Localized Immunoglobulin Light-Chain Amyloidosis of the Ulnar Nerve

Amyloidosis is a disorder caused by extracellular tissue deposition of insoluble fibrils. Amyloidosis can be divided into systemic or localized disease. Primary systemic amyloidosis is a multisystem disease caused by the deposition of amyloid in various tissues. Localized amyloidosis has different characteristics than those of systemic amyloidosis. In this paper, we present the case of a middle-aged woman who presented with worsening ulnar nerve palsy. Electrophysiological examination and MRI indicated a tumor surrounding the ulnar nerve in the forearm. However, the operative findings revealed that ulnar nerve fascicles were replaced with a yellow tissue, which was diagnosed as amyloid light-chain λ amyloidosis, based on histopathological examination. Systemic amyloidosis was ruled out after the screening examinations. This paper is the first report of the ulnar nerve as the sole site of localized immunoglobulin light-chain amyloidosis manifestation

Transport characteristics of deuterium and hydrogen plasmas with ion internal transport barrier in the Large Helical Device

A remarkable extension of the high-ion-temperature (high-Ti) regime was obtained in deuterium plasma experiments in the Large Helical Device. In order to clarify transport characteristics in the ion internal transport barrier (ITB) formation with an isotope effect, a dataset of pure deuterium (nD/ne  >  0.8) and pure hydrogen (nH/ne  >  0.8) plasmas in the high-Ti regime were analyzed, and two mechanisms of transport improvement were characterized. A significant reduction of ion heat transport in the core of both deuterium and hydrogen plasmas was observed, indicating ion ITB formation. The dependence of the ion heat diffusivity on temperature ratio (Te/Ti) and normalized Ti-gradient (R/LTi  =  −(R/Ti)(dTi/dr)) was investigated in the core region, in which gyrokinetic simulations with the GKV code predict the destabilization of ion temperature gradient (ITG) modes. The Te/Ti dependence shows ITG-like property, while a significant deviation from the ITG-like property is found in the R/ dependence, indicating suppression of the ITG mode in the large R/ regime and resultant ion ITB formation. In the comparison between deuterium plasma and hydrogen plasma, the lower transport in the deuterium plasma is observed in both ion and electron heat diffusivities, indicating a significant isotope effect. It was found with the nonlinear turbulent transport simulation with GKV that the zonal flow enhancement contributes to the ITG suppression in the deuterium plasma

Isotope effects on transport in LHD

Isotope effects are one of the most important issues for predicting future reactor operations. Large helical device (LHD) is the presently working largest stellarator/helical device using super conducting helical coils. In LHD, deuterium experiments started in 2017. Extensive studies regarding isotope effects on transport have been carried out. In this paper, the results of isotope effect studies in LHD are reported. The systematic studies were performed adjusting operational parameters and nondimensional parameters. In L mode like normal confinement plasma, where internal and edge transport barriers are not formed, the scaling of global energy confinement time (τE) with operational parameters shows positive mass dependence (M0.27; where M is effective ion mass) in electron cyclotron heating plasma and no mass dependence (M0.0) in neutral beam injection heating plasma. The non-negative ion mass dependence is anti-gyro-Bohm scaling. The role of the turbulence in isotope effects was also found by turbulence measurements and gyrokinetic simulation. Better accessibility to electron and ion internal transport barrier (ITB) plasma is found in deuterium (D) plasma than in hydrogen (H). Gyro kinetic non-linear simulation shows reduced ion heat flux due to the larger generation of zonal flow in deuterium plasma. Peaked carbon density profile plays a prominent role in reducing ion energy transport in ITB plasma. This is evident only in plasma with deuterium ions. New findings on the mixing and non-mixing states of D and H particle transports are reported. In the mixing state, ion particle diffusivities are higher than electron particle diffusivities and D and H ion density profiles are almost identical. In the non-mixing state, ion particle diffusivity is much lower than electron diffusivity. Deuterium and hydrogen ion profiles are clearly different. Different turbulence structures were found in the mixing and non-mixing states suggesting different turbulence modes play a role

