Crossover from gapped-to-gapless Dirac surface states in magnetic topological insulator MnBi2Te4

Intrinsic magnetic topological insulators (MTIs) host exotic topological phases such as quantized anomalous Hall insulating phase, arising due to the large magnetic exchange gap. However, the interplay of magnetism and topology in these systems in different temperature regimes remains elusive. In this work, we present the logarithmic temperature-dependence of conductivity for sub-100 nm thick exfoliated flakes of MTI MnBi2Te4in the presence of out-of-plane magnetic fields and extracted the linear slope,κ. We observed a characteristic change,Δκ∼-0.5in the low-temperature regime, indicating the gapped Dirac surface state according to Lu-Shen theory. We also report the recovery of topological properties in the system via the weak-antilocalization effect in the vicinity of antiferromagnetic to paramagnetic transition and in the paramagnetic regime. Hikami-Larkin-Nagaoka analysis suggested the presence of topological surface states. Therefore, our study helps in understanding how intrinsic magnetism masks topological properties in an MTI as long as magnetic ordering persists.

Correction: In situ laser irradiation: the kinetics of the changes in the nonlinear/linear optical parameters of As50Se40Sb10 thin films for photonic applications

[This corrects the article DOI: 10.1039/D1RA02368C.].

Correction: Influence of time dependent laser-irradiation for tuning the linear-nonlinear optical response of quaternary Ag10In15S15Se60 films for optoelectronic applications

[This corrects the article DOI: 10.1039/D2RA07981J.].

Annealing-induced phase transformation in In10Se70Te20 thin films and its structural, optical and morphological changes for optoelectronic applications

In2Se3 and In2Te3 have great importance in various device fabrications. The present report is based on the annealing-induced phase formation of both In2Se3 and In2Te3 from In10Se70Te20 thin films at different annealing temperatures as found from the XRD analysis and well supported by the Raman study. The average crystallite size increased with a decrease in the dislocation density. The surface morphology changed with annealing and increased in particle size as noticed from the FESEM images. The uniform distribution and presence of constituent elements in the film were verified using EDX data. The increase in transmittance is accompanied by a decrease in extinction coefficient, optical density and increase in skin depth with annealing. The increase in optical bandgap from 0.418 eV to 0.645 eV upon annealing at 250 °C is associated with a decrease in disorder. The steepness parameter increased and the Se-p value decreased with annealing. The refractive index decreased with an increase in oscillator energy and decrease in dispersion energy. The quality factor, dielectric loss, optical conductivity and electrical susceptibility decreased. The optical electronegativity and plasma frequency increased with annealing. There is a significant change in the non-linear susceptibility and non-linear refractive index with annealing. The observed changes in the film structure and optical behaviour are due to the annealing-induced phase formation from the In10Se70Te20 host matrix upon annealing. Such materials are suitable for optoelectronic and phase change devices.

Bulk-surface coupling in dual topological insulator Bi1Te1and Sb-doped Bi1Te1single crystals via electron-phonon interaction

Recently,Bi1Te1has been proved to be a dual topological insulator (TI), a new subclass of symmetry-protected topological phases, and predicted to be higher order topological insulator (HOTI). Being a dual TI (DTI), Bi₁Te₁is said to host quasi-1D surface states (SSs) due to weak TI phase and topological crystalline insulating SSs at the same time. On the other hand, HOTI supports topologically protected hinge states. So,Bi1Te1is a unique platform to study the electrical signature of topological SS (TSS) of fundamentally different origins. Though there is a report of magneto-transport measurements on large-scale Bi₁Te₁thin films, the Bi₁Te₁single crystal is not studied experimentally to date. Even the doping effect in a DTI Bi₁Te₁is missing in the literature. In this regard, we performed the perpendicular and parallel field magneto-transport measurement on the exfoliated microflake of Bi₁Te₁and Sb-doped Bi₁Te₁single crystals, grown by the modified Bridgmann method. Ourmetallicsample shows the weak anti-localization behavior analyzed by the multi-channel Hikami-Larkin-Nagaoka equation. We observed the presence of a pair of decoupled TSS. Further, we extracted the dephasing index (β) from temperature (T)-dependence of phase coherence length (Lϕ), following the power law equation (Lϕ∝T-β). The thickness-dependent value ofβindicates the transition in the dephasing mechanism from electron-electron to electron-phonon interaction with the increase in thickness, indicating the enhancement in the strength of bulk-surface coupling. Sb-doped system shows weakened bulk-surface coupling, hinted by the reduced dephasing indices.

