Overview of recent TJ-II stellarator results

The main results obtained in the TJ-II stellarator in the last two years are reported. The most important topics investigated have been modelling and validation of impurity transport, validation of gyrokinetic simulations, turbulence characterisation, effect of magnetic configuration on transport, fuelling with pellet injection, fast particles and liquid metal plasma facing components. As regards impurity transport research, a number of working lines exploring several recently discovered effects have been developed: the effect of tangential drifts on stellarator neoclassical transport, the impurity flux driven by electric fields tangent to magnetic surfaces and attempts of experimental validation with Doppler reflectometry of the variation of the radial electric field on the flux surface. Concerning gyrokinetic simulations, two validation activities have been performed, the comparison with measurements of zonal flow relaxation in pellet-induced fast transients and the comparison with experimental poloidal variation of fluctuations amplitude. The impact of radial electric fields on turbulence spreading in the edge and scrape-off layer has been also experimentally characterized using a 2D Langmuir probe array. Another remarkable piece of work has been the investigation of the radial propagation of small temperature perturbations using transfer entropy. Research on the physics and modelling of plasma core fuelling with pellet and tracer-encapsulated solid-pellet injection has produced also relevant results. Neutral beam injection driven Alfvénic activity and its possible control by electron cyclotron current drive has been examined as well in TJ-II. Finally, recent results on alternative plasma facing components based on liquid metals are also presentedThis work has been carried out within the framework of the EUROfusion Consortium and has received funding from the Euratom research and training programme 2014–2018 under Grant Agreement No. 633053. It has been partially funded by the Ministerio de Ciencia, Inovación y Universidades of Spain under projects ENE2013-48109-P, ENE2015-70142-P and FIS2017-88892-P. It has also received funds from the Spanish Government via mobility grant PRX17/00425. The authors thankfully acknowledge the computer resources at MareNostrum and the technical support provided by the Barcelona S.C. It has been supported as well by The Science and Technology Center in Ukraine (STCU), Project P-507F

Differential clinical characteristics and prognosis of intraventricular conduction defects in patients with chronic heart failure

Intraventricular conduction defects (IVCDs) can impair prognosis of heart failure (HF), but their specific impact is not well established. This study aimed to analyse the clinical profile and outcomes of HF patients with LBBB, right bundle branch block (RBBB), left anterior fascicular block (LAFB), and no IVCDs. Clinical variables and outcomes after a median follow-up of 21 months were analysed in 1762 patients with chronic HF and LBBB (n = 532), RBBB (n = 134), LAFB (n = 154), and no IVCDs (n = 942). LBBB was associated with more marked LV dilation, depressed LVEF, and mitral valve regurgitation. Patients with RBBB presented overt signs of congestive HF and depressed right ventricular motion. The LAFB group presented intermediate clinical characteristics, and patients with no IVCDs were more often women with less enlarged left ventricles and less depressed LVEF. Death occurred in 332 patients (interannual mortality = 10.8%): cardiovascular in 257, extravascular in 61, and of unknown origin in 14 patients. Cardiac death occurred in 230 (pump failure in 171 and sudden death in 59). An adjusted Cox model showed higher risk of cardiac death and pump failure death in the LBBB and RBBB than in the LAFB and the no IVCD groups. LBBB and RBBB are associated with different clinical profiles and both are independent predictors of increased risk of cardiac death in patients with HF. A more favourable prognosis was observed in patients with LAFB and in those free of IVCDs. Further research in HF patients with RBBB is warranted

Neumonía recurrente adquirida en la comunidad en la edad pediátrica. ¿Factor de riesgo para el desarrollo de asma infantil?

