[Gastrointestinal tumors with SWI/SNF complex deficiency: a clinicopathological analysis of 36 cases]

Objective: To investigate the clinicopathological characteristics of gastrointestinal tumors with SWI/SNF complex deficiency and to perform a prognostic analysis of the patients. Methods: Gastrointestinal tumor cases with SWI/SNF complex deficiency expression diagnosed at the Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai, China from August 2021 to May 2023 were collected. Hematoxylin and eosin (HE) stained slides were reviewed, and immunohistochemical results were analyzed. Clinical and pathological information was recorded, and relevant literature was reviewed. Results: A total of 36 cases of gastrointestinal tumor with loss of SWI/SNF complex expression were identified, including 28 males (77.8%) and 8 females (22.2%). The average age at diagnosis was 70 years (range 48-85 years). Clinical staging showed 3 cases in stage Ⅰ (8.3%), 12 cases in stage Ⅱ (33.3%), 19 cases in stage Ⅲ (52.8%), and 2 cases in stage Ⅳ (5.6%). Complete or partial loss of ARID1A expression was observed in 20 cases (55.6%); complete or partial loss of SMARCA2 expression was observed in 24 cases (66.7%). SMARCA4 exhibited complete loss of expression in 4 cases (11.1%). Eleven cases (30.6%) showed concurrent complete or partial losses of both ARID1A and SMARCA2 expression. Twelve cases (33.3%) had mismatch repair protein deficiency, all of which were characterized by MLH1/PMS2 absence. Mismatch repair protein deficiency was associated with loss of ARID1A expression (P<0.01). Patients with mismatch repair protein deficiency were also associated with earlier clinical stage and a lower risk of lymph node metastasis compared to the ones with intact mismatch repair proteins (P<0.05). Conclusions: SWI/SNF complex deficiency in gastrointestinal tumors is associated with dedifferentiation and often accompanied by mismatch repair protein deficiency. Compared to the cases with intact mismatch repair proteins, the cases with defective mismatch repair protein have an earlier clinical stage and a lower risk of lymph node metastasis.

[Clinical, endoscopic, and pathological analyses of 14 cases of gastric adenocarcinoma of the fundic gland type]

Objective: Gastric adenocarcinoma of the fundic gland type (GA-FG) is rare and often occurs in patients who are not infected with Helicobacter pylori. The current study analyzed and summarized the clinical, endoscopic, and pathological features of GA-FG, in an effort to improve its diagnosis. Methods: Patients who were diagnosed with GA-FG and treated with endoscopic submucosal dissection (ESD) resection at the Department of Gastroenterology, First Affiliated Hospital of Zhejiang Chinese Medical University from January 1st 2020 to October 1st 2022 were included in the study. Their clinical manifestations, endoscopic features, pathological immunohistochemistry, and other characteristics were analyzed. Results: A total of 14 patients with GA-FG were included in the study, 5 males and 9 females, with a mean age of 59 years. Most had no substantial clinical manifestations. Twelve patients were H. pylori-negative, all patients underwent ESD resection, and all patients survived during the follow-up period of 13±9 months. Eleven patients had postoperative endoscopic follow-up records, and no recurrence was detected. Fifteen lesions were detected (2 were present in 1 patient). Twelve were located in the upper 1/3 of the stomach, 10 were ≤ 1 cm in diameter, 12 had a morphology of type 0-Ⅱa, 8 had visible discoloration changes, and 12 had visible vasodilation on the surface. Magnified endoscopy and narrow-band imaging indicated that 12 of the lesions had enlarged marginal crypt epithelium, without any obvious microvascular pattern abnormalities and no obvious borderline. After resection the pathological specimens were all without vascular infiltration, and there was no atrophy of the mucosa at the edge of the lesion. In immunohistochemistry analyses MUC-2 was negative in all cases. MUC5AC was negative in 11 cases, MUC-6 was positive in all cases, and Ki-67 was ≤ 5% in 12 cases. Conclusions: GA-FG is a newly identified type of gastric cancer with low malignancy and a good prognosis. Characteristic discoloration and surface dilated vessels are often evident endoscopically. Enlarged marginal crypt epithelium and no visible boundary lines are often apparent in magnification endoscopy and narrow band imaging.

Long-Term Results of Induction Chemotherapy for Esophageal Squamous Cell Carcinoma Receiving Concurrent Chemoradiotherapy

PURPOSE/OBJECTIVE(S)

This study aimed to investigate the long-term clinical outcomes and toxicities of induction chemotherapy (IC) followed by concurrent chemoradiotherapy (CCRT) versus CCRT alone in patients with esophageal squamous cell carcinoma (ESCC).

MATERIALS/METHODS

Between 2008 and 2022, 271 ESCC patients who received definitive CCRT (IC followed by CCRT, n = 72; CCRT alone, n = 199) were enrolled. Radiotherapy technique included intensity modulated radiation therapy (IMRT) or volumetric modulated arc therapy (VMAT). Through a propensity score matched (PSM) method, 71 patients receiving IC and CCRT were matched 1:1 to patients who received CCRT alone, according to age, gender, performance status, tumor length, and pre-treatment TN stage. The Kaplan-Meier method and Cox proportional hazards model were applied to analyze survival and prognosis.

RESULTS

The IC + CCRT group had no improvement in 5-year overall survival (OS) rate (39.0% vs 29.3%, p = 0.360), recurrence-free survival (RFS) rate (39.0% vs 26.9%, p = 0.142), and distant metastasis-free survival (DMFS) rate (33.6% vs 27.2%, p = 0.515) compared with the CCRT group. The overall clinical response rate was 45.1% after IC in the IC + CCRT group. The IC responders (CR + PR + SD) group showed more favorable 5-year OS (41.7% vs. 14.3% vs. 29.3%, p < 0.001), RFS (41.7% vs. 14.3% vs. 26.9%, p < 0.001) and DMFS (37.3% vs. 0% vs. 27.2%, p < 0.001) compared with the IC non-responders (PD) group and the CCRT group. Besides, the 5-year OS rate (65.6% vs. 17.6% vs. 29.3%, p < 0.001), RFS rate (65.6% vs. 17.6% vs. 26.9%, p < 0.001), and DMFS rate (62.5% vs. 10.3% vs. 27.2%, p < 0.001) of the IC good responders (CR + PR) were significantly higher than that of the IC poor responders (SD + PD) and CCRT group. Multivariate analysis revealed that total radiotherapy time (≥ 49 days) and AJCC stage (Ⅲ/Ⅳ) were independent predictive factors of OS, RFS and DMFS. Besides, age was an independent predictive factor of DMFS. No significant difference was observed in the rates of grades 3-4 toxicities between both groups.

CONCLUSION

Our results showed the addition of IC to CCRT was not superior to CCRT in unselected ESCC patients, while IC responders could benefit from this regime without increase in toxicities.