Influence of time dependent laser-irradiation for tuning the linear-nonlinear optical response of quaternary Ag10In15S15Se60 films for optoelectronic applications

The impact of laser irradiation on thin films results in multiple beneficial modifications of their structural, morphological, nonlinear-linear properties for optoelectronics applications. This work deals with the thermally evaporated Ag10In15S15Se60 films and post-laser irradiation to study the variations in structural and optical properties. The current investigation was carried out for different laser irradiation time durations such as 0, 10, 20, 30, and 60 minutes by 532 nm laser (2.34 eV). According to the X-ray diffraction analysis, all thin films have polycrystalline character. The change in the surface morphology after being exposed to the laser has been checked by FESEM, whereas the presence of constitutional elements has been verified by the EDX study. The related changes with laser irradiation in the optical properties, including both linear and nonlinear, were studied using UV-Vis spectroscopy data. The irradiation caused an enhancement in the transmission, and the absorption edge moved towards a lower wavelength, increasing the bandgap energy from 1.71 eV to 1.88 eV. The refractive index reduced as a result of the film's altered structure. The behaviour of the refractive index satisfies Moss's rule (E g n 4 = const). The nonlinear refractive index, first-order and 3rd order nonlinear susceptibility, is found to be decreased with laser irradiation. The dielectric parameters are also observed to be decreased with irradiation. Considering all the alterations in its properties caused by irradiation, the Ag10In15S15Se60 sample could be a favourable material for various photonic devices.

Probing electron-phonon and phonon-phonon coupling in type-II Dirac semi-metal NiTe2via temperature-dependent Raman spectroscopy

We report the temperature-dependent structural characterization of type-II Dirac semimetal NiTe₂in the form of a bulk single crystal and a nanoflake (200 nm thick). Detailed x-ray diffraction study along with Rietveld refinement analysis reveals superior crystallinity and linear thermal expansion coefficient (α_T) of 5.56 × 10^-6and 22.5 × 10^-6K^-1along a or b and c lattice directions, respectively. Temperature evolution of Raman spectra shows non-linear variations in the phonon frequency and full-width half maxima of the out-of-plane A1gand in-plane E_gmodes. Raman mode E2g1, corresponding to an in-plane vibration, disappears on decreasing the thickness from bulk to nanoflake. Quantitative analysis with anharmonic model yields dominating electron-phonon interaction over phonon-phonon interaction mediated by three- and four-phonon processes.

The impact of fluence dependent proton ion irradiation on the structural and optical properties of Bi5In30Se65 thin films for nonlinear optical devices

The influence of 30 keV proton ion irradiation on the surface morphology, surface topography and optical properties of Bi5In30Se65 thin films.

Observation of high nonlinearity in Bi doped BixIn35-xSe65 thin films with annealing

The present work demonstrates the impact of thermal annealing on the structural, linear, and non-linear optical characteristics of thermally evaporated BixIn35-xSe65 (x = 0, 5, 10, 15 at%) thin films. The prominent crystalline phases have been developed for all annealed films at 450 °C whereas the films remain amorphous at 350 °C annealing. The XRD and Raman analysis showed the phase transformation of Bi-doped films and new Bi2Se3 phases developed upon annealing at 450 °C. The phase transformation induced change increased the linear and nonlinear properties with great extent as seen from the UV-visible optical studies. The direct and indirect optical bandgaps decreased with annealing temperature and also with Bi % content due to the formation of surface dangling bonds near the crystallite sites. The static linear refractive index and high-frequency dielectric constants were increased with annealing. The third-order non-linear susceptibility and non-linear refractive index were found to be greatly influenced by annealing temperature and increased with bismuth content. The FESEM micrographs also showed the phase transformation and EDX analysis showed the composition. The results obtained from the materials showed the potentiality to be useful for photovoltaic and optoelectronic applications.

Design and Development of 3D Brain MRI System Using Deep Neural Networks

A Brain tumor is otherwise known as intracranial tumor. It is a formation of abnormal cells within the brain. A tumor cells grows continuously in the brain and destroys the cells in that specific region causing brain damage. The main problem in the tumor detection is that some normal brain cells tend to behave as tumor cell which leads to misclassification or unwanted brain surgery. A great challenge for the researchers is to identify the region and appropriate tumor mass. Due to this main reason, automated classifications are acquired for the early detection of brain tumor. In this research work, two standard datasets were used to test the developed classification algorithms. In this study, four different deep learning models were utilized to identify the accurate fit model to classify the brain tumor. From the results, it was observed that googlenet has achieved maximum mean classification accuracy of 98.2%, sensitivity 98.67% and specificity 96.17%. Our proposed model can be used to classify the brain tumor more accurately and effectively.

