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Bor-Shiuan Shyr,&ast; Jwo-Huey Yu,&ast; Shih-Chin Chen, Shin-E Wang, Yi-Ming Shyr, Bor-Uei Shyr General Surgery, Department of Surgery, Taipei Veterans General Hospital and National Yang Ming Chiao Tung University, Taipei, Taiwan, Republic of China&ast;These authors contributed equally to this workCorrespondence: Bor-Uei Shyr, General Surgery, Department of Surgery, Taipei Veterans General Hospital and National Yang Ming Chiao Tung University, 10 Floor 201 Section 2 Shipai Road, Taipei, 112, Taiwan, Republic of China, Tel +886-2-28757652, Fax +886-2-28757537, Email punkid830@gmail.comAim: Whether to execute pancreaticoduodenectomy or not for older people could pose a dilemma. This study clarifies the safety and justification of robotic pancreaticoduodenectomy (RPD) for older individuals over 80.Methods: A total of 500 patients undergoing RPD were divided into group O (≥ 80 y/o) and group Y (< 80 y/o) for comparison.Results: There were 62 (12.4%) patients in group O. Surgical mortality was 1.6% for overall patients and higher in group O, 6.5% vs 0.9%; p = 0.001. The surgical complication was comparable between groups O and Y. Delayed gastric emptying and bile leakage were higher in group O, 9.7% vs 2.5%; p = 0.004, and 6.5% vs 0.9%; p = 0.001, respectively. Length of stay was also longer in group O, with a median of 26 vs 19 days; p = 0.001. Survival outcome after RPD was poorer in group O for overall periampullary adenocarcinomas, with a 5-year survival of 48.1% vs 51.2%; p = 0.025 and also for the subgroup of pancreatic head adenocarcinoma, with a 3-year survival of 27.4% vs 42.5%; p = 0.030.Conclusion: RPD is safe and justified for the selected octogenarians and even nonagenarians, whoever is fit for a major operation. Nevertheless, pancreatic head cancer and higher mortality risk for the aged over 80 with advanced ASA score ≥ 3 should be informed as part of counselling in offering RPD.Keywords: nonagenarian, octogenarian, pancreas, pancreaticoduodenectomy, robotic

Jia Xu,1 Ming-Ying Zhang,2 Wei Jiao,1 Cong-Qi Hu,1 Dan-Bin Wu,2 Jia-Hui Yu,1 Guang-Xing Chen2,3 1First Clinical Medical School, Guangzhou University of Chinese Medicine, Guangzhou, 510405, Guangdong, People’s Republic of China; 2Department of Rheumatology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510405, Guangdong, People’s Republic of China; 3Baiyun Hospital of The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510470, Guangdong, People’s Republic of ChinaCorrespondence: Guang-Xing ChenDepartment of Rheumatology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510405, Guangdong, People’s Republic of ChinaEmail cgx02@hotmail.comObjective: Rheumatoid arthritis (RA) is one of the most prevalent inflammatory arthritis worldwide. However, the genes and pathways associated with macrophages from synovial fluids in RA patients still remain unclear. This study aims to screen and verify differentially expressed genes (DEGs) related to identifying candidate genes related to synovial macrophages in rheumatoid arthritis by bioinformatics analysis.Methods: We searched the Gene Expression Omnibus (GEO) database, and GSE97779 and GSE10500 with synovial macrophages expression profiling from multiple RA microarray dataset were selected to conduct a systematic analysis. GSE97779 included nine macrophage samples from synovial fluids of RA patients and five macrophage samples from primary human blood of HC. GSE10500 included five macrophage samples from synovial fluids of RA patients and three macrophage samples from primary human blood of HC. Functional annotation of DEGs was performed, including Gene Ontology (GO) analysis and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analysis. Protein–protein interaction (PPI) network of DEGs was established using the STRING database. CytoHubba was used to identify hub genes. MCODE was used to determine gene clusters in the interactive network.Results: There were 2638 DEGs (1425 upregulated genes and 1213 downregulated ones) and 889 DEGs (438 upregulated genes and 451 downregulated ones) selected from GSE97779 and GSE10500, respectively. Venn diagrams showed that 173 genes were upregulated and 106 downregulated in both two datasets. The top 10 hub genes, including FN1, VEGFA, HGF, SERPINA1, MMP9, PPBP, CD44, FPR2, IGF1, and ITGAM, were identified using the PPI network.Conclusion: This study provides new insights for the potential biomarkers and the relevant molecular mechanisms in RA patients. Our findings suggest that the 10 candidate genes might be used in diagnosis, prognosis, and therapy of RA in the future. However, further studies are required to confirm the expression of these genes in synovial macrophages in RA and control specimen.Keywords: rheumatoid arthritis, synovitis macrophages, key genes, pathways, bioinformatics analysis

