model for EndStage Liver Disease(MELD)scores were independent predictors of death.The causes of death in 90.3%of cases were due to complications related to liver disease.CONCLUSION:SAGT was associated with lower survival.SAGT,Child-Pugh B,and high Child-Pugh and MELD scores were independent negative predictors of survival.