Atomic Diffusion-Induced Polarization and Superconductivity in Topological Insulator-Based Heterostructures

The proximity effect at a highly transparent interface of an s-wave superconductor (S) and a topological insulator (TI) provides a promising platform to create Majorana zero modes in artificially designed heterostructures. However, structural and chemical issues pertinent to such interfaces have been poorly explored so far. Here, we report the discovery of Pd diffusion-induced polarization at interfaces between superconductive Pd1+x(Bi0.4Te0.6)2 (xPBT, 0 ≤ x ≤ 1) and Pd-intercalated Bi2Te3 by using atomic-resolution scanning transmission electron microscopy. Our quantitative image analysis reveals that nanoscale lattice strain and QL polarity synergistically suppress and promote Pd diffusion at the normal and parallel interfaces, formed between Te-Pd-Bi triple layers (TLs) and Te-Bi-Te-Bi-Te quintuple layers (QLs), respectively. Further, our first-principles calculations unveil that the superconductivity of the xPBT phase and topological nature of the Pd-intercalated Bi2Te3 phase are robust against the broken inversion symmetry. These findings point out the necessity of considering the coexistence of electric polarization with superconductivity and topology in such S-TI systems.

Antiferromagnetic topological insulator with selectively gapped Dirac cones

Antiferromagnetic (AF) topological materials offer a fertile ground to explore a variety of quantum phenomena such as axion magnetoelectric dynamics and chiral Majorana fermions. To realize such intriguing states, it is essential to establish a direct link between electronic states and topology in the AF phase, whereas this has been challenging because of the lack of a suitable materials platform. Here we report the experimental realization of the AF topological-insulator phase in NdBi. By using micro-focused angle-resolved photoemission spectroscopy, we discovered contrasting surface electronic states for two types of AF domains; the surface having the out-of-plane component in the AF-ordering vector displays Dirac-cone states with a gigantic energy gap, whereas the surface parallel to the AF-ordering vector hosts gapless Dirac states despite the time-reversal-symmetry breaking. The present results establish an essential role of combined symmetry to protect massless Dirac fermions under the presence of AF order and widen opportunities to realize exotic phenomena utilizing AF topological materials.

Nonlinear Transport due to Magnetic-Field-Induced Flat Bands in the Nodal-Line Semimetal ZrTe_{5}

The Dirac material ZrTe_{5} at very low carrier density was recently found to be a nodal-line semimetal, where ultraflat bands are expected to emerge in magnetic fields parallel to the nodal-line plane. Here, we report that in very low carrier-density samples of ZrTe_{5}, when the current and the magnetic field are both along the crystallographic a axis, the current-voltage characteristics presents a pronounced nonlinearity which tends to saturate in the ultra quantum limit. The magnetic-field dependence of the nonlinear coefficient is well explained by the Boltzmann theory for flat-band transport, and we argue that this nonlinear transport is likely due to the combined effect of flat bands and charge puddles; the latter appear due to very low carrier densities.

Top-Down Fabrication of Bulk-Insulating Topological Insulator Nanowires for Quantum Devices

In a nanowire (NW) of a three-dimensional topological insulator (TI), the quantum confinement of topological surface states leads to a peculiar sub-band structure that is useful for generating Majorana bound states. Top-down fabrication of TINWs from a high-quality thin film would be a scalable technology with great design flexibility, but there has been no report on top-down-fabricated TINWs where the chemical potential can be tuned to the charge neutrality point (CNP). Here we present a top-down fabrication process for bulk-insulating TINWs etched from high-quality (Bi_1-xSb_x)₂Te₃ thin films without degradation. We show that the chemical potential can be gate-tuned to the CNP, and the resistance of the NW presents characteristic oscillations as functions of the gate voltage and the parallel magnetic field, manifesting the TI-sub-band physics. We further demonstrate the superconducting proximity effect in these TINWs, preparing the groundwork for future devices to investigate Majorana bound states.