Impact of Magnetic Field Configuration on Heat Transport in Stellarators and Heliotrons

We assess the magnetic field configuration in modern fusion devices by comparing experiments with the same heating power, between a stellarator and a heliotron. The key role of turbulence is evident in the optimized stellarator, while neoclassical processes largely determine the transport in the heliotron device. Gyrokinetic simulations elucidate the underlying mechanisms promoting stronger ion scale turbulence in the stellarator. Similar plasma performances in these experiments suggests that neoclassical and turbulent transport should both be optimized in next step reactor designs

The role of preoperative glycemic control in decreasing surgical site infections in lower extremity fractures

Abstract Background Postoperative surgical site infections (SSIs) are an important complication to prevent in surgical treatment. Patients with diabetes mellitus (DM) have a higher risk of SSIs. Preoperative glycemic control is required. For patients with orthopedic trauma, the duration of preoperative glycemic control is limited because delaying operative treatment is difficult. However, whether preoperative glycemic control would decrease the risk of SSIs in diabetic patients with lower extremity fractures is unclear. The first aim of this study was to investigate the rate of SSIs among patients with DM who had undergone preoperative glycemic control, compared with that of patients without DM. As the secondary aim, we sought to demonstrate among patients with DM whether preoperative glycemic control would affect the development of SSIs between patients with controlled DM and patients with poorly controlled DM. Methods In this retrospective cohort study, 1510 patients treated surgically for lower extremity fractures were enrolled. Data collected were patient age, sex, body mass index, history of DM, development of SSIs, tobacco use, the presence of an open fracture, the period between the day of injury and the operation, the length of surgery, and blood glucose levels on admission and on the day before surgery. Results The rate of total SSIs was 6.0% among patients with DM and 4.4% among patients without DM (p = 0.31). Multivariate logistic regression revealed a significant association between the development of SSIs and the presence of DM (odds ratio, 1.79; 95% confidence interval 1.01–3.19; p = 0.047). The results of the secondary study revealed that the rate of early SSIs was significantly higher in the poorly controlled DM group than in the controlled DM group (5.9% vs. 1.5%; p = 0.032). However, multivariate logistic regression revealed that control levels of DM were not significantly associated with the development of SSIs. Conclusions Even though patients with DM had undergone preoperative glycemic control, SSIs were significantly associated with DM, especially when the patients had poorly controlled DM. This finding suggested that continuous glycemic control is important preoperatively and postoperatively to prevent SSIs

Comparison of Multifurcated and Composite Vascular Grafts for Abdominal Aortic Aneurysms with Iliac Arterial Lesions

Introduction: Reconstructing the internal iliac artery (IIA) may help to prevent pelvic ischemia during open repair of abdominal aortic aneurysms (AAAs) with iliac arterial lesions. Composite grafts combined with Y-shaped and straight vascular grafts have previously been used to reconstruct the IIA. However, multifurcated vascular grafts have recently been used to treat AAAs with iliac arterial lesions. We, therefore, assessed the viability of multifurcated vascular grafts for AAAs with iliac arterial lesions. Materials and Methods: We retrospectively reviewed 87 patients who underwent elective open repair with reconstruction of IIAs under infrarenal clamp for AAAs with iliac arterial lesions between April 2002 and August 2015. Forty-three patients received multifurcated vascular grafts including 23 patients who underwent reconstructed unilateral IIA, and 44 patients received composite grafts including forty patients with reconstructed unilateral IIA. We compared the multifurcated and composite graft groups among all patients and also compared among patients who underwent unilateral IIA reconstruction. Results: There were no significant differences between the two groups among all patients in terms of intra- and post-operative data. There were no cases of hospital death or buttock claudication. In propensity score matching analysis among patients with unilateral IIA reconstruction, 22 patients were extracted each group. There were no significant differences in any preoperative or perioperative parameters between the groups. Conclusions: We could not show the availability of open repair using multifurcated vascular grafts for AAA with iliac arterial lesions with comparable results compared to composite grafts

Open Access Rupture of equine pericardial aortic-root patch

after aortic valve replacement with aortic annulus enlargement: a case repor