Automatic Facial Emotional Valence Detection System Modelling Using Crafted Features and Deep Neural Network

This work provides a method that merges handcrafted and automatic feature extraction with deep convolutional neural network (D-CNN) and visualization bagging (VB) to acquire effectual and improved results from traditional facial expression recognition (FER) results. To acquire features, pre-trained model with D-CNN architecture is experimented with Dense and over sparse network. After extracting merged information, it is imposed over every featured image to protect structural information of all textured image. Therefore, dimensionality reduction of implicit feature extraction is done with maximal pooling approach. At last, deep CNN is used to recognize class label only for testing images that was trained and classified using soft-max classifier. To validate robustness for recognizing facial expression under complex setup, simulation was performed by merging available dataset with online dataset. Experimental results demonstrate that anticipated model can acquire recognition rate with training speed on training image is approximately two times faster than that of prevailing model. The anticipated model shows better trade off in comparison with prevailing models. Simulation is done with MATLAB simulation environment.

Sinecatechins ointment as a potential novel treatment for usual type vulval intraepithelial neoplasia: a single-centre double-blind randomised control study

OBJECTIVE

To compare the safety and efficacy of 10% sinecatechins (Veregen® ) ointment against placebo in the treatment of usual type vulvar intraepithelial neoplasia (uVIN).

DESIGN

A Phase II double-blind randomised control trial.

SETTING

A tertiary gynaecological oncology referral centre.

POPULATION

All women diagnosed with primary and recurrent uVIN.

METHODS

Eligible patients were randomised 1:1 to receive either sinecatechins or placebo ointment (applied three times daily for 16 weeks) and were followed up at 2, 4, 8, 16, 32 and 52 weeks.

MAIN OUTCOME MEASURES

The primary outcome measure, recorded at 16 and 32 weeks, was histological response (HR). Secondary outcome measures included clinical (CR) response, toxicity, quality of life and pain scores.

RESULTS

There was no observed difference in HR between the two arms. However, of the 26 patients who were randomised, all 13 patients who received sinecatechins showed either complete (n = 5) or partial (n = 8) CR, when best CR was evaluated. In placebo group, three patients had complete CR, two had partial CR, six had stable disease and two were lost to follow up. Patients in the sinecatechins group showed a statistically significant improvement in best observed CR as compared with the placebo group (P = 0.002). There was no difference in toxicity reported in either group.

CONCLUSION

Although we did not observe a difference in HR between the two treatment arms, we found that 10% sinecatechins application is safe and shows promise in inducing clinical resolution of uVIN lesions and symptom improvement, thus warranting further investigation in a larger multicentre study.

TWEETABLE ABSTRACT

A randomised control study indicating that sinecatechins ointment may be a novel treatment for uVIN.

In situ laser irradiation: the kinetics of the changes in the nonlinear/linear optical parameters of As50Se40Sb10 thin films for photonic applications

The photosensitivity of amorphous chalcogenide thin films brings out light-induced changes in the nonlinear and linear optical parameters upon sub-bandgap and bandgap laser irradiation. The present work reports the in situ laser irradiated changes in the optical properties of As50Se40Sb10 thin films. The thermally evaporated film showed an exponential decrease in optical bandgap and increase in Urbach energy. The decay rate of the bandgap was 6.24 min and growth rate of Urbach energy was 6.67 min respectively. The dynamics of photo-induced changes were observed from the changes in linear refractive index and its dependent parameters such as 3rd order nonlinear susceptibility, nonlinear refractive index, dispersion and dielectric parameters. The conversion of heteropolar to homopolar bonds induced the photodarkening mechanism that changed the dispersion parameters. The decrease in E d and E o reduced the oscillator strength along with the zero-frequency dielectric constant. The optical and electrical conductivity changed significantly with time. The changes were saturated with time which brings stability in the film properties that is useful for various optical applications. However, no structural and compositional changes upon laser irradiation were noticed from the X-ray diffraction and EDX studies respectively. The surface homogeneity was checked from the FESEM picture.

