Clinical Presentation, Risk Factors, and Comparison of Laboratory Diagnostics for Seasonal Influenza Virus Among Cambodians From 2007 to 2020

Background

Despite its global significance, challenges associated with understanding the epidemiology and accurately detecting, measuring, and characterizing the true burden of seasonal influenza remain in many resource-poor settings.

Methods

A prospective observational study was conducted in Cambodia at 28 health facilities between 2007 and 2020 utilizing passive surveillance data of patients presenting with acute undifferentiated febrile illness (AUFI) to describe the prevalence of influenza A and B and characterize associated risk factors and symptoms using a questionnaire. A comparison of rapid influenza diagnostic tests (RIDTs) and real-time reverse transcription polymerase chain reaction (rRT-PCR) results was also conducted.

Results

Of 30 586 total participants, 5634 (18.4%) tested positive for either influenza A or B, with 3557 (11.6%) positive for influenza A and 2288 (7.5%) positive for influenza B during the study. Influenza A and B were strongly associated with the rainy season (odds ratio [OR], 2.30; P < .001) and being from an urban area (OR, 1.45; P < .001). Analysis of individual symptoms identified cough (OR, 2.8; P < .001), chills (OR, 1.4; P < .001), and sore throat (OR, 1.4; P < .001) as having the strongest positive associations with influenza among patients with AUFI. Analysis comparing RIDTs and rRT-PCR calculated the overall sensitivity of rapid tests to be 0.492 (95% CI, 0.479-0.505) and specificity to be 0.993 (95% CI, 0.992-0.994) for both influenza type A and B.

Conclusions

Findings from this 14-year study include describing the epidemiology of seasonal influenza over a prolonged time period and identifying key risk factors and clinical symptoms associated with infection; we also demonstrate the poor sensitivity of RIDTs in Cambodia.

Etiology and risk factors for diarrheal disease amongst rural and peri-urban populations in Cambodia, 2012-2018

Diarrheal diseases are a leading cause of mortality and morbidity, disproportionally affecting persons residing in low and middle-income countries. Accessing high-resolution surveillance data to understand community-level etiology and risk remains challenging, particularly in remote and resource limited populations. A multi-year prospective cohort study was conducted in two rural and two peri-urban villages in Cambodia from 2012 to 2018 to describe the epidemiology and etiology of acute diarrheal diseases within the population. Suspected diarrheal episodes among participants were self-reported or detected via routine weekly household visits. Fresh stool and fecal swabs were tested, and acute-illness and follow-up participant questionnaires collected. Of 5027 enrolled participants, 1450 (28.8%) reported at least one diarrheal incident. A total of 4266 individual diarrhea case events were recorded. Diarrhea incidence rate was calculated to be 281.5 persons per 1000 population per year, with an event rate of 664.3 individual diarrhea events occurring per 1000 population per year. Pathogenic Escherichia coli, Aeromonas spp., and Plesiomonas shigelloides were the most prevalent bacterial infections identified. Hookworm and Strongyloides stercoralis were the predominant helminth species, while Blastocystis hominis and Giardia lamblia were the predominant protozoan species found. Norovirus genotype 2 was the predominant virus identified. Mixed infections of two or more pathogens were detected in 36.2% of positive cases. Risk analyses identified unemployed status increased diarrhea risk by 63% (HR = 1.63 [95% CI 1.46, 1.83]). Individuals without access to protected water sources or sanitation facilities were 59% (HR = 1.59 [95% CI 1.49, 1.69]) and 19% (HR = 1.19 [95% CI 1.12, 1.28]) greater risk of contracting diarrhea, respectively. Patient-level surveillance data captured in this long-term study has generated a unique spatiotemporal profile of diarrheal disease in Cambodia. Understanding etiologies, together with associated epidemiological and community-level risk, provides valuable public health insight to support effective planning and delivery of appropriate local population-targeted interventions.

Invasive pseudomembranous upper airway and tracheal Aspergillosis refractory to systemic antifungal therapy and serial surgical debridement in an Immunocompetent patient

BACKGROUND

The development of respiratory infections secondary to Aspergillus spp. spores found ubiquitously in the ambient environment is uncommon in immunocompetent patients. Previous reports of invasive upper airway aspergillosis in immunocompetent patients have generally demonstrated the efficacy of treatment regimens utilizing antifungal agents in combination with periodic endoscopic debridement, with symptoms typically resolving within months of initiating therapy.