[Etiological and epidemiological characteristics of Vibrio cholerae in Beijing, 2015-2021]

Objective: To analyze the etiological and epidemiological characteristics of Vibrio cholerae in Beijing during 2015-2021 and provide evidence for the prevention and control of cholera. Methods: The V. cholerae strains isolated in Beijing during 2015-2021 were analyzed by serotyping and virulence genes detection. Pulsed field gel electrophoresis (PFGE) was performed for the molecular typing of the strains. Based on the collected epidemiological and clinical data of cholera cases,the epidemiological characteristics of cholera were analyzed by descriptive epidemiology method. Results: A total of 76 Vibrio cholerae O1 strains were isolated in Beijing during 2015-2021, including 61 strains from human, 10 strains from environment and 5 strains from seafood. The 76 strains consisted of 68 Ogawa strains and 8 Inaba strains. Six Ogawa strains isolated from sporadic cases carried ctxAB. After NotⅠ digestion, 76 strains were divided into 33 PFGE patterns. From 2015 to 2021, a total of 38 cholera epidemics were reported in Beijing, most of them were sporadic ones, accounting for 92.11% (35/38). A total of 45 cases were reported, and the cases occurred during June-September accounted for 97.78% (44/45). Cholera cases occurred in 9 districts of Beijing, and the cases reported in Chaoyang district accounted for 42.22% (19/45) and in Changping district accounted for 31.11% (14/45). The age of the cholera cases ranged from 19 to 63 years. Except for one case with unknown clinical symptoms, 44 cases had diarrhea symptoms with 84.09% (37/44) of the cases reporting diarrhea (3-9 times/day), followed by yellow watery stool (95.45%, 42/44), abdominal pain (68.18%, 30/44), nausea and vomiting (40.91%, 18/44) and fever (36.36%, 16/44). Conclusion: Vibrio cholerae strains isolated in Beijing during 2015-2021 were mainly O1 serotype Ogawa,most of which were non-toxigenic. The PFGE of the strains varied. Cholera epidemics occurred in 9 districts of Beijing, but most were sporadic ones with incidence peak during June-September.

[The value of OLGA staging system in risk assessment of gastric precancerous states and precancerous lesions]

Objective: To investigate the role of operative link on gastritis assessment (OLGA) staging system in risk assessment of gastric precancerous states and precancerous lesions. Methods: A total of 682 patients undergoing gastroscopy from January to July 2016 at the First Hospital of Jiaxing were enrolled. According to the results of gastroscopy and pathology, patients were divided into five groups by OLGA staging system, respectively. The differences of atrophic progression/reversion rate, detection rates of intraepithelial neoplasia and gastric cancer among different OLGA groups during 5-year follow-up were compared. Results: A total of 437 patients completed endoscopic follow-up, including 207 cases in Stage-0, 158 cases in Stage-Ⅰ, 47 cases in Stage-Ⅱ, 18 cases in Stage-Ⅲ and 7 cases in Stage-Ⅳ. There were 24 cases of atrophy progression, 78 cases of atrophy reversion, 5 cases of intraepithelial neoplasia and 2 cases of gastric cancer. The atrophy progression rate correlated with the rising OLGA stages(χ²=19.14, P<0.001);The rate of atrophy reversion in high-risk group was significantly lower than that in low-risk group(χ²=4.96, P=0.026); The detection rate of intraepithelial neoplasia and gastric cancer in high-risk group was significantly higher than that in low-risk group(χ²=29.63, 11.60, both P<0.05). Conclusions: Histological OLGA staging system is helpful to realize the risk stratification assessment of gastric precancerous states and precancerous lesions. It has practical significance to formulate individualized endoscopic/histological follow-up plan for OLGA high-risk group.

[Differential diagnosis between pulmonary artery sarcoma and central chronic pulmonary thromboembolism:a preliminary study on CT signs]

Objective: To improve the diagnostic accuracy of pulmonary artery sarcoma, and to distinguish it from central chronic pulmonary thromboembolism using CT scans. Methods: In this retrospective study, two groups of pulmonary artery sarcoma (PAS group) and central chronic pulmonary thromboembolism (central CPTE group) confirmed by pathology at our hospital between August 2009 and July 2019 were enrolled, clinical features and pre-operative CT pulmonary artery manifestation were collected, and the key points of differential diagnosis were summarized. Results: The study was composed of 13 cases in the PAS group including 10 males (76.9%), with an average age of (45.4±15.5) years. There were 19 patients in the central CPTE group including 14 males (73.7%), with an average age of (38.6±14.1) years. There were no significant differences in gender and age between the two groups. Deep venous thrombosis in the lower extremities was significantly higher in the central CPTE group than in the PAS group (7/19 vs. 0/13, P=0.025), and the N-terminal pro-brain natriuretic peptide value was higher in the central CPTE group than in the PAS group [674.50(261.70-1 977.70) vs. 66.00(28.10-505.50),P=0.001]. In CT pulmonary angiography, the involvement of the main pulmonary artery, and the proximal lesion showing an acute angle to the pulmonary artery wall were more common in the PAS group [11(84.6%) vs. 5(26.3%), P=0.003; 11(84.6%) vs. 2(10.5%), P<0.001, respectively]. The swelling index of the main pulmonary and the left/right main pulmonary arteries in the PAS group were significantly higher, as well as the dilatation in the lobar and segmental pulmonary arteries [1.19±0.17 vs. 0.99±0.19,P=0.006, 10(76.9%) vs. 2(10.5%), P<0.001, respectively]. The right ventricular transverse diameter/left ventricular transverse diameter (RVd/LVd) and pulmonary artery diameter/ascending aortic diameter ratio (Pad/Aod) were significantly lower in PAS group than those in the central CPTE group (0.97±0.19 vs. 1.23±0.35,P=0.020; 0.98±0.25 vs. 1.15±0.20,P=0.039). Conclusions: In CT pulmonary angiography, filling defects involving the main pulmonary artery and showing expansive growth were highly suggestive of pulmonary artery sarcoma. The history of deep venous thrombosis of the lower extremities was helpful for the diagnosis of chronic pulmonary embolism.

[Fibrinogen gamma-chain mutation, p.Ile171His, leads to hereditary hypofibrinogenemia]

Objective: To explore the clinical phenotype and genotype of a family with hereditary hypofibrinogenemia. Methods: Activated partial thrombin time (APTT), prothrombin time (PT),thrombin time (TT) and thrombelastogram (TEG) were tested in all family members. Fibrinogen activity and antigen were detected by Clauss method and immunoturbidimetric method respectively. All exons and flanking sequences of fibrinogen FGA,FGB,FGG genes were analyzed by PCR, and the products were subjected to Sanger sequencing. Results: The proband represented prolonged PT and TT, low Fg activity and antigen, elevated K value and decreased Angle value in TEG. Other family members reported similar changes including proband's father,daughter and son, and his elder brother and his niece. Exon 5 c.510_512 of FGG gene in the proband revealed a minor deletion mutation. Conclusion: The novel heterozygous missense mutation of exon 5 c.510_512del (Gln170_Ile171 del ins His) of FGG gene is the molecular mechanism that leads to hereditary hypofibrinogenemia in this family.

