Learning from each other: Cross-cutting diagnostic development activities between magnetic and inertial confinement fusion (invited).

Inertial Confinement Fusion and Magnetic Confinement Fusion (ICF and MCF) follow different paths toward goals that are largely common. In this paper, the claim is made that progress can be accelerated by learning from each other across the two fields. Examples of successful cross-community knowledge transfer are presented that highlight the gains from working together, specifically in the areas of high-resolution x-ray imaging spectroscopy and neutron spectrometry. Opportunities for near- and mid-term collaboration are identified, including in chemical vapor deposition diamond detector technology, using gamma rays to monitor fusion gain, handling neutron-induced backgrounds, developing radiation hard technology, and collecting fundamental supporting data needed for diagnostic analysis. Fusion research is rapidly moving into the igniting and burning regimes, posing new opportunities and challenges for ICF and MCF diagnostics. This includes new physics to probe, such as alpha heating; increasingly harsher environmental conditions; and (in the slightly longer term) the need for new plant monitoring diagnostics. Substantial overlap is expected in all of these emerging areas, where joint development across the two subfields as well as between public and private researchers can be expected to speed up advancement for all.

Radiated power and soft x-ray diagnostics in the SMART tokamak.

A multi-energy soft x-ray diagnostic is planned to operate in the small aspect ratio tokamak (SMART), consisting of five cameras: one for core measurements, two for edge, and two for divertors. Each camera is equipped with four absolute extreme ultra-violet diodes, with three of them filtered by Ti and Al foils for C and O line emissions, respectively, and Be foils for temperature measurements. In addition, two spectrometers will be installed with a vertical line of sight for impurity control. This study introduces a synthetic model designed to characterize radiated power and soft x-ray emissions. The developed code extracts the radiated power and Zeff values by leveraging distributions of electron density, temperatures, and impurity concentrations. The investigation is centered on the predicted scenarios of SMART's first phase of operation (Ip = 100 kA; Bt = 0.1 T), employing a double-null configuration with positive and negative triangularity. The anticipated impurities encompass C (1%) and Fe (0.01%) from the vessel, as well as O and N (0.1%) from air and water. For simplicity, the distribution is assumed to be homogeneous within the plasma, considering different mixtures with Zeff values ranging between 1 and 2. Finally, the model estimates signal strength for the diagnostic design, proving its feasibility.

X-ray sources for in situ wavelength calibration of x-ray imaging crystal spectrometers.

X-ray sources for a range of wavelengths are being considered for in situ calibration of X-ray Imaging Crystal Spectrometers (XICSs) and for monitoring line shifts due to changes in the crystal temperature, which can vary during experimental operation over a day [A. Ince-Cushman et al., Rev. Sci. Instrum. 79, 10E302 (2008), L. Delgado-Aparicio et al., Plasma Phys. Control. Fusion 55, 125011 (2013)]. Such crystal temperature dependent shifts, if not accounted for, could be erroneously interpreted as Doppler shifts leading to errors in plasma flow-velocity measurements. The x-ray sources encompass characteristic x-ray lines falling within the wavelength range of 0.9-4.0 Å, relevant for the XICSs on present and future fusion devices. Several technological challenges associated with the development of x-ray sources for in situ calibration are identified and are being addressed in the design of multiple x-ray tubes, which will be installed inside the spectrometer housing of the XICS for the JT-60SA tokamak. These x-ray sources will be especially useful for in situ calibration between plasma discharges. In this paper, laboratory experiments are described that were conducted with a Cu x-ray source, a heated quartz (102) crystal, and a pixelated Pilatus detector to measure the temperature dependent shifts of the Cu Kα1 and Kα2 lines at 1.5405 and 1.5443 Å, respectively, and to evaluate the 2d-lattice constant for the Bragg reflecting crystal planes as a function of temperature, which, in the case of in situ wavelength calibration, would have to be used for numerical analysis of the x-ray spectra from the plasma.

Results from a synthetic model of the ITER XRCS-Core diagnostic based on high-fidelity x-ray ray tracing.

A high-fidelity synthetic diagnostic has been developed for the ITER core x-ray crystal spectrometer diagnostic based on x-ray ray tracing. This synthetic diagnostic has been used to model expected performance of the diagnostic, to aid in diagnostic design, and to develop engineering tolerances. The synthetic model is based on x-ray ray tracing using the recently developed xicsrt ray tracing code and includes a fully three-dimensional representation of the diagnostic based on the computer aided design. The modeled components are: plasma geometry and emission profiles, highly oriented pyrolytic graphite pre-reflectors, spherically bent crystals, and pixelated x-ray detectors. Plasma emission profiles have been calculated for Xe44+, Xe47+, and Xe51+, based on an ITER operational scenario available through the Integrated Modelling & Analysis Suite database, and modeled within the ray tracing code as a volumetric x-ray source; the shape of the plasma source is determined by equilibrium geometry and an appropriate wavelength distribution to match the expected ion temperature profile. All individual components of the x-ray optical system have been modeled with high-fidelity producing a synthetic detector image that is expected to closely match what will be seen in the final as-built system. Particular care is taken to maintain preservation of photon statistics throughout the ray tracing allowing for quantitative estimates of diagnostic performance.