Clinical characteristics and outcomes of pheochromocytoma crisis: a literature review of 200 cases

PURPOSE

Pheochromocytoma crisis is a life-threatening endocrine emergency that requires prompt diagnosis and treatment. Because of its rarity, sudden onset, and lack of internationally uniform and validated diagnostic criteria, pheochromocytoma crisis remains to be fully clarified. Therefore, we aimed to describe the clinical characteristics and outcomes of pheochromocytoma crisis through a literature review.

METHODS

We performed a systematic literature search of PubMed/MEDLINE database, Igaku-Chuo-Zasshi (Japanese database), and Google Scholar to identify case reports of pheochromocytoma crisis published until February 5, 2021. Information was extracted and analyzed from the literature that reported adequate individual patient data of pheochromocytoma crisis in English or Japanese. Cases were also termed as pheochromocytoma multisystem crisis (PMC) if patients had signs of hyperthermia, multiple organ failure, encephalopathy, and labile blood pressure.

RESULTS

In the 200 cases of pheochromocytoma crisis identified from 187 articles, the mean patient age was 43.8 ± 15.5 years. The most common symptom was headache (39.5%). The heart was the most commonly damaged organ resulting from a complication of a pheochromocytoma crisis (99.0%), followed by the lungs (44.0%) and the kidney (21.5%). PMC accounted for 19.0% of all pheochromocytoma crisis cases. After excluding 12 cases with unknown survival statuses, the mortality rate was 13.8% (26/188 cases). Multivariable logistic regression analysis revealed that nausea and vomiting were significantly associated with a higher mortality rate.

CONCLUSION

Pheochromocytoma can present with different symptomatology, affecting different organ systems. Clinicians should be aware that patients with nausea or vomiting are at a higher risk of death because of pheochromocytoma crisis.

Giant magnetochiral anisotropy from quantum-confined surface states of topological insulator nanowires

Wireless technology relies on the conversion of alternating electromagnetic fields into direct currents, a process known as rectification. Although rectifiers are normally based on semiconductor diodes, quantum mechanical non-reciprocal transport effects that enable a highly controllable rectification were recently discovered^1-9. One such effect is magnetochiral anisotropy (MCA)^6-9, in which the resistance of a material or a device depends on both the direction of the current flow and an applied magnetic field. However, the size of rectification possible due to MCA is usually extremely small because MCA relies on inversion symmetry breaking that leads to the manifestation of spin-orbit coupling, which is a relativistic effect^6-8. In typical materials, the rectification coefficient γ due to MCA is usually ∣γ∣ ≲ 1 A^-1 T^-1 (refs. ^8-12) and the maximum values reported so far are ∣γ∣ ≈ 100 A^-1 T^-1 in carbon nanotubes¹³ and ZrTe₅ (ref. ¹⁴). Here, to overcome this limitation, we artificially break the inversion symmetry via an applied gate voltage in thin topological insulator (TI) nanowire heterostructures and theoretically predict that such a symmetry breaking can lead to a giant MCA effect. Our prediction is confirmed via experiments on thin bulk-insulating (Bi_1-xSb_x)₂Te₃ (BST) TI nanowires, in which we observe an MCA consistent with theory and ∣γ∣ ≈ 100,000 A^-1 T^-1, a very large MCA rectification coefficient in a normal conductor.

Gigantic Magnetochiral Anisotropy in the Topological Semimetal ZrTe_{5}

Topological materials with broken inversion symmetry can give rise to nonreciprocal responses, such as the current rectification controlled by magnetic fields via magnetochiral anisotropy. Bulk nonreciprocal responses usually stem from relativistic corrections and are always very small. Here we report our discovery that ZrTe_{5} crystals in proximity to a topological quantum phase transition present gigantic magnetochiral anisotropy, which is the largest ever observed to date. We argue that a very low carrier density, inhomogeneities, and a torus-shaped Fermi surface induced by breaking of inversion symmetry in a Dirac material are central to explain this extraordinary property.