CASE PRESENTATION

A 43-year-old previously healthy female presented with worsening respiratory symptoms after failing to respond to long-term antibiotic treatment of bacterial sinusitis. Biopsy of her nasopharynx and trachea revealed extensive fungal infiltration and Aspergillus fumigatus was isolated on tissue culture. Several months of oral voriconazole monotherapy failed to resolve her symptoms and she underwent mechanical debridement for symptom control. Following transient improvement, her symptoms subsequently returned and failed to fully resolve in spite of increased voriconazole dosing and multiple additional tissue debridements over the course of many years.

CONCLUSIONS

Invasive upper airway aspergillosis is exceedingly uncommon in immunocompetent patients. In the rare instances that such infections do occur, combinatorial voriconazole and endoscopic debridement is typically an efficacious treatment approach. However, some patients may continue to experience refractory symptoms. In such cases, continued aggressive treatment may potentially slow disease progression even if complete disease resolution cannot be achieved.

Primary yolk sac tumour of the prostate mimicking small round blue cell tumour

Prostatic yolk sac tumour is a germ cell tumour with a wide range of age of occurrence, unusual anatomic locations, diverse morphologic patterns, and aggressive biologic behavior, posing challenges both to diagnosis and clinical management. We report a rare case of primary yolk sac tumour of the prostate with extensive local and liver metastasis, the latter of which exhibited sheets of small blue cells expressing CD99 and focal sall4 on biopsy. Positivity for CD99 and gata3 in the initial biopsy raised the differential diagnosis of Ewing sarcoma and poorly differentiated carcinoma. The primary tumour demonstrated an admixture of solid and glandular growth patterns and occasional Schiller-Duval bodies. A panel of immunohistochemical stains showing positivity for AE1/3, sall4, cdx2, and focal alpha-fetoprotein, and negativity for oct-4, facilitated the diagnosis. A thorough review of the literature and our current report indicate that a large tumour load, incomplete tumour resection, limited response to preoperative neoadjuvant chemotherapy, and late stage of the disease are predictive factors for a poor clinical outcome.

Combined Sclerosing and Spindle Cell Rhabdomyosarcoma in Previous Craniotomy Site: A Case Report and a Review of the Literature

Sclerosing rhabdomyosarcoma (RMS) is a rare subtype of RMS with unique prominent stromal hyalinization and a pseudovascular architecture. It overlaps morphologically with spindle cell RMS and poses both diagnostic and therapeutic challenges because of its rarity and aggressive clinical course. In this article, we report a case of sclerosing RMS arising from a prior craniotomy site, which demonstrated both sclerosing and spindle cell components. A literature review of RMS with sclerosing morphology identified 122 cases. Our review documents the following: sclerosing RMS occurs in both childhood and adult populations, has a predilection for the head and neck areas, and has a worse prognosis in adults. Sclerosing RMS harbors a high frequency of MYOD1 mutations, conferring a poor clinical outcome. Sclerosing RMS and spindle RMS likely represent a morphologic spectrum of one entity.

Leiomyosarcoma of the head and neck: A 17-year single institution experience and review of the National Cancer Data Base

BACKGROUND

Leiomyosarcoma is a rare neoplasm of the head and neck. The purpose of this study was to present our single-institution case series of head and neck leiomyosarcoma and a review of cases in the National Cancer Data Base (NCDB).

METHODS

Patients with head and neck leiomyosarcoma at the University of Pennsylvania and in the NCDB were identified. Demographic characteristics, tumor factors, treatment paradigms, and outcomes were evaluated for prognostic significance.

RESULTS

Nine patients with head and neck leiomyosarcoma from the institution were identified; a majority had high-grade disease and cutaneous leiomyosarcoma, with a 5-year survival rate of 50%. Two hundred fifty-nine patients with leiomyosarcoma were found in the NCDB; macroscopic positive margins and high-grade disease were associated with poor prognosis (P < .01), and positive surgical margins were related to adjuvant radiation (P < .001).

CONCLUSION

Head and neck leiomyosarcoma presents at a high grade and is preferentially treated with surgery. Several demographic and tumor-specific factors are associated with outcomes and prognosis.

Metastatic Alveolar Soft Part Sarcoma of the Spinal Cord: A Case Report and Review of Literature

BACKGROUND

Alveolar soft part sarcoma (ASPS) is a rare, malignant soft-tissue neoplasm typically seen in young adults that possesses an unusual tendency to metastasize. Metastases to the intramedullary compartment of the spinal cord, however, are exceptionally rare and have not been described in the literature.