Versatile multi-energy hard x-ray camera to study confined and unconfined fast electron dynamics and anisotropies (Invited).

A powerful and flexible hard x-ray (HXR) camera has been recently installed and tested on the WEST tokamak (CEA, France) in collaboration with the Princeton Plasma Physics Laboratory. The diagnostic is a pinhole camera fielded with a 2D pixel detector equipped with a 1 mm thick CdTe sensor. The novelty of this diagnostic technique is the detector's capability of adjusting the threshold energy at the pixel level. This innovation provides great flexibility in the energy configuration, allowing simultaneous space, energy, and time resolved x-ray measurements. The novel camera has been used to measure the core radiation from non-Maxwellian (fast) electrons accelerated by Lower Hybrid (LH) waves and also the beam-target emission of tungsten in the divertor region produced by fast electron losses interacting with the target. In addition, anisotropic hard x-ray emission has been detected for the first time at the WEST core and edge plasma, with opposite toroidal intensity trends. Experimental vertical and toroidal HXR profiles have been successfully reproduced with the LH code LUKE.

Seventy years of pheochromocytomas and paragangliomas in Argentina. The FRENAR database.

Pheochromocytomas and paragangliomas (PPGL) are neuroendocrine tumors characterized by the excessive production of catecholamines. This study aims to describe the clinical characteristics of PPGL cases in Argentina over recent decades. A multicenter retrospective cross-sectional analysis was carried out using a database comprising both pediatric and adult patients with confirmed PPGL diagnoses based on pathological reports. A cohort of 486 patients with PPGL was recruited. Women represent 58.4% of the patients, with a mean age of 38.3 years old at the time of diagnosis and 15.2% of the patients were under the age of 18. Hypertension, as well as classic signs and symptoms, were present in 80.9% of the patients. The adrenal incidentaloma, as a mode of presentation, increased in the last two decades rising from 3.9% (1953-2000) to 21.8% (2001-2022), p<0.001. Most tumors were located within the adrenal glands, accounting 83.0% of the cases, with bilateral occurrences noted in 20.0%. The median tumor size was 4.8cm. Local recurrence and metastases were observed in 10.9% and 12.2%. Out of 412 patients, 87.0% exhibited urinary excretion elevation of catecholamines and/or their metabolites. Furthermore, 148 patients, representing 30.4% of the study population, displayed a distinct genetic profile indicative of hereditary syndromes. The distribution of hereditary syndromes revealed that MEN2, VHL, and PGL4 constituted the most prevalent syndromes. This population-based study, spanning seven decades, offers valuable insights into the demographic and clinical characteristics of PPGL patients in Argentina.

Characterization and treatment of enuresis in overactive bladder patients. / Caracterización y tratamiento de la enuresis en pacientes con vejiga hiperactiva.

OBJECTIVE: To define the types of overactive bladder (OAB) patient enuresis and study daytime bladder treatment response. MATERIALS AND METHODS: A prospective, multi-center study of OAB patients with enuresis treated with anticholinergics or neuromodulation over 3 months from 2019 to 2021 was carried out. Variables achieved from the voiding calendar and PLUTSS (Pediatric Lower Urinary Tract Score System), as well as enuresis-related variables, were collected. Two study groups were created -primary enuresis (PE) and secondary enuresis (SE). Partial enuretic response (PER) was defined as a > 50% reduction in baseline enuresis, and complete enuretic response (CER) as a 100% reduction. A multivariate analysis was eventually conducted to detect CER independent predictive factors. RESULTS: 152 OAB patients were included. 109 of them (71.7%) had enuresis -29 (26.7%) SE and 80 (73.3%) PE. PLUTSS score was higher in PE patients than in SE patients (20.8 vs. 17.2; p= 0.001). PER and CER were significantly higher in the SE group (55.2% vs. 15%; p= 0.000 in PER, and 48.3% vs. 5%; p= 0.000 in CER). In the multivariate analysis, SE patients demonstrated to have a 50-fold increased probability of responding to daytime bladder treatment than PE patients (OR: 49.79; 95%CI: 6.73-36.8). CONCLUSIONS: Most OAB children have PE and not SE, which explains why enuresis does not typically respond to daytime bladder treatment. Characterizing the type of enuresis in OAB children is important to adequately approach treatment.

OBJETIVOS: Definir los tipos de enuresis de los pacientes con vejiga hiperactiva (VH) y estudiar su respuesta al tratamiento vesical diurno. MATERIAL Y METODOS: Estudio prospectivo y multicéntrico: pacientes con VH y enuresis, tratados con anticolinérgicos o neuromodulación durante 3 meses (2019-2021). Recogimos variables obtenidas del calendario miccional, cuestionario PLUTSS (Pediatric Lower Urinary Tract Score System), y relacionadas con la enuresis. Generamos 2 grupos de estudio: enuresis primaria (EP) y enuresis secundaria (ES). Consideramos respuesta parcial enurética (RPE) a la reducción del valor de enuresis inicial en más de un 50% y respuesta completa (RCE) el 100%. Finalmente realizamos un análisis multivariante para detectar factores predictivos independientes de RCE. RESULTADOS: Incluimos 152 pacientes con VH, 109 de los cuales presentaban enuresis (71,7%): 29 ES (26,7%) y 80 EP (73,3%). El valor PLUTSS fue mayor en pacientes con EP que en ES (20,8 vs. 17,2, p= 0,001.) La RPE y la RCE fueron significativamente mayores en el grupo de ES (55,2% vs. 15%, p= 0,000 en RPE y 48,3% vs. 5%, p= 0,000 en RCE). En el análisis multivariante se identificó que los pacientes con ES tienen una probabilidad de responder al tratamiento vesical diurno 50 veces superior que los pacientes con EP (OR 49,79, IC95% 6,73-36,8). CONCLUSIONES: La mayoría de niños con VH tienen una EP y no secundaria, por lo que generalmente la enuresis de estos pacientes no responde al tratamiento vesical diurno. Es importante caracterizar el tipo de enuresis de los niños con VH para plantear su tratamiento de forma adecuada.