ObjetivoDeterminar si la neumonía recurrente adquirida en la comunidad (NR) constituye un factor de riesgo para desarrollar asma infantil (AI), comparado con los niños que padecen un sólo un episodio de neumonía o neumonía no recurrente (NNR). Determinar si los pacientes con AI están más predispuestos a padecer NR.DiseñoEstudio de cohortes históricas.EmplazamientoAtención primaria.ParticipantesUn total de 80 episodios de neumonía identificados en 65 niños entre el 1 de enero de 1996 y el 30 de junio de 1999.Mediciones principalesRiesgo relativo (RR) y su intervalo de confianza (IC del 95%) de asma infantil en presencia de neumonía recurrente frente a neumonía no recurrente, y RR de neumonía recurrente en presencia de asma infantil.ResultadosDe 65 niños incluidos, 18 niños presentaron NR (27,7%; IC del 95%, 16,8-38,6). La prevalencia de AI fue del 49,2% (32 niños) (IC del 95%, 37,1-61,4). El diagnóstico en algún momento de AI fue superior en niños con NR (RR = 4,1; IC del 95%, 1,9-8,9). No hubo diferencias entre la incidencia de NR y NNR en niños previamente diagnosticados de AI (RR = 1,28; IC del 95%, 0,5-3).ConclusionesEs necesario realizar un seguimiento especial a todo niño diagnosticado de NR en atención primaria, ya que las posibilidades de presentar AI en el futuro son mayores en estos casos.ObjectiveTo determine if recurrent community acquired pneumonia (RP) is a risk factor for developing childhood asthma (CA), compared with those children who only suffer one episode of pneumonia or non-recurrent pneumonia (NRP).To determine if patients with CA are more disposed to suffer RP.DesignHistorical cohort study.SettingPrimary care.ParticipantsA total of 80 episodes of pneumonia identified in 65 infants between the 1st of February 1996 and 30th June 1999.Principal measurementsThe relative risk (RR) and confidence interval (95% CI) of childhood asthma in the presence of recurrent pneumonia as compared to non-recurrent pneumonia, and the RR of recurrent pneumonia in the presence of childhood asthma.ResultsOf the 65 children included, 18 had RP (27.7%; 95% CI, 16.8-38.6). The prevalence of CA was 49.2% (32 children) (95% CI, 37.1-61.4). The diagnosis of CA at any time was higher in children with RP (RR=4.1; 95% CI, 1.9-8.9). There were no differences between the incidence of RP and NRP in children previously diagnosed with CA (RR=1.28; 95% CI, 0.5-3.0).ConclusionsA special follow-up needs to be carried out on all children diagnosed with RP in primary care, since the possibility of presenting with CA is higher in these cases

Utilidad de la exploración física para el diagnóstico de neumonía infantil adquirida en la comunidad en un centro de atención primaria

Objetivo. Determinar la utilidad diagnóstica de tres signos clínicos (fiebre, tos, estertores crepitantes) para el diagnóstico de neumonía en niños; evaluar la concordancia en la interpretación de la radiografía de tórax por dos radiólogos. Diseño. Estudio de pruebas diagnósticas. Emplazamiento. Atención primaria. Material. Trescientas cincuenta historias clínicas de niños a los que se practicó una radiografía de tórax urgente para diagnosticar neumonía entre el 1 de enero de 1996 y el 30 de junio de 1999. Mediciones principales. a) Prevalencia de neumonía en toda la muestra y en dos subgrupos de edad: igual o inferior a 5 años y superior a 5 años; b) cocientes de probabilidad positivo y negativo e intervalos de confianza del 95% (IC del 95%). Se consideró la radiografía de tórax como estándar de referencia, y c) concordancia interradiólogos-índice kappa (*). Resultados. La prevalencia de neumonía en toda la muestra fue del 22,9% (IC del 95%, 18,5-27,3); en los niños de 5 años de edad o menores fue del 20,4% (IC del 95%, 15,6-25,2), y en los mayores de 5 años, del 31,3% (IC del 95%, 21,1-41,4). Los signos estudiados sólo tuvieron alguna utilidad para confirmar el diagnóstico en mayores de 5 años: el cociente de probabilidad positivo fue de 3,52 (IC del 95%, 1,28-9,69) y los radiólogos coincidieron en el diagnóstico en el 93,1% de las radiografías de tórax (* = 0,8; IC del 95%, 0,77-0,83). Conclusiones. En este estudio no se constató la presencia de un subconjunto de signos clínicos que aseguren de forma inequívoca el diagnóstico de neumonía en niños

Correction to: An individualised versus a conventional pneumoperitoneum pressure strategy during colorectal laparoscopic surgery: Rationale and study protocol for a multicentre randomised clinical study (Trials DOI: 10.1186/s13063-019-3255-1)