CASE DESCRIPTION

We report the case of a 23-year-old woman with disseminated ASPS to the lung and brain who presented with progressive lower-extremity weakness and loss of sensation after radiation and chemotherapy. Magnetic resonance imaging revealed a 1.3-cm avidly enhancing lesion within the central thoracic spinal cord at T3. A T2-T4 laminectomy was undertaken and resulted in a gross total resection. Histopathologically, the mass was composed of organoid nests containing epithelioid cells with eosinophilic, granular cytoplasm separated by sinusoidal spaces. Immunohistochemistry demonstrated convincing positive TFE3 staining. Postoperative imaging confirmed the complete resection of the mass, and her examination was notable for intact sensation and impaired motor function that gradually improved.

CONCLUSIONS

A review of the literature found that the reported case represents the first instance of primary or metastatic ASPS in the spinal cord. Metastatic ASPS should thus be included in the differential diagnosis in patients with known disease and neurologic impairment or back pain. Imaging of the spine should then be considered.

Malignant round cell tumor of bone with EWSR1-NFATC2 gene fusion

Gene rearrangements involving the Ewing sarcoma breakpoint region 1 (EWSR1) gene are seen in a broad range of sarcomas and some nonmesenchymal neoplasms. Ewing sarcoma is molecularly defined by a fusion of the EWSR1 gene (or rarely the related FUS gene) to a member of the E26 transformation-specific (ETS) family of transcription factors, frequently the EWSR1-FLI1 fusion. More recently, EWSR1 gene fusion to non-ETS family members, including the nuclear factor of activated T cells, cytoplasmic, calcineurin-dependent 2 (NFATC2) gene, has been reported in a histological variant of Ewing sarcoma. Here, we report a malignant round cell tumor of bone with an EWSR1-NFATC2 fusion gene. This report builds upon the unusual morphological and clinical presentation of bone neoplasms containing an EWSR1-NFATC2 fusion gene.

Ossifying fibromyxoid tumor metastatic to the thyroid: a case report and review of the literature

Ossifying fibromyxoid tumors are rare soft-tissue neoplasms, usually with an indolent course. However, atypical/malignant variants have been described, showing either local recurrence after complete excision or metastasis to the lungs, mediastinum, adrenals, or soft tissue. We report the case of an ossifying fibromyxoid tumor of the left ankle that metastasized to the lung and thyroid gland 12 years after the initial diagnosis and surgical treatment. To our knowledge, this is the first reported case of this neoplasm metastasizing to the thyroid gland.

Utility of ProExC and IMP3 immunocytochemical staining in atypical glandular cells of undetermined significance in liquid-based cervical cytology

The diagnosis of atypical glandular cells of undetermined significance (AGUS) in liquid-based cervical cytology specimens shows significant underlying pathology in only 30% of cases, while the remaining cases are found to be benign (reactive, reparative/metaplastic). Previous studies have reported positive ProExC and IMP3 staining in neoplastic glandular lesions of the uterine cervix and corpus. We present our experience with the utility of these markers in the evaluation of AGUS cases in liquid-based cervical cytology. The case cohort included 34 cases diagnosed as AGUS. ProExC and IMP3 immunocytochemical (ICC) stains were performed on ThinPrep® slides and the results correlated with subsequent biopsy findings. Positive expression was classified as strong diffuse nuclear immunostaining for ProExC and granular cytoplasmic for IMP3. The presence of AGUS cells on the ICC stained slides was confirmed in all cases. IMP3 was positive in 80% of glandular neoplasms and negative in 93% non-glandular lesions/cases negative for squamous intraepithelial lesion (SIL). ProExC was positive in 60% of glandular neoplasms and negative in 83% non-glandular lesions/cases negative for SIL. When used as a panel (ProExC + IMP3), at least one stain was positive in 100% of glandular neoplasm cases and they were both negative in 83% of non-glandular lesions/cases negative for SIL. Based on this study, both ProExC and IMP3, when used as an immuno panel, can predict the presence of glandular lesions on subsequent biopsies and can serve as an aid in the diagnosis and management of AGUS cases.

The angular magnetothermoelectric power of a charge density wave system

The angular dependence of the magnetothermopower of a charge transfer organic salt α-(ET)(2)KHg(SCN)(4) below (4 K) and above (9 K) the phase transition temperature, T(p) = 8 K, and under fields of 15 T and 25 T, below and above the 'kinkfield', has been studied. We find that for a longitudinal thermoelectric measurement both an interlayer thermopower (the Seebeck effect), S(zz), and a transverse thermopower (the Nernst effect), S(yz), exist in all three different B-T phases (the CDW (0), CDW (x) and metallic states) with large amplitude. Both thermoelectric effects display a resonant-like behavior without a sign reversal at the angles corresponding to angular magnetoresistance oscillation minima and maxima in this compound. The resonant behavior is most evident in the CDW(0) state, indicating a mechanism involving the Fermi surface nesting. Angular dependences reveal different behaviors of the thermopower and Nernst effect in the high magnetic field (CDW(x)) state.