Calculation of an Enhanced A_{1g} Symmetry Mode Induced by Higgs Oscillations in the Raman Spectrum of High-Temperature Cuprate Superconductors

In superconductors the Anderson-Higgs mechanism allows for the existence of a collective amplitude (Higgs) mode which can couple to eV light mainly in a nonlinear Raman-like process. The experimental nonequilibrium results on isotropic superconductors have been explained going beyond the BCS theory including the Higgs mode. Furthermore, in anisotropic d-wave superconductors strong interaction effects with other modes are expected. Here we calculate the Raman contribution of the Higgs mode from a new perspective, including many-body Higgs oscillations effects and their consequences in conventional, spontaneous Raman spectroscopy. Our results suggest a significant contribution to the intensity of the A_{1g} symmetry Raman spectrum in d-wave superconductors. In order to test our theory, we predict the presence of measurable characteristic oscillations in THz quench-optical probe time-dependent reflectivity experiments.

Quantum confinement of the Dirac surface states in topological-insulator nanowires

The non-trivial topology of three-dimensional topological insulators dictates the appearance of gapless Dirac surface states. Intriguingly, when made into a nanowire, quantum confinement leads to a peculiar gapped Dirac sub-band structure. This gap is useful for, e.g., future Majorana qubits based on TIs. Furthermore, these sub-bands can be manipulated by a magnetic flux and are an ideal platform for generating stable Majorana zero modes, playing a key role in topological quantum computing. However, direct evidence for the Dirac sub-bands in TI nanowires has not been reported so far. Here, using devices fabricated from thin bulk-insulating (Bi1-xSbx)2Te3 nanowires we show that non-equidistant resistance peaks, observed upon gate-tuning the chemical potential across the Dirac point, are the unique signatures of the quantized sub-bands. These TI nanowires open the way to address the topological mesoscopic physics, and eventually the Majorana physics when proximitized by an s-wave superconductor.

Two-Dimensional-Dirac Surface States and Bulk Gap Probed via Quantum Capacitance in a Three-Dimensional Topological Insulator

BiSbTeSe₂ is a 3D topological insulator (3D-TI) with Dirac type surface states and low bulk carrier density, as donors and acceptors compensate each other. Dominating low-temperature surface transport in this material is heralded by Shubnikov-de Haas oscillations and the quantum Hall effect. Here, we experimentally probe and model the electronic density of states (DOS) in thin layers of BiSbTeSe₂ by capacitance experiments both without and in quantizing magnetic fields. By probing the lowest Landau levels, we show that a large fraction of the electrons filled via field effect into the system ends up in (localized) bulk states and appears as a background DOS. The surprisingly strong temperature dependence of such background DOS can be traced back to Coulomb interactions. Our results point at the coexistence and intimate coupling of Dirac surface states with a bulk many-body phase (a Coulomb glass) in 3D-TIs.

Long-term survival of a patient with acute neonatal-onset metabolic encephalopathy with carbamoyl phosphate synthetase 1 deficiency

OBJECTIVE

Long-term survival of patients with neonatal-onset carbamoyl-phosphate synthetase 1 deficiency (CPS1D), an autosomal recessive disorder characterized by repeated, life-threatening hyperammonemia, is rare. We describe the diagnosis and clinical management of a teenager with neonatal-onset CPS1D who did not undergo therapeutic liver transplantation.

CASE REPORT

Following emergent neonatal therapy, the patient was diagnosed with CPS1D based on clinical, radiological, biochemical and genetic analyses. Her clinical course, neurobehavioral development and therapeutic interventions are presented and discussed.

RESULTS

Born from nonconsanguineous parents, the proband underwent phototherapy for neonatal jaundice, associated with acute encephalopathy, apnea and cerebral edema. Based on blood and urinary biochemical abnormalities, neonatal-onset CPS1D was diagnosed. Her hyperammonemia was corrected by hemodialysis, followed by sodium benzoate, L-arginine, levocarnitine and protein-free diet therapy. Because of a relapse and persistent neurobehavioral regression by age 1, a planned liver transplantation was cancelled. At age 10, sodium phenylbutyrate was substituted as ammonia scavenger. Genetic testing revealed compound heterozygote c.2359C>T (R787X) and c.236+6T>C variants of CPS1, confirming her diagnosis. Despite severe neurological sequelae, the patient is 16 and in stable condition.

