The saturated state of turbulence driven by the ion-temperature-gradient instability is investigated using a two-dimensional long-wavelength fluid model that describes the perturbed electrostatic potential and perturbed ion temperature in a magnetic field with constant curvature (a $Z$ -pinch) and an equilibrium temperature gradient. Numerical simulations reveal a well-defined transition between a finite-amplitude saturated state dominated by strong zonal-flow and zonal temperature perturbations, and a blow-up state that fails to saturate on a box-independent scale. We argue that this transition is equivalent to the Dimits transition from a low-transport to a high-transport state seen in gyrokinetic numerical simulations (Dimits et al., Phys. Plasmas, vol. 7, 2000, 969). A quasi-static staircase-like structure of the temperature gradient intertwined with zonal flows, which have patch-wise constant shear, emerges near the Dimits threshold. The turbulent heat flux in the low-collisionality near-marginal state is dominated by turbulent bursts, triggered by coherent long-lived structures closely resembling those found in gyrokinetic simulations with imposed equilibrium flow shear (van Wyk et al., J. Plasma Phys., vol. 82, 2016, 905820609). The breakup of the low-transport Dimits regime is linked to a competition between the two different sources of poloidal momentum in the system – the Reynolds stress and the advection of the diamagnetic flow by the $\boldsymbol {E}\times \boldsymbol {B}$ flow. By analysing the linear ion-temperature-gradient modes, we obtain a semi-analytic model for the Dimits threshold at large collisionality.

Local linear gyrokinetic simulations show that electron temperature gradient (ETG) instabilities are the fastest growing modes for k y ρ i ≳ 0.1 in the steep gradient region for a JET pedestal discharge (92174) where the electron temperature gradient is steeper than the ion temperature gradient. Here, k y is the wavenumber in the direction perpendicular to both the magnetic field and the radial direction, and ρ i is the ion gyroradius. At k y ρ i ≳ 1, the fastest growing mode is often a novel type of toroidal ETG instability. This toroidal ETG mode is driven at scales as large as k y ρ i ∼ (ρ i /ρ e )L Te /R 0 ∼ 1 and at a sufficiently large radial wavenumber that electron finite Larmor radius effects become important; that is, K x ρ e ∼ 1, where K x is the effective radial wavenumber. Here, ρ e is the electron gyroradius, R 0 is the major radius of the last closed flux surface, and 1/L Te is an inverse length proportional to the logarithmic gradient of the equilibrium electron temperature. The fastest growing toroidal ETG modes are often driven far away from the outboard midplane. In this equilibrium, ion temperature gradient instability is subdominant at all scales and kinetic ballooning modes are shown to be suppressed by E × B shear. ETG modes are very resilient to E × B shear. Heuristic quasilinear arguments suggest that the novel toroidal ETG instability is important for transport.

Electromagnetic (EM) instabilities and turbulence driven by the electron-temperature gradient (ETG) are considered in a local slab model of a tokamak-like plasma. Derived in a low-beta asymptotic limit of gyrokinetics, the model describes perturbations at scales both larger and smaller than the electron inertial length $d_e$ , but below the ion Larmor scale $\rho _i$ , capturing both electrostatic and EM regimes of turbulence. The well-known electrostatic instabilities – slab and curvature-mediated ETG – are recovered, and a new instability is found in the EM regime, called the thermo-Alfvénic instability (TAI). It exists in both a slab version (sTAI, destabilising kinetic Alfvén waves) and a curvature-mediated version (cTAI), which is a cousin of the (electron-scale) kinetic ballooning mode. The cTAI turns out to be dominant at the largest scales covered by the model (greater than $d_e$ but smaller than $\rho _i$ ), its physical mechanism hinging on the fast equalisation of the total temperature along perturbed magnetic field lines (in contrast to kinetic ballooning mode, which is pressure balanced). A turbulent cascade theory is then constructed, with two energy-injection scales: $d_e$ , where the drivers are slab ETG and sTAI, and a larger (parallel system size dependent) scale, where the driver is cTAI. The latter dominates the turbulent transport if the temperature gradient is greater than a certain critical value, which scales inversely with the electron beta. The resulting heat flux scales more steeply with the temperature gradient than that due to electrostatic ETG turbulence, giving rise to stiffer transport. This can be viewed as a physical argument in favour of near-marginal steady-state in electron-transport-controlled plasmas (e.g. the pedestal). While the model is simplistic, the new physics that is revealed by it should be of interest to those attempting to model the effect of EM turbulence in tokamak-relevant configurations with high beta and large ETGs.

