Late-onset and long-lasting neutropenias in the young: A new entity anticipating immune-dysregulation disorders

This study identifies a new chronic form of immune neutropenia in the young with or without detectable indirect anti-neutrophil antibodies, characterized by mild/moderate neutropenia low risk of severe infection (14%), tendency to develop autoimmune phenomena over the course of the disease (cumulative incidence of 58.6% after 20 years of disease duration), leukopenia, progressive reduction of absolute lymphocyte count and a T- and B-cell profile similar to autoimmune disorders like Sjogren syndrome, rheumatoid arthritis, and systemic lupus erythematosus (increased HLADR+ and CD3 + TCRγδ cells, reduced T regulatory cells, increased double-negative B and a tendency to reduced B memory cells). In a minority of patients, P/LP variants related to primary immuno-regulatory disorders were found. This new form may fit the group of "Likely acquired neutropenia," a provisional category included in the recent International Guidelines on Diagnosis and Management of Neutropenia of EHA and EUNET INNOCHRON ACTION 18233. The early recognition of this form of neutropenia would help clinicians to delineate better specific monitoring plans, genetic counseling, and potentially targeted therapies.

µRANIA-V: an innovative solution for neutron detection in homeland security

Detection of neutrons is becoming of the utmost importance, especially in the studies of radioactive waste and in homeland security applications. The crisis of 3He availability has required the development of innovative techniques. One solution is to develop light gas detectors for neutron counting to be used as portals for ports and airports. The neutron is converted on the Boron-coated cathode, releasing a charged particle, whose passage can be identified by the gas detector. While several technologies have been deployed in the past, the project μRANIA-V (μRwell Advanced Neutron Identification Apparatus) aims to detect thermal neutrons by means of the μRwell technology, an innovative gas detector. The goal is to produce tiles to operate as portals in homeland security or for radioactive waste management. The technological transfer towards the industry has started, thus the production can be cost-effective also owing to a construction process relatively easier compared to similar apparatus. By reading directly the signals from the amplification stage, the neutrons can be counted with simplified electronics further reducing the total cost. In this paper, the project will be described, with details on the μRwell technology and on the neutron counting, on the test beam performed, and on the future plans.

A COMPARISON OF OXIDE DECAY HEAT SIMULATIONS AND NUCLEAR DATA LIBRARIES WITH FUSION IRRADIATION EXPERIMENTS

We compare existing experimental decay heat data sets measured at the JAEA fusion neutron source (FNS), which employed a fast extraction rabbit system that in certain cases allowed the measurements to capture, at short cooling times, the decay profile of 16N in a range of oxides. Focussing on those data points and timescales that can be attributed to 16N, we compare measurements to simulations performed using the FISPACT-II inventory code together with evaluated nuclear data libraries. Making small corrections for other contributions at these short times, we derive integral cross section data estimates for 16O(n,p)16N from 12 oxide sample measurements and compare with previously obtained measurements in the IAEA EXFOR database and evaluations in the nuclear data libraries themselves.

Comparison between measurement and calculations for a 14 MeV neutron water activation experiment

The nuclear heat loads due to gamma rays emitted from the decay of 16N and delayed neutrons from17N, generated by the activation of water in cooling circuits, are critical for ITER design. The assessment of nuclear heating from activated water is complex; it requires temporal and spatial dependent transport and activation calculations taking into account variation of irradiation, water flow conditions and cooling circuits’ parameters. A water activation experiment has been recently conducted at the14 MeV Frascati Neutron Generator (FNG) in order to validate the methodology for water activation assessment used for ITER and to reduce the safety factors applied to the calculation results, which have a large impact on the schedule, commissioning and licensing. Water circulating inside an ITER First Wall (FW) mock-up was irradiated with 14 MeV neutrons and then measured using a large CsI scintillator detector. The system consists of a closed water loop where the cooling water, transiting through an ITER FW mock-up, is irradiated by FNG. The induced 16N activity via 14 MeV neutrons interactions with 16O via the 16O(n,p)16N reaction is measured in a dedicated counting station via an expansion volume. The water then passes to a much larger holding delay tank, and after several 16N half-lives decay time, it is then recirculated and exposed again to neutrons in the ITER First Wall (FW) mock-up. The measured 16N activity is obtained measuring the emitted characteristic 6.13 and 7.12 MeV gamma-rays. Calculations were performed in an accurate model of the FW mock-up using the MCNP Monte Carlo code and FENDL-3.1 nuclear data library to obtain the predicted flux impinging on the water. The EASY-2007 inventory code was used to predict the 16N activity. In this work, a comparison between measurements and calculations is reported together with associated uncertainty analysis.

