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Background/Aim. Despite technological advances in diagnosis and treatment, in-hospital mortality with acute aortic dissection type B is still about 11%. The purpose of this study was to assess the risk factors for early and long-term adverse outcomes in patients with acute aortic dissection type B treated medically or with conventional open surgery. Methods. The present study included 104 consecutive patients with acute aortic dissection type B treated in our Center from January 1st, 1998 to January 1st, 2007. Patient demographic and clinical characteristics as well as in-hospital complications were reviewed. Univariate and multivariate testing was performed to identify the predictors of in-hospital (30-day) and late (within 9 years) mortality. Results. 92 (88.5%) patients were treated medically, while 12 (11.5%) patients with complicated acute aortic dissection type B were treated by open surgical repair. In-hospital complications occurred in 35.7% patients, the most often being acute renal failure (28%), hypotension/shock (24%), mesenteric ischemia (12%), and limb ischemia (8%). The in-hospital mortality rate was 15.7% and the 9-year mortality rate was 51.9%. Independent predictors of early mortality in patients with acute aortic dissection type B were uncontrolled hypertension (HR-20.69) and a dissecting aorta diameter >4.75 cm (HR-6.30). Independent predictors of late mortality were relapsing pain (HR-7.93), uncontrolled hypertension (HR-7.25), and a pathologic difference in arterial blood pressure (>20 mmHg) (HR-5.33). Conclusion. Knowledge of key risk factors may help with a better choice of treatment and mortality reduction in acute aortic dissection type B patients.

Experiments on ASDEX Upgrade (AUG) in 2021 and 2022 have addressed a number of critical issues for ITER and EU DEMO. A major objective of the AUG programme is to shed light on the underlying physics of confinement, stability, and plasma exhaust in order to allow reliable extrapolation of results obtained on present day machines to these reactor-grade devices. Concerning pedestal physics, the mitigation of edge localised modes (ELMs) using resonant magnetic perturbations (RMPs) was found to be consistent with a reduction of the linear peeling-ballooning stability threshold due to the helical deformation of the plasma. Conversely, ELM suppression by RMPs is ascribed to an increased pedestal transport that keeps the plasma away from this boundary. Candidates for this increased transport are locally enhanced turbulence and a locked magnetic island in the pedestal. The enhanced D-alpha (EDA) and quasi-continuous exhaust (QCE) regimes have been established as promising ELM-free scenarios. Here, the pressure gradient at the foot of the H-mode pedestal is reduced by a quasi-coherent mode, consistent with violation of the high-n ballooning mode stability limit there. This is suggestive that the EDA and QCE regimes have a common underlying physics origin. In the area of transport physics, full radius models for both L- and H-modes have been developed. These models predict energy confinement in AUG better than the commonly used global scaling laws, representing a large step towards the goal of predictive capability. A new momentum transport analysis framework has been developed that provides access to the intrinsic torque in the plasma core. In the field of exhaust, the X-Point Radiator (XPR), a cold and dense plasma region on closed flux surfaces close to the X-point, was described by an analytical model that provides an understanding of its formation as well as its stability, i.e., the conditions under which it transitions into a deleterious MARFE with the potential to result in a disruptive termination. With the XPR close to the divertor target, a new detached divertor concept, the compact radiative divertor, was developed. Here, the exhaust power is radiated before reaching the target, allowing close proximity of the X-point to the target. No limitations by the shallow field line angle due to the large flux expansion were observed, and sufficient compression of neutral density was demonstrated. With respect to the pumping of non-recycling impurities, the divertor enrichment was found to mainly depend on the ionisation energy of the impurity under consideration. In the area of MHD physics, analysis of the hot plasma core motion in sawtooth crashes showed good agreement with nonlinear 2-fluid simulations. This indicates that the fast reconnection observed in these events is adequately described including the pressure gradient and the electron inertia in the parallel Ohm’s law. Concerning disruption physics, a shattered pellet injection system was installed in collaboration with the ITER International Organisation. Thanks to the ability to vary the shard size distribution independently of the injection velocity, as well as its impurity admixture, it was possible to tailor the current quench rate, which is an important requirement for future large devices such as ITER. Progress was also made modelling the force reduction of VDEs induced by massive gas injection on AUG. The H-mode density limit was characterised in terms of safe operational space with a newly developed active feedback control method that allowed the stability boundary to be probed several times within a single discharge without inducing a disruptive termination. Regarding integrated operation scenarios, the role of density peaking in the confinement of the ITER baseline scenario (high plasma current) was clarified. The usual energy confinement scaling ITER98(p,y) does not capture this effect, but the more recent H20 scaling does, highlighting again the importance of developing adequate physics based models. Advanced tokamak scenarios, aiming at large non-inductive current fraction due to non-standard profiles of the safety factor in combination with high normalised plasma pressure were studied with a focus on their access conditions. A method to guide the approach of the targeted safety factor profiles was developed, and the conditions for achieving good confinement were clarified. Based on this, two types of advanced scenarios (‘hybrid’ and ‘elevated’ q-profile) were established on AUG and characterised concerning their plasma performance.