Angiomatosis of the paranasal sinuses

Angiomatosis is a rare benign lesion of the head and neck that can be mistaken for either a vascular malformation or malignant disease as a result of its infiltrative nature. The recurrence rate of angiomatosis requiring surgery is reported to be >90%, and as such the otolaryngologist treating this condition should endeavor to remove all disease during the first operation while maintaining a high level of suspicion for recurrence during postoperative surveillance. This case represents the first report of angiomatosis involving the nose and/or paranasal sinuses, and extends the differential diagnosis of sinonasal tumors, of which the otolaryngologist must be aware. A description of the surgical care and postoperative surveillance recommendations is detailed in this first reported case of angiomatosis of the paranasal sinuses.

Note: adhesive stamp electrodes using spider silk masks for electronic transport measurements of supra-micron sized samples

A procedure for fabricating adhesive stamp electrodes based on gold coated adhesive tape used to measure electronic transport properties of supra-micron samples in the lateral range 10-100 μm and thickness >1 μm is described. The electrodes can be patterned with a ~4 μm separation by metal deposition through a mask using Nephila clavipes spider dragline silk fibers. Ohmic contact is made by adhesive lamination of a sample onto the patterned electrodes. The performance of the electrodes with temperature and magnetic field is demonstrated for the quasi-one-dimensional organic conductor (TMTSF)(2)PF(6) and single crystal graphite, respectively.

MUM-1 Expression Differentiates Tumors in the PEComa Family From Clear Cell Sarcoma and Melanoma

PEComas are mesenchymal neoplasms composed of perivascular epithelioid cells (PEC) and include a spectrum of tumors. PEComas and malignant melanoma share common morphological, immunohistochemical, and ultrastructural features, such as epithelioid cell morphology and melanocytic immunophenotype. Melanocytic markers commonly expressed in PEC tumors include HMB-45, Melan-A/MART-1, tyrosinase, microphthalmia transcription factor (MITF), and occasionally, S100. Given this morphological and immunophenotypical overlap, the differential diagnosis between a PEComa and malignant melanoma can represent a challenge. Additional diagnostic difficulty is the differentiation of melanoma and PEComa from clear cell sarcoma that is indistinguishable from melanoma based on the immunohistochemical profile. Recent studies have shown that MUM-1, a known lymphocyte marker shows positive immunostaining in nevi and melanomas, its expression in PEComas and clear cell sarcoma, however, has not been previously addressed. In this study, the authors analyzed MUM-1 expression using immunohistochemistry in PEComas (n = 8), the PEComa family members, angiomyolipomas (n = 13), and clear cell sarcomas (n = 11) and compared the staining pattern with malignant melanomas (n = 25), both primary (n = 14) and metastatic (n = 11). It was found that 92.3% of primary melanomas and 81.3% of metastatic melanomas were MUM-1 positive. In contrast, MUM-1 was only weakly positive in only 25% of PEComas and negative in all angiomyolipomas. MUM-1 expression was noted in 72.7% of clear cell sarcomas. The study demonstrated differential MUM-1 expression between PEComas and other true melanocytic tumors and suggested that the addition of MUM-1 to the usual panel of melanocyte markers could be a helpful adjunctive study to aid in the differential diagnosis between these entities.

Co[V2]o4: a spinel approaching the itinerant electron limit

Studies of the structure, magnetization, and resistivity under pressure on stoichiometric normal spinel Co[V(2)]O(4) single crystals show (i) absence of a structural distortion, (ii) abnormal magnetic critical exponents, and (iii) metallic conductivity induced by pressures at low temperatures. All these results prove that Co[V(2)]O(4) sits on the edge of the itinerant-electron limit. Compared with similar measurements on Fe[V(2)]O(4) and other A[V(2)]O(4) studies, it is shown that a critical V-V separation for a localized-itinerant electronic phase transition exists.

Density-of-state oscillation of quasiparticle excitation in the spin density wave phase of (TMTSF)2ClO4

Systematic measurements of the magnetocaloric effect, heat capacity, and magnetic torque under a high magnetic field up to 35 T are performed in the spin density wave (SDW) phase of a quasi-one-dimensional organic conductor (TMTSF)2ClO4. In the SDW phase above 26 T, where the quantum Hall effect is broken, rapid oscillations (ROs) in these thermodynamic quantities are observed, which provides clear evidence of the density-of-state (DOS) oscillation near the Fermi level. The resistance is semiconducting and the heat capacity divided by temperature is extrapolated to zero at 0 K in the SDW phase, showing that all the energy bands are gapped, and there is no DOS at the Fermi level. The results show that the ROs are ascribed to the DOS oscillation of the quasiparticle excitation.

