DIII-D physics research addresses critical challenges for the operation of ITER and the next generation of fusion energy devices. This is done through a focus on innovations to provide solutions for high performance long pulse operation, coupled with fundamental plasma physics understanding and model validation, to drive scenario development by integrating high performance core and boundary plasmas. Substantial increases in off-axis current drive efficiency from an innovative top launch system for EC power, and in pressure broadening for Alfven eigenmode control from a co-/counter- I p steerable off-axis neutral beam, all improve the prospects for optimization of future long pulse/steady state high performance tokamak operation. Fundamental studies into the modes that drive the evolution of the pedestal pressure profile and electron vs ion heat flux validate predictive models of pedestal recovery after ELMs. Understanding the physics mechanisms of ELM control and density pumpout by 3D magnetic perturbation fields leads to confident predictions for ITER and future devices. Validated modeling of high- Z shattered pellet injection for disruption mitigation, runaway electron dissipation, and techniques for disruption prediction and avoidance including machine learning, give confidence in handling disruptivity for future devices. For the non-nuclear phase of ITER, two actuators are identified to lower the L–H threshold power in hydrogen plasmas. With this physics understanding and suite of capabilities, a high poloidal beta optimized-core scenario with an internal transport barrier that projects nearly to Q = 10 in ITER at ∼ 8 MA was coupled to a detached divertor, and a near super H-mode optimized-pedestal scenario with co- I p beam injection was coupled to a radiative divertor. The hybrid core scenario was achieved directly, without the need for anomalous current diffusion, using off-axis current drive actuators. Also, a controller to assess proximity to stability limits and regulate β N in the ITER baseline scenario, based on plasma response to probing 3D fields, was demonstrated. Finally, innovative tokamak operation using a negative triangularity shape showed many attractive features for future pilot plant operation.

Purpose: To retrospectively assess immediate and 1-year success rate of type 2 endoleak (T2E) treatment with ethylene-vinyl-alcohol-polymer using three-dimensional (3D) image fusion guidance with cone beam computed tomography via trans-arterial embolization (TAE) or direct percutaneous sac injection (DPSI). Materials and methods: A total of 37 patients with T2E who were treated either using TAE (34/37; 92%) or DPSI (9/37; 8%) were included. There were 34 men and 3 women with a mean age of 86 +/- 9 (SD) years (range: 67-104 years). Mean aneurysm diameter was 67 +/- 14 (SD) mm (range: 42-101 mm) at pre-procedure evaluation. Immediate success was complete embolization of the sac and feeding artery. 1-year success was reduction or stability of the aneurysmal sac diameter based on pre-procedure and 12-month follow-up examinations. Safety (treatment-related complications), patient demographics, duration of procedure and contrast volume were reported. Results: Immediate and 1-year successful outcomes were reported in 94% (n=32) and 88% (n=28) of patients after TAE and 100% (n=9) and 89% (n = 8) after DPSI. T2E treatments were immediately successful for 95% of the procedures (41/43) and for 88% (36/41) at 1 year. Overall, T2E treatment was effective in 33 patients (89%). No major complications occurred. Mean procedure time and contrast volume were significantly different between the 2 techniques with respectively 87 +/- 16 (SD) min (range: 65-120 min) and 75 +/- 26 (SD) mL (range: 40-130 mL) for TAE and 32 +/- 10 (SD) min (range: 20-50 min) (P < 0.01) and 6 +/- 6 (SD) mL (range: 2-22 mL) (P < 0.01) for DPSI. Mean aneurysm diameter at 1-year was 68 +/- 7 (SD) mm (range: 43-101 mm). No significant differences in the pre-procedure sac diameter were found at long-term follow-up between patients without T2E and those with persistent T2E (P=0.1) in the successful embolization group (n = 33). Conclusion: TAE or DPSI treatments of T2E with ethylene-vinyl-alcohol-polymer using 3D-image fusion guidance were immediately successful for 95% of the procedures and remained effective for 88%. Longer follow-up is necessary to assess sac stability in the case of persistent endoleak. (C) 2020 Societe francaise de radiologie. Published by Elsevier Masson SAS. All rights reserved.

