Including osteoprotegerin and collagen IV in a score-based blood test for liver fibrosis increases diagnostic accuracy

BACKGROUND: Noninvasive methods for liver fibrosis evaluation in chronic liver diseases have been recently developed, i.e. transient elastography (Fibroscan™) and blood tests (Fibrometer®, Fibrotest®, and Hepascore®). In this study, we aimed to design a new score in chronic hepatitis C (CHC) by selecting blood markers in a large panel and we compared its diagnostic performance with those of other noninvasive methods. METHODS: Sixteen blood tests were performed in 306 untreated CHC patients included in a multicenter prospective study (ANRS HC EP 23 Fibrostar) using METAVIR histological fibrosis stage as reference. The new score was constructed by non linear regression using the most accurate biomarkers. RESULTS: Five markers (alpha-2-macroglobulin, apolipoprotein-A1, AST, collagen IV and osteoprotegerin) were included in the new function called Coopscore©. Using the Obuchowski Index, Coopscore© shows higher diagnostic performances than for Fibrometer®, Fibrotest®, Hepascore® and Fibroscan™ in CHC. Association between Fibroscan™ and Coopscore© might avoid 68% of liver biopsies for the diagnosis of significant fibrosis. CONCLUSION: Coopscore© provides higher accuracy than other noninvasive methods for the diagnosis of liver fibrosis in CHC. The association of Coopscore© with Fibroscan™ increases its predictive value

Comprehensive Measurements and Modeling of SOL, and Core Plasma Fueling and Carbon Sources in DIII-D

Plasma boundary modeling of low density, low confinement plasmas in DIII-D has been benchmarked against a comprehensive set of measurements and indicates that recycling of deuterium ions at the divertor targets, and chemical sputtering at the divertor target plates and walls, can explain the poloidal core fueling profile and core carbon density. Key measurements included the 2-D intensity distribution of deuterium neutral and low-charge state carbon emission in the divertor and around the midplane of the high-field scrape-off layer (SOL). Chemical sputtering plays an important role in producing carbon at the divertor targets and walls, and was found to be a prerequisite to reproduce the measured emission distribution

First Wall and Operational Diagnostics

In this chapter we review numerous diagnostics capable of measurements at or near the first wall, many of which contribute information useful for safe operation of a tokamak. There are sections discussing infrared cameras, visible and VUV cameras, pressure gauges and RGAs, Langmuir probes, thermocouples, and erosion and deposition measurements by insertable probes and quartz microbalance. Also discussed are dust measurements by electrostatic detectors, laser scattering, visible and IR cameras, and manual collection of samples after machine opening. In each case the diagnostic is discussed with a view toward application to a burning plasma machine such as ITER

Transport of Elm Energy and Particles Into the Sol and Divertor of DIII-D

A271 TRANSPORT OF ELM ENERGY AND PARTICLES INTO THE SOL AND DIVERTOR OF DIII-D. The reduction in size of Type I edge localized models (ELMs) with increasing density is explored in DIII-D for the purpose of studying the underlying transport of ELM energy. The separate convective and conductive transport of energy due to an ELM is determined by Thomson scattering measurements of electron density and temperature in the pedestal. The conductive transport from the pedestal during an ELM decreases with increasing density, while the convective transport remains nearly constant. The scaling of the ELM energy loss is compared with an edge stability model. The role of the divertor sheath in limiting energy loss from the pedestal during an ELM is explored. Evidence of outward radial transport to the midplane wall during an ELM is also presented

Edge localized mode control with an edge resonant magnetic perturbation

A low amplitude (δbr∕BT=1 part in 5000) edge resonantmagnetic field perturbation with toroidalmode number n=3 and poloidal mode numbers between 8 and 15 has been used to suppress most large type I edge localized modes(ELMs) without degrading core plasma confinement. ELMs have been suppressed for periods of up to 8.6 energy confinement times when the edge safety factor q95 is between 3.5 and 4. The large ELMs are replaced by packets of events (possibly type II ELMs) with small amplitude, narrow radial extent, and a higher level of magnetic field and density fluctuations, creating a duty cycle with long “active” intervals of high transport and short “quiet” intervals of low transport. The increased transport associated with these events is less impulsive and slows the recovery of the pedestal profiles to the values reached just before the large ELMs without the n=3 perturbation. Changing the toroidal phase of the perturbation by 60° with respect to the best ELM suppression case reduces the ELM amplitude and frequency by factors of 2–3 in the divertor, produces a more stochastic response in the H-mode pedestal profiles, and displays similar increases in small scale events, although significant numbers of large ELMs survive. In contrast to the best ELM suppression case where the type I ELMs are also suppressed on the outboard midplane, the midplane recycling increases until individual ELMs are no longer discernable. The ELM response depends on the toroidal phase of the applied perturbation because intrinsic error fields make the target plasma nonaxisymmetric, and suggests that at least some of the variation in ELM behavior in a single device or among different devices is due to differences in the intrinsic error fields in these devices. These results indicate that ELMs can be suppressed by small edge resonantmagnetic field perturbations. Extrapolation to next-step burning plasma devices will require extending the regime of operation to lower collisionality and understanding the physical mechanism responsible for the ELM suppression.This work was funded by the U.S. Department of Energy under Grant Nos. DE-FC02-04ER54698, DE-FG02- 04ER54758, DE-FG03-01ER54615, W-7405-ENG-48, DEFG03-96ER54373, DE-FG02-89ER53297, DE-AC05- 00OR22725, and DE-AC04-94AL85000

Physics Processes in Disruption Mitigation Using Massive Noble Gas Injection

Methods for detecting imminent disruptions and mitigating disruption effects using massive injection of noble gases (He, Ne, or Ar) have been demonstrated on the DIII-D tokamak [1]. A jet of high injected gas density (> 10{sup 24} m{sup -3}) and pressure (> 20 kPa) penetrates the target plasma at the gas sound speed ({approx}300-500 m/s) and increases the atom/ion content of the plasma by a factor of > 50 in several milliseconds. UV line radiation from the impurity species distributes the plasma energy uniformly on the first wall, reducing the thermal load to the divertor by a factor of 10. Runaway electrons are almost completely eliminated by the large density of free and bound electrons supplied by the gas injection. The small vertical plasma displacement before current quench and high ratio of current decay rate to vertical growth rate result in a 75% reduction in peak halo current amplitude and attendant forces

Density and Temperature Profile Modifications with Electron Cyclotron Power Injection in Quiescent Double Barrier Discharges on DIII-D

Quiescent double barrier (QDB) conditions often form when an internal transport barrier is created with high-power neutral-beam injection into a quiescent H-mode (QH) plasma. These QH-modes offer an attractive, high-performance operating scenario for burning plasma experiments due to their quasi-stationarity and lack of edge localized modes (ELMs). Our initial experiments and modeling using ECH/ECCD in QDB shots were designed to control the current profile and, indeed, we have observed a strong dependence on the q-profile when EC-power is used inside the core transport barrier region. While strong electron heating is observed with EC power injection, we also observe a drop in the other core parameters; ion temperature and rotation, electron density and impurity concentration. These dynamically changing conditions provide a rapid evolution of T{sub e} T{sub i} profiles accessible with 0.3 < (T{sub e} T{sub i}){sub axis} < 0.8 observed in QDB discharges. We are exploring the correlation and effects of observed density profile changes with respect to these time-dependent variations in the temperature ratio. Thermal and particle diffusivity calculations over this temperature ratio range indicate a consistency between the rise in temperature ratio and an increase in transport corresponding to the observed change in density