[A multicenter randomized controlled study of bismuth-containing quadruple therapy followed by Jing-Hua-Wei-Kang in the treatment of patients newly diagnosed with Helicobacter pylori infection and dyspepsia]

Objective: To investigate the Helicobacter pylori (H. pylori) eradication rate and improvement of dyspepsia in patients who were newly diagnosed with H. pylori infection and dyspepsia and treated by bismuth-containing quadruple therapy followed by Jing-Hua-Wei-Kang(JHWK). Methods: Patients who were newly diagnosed with dyspepsia and H. pylori infection and treated in 16 medical centers in China between December 1, 2017 and September 30, 2019 were randomly divided into two groups. The experimental group received bismuth-containing quadruple therapy (esomeprazole+amoxicillin+furazolidone+colloidal bismuth pectin capsule, 14 days), followed by JHWK (30 days), and the course of treatment was 44 days in total. In the control group, the administration regimen was bismuth-containing quadruple therapy (esomeprazole+amoxicillin+furazolidone+colloidal bismuth pectin capsule, 14 days). The main outcome measure was H. pylori eradication rate, while the secondary outcome measures were dyspepsia symptom changes and adverse events during the treatment and the 1st month after treatment. Results: A total of 1 054 patients were included in the study. There were 522 cases enrolled in the experimental group, including 224(42.91%) men and 298(57.09%) women, and the age was 53(26, 73) years old; 532 cases enrolled in the control group, including 221(41.54%) men and 311(58.46%) women, and the age was 46(22, 71) years old. Based on PP analysis, it was found that the H. pylori eradication rate in the experimental group was significantly higher than those in the control group (93.85% vs 87.88%, P=0.001). In the group of all enrolled patients, the symptom dyspepsia after H. pylori eradication was significantly improved compared with that before treatment [4(4, 7) vs 15(10, 22), P<0.001], so was the superior and middle abdominal pain [1(1, 4) vs 4(1, 8), P<0.001], the postprandial fullness [1(1, 4) vs 4(4, 9), P<0.001], the early satiety [1(1, 1) vs 4(1, 4), P<0.001], and the heartburn [1(1, 1) vs 1(1, 4), P<0.001]. The symptom dyspepsia after treatment was significantly improved compared with that before treatment in the experimental, the control groups, the successful and the unsuccessful H. pylori eradication groups. The superior and middle abdominal pain after treatment was signifcantly improved than that before treatment [1(1, 2) vs 1(1, 4), P<0.001], so were the postprandial fullness [1(1, 3) vs 1(1, 4), P=0.002] and the dyspepsia[4(4, 7) VS 7(4, 10), P<0.001]. There was no statistically significant difference in the incidence of adverse events between the experimental group and the control group (1.34% vs 0.38%, P=0.09). Conclusions: Compared with bismuth-containing quadruple therapy, bismuth-containing quadruple therapy followed by JHWK significantly improves the H. pylori eradication rate without increasing the incidence of adverse events. H. pylori eradication therapy can improve symptoms of patients with H. pylori infection and dyspepsia.

[Analysis on epidemiological characteristics of multidrug-resistant Salmonella Kentucky in Beijing, 2010-2020]

Objective: To investigate the epidemiological, drug resistance and molecular characteristics of Salmonella (S.) Kentucky strains isolated from diarrheal patients in Beijing. Methods: The drug susceptibility of 22 S. Kentucky strains isolated in Beijing during 2010-2020 was tested by using the micro broth dilution method. The multilocus sequence typing (MLST), drug resistance genes and Salmonella genomic island (SGI) identifications of the strains were performed by whole-genome sequencing (WGS).The pulsed field gel electrophoresis (PFGE) was performed to analyze the molecular epidemiological characteristics of the isolates. Results: The 22 strains were highly resistant to 8-22 kinds of antibiotics, especially to ciprofloxacin, cephalosporins and azithromycin, etc., showing a super high level of multidrug resistance and 21 strains were positive for extended-spetrum beta-lactamase (ESBL). The WGS analysis revealed that all the isolates belonged to ST198, carrying SGI1-K. The drug resistance genes tetA, sul1 and qacE were identified in all strains and Quinolone resistance-determining regions (QRDRs) showed 2 mutations in gyrA (S83F, D87 N) and 3 mutations in the parC gene (T57S, S80I, T255S). The resistance genes associated with β-lactam antibiotics (blaCTX-M-55, blaCTX-M-14b, blaTEM-141, blaTEM-206, blaTEM-209, blaTEM-214, blaTEM-1B), resistance genes associated with aminoglycosides [aac(3)-Id, aac(3)-IId, aac(6')-Iaa, aadA7, aadA17, aph(3')-Ia, aph(3'')-Ib, aph(6)-Id,rmtB] as well as floR, dfrA14, mphA and qnrS1 had significant differences in the strains of different years, which were highly consistent with the drug-resistant phenotype. Furthermore, phylogenetic analysis showed that the similarity of the 22 strains was more than 85%, and the strains were highly homologous to CIP-resistant ST198-X1 circulating in the world. In the process of spread, the drug resistance and PFGE spectrums had changed, two clusters had formed. Conclusions: The S. Kentucky strains isolated in Beijing shared high homology with the multidrug-resistant strain ST198-X1-SGI-1K isolated in the world, which has maintained a low level of spread since 2016, causing sporadic infections and clusters of diarrhea, and has serious resistances to fluoroquinolones, ESBLs and azithromycin. The surveillance for multidrug-resistant S. Kentucky should be strengthened.

[Deep learning based lesion detection from anterior segment optical coherence tomography images and its application in the diagnosis of keratoconus]

Objective: To developed an image analysis system of anterior segment optical coherence tomography (AS-OCT) examination results based on deep learning technology, and to evaluate its effect in identifying various types of corneal pathologies and quantified indices. Methods: A total of 4 026 patients (5 617 eyes), including 1 977 males and 2 049 females, aged (45±23) years, were enrolled in Qingdao Eye Hospital from January 2011 to August 2019. The AS-OCT images were used as a training dataset, which were labeled with location information of 16 corneal pathologies (including corneal epithelial defect, corneal epithelial thickening, corneal thinning and so on) by clinical experts, as well as the tissue stratification of the corneal epithelium and stroma. The labeled AS-OCT images were used to train the corneal pathology detection model and corneal stratification model based on deep convolutional neural network algorithm. Then 1 709 AS-OCT images of the affected eyes were collected as a validation dataset. Compared with the artificial labeling results, the accuracy, sensitivity and specificity were evaluated in the corneal pathology detection model, and the overlapping rate (Dice coefficient) between the labeled area of the model and the artificial labeling area was used to evaluate the corneal stratification model. Results: The results of 5 617 training sets showed that there were 1 472 cases of corneal epithelial defect, 2 416 cases of corneal epithelial thickening, 2 001 cases of corneal thinning, 780 cases of corneal lordosis, 2 064 cases of corneal thickening, 358 cases of subepithelial blisters, 486 cases of subepithelial opacity, 1 010 cases of corneal ulcer, 3 635 cases of stromal opacity, 1 060 cases of posterior elastic layer fold, 137 cases of posterior elastic layer detachment, 665 cases of keratic precipitate, 176 cases of corneal perforation, 127 cases of corneal foreign body, 299 cases of after lamellar keratoplasty (LKP) and 234 cases of after penetrating keratoplasty (PKP). Among 1 709 images, 1 596 were manually labeled. The average sensitivity and specificity of the corneal pathology detection model were 96.5% and 96.1% compared with the results of manual labeling. Fifteen samples were missed for detection, and the rate was 0.93%. The average Dice coefficients of the corneal stratification model for the corneal epithelium and stroma were 0.985 and 0.917, respectively. Conclusions: Our artificial intelligence-based diagnosis system with AS-OCT is able to give quantified information and location information of corneal lesions with high accuracy, which can help ophthalmologists improve the efficiency and accuracy of diagnosis. (Chin J Ophthalmol, 2021, 57: 447-453).