77Se and 63Cu NMR studies of the electronic correlations in CuxTiSe2 (x = 0.05, 0.07)

We report a (77)Se and (63)Cu nuclear magnetic resonance (NMR) investigation on the charge-density-wave (CDW) superconductor Cu(x)TiSe(2) (x = 0.05 and 0.07). At high magnetic fields where superconductivity is suppressed, the temperature dependence of (77)Se and (63)Cu spin-lattice relaxation rates 1/T(1) follow a linear relation. The slope of (77)Se 1/T(1) versus T increases with the Cu doping. This can be described by a modified Korringa relation which suggests the significance of electronic correlations and the Se 4p- and Ti 3d-band contribution to the density of states at the Fermi level in the studied compounds.

Primary musculoskeletal sarcoidosis

Sarcoidosis is a well-described clinical entity with several types of presentation among different organ systems. However, primary musculoskeletal manifestation is a rare and seldom-described manifestation. A retrospective review of patients seen at our institution from 1999 to 2009 was performed to identify patients with such presentation. Eleven patients with musculoskeletal sarcoidosis were identified. Seven patients presented with solitary lesions, while 4 presented with multiple foci of disease. Histologically, all lesions revealed granulomatous inflammation consistent with sarcoidosis. Cultures and gram stain were negative in all patients. One patient was found to have evidence of pulmonary sarcoidosis after diagnosis of musculoskeletal sarcoidosis. Eight patients had primarily soft tissue involvement with visible masses, while 3 patients had primarily osseous involvement with no mass. Pain was reported by 9 of 11 patients. On magnetic resonance imaging, all lesions were dark on T1, bright on T2, and poorly marginated. Magnetic resonance imaging was noted to be more accurate in revealing the pathology than radiographic imaging. Four patients underwent complete excision and 1 received a steroid injection. The remaining patients required no further treatment after diagnosis. Musculoskeletal sarcoidosis is rare and can present as single or multiple lesions. Definitive diagnosis is made by biopsy. The decision to operate should be based on symptoms, issues with cosmesis, impending fractures, growth, and/or involvement of neuro-vascular structures. Patients should be evaluated for pulmonary involvement.

TFE3 expression in tumors of the microphthalmia-associated transcription factor (MiTF) family

The DNA-binding factor TFE3 is closely related to microphthalmia-associated transcription factor (MiTF) and is over-expressed in alveolar soft part sarcoma (ASPS) and select renal cell carcinomas. Reports of TFE3 expression in PEComa prompted investigation into TFE3 expression among other members of the putative MiTF group of neoplasms. The authors examined cases of PEComa (n = 6), conventional angiomyolipoma (AML; n = 22), metastatic melanoma (n = 16), and clear cell sarcoma (CCS; n = 9) for TFE3 expression. Nuclear immunostaining was observed in 74% (39/53) of cases, as follows: 5/6 PEComas, 18/22 AMLs, 10/16 metastatic melanomas, and 6/9 CCSs. However, with the exception of PEComas, compared with ASPS controls, TFE3 staining was significantly less intense in the tumors examined. These results illustrate that TFE3 immunoreactivity is detectable in other members of the MiTF family of neoplasms. For this reason, such neoplasms warrant consideration in the differential diagnosis with nuclear TFE3 immunoreactivity, particularly when staining is focal and less intense.

Dermoid cyst of the parotid gland

A dermoid cyst is an ectodermally differentiated form of teratoma. Its occurrence in the parotid gland is very rare. Such a presentation must be properly evaluated in order to rule out malignancy. We describe the diagnostic evaluation and surgical management of a parotid dermoid cyst in an 18-year-old man. We also review the embryologic pathogenesis of the tumor and the usefulness of the physical examination, preoperative fine-needle aspiration cytology, magnetic resonance imaging, and computed tomography in evaluating the extent of the tumor, its histologic features, and its cystic characteristics. Finally, we discuss the role of surgical management in terms of preserving facial nerve integrity and preventing recurrence.