Efficacy of sacral transcutaneous electrical nerve stimulation in patients with overactive bladder refractory to anticholinergic treatment: a prospective multi-center study. / Eficacia de la electroestimulación transcutánea sacra en pacientes con vejiga hiperactiva refractarios a fármacos anticolinérgicos. Estudio prospectivo y multicéntrico.

OBJECTIVE: To determine whether sacral transcutaneous electrical nerve stimulation (S-TENS) is an effective treatment in patients refractory to anticholinergic drugs (Achs). MATERIALS AND METHODS: A prospective multi-center study of patients with overactive bladder (OB) refractory to Achs treated with S-TENS from 2018 to 2021 was carried out. S-TENS was applied over 3 months. Symptom progression was assessed using the voiding calendar and the Pediatric Lower Urinary Tract Symptoms Score (PLUTSS), excluding questions 3 and 4 -referring to enuresis- so that progression of daytime symptoms only (LUTS variable) was analyzed. RESULTS: 66 patients -50% of whom were female- were included, with a mean age of 9.5 years (range: 5-15). S-TENS significantly lowered PLUTSS (19.1 baseline vs. 9.5 final, p< 0.001) and LUTS (13.1 baseline vs. 4.8 final, p< 0.001). It also reduced the number of mictions (8.5 baseline vs. 6.4 final, p< 0.001), while increasing urine volume in the voiding records (214 ml baseline vs. 258 ml final, p< 0.001). Enuresis was the only variable refractory to S-TENS. Complication rate was 3% (2 patients with dermatitis in the S-TENS application area). CONCLUSIONS: S-TENS is effective and safe in the short-term in patients with OB refractory to Achs. Further studies assessing long-term efficacy and potential relapses are required.

OBJETIVOS: Determinar si la electroterapia nerviosa transcutánea a nivel sacro (TENS-S) es un tratamiento efectivo en pacientes refractarios a fármacos anticolinérgicos (Ach). MATERIAL Y METODOS: Estudio prospectivo y multicéntrico: pacientes con VH refractaria a Ach tratados con TENS-S entre 2018-2021. El TENS-S se aplicó durante 3 meses. La evolución sintomática fue evaluada utilizando el calendario miccional y el cuestionario PLUTSS (Pediatric Lower Urinary Tract Symptoms Score), pero excluyendo sus preguntas 3 y 4 (referidas a la enuresis) para analizar solamente la evolución de la sintomatología diurna (variable LUTS). RESULTADOS: Fueron incluidos 66 pacientes (50% niñas), con una edad media de 9,5 años (rango: 5-15). El TENS-S disminuyó significativamente el PLUTSS (19,1 inicial vs 9,5 final, p< 0,001) y el LUTS (13,1 inicial vs 4,8 final, p< 0,001). Además, redujo el número de micciones (8,5 inicial vs 6,4 final, p< 0,001) y aumentó el volumen de orina en los registros miccionales (214 ml inicial vs 258 ml final, p< 0,001). La enuresis fue la única variable refractaria al TENS-S. La tasa de complicaciones fue del 3% (2 pacientes, dermatitis en el área de aplicación del TENS-S). CONCLUSIONES: El TENS-S es efectivo y seguro a corto plazo en pacientes con VH refractarios a los Ach. Deben realizarse estudios para evaluar la eficacia a largo plazo y posibles recaídas.

Evaluación de las consecuencias físicas y psicosociales de la diástasis de rectos abdominales y su interferencia en la salud: un estudio mixto / Evaluation of the physical and psychosocial consequences of the diastasis of the rectus abdominis and its interference in health: A mixed study

Introducción: La diástasis de rectos abdominales (DRA) se define como la separación de los rectos abdominales a lo largo de la línea alba. Esta condición puede darse en ambos sexos, siendo frecuente en la mujer durante el embarazo y posparto. Existe poca evidencia sobre las consecuencias de la DRA en la calidad de vida de las mujeres. Objetivo: El análisis de la percepción de los síntomas de DRA y su repercusión a nivel físico, psicológico y social en mujeres afectadas por esta condición. Pacientes y métodos: Estudio observacional por medio de una encuesta online semiestructurada, compuesta por 30 preguntas cerradas y 2 abiertas. Los criterios de inclusión fueron mujeres adultas de habla hispana, que hubiesen dado a luz y que presentasen diástasis abdominal. Los datos se analizaron de forma cuantitativa y la información cualitativa se obtuvo mediante un análisis de contenido de las preguntas abiertas. Resultados: Trescientas diecinueve mujeres con DRA fueron incluidas. Los resultados mostraron una afectación negativa de la DRA en la calidad de vida, las capacidades funcionales y en la salud uroginecológica y digestiva. Así mismo se evidenció un impacto negativo a nivel emocional, en la imagen corporal y una mala salud autopercibida. Conclusión:La DRA tiene un impacto negativo en la salud de la mujer. Las mujeres con DRA presentan una afectación de la calidad de vida y de las capacidades funcionales, una alteración de la imagen corporal, sentimientos de abandono por parte de las instituciones sanitarias, vergüenza, tristeza, impotencia, falta de autoestima, resignación y presión social.(AU)