A compact electron beam ion trap in support of high-temperature plasma diagnostics based on conduction-cooled superconducting coils

Spectroscopic diagnostics of future fusion reactor plasmas require information on impurity line emissions, especially for relevant high-Z metal elements (e.g., tungsten). These materials will be widely used as plasma facing components for their high heat tolerance and low sputtering yield. Based on an electron beam ion trap, a compact impurity spectra platform is developed to mimic the high-temperature environment of a fusion reactor. The proposed platform can deliver a focused e-beam at energies over 30 keV using a confining magnetic field of ∼1.0 T generated by two superconducting coils (NbTi). Cooled by a closed-loop cryocooler, the coils can avoid the usage of a complicated cryogenic system involving the handling of liquid helium. For spectroscopic studies of highly charged ions, a spherically curved crystal spectrometer is proposed to measure a wavelength range around 2-4 Å covering the typical wavelength range expected to be emitted by metal ions in a fusion plasma. This paper reports the design and development progress of the platform.

Real-time signal processing system based on FPGA for motional Stark effect diagnostic on EAST

The plasma current density profile plays a key role in the development of a high poloidal beta scenario, which is essential for long-pulse and high-performance plasma operation on a tokamak. Based on the polarimetry technique, a Motional Stark Effect (MSE) diagnostic has been built on the Experimental Advanced Superconducting Tokamak. To be prepared for real-time (RT) feedback control of the plasma current density profile in the future, a RT signal processing system has been developed. The RT signal processing system is composed of three functional modules: analog-to-digital conversion (ADC) module, polarization information extraction module, and digital-to-analog conversion (DAC) module. The final objective of this system is to acquire the polarization information of the MSE. Based on the field-programmable gate array unit, fast Fourier transformation is adopted to process the Photoelastic Modulator (PEM) digital signal, which was converted from a PEM signal via the ADC module. By means of frequency spectrum separation, the components around double modulating frequencies are restored through inverse fast Fourier transformation. Furthermore, the two amplitudes of their corresponding components can be obtained through a digital harmonic analyzer technique. Afterward, the ratio of the two amplitudes is calculated by arc tangent so that the polarization angle is obtained. Finally, the information of this polarization angle is converted into a voltage signal by the DAC module and then output in RT. The test results based on the RT signal processing system are in good agreement with those based on the phase lock-in amplifiers. The working cycle of this system is shorter than 10 ms, which meets the requirements of the MSE diagnostic as a RT controller. The algorithm of RT signal processing and the relevant technology applied for building this system are presented in the main body of this paper in detail.

Development and preliminary test of a space-resolved vacuum-ultraviolet spectroscopy in EAST

The impurity radiation from the divertor region of the EAST tokamak is dominantly in the wavelength range of vacuum ultraviolet (VUV) due to the elevated edge electron temperature. A space-resolved VUV spectroscopy is developed to measure impurity radiation in the divertor region. An eagle-type VUV spectrometer with a focal length of 1 m is adopted in this system, equipped with a spherical grating and a charged-coupled device (CCD) detector. The performance of the VUV spectrometer is preliminarily tested on a synchrotron radiation facility. The wavelength calibration is conducted near 65 nm. It is found that the wavelength range observed by the CCD detector is about 11.07 nm around the central wavelength of about 65 nm. With a linear dispersion of 0.0053 nm/pixel, it is possible to measure the ion temperature lower than 20 eV at the edge region by analyzing the Doppler broadening of a carbon line. These test results show that the performance of the VUV spectrometer is capable of measuring divertor radiation and analyzing the ion temperature of edge impurity ions.

[A comparative study of new gastric cancer screening scoring system and new ABC method for screening gastric cancer and precancerous lesions]

Objective: To compare the value of new gastric cancer screening scoring system and serum pepsinogen (PG) combined with gastrin-17 (G-17) (new ABC method) in screening gastric cancer and precancerous lesions. Methods: A total of 576 patients were enrolled after the examination of endoscopy at Endoscopy Center,Department of Gastroenterology,from December 2017 to December 2019. There were 275 males and 301 females with an age of 40-72 (52±10) years. According to the new ABC method and the new gastric cancer screening scoring system, the population was divided into three groups according to age,gender,serum helicobacter pylori antibody test, PG Ⅰ/PG Ⅱ(PGR) and G-17 before endoscopy. The detection rates of gastric cancer and atrophic gastritis by two different methods were analyzed and the value in screening gastric cancer and precancerous lesions were evaluated. Statistical analysis was accomplished by Chi-square test and Gamma coefficient analysis. Results: A total of 576 patients were enrolled. According to the new ABC method, 382 patients were classified into low-risk group, 170 patients into middle-risk group and 24 patients into high-risk group, respectively. In the new ABC method, 1 case of gastric cancer (0.3%) was detected in low-risk group, 8 cases (4.7%) in middle-risk group and 3 cases (12.5%) in high-risk group. As for atrophic gastritis, 89 cases (23.3%) was detected in low-risk group, 94 cases (55.3%) in middle-risk group and 18 cases (75.0%) in high-risk group. According to the new gastric cancer screening scoring system, 336 patients were classified into low-risk group, 205 patients into middle-risk group and 35 patients into high-risk group, respectively. One case of gastric cancer (0.3%) was detected in low-risk group, 6 cases (2.9%) in middle-risk group and 5 cases (14.3%) in high-risk group. As for atrophic gastritis, 41 cases (12.2%) were detected in low-risk group, 134 cases (65.4%) in middle-risk group and 26 cases (74.3%) in high-risk group. In this two methods, the prevalence of gastric cancer increased according to the disease stage (χ²=22.509, P<0.01; χ²=24.156, P<0.01); in terms of atrophic gastritis, the detection rate of the new screening scoring system in the low-risk group was significantly lower than that in the new ABC method (χ²=14.844, P<0.01), but higher in the middle-risk group (χ²=3.955, P=0.047). Gamma coefficient test showed that there were strong correlations between gastroscopy pathology and classification grade of both methods (P<0.01). Conclusions: Both methods are suitable for screening gastric cancer and precancerous lesions, and the new scoring system may be more valuable in screening gastric cancer and precancerous lesions.

[The status and health risk assessment of dietary fipronil contamination among 20 provinces of China]

Objective: To understand the status and health risk assessment of dietary fipronil contamination among 20 provinces of China. Methods: A total of 13 kinds of dietary samples in Chinese total diet study include cereals, legumes, potatoes, meats, eggs, aquatics, dairies, vegetables, fruits, sugars, beverages and water, alcohols, condiments and their corresponding products. Among them, condiments were used in the preparation of 12 other sample categories; thus, the actual mixed dietary samples of each province covered 12 groups. A total of 240 mixed dietary samples were collected from 20 provinces in China from 2009 to 2013. After the sample extraction and cleanup, dietary samples were analyzed for the residues of fipronil and its metabolites to obtain the contamination levels of fipronil residues using liquid chromatography-high resolution mass spectrometry. The dietary intake of adult residents was estimated based on food consumption of general population of China. Results: Among the 240 dietary samples, the detection rate of fipronil was 10.4% (25 samples), and the detection rates of fipronil metabolites, i.e. fipronil desulfinyl, fipronil sulfone and fipronil sulfide were 20.4% (49 samples), 40.0% (96 samples) and 8.8% (21 samples), respectively. According to the dietary exposure analysis, the average lower and upper dietary exposure levels of fipronil residues in adult residents of China were 11.34 and 12.35 ng·kg(-1)·d(-1), accounting for 5.7% and 6.2% of acceptable daily intake (ADI), respectively. The highest adult dietary intake of fipronil residues was found in Hunan province, with a value of 72.98 ng·kg(-1)·d(-1), accounting for 36.5% of ADI. Vegetables were the main dietary source of fipronil residues, which contributed to 71.0% of the total intake dose. Conclusion: Fipronil residues were detected in varying degrees in dietary samples, yet the health risk caused by the dietary intake of adult residents among 20 provinces of China is low.