Role of annealing temperature on optimizing the linear and nonlinear optical properties of As40Se50Ge10 films

The present work shows the effect of annealing conditions on the linear and nonlinear optical properties of two-year-old thermally evaporated 800 nm As₄₀Se₅₀Ge₁₀ thin films. The aging effect in this film is clearly noticeable as compared with the old observation. The two-year-old films were annealed at different temperatures like 373, 413, 453 and 493 K for 1 h. The optical parameters were calculated from the optical transmittance and reflectance spectra measured at normal incidence of light by spectrometer in the 500-1000 nm range. The linear refractive index (n) and extinction coefficient (k) were decreased with annealing temperature. The observation reveals the increase in optical band gap with increase in annealing temperature while the width of the tail in the gap has an opposite behaviour. The oscillator energy, dispersion energy, dielectric constant, the loss factor, and optical conductivity were discussed in detail. The nonlinear refractive index and optical susceptibility were calculated by using Miller's formula which decreased with annealing temperature. The changes in both linear and nonlinear optical parameters with annealing temperature showed that annealing temperature can be considered as a useful factor for controlling the optical properties of As₄₀Se₅₀Ge₁₀ chalcogenide films which could be the candidate for numerous photonic applications. The structural study was done by X-ray diffraction and Raman spectroscopy.

Topological insulator n-p-n junctions in a magnetic field

Electrical transport in three dimensional topological insulators (TIs) occurs through spin-momentum locked topological surface states that enclose an insulating bulk. In the presence of a magnetic field, surface states get quantized into Landau levels giving rise to chiral edge states that are naturally spin-polarized due to spin momentum locking. It has been proposed that p-n junctions of TIs exposed to external magnetic fields can manifest unique spin dependent effects, apart from forming basic building blocks for highly functional spintronic devices. Here, for the first time we study electrostatically defined n-p-n junctions of dual-gated devices of the three dimensional topological insulator BiSbTe1.25Se1.75 in the presence of a strong magnetic field, revealing striking signatures of suppressed or enhanced electrical transport depending upon the chirality of quantum Hall edge states created at the n-p and p-n junction interfaces. Theoretical modeling combining the electrostatics of the dual gated TI n-p-n junction with the Landauer Buttiker formalism for transport through a network of chiral edge states explains our experimental data. Our work not only opens up a route towards exotic spintronic devices but also provides a test bed for investigating the unique signatures of quantum Hall effects in topological insulators.

Restoring Superconductivity in the Quantum Metal Phase of NbSe2 Using Dissipative Coupling

Localization arguments forbid the appearance of a metallic ground state in two dimensions. Yet, a large variety of disordered superconductors are known to manifest an anomalous metal phase in the zero temperature limit. While previous observations were confined to noncrystalline "dirty" superconductors, the recent observation of the so-called Bose metal phase in crystalline thin flakes of NbSe₂ has sparked off intense debate. While the exact nature of this phase remains unknown, it is thought that quantum fluctuations play a decisive role in Bose metal physics. In this work, we study the response of the anomalous metal phase in thin flakes of NbSe₂ to dissipative coupling. We evince a dramatic quenching of the Bose metal phase when dissipative coupling is strong, fully restoring a zero resistance superconducting state in the entire region of the magnetic field (H)-temperature (T) phase diagram where the Bose metal phase is otherwise observed. The suppression of the Bose metal phase by dissipative coupling is possible only in a quantum system where dissipation can directly affect system thermodynamics. Our observation of a dissipative phase transition in two-dimensional NbSe₂ firmly establishes the quantum nature of the anomalous metal phase in this class of "clean" superconductors.

Tuning the band gap of hybrid lead free defect perovskite nano crystals for solar cell applications

In recent reports, combinations of lead free organic inorganic halide perovskites have shown significant advances in solar cell devices.

Surgery for Blue Rubber Bleb Nevus Syndrome-a Case Report

Blue rubber bleb nevus syndrome (BRBNS) is a rare disease characterised by multiple venous malformations and haemangioma in the skin and visceral organs. The lesion often involves the cutaneous and gastrointestinal tract. Most common visceral organ affected is the GIT. Most predominant region involved in the GIT is small bowel. However, vascular lesions can occur anywhere from oral mucosa to anal canal. GIT bleed is relatively slow, resulting in minor, chronic and occult blood loss. The syndrome in the GIT may also present with severe complications such as rupture, volvulus, intussusceptions and even death. Cutaneous malformations are usually asymptomatic and do not require treatment. The treatment of GIT lesions is determined by the extent of intestinal involvement and severity of the disease. Most patients respond to supportive therapy such as iron supplementation and blood transfusion. Surgical resection, endoscopic sclerosis and laser photocoagulation have been proposed for more significant haemorrhage and severe complications. Here, we present a case of BRBNS in a 13-year-old girl involving the GIT especially the large bowel, presenting with the complaints of bleeding per rectum and iron deficiency anaemia. Initially, endoscopic sclerotherapy was performed, but to no response. Hence, proceeded with surgical resection.