Jea H Yu,1 Jaycob Avaylon,1 Hyein Kil,1 Jisoo K Kim,1 Ron P Gallemore1,21Department of Clinical Research, Retina Macula Institute, Torrance, CA, USA; 2Department of Ophthalmology, University of California, Los Angeles, CA, USAPurpose: To report a case of endophthalmitis associated with Legionella Pneumophila.Case Report: A 46-year-old, highly myopic male with a complex history of recurrent retinal detachments, macular hole, cataract surgery and an infected scleral buckle in the left eye, presented with pain, redness, hypopyon and vision loss in the left eye, 14 days following blunt head trauma. Empirical treatment for endophthalmitis with intravitreal injections of Vancomycin and Ceftazidime afforded minimal improvement. He developed recurrent hypopyon and underwent vitrectomy surgery with intravitreal antibiotic injections at the time of surgery and had improvement. Intraoperative culture was positive for Legionella Pneumophila. He had continued episodes of recurrent inflammation which were quelled by intravitreal moxifloxacin injections performed every 3–10 days. He developed a recurrent RD with proliferative vitreoretinopathy (PVR) and underwent vitrectomy with silicone oil. The retina was reattached but had no light perception vision in the affected eye.Conclusion: When endophthalmitis is contracted in a work-place setting, a culture for L. pneumophila should be considered. A combination of intravitreal moxifloxacin and oral azithromycin may be effective.Keywords: endophthalmitis, Legionella Pneumophila, Legionnaire’s disease

Jianfeng Huang,1,* Xiaopeng Yuan,2,* Qingfeng Pang,3 Haowen Zhang,4 Jiahua Yu,4 Bo Yang,1 Leyuan Zhou,1 Fuzheng Zhang,1 Fenju Liu4 1Department of Radiation Oncology, Affiliated Hospital of Jiangnan University, Wuxi, People’s Republic of China; 2Department of Radiation Oncology, Nantong Tumor Hospital, Affiliated Tumor Hospital of Nantong University, Nantong, People’s Republic of China; 3Department of Physiopathology, Wuxi School of Medicine, Jiangnan University, Wuxi, People’s Republic of China; 4State Key Laboratory of Radiation Medicine and Protection, School of Radiation Medicine and Protection, Medical College of Soochow University, Collaborative Innovation Center of Radiological Medicine of Jiangsu Higher Education Institutions, Jiangsu Provincial Key Laboratory of Radiation Medicine and Protection, Suzhou, People’s Republic of China *These authors contributed equally to this work Introduction: In this study, the radiation-enhancing effects of combined treatment with nimotuzumab, a humanized EGFR-blocking antibody, and celecoxib, a COX-2 selective inhibitor, in human nasopharyngeal carcinoma (NPC) cells were investigated. Materials and methods: 3-(4,5-Dimethylthiazol-2yl)-2,5-diphenyltetrazolium bromide and clonogenic survival assays were done to evaluate the combined cytotoxic and radiosensitizing effects of nimotuzumab or celecoxib or the combination on CNE1 and CNE2 cells. Western blot analysis was performed to identify the effect of nimotuzumab and/or celecoxib with or without irradiation on the cytoplasmic and nuclear EGFR signaling pathways in CNE2 cells. Results: Our results demonstrated that concurrent administration of nimotuzumab and celecoxib cooperatively enhanced the cytotoxicity and radiosensitivity of CNE2 cells but not CNE1 cells. The combination of both drugs with or without irradiation also cooperatively inhibited cytoplasmic and nuclear EGFR signaling pathways in CNE2 cells. Conclusion: Our results suggest a promising approach for the treatment of poorly differentiated NPC. Keywords: celecoxib, cyclooxygenase-2, epidermal growth factor receptor, nasopharyngeal carcinoma, nimotuzumab, radiosensitivity