[Comparison of different serological methods in screening early gastric cancer]

Objective: To compare the consistency and detection rate of early gastric cancer (EGC) of three different methods including anti-Helicobacter pylori (Hp) antibody combined with pepsinogen (PG) (ABC method), serum PG combined with gastrin-17 (G-17) (new ABC method) and the new scoring system. Methods: Serological tests were performed in Zhejiang population, which divided the subjects into low risk, intermediate risk and high risk groups. High risk subjects were examined by endoscopic and pathological examination. SPSS19.0 were used to evaluate the consistency of three methods. According to the receiver operating characteristic (ROC) curve, the ratio of G-17 to PG (PGR) was calculated for the optimal diagnostic cut-off value of EGC. Results: A total of 30 126 subjects were recruited. Based on the data of ABC method, the proportions of low risk, intermediate risk and high risk group were 15 368 (51.01%), 13 246 (43.97%), and 1 512 (5.02%), respectively. These proportions by the new ABC method were 20 584 (68.32%), 8 990 (29.84%), 552 cases (1.83%), respectively. By new scoring system, these were 20 810 (69.08%), 8 059 (26.75%), and 1 257 (4.17%), respectively. Among them, 1 263 subjects underwent endoscopy and 22 cases (1.74%) were finally diagnosed as gastric cancer including 19 EGC (86.4%). There were 1 case (0.35%), 14 cases (1.84%), and 7 cases (3.21%) with gastric cancer in low risk, intermediate risk, and high risk groups by ABC methods, respectively. Gastric cancer patients were 7 (1.68%), 10 (1.38%), and 5 (4.10%) in three groups respectively by new ABC methods. Via new scoring system, gastric cancer were detected in 5 (0.66%), 9 (2.22%), and 8 (7.84%) patients of three risk groups respectively. The consistency of three screening methods was poor. The detection rate of gastric cancer in high risk group was higher than that in the other two (P<0.05). The area under the curve (AUC) for diagnosis of gastric cancer by G-17 and PGR was 0.588 and 0.729, respectively. According to the PGR cut-off value determined by the fitted model, the incidence of gastric cancer in the low, intermediate and high risk groups was 0.94%, 1.97%, and 6.31%, respectively. When the cut-off value is PGR<4.135, the sensitivity is 0.855 and the specificity is 0.545. Conclusion: The new scoring system has a better predictive value in EGC screening. The detection rate of EGC in high risk group is higher than that in low and intermediate risk groups.

[Pathogenic surveillance and related factors on bacillary dysentery in Beijing, 2008-2017]

Objective: To analyze the pathogenic surveillance programs and related factors on bacillary dysentery in Beijing, 2008-2017, to provide evidence for the practices of diagnosis, treatment and prevention of the disease. Methods: Analysis was conducted on surveillance data of bacillary dysentery, collected from the surveillance areas of national bacillary dysentery in Beijing. Shigella positive rate of stool samples were used as the gold standard while detection rate of Shigella, diagnostic accordance rate and resistance were computed on data from the surveillance programs. Chi-square test was used to compare the rates and unconditional logistic regression was used to analyze the related factors of Shigella infection. Results: Both the reported incidence rate on bacillary dysentery and detection rate of Shigella in diarrhea patients showed significantly decreasing trend, from 2008 to 2017. The accordance rate of bacillary dysentery was only 7.80% (111/1 423). Shigella sonnei was the most frequently isolated strain (73.95%, 159/215) followed by Shigella flexnery. Results from the multivariate logistic regression of Shigella positive rate revealed that among those patients who were routine test of stool positive vs. routine test of stool positive (OR=1.863, 95%CI: 1.402-2.475), onset from July to October vs. other months'time (OR=7.271, 95%CI: 4.514-11.709) temperature ≥38 ℃vs. temperature <38 ℃(OR=4.516, 95%CI: 3.369-6.053) and age from 6 to 59 years old vs. other ages (OR=1.617, 95%CI: 1.085-2.410), presenting higher positive detection rates of Shigella from the stool tests. The resistant rates on ampicillin and nalidixic acid were 97.57% (201/206) and 94.90% (186/196), both higher than on other antibiotics. The resistant rates on ciprofloxacin (16.33%, 32/196), ofloxacin (9.57%, 11/115) and on amoxilin (15.05%, 31/206) were relatively low. The resistant rate appeared higher on Shigella flexnery than on Shigella sonnei. The proportion of strains with resistance on 3 more drugs, was 30.00%(21/70). Conclusions: The diagnostic accordance rate of bacillary dysentery in Beijing was low, with severe resistance of Shigella. Our findings suggested that clinicians should take multiple factors into account in their practices about epidemiological history, clinical symptom and testing results for diarrhea patients.

Development of wavelength calibration techniques for high-resolution x-ray imaging crystal spectrometers on the EAST tokamak

Newly developed large-area pixelated two-dimensional detector and two-crystal assemblies were deployed for the first time on tokamaks to enable time-resolved Bragg-diffracted x-ray imaging with good framing rate and water-cooling capabilities for in-vacuum long-pulse operations. High-quality helium-like (He-like) and hydrogen-like (H-like) argon spectra have been observed simultaneously for the first time on a single detector for a wide range of plasma parameters to infer both ion temperature and rotation profiles and support studies on spontaneous rotation, impurity transport, and RF physics. Since tokamak plasmas rotate in both the poloidal (θ) and toroidal (ϕ) directions, a reliable wavelength calibration is needed to account for the correct Doppler shift as well as to compute the spectrometer's instrumental function. Ly_α lines emitted from Cd x-ray tubes are proposed to be used as "markers" to provide an in situ calibration of the EAST's X-ray imaging crystal spectrometer systems measuring He- and H-like argon spectra. The first lab test indicated that the X-ray tube can excite strong Ly_α lines at 15 kV voltage and 1 mA current when the crystal is shined for 10 min. Other indirect calibration methods using locked-mode discharge scenarios were also studied as complementary methods.

Edge toroidal charge exchange spectra analysis in the EAST

An edge toroidal charge exchange recombination spectroscopy (eCXRS) diagnostic has been deployed successfully on the Experimental Advanced Superconducting Tokamak (EAST) recently, providing edge plasma ion temperature and toroidal rotation. Edge CXRS on EAST typically monitors the carbon vi (529.059 nm, n = 8 → 7) spectral line. Spectral lines emitted from other different impurities that appeared in the wavelength ranges of 528 nm-530 nm illustrate the need to revise the edge change exchange spectra analysis in this region. Since the eCXRS sightlines end on the ion cyclotron range of frequencies (ICRF) stainless steel antenna, the passive Fe lines coming from the antenna could be recorded by eCXRS diagnostic when ICRF is used. A revised edge toroidal charge exchange spectra analysis including Fe spectral lines is presented. The accuracy of eCXRS measurement has been improved by the revised spectra analysis.