Introduction: Diastasis rectus abdominis (DRA) is defined as the separation of the rectus abdominis along the linea alba. This condition can occur in both sexes, being frequent in women during pregnancy and pospartum. There is little evidence on the consequences of DRA on the quality of life of women. Objective: The analysis of the perception of the symptoms of and its repercussion on a physical, psychological and social level in women affected by this condition. Patients and methods: Observational study through a semi-structured online survey, composed of 30 closed questions and 2 open ones. The inclusion criteria were adult Spanish-speaking women who had given birth and who presented abdominal diástasis. The data were analyzed quantitatively and the qualitative information was obtained through a content analysis of the open questions. Results: 319 women with DRA were included. The results showed a negative effect of DRA on quality of life, functional capacities, and urogynecological and digestive health. Likewise, a negative impact was evidenced at an emotional level, on body image and poor self-perceived health. Conclusion: DRA has a negative impact on women's health. Women with DRA present an impairment of the quality of life and functional capacities, an alteration in body image, feelings of abandonment by health institutions, shame, sadness, powerlessness, lack of self-esteem, resignation and social pressure.(AU)

[Evaluation of the physical and psychosocial consequences of the diastasis of the rectus abdominis and its interference in health: A mixed study]. / Evaluación de las consecuencias físicas y psicosociales de la diástasis de rectos abdominales y su interferencia en la salud: un estudio mixto.

INTRODUCTION: Diastasis rectus abdominis (DRA) is defined as the separation of the rectus abdominis along the linea alba. This condition can occur in both sexes, being frequent in women during pregnancy and pospartum. There is little evidence on the consequences of DRA on the quality of life of women. OBJECTIVE: The analysis of the perception of the symptoms of and its repercussion on a physical, psychological and social level in women affected by this condition. PATIENTS AND METHODS: Observational study through a semi-structured online survey, composed of 30 closed questions and 2 open ones. The inclusion criteria were adult Spanish-speaking women who had given birth and who presented abdominal diástasis. The data were analyzed quantitatively and the qualitative information was obtained through a content analysis of the open questions. RESULTS: 319 women with DRA were included. The results showed a negative effect of DRA on quality of life, functional capacities, and urogynecological and digestive health. Likewise, a negative impact was evidenced at an emotional level, on body image and poor self-perceived health. CONCLUSION: DRA has a negative impact on women's health. Women with DRA present an impairment of the quality of life and functional capacities, an alteration in body image, feelings of abandonment by health institutions, shame, sadness, powerlessness, lack of self-esteem, resignation and social pressure.

Spatial calibration and synthetic diagnostic of a multi-energy hard x-ray camera at WEST tokamak.

WEST (tungsten environment in steady-state tokamak) is starting operation for the first time with a water-cooled full tungsten divertor, enabling long pulse operation. Heating is provided by radiofrequency systems, including lower hybrid current drive (LHCD). In this context, a compact multi-energy hard x-ray camera has been installed for energy and space-resolved measurements of the electron temperature, the fast electron tail density produced by LHCD and runaway electrons, and the beam-target emission of tungsten at the target due to fast electron losses interacting with the divertor plates. The diagnostic is a pinhole camera based on a 2D pixel array detector (Pilatus 3 CdTe CMOS Hybrid-Pixel detector produced by DECTRIS). The novelty of this diagnostic technique is the detector's capability of adjusting the threshold energy at pixel level. This innovation provides great flexibility in the energy configuration, allowing simultaneous space and energy-resolved x-ray measurements. This contribution details two important steps in the preparation of the diagnostic operation. First, the in-vessel spatial calibration that was carried out with a radioactive source. Second, the synthetic diagnostic is obtained by the suite of codes ALOHA/C3PO/LUKE/R5-X2, which simulates LH wave propagation and absorption, as well as the fast electron bremsstrahlung production.

