MRI for assessment of anal fistula

Magnetic resonance imaging (MRI) is the best imaging modality for preoperative assessment of patients with anal fistula. MRI helps to accurately demonstrate disease extension and predict prognosis. This in turn helps make therapy decisions and monitor therapy. The pertinent anatomy, fistula classification and MRI findings will be discussed

Pedestal evolution physics in low triangularity JET tokamak discharges with ITER-like wall

The pressure gradient of the high confinement pedestal region at the edge of tokamak plasmas rapidly collapses during plasma eruptions called edge localised modes (ELMs), and then re-builds over a longer time scale before the next ELM. The physics that controls the evolution of the JET pedestal between ELMs is analysed for 1.4 MA, 1.7 T, low triangularity, delta = 0.2, discharges with the ITER-like wall, finding that the pressure gradient typically tracks the ideal magneto-hydrodynamic ballooning limit, consistent with a role for the kinetic ballooning mode. Furthermore, the pedestal width is often influenced by the region of plasma that has second stability access to the ballooning mode, which can explain its sometimes complex evolution between ELMs. A local gyrokinetic analysis of a second stable flux surface reveals stability to kinetic ballooning modes; global effects are expected to provide a destabilising mechanism and need to be retained in such second stable situations. As well as an electronscale electron temperature gradient mode, ion scale instabilities associated with this flux surface include an electro-magnetic trapped electron branch and two electrostatic branches propagating in the ion direction, one with high radial wavenumber. In these second stability situations, the ELM is triggered by a peeling-ballooning mode; otherwise the pedestal is somewhat below the peeling-ballooning mode marginal stability boundary at ELM onset. In this latter situation, there is evidence that higher frequency ELMs are paced by an oscillation in the plasma, causing a crash in the pedestal before the peeling-ballooning boundary is reached. A model is proposed in which the oscillation is associated with hot plasma filaments that are pushed out towards the plasma edge by a ballooning mode, draining their free energy into the cooler plasma there, and then relaxing back to repeat the process. The results suggest that avoiding the oscillation and maximising the region of plasma that has second stability access will lead to the highest pedestal heights and, therefore, best confinement-a key result for optimising the fusion performance of JET and future tokamaks, such as ITER

Identification of epithelialization in high transsphincteric fistulas

textabstractBackground At present, transanal advancement flap repair (TAFR) is the treatment of choice for transsphincteric fistulas passing through the upper and middle third of the external anal sphincter. It has been suggested that epithelialization of the fistula tract contributes to the failure of the treatment. The aim of this study was to assess the prevalence of epithelialization of the fistula tract and to study its effect on the outcome of TAFR and TAFR combined with ligation of the intersphincteric fistula tract (LIFT). Methods Forty-four patients with a high transsphincteric fistula of cryptoglandular origin underwent TAFR. Nine of these patients underwent a combined procedure of TAFR with LIFT. In all patients the fistula tract was excised from the external opening up to the outer border of the external anal sphincter. In patients undergoing TAFR combined with LIFT an additional central part of the intersphincteric fistula tract was excised. A total of 53 specimens were submitted. Histopathological examination of the specimens was carried out by a pathologist, blinded for clinical data. Results Epithelialization of the distal and intersphincteric fistula tract was observed in only 25 and 22% of fistulas, respectively. There was no difference in outcome between fistulas with or without epithelialization. Conclusions Epithelialization of high transsphincteric fistulas is rare and does not affect the outcome of TAFR and TAFR combined with LIFT