Pressure-dependent metallic and superconducting phases in a germanium artificial metal

Germanium (Ge) becomes an "artificial metal" and a superconductor (T(c) approximately 5 K) above the pressure-induced semiconductor-(diamond structure)-to-metal (beta-Sn structure) transition at 10 GPa. We report single crystal resistance studies of the pressure-dependent metallic and metastable phases in the range 2.6 to 23 GPa, and show for a controlled pressure release, Ge is a metastable metal below 3 GPa. We find Ge has a superconducting upper critical field of 300 Oe (at 10.7 GPa and 1.8 K), above which a positive magnetoresistance consistent with that of a compensated closed orbit metal is observed.

Proximity detector circuits: an alternative to tunnel diode oscillators for contactless measurements in pulsed magnetic field environments

A radio frequency oscillator circuit based on a proximity detector integrated circuit is described as an alternative for the traditional tunnel diode oscillator used for pulsed magnetic field measurements at low temperatures. The proximity detector circuit design, although less sensitive than tunnel diode oscillator circuits, has a number of essential advantages for measurements in the extreme environments of pulsed magnetic fields. These include the insensitivity of operation to voltages induced in the inductor coil, the elimination of a diode bias circuit and tuning, and a broad dynamic range of resonant frequency variation. The circuit has been successfully applied to measure the superconducting upper critical field in Ba(0.55)K(0.45)Fe2As2 single crystals up to 60 T.

Chemical pressure induced spin freezing phase transition in kagome pr langasites

The 2D kagome system Pr3Ga5SiO14 has been previously identified as a spin-liquid candidate in zero field, displaying no magnetic long-ranged order down to at least 35 mK. Perturbations upon such systems, either under applied fields or applied pressure, should induce a spin freezing phase transition, but there are very few experimental realizations of this phenomena other than the well-studied 3D pyrochlore Tb2Ti2O7. In this Letter, we report the observation of a spin freezing phase transition in Pr3Ga5SiO14 through the application of chemical pressure--that is, through a systematic substitution on the Si site with larger ions and an elongation of the nearest-neighbor Pr-Pr distance in the kagome lattice. This results in a suppression of the T2 component of the heat capacity, and the reduction of the exchange constant eventually leads to dipolar-driven spin freezing.

Antiferromagnetic d-electron exchange via a spin-singlet pi-electron ground state in an organic conductor

Electron spin resonance reveals the spin behavior of conduction (pi) and localized (d) electrons in beta-(BDA-TTP)2MCl4 (M=Fe, Ga). Both the Ga3+(S=0) and Fe3+(S=5/2) compounds exhibit a metal-insulator transition at 113 K with the simultaneous formation of a spin-singlet ground state in the pi electron system of the donor molecules. The behavior is consistent with charge ordering in beta-(BDA-TTP)2MCl4 at the metal-insulator transition. At 5 K, the Fe3+ compound orders antiferromagnetically, even though the pi electrons, which normally would facilitate magnetic exchange, are localized nonmagnetic singlets.

Vortex dynamics and the Fulde-Ferrell-Larkin-Ovchinnikov state in a magnetic-field-induced organic superconductor

Under special conditions, a superconducting state where the order parameter oscillates in real space, the so-called FFLO state, is theoretically predicted to exist near the upper critical field, as first proposed by Fulde and Ferrell, and Larkin and Ovchinnikov. We report systematic measurements of the interlayer resistance in high magnetic fields to 45 T in the two-dimensional magnetic-field-induced organic superconductor lambda-(BETS)2FeCl4, where BETS is bis(ethylenedithio)tetraselenafulvalene. The resistance is found to show characteristic dip structures in the superconducting state. The results are consistent with pinning interactions between the vortices penetrating the insulating layers and the order parameter of the FFLO state. This gives strong evidence for an oscillating order parameter in real space.

Resonant nernst effect in the metallic and field-induced spin density wave States of (TMTSF)2ClO4

We examine an unusual phenomenon where, in tilted magnetic fields near magic angles parallel to crystallographic planes, a "giant" resonant Nernst signal has been observed by Wu et al. [Phys. Rev. Lett. 91, 056601 (2003)] in the metallic state of an organic conducting Bechgaard salt. We show that this effect appears to be a general feature of these materials and is also present in the field-induced spin density wave phase with even larger amplitude. Our results place conditions on any model that treats the metallic state as a state with finite Cooper pairing.

Quantum oscillation of Hall resistance in the extreme quantum limit of an organic conductor (TMTSF)2ClO4

We report resistance and magnetic torque experiments under a high magnetic field up to 45 T in a three dimensional quantum Hall (QH) system (TMTSF)(2)ClO(4), where TMTSF = tetramethyltetraselenafulvalene. The Hall resistance shows huge oscillations accompanied with sign reversal after the final QH state, where the Landau level filling factor is unity, is removed above 26 T. The magnetic torque also oscillates with the field. The results suggest that a novel quantum state, where the character of the carriers periodically changes with the field, is stabilized in the extreme quantum limit.