Los fenómenos pop-off como factores protectoresde enfermedad renal crónica en niños con válvulasde uretra posterior / Pop-off mechanisms as protective factors against chronic renal disease in children with posterior urethral valves

Objetivos: Identificar si los fenómenos pop-off actúan como factoresprotectores de enfermedad renal crónica o terminal en pacientes conválvulas de uretra posterior. Material y métodos: Estudio de cohortes retrospectivo de los pa-cientes con válvulas de uretra posterior tratados en un hospital infantil detercer nivel. Se recogieron variables demográficas, clínicas, analíticas yradiológicas. Se consideraron fenómenos pop-off: reflujo vesicoureteralde alto grado unilateral con displasia renal ipsilateral y sin afectación delriñón contralateral, urinoma, ascitis urinaria prenatal, divertículo vesicalgrande y uraco persistente. Para el análisis estadístico se han utilizadoregresiones logísticas múltiples y regresión de Cox multivariante. Resultados: Se incluyeron 70 pacientes intervenidos de válvulas deuretra posterior y visitados en nuestro centro desde 2010 hasta agostode 2020. Catorce (20%) presentaban fenómenos pop-off y 56 (80%)no. Los fenómenos pop-off fueron protectores para el desarrollo deenfermedad renal crónica (0 vs. 27%; p = 0,03) y podrían proteger de lanecesidad de terapia renal sustitutiva (0 vs. 9%; p = 0,58). Los valores decreatinina nadir (mg/dl) fueron predictores de desarrollo de enfermedadrenal crónica (0,37 vs. 0,53; p < 0,0001) y de necesidad de terapia renalsustitutiva (0,38 vs. 1,21; p < 0,001). Conclusiones: Los fenómenos pop-off actúan como factor protectorde enfermedad renal crónica en los pacientes con válvulas de uretraposterior. La creatinina nadir es un factor predictor de enfermedad renalcrónica y de necesidad de terapia renal sustitutiva. Se necesita un tamañode muestra mayor para determinar si los fenómenos pop-off protegende la necesidad de terapia renal sustitutiva.(AU)

Objective: To identify whether pop-off mechanisms act as protec-tive factors against chronic or end-stage renal disease in patients withposterior urethral valves. Materials and methods: A retrospective cohort study of patients withposterior urethral valves treated at a tertiary care children’s hospital wascarried out. Demographic, clinical, analytical, and radiological variableswere collected. Considered as pop-off mechanisms were: unilateral high-grade vesicoureteral reflux with ipsilateral renal dysplasia and withoutinvolvement of the contralateral kidney, urinoma, prenatal urinary ascites,large bladder diverticulum, and persistent urachus. Multiple logistic regres-sion and multivariate Cox regression were used for statistical analysis. Results: 70 patients undergoing posterior urethral valve surgery inour institution from 2010 to August 2020 were included. 14 (20%) hadpop-off mechanisms and 56 (80%) did not. Pop-off mechanisms pro-tected against developing chronic renal disease (0% vs. 27%; p = 0.03)and could protect against the need for renal replacement therapy (0%vs. 9%; p = 0.58). Nadir creatinine values (mg/dl) were predictors forthe development of chronic renal disease (0.37 vs. 0.53; p < 0.0001)and the need for renal replacement therapy (0.38 vs. 1.21; p < 0.001). Conclusions: Pop-off mechanisms act as a protective factor againstchronic renal disease in patients with posterior urethral valves. Nadircreatinine is a predictor of chronic renal disease and the need for renalreplacement therapy. A larger sample size is needed to determine whetherpop-off mechanisms protect against the need for renal replacement therapy.(AU)

Pop-off mechanisms as protective factors against chronic renal disease in children with posterior urethral valves. / Los fenómenos pop-off como factores protectores de enfermedad renal crónica en niños con válvulas de uretra posterior.

OBJECTIVE: To identify whether pop-off mechanisms act as protective factors against chronic or end-stage renal disease in patients with posterior urethral valves. MATERIALS AND METHODS: A retrospective cohort study of patients with posterior urethral valves treated at a tertiary care children's hospital was carried out. Demographic, clinical, analytical, and radiological variables were collected. Considered as pop-off mechanisms were: unilateral high-grade vesicoureteral reflux with ipsilateral renal dysplasia and without involvement of the contralateral kidney, urinoma, prenatal urinary ascites, large bladder diverticulum, and persistent urachus. Multiple logistic regression and multivariate Cox regression were used for statistical analysis. RESULTS: 70 patients undergoing posterior urethral valve surgery in our institution from 2010 to August 2020 were included. 14 (20%) had pop-off mechanisms and 56 (80%) did not. Pop-off mechanisms protected against developing chronic renal disease (0% vs. 27%; p = 0.03) and could protect against the need for renal replacement therapy (0% vs. 9%; p = 0.58). Nadir creatinine values (mg/dl) were predictors for the development of chronic renal disease (0.37 vs. 0.53; p < 0.0001) and the need for renal replacement therapy (0.38 vs. 1.21; p < 0.001). CONCLUSIONS: Pop-off mechanisms act as a protective factor against chronic renal disease in patients with posterior urethral valves. Nadir creatinine is a predictor of chronic renal disease and the need for renal replacement therapy. A larger sample size is needed to determine whether pop-off mechanisms protect against the need for renal replacement therapy.