Assessment of adulteration in raw herbal trade of important medicinal plants of India using DNA barcoding

A number of studies have shown that there could be widespread substitution and/or adulteration (hereafter referred to as substitution) in raw herbal trade of medicinal plants. Substitution could potentially endanger the health and safety of the consumers. In this study, the extent of adulteration in raw herbal trade of 30 important medicinal plants in South India was analyzed. Biological reference material (BRM) consisting of taxonomically authenticated samples of each of the 30 species along with 14 other co-occurring and congeneric allied species that are likely to be used in adulteration was established. DNA barcode signatures of 124 BRM using two candidate regions, nr-ITS and psbA-trnH were identified. A total of 203 herbal trade samples representing the 30 medicinal plant species were collected from 34 locations in South India. Using the DNA barcode sequences of the BRM as reference, the analysis indicated that the substitution ranged from 20 to 100%. Overall, approximately 12% of the market samples were adulterated. Considering the potential health hazard that such adulteration can cause, the need for a national regulatory framework that can authenticate and regulate raw herbal trade in the country is discussed.

Band Structure of Topological Insulator BiSbTe1.25Se1.75

We present our angle resolved photoelectron spectroscopy (ARPES) and density functional theory results on quaternary topological insulator (TI) BiSbTe_1.25Se_1.75 (BSTS) confirming the non-trivial topology of the surface state bands (SSBs) in this compound. We find that the SSBs, which are are sensitive to the atomic composition of the terminating surface have a partial 3D character. Our detailed study of the band bending (BB) effects shows that in BSTS the Dirac point (DP) shifts by more than two times compared to that in Bi₂Se₃ to reach the saturation. The stronger BB in BSTS could be due to the difference in screening of the surface charges. From momentum density curves (MDCs) of the ARPES data we obtained an energy dispersion relation showing the warping strength of the Fermi surface in BSTS to be intermediate between those found in Bi₂Se₃ and Bi₂Te₃ and also to be tunable by controlling the ratio of chalcogen/pnictogen atoms. Our experiments also reveal that the nature of the BB effects are highly sensitive to the exposure of the fresh surface to various gas species. These findings have important implications in the tuning of DP in TIs for technological applications.

Granular topological insulators

We demonstrate experimentally that a macroscopic topological insulator (TI) phase can emerge in a granular conductor composed of an assembly of tunnel coupled TI nanocrystals of dimension ∼10 nm × 10 nm × 2 nm. Electrical transport measurements on thin films of Bi₂Se₃ nanocrystals reveal the presence of decoupled top and bottom topological surface states that exhibit large surface state penetration depths (∼30 nm at 2 K). By tuning the size of the nanocrystals and the couplings between them, this new class of TIs may be readily tuned from a non-topological to a topological insulator phase, that too with designer properties. Paradoxically, this seemingly 'dirty' system displays properties that are closer to an ideal TI than most known single crystal systems, making granular/nanocrystalline TIs an attractive platform for future TI research.

Intermediate stages of surface state formation and collapse of topological protection to transport in Bi2Se3

Surface states consisting of helical Dirac fermions have been extensively studied in three-dimensional topological insulators. Yet, experiments to date have only investigated fully formed topological surface states (TSS) and it is not known whether preformed or partially formed surface states can exist or what properties they could potentially host. Here, by decorating thin films of Bi₂Se₃ with nanosized islands of the same material, we show for the first time that not only can surface states exist in various intermediate stages of formation but they exhibit unique properties not accessible in fully formed TSS. These include tunability of the Dirac cone mass, vertical migration of the surface state wave-function and the appearance of mid-gap Rashba-like states as exemplified by our theoretical model for decorated TIs. Our experiments show that an interplay of Rashba and Dirac fermions on the surface leads to an intriguing multi-channel weak anti-localization effect concomitant with an unprecedented tuning of the topological protection to transport. Our work offers a new route to engineer topological surface states involving Dirac-Rashba coupling by nano-scale decoration of TI thin films, at the same time shedding light on the real-space mechanism of surface state formation in general.