CONCLUSIONS

Our case suggests that early hemodialysis and pharmacologic interventions for acute neonatal hyperammonemia can improve the prognosis of patients with neonatal-onset CPS1D.

Uniaxial-strain control of nematic superconductivity in SrxBi2Se3

Nematic states are characterized by rotational symmetry breaking without translational ordering. Recently, nematic superconductivity, in which the superconducting gap spontaneously lifts the rotational symmetry of the lattice, has been discovered. In nematic superconductivity, multiple superconducting domains with different nematic orientations can exist, and these domains can be controlled by a conjugate external stimulus. Domain engineering is quite common in magnets but has not been achieved in superconductors. Here, we report control of the nematic superconductivity and their domains of SrxBi2Se3, through externally-applied uniaxial stress. The suppression of subdomains indicates that it is the Δ4y state that is most favoured under compression along the basal Bi-Bi bonds. This fact allows us to determine the coupling parameter between the nematicity and lattice distortion. These results provide an inevitable step towards microscopic understanding and future utilization of the unique topological nematic superconductivity.

Effect of drying methods and parameters on the antioxidant properties of tea (Camellia sinensis) leaves

Background

Conventional drying using heated air oven is commonly used as a method for preserving the product but often affects the nutritional value, taste, and texture. However, the heat from the drying method can oxidize and destroy heat-sensitive compounds. Superheated steam (SHS) drying uses superheated steam instead of hot air or combustion gases in a direct dryer and was reported better at preserving the nutritional values of food products.

Aim

To evaluate the effect of SHS drying on antioxidant properties of tea leaves. The study also compared SHS drying with conventional and freeze-drying methods.

Results

Tea leaves dried using freeze drying retained the highest level of antioxidant properties compared to other drying methods. The leaves dried using SHS exhibited significantly higher radical scavenging activity, ORAC and FRAP values compared to oven drying method. At different drying temperatures (150 °C and 175 °C), oven dried leaves showed significantly higher (p < 0.05) antioxidant properties than that of SHS dried ones. Tea leaves dried for 60, 75, and 90 min using SHS showed significantly higher (p < 0.05) FRAP and ORAC values, and also total phenolic content compared to oven dried tea leaves.

Conclusion

Tea leaves dried using SHS drying method retained higher level of antioxidant properties compared to oven drying. The drying method also retained lower antioxidant properties as drying time increased. Further study involving SHS drying in food-related fields should be conducted to support its usefulness.

Graphical abstract

Generalized Anderson's theorem for superconductors derived from topological insulators

A well-known result in unconventional superconductivity is the fragility of nodal superconductors against nonmagnetic impurities. Despite this common wisdom, Bi₂Se₃-based topological superconductors have recently displayed unusual robustness against disorder. Here, we provide a theoretical framework that naturally explains what protects Cooper pairs from strong scattering in complex superconductors. Our analysis is based on the concept of superconducting fitness and generalizes the famous Anderson's theorem into superconductors having multiple internal degrees of freedom with simple assumptions such as the Born approximation. For concreteness, we report on the extreme example of the Cu _x (PbSe)₅(BiSe₃)₆ superconductor. Thermal conductivity measurements down to 50 mK not only give unambiguous evidence for the existence of nodes but also reveal that the energy scale corresponding to the scattering rate is orders of magnitude larger than the superconducting energy gap. This provides the most spectacular case of the generalized Anderson's theorem protecting a nodal superconductor.

Conversion of a conventional superconductor into a topological superconductor by topological proximity effect

Realization of topological superconductors (TSCs) hosting Majorana fermions is a central challenge in condensed-matter physics. One approach is to use the superconducting proximity effect (SPE) in heterostructures, where a topological insulator contacted with a superconductor hosts an effective p-wave pairing by the penetration of Cooper pairs across the interface. However, this approach suffers a difficulty in accessing the topological interface buried deep beneath the surface. Here, we propose an alternative approach to realize topological superconductivity without SPE. In a Pb(111) thin film grown on TlBiSe₂, we discover that the Dirac-cone state of substrate TlBiSe₂ migrates to the top surface of Pb film and obtains an energy gap below the superconducting transition temperature of Pb. This suggests that a Bardeen-Cooper-Schrieffer superconductor is converted into a TSC by the topological proximity effect. Our discovery opens a route to manipulate topological superconducting properties of materials.