Peeling-ballooning stability of tokamak plasmas with applied 3D magnetic fields

The poloidal harmonics of the toroidal normal modes of an unstable axisymmetric tokamak plasma are employed as basis functions for the minimisation of the 3D energy functional. This approach presents a natural extension of the perturbative method considered in Anastopoulos Tzanis et al (2019 Nucl. Fusion 59 126028). This variational formulation is applied to the stability of tokamak plasmas subject to external non-axisymmetric magnetic fields. A comparison of the variational and perturbative methods shows that for D-shaped, high β N plasmas, the coupling of normal modes becomes strong at experimentally relevant applied 3D fields, leading to violation of the assumptions that justify a perturbative analysis. The variational analysis employed here addresses strong coupling, minimising energy with respect to both toroidal and poloidal Fourier coefficients. In general, it is observed that ballooning unstable modes are further destabilised by the applied 3D fields and field-aligned localisation of the perturbation takes place, as local ballooning theory suggests. For D-shaped high β N plasmas, relevant to experimental cases, it is observed that the existence of intermediate n unstable peeling-ballooning modes, where a maximum in the growth rate spectrum typically occurs, leads to a destabilising synergistic coupling that strongly degrades the stability of the 3D system

Modelling of the effect of ELMs on fuel retention at the bulk W divertor of JET

Effect of ELMs on fuel retention at the bulk W target of JET ITER-Like Wall was studied with multi-scale calculations. Plasma input parameters were taken from ELMy H-mode plasma experiment. The energetic intra-ELM fuel particles get implanted and create near-surface defects up to depths of few tens of nm, which act as the main fuel trapping sites during ELMs. Clustering of implantation-induced vacancies were found to take place. The incoming flux of inter-ELM plasma particles increases the different filling levels of trapped fuel in defects. The temperature increase of the W target during the pulse increases the fuel detrapping rate. The inter-ELM fuel particle flux refills the partially emptied trapping sites and fills new sites. This leads to a competing effect on the retention and release rates of the implanted particles. At high temperatures the main retention appeared in larger vacancy clusters due to increased clustering rate

Modelling of tungsten erosion and deposition in the divertor of JET-ILW in comparison to experimental findings

The erosion, transport and deposition of tungsten in the outer divertor of JET-ILW has been studied for an HMode discharge with low frequency ELMs. For this specific case with an inter-ELM electron temperature at the strike point of about 20 eV, tungsten sputtering between ELMs is almost exclusively due to beryllium impurity and self-sputtering. However, during ELMs tungsten sputtering due to deuterium becomes important and even dominates. The amount of simulated local deposition of tungsten relative to the amount of sputtered tungsten in between ELMs is very high and reaches values of 99% for an electron density of 5E13 cm$^{-3}$ at the strike point and electron temperatures between 10 and 30 eV. Smaller deposition values are simulated with reduced electron density. The direction of the B-field significantly influences the local deposition and leads to a reduction if the E×B drift directs towards the scrape-off-layer. Also, the thermal force can reduce the tungsten deposition, however, an ion temperature gradient of about 0.1 eV/mm or larger is needed for a significant effect. The tungsten deposition simulated during ELMs reaches values of about 98% assuming ELM parameters according to free-streaming model. The measured WI emission profiles in between and within ELMs have been reproduced by the simulation. The contribution to the overall net tungsten erosion during ELMs is about 5 times larger than the one in between ELMs for the studied case. However, this is due to the rather low electron temperature in between ELMs, which leads to deuterium impact energies below the sputtering threshold for tungsten

Impact of fast ions on density peaking in JET : fluid and gyrokinetic modeling

The effect of fast ions on turbulent particle transport, driven by ion temperature gradient (ITG)/trapped electron mode turbulence, is studied. Two neutral beam injection (NBI) heated JET discharges in different regimes are analyzed at the radial position rho(t) = 0.6, one of them an L-mode and the other one an H-mode discharge. Results obtained from the computationally efficient fluid model EDWM and the gyro-fluid model TGLF are compared to linear and nonlinear gyrokinetic GENE simulations as well as the experimentally obtained density peaking. In these models, the fast ions are treated as a dynamic species with a Maxwellian background distribution. The dependence of the zero particle flux density gradient (peaking factor) on fast ion density, temperature and corresponding gradients, is investigated. The simulations show that the inclusion of a fast ion species has a stabilizing influence on the ITG mode and reduces the peaking of the main ion and electron density profiles in the absence of sources. The models mostly reproduce the experimentally obtained density peaking for the L-mode discharge whereas the H-mode density peaking is significantly underpredicted, indicating the importance of the NBI particle source for the H-mode density profile