Sentinel lymph node status in vulval cancer: systematic reviews of test accuracy and decision-analytic model-based economic evaluation

BACKGROUND

Vulval cancer causes 3-5% of all gynaecological malignancies and requires surgical removal and inguinofemoral lymphadenectomy (IFL). Complications affect > 50% of patients, including groin wound infection, lymphoedema and cellulitis. A sentinel lymph node (SLN) is the first groin node with the highest probability of malignancy. SLN biopsy would be useful if it could accurately identify patients in whom cancer has spread to the groin, without removing all groin nodes. SLNs can be identified by isosulfan blue dye and/or technetium-99 ((99m)Tc) radioactive tracer during lymphoscintigraphy. The blue dye/(99m)Tc procedure only detects SLN, not metastases - this requires histological examination, which can include ultrastaging and staining with conventional haematoxylin and eosin (H&E) or immunohistochemistry.

OBJECTIVES

To determine the test accuracy and cost-effectiveness of the SLN biopsy with (99m)Tc and/or blue dye compared with IFL or clinical follow-up for test negatives in vulval cancer, through systematic reviews and economic evaluation.

DATA SOURCES

Standard medical databases, including MEDLINE, EMBASE, Science Citation Index and The Cochrane Library, medical search gateways, reference lists of review articles and included studies were searched to January 2011.

METHODS

For accuracy and effectiveness, standard methods were used and reported according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Searches were to January 2011, with no language restrictions. Meta-analyses were carried out with Meta-Disc version 1.4 (Javier Zamora, Madrid, Spain) for accuracy; none was appropriate for effectiveness. The economic evaluation from a NHS perspective used a decision-tree model in DATA TreeAge Pro Healthcare 2001 (TreeAge Software, Inc., Williamstown, MA, USA). Six options (blue dye with H&E, blue dye with ultrastaging, (99m)Tc with H&E, (99m)Tc with ultrastaging, blue dye/(99m)Tc with H&E, blue dye/(99m)Tc with ultrastaging) were compared with IFL. Deterministic and probabilistic sensitivity analyses were conducted.

RESULTS

For accuracy, of the 26 included studies, most evaluated (99m)Tc/blue dye combined. Four studies had clinical follow-up only for test negatives and five had clinical follow-up for all and IFL for test negatives. Numbers with no SLN found were difficult to distinguish from those with negative SLN biopsies. The largest group of 11 studies using (99m)Tc/blue dye, ultrastaging and immunohistochemistry had a pooled sensitivity of 95.6% [95% confidence interval (CI) 91.5% to 98.1%] and a specificity of 100% (95% CI 99.0% to 100%). Mean SLN detection rates were 94.6% for (99m)Tc, 68.7% for blue dye and 97.7% for both. One study measured global health status quality of life (QoL) and found no difference between SLN biopsy and IFL. One patient preference evaluation showed that 66% preferred IFL rather than a 5% false-negative rate from SLN biopsy. For effectiveness, of 14,038 references, one randomised controlled trial, three case-control studies and 13 case series were found. Approximately 50% died from vulval cancer and 50% from other causes during follow-ups. Recurrences were in the ratio of approximately 4 : 2 : 1 vulval, groin and distant, with more recurrences in node-positive patients. No studies reported QoL. For cost per death averted, IFL was less costly and more effective than strategies using SLN biopsy. For morbidity-free survival and long-term morbidity-free survival, (99m)Tc with ultrastaging was most cost-effective. Strategies with blue dye only and H&E only were never cost-effective. The incremental cost-effectiveness ratio for (99m)Tc with ultrastaging compared with IFL was £4300 per case of morbidity-free survival and £7100 per long-term morbidity-free survival.

LIMITATIONS

The main limitations of this study include the lack of good-quality evidence on accuracy, effectiveness and QoL. A large project such as this takes time to publish, so the most recent studies are not included.

CONCLUSIONS

A sensitive and specific combined metastatic SLN detection test and information on generic QoL in vulval cancer is urgently required.

FUNDING

The National Institute for Health Research Health Technology Assessment programme.

Sentinel lymph node biopsy in vulval cancer: systematic review and meta-analysis

BACKGROUND

The purpose of this study was to determine the accuracy of sentinel lymph node (SLN) biopsy with technetium 99 (99mTc) and/or blue dye-enhanced lymphoscintigraphy in vulval cancer.

METHODS

Sensitive searches of databases were performed upto October 2013. Studies with at least 75% of women with FIGO stage IB or II vulval cancer evaluating SLN biopsy with 99mTc, blue dye or both with reference standard of inguinofemoral lymphadenectomy (IFL) or clinical follow-up were included. Meta-analyses were performed using Meta-Disc version 1.4.