Realizing topological superconductivity is essential for applicable fault-tolerant quantum computation. Here, Trang et al. report migration of Dirac-cone from TlBiSe₂ substrate to top surface of superconducting Pb film due to topological proximity effect, suggesting realization of topological superconductivity.

Pyogenic spondylitis with acute course caused by Corynebacterium simulans

Corynebacterium simulans was first reported in 2000. Although it is a member of the normal skin flora, some cases of C. simulans infection have been reported. Other Corynebacterium spp. rarely cause chronic pyogenic spondylitis, and pyogenic spondylitis caused by C. simulans has not been reported at all. Here we report a case of acute pyogenic spondylitis due to C. simulans. A 78-year-old man with diabetes mellitus visited our hospital with a 3-day history of lower back pain and fever. Blood culture revealed C. simulans and magnetic resonance images of lumbar vertebrae showed pyogenic spondylitis. He recovered after treatment by vancomycin for 9 weeks and was discharged home. No recurrence has been observed for half a year. This is likely the first reported case of pyogenic spondylitis by C. simulans. In general, Corynebacterium spp. cause chronic pyogenic spondylitis, but this case showed an acute course.

Nationwide survey on cerebral amyloid angiopathy in Japan

BACKGROUND AND PURPOSE

A nationwide survey was conducted to understand the epidemiology of cerebral amyloid angiopathy-related intracerebral hemorrhage (CAA-related ICH) and cerebral amyloid angiopathy-related inflammation/vasculitis (CAA-ri) in Japan.

METHODS

To estimate the total number and clinical features of patients with CAA-related ICH and CAA-ri between January 2012 and December 2014 and to analyze their clinical features, questionnaires were sent to randomly selected hospitals in Japan.

RESULTS

In the first survey, 2348 of 4657 departments responded to the questionnaire (response rate 50.4%). The total numbers of reported patients with CAA-related ICH and CAA-ri were 1338 and 61, respectively, and their total numbers in Japan were estimated to be 5900 [95% confidence interval (CI) 4800-7100] and 170 (95% CI 110-220), respectively. The crude prevalence rates were 4.64 and 0.13 per 100 000 population, respectively. The clinical information of 474 patients with CAA-related ICH obtained in the second survey was as follows: (i) the average age of onset was 78.4 years; (ii) the prevalence increased with age; (iii) the disease was common in women; and (iv) hematoma most frequently occurred in the frontal lobe. Sixteen patients with CAA-ri for whom data were collected in the second survey had the following characteristics: (i) median age of onset was 75 years; (ii) cognitive impairment and headache were the most frequent initial manifestations; and (iii) focal neurological signs, such as motor paresis and visual disturbance, were frequently observed during the clinical course.

CONCLUSIONS

The numbers of patients with CAA-related ICH and CAA-ri in Japan were estimated.

Nanomosaic of Topological Dirac States on the Surface of Pb5Bi24Se41 Observed by Nano-ARPES

We have performed scanning angle-resolved photoemission spectroscopy with a nanometer-sized beam spot (nano-ARPES) on the cleaved surface of Pb₅Bi₂₄Se₄₁, which is a member of the (PbSe)₅(Bi₂Se₃)_{3 m} homologous series (PSBS) with m = 4 consisting of alternate stacking of the topologically trivial insulator PbSe bilayer and four quintuple layers (QLs) of the topological insulator Bi₂Se₃. This allows us to visualize a mosaic of topological Dirac states at a nanometer scale coming from the variable thickness of the Bi₂Se₃ nanoislands (1-3 QLs) that remain on top of the PbSe layer after cleaving the PSBS crystal, because the local band structure of topological origin changes drastically with the thickness of the Bi₂Se₃ nanoislands. A comparison of the local band structure with that in ultrathin Bi₂Se₃ films on Si(111) gives us further insights into the nature of the observed topological states. This result demonstrates that nano-ARPES is a very useful tool for characterizing topological heterostructures.