OBJETIVOS: Identificar si los fenómenos pop-off actúan como factores protectores de enfermedad renal crónica o terminal en pacientes con válvulas de uretra posterior. MATERIAL Y METODOS: Estudio de cohortes retrospectivo de los pacientes con válvulas de uretra posterior tratados en un hospital infantil de tercer nivel. Se recogieron variables demográficas, clínicas, analíticas y radiológicas. Se consideraron fenómenos pop-off: reflujo vesicoureteral de alto grado unilateral con displasia renal ipsilateral y sin afectación del riñón contralateral, urinoma, ascitis urinaria prenatal, divertículo vesical grande y uraco persistente. Para el análisis estadístico se han utilizado regresiones logísticas múltiples y regresión de Cox multivariante. RESULTADOS: Se incluyeron 70 pacientes intervenidos de válvulas de uretra posterior y visitados en nuestro centro desde 2010 hasta agosto de 2020. Catorce (20%) presentaban fenómenos pop-off y 56 (80%) no. Los fenómenos pop-off fueron protectores para el desarrollo de enfermedad renal crónica (0 vs. 27%; p = 0,03) y podrían proteger de la necesidad de terapia renal sustitutiva (0 vs. 9%; p = 0,58). Los valores de creatinina nadir (mg/dl) fueron predictores de desarrollo de enfermedad renal crónica (0,37 vs. 0,53; p < 0,0001) y de necesidad de terapia renal sustitutiva (0,38 vs. 1,21; p < 0,001). CONCLUSIONES: Los fenómenos pop-off actúan como factor protector de enfermedad renal crónica en los pacientes con válvulas de uretra posterior. La creatinina nadir es un factor predictor de enfermedad renal crónica y de necesidad de terapia renal sustitutiva. Se necesita un tamaño de muestra mayor para determinar si los fenómenos pop-off protegen de la necesidad de terapia renal sustitutiva.

Multi-energy reconstructions, central electron temperature measurements, and early detection of the birth and growth of runaway electrons using a versatile soft x-ray pinhole camera at MST.

A multi-energy soft x-ray pinhole camera has been designed, built, and deployed at the Madison Symmetric Torus to aid the study of particle and thermal transport, as well as MHD stability physics. This novel imaging diagnostic technique employs a pixelated x-ray detector in which the lower energy threshold for photon detection can be adjusted independently on each pixel. The detector of choice is a PILATUS3 100 K with a 450 µm thick silicon sensor and nearly 100 000 pixels sensitive to photon energies between 1.6 and 30 keV. An ensemble of cubic spline smoothing functions has been applied to the line-integrated data for each time-frame and energy-range, obtaining a reduced standard-deviation when compared to that dominated by photon-noise. The multi-energy local emissivity profiles are obtained from a 1D matrix-based Abel-inversion procedure. Central values of Te can be obtained by modeling the slope of the continuum radiation from ratios of the inverted radial emissivity profiles over multiple energy ranges with no a priori assumptions of plasma profiles, magnetic field reconstruction constraints, high-density limitations, or need of shot-to-shot reproducibility. In tokamak plasmas, a novel application has recently been tested for early detection, 1D imaging, and study of the birth, exponential growth, and saturation of runaway electrons at energies comparable to 100 × Te,0; thus, early results are also presented.

Robust analysis of space-, time-, and energy-resolved soft x-ray measurements of magnetically confined fusion plasmas (invited).

A novel compact multi-energy soft x-ray (ME-SXR) diagnostic based on the PILATUS3 100K x-ray detector has been developed in collaboration between the Princeton Plasma Physics Laboratory and the University of Wisconsin-Madison and tested on the Madison Symmetric Torus (MST) reversed-field pinch. This solid-state photon-counting detector consists of a two-dimensional array of ∼100 000 pixels for which the lower photon absorption cutoff energy can be independently set, allowing it to be configured for a unique combination of simultaneous spatial, spectral, and temporal resolution of ∼1 cm, 100 eV, and 500 Hz, respectively. The diagnostic is highly versatile and can be readily adapted to diverse plasma operating conditions and scientific needs without any required downtime. New results from improved-confinement and quasi-single helicity plasmas in the MST demonstrate how the detector can be applied to study multiple aspects of the evolution of magnetically confined fusion-grade plasmas. These include observing the evolution of thermal emissivity, characterizing the energy of mid-Z excitation lines, extracting the Te profile, and observing the evolution of non-thermal populations. A technique for integrating the ME-SXR diagnostic into an integrated data analysis framework based on Bayesian inference is also presented. This allows ME-SXR measurements to be combined with data for complementary diagnostics in order to simultaneously infer Te and nZ from all available information.

Calibration of a versatile multi-energy soft x-ray diagnostic for WEST long pulse plasmas.

A compact multi-energy soft x-ray diagnostic is being installed on the W Environment in Steady-state Tokamak (WEST), which was designed and built to test ITER-like tungsten plasma facing components in a long pulse (∼1000 s) scenario. The diagnostic consists of a pinhole camera fielded with the PILATUS3 photon-counting Si-based detector (≲100 kpixel). The detector has sensitivity in the range 1.6-30 keV and enables energy discrimination, providing a higher energy resolution than conventional systems with metal foils and diodes with adequate space and time resolution (≲1 cm and 2 ms). The lower-absorption cut-off energy is set independently on each one of the ∼100 kpixels, providing a unique opportunity to measure simultaneously the plasma emissivity in multiple energy ranges and deduce a variety of plasma parameters (e.g., Te, nZ, and ΔZeff). The energy dependence of each pixel is calibrated here over the range 3-22 keV. The detector is exposed to a variety of monochromatic sources-fluorescence emission from metallic targets-and for each pixel, the lower energy threshold is scanned to calibrate the energy dependence. The data are fit to a responsivity curve ("S-curve") that determines the mapping between the possible detector settings and the energy response for each pixel. Here, the calibration is performed for three energy ranges: low (2.3-6 keV), medium (4.5-13.5 keV), and high (5.4-21 keV). We determine the achievable energy resolutions for the low, medium, and high energy ranges as 330 eV, 640 eV, and 950 eV, respectively. The main limitation for the energy resolution is found to be the finite width of the S-curve.