After a 26-month vent ASDEX Upgrade (AUG) went back in operation with a newly designed upper W-divertor suitable for alternative divertor configurations (featuring in-vessel coils and cryo-pump). Parameter scans and an extensive set of measurements were obtained and their interpretation is ongoing. Prompted by the ITER wall change, dedicated experiments on non-boronized plasma startup were contrasted to that employing asymmetric and more symmetric boronizations. The asymmetric boronization proved to be as beneficial as the more symmetric one, which is in contrast to previous model calculations assuming perfect sticking of boron (measurements suggest sticking ≈ 0.3). In the startup phase also the impurity influxes at the outboard limiters were investigated contrasting the unboronized case featuring cold edges (low- Z radiation) to the boronized case, in which the lifetime of the boron layers could be estimated. Pedestal stability investigations revealed that the quasi-continuous exhaust (QCE) regime is obtained when ballooning modes are active in the vicinity of the separatrix and the global peeling-ballooning stability is high enough. Thus, at high enough shaping and high gas flux both can be achieved and QCE is a consequence. The closely related enhanced D-alpha (EDA) mode is not clearly distinguishable from QCE, e.g. the quasi-coherent mode characteristic for EDA also shows up in QCE. In QCE the impurity transport is behaving benign as could be measured for Ne with a novel analysis method making use of a comprehensive set of CXRS measurements. For high radiative fractions the regime of the X-point radiator (XPR) is accessible at AUG and the understanding of its access conditions and behaviour is further developed. Due to the localized radiative cooling at the X-point the XPR can be well diagnosed and thus controlled. For negative triangularity shapes, further experiments at increased shaping resulted in strongly heated L-mode plasmas avoiding ELMs. Two integrated modelling approaches towards ITER suggested that core W-accumulation will be no issue for ITER and that the fusion yield in ITER may be Q = 12 (i.e. ITPA20-IL scaling is too pessimistic). Further, investigations of the ITER ramp-down in AUG provide insights into maintaining position control. Various aspects of shattered pellet injection were investigated in AUG and one of the results show that with increasing Ne fraction the radiation during the current quench increases and the current decay becomes faster.

Coiling of the artery is a rare morphologic entity, most frequently found in the internal carotid arteries. Coiling of other arteries is rarely reported because it is usually asymptomatic. We report a case of 360° coiling of the right external iliac artery found by color duplex scan and arteriography. The patient was a 72-year-old man who presented with a 2-month history of an ischemic ulcer on his right toe and a right ankle-brachial-pressure index (ABPI) of 0.0 and 0.4 on admission. We resected 7 cm of the affected artery and performed end-to-end reconstruction. After 2 months of follow-up, his ischemic ulcer had healed and the ABPI of the right foot was 0.0 and 0.8.

Temperature fields in electric energy generators may lead to mechanical dissbalance of an already balanced rotor. The author collected information in a number of steam power plants and confirmed the existence of the problem. This paper is presents the specific case of thermal deformation of the rotor, caused by an asymmetrical temperature field in scale of rotor. On the grounds of the relevant physical aspects, we propose a mathematical model identifying fields in a turbo generator rotor and suggest the optimum control by which the unwanted effects are eliminated. nema

The development of operational scenarios without large Type-I ELMs is of utmost importance for the stable operation and longevity of future tokamaks. The EUROfusion tokamak exploitation program has therefore made the understanding of ELM-free regimes a major topic of exploration across all its contributing devices (ASDEX Upgrade, JET, MAST-Upgrade, TCV, and WEST). An integrated program to investigate a range of Type-I ELM-free regimes has been developed covering the enhanced D-alpha (EDA), magnetic perturbations (MP), negative triangularity (NT), quasi-continuous exhaust (QCE), quiescent H-mode (QH), the baseline small ELMs (SE), I-mode, and X-point radiator (XPR) regimes. This contribution focuses on the development and understanding of the NT and QCE regimes on ASDEX Upgrade, JET, and TCV. The importance of transport via ballooning modes in both regimes is highlighted, as well as the progress in developing access models based on ideal-MHD. In the case of the QCE, this can also be expressed as a minimum separatrix density, which corresponds well to experimentally measured separatrix densities. Particular focus is paid to the performance of the QCE in terms of the achieved pedestal top values, which, when appropriately normalised, do not differ significantly from ELMy H-mode plasmas. This, combined with the predicted minimum separatrix density for the 15 MA ITER baseline plasma, highlight the relevance of the QCE as a potential operational scenario for both ITER and future reactors.

Tokamak operational regimes with small edge localized modes (ELMs) could be a solution to the problem of large transient heat loads in future fusion reactors because they provide quasi-continuous exhaust while keeping a good plasma confinement. A ballooning mode mechanism near the last closed flux surface (LCFS) governed by an interplay of the pressure gradient and the magnetic shear there has been proposed for small ELMs in high density ASDEX Upgrade and TCV discharges. In this manuscript we explore different factors relevant for plasma edge stability in a wide range of edge safety factors by changing the connection length between the good and the bad curvature side. Simultaneously this influences the stabilizing effect of the local magnetic shear close to the LCFS as well as the \\(E B\\) flow shear. Ideal ballooning stability calculations with the HELENA code reveal that small ELM plasmas are indeed unstable against ballooning modes very close to the LCFS but can exhibit second ballooning stability in the steep gradient region which correlates with enhanced confinement. We also present first non-linear simulations of small ELM regimes with the JOREK code including the \\(E B\\) shear which indeed develop ballooning like fluctuations in the high triangularity limit. In the region where the small ELMs originate the dimensionless parameters are very similar in our investigated discharges and in a reactor, making this regime the ideal exhaust scenario for a future reactor.