High magnetic field induced charge density wave state in a quasi-one-dimensional organic conductor

The quasi-one-dimensional organic conductor (Per)2Pt(mnt)2 exhibits a charge density wave ground state below 8 K. Magnetoresistance and magnetization measurements show that the charge density wave is suppressed with magnetic fields of order 20 T, above which a high resistance state, with a cascade of subphases, appears. This new state, tentatively identified as a field induced charge density wave, reenters a low resistance state above 40 T. The results are presented in light of theoretical work [D. Zanchi et al. Phys. Rev. B 53, 1240 (1996)]] involving field induced charge density wave ground states in high magnetic fields.

Loss of cables protein expression in human non-small cell lung cancer: a tissue microarray study

Loss of heterozygosity (LOH) on chromosome 18q is common in lung cancer. The genes involved in LOH on 18q in lung cancer have not been well characterized. Cables, a cyclin-dependent kinase (cdk) interacting protein, has recently been identified and mapped to human chromosome 18q11-12. Cables inhibits cell growth and suppresses tumor formation in nude mice, making it a candidate gene for 18q LOH in lung cancer. Little is known regarding Cables protein expression in human non-small cell lung cancer (NSCLC). In this study we examined Cables expression in 163 NSCLC and nonneoplastic lung specimens using tissue microarrays. Strong nuclear staining was present in normal lung and bronchial tissue. We also evaluated the Cables protein expression pattern and its correlation with histopathologic features and with clinical course of NSCLC. The results of the present study demonstrate for the first time that numerous NSCLCs (45%) lose Cables expression. Furthermore, more adenocarcinomas show a loss of this novel protein than do squamous counterparts. The relationship between tumor histology type and Cables expression appears to be statistically significant (P = 0.028). Our results suggest that Cables may be involved in the pathogenesis of NSCLC.

Differential expression of high-affinity melatonin receptors (MT1) in normal and malignant human breast tissue

Melatonin is a pineal hormone that strongly inhibits the growth of breast cancer cells in vitro and in vivo. We report thefirst use of immunohistochemical analysis to determine the distribution of the high-affinity melatonin receptor subtype, MTI, in human breast tissue, the hypothalamic suprachiasmatic nucleus, and skin. The MT1 antibody, which is specific for the cytoplasmic portion of the receptor, produced cytoplasmic staining in normal-appearing breast epithelial cells and ductal carcinoma cells; stromal cells, myoepithelial cells, and adipocytes were nonreactive. The majority of nonneoplastic samples (13/19 [68%]) were negative to weakly positive, while moderate to strong reactivity was seen in most cancer samples (49/65 [75%]). Thus, although MT1 receptors were detectable in normal and malignant breast epithelium, high receptor levels occurred more frequently in tumor cells (P < .001), and tumors with moderate or strong reactivity were more likely to be high nuclear grade (P < .045). These findings may have implications for the use of melatonin in breast cancer therapy.

Three-dimensional fermi-liquid ground state in the quasi-one-dimensional cuprate PrBa(2)Cu(4)O(8)

The interchain resistivity of PrBa(2)Cu(4)O(8) has been measured in high magnetic fields up to 30 T. Co-herent interchain transport at low temperatures is destroyed by a large magnetic field applied perpendicular to the CuO chains. Comparisons with quasiclassical transport theory provide strong experimental support for a three-dimensional Fermi-liquid ground state in PrBa(2)Cu(4)O(8), despite extreme anisotropy in its electronic properties and the presence of strong electron correlations.

MCM2 is an independent predictor of survival in patients with non-small-cell lung cancer

PURPOSE

Minichromosome maintenance protein 2 (MCM2) is a component of the prereplicative complex. It is essential for eukaryotic DNA replication and is only expressed in proliferating cells. The prognostic utility of MCM2 compared with Ki-67, another marker of proliferating cells, on survival of patients with non-small-cell lung cancer (NSCLC) was studied.

PATIENTS AND METHODS

We examined the immunohistochemical expression of MCM2 and Ki-67 in primary pathologic tumor specimens from 221 NSCLC patients. For each marker, the fraction of tumor cells with positive staining was assessed as a percentage and categorized into four groups: 0% to 24%, 25% to 49%, 50% to 74%, and > or = 75%. MCM2 and Ki-67 immunoreactivities were compared with each other, and associations with pathologic and clinical parameters predictive of survival were analyzed with the chi(2) test. Cox regression models were used to assess associations between MCM2 and Ki-67 and survival while controlling for confounders.