OVERVIEW OF NEUTRON MEASUREMENTS IN JET FUSION DEVICE

The design and operation of ITER experimental fusion reactor requires the development of neutron measurement techniques and numerical tools to derive the fusion power and the radiation field in the device and in the surrounding areas. Nuclear analyses provide essential input to the conceptual design, optimisation, engineering and safety case in ITER and power plant studies. The required radiation transport calculations are extremely challenging because of the large physical extent of the reactor plant, the complexity of the geometry, and the combination of deep penetration and streaming paths. This article reports the experimental activities which are carried-out at JET to validate the neutronics measurements methods and numerical tools used in ITER and power plant design. A new deuterium-tritium campaign is proposed in 2019 at JET: the unique 14 MeV neutron yields produced will be exploited as much as possible to validate measurement techniques, codes, procedures and data currently used in ITER design thus reducing the related uncertainties and the associated risks in the machine operation.

99mTc by 99Mo produced at the ENEA-FNG facility of 14MeV neutrons

A severe supply crisis of ⁹⁹Mo, precursor of ^99mTc a diagnostic radionuclide largely used in Nuclear Medicine, occurred in 2008-2009 due to repeated shut-down of the two main (aged) fission reactors. An alternative route for producing ⁹⁹Mo by ¹⁰⁰Mo(n,2n)⁹⁹Mo reaction was investigated at ENEA. The experiment, designed according to Monte Carlo simulations performed with the Fluka code, produced ⁹⁹Mo by irradiating a natural Molybdenum powdered target with 14MeV neutrons produced at the Frascati Neutron Generator. The ⁹⁹Mo specific activity was measured at metrological level by γ-ray spectrometry.

Non-anaplastic peripheral T cell lymphoma in children and adolescents-an international review of 143 cases

Peripheral T cell lymphomas (PTCL) are rare in children and adolescents, and data about outcome and treatment results are scarce. The present study is a joint, international, retrospective analysis of 143 reported cases of non-anaplastic PTCL in patients <19 years of age, with a focus on treatment and outcome features. One hundred forty-three patients, between 0.3 and 18.7 years old, diagnosed between 2000 and 2015 were included in the study. PTCL not otherwise specified was the largest subgroup, followed by extranodal NK/T cell lymphoma, hepatosplenic T cell lymphoma (HS TCL), and subcutaneous panniculitis-like T cell lymphoma (SP TCL). Probability of overall survival (pOS) at 5 years for the whole group was 0.56 ± 0.05, and probability of event-free survival was (pEFS) 0.45 ± 0.05. Patients with SP TCL had a good outcome with 5-year pOS of 0.78 ± 0.1 while patients with HS TCL were reported with 5-year pOS of only 0.13 ± 0.12. Twenty-five percent of the patients were reported to have a pre-existing condition, and this group had a dismal outcome with 5-year pOS of 0.29 ± 0.09. The distribution of non-anaplastic PTCL subtypes in pediatric and adolescent patients differs from what is reported in adult patients. Overall outcome depends on the subtype with some doing better than others. Pre-existing conditions are frequent and associated with poor outcomes. There is a clear need for subtype-based treatment recommendations for children and adolescents with PTCL.