Multi-energy calibration of a PILATUS3 CdTe detector for hard x-ray measurements of magnetically confined fusion plasmas.

A multi-energy hard x-ray pin-hole camera based on the PILATUS3 X 100K-M CdTe detector has been developed at the Princeton Plasma Physics Laboratory for installation on the Tungsten Environment in Steady State Tokamak. This camera will be employed to study thermal plasma features such as electron temperature as well as non-thermal effects such as fast electron tails produced by a lower hybrid radiofrequency current drive and the birth of runaway electrons. The innovative aspect of the system lies in the possibility of setting the threshold energy independently for each of the ∼100k pixels of the detector. This feature allows for the measurement of the x-ray emission in multiple energy ranges with adequate space and time resolution (∼1 cm, 2 ms) and coarse energy resolution. In this work, the energy dependence of each pixel was calibrated within the range 15 keV-100 keV using a tungsten x-ray tube and emission from a variety of fluorescence targets (from yttrium to uranium). The data corresponding to pairs of Kα emission lines are fit to the characteristic responsivity ("S-curve"), which describes the detector sensitivity across the 64 possible energy threshold values for each pixel; this novel capability is explored by fine-tuning the voltage of a six-bit digital-analog converter after the charge-sensitive amplifier for each of the ∼100k pixels. This work presents the results of the calibration including a statistical analysis. It was found that the achievable energy resolution is mainly limited by the width of the S-curve to 3 keV-10 keV for threshold energies up to 50 keV, and to ≥20 keV for energies above 60 keV.

Pharmacological and toxicological effects of Ruta chalepensis L. on experimentally induced seizures and electroencephalographic spectral power in mice.

ETHNOPHARMACOLOGICAL RELEVANCE: Ruta chalepensis L. (Rutaceae) is used in traditional medicine to treat a wide variety of disorders such as rheumatism, fever, mental disorders, dropsy, neuralgia, menstrual problems, anxiety, and epilepsy. AIM OF THE STUDY: To evaluate and compare the anticonvulsant properties of an aqueous extract and ethyl acetate (AcOEt) fraction of R. chalepensis on pentylenetetrazole (PTZ)-induced seizures and maximal electroshock (MES) test in mice, by analyzing behavior and electroencephalogram (EEG), as well as GABAA receptors involvement. METHODS: The effect of an acute administration of different dosage of the aqueous extract (300 or 500 mg/kg) or AcOEt fraction (100, 300, 500 or 1000 mg/kg) of R. chalepensis was explored on two different models of acute seizure induction in mice, the PTZ and maximal electroshock (MES) tests. Behavioral and electrographic effects were quantified. Additionally, the possible involvement of the GABAA receptors was explored in the presence of picrotoxin (a non-competitive antagonist of the GABAA receptor). RESULTS: AcOEt fraction of R. chalepensis was more efficient than aqueous extract to reduce the incidence of tonic-clonic seizures and mortality in a significant and dose-dependent manner in both the PTZ and MES tests. This anticonvulsant effect was not abolished in the presence of picrotoxin. The EEG spectral power analysis revealed that aqueous extract decreased alpha and beta power, while AcOEt fraction decreased alpha and gamma power confirming previous findings of its depressant effect in the central nervous system. It is important to mention that the highest dosage of the AcOEt (1000 mg/kg) produced a severe suppression or isoelectric EEG activity (EEG flattening), recognized as a comatose state, suggesting a neurotoxic effect at this dosage. CONCLUSION: Our data reinforce that depressant and anticonvulsant effects of R. chalepensis depend in part on the presence of constituents from medium polarity. We also found that anticonvulsant effect is not mediated by GABAA receptors. In addition, cautious is emphasized when high doses of this natural product are used in traditional medicine since it might produce neurotoxic effects.

Ureteropieloplastia Anderson-Hynes laparoscópica en niños. Nuestra experiencia / Our experience with laparoscopic Anderson-Hynes ureteropyeloplasty