Observation of Chiral Fermions with a Large Topological Charge and Associated Fermi-Arc Surface States in CoSi

Topological semimetals materialize a new state of quantum matter where massless fermions protected by a specific crystal symmetry host exotic quantum phenomena. Distinct from well-known Dirac and Weyl fermions, structurally chiral topological semimetals are predicted to host new types of massless fermions characterized by a large topological charge, whereas such exotic fermions are yet to be experimentally established. Here, by using angle-resolved photoemission spectroscopy, we experimentally demonstrate that a transition-metal silicide CoSi hosts two types of chiral topological fermions, a spin-1 chiral fermion and a double Weyl fermion, in the center and corner of the bulk Brillouin zone, respectively. Intriguingly, we found that the bulk Fermi surfaces are purely composed of the energy bands related to these fermions. We also find the surface states connecting the Fermi surfaces associated with these fermions, suggesting the existence of the predicted Fermi-arc surface states. Our result provides the first experimental evidence for the chiral topological fermions beyond Dirac and Weyl fermions in condensed-matter systems, and paves the pathway toward realizing exotic electronic properties associated with unconventional chiral fermions.

Observation of Room-Temperature Photoluminescence Blinking in Armchair-Edge Graphene Nanoribbons

By enhancing the photoluminescence from aligned seven-atom wide armchair-edge graphene nanoribbons using plasmonic nanoantennas, we are able to observe blinking of the emission. The on- and off-times of the blinking follow power law statistics. In time-resolved spectra, we observe spectral diffusion. These findings together are a strong indication of the emission originating from a single quantum emitter. The room temperature photoluminescence displays a narrow spectral width of less than 50 meV, which is significantly smaller than the previously observed ensemble line width of 0.8 eV. From spectral time traces, we identify three optical transitions, which are energetically situated below the lowest bulk excitonic state E₁₁ of the nanoribbons. We attribute the emission to transitions involving Tamm states localized at the end of the nanoribbon. The photoluminescence from a single ribbon is strongly enhanced when its end is in the antenna hot spot resulting in the observed single molecule characteristics of the emission. Our findings illustrate the essential role of the end termination of graphene nanoribbons in light emission and allow us to construct a model for photoluminescence from nanoribbons.

Anomalous Fraunhofer Patterns in Gated Josephson Junctions Based on the Bulk-Insulating Topological Insulator BiSbTeSe2

One-dimensional Majorana modes are predicated to form in Josephson junctions based on three-dimensional topological insulators (TIs). While observations of supercurrents in Josephson junctions made on bulk-insulating TI samples have been reported recently, the Fraunhofer patters observed in such TI-based Josephson junctions, which sometimes present anomalous features, are still not well-understood. Here, we report our study of highly gate-tunable TI-based Josephson junctions made of one of the most bulk-insulating TI materials, BiSbTeSe₂, and Al. The Fermi level can be tuned by gating across the Dirac point, and the high transparency of the Al-BiSbTeSe₂ interface is evinced by a high characteristic voltage and multiple Andreev reflections, with peak indices reaching 12. Anomalous Fraunhofer patterns with missing lobes were observed in the entire range of gate voltage. We found that, by employing an advanced fitting procedure to use the maximum entropy method in a Monte Carlo algorithm, the anomalous Fraunhofer patterns are explained as a result of inhomogeneous supercurrent distributions on the TI surface in the junction. Besides establishing a highly promising fabrication technology, this work clarifies one of the important open issues regarding TI-based Josephson junctions.

Inhibition of Human Platelet Functions by Verapamil

The effects of verapamil, a coronary vasodilator, on platelet functions were studied.