Focal nodular hyperplasia of the liver: an emerging complication of hematopoietic SCT in children

Hepatic focal nodular hyperplasia (FNH) is a nonmalignant condition rarely affecting children previously treated for cancer, especially those who received hematopoietic SCT (HSCT). Some aspects of its pathogenesis still remain unclear and a strong association with specific risk factors has not yet been identified. We report here a single institution's case series of 17 patients who underwent HSCT and were diagnosed with FNH, analyzing retrospectively their clinical features and the radiological appearance of their hepatic lesions. We aimed to compare the diagnostic accuracy of ultrasound (US) and magnetic resonance imaging (MRI) and to explore the role of transient elastography (FibroScan) to evaluate the degree of hepatic fibrosis in FNH patients. Our analysis showed an association of FNH with age at transplant ⩽12 years (hazard ratio (HR) 9.10); chronic GVHD (HR 2.99); hormone-replacement therapy (HR 4.02) and abdominal radiotherapy (HR 4.37). MRI proved to be a more accurate diagnostic tool compared with US. Nine out of 12 patients who underwent FibroScan showed hepatic fibrosis. Our study points out that FNH is an emerging complication of HSCT, which requires a lifelong surveillance to follow its course in cancer patients.

A diamond based neutron spectrometer for diagnostics of deuterium-tritium fusion plasmas

Single crystal Diamond Detectors (SDD) are being increasingly exploited for neutron diagnostics in high power fusion devices, given their significant radiation hardness and high energy resolution capabilities. The geometrical efficiency of SDDs is limited by the size of commercially available crystals, which is often smaller than the dimension of neutron beams along collimated lines of sight in tokamak devices. In this work, we present the design and fabrication of a 14 MeV neutron spectrometer consisting of 12 diamond pixels arranged in a matrix, so to achieve an improved geometrical efficiency. Each pixel is equipped with an independent high voltage supply and read-out electronics optimized to combine high energy resolution and fast signals (<30 ns), which are essential to enable high counting rate (>1 MHz) spectroscopy. The response function of a prototype SDD to 14 MeV neutrons has been measured at the Frascati Neutron Generator by observation of the 8.3 MeV peak from the (12)C(n, α)(9)Be reaction occurring between neutrons and (12)C nuclei in the detector. The measured energy resolution (2.5% FWHM) meets the requirements for neutron spectroscopy applications in deuterium-tritium plasmas.

Response of LaBr3(Ce) scintillators to 2.5 MeV fusion neutrons

Measurements of the response of LaBr3(Ce) to 2.5 MeV neutrons have been carried out at the Frascati Neutron Generator and at tokamak facilities with deuterium plasmas. The observed spectrum has been interpreted by means of a Monte Carlo model. It is found that the main contributor to the measured response is neutron inelastic scattering on (79)Br, (81)Br, and (139)La. An extrapolation of the count rate response to 14 MeV neutrons from deuterium-tritium plasmas is also presented. The results are of relevance for the design of γ-ray diagnostics of fusion burning plasmas.

X-ray beam monitor made by thin-film CVD single-crystal diamond

A novel beam position monitor, operated at zero bias voltage, based on high-quality chemical-vapor-deposition single-crystal Schottky diamond for use under intense synchrotron X-ray beams was fabricated and tested. The total thickness of the diamond thin-film beam monitor is about 60 µm. The diamond beam monitor was inserted in the B16 beamline of the Diamond Light Source synchrotron in Harwell (UK). The device was characterized under monochromatic high-flux X-ray beams from 6 to 20 keV and a micro-focused 10 keV beam with a spot size of approximately 2 µm × 3 µm square. Time response, linearity and position sensitivity were investigated. Device response uniformity was measured by a raster scan of the diamond surface with the micro-focused beam. Transmissivity and spectral responsivity versus beam energy were also measured, showing excellent performance of the new thin-film single-crystal diamond beam monitor.