Simultaneous measurement of C VI, Ne X, and Li III charge exchange lines on EAST

The core toroidal charge exchange recombination spectroscopy system on experimental advanced superconducting tokamak (EAST) has been enhanced recently to extend the spectral range. The C VI charge exchange line at 529.059 nm, Ne X line at 524.897 nm, and Li III line at 516.67 nm are observed successfully. The measurements were performed by injecting neon gas and dropping lithium powder simultaneously during the 2016 EAST experimental campaign. One channel connected to a neon lamp is used to perform the real-time wavelength calibration on a shot-to-shot basis. The preliminary results indicate that ion temperature profiles from the carbon and neon impurities are in excellent agreement and provide a consistency check of the measurement from different impurities. Toroidal velocity correction associated with the energy-dependent cross section has been performed. Toroidal rotation of neon impurity is obviously faster than C VI across the whole profile. A cumulative and saturated effect of core lithium ions was observed.

Four-dimensional calibration turntable of the motional Stark effect diagnostic on EAST

The motional Stark effect (MSE) diagnostic is applied to measure the safety factor q and current density profile of a tokamak device, which are important parameters in realizing the high-performance and long-pulse steady state of a tokamak. A single-channel MSE diagnostic based on dual photoelastic modulators, whose sightline meets with the neutral beam injection at a major radius of R = 2.12 m, has been built for the D window of the Experimental Advanced Superconducting Tokamak (EAST). According to the requirements of MSE diagnostic polarimetric calibration, a high-precision four-dimensional calibration turntable, driven by four stepping motors and controlled by software running on the computer, was designed for EAST. The turntable allows us to rapidly calibrate the MSE diagnostic in a series of positions and angles during EAST maintenance. The turntable can move in four dimensions of translation, yaw, pitch, and roll of the polarizer and can create linearly polarized light at any given angle with accuracy of ∼0.05° for the MSE system offline calibration. The experimental results of the MSE diagnostic calibration in the laboratory show that the turntable has the advantages of high positioning accuracy, flexible spatial movement, and convenient control and fully meets the calibration requirements of an MSE diagnosis system.

Upgrade of X-ray crystal spectrometer for high temperature measurement using neon-like xenon lines on EAST

A two-crystal X-ray spectrometer system has been implemented in the EAST tokamak to simultaneously diagnose high- and low-temperature plasmas using He- and H-like argon spectra. But for future fusion devices like ITER and Chinese Fusion Engineering Test Reactor (CFETR), argon ions become fully stripped in the core and the intensity of the H-like lines will be significantly at high temperatures (T_e > 5 keV). With increasing auxiliary heating power on EAST, the core plasma temperature could also reach 5 keV and higher. In such conditions, the use of a xenon puff becomes an appropriate choice for both ion-temperature and flow-velocity measurements. A new two-crystal system using a quartz 110 crystal (2d = 4.913 Å) to view He-like argon lines and a quartz 011 crystal (2d = 6.686 Å) to view Ne-like xenon spectra has been deployed on a poloidal X-ray crystal spectrometer. While the He-like argon spectra will be used to measure the plasma temperature in the edge plasma region, the Ne-like xenon spectra will be used for measurement in the hot core. The new crystal arrangement allows a wide temperature measurement ranging from 0.5 to 10 keV or even higher, being the first tests for burning plasmas like ITER and CFETR. The preliminary result of lab-tests, Ne-like xenon lines measurement will be presented.

Influence of neutral beam attenuation on beam emission spectroscopy and charge exchange recombination spectroscopy

Neutral beam attenuation is simulated by means of consulting the ADAS (Atomic Data and Analysis Structure) database based on experimentally diagnosed radial plasma density and electron temperature profiles on the Experimental Advanced Superconducting Tokamak (EAST). Two-dimensional distributions of beam emission and charge exchange recombination photon flux are simulated, taking neutral beam attenuation into account, together with comparison with experimental results of Beam Emission Spectroscopy (BES) and Charge eXchange Recombination Spectroscopy (CXRS). A photon number which is over 10¹⁴ promises a sufficient photon flux for typical detectors of BES, CXRS, and UltraFast-CXRS (UF-CXRS) diagnostics. Evidence shows that the ADAS database overvalues neutral beam injection effective stopping coefficient on the EAST tokamak. The joint diagnostic of BES and UF-CXRS which is under development to measure plasma pressure with a high temporal resolution of 1 μs will have strong signals in a radial range of 0.6 < ρ < 0.8. The steep gradients of plasma density and C⁶⁺ density at ρ ∼ 1 bring great difficulty to edge plasma investigation by this joint diagnostic.

Development of beam emission spectroscopy diagnostic on EAST

Beam Emission Spectroscopy (BES) diagnostic based on Neutron Beam Injection (NBI) on the Experimental Advanced Superconducting Tokamak has been developed. This system consists of 16 × 8 channels which can diagnose the density fluctuation in a rectangular area of about 20 × 10 cm² in the cross section, whose radial position is adjustable from the core to edge just by means of changing the angle of the rotation mirror. The spatial resolution is about 1-3 cm according to the diagnosed radial position. The temporal resolution is 1 μs. Space calibration of the diagnostic system is done based on the reversibility of the optical path. The NBI modulation experiment shows the success of BES development.

[Helicobacter pylori eradication and gastroesophageal reflux disease: a Meta-analysis]

OBJECTIVE

To systematically evaluate whether eradication of Helicobacter pylori (H.pylori) is associated with the development of endoscopic gastroesophageal reflux disease (GERD) and reflux symptoms.

METHODS

PubMed, CENTRAL, Embase, CNKI and Wanfang Database from April 1978 to April 2015 were retrieved to collect the randomized controlled trials (RCTs) comparing the incidence of reflux symptoms or reflux esophagitis in patients receiving H. pylori eradication treatment and those without treatment. The quality of trials was evaluated by the Cochrane Collaboration's tool for assessing risk of bias and Jadad scoring. A Meta-analysis was conducted by using RevMan 5.20 software.

RESULTS

Twenty RCTs involving 6 575 cases were included. Meta-analysis showed that: (1) There was a positive link between H. pylori eradication and endoscopic reflux esophagitis. The diagnostic rate of endoscopic reflux esophagitis after H. pylori eradication therapy was higher than that of control group(7.25% vs 4.20%; OR=1.62, 95%CI 1.20-2.19, P=0.002). Subgroup analysis found that Asian patients, 40 to 50 years old, follow-up time more than 1 year, and peptic ulcer had higher incidence of endoscopic reflux esophagitis; (2) The incidence of reflux symptoms was not significantly different between H. pylori eradication group and control group (25.2% vs 24.6%; OR=1.03, 95%CI 0.87-1.21, P=0.76). Further analysis indicated that reflux symptoms were not related to some relevant factors, such as races, age at diagnosis, follow-up time and underlying diseases.

CONCLUSIONS

The eradication of H. pylori is considered as one of risk factors for GERD, especially in Asian populations, long time follow-up, 40 to 50 years old and patients with peptic ulcer. Meanwhile, the eradication of H. pylori does not suggest the correlation with reflux symptoms. H. pylori eradication therapy should be administrated according to patients' individual conditions.