Platelet aggregation induced by ADP, epinephrine or collagen was inhibited by verapamil in vitro. Calcium ionophore A23187-induced platelet aggregation was also inhibited by verapamil in a concentration dependent manner. In washed platelets, verapamil caused a dose-dependent inhibition of serotonin release induced either by thrombin or A23187 in the absence of extracellular calcium. Addition of 1 mM CaCl2 with A23187 or thrombin partially overcame this inhibition. Addition of 1 mM CaCl2 in the absence of verapamil had no effect on thrombin- or A23187-induced secretion. When verapamil was administered to the healthy volunteers at the dosage commonly used, inhibition of platelet aggregation was observed 2 hrs after the drug ingestion. It is of great interest that verapamil potentiated the anti-aggregating activity of prostacyclin in vitro.

Our results may suggest a potential role for verapamil in the treatment of thrombotic disorders.

Low-Dose Induction Radiotherapy for Stomach Conservation in Patients with Massive Gastric Lymphoma

Low-dose induction radiotherapy was performed in 4 patients with massive gastric lymphoma in order to treat the disease without gastrectomy. Following the radiotherapy, gastric lesions had shrunk considerably without any complications. Standard chemotherapy and/or radiotherapy could then be performed safely, and stomach conservation could be achieved in all 4 patients.

Risk of serious adverse events and fatal adverse events with sorafenib in patients with solid cancer: a meta-analysis of phase 3 randomized controlled trials†

Background

Sorafenib is a multikinase-tyrosine kinase inhibitor commonly used in a variety of cancers. There are concerns about the increased risk of serious adverse events (SAEs) and fatal adverse events (FAEs) with sorafenib. We performed an up-to-date meta-analysis of all phase 3 randomized controlled trials (RCTs) of sorafenib to quantify the increased risk of SAEs and FAEs.

Patients and methods

We carried out a systematic search of electronic databases for studies published from inception to February 2016 without any restrictions. Eligibility criteria included phase 3 RCTs of solid tumors comparing sorafenib, alone or in combination with nontargeted chemotherapy (Sorafenib arm) versus placebo or nontargeted chemotherapy (control arm). Data on SAEs and FAEs for both the arms were extracted from each study and pooled to determine the overall incidence, relative risks (RRs) and 95% Confidence Intervals (CIs).

Results

Of 471 studies identified, a total of 12 phase 3 RCTs involving 6797 solid cancer patients comparing sorafenib with control met the eligibility criteria and were included. The overall incidence of SAEs and FAEs with sorafenib were 26.4% (95% CI, 18.0-36.9%) and 1.3% (95% CI: 0.8-2.2%), respectively. Compared with control, sorafenib use significantly increased the risk of both SAEs (RR: 1.49, 95% CI: 1.18-1.89, P = 0.001) and FAEs (RR: 1.82, 95% CI: 1.05-3.14, P = 0.033). This association varied significantly with cancer types (P < 0.001) and approval status (P = 0.012) for SAEs but no evidence of heterogeneity was found for FAEs.

Conclusions

This meta-analysis of phase 3 RCTs demonstrates an increased risk of both SAEs and FAEs with sorafenib use in adult patients with solid cancers. This quantification of increased risks of SAEs and FAEs will be important in considering the trade-off of sorafenib treatment during shared decision-making.

Planar Hall effect from the surface of topological insulators

A prominent feature of topological insulators (TIs) is the surface states comprising of spin-nondegenerate massless Dirac fermions. Recent technical advances have made it possible to address the surface transport properties of TI thin films by tuning the Fermi levels of both top and bottom surfaces. Here we report our discovery of a novel planar Hall effect (PHE) from the TI surface, which results from a hitherto-unknown resistivity anisotropy induced by an in-plane magnetic field. This effect is observed in dual-gated devices of bulk-insulating Bi_2-x Sb _x Te₃ thin films, where the field-induced anisotropy presents a strong dependence on the gate voltage with a characteristic two-peak structure near the Dirac point. The origin of PHE is the peculiar time-reversal-breaking effect of an in-plane magnetic field, which anisotropically lifts the protection of surface Dirac fermions from backscattering. The observed PHE provides a useful tool to analyze and manipulate the topological protection of the TI surface.