A review of clinical and surgical outcomes of endoscopic endonasal skull base surgery in a Tertiary Center in Sarawak

Background: Endoscopic endonasal approach (EEA) for skull base tumor has been extensively developed in recent years. Objectives: To review the demographic data, indications, clinical presentations and surgical outcomes of endoscopic endonasal skull base surgeries performed. Methods: A retrospective analysis on all patients who had undergone endoscopic endonasal skull base surgery at the Skull Base Unit (ENT & Neurosurgery) from December 2013 to December 2015. Results: A total 34 cases were operated on during the study period. Female patients account for 44% of patients while 56% were male patients, with ages ranging from 8 to 77 years, with the mean age of 51.88 years. Majority of the cases were pituitary tumors (41%), followed by sinonasal tumors (15%), meningioma (12%), clival tumor (8%), cerebrospinal fluid (CSF) leak repair (8%) and frontal mucocoele (6%). Transsellar approach was the commonest approach (41%) followed by the transclival, transplanum, transfrontal approaches. In about 80% of cases, CSF leak was encountered intraoperatively and was successfully repaired endoscopically with the Hadad-Bassagasteguy flap and with the insertion of a lumbar drain. Only one case (3%) of CSF leak was noted postoperatively which was then successful repaired endoscopically with a nasoseptal flap. Systemic complications and intracranial infections were seen in 3 cases (8%) and were managed accordingly. No cases of epitaxis requiring surgical intervention were noted post operatively

First Report from the Asian Rotavirus Surveillance Network

Rotavirus remains the most common cause of severe, dehydrating diarrhea among children worldwide. Several rotavirus vaccines are under development. Decisions about new vaccine introduction will require reliable data on disease impact. The Asian Rotavirus Surveillance Network, begun in 2000 to facilitate collection of these data, is a regional collaboration of 36 hospitals in nine countries or areas that conduct surveillance for rotavirus hospitalizations using a uniform World Health Organization protocol. We summarize the Network's organization and experience from August 2001 through July 2002. During this period, 45% of acute diarrheal hospitalizations among children 0–5 years were attributable to rotavirus, higher than previous estimates. Rotavirus was detected in all sites year-round. This network is a novel, regional approach to surveillance for vaccine-preventable diseases. Such a network should provide increased visibility and advocacy, enable more efficient data collection, facilitate training, and serve as the paradigm for rotavirus surveillance activities in other regions

DIII-D research advancing the physics basis for optimizing the tokamak approach to fusion energy

Funding Information: This material is based upon work supported by the US Department of Energy, Office of Science, Office of Fusion Energy Sciences, using the DIII-D National Fusion Facility, a DOE Office of Science user facility, under Awards DE-FC02-04ER54698 and DE-AC52-07NA27344. Publisher Copyright: © 2022 IAEA, Vienna.DIII-D physics research addresses critical challenges for the operation of ITER and the next generation of fusion energy devices. This is done through a focus on innovations to provide solutions for high performance long pulse operation, coupled with fundamental plasma physics understanding and model validation, to drive scenario development by integrating high performance core and boundary plasmas. Substantial increases in off-axis current drive efficiency from an innovative top launch system for EC power, and in pressure broadening for Alfven eigenmode control from a co-/counter-I p steerable off-axis neutral beam, all improve the prospects for optimization of future long pulse/steady state high performance tokamak operation. Fundamental studies into the modes that drive the evolution of the pedestal pressure profile and electron vs ion heat flux validate predictive models of pedestal recovery after ELMs. Understanding the physics mechanisms of ELM control and density pumpout by 3D magnetic perturbation fields leads to confident predictions for ITER and future devices. Validated modeling of high-Z shattered pellet injection for disruption mitigation, runaway electron dissipation, and techniques for disruption prediction and avoidance including machine learning, give confidence in handling disruptivity for future devices. For the non-nuclear phase of ITER, two actuators are identified to lower the L-H threshold power in hydrogen plasmas. With this physics understanding and suite of capabilities, a high poloidal beta optimized-core scenario with an internal transport barrier that projects nearly to Q = 10 in ITER at ∼8 MA was coupled to a detached divertor, and a near super H-mode optimized-pedestal scenario with co-I p beam injection was coupled to a radiative divertor. The hybrid core scenario was achieved directly, without the need for anomalous current diffusion, using off-axis current drive actuators. Also, a controller to assess proximity to stability limits and regulate β N in the ITER baseline scenario, based on plasma response to probing 3D fields, was demonstrated. Finally, innovative tokamak operation using a negative triangularity shape showed many attractive features for future pilot plant operation.Peer reviewe