RESULTS

Independent variables significantly associated with survival were tumor stage, performance status, and staining category. Patients with less than 25% MCM2 immunoreactivity had a longer median survival time than patients with > or = 25% MCM2 immunoreactivity (46 v 31 months; P =.039) and a lower relative risk (RR) of death (RR, 0.55, 95% confidence interval, 0.34 to 0.88). There was no significant association between survival and Ki-67 expression.

CONCLUSION

Immunostaining of tumor cells for MCM2 is an independent prognostic parameter of survival for patients with NSCLC. Interpretable results can be obtained on more than 96% of paraffin-embedded specimens, and approximately 35% will be in the favorable subgroup, with less than 25% positively stained tumor cells. Whether MCM2 is predictive of response to therapy needs to be studied.

Superconductivity in an organic insulator at very high magnetic fields

We investigate by electrical transport the field-induced superconducting state (FISC) in the organic conductor lambda-(BETS)2FeCl4. Below 4 K, antiferromagnetic-insulator, metallic, and eventually superconducting (FISC) ground states are observed with increasing in-plane magnetic field. The FISC state survives between 18 and 41 T and can be interpreted in terms of the Jaccarino-Peter effect, where the external magnetic field compensates the exchange field of aligned Fe3+ ions. We further argue that the Fe3+ moments are essential to stabilize the resulting singlet, two-dimensional superconducting state.

Quantum melting of the quasi-two-dimensional vortex lattice in kappa- (ET)2Cu(NCS)(2)

We report torque magnetization measurements in regions of the mixed state phase diagram ( B approximately mu(o)H(c2) and T(c)/10(3)) of the organic superconductor kappa-(ET)2Cu(NCS)(2), where quantum fluctuations are expected to dominate thermal effects. Over most of the field range below the irreversibility line ( B(irr)), magnetothermal instabilities are observed in the form of flux jumps. The abrupt cessation of these instabilities just below B(irr) indicates a quantum melting transition from a quasi-two-dimensional vortex lattice phase to a quantum liquid phase.

Field-induced dynamic diamagnetism in a charge-density-wave system

ac susceptibility measurements of the charge-density-wave (CDW) compound alpha-(BEDT-TTF)(2)-KHg(SCN)(4) at magnetic fields, mu0H >23 T, above its Pauli paramagnetic limit, reveal unambiguously that the magnetic hysteresis observed previously within this CDW phase is diamagnetic and can only be explained by induced currents. It is argued that the ensemble of experimental techniques amounts to a strong case for dissipationless conductivity within this phase.

Field-induced metal-insulator transition in a two-dimensional organic superconductor

The quasi-two-dimensional organic superconductor beta"-(BEDT-TTF)2SF5CH2CF2SO3 (Tc approximately 4.4 K) shows very strong Shubnikov-de Haas (SdH) oscillations which are superimposed on a highly anomalous steady background magnetoresistance, Rb. Comparison with de Haas-van Alphen oscillations allows a reliable estimate of Rb which is crucial for the correct extraction of the SdH signal. At low temperatures and high magnetic fields insulating behavior evolves. The magnetoresistance data violate Kohler's rule, i.e., cannot be described within the framework of semiclassical transport theory, but converge onto a universal curve appropriate for dynamical scaling at a metal-insulator transition.

Magnetic breakdown at high fields: semiclassical and quantum treatments

The effects of finite temperature and noninteracting spins on magnetic breakdown (MB) in a quasi-two-dimensional organic conductor have been determined by computing the field-dependent free energy using a realistic crystal structure with no adjustable parameters. The de Haas-van Alphen oscillation spectra, including the MB phenomena, are thereby obtained microscopically. Within the range of computed magnetic field, from 170 to 1400 T, we find remarkable agreement between the predictions of the semiclassical and quantum treatment. We also find that the Zeeman effect leads to splitting of a frequency corresponding to the fundamental orbit.

Cyclotron resonance in the layered perovskite superconductor Sr2RuO4

We have observed cyclotron resonance in the layered perovskite superconductor Sr2RuO4. We obtain cyclotron masses for the alpha, beta, and gamma Fermi surfaces of (4.33+/-0.05)m(e), (5.81+/-0. 05)m(e), and (9.71+/-0.2)m(e), respectively. The appreciable differences between these results and those obtained from de Haas-van Alphen measurements are attributable to strong electron-electron interactions in this system. Our findings appear to be consistent with predictions for an interacting Fermi liquid; indeed, semiquantitative agreement is obtained for the electron pockets beta and gamma.