[Clinicopathologic characteristics of head and neck carcinoma showing thymus-like element]

Objective: To investigate clinicopathological features of carcinoma showing thymus-like elements (CASTLE) in the head and neck regions. Methods: Clinicopathological data of 7 patients with CASTLE in the head and neck regions were retrospectively reviewed.Immunohistochemical staining and in situ hybridization for EBER were performed. BRAF(V600E) mutation was examined by ARMS method in 6 cases. Results: There were 5 females and 2 males with age between 49 and 78 years (average of 65.6 years). All tumors were solitary nodular lesions with an infiltrative border, including 6 intrathyroid tumors and 1 extrathyroid tumor in the laryngeal pharynx.The tumors were 1.7-4.1 cm in diameter (average of 3.0 cm). Four cases demonstrated lymph node metastasis.All patients were alive without metastasis during follow-up, except one consultation case (with FNA sample) developed recurrence at the primary site. The cases showed different immunoreaction to CD5, diffuse immunoreaction with p63, CK5/6 and CD117, but negative staining for TTF1, TG and calcitonin. One case showed positive immunoreaction with Synin less than 30% tumor cells. The Ki-67 labeling index was between 3% and 90%. No BRAF(V600E) mutation and EB virus infection were detected. Conclusions: Extrathyroid CASTLE involving laryngeal pharynx shows the similar morphological and immunohistochemical features with intrathyroid CASTLE.Immunohistochemical markers of CD5 and CD117 are helpful in the diagnosis. Ki-67 labeling index can be high in CASTLE, especially in lymphoepithelioma type. CD5-negative CASTLE may have neuroendocrine differentiation. BRAF(V600E) mutation and EB virus may not be involved in the carcinogenesis of CASTLE.

[Risk factors of peripartum hysterectomy in placenta previa: a retrospective study of 3 840 cases]

OBJECTIVE

To investigate the risk factors of peripartum hysterectomy in placenta previa through retrospective study of 3 840 placenta previa cases.

METHODS

The clinical data of 3 840 patients with placenta previa who delivered in West China Second University Hospital between Jan 2005 and June 2014 were analyzed retrospectively. The relationship of certain factors and peripartum hysterectomy was analyzed, including maternal age, residence place, parity, prior curettage, prior cesarean section, twin or multiple pregnancy, antenatal vaginal bleeding, type of placenta previa, suspected placenta accreta, antenatal level of hemoglobin and gestational age at delivery.

RESULTS

The prevalence of placenta previa was 4.84%(3 840/79 304)in West China Second University Hospital during the study period, and the incidence of preipartum hysterectomy in patients with placenta previa was 2.76%(106/3 840). One-factor analysis demonstrated that residence place, parity, times of prior curettage, prior cesarean section, prenatal vaginal bleeding, anterior placenta, type of placenta previa, placenta accreta, antenatal anemia and gestational age at delivery were potential risk factors for peripartum hysterectomy(P<0.01). Variables with P<0.1 in one-factor analysis were introduced to multi-factor logistic regression analysis, which suggested that one prior cesarean section(OR=12.9,95% CI:6.3-26.3), two or more prior cesarean sections(OR=14.4, 95%CI:3.9-53.2), anterior placenta(OR=4.8, 95%CI:2.1-10.7), complete placenta previa(OR=5.9, 95%CI: 1.8-42.5), placenta accreta(OR=11.2, 95%CI:6.8-18.6), antenatal hemoglobin<100 g/L(OR=1.7, 95%CI: 1.0-2.8)and delivery before 34 gestational weeks(OR=3.2, 95%CI: 1.6-6.3)were independent risk factors of peripartum hysterectomy in patients with placenta previa(P<0.05).

CONCLUSIONS

Prior cesarean section, anterior placenta, complete placenta previa, placenta accreta, antenatal anemia and delivery before 34 gestational weeks are high risk factors of peripartum hysterectomy in placenta previa patients. Perinatal care and risk evaluation before cesarean section are important to improve perinatal outcomes and reduce peripartum hysterectomy.

Improved spatial calibration for the CXRS system on EAST

A Charge eXchange Recombination Spectroscopy (CXRS) diagnostic system has been developed to measure profiles of ion temperature and rotation since 2014 on EAST. Several techniques have been developed to improve the spatial calibration of the CXRS diagnostic. The sightline location was obtained by measuring the coordinates of three points on each sightline using an articulated flexible coordinate measuring arm when the vessel was accessible. After vacuum pumping, the effect of pressure change in the vacuum vessel was evaluated by observing the movement of the light spot from back-illuminated sightlines on the first wall using the newly developed articulated inspection arm. In addition, the rotation of the periscope after vacuum pumping was derived by using the Doppler shift of neutral beam emission spectra without magnetic field. Combining these techniques, improved spatial calibration was implemented to provide a complete and accurate description of the EAST CXRS system. Due to the effects of the change of air pressure, a ∼0.4° periscope rotation, yielding a ∼20 mm movement of the major radius of observation positions to the lower field side, was derived. Results of Zeeman splitting of neutral beam emission spectra with magnetic field also showed good agreement with the calibration results.

Fast-ion Dα spectrum diagnostic in the EAST

In toroidal magnetic fusion devices, fast-ion D-alpha diagnostic (FIDA) is a powerful method to study the fast-ion feature. The fast-ion characteristics can be inferred from the Doppler shifted spectrum of D_α light according to charge exchange recombination process between fast ions and probe beam. Since conceptual design presented in the last HTPD conference, significant progress has been made to apply FIDA systems on the Experimental Advanced Superconducting Tokamak (EAST). Both co-current and counter-current neutral beam injectors are available, and each can deliver 2-4 MW beam power with 50-80 keV beam energy. Presently, two sets of high throughput spectrometer systems have been installed on EAST, allowing to capture passing and trapped fast-ion characteristics simultaneously, using Kaiser HoloSpec transmission grating spectrometer and Bunkoukeiki FLP-200 volume phase holographic spectrometer coupled with Princeton Instruments ProEM 1024B eXcelon and Andor DU-888 iXon3 1024 CCD camera, respectively. This paper will present the details of the hardware descriptions and experimental spectrum.

Validation of fast-ion D-alpha spectrum measurements during EAST neutral-beam heated plasmas

To investigate the fast ion behavior, a fast ion D-alpha (FIDA) diagnostic system has been installed on EAST. Fast ion features can be inferred from the Doppler shifted spectrum of Balmer-alpha light from energetic hydrogenic atoms. This paper will focus on the validation of FIDA measurements performed using MHD-quiescent discharges in 2015 campaign. Two codes have been applied to calculate the D_α spectrum: one is a Monte Carlo code, Fortran 90 version FIDASIM, and the other is an analytical code, Simulation of Spectra (SOS). The predicted SOS fast-ion spectrum agrees well with the measurement; however, the level of fast-ion part from FIDASIM is lower. The discrepancy is possibly due to the difference between FIDASIM and SOS velocity distribution function. The details will be presented in the paper to primarily address comparisons of predicted and observed spectrum shapes/amplitudes.

Measurement of helium-like and hydrogen-like argon spectra using double-crystal X-ray spectrometers on EAST

A two-crystal assembly was deployed on the tangential X-ray crystal spectrometer to measure both helium-like and hydrogen-like spectra on EAST. High-quality helium-like and hydrogen-like spectra were observed simultaneously for the first time on one detector for a wide range of plasma parameters. Profiles of line-integrated core ion temperatures inferred from two spectra were consistent. Since tungsten was adopted as the upper divertor material, one tungsten line (W XLIV at 4.017 Å) on the short-wavelength side of the Lyman-α line (Lα1) was identified for typical USN discharges, which was diffracted by a He-like crystal (2d = 4.913 Å). Another possible Fe XXV line (1.85 Å) was observed to be located on the long-wavelength side of resonance line (w), which was diffracted from a H-like crystal (2d = 4.5622 Å) on the second order. Be-like argon lines were also observable that fill the detector space between the He-like and H-like spectra.