RESULTS

Of the 2950 references, 29 studies (1779 women) were included; most of them evaluated 99mTc combined with blue dye. Of these, 24 studies reported results for SLN followed by IFL, and 5 reported clinical follow-up only for SLN negatives. Pooling of all studies was inappropriate because of heterogeneity. Mean SLN detection rates were 94.0% for 99mTc, 68.7% for blue dye and 97.7% for both. SLN biopsy had pooled sensitivity of 95% (95% CI 92-98%) with negative predictive value (NPV) of 97.9% in studies using 99mTc/blue dye, ultrastaging and immunohistochemistry with IFL as reference. Pooled sensitivity for SLN with clinical follow-up for SLN-negatives was 91% (85-95%) with NPV 95.6%. Patients undergoing SLN biopsy experienced less morbidity than those undergoing IFL.

CONCLUSIONS

Sentinel lymph node biopsy using 99mTC, blue dye and ultrastaging with immunohistochemistry is highly accurate when restricted to carefully selected patients, within a rigorous protocol, with close follow-up and where sufficient numbers for learning curve optimisation exist. Patients must make an informed choice between the slightly higher groin recurrence rates of SLN biopsy vs the greater morbidity of IFL.

Anamolous course of right common carotid artery in a case of papillary carcinoma thyroid

Anamolous Course of Carotid Artery is one of the rarest of the rare anamoly, we describe one such case of anamolous Course of Right Common Carotid Artery.

Degradation studies of organic acids in commercially packed fruit juices: A reverse phase high performance liquid chromatographic approach

Organic acids are important constituents of fruit juices. They render tartness, flavour and specific taste to fruit juices. Shelf life and stability of fruit juices are important factors, which determine their nutritional quality and freshness. In this view, the effect of storage on the concentration of organic acids in commercially packed fruit juices is studied by reverse phase high performance liquid chromatography (RP-HPLC). Ten packed fruit juices from two different brands are stored at 30°C for 24, 48 and 72 hours. A reverse phase high performance liquid chromatographic method is used to determine the concentration of oxalic, tartaric, malic, ascorbic and citric acid in the fruit juices during storage. The chromatographic analysis of organic acids is carried out using mobile phase 0.5% (w/v) ammonium dihydrogen orthophosphate buffer (pH 2.8) on C18 column with UV-Vis detector. The results show that the concentration of organic acids generally decreases in juices under study with the increase in storage time. All the fruit juices belonging to tropicana brand underwent less organic acid degradation in comparison to juices of real brand. Orange fruit juice is found to be least stable among the juices under study, after the span of 72 hours. Amongst all the organic acids under investigation minimum stability is shown by ascorbic acid followed by malic and citric acid.

Congenital adrenal hyperplasia masquerading as periodic paralysis in an adolescent girl

Congenital adrenal hyperplasia is an uncommon diagnosis in routine clinical practice. 21-hydroxylase deficiency, which is its most common subtype, may be diagnosed at birth in a female infant by virilisation or by features of salt wasting in both genders. However, other uncommon subtypes of this condition such as 17-alpha-hydroxylase deficiency, 11-beta-hydroxylase deficiency may present much later in adolescence or adulthood. A high index of suspicion is necessary when evaluating children with hypertension, hypokalaemia, metabolic alkalosis or sexual infantilism.

Role of rigidity and temperature in the kinetics of photodarkening in Ge(x)As(45-x)Se55 thin films

We present insightful results on the kinetics of photodarkening (PD) in Ge(x)As(45-x)Se55 glasses at the ambient and liquid helium temperatures when the network rigidity is increased by varying x from 0 to 16. We observe a many fold change in PD and its kinetics with decreasing network flexibility and temperature. Moreover, temporal evolution of PD shows a dramatic change with increasing x.

Differential trends in the rising incidence of endometrial cancer by type: data from a UK population-based registry from 1994 to 2006

Background:

Endometrial cancer is the most common gynaecological cancer in the western world, the incidence increasing in the United Kingdom by over 40% since 1993. Two types of endometrial cancer exist – oestrogen-dependent type 1 with good prognosis and non-oestrogen-dependent type 2 with poor prognosis. The histopathological distribution of the increase in endometrial cancer is unknown. This study investigates the observed incidence trends of the two types, the age, stage, and socioeconomic distribution of this increase and survival outcome.

Methods:

Data were analysed from 6867 women with endometrial cancer registered between 1994 and 2006, at a UK population-based cancer registry.