Hyperoxia exposure in premature infants increases the risk of subsequent lung diseases, such as asthma and bronchopulmonary dysplasia. Fibroblasts help maintain bronchial and alveolar integrity. Thus, understanding mechanisms by which hyperoxia influences fibroblasts is critical. Cellular senescence is increasingly recognized as important to the pathophysiology of multiple diseases. We hypothesized that clinically relevant moderate hyperoxia (<50% O2) induces senescence in developing fibroblasts. Using primary human fetal lung fibroblasts, we investigated effects of 40% O2 on senescence, endoplasmic reticulum (ER) stress, and autophagy pathways. Fibroblasts were exposed to 21% or 40% O2 for 7 days with etoposide as a positive control to induce senescence, evaluated by morphological changes, β-galactosidase activity, and DNA damage markers. Senescence-associated secretory phenotype (SASP) profile of inflammatory and profibrotic markers was further assessed. Hyperoxia decreased proliferation but increased cell size. SA-β-gal activity and DNA damage response, cell cycle arrest in G2/M phase, and marked upregulation of phosphorylated p53 and p21 were noted. Reduced autophagy was noted with hyperoxia. mRNA expression of proinflammatory and profibrotic factors (TNF-α, IL-1, IL-8, MMP3) was elevated by hyperoxia or etoposide. Hyperoxia increased several SASP factors (PAI-1, IL1-α, IL1-β, IL-6, LAP, TNF-α). The secretome of senescent fibroblasts promoted extracellular matrix formation by naïve fibroblasts. Overall, we demonstrate that moderate hyperoxia enhances senescence in primary human fetal lung fibroblasts with reduced autophagy but not enhanced ER stress. The resulting SASP is profibrotic and may contribute to abnormal repair in the lung following hyperoxia.

Cancer cell invasion is an important characteristic of malignant tumors. Cancer cells overcome the constraints of tight junctions (TJ) to invade other tissues, but less is known about the regulating role of tight junction on bladder cancer (BC) invasion. In order to identify the invasion-regulating function of tight junction component, we investigated the oncogenetic features of zonula occludens-1 associated nucleic acid binding protein (ZONAB), a TJ protein that is usually highly expressed in solid cancers. Expression of ZONAB was found to be up-regulated in human BC cell lines detected by real-time PCR, Western blotting. ZONAB expression was significantly up-regulated in BC cell lines and negatively regulated E-cadherin expression. Overexpression of ZONAB by stable transduction in human BC cell lines promoted invasion detected by transwell invasion assay. Conversely, stable suppression of ZONAB expression by RNA interference (RNAi) in BC cells attenuated invasion. A similar role for ZONAB in promoting invasion and EMT was observed in xenografts. In summary, ZONAB is up-regulated in BC cell lines, which promotes invasion, demonstrating the important role it plays in tumorogenesis and cancer progression.

Le lesioni occlusive dei tronchi sovraortici (TSA) prossimali sono dominate dalle lesioni ateromatose. Le forme diffuse sono piu rare, mentre la frequenza delle forme associate a lesioni delle biforcazioni carotidee aumenta. L’arteriografia diagnostica e sostituita dalla TC e dalla risonanza magnetica con contrasto. Le indicazioni della rivascolarizzazione chirurgica si sono ridotte nel corso dell’ultimo decennio, in particolare per i TSA prossimali, accessibili mediante sternotomia, in virtu del miglioramento dei risultati delle tecniche endoluminali, in particolare a causa del ricorso piu frequente allo stenting. Il confronto dei due metodi rimane difficile.

Following interventional radiology procedures, bleeding can occur in 0.5 to 4% of the cases. Risk factors are related to the patient, to the procedure, and to the end organ. Bleeding is treated usually by interventional radiologists and consists mainly of embolization. Bleeding complications are preventable: before the procedure by checking hemostasis, during the procedure by ensuring the accurate puncture site (with ultrasound or fluoroscopy guidance) or by treating the puncture path using gelatin sponge, curaspon(®), biological glue or thermocoagulation, and after the procedure by carefully monitoring the patients.

Les anévrismes des artères viscérales sont des pathologies rares dont la mortalité en cas de rupture est estimée entre 25 et 70 % dans la littérature. Leur traitement est principalement du ressort de la radiologie interventionnelle. Les techniques d’embolisation dépendent de la localisation, de l’organe atteint, de l’anatomie artérielle locorégionale et de l’expérience de l’opérateur. Le succès après traitement par radiologie interventionnelle est supérieur à 90 %. La principale complication est la reperméabilisation de l’anévrisme, d’où l’importance de la surveillance post-thérapeutique qui est réalisée au mieux par l’IRM.

Les saignements post-radiologie interventionnelle s’observent dans 0,5 à 4 % des cas. Les facteurs de risque sont liés au patient, au geste et à l’organe traité. Leur traitement peut souvent être réalisé par les équipes de radiologie interventionnelle, principalement par embolisation. Ces complications hémorragiques peuvent être prévenues : avant le geste, par vérification de l’hémostase, pendant le geste, en s’assurant d’une ponction au bon site (repérage échographique ou scopique) et/ou en traitant le trajet de ponction (curaspon, colle biologique, thermo-coagulation). Après le geste, il faut s’assurer d’une bonne surveillance du patient.