First measurement of the edge charge exchange recombination spectroscopy on EAST tokamak

An edge toroidal charge exchange recombination spectroscopy (eCXRS) diagnostic, based on a heating neutral beam injection (NBI), has been deployed recently on the Experimental Advanced Superconducting Tokamak (EAST). The eCXRS, which aims to measure the plasma ion temperature and toroidal rotation velocity in the edge region simultaneously, is a complement to the exiting core CXRS (cCXRS). Two rows with 32 fiber channels each cover a radial range from ∼2.15 m to ∼2.32 m with a high spatial resolution of ∼5-7 mm. Charge exchange emission of Carbon VI CVI at 529.059 nm induced by the NBI is routinely observed, but can be tuned to any interested wavelength in the spectral range from 400 to 700 nm. Double-slit fiber bundles increase the number of channels, the fibers viewing the same radial position are binned on the CCD detector to improve the signal-to-noise ratio, enabling shorter exposure time down to 5 ms. One channel is connected to a neon lamp, which provides the real-time wavelength calibration on a shot-to-shot basis. In this paper, an overview of the eCXRS diagnostic on EAST is presented and the first results from the 2015 experimental campaign will be shown. Good agreements in ion temperature and toroidal rotation are obtained between the eCXRS and cCXRS systems.

Nonlinear Transition from Mitigation to Suppression of the Edge Localized Mode with Resonant Magnetic Perturbations in the EAST Tokamak

Evidence of a nonlinear transition from mitigation to suppression of the edge localized mode (ELM) by using resonant magnetic perturbations (RMPs) in the EAST tokamak is presented. This is the first demonstration of ELM suppression with RMPs in slowly rotating plasmas with dominant radio-frequency wave heating. Changes of edge magnetic topology after the transition are indicated by a gradual phase shift in the plasma response field from a linear magneto hydro dynamics modeling result to a vacuum one and a sudden increase of three-dimensional particle flux to the divertor. The transition threshold depends on the spectrum of RMPs and plasma rotation as well as perturbation amplitude. This means that edge topological changes resulting from nonlinear plasma response plays a key role in the suppression of ELM with RMPs.

[Environmental factors and primary biliary cirrhosis]

The complex interplay between immune factors and genetic susceptibility plays an essential role in autoimmune diseases. This is especially true for primary biliary cirrhosis (PBC). PBC is an autoimmune cholestatic liver disease characterized by the destruction of the small intrahepatic bile ducts and the presence of high-titer antimitochondrial antibodies (AMA). Among the currently known risk factors, genetic predisposition remains to be the dominant one. However, it is insufficient to explain the different geographic distributions of PBC and the incomplete concordance in identical twins. This suggests an association between specific environmental factors and the development of PBC. Nevertheless, a clear and rational association of environmental factors with primary biliary cirrhosis has not yet been fully elucidated. Our current understanding of the environmental triggers of PBC is limited to numerous suspected factors involved in its development, such as xenobiotics, electrophilic drugs, infection, and other physical, chemical, and even biological factors. Although the factors leading to the breakdown of immune tolerance in PBC are still largely unknown, related geoepidemiological studies may help us better understand the impact of the environment. In addition, a better understanding of the interplay between environmental factors and PBC is the critical step toward improving our management and control of PBC and autoimmunity in general.

[Effects of statin intervention on mild coronary plaque progression assessed by serial coronary CT angiography]

OBJECTIVE

To assess the effects of statin treatment on mild coronary plaque progression by serial coronary CT angiography.

METHODS

A total of 120 consecutive patients (74 men, ages(58.9±8.1)years) with mild (≤50%luminal narrowing and lesion length<20 mm) non-calcified plaque detected by coronary CT angiography during September 2012 and December 2013 were prospectively enrolled in this study.Subjects were divided into three groups: no statin (n=36), statin lowering LDL-C <50% (n=43), and statin lowering LDL-C ≥50%(n=41). Serial scans were performed after a median interval of 705 (interquartile range: 467, 803) days.Total plaque volume, percent plaque volume for both baseline and follow-up were measured.Baseline and follow-up data were compared.

RESULTS

Compared with baseline, total plaque volume in no statin group showed increasing trend by the end of follow-up ((97.3±57.8) mm(3) vs. (82.2±57.7) mm(3,) P=0.075). However, no significant change was observed as for total plaque volume ((78.5±45.2) mm(3) vs.(77.6±50.5) mm(3), P=0.910) in the statin lowering LDL-C <50% group.Total plaque volume was significantly reduced by the end of follow-up ((61.5 ± 46.1) mm(3) vs.(77.7±48.1) mm(3), P=0.024) in the statin lowering LDL-C ≥50% group.Percent plaque volume in no statin group was significantly increased by the end of follow-up ((51.9±16.5)% vs.(45.9±12.8)%, P=0.036). However, no significant change was observed as for percent plaque volume ((49.1±13.7)% vs.(47.5±14.9)%, P=0.554) in the statin lowering LDL-C <50% group. Percent plaque volume was significantly reduced by the end of follow-up ((39.1±17.1)% vs.(48.2±15.0)%, P=0.003) in the statin lowering LDL-C ≥50% group. Multivariable linear regression analysis showed that both higher baseline total plaque volume(β=-0.50, P<0.001) and statin lowering LDL-C ≥50%(β=-0.32, P=0.001) were independent determinants of plaque regression.

CONCLUSION

This study suggests that LDL-C reduction ≥50% post statin treatment can retard plaque progression, and even induce regression of mild non-calcified coronary plaque, patients with greater baseline coronary plaque volume are more likely to benefit from statin therapy.

Upgrades of imaging x-ray crystal spectrometers for high-resolution and high-temperature plasma diagnostics on EAST

Upgrade of the imaging X-ray crystal spectrometers continues in order to fulfill the high-performance diagnostics requirements on EAST. For the tangential spectrometer, a new large pixelated two-dimensional detector was deployed on tokamaks for time-resolved X-ray imaging. This vacuum-compatible detector has an area of 83.8 × 325.3 mm(2), a framing rate over 150 Hz, and water-cooling capability for long-pulse discharges. To effectively extend the temperature limit, a double-crystal assembly was designed to replace the previous single crystals for He-like argon line measurement. The tangential spectrometer employed two crystal slices attached to a common substrate and part of He- and H-like Ar spectra could be recorded on the same detector when crystals were chosen to have similar Bragg angles. This setup cannot only extend the measurable Te up to 10 keV in the core region, but also extend the spatial coverage since He-like argon ions will be present in the outer plasma region. Similarly, crystal slices for He-like iron and argon spectra were adopted on the poloidal spectrometer. Wavelength calibration for absolute rotation velocity measurement will be studied using cadmium characteristic L-shell X-ray lines excited by plasma radiation. A Cd foil is placed before the crystal and can be inserted and retracted for in situ wavelength calibration. The Geant4 code was used to estimate X-ray fluorescence yield and optimize the thickness of the foil.

Conceptual design of a fast-ion D-alpha diagnostic on experimental advanced superconducting tokamak

To investigate the fast ion behavior, a fast ion D-alpha (FIDA) diagnostic system has been planned and is presently under development on Experimental Advanced Superconducting Tokamak. The greatest challenges for the design of a FIDA diagnostic are its extremely low intensity levels, which are usually significantly below the continuum radiation level and several orders of magnitude below the bulk-ion thermal charge-exchange feature. Moreover, an overlaying Motional Stark Effect (MSE) feature in exactly the same wavelength range can interfere. The simulation of spectra code is used here to guide the design and evaluate the diagnostic performance. The details for the parameters of design and hardware are presented.