Results:

Increased endometrial cancer incidence is confined to type 1 cancers with a significant increase in age standardised incidence rate (ASR) from 12.0 per 100 000 (confidence interval (CI) 10.7–13.2) in 1994 to 16.3 per 100 000 (CI 14.9–17.7), P<0.001 in 2006, while ASR of type 2 cancer changed from 2.5 per 100 000 (CI 2.0–3.1) in 1994 to 2.2 per 100 000 (CI 1.7–2.7) in 2006, which was not statistically significant P>0.05. Increase in type 1 cancer is most marked in age groups 60–69 years (P<0.001) and 70–79 years (P<0.001) and distributed equally among socioeconomic quintiles. While outcome for type 1 cancer has improved, 1-year survival in type 2 cancer is unchanged from 73.1% in 1994 to 74.3%, P=0.089 and 5-year survival decreased from 55.1% to 40.9%, P=0.001.

Conclusion:

Increased incidence in endometrial cancer is confined to type 1 cancers, seen most in the 60–79 age groups and across all socioeconomic quintiles. Survival in type 2 cancer has decreased significantly. Urgent research is needed to investigate prevention strategies in type 1 and improve therapy in type 2 cancers.

Carboplatin, ifosfamide, and mesna (CIM) for the treatment of gynecological carcinosarcoma

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Background: A GOG trial comparing cisplatin/ifosfamide/mesna chemotherapy versus whole abdominal irradiation for FIGO stages I-IV carcinosarcoma (CS) showed an estimated median survival (MS) of 50 months for chemotherapy but high toxicity. This study investigates the efficacy and tolerability of a novel regimen using carboplatin AUC 5, ifosfamide 3 g/m2 and mesna 1 g/m2 (CIM) in both the adjuvant and metastatic setting. Methods: Retrospective analysis of women with CS treated from May 1997-May 2007 with CIM (group 1) versus other chemotherapy regimens (group 2). Toxicity was graded according to the Common Toxicity Criteria and MS estimated using the Kaplan-Meier method. Results: Of 51 eligible women (median age 71 years) 35 (69%) had stage 3 or 4 disease. 35/51 (69%) received chemotherapy; 2 with stage 1c disease received pelvic radiotherapy (pRT) alone whilst the remaining 14 were unfit for any treatment. Median follow-up for the treated patients is 45 months. 11/35 patients (31%) received CIM as first-line chemotherapy. Other regimens included: carboplatin (n = 14); carboplatin/paclitaxel (n = 3); carboplatin/epirubicin (n = 3); carboplatin/doxorubicin (n = 2); doxorubicin/ifosfamide (n = 1); cisplatin/ifosfamide (n = 1). 20/35 (57%) received adjuvant chemotherapy (AC) of which 8 received CIM; 11/20 patients also received adjuvant pRT. MS in the CIM AC group is 54.7 months compared to 37.4 months for other regimens. 3/8 patients (37.5%) in the CIM arm developed recurrent disease compared to 9/12 (75%) for other regimens. 4/16 patients received CIM as first- or second-line palliative chemotherapy. All patients responded of whom 2 achieved clinical and radiological complete response (CR). One woman subsequently relapsed and achieved a second CR with CIM. MS for all chemotherapy-treated patients is 54.7 months (group 1) versus 20.6 months (group 2) (p = 0.07). No patients in group 1 experienced any grade 3/4 toxicity and all patients completed the prescribed treatment. There were 2 unexpected treatment-related deaths in group 2, one of whom received carboplatin/paclitaxel and the other carboplatin/epirubicin. Conclusions: CIM appears to be efficacious and well tolerated in the treatment of CS and merits further investigation in clinical trials.

No significant financial relationships to disclose.

Diffusely Infiltrating Endometrial Carcinomas With No Stromal Response: Report of a Series, Including Cases With Cervical and Ovarian Involvement and Emphasis on the Potential for Misdiagnosis

Endometrial carcinomas, particularly of endometrioid type, can invade the myometrium or cervix without eliciting a stromal desmoplastic or inflammatory response and have been referred to as diffusely infiltrating endometrial carcinomas. This study describes a series of 14 endometrial carcinomas infiltrating as single “naked” glands without a stromal response. The neoplasms consisted of 12 endometrioid carcinomas, 1 mixed endometrioid and clear cell carcinoma, and 1 serous carcinoma. In all cases, there was myometrial invasion without stromal response. Seven cases exhibited cervical stromal involvement and in 2 there was involvement of both ovaries in a similar pattern. Several of the cases were seen in consultation and the pattern of infiltration raised a number of differential diagnoses, both benign and malignant, depending on the site of tumor involvement, including adenomyosis, adenomyoma, primary endocervical glandular lesions, cervical mesonephric remnants, endometriosis or tuboendometrioid metaplasia, and ovarian cortical inclusion cysts. Although this pattern of invasion has been reported previously, it continues to present diagnostic difficulties.