Electron cyclotron emission (ECE) imaging is a passive radiometric technique that measures electron temperature fluctuations; and microwave imaging reflectometry (MIR) is an active radar imaging technique that measures electron density fluctuations. Microwave imaging diagnostic instruments employing these techniques have made important contributions to fusion science and have been adopted at major fusion facilities worldwide including DIII-D, EAST, ASDEX Upgrade, HL-2A, KSTAR, LHD, and J-TEXT. In this paper, we describe the development status of three major technological advancements: custom mm-wave integrated circuits (ICs), digital beamforming (DBF), and synthetic diagnostic modeling (SDM). These have the potential to greatly advance microwave fusion plasma imaging, enabling compact and low-noise transceiver systems with real-time, fast tracking ability to address critical fusion physics issues, including ELM suppression and disruptions in the ITER baseline scenario, naturally ELM-free states such as QH-mode, and energetic particle confinement (i.e. Alfvén eigenmode stability) in highperformance regimes that include steady-state and advanced tokamak scenarios. Furthermore, these systems are fully compatible with today's most challenging non-inductive heating and current drive systems and capable of operating in harsh environments, making them the ideal approach for diagnosing long-pulse and steady-state tokamaks.

Supramolecular nanosubstrate-mediated delivery (SNSMD) leverages the power of molecular self-assembly and a nanostructured substrate platform for the low toxicity, highly efficient co-delivery of biological factors encapsulated in a nanovector. Human fibroblasts are successfully reprogrammed into induced pluripotent stems and transdifferentiated into induced neuronal-like cells.

The absolute rate of nonlinear energy transfer among broadband turbulence, low-frequency zonal flows (ZFs) and geodesic acoustic modes (GAMs) was measured for the first time in fusion-grade plasmas using two independent methods across a range of heating powers. The results show that turbulent kinetic energy from intermediate frequencies (20-80 kHz) was transferred into ZFs and GAMs, as well as into fluctuations at higher frequencies (>80  kHz). As the heating power was increased, the energy transfer from turbulence into GAMs and the GAM amplitudes increased, peaked and then decreased, while the energy transfer into the ZFs and the ZFs themselves increased monotonically with heating power. Thus there exists a competition between ZFs and GAMs for the transfer of turbulent energy, and the transfer into ZFs becomes dominant as the heating power is increased. The poloidal-radial Reynolds stress and the mean radial electric field profiles were also measured at different heating powers and found to be consistent with the energy transfer measurement. The results suggest that ZFs play an important role in the low-to-high (L-H) plasma confinement transition.

Collisional electron drift wave turbulence generates drift wave packet structures with density and vorticity fluctuations in the central plasma pressure gradient region of a linear plasma device. Tracking these packets reveals that they follow an outward directed spiral-shaped trajectory in the (r,θ) plane, are azimuthally stretched, and develop anisotropy as they approach an axisymmetric, radially sheared azimuthal flow located at the plasma boundary. Nonlinear energy transfer measurements and time-delay analysis confirm that structure absorption amplifies the sheared flow. Similar mechanisms likely operate at the edge of confined toroidal plasmas and should lead to the amplification of sheared flows at the boundary of these devices as well.