Visceral artery aneurysms are rare but their estimated mortality due to rupture ranges between 25 and 70%. Treatment of visceral artery aneurysm rupture is usually managed by interventional radiology. Specific embolization techniques depend on the location, affected organ, locoregional arterial anatomy, and interventional radiologist skill. The success rate following treatment by interventional radiology is greater than 90%. The main complication is recanalization of the aneurysm, showing the importance of post-therapeutic monitoring, which should preferably be performed using MR imaging.

Purpose. Conventional balloon angioplasty of anastomotic stenosis following bypass surgery is insufficient at mid- and long-term. However, short-term results with cutting balloon angioplasty (CBA) are satisfactory. The purpose of this Study is to determine the long-term results using this technique.Materials and methods. Between January 2002 and January 2006, all patients with anastomotic stenosis more than one month after bypass surgery, shorter than 2 cm and > 50%, were referred without randomisation to CBA.Results. A total of 19 patients with mean age of 63.5 years (55-82 years), 14 males and 5 females, were included. Twenty stenoses (femoral n = 15, popliteal n = 4 and calf n = 1) managed with CBA affected 17 infra-inguinal and 2 suprainguinal bypasses. One patient had anastomotic stenoses at both extremities. The rate of technical success aws 100%. Mean follow-up was 32 months (12-42). Three deaths Occurred during follow-up. One patient presented with restenosis at 3 months, successfully treated with repeat CBA. No thrombosis or infection was observed.Conclusion. The results with CBA appear persistent and compete favorably with results from surgical repair. A randomized trial Would be necessary to confirm these results.

PURPOSE:Conventional balloon angioplasty of anastomotic stenosis following bypass surgery is insufficient at mid- and long-term. However, short-term results with cutting balloon angioplasty (CBA) are satisfactory. The purpose of this study is to determine the long-term results using this technique. Materials and methods. Between January 2002 and January 2006, all patients with anastomotic stenosis more than one month after bypass surgery, shorter than 2 cm and>50%, were referred without randomisation to CBA.RESULTS:A total of 19 patients with mean age of 63.5 years (55-82 years), 14 males and 5 females, were included. Twenty stenoses (femoral n=15, popliteal n=4 and calf n=1) managed with CBA affected 17 infrainguinal and 2 suprainguinal bypasses. One patient had anastomotic stenoses at both extremities. The rate of technical success aws 100%. Mean follow-up was 32 months (12-42). Three deaths occurred during follow-up. One patient presented with restenosis at 3 months, successfully treated with repeat CBA. No thrombosis or infection was observed.CONCLUSION:The results with CBA appear persistent and compete favorably with results from surgical repair. A randomized trial would be necessary to confirm these results.

Connaître la gamme diagnostique des masses cardiaques. Savoir différencier un thrombus d'une tumeur intracardiaque. Connaître l'aspect IRM et TDM des lésions les plus fréquentes. Les thrombus intracardiaques sont les lésions les plus fréquemment rencontrée. Le myxome de l'oreillette gauche est la tumeur bénigne la plus fréquente. Les métastases cardiaques sont plus fréquentes que les tumeurs malignes primitives. La recherche d'une prise de contraste est un élément clé du diagnostic radiologique. La caractérisation d'une masse intracardiaque est une demande courante en imagerie de coupe. L'IRM est une technique pertinente pour étudier une masse cardiaque du fait de sa résolution en signal élevé. Elle permet notamment de rechercher des composants spécifiques dans la lésion (graisse), d'étudier sa mobilité avec des séquences ciné MR et d'analyser son rehaussement dynamique et tardif. Un thrombus est en général avasculaire (sauf exception). Le scanner offre un moins bon contraste tissulaire mais du fait de sa résolution spatiale élevée permet de mieux préciser les rapports anatomiques d'une lésion (coronaires, péricarde). Ces 2 examens peuvent donc s'avérer complémentaires.

L’histoire naturelle des anévrysmes de l’aorte abdominale sous-rénale (AAA) est marquée par une augmentation progressive de taille (environ 4 mm par an). Le risque de rupture dépend principalement du diamètre anévrysmal. Lorsque le diamètre est compris entre 5 et 5,9 cm, le risque de rupture est de 11% par an et il s’élève à plus de 25% au-delà de 6 cm (1). Ainsi, la rupture d’AAA est actuellement responsable de 1 à 2% des décès des hommes âgés de plus de 65 ans dans les pays industrialisés (2).