OBJETIVO: Analizar si la aplicación de la cirugía laparoscópica en el tratamiento de la estenosis pieloureteral (EPU) ha sido beneficiosa para el paciente pediátrico. MATERIAL Y MÉTODO: Hemos revisado de forma retrospectiva las historias clínicas de todos aquellos pacientes intervenidos de EPU desde enero de 1997 hasta diciembre de 2017. Se excluyeron las que tuvieron seguimiento menor a 6 meses, y las cirugías videoasistidas. Se han comparado la cirugía abierta con la cirugía laparoscópica. Se han recogido los siguientes datos: abordaje quirúrgico, necesidad y tipo de derivación urinaria, tiempo quirúrgico, estancia media, complicaciones, tasa de reestenosis. Los parámetros ecográficos y del renograma diurético también han sido recogidos. RESULTADOS: Se han analizado 328 pieloplastias, 142 se realizaron laparoscópicamente. La tasa de éxito global ha sido del 96,6%, existiendo un 11,9% de complicaciones, sin existir diferencias significativas entre la cirugía abierta y la laparoscópica. En el 97,5% de las cirugías, la orina se derivó mediante catéter nefroureteral externo, catéter doble J o catéter tipo Salle, existiendo diferencias entre cirugía abierta y laparoscópica. El tiempo quirúrgico medio fue significativamente superior en la cirugía laparoscópica. La estancia media fue menor en el grupo de cirugía laparoscópica de forma significativa. CONCLUSIÓN: La vía de abordaje no es un factor que influya en el éxito de la cirugía de la EPU, por ello pensamos que la cirugía laparoscópica es la técnica de elección en pacientes pediátricos

OBJECTIVE: To analyze whether the application of laparoscopic surgery in the treatment of pyeloureteral junction obstruction (PUJO) has been beneficial for pediatric patients. MATERIALS AND METHODS: Medical records of all patients undergoing PUJO surgery from January 1997 to December 2017 were retrospectively reviewed. Patients with < 6-month follow-up and patients undergoing video-assisted surgery were excluded. Open surgery was compared with laparoscopic surgery. The following data were collected: surgical approach, need for and type of urinary diversion, operating time, mean hospital stay, complications, and restenosis rate. Ultrasound and diuretic renogram parameters were also retrieved. RESULTS: 328 Anderson-Hynes pyeloplasties were analyzed, 142 of which had been performed laparoscopically. Overall success rate was 96.6%, and complication rate was 11.9%. No significant differences were noted between open and laparoscopic surgery. In 97.5% of surgeries, urine was diverted using an external nephroureteral catheter, a double J stent, or a Salle stent, with significant differences between open and laparoscopic surgery. Mean operating time was significantly longer in laparoscopic surgery. Mean hospital stay was significantly shorter in the laparoscopic surgery group. CONCLUSION: Surgical approach does not play a role in PUJO surgery success. Therefore, in our view, laparoscopic surgery should be the technique of choice in pediatric patients

Our experience with laparoscopic Anderson-Hynes ureteropyeloplasty. / Ureteropieloplastia Anderson-Hynes laparoscópica en niños. Nuestra experiencia.

OBJECTIVE: To analyze whether the application of laparoscopic surgery in the treatment of pyeloureteral junction obstruction (PUJO) has been beneficial for pediatric patients. MATERIALS AND METHODS: Medical records of all patients undergoing PUJO surgery from January 1997 to December 2017 were retrospectively reviewed. Patients with <6-month follow-up and patients undergoing video-assisted surgery were excluded. Open surgery was compared with laparoscopic surgery. The following data were collected: surgical approach, need for and type of urinary diversion, operating time, mean hospital stay, complications, and restenosis rate. Ultrasound and diuretic renogram parameters were also retrieved. RESULTS: 328 Anderson-Hynes pyeloplasties were analyzed, 142 of which had been performed laparoscopically. Overall success rate was 96.6%, and complication rate was 11.9%. No significant differences were noted between open and laparoscopic surgery. In 97.5% of surgeries, urine was diverted using an external nephroureteral catheter, a double J stent, or a Salle stent, with significant differences between open and laparoscopic surgery. Mean operating time was significantly longer in laparoscopic surgery. Mean hospital stay was significantly shorter in the laparoscopic surgery group. CONCLUSION: Surgical approach does not play a role in PUJO surgery success. Therefore, in our view, laparoscopic surgery should be the technique of choice in pediatric patients.

OBJETIVO: Analizar si la aplicación de la cirugía laparoscópica en el tratamiento de la estenosis pieloureteral (EPU) han sido beneficiosos para el paciente pediátrico. MATERIAL Y METODO: Hemos revisado de forma retrospectiva las historias clínicas de todos aquellos pacientes intervenidos de EPU desde enero 1997 hasta diciembre 2017. Se excluyeron las que tuvieron seguimiento menor a 6 meses, y las cirugías videoasistidas. Se han comparado la cirugía abierta con la cirugía laparoscópica. Se han recogido los siguientes datos: abordaje quirúrgico, necesidad y tipo de derivación urinaria, tiempo quirúrgico, estancia media, complicaciones, tasa de reestenosis. Los parámetros ecográficos y del renograma diurético también han sido recogidos. RESULTADOS: Se han analizado 328 pieloplastias, 142 se realizaron laparoscópicamente. La tasa de éxito global ha sido del 96,6%, existiendo un 11,9% de complicaciones; sin existir diferencias significativas entre la cirugía abierta y la laparoscópica. En el 97,5% de las cirugías, la orina se derivó mediante catéter nefroureteral externo, catéter doble J o catéter tipo Salle; existiendo diferencias entre cirugía abierta y laparoscópica. El tiempo quirúrgico medio fue significativamente superior en la cirugía laparoscópica. La estancia media fue menor en el grupo de cirugía laparoscópica de forma significativa. CONCLUSION: La vía de abordaje no es un factor que influya en el éxito de la cirugía de la EPU, por ello pensamos que la cirugía laparoscópica es la técnica de elección en pacientes pediátricos.