Utilizing an array of new diagnostics and simulation/modelling techniques, recent DIII-D experiments have elucidated a variety of energetic ion transport behaviour in the presence of instabilities ranging from large-scale sawteeth to fine spatial scale microturbulence. Important new insights include sawteeth, such as those of the ITER baseline scenario, causing major redistribution of the energetic ion population; high levels of transport induced by low-amplitude Alfvén eigenmodes can be caused by the integrated effect of a large number of simultaneous modes; and microturbulence can contribute to the removal of alpha ash while having little effect on fusion alphas. This paper provides an overview of recent and upcoming results from the DIII-D Energetic Particles research programme. © 2011 IAEA, Vienna.

Visible imaging has been used to provide the 2D spatial structure and temporal evolution of the profile of highenergy neutrals introduced by neutral beam injection, the fast ion profile and a variety of plasma instabilities in DIII-D plasmas; the combination of these techniques form a comprehensive fast ion physics diagnostic suite. The injected neutral profile is imaged in Doppler shifted Dα light induced by collisional excitation. Fast ion profile information was obtained through imaging of Doppler shifted fast ion Dα light (FIDA) emitted by re-neutralized energetic ions. Imaging of FIDA emission during sawtooth events shows a large central depletion following sawtooth crashes-indicative of a broad redistribution of fast ions. Two examples of instability structure measurements are given. Measurements of the detailed 2D poloidal structure of rotating tearing modes were obtained using spectrally filtered fast imaging of broadband visible bremsstrahlung emission, a method which is capable of imaging with high resolution the structure of coherent oscillations in the core of current and next-step fusion plasma experiments and can be applied to virtually any mode with a finite perturbed bremsstrahlung emissivity and frequency in the laboratory frame. Measurements are also presented of the n = 0 energetic particle geodesic acoustic mode which were made by observing fluctuations in active emission. © 2010 IAEA, Vienna Printed in the UK & the USA.

Wide-angle, 2D imaging of Doppler-shifted, Balmer alpha (D α) emission from high energy injected neutrals, charge exchange recombination (CER) emission from neutral beam interaction with thermal ions and fully stripped impurity ions and visible bremsstrahlung (VB) from the core of DIII-D plasmas has been carried out. Narrowband interference filters were used to isolate the specific wavelength ranges of visible radiation for detection by a tangentially viewing, fast-framing camera. Measurements of the Dα emission from fast neutrals injected into the plasma from the low field side reveal the vertical distribution of the beam, its divergence and the variation in its radial penetration with density. Modeling of this emission using both a full Monte Carlo collisional radiative code as well as a simple beam attenuation code coupled to Atomic Data and Analysis Structure emissivity lookup tables yields qualitative agreement, however the absolute magnitudes of the emissivities in the predicted distribution are larger than those measured. Active measurements of carbon CER brightness are in agreement with those made independently along the beam midplane using DIII-D's multichordal, CER spectrometer system, confirming the potential of this technique for obtaining 2D profiles of impurity density. Passive imaging of VB, which can be inverted to obtain local emissivity profiles, is compared with measurements from both a calibrated filter/photomultiplier array and the standard multichordal CER spectrometer system. © 2010 IOP Publishing Ltd.

An azimuthally symmetric radially sheared azimuthal flow is driven by a nondiffusive, or residual, turbulent stress localized to a narrow annular region at the boundary of a cylindrical magnetized helicon plasma device. A no-slip condition, imposed by ion-neutral flow damping outside the annular region, combined with a diffusive stress arising from turbulent and collisional viscous damping in the central plasma region, leads to net plasma rotation in the absence of momentum input.