After publication of our article [1] the authors have notified us that there are changes in the primary outcome and the statistical analysis plan of the study. These changes were made after the recruitment of participants and after approval by the Institutional Review Board, and registration at clinicaltrials.gov (study identifier), but before cleaning and closing of the database. The Postoperative Quality of Recovery Scale (PQRS), an outcome used in the IPPCollapse II study, is a five– dimensional ordinal scale designed to estimate patients' recovery in the postoperative period [2]. Each patient is scored at predefined time points and is classified as either 'recovered' if the score reaches at least the predetermined baseline score or 'not recovered' if otherwise. The five dimensions are then combined in an 'overall score' – a patient is classified as 'overall recovered' if 'recovered' in every domain and as 'overall not recovered' if 'not recovered' in any of the five domains. Outcome variables that are repeatedly assessed over time in the same study patients are to be treated as 'repeated measures' or 'longitudinal data' [3]. Common statistical techniques applied on cross-sectional data assume independence between observations [4]. This crucial assumption is not fulfilled by 'repeated measures' or 'longitudinal data'. Ignoring this correlation can lead to biased estimates, invalid P values and confidence intervals, as well as loss of statistical power [5, 6]. We incorrectly detailed how the PQRS score was to be analysed. We suggested to treat the scores at the four different time points as individual outcomes. From hindsight we feel that this approach does not consider the conceptual underlying model (i.e., between patients' variability) and the temporal design. Furthermore, we also imperfectly reported our primary outcome since we did not specified which domain of the scale was analyzed as primary endpoint although we did report which one we used (i.e. physiologic score) in the sample size calculation. We therefore changed the primary and secondary outcomes as follows: 1. The primary outcome of the IPPCollapse II study is the recovery of the 'physiologic' component of the PQRS score over the assessed time points; 2. The other domains, i.e., the 'nociceptive', 'emotional', 'cognitive', and 'functional' components, as well as the 'overall score' are used as secondary outcomes; 3. Association between group assignment and recovery of PQRS score in each domain is assessed by a mixed logistic regression, introducing patients as random factors, and age, weight, BMI and sex as covariables; 4. The originally reported analysis (i.e. ordinal regression) is still carried out, however only as a sensitivity analysis

An individualised versus a conventional pneumoperitoneum pressure strategy during colorectal laparoscopic surgery: rationale and study protocol for a multicentre randomised clinical study

Abstract Background A recent study shows that a multifaceted strategy using an individualised intra-abdominal pressure titration strategy during colorectal laparoscopic surgery results in an acceptable workspace at low intra-abdominal pressure in most patients. The multifaceted strategy, focused on lower to individualised intra-abdominal pressures, includes prestretching the abdominal wall during initial insufflation, deep neuromuscular blockade, low tidal volume ventilation settings and a modified lithotomy position. The study presented here tests the hypothesis that this strategy improves outcomes of patients scheduled for colorectal laparoscopic surgery. Methods The Individualized Pneumoperitoneum Pressure in Colorectal Laparoscopic Surgery versus Standard Therapy (IPPCollapse-II) study is a multicentre, two-arm, parallel-group, single-blinded randomised 1:1 clinical study that runs in four academic hospitals in Spain. Patients scheduled for colorectal laparoscopic surgery with American Society of Anesthesiologists classification I to III who are aged > 18 years and are without cognitive deficits are randomised to an individualised pneumoperitoneum pressure strategy (the intervention group) or to a conventional pneumoperitoneum pressure strategy (the control group). The primary outcome is recovery assessed with the Post-operative Quality of Recovery Scale (PQRS) at postoperative day 1. Secondary outcomes include PQRS score in the post anaesthesia care unit and at postoperative day 3, postoperative complications until postoperative day 28, hospital length of stay and process-related outcomes. Discussion The IPPCollapse-II study will be the first randomised clinical study that assesses the impact of an individualised pneumoperitoneum pressure strategy focused on working with the lowest intra-abdominal pressure during colorectal laparoscopic surgery on relevant patient-centred outcomes. The results of this large study, to be disseminated through conference presentations and publications in international peer-reviewed journals, are of ultimate importance for optimising the care and safety of laparoscopic abdominal surgery. Selection of patient-reported outcomes as the primary outcome of this study facilitates the translation into clinical practice. Access to source data will be made available through anonymised datasets upon request and after agreement of the Steering Committee of the IPPCollapse-II study. Trial registration ClinicalTrials.gov, NCT02773173. Registered on 16 May 2016. EudraCT, 2016-001693-15. Registered on 8 August 2016