We extend our previous work on the two-dimensional (2-D) Dimits transition in ion-scale turbulence (Ivanov et al., J. Plasma Phys., vol. 86, 2020, 855860502) to include variations along the magnetic field. We consider a three-field fluid model for the perturbations of electrostatic potential, ion temperature, and ion parallel flow in a constant-magnetic-curvature geometry without magnetic shear. It is derived in the cold-ion, long-wavelength asymptotic limit of the gyrokinetic theory. Just as in the 2-D model, a low-transport (Dimits) regime exists and is found to be dominated by a quasistatic staircase-like arrangement of strong zonal flows and zonal temperature. This zonal staircase is formed and maintained by a negative turbulent viscosity for the zonal flows. Unlike the 2-D model, the three-dimensional (3-D) one does not suffer from an unphysical blow up beyond the Dimits threshold where the staircase becomes nonlinearly unstable. Instead, a well-defined finite-amplitude saturated state is established. This qualitative difference between the 2-D and 3-D models is due to the appearance of small-scale ‘parasitic’ modes that exist only if we allow perturbations to vary along the magnetic field lines. These modes extract energy from the large-scale perturbations and provide an effective enhancement of large-scale thermal diffusion, thus aiding the energy transfer from large injection scales to small dissipative ones. We show that in our model, the parasitic modes always favour a zonal-flow-dominated state. In fact, a Dimits state with a zonal staircase is achieved regardless of the strength of the linear drive, provided the system is sufficiently extended along the magnetic field and sufficient parallel resolution is provided.

The equations of electrostatic drift kinetics are observed to possess a symmetry associated with their intrinsic scale invariance. Under the assumptions of spatial periodicity, stationarity, and locality, this symmetry implies a particular scaling of the turbulent heat flux with the system's parallel size, from which its scaling with the equilibrium temperature gradient can be deduced under some additional assumptions. This macroscopic transport prediction is then confirmed numerically for a reduced model of electron-temperature-gradient-driven turbulence in slab geometry. The system realises this scaling through a turbulent cascade from large to small perpendicular spatial scales. The route of this cascade through wavenumber space (i.e. the relationship between parallel and perpendicular scales in the inertial range) is shown to be determined by a balance between nonlinear-decorrelation and parallel-dissipation timescales. This type of ‘critically balanced’ cascade, which maintains a constant energy flux despite the presence of parallel dissipation throughout the inertial range (as well as order-unity dissipative losses at the outer scale) is expected to be a generic feature of plasma turbulence. The outer scale of the turbulence, on which the turbulent heat flux depends, is determined by the breaking of drift-kinetic scale invariance due to the existence of large-scale parallel inhomogeneity (the parallel system size).

Background: Rectal cancer located in distal third still remains a technical challenge for surgeons. Transanal total mesorectal excision with laparoscopic assistance is quite new surgical approach for rectal cancer treatment that seems to solve some of the associated technical issues. The aim of the study was to present our experience in laparoscopy-assisted transanal total mesorectal excision. Materials and methods: After obtaining approval from the local Ethics Committee, a single centre prospective double-arm comparative non-randomized trial was initiated. With recruiting still in progress at present, between 27.02.2017 and 01.10.2017 four laparoscopy-assisted transanal total mesorectal excision procedures and two laparoscopic total mesorectal excisions were performed in the department of Endoscopic Endocrine Surgery and Coloproctolgy at the Military Medical Academy in Sofia. Results: There is no conversion in both groups. No postoperative mortality 30 days after surgery. The quality of total mesorectal excision was satisfactory in all patients estimated by the Quirque classification. There was no distal or proximal tumor involvement of surgical margins. In one of the cases, we reported positive circumferential resection margin. We had two cases with postoperative morbidity. Conclusion: Transanal total mesorectal excision with laparoscopic assistance is quite new minimally invasive surgical approach for rectal cancer treatment. Avoiding the procedure-related complications during the learning curve is essential before applying the method to every patient. Multicenter randomized control trial is needed so that we could answer the questions raised in this study.

We extend our previous work on the 2D Dimits transition in ion-scale turbulence (Ivanov et al. 2020) to include variations along the magnetic field. We consider a three-field fluid model for the perturbations of electrostatic potential, ion temperature, and ion parallel flow in a constant-magnetic-curvature geometry without magnetic shear. It is derived in the cold-ion, long-wavelength asymptotic limit of the gyrokinetic theory. Just as in the 2D model, a low-transport (Dimits) regime exists and is found to be dominated by a quasi-static staircase-like arrangement of strong zonal flows and zonal temperature. This zonal staircase is formed and maintained by a negative turbulent viscosity for the zonal flows. Unlike the 2D model, the 3D one does not suffer from an unphysical blow up beyond the Dimits threshold where the staircase becomes nonlinearly unstable. Instead, a well-defined finite-amplitude saturated state is established. This qualitative difference between 2D and 3D is due to the appearance of small-scale 'parasitic' modes that exist only if we allow perturbations to vary along the magnetic field lines. These modes extract energy from the large-scale perturbations and provide an effective enhancement of largescale thermal diffusion, thus aiding the energy transfer from large injection scales to small dissipative ones. We show that in our model, the parasitic modes always favour a zonal-flow-dominated state. In fact, a Dimits state with a zonal staircase is achieved regardless of the strength of the linear drive provided the system is sufficiently extended along the magnetic field and sufficient parallel resolution is provided.

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