The DIII-D tokamak is equipped with neutral beam sources that inject in four different directions; in addition, the plasma can be moved up or down to compare off-axis with on-axis injection. Fast-ion data for eight different conditions have been obtained: co/counter, near-tangential/near-perpendicular and on-axis/off-axis. Neutron measurements during short beam pulses assess prompt and delayed losses under low-power conditions. As expected, co-injection has fewer losses than counter, tangential fewer than perpendicular and on-axis fewer than off-axis; the differences are greater at low current than at higher current. The helicity of the magnetic field has a weak effect on the overall confinement. Fast-ion Dα (FIDA) and neutron measurements diagnose the confinement at higher power. The basic trends are the same as in low-power plasmas but, even in plasmas without long wavelength Alfvén modes or other MHD, discrepancies with theory are observed, especially in higher temperature plasmas. At modest temperature, two-dimensional images of the FIDA light are in good agreement with the simulations for both on-axis and off-axis injection. Discrepancies with theory are more pronounced at low fast-ion energy and at high plasma temperature, suggesting that fast-ion transport by microturbulence is responsible for the anomalies. © 2009 IOP Publishing Ltd.

Neutral beam current drive (NBCD) experiments in DIII-D using vertically shifted plasmas to move the current drive away from the axis have clearly demonstrated robust off-axis NBCD. Time-dependent measurements of magnetic field pitch angles by the motional Stark effect diagnostic are used to obtain the evolution of the poloidal magnetic flux, which indicates a broad off-axis NBCD profile with a peak at about half the plasma minor radius. In most cases, the measured off-axis NBCD profile is consistent with calculations using an orbit-following Monte Carlo code for the beam ion slowing down including finite-orbit effects provided there is no large-scale magnetohydrodynamic activity such as Alfv́n eigenmodes modes or sawteeth. An alternative analysis method shows good agreement between the measured pitch angles and those from simulations using transport-equilibrium codes. Two-dimensional image of Doppler-shifted fast ion Dα light emitted by neutralized energetic ions shows clear evidence for a hollow profile of beam ion density, consistent with classical beam ion slowing down. The magnitude of off-axis NBCD is sensitive to the alignment of the beam injection relative to the helical pitch of the magnetic field lines. If the signs of toroidal magnetic field and plasma current yield the proper helicity, both measurement and calculation indicate that the efficiency is as good as on-axis NBCD because the increased fraction of trapped electrons reduces the electron shielding of the injected ion current, in contrast with electron current drive schemes where the trapping of electrons degrades the efficiency. The measured off-axis NBCD increases approximately linearly with the injection power, although a modest amount of fast ion diffusion is needed to explain an observed difference in the NBCD profile between the measurement and the calculation at high injection power. © 2009 American Institute of Physics.

Doppler shifted fast ion Dα light (FIDA) emitted by neutralized energetic ions is imaged in the DIII-D tokamak using a fast framing camera in conjunction with a narrowband interference filter. Both the 2D spatial structure and temporal evolution of the FIDA emission are in agreement with Monte Carlo simulations assuming classical energetic ion slowing down. This technique can be used to obtain 2D energetic ion profile information in fusion plasmas. © 2009 IOP Publishing Ltd.

Modification of the two existing DIII-D neutral beamlines is planned to allow vertical steering to provide off-axis neutral beam current drive (NBCD) peaked as far off-axis as half the plasma minor radius. New calculations for a downward-steered beam indicate strong current drive with good localization off-axis so long as the toroidal magnetic field, BT, and the plasma current, Ip, point in the same direction. This is due to good alignment of neutral beam injection (NBI) with the local pitch of the magnetic field lines. This model has been tested experimentally on DIII-D by injecting equatorially mounted NBs into reduced size plasmas that are vertically displaced with respect to the vessel midplane. The existence of off-axis NBCD is evident in the changes seen in sawtooth behaviour in the internal inductance. By shifting the plasma upwards or downwards, or by changing the sign of the toroidal field, off-axis NBCD profiles measured with motional Stark effect data and internal loop voltage show a difference in amplitude (40-45%) consistent with differences predicted by the changed NBI alignment with respect to the helicity of the magnetic field lines. The effects of NBI direction relative to field line helicity can be large even in ITER: off-axis NBCD can be increased by more than 30% if the BT direction is reversed. Modification of the DIII-D NB system will strongly support scenario development for ITER and future tokamaks as well as provide flexible scientific tools for understanding transport, energetic particles and heating and current drive. © 2009 IAEA, Vienna.