Search

Simulations of doublet III-D, the joint European tokamak, and the tokamak fusion test reactor L-mode tokamak plasmas are carried out using the PTRANSP predictive integrated modeling code. The simulation and experimental temperature profiles are compared. The time evolved temperature profiles are computed utilizing the Multi-Mode anomalous transport model version 7.1 (MMM7.1) which includes transport associated with drift-resistive-inertial ballooning modes (the DRIBM model [T. Rafiq et al., Phys. Plasmas 17, 082511 (2010)]). The tokamak discharges considered involved a broad range of conditions including scans over gyroradius, ITER like current ramp-up, with and without neon impurity injection, collisionality, and low and high plasma current. The comparison of simulation and experimental temperature profiles for the discharges considered is shown for the radial range from the magnetic axis to the last closed flux surface. The regions where various modes in the Multi-Mode model contribute to transport are illustrated. In the simulations carried out using the MMM7.1 model it is found that: The drift-resistive-inertial ballooning modes contribute to the anomalous transport primarily near the edge of the plasma; transport associated with the ion temperature gradient and trapped electron modes contribute in the core region but decrease in the region of the plasma boundary; and neoclassical ion thermal transport contributes mainly near the center of the discharge. [ABSTRACT FROM AUTHOR]

Introduction: Tranexamic acid (TXA) is an antifibrinolytic agent that can be used to reduce blood loss in total knee arthroplasty (TKA) patients. Due to its thrombogenic properties, intravenous (IV) TXA is contraindicated in patients who have an increased risk of arterial or venous thrombosis. For such patients, intraarticular (IA) TXA may be a safe alternative. In this study, we compare: 1) complication rates; 2) intraoperative blood loss; and 3) need for transfusion in TKA patients who received IA TXA versus patients who used IV TXA., Materials and Methods: A retrospective chart review of a single surgeon was performed for patients who received a TKA and had either IV TXA or IA TXA (due to increased risk of thrombosis). This yielded 60 patients who had a mean age of 65 years (range, 36 to 84 years). Twenty-six patients received IA TXA as a consequence of being ineligible for IV TXA, because of increased risk for arterial or venous thromboembolism. Thirty-four patients received IV TXA. Complication rates and need for transfusion were evaluated as categorical variables. Amount of blood loss was evaluated as a continuous variable. All categorical variables and continuous variables were analyzed using chi-square test and student's t-test respectively., Results: Overall, four patients (7 %) developed complications after the procedure, three of which were in the IA cohort and one in the IV cohort (p= 0.444). In the IA cohort, two patients developed arthrofibrosis and subsequently underwent manipulation under anesthesia. Additionally, one patient in this group developed a hematoma one week after TKA. This patient was managed conservatively until the condition resolved, and no further issues have been reported. One patient in the IV cohort developed a deep vein thrombosis, which was appropriately treated with no further issues. There was no significant difference in mean blood loss or number of transfusions between patients who received IA TXA or IV TXA (289 mL vs. 268 mL, p= 0.503; 3 vs. 4, p= 0.651, respectively)., Conclusion: High-risk patients who have contraindications against intravenous TXA may be good candidates for intraarticular TXA. Our study demonstrated no significant differences in complication rates, blood loss, and transfusion rates in patients who received intravenous TXA as compared to those who received intraarticular TXA during total knee arthroplasty. We conclude that the intraarticular administration of TXA may be a safe and effective alternative for patients who have contraindications against intravenous TXA.

Background/aims: The purpose of this study is to understand how outpatients awaiting initial gastroenterology consultation seek medical information on the Internet and how wait times affect Internet usage., Materials and Methods: A cross-sectional survey of 87 gastroenterology outpatients awaiting consultation was performed at a tertiary care center., Results: Fifty-two patients (60%) utilized the Internet for medical information. The mean age of patients using the Internet was 41 years, whereas the mean age of those not using the Internet was 60 years (p<0.0001). The Internet was used by 71% of females and 47% of males (p<0.05). Regarding the educational level, the Internet was sought by 33% of the patients possessing less than secondary school education, 59% possessing secondary school education, 66% with an undergraduate degree, and 100% with a postgraduate degree (p=0.14). The mean wait time for consultation for patients who utilized the Internet was 158 days, and for patients who did not was 147 days (p=0.60). The most common websites searched were medical, 71%. The most common medical information sought was symptoms and diagnosis by 85% of patients. The reasons for Internet use were wait times for 36% of patients and recommendation by a physician for 10%. Eighty seven percent of the patients who utilized the Internet believed that they suffered from an unidentified disease, whereas 46% of patients who did not utilize the Internet believed the same (p=0.0001)., Conclusion: Younger patients and females were more likely to use the Internet, but wait times did not affect Internet usage. The Internet is a powerful patient resource; however, further physician guidance is required to help patients identify reliable resources.

Background: The Internet is becoming an increasingly common source of health information for patients., Objective: To examine the quality of gastrointestinal disease- and symptom-related Internet sites that might be searched by patients., Methods: A total of 120 websites were evaluated from July to November 2009 using the DISCERN instrument to determine the quality of content of health and treatment information., Results: There was substantial variability in the quality of Internet resources regarding gastrointestinal diseases and their symptoms. Information-based and institutional websites were rated highest. Resources related to celiac disease, colon cancer and abdominal pain scored the highest., Conclusions: Overall, the quality of web-based resources was variable. Because patient education is important in the management of gastroenterological diseases, the increasing use of the Internet poses new opportunities and challenges for physicians.

Collagenous colitis and lymphocytic colitis, the two types of microscopic colitis, cause watery diarrhea. Budesonide, a glucocorticoid medication with limited systemic availability, is commonly used to treat these illnesses. Budesonide has proven efficacy in the induction of clinical remission in both collagenous colitis and lymphocytic colitis. Budesonide is effective as a maintenance drug for patients with collagenous colitis, but has not been studied for this indication in patients with lymphocytic colitis. This drug improves quality of life in patients while causing few mild adverse events. Budesonide is an effective treatment of microscopic colitis that is safe and well tolerated.

Microscopic colitis (MC) causes chronic diarrhea, abdominal cramping, nausea, and weight loss. Colonic mucosa appears normal on endoscopy; however, biopsies show abnormalities such as intraepithelial lymphocytosis in lymphocytic colitis, and a thickened subepithelial collagen band in collagenous colitis. Epidemiologic data demonstrates that MC is a more common cause of diarrhea than previously shown. Although the etiology of this condition is unclear, certain well-defined risk factors exist. Recently there has been more research on the pathophysiology of MC, and studies on treatment have demonstrated budesonide to be most effective, although other treatments also hold promise.

Lymphocytic colitis, a cause of chronic watery diarrhea, is histologically characterized by increased intraepithelial lymphocytosis. Studies have associated this disorder with celiac disease, although there are no reports of patients with both lymphocytic colitis and colon cancer. The present case report describes a patient with lymphocytic colitis, which manifested five years after he presented with a cecal adenocarcinoma, and three years following a diagnosis of celiac disease. Pathological review of his initial resection specimen demonstrated lymphocytic enterocolitis, indicating a five-year latency in the presentation of this disease.

A simple generic one-dimensional continuum model of driven dissipative systems is proposed to explain self-organized bursty heat transport in tokamaks. Extensive numerical simulations of this model reproduce many features of present day tokamaks such as submarginal temperature profiles, intermittent transport events, 1/f scaling of the frequency spectra, propagating fronts, etc. This model utilizes a minimal set of phenomenological parameters, which may be determined from experiments and/or simulations. Analytical and physical understanding of the observed features has also been attempted.