New developments in the diagnostics for the fusion products on JET in preparation for ITER (invited)

Notwithstanding the advances of the past decades, significant developments are still needed to satisfactorily diagnose “burning plasmas.” D–T plasmas indeed require a series of additional measurements for the optimization and control of the configuration: the 14 MeV neutrons, the isotopic composition of the main plasma, the helium ash, and the redistribution and losses of the alpha particles. Moreover a burning plasma environment is in general much more hostile for diagnostics than purely deuterium plasmas. Therefore, in addition to the development and refinement of new measuring techniques, technological advances are also indispensable for the proper characterization of the next generation of devices. On JET an integrated program of diagnostic developments, for JET future and in preparation for ITER, has been pursued and many new results are now available. In the field of neutron detection, the neutron spectra are now routinely measured in the energy range of 1–18 MeV by a time of flight spectrometer and they have allowed studying the effects of rf heating on the fast ions. A new analysis method for the interpretation of the neutron cameras measurements has been refined and applied to the data of the last trace tritium campaign (TTE). With regard to technological upgrades, chemical vapor deposition diamond detectors have been qualified both as neutron counters and as neutron spectrometers, with a potential energy resolution of about one percent. The in situ calibration of the neutron diagnostics, in preparation for the operation with the ITER-like wall, is also promoting important technological developments. With regard to the fast particles, for the first time the temperature of the fast particle tails has been obtained with a new high purity Germanium detector measuring the gamma emission spectrum from the plasma. The effects of toroidal Alfven eigenmodes modes and various MHD instabilities on the confinement of the fast particles have been determined with a combination of gamma ray cameras, neutral particle analyzers, scintillator probe, and Faraday cups. From a more technological perspective, various neutron filters have been tested to allow measurement of the gamma ray emission also at high level of neutron yield.

Treatment of pediatric non-Hodgkin lymphomas in a country with limited resources: results of the first national protocol in Nicaragua

We report the results of a protocol for the diagnosis and treatment of pediatric non-Hodgkin lymphomas (NHL) conducted in Nicaragua in the context of an international collaborative program. Fifty-three children with NHL treated between 1996 and 2003 were retrospectively evaluated. Therapy was designed based on local drug availability and affordability with dose and schedule adaptations for Burkitt and lymphoblastic lymphomas. With a median follow-up of 3 years, the projected 9-year overall survival was 63% and event-free survival 53%. The treatment was efficacious, feasible, and well tolerated in spite of the local socio-economical conditions.

A prospective study of BK-virus-associated haemorrhagic cystitis in paediatric patients undergoing allogeneic haematopoietic stem cell transplantation

We investigated the incidence, risk factors and outcome of haemorrhagic cystitis (HC) in paediatric patients undergoing HSCT and the predictive value of BK viruria and viraemia for developing HC. Over a period of 54 months, 74 patients were recruited. The cumulative incidence of HC was 22%. Among 15 patients prospectively monitored for BK viruria and viraemia, four patients developed HC of grade > or =II. This group, which had two consecutive BK positive samples, showed a sensitivity of 100%, a specificity of 82%, a positive predictive value of 67%, and negative predictive value of 100% for developing HC. Analysed by a receiver-operator characteristic curve (ROC), a urine BK load >9 x 10(6) genomic copies/ml had a sensitivity of 95% and specificity of 90%; while a blood BK load >1 x 10(3) genomic copies/ml had a sensitivity of 40% and a specificity of 93% for HC, respectively. In univariate analysis, BK positivity was the only factor significantly associated with HC. After a median follow-up of 1.8 years, patients with HC showed a lower overall survival, 40 vs 65%, P 0.01, and a lower event-free survival, 42 vs 62%, P 0.03, compared to patients without HC. We conclude that BK detection in urine and/or plasma is a specific predictor for developing HC.