Bilan d’imagerie pré-thérapeutique. Intérêt et limites des différentes techniques d’explorations. Quand et comment revasculariser. Les résultats en terme de sauvetage de membre et de perméabilité. Lésions infra-inguinales et/ou jambières : angiographie diagnostique et thérapeutique. Le traitement endovasculaire est la première ligne thérapeutique. Actuellement la revascularisation est indiquée en cas d’ischémie stade III ou IV de Rutherford. Le traitement endovasculaire n’entrave pas une chirurgie en cas d’échec. Malgré les progrès techniques des TDM et des IRM, l’exploration des artères jambières (Below the Knee) reste actuellement le plus souvent du domaine de l’angiographie grâce à sa résolution spatiale. L’amélioration du matériel de navigation et de revascularisation fait que l’artériographie est devenue diagnostique et thérapeutique avec plusieurs outils (Stents, Cutting Balloon, cryoplastie…) de revascularisation disponibles. Les indications de revascularisation à cet étage sont actuellement réservées aux ischémies critiques. Les études montrent des résultats comparables entre la chirurgie et le traitement endovasculaire pour le taux de sauvetage de membre ; par contre la perméabilité est supérieure dans le groupe chirurgie mais avec un coût plus élevé. Il n’existe pas de recommandations actuellement venant des sociétés savantes pour cette pathologie. Notre préférence va au traitement endovasculaire en premier et en cas d’échec un traitement chirurgical est envisagé.

Cytokine imbalance and cellular migration to inflammatory sites are critical components of allergic diseases. Redirecting cytokine imbalance and inhibiting cell migration therefore represent important therapeutic strategies for the treatment of these disorders. We studied the in vitro effect of the non-sedating H1-receptor antagonists ebastine, carebastine, epinastine, cetirizine, and ketotifen on cytokine secretion by human T cells under various co-stimulatory conditions and the migratory activity of activated T cells as well as production of pro-inflammatory cytokines by macrophages. Ebastine and carebastine inhibited T cell proliferation and production of IL-4, IL-5, IL-6, and TNF-α by T cells under co-stimulation with CD28 plus CD3, CD26 plus CD3, and CD3 plus phorbol myristate acetate, whereas these drugs had no effect on the production of IL-2 and IFN-γ. Ebastine and carebastine also inhibited T cell migration and production of TNF-α and IL-6 by macrophages. Epinastine inhibited T cell proliferation and production of IL-2, IFN-γ, IL-4, and IL-5, whereas it elicited no effect on the production of IL-6 and TNF-α by T cells and macrophages as well as T cell migration. Cetirizine and ketotifen had no effects on cytokine production and T cell migration. Our results suggest that certain H1-receptor antagonists, most notably ebastine and carebastine, can influence T cell migration and cytokine production in addition to antagonizing the H1 receptor. These drugs therefore might be useful against T cell-mediated allergic inflammatory disorders such as asthma, atopic dermatitis, and psoriasis.

RATIONALE: Churg-Strauss syndrome (CSS) is a necrotizing systemic vasculitis which affects the small- to medium-sized blood vessels and is characterized by asthma, eosinophilia, and extravascular eosinophilic granuloma. Recently we experienced a case of CSS with colonic involvement. CASE REPORT: A 39-year-old female had developed abdominal discomfort and diarrhea 2 weeks ago. Also she had complained both knee joint pain and purpura on lower leg. 3 months ago, she experienced similar joint pain and skin lesion and improved with oral corticosteroids administration. She was diagnosed as bronchial asthma 1 year ago but had no medication. WBC was 15,590/mm3 with 47.9% eosinophil. CPA revealed bilateral pleural fluid. On PNS view, there was both maxillary & ethmoidal wall thickening. Pleural fluid analysis showed increase eosinophils. Echocardiography showed thickened interventricular septum and hypokinesia. There were multiple erosions in the sigmoid and transverse colon on colonoscopic examination. Biopsy revealed increased perivascular eosinophilic infiltration. After high dose corticosteroid (1 mg/kg) and cyclophosphamide administration. Her gastrointestinal, skin, and joint symptoms rapidly disappeared. Also blood eosinophil count decreased. CONCLUSIONS: We present a case CSS with colonic involvement. In case of gastrointestinal involvement like our patient, cyclophosphamide is indicated as a part of the first-line therapy because of poor prognosis. Congestive heart failure is also a major concern, so we may evaluate her cardiac function regular interval.