Search

Gastrointestinal mucormycosis is a rare infection in solid organ transplant recipients. Our patient, a 79-year-old male, presented with severe dysphagia and odynophagia about 2 weeks after receiving a renal transplant. An upper gastrointestinal (UGI) endoscopy revealed esophagitis and gastric ulceration, the cultures from which grew Rhizopus species. A usual treatment strategy should include Amphotericin B as monotherapy or in combination with Posaconazole or Isavuconazole for such infections. Our patient was treated with Isavuconazole monotherapy, in an effort to minimize renal toxicity from Amphotericin B to the new allograft. Unique to our case was a successful clinical response and resolution of UGI lesions with Isavuconazole monotherapy. Due to the vagueness of presenting symptoms, such infections can be easily missed in an immunocompromised patient which can have tragic outcomes. Prompt diagnosis and modulation of immunosuppression are essential to decrease mortality and morbidity. Isavuconazole is a novel agent and can be used as a monotherapy for such infections, especially in renal transplant recipients.

A review of the treatment of allergic and invasive fungal sinusitis, as well as a presentation of the first recorded case of a conversion from allergic fungal sinusitis (AFS) to chronic granulomatous invasive sinusitis and the fourth case of invasive fungal sinusitis associated with Curvularia. This immunocompetent patient suffering from chronic AFS converted after repeated high-dose steroid tapers and noncompliance. AFS may present atypically and should be suspected even in immunocompetent patients with sinus disease who report new onset pain and neurologic symptoms. Clinicians should consider the potential complications associated with repeated systemic steroid administration. Laryngoscope, 129:2447-2450, 2019.

This paper presents design challenges and solutions for the fifth generation (5G) phased-array transceiver ICs in millimeter-wave (MMW) frequency bands. A 28nm bulk CMOS device technology is selected to integrate multiple RF phased-array elements in a single-chip to achieve a high-level of TX EIRP and RX sensitivity. Several design approaches of gain, P OUT , stability, reliability and linearity enhancement techniques are applied to enable CMOS as a key device solution for 5G applications in MMW frequency bands. A 39GHz band 16-channel CMOS RF phased-array transceiver IC is designed and can support 4T/4R MIMO base-station applications including ×64 RF phased-array ICs (total 1,024 phased-array elements). T/RX paths have gain dynamic ranges of >30/40dB for flexibility and scalability. The TX path shows P OUT /Ch. of >6.0dBm at EVM of -34dB (800MHz) and P DC /Ch. of 105mW. The RX path performs NF of 4.2dB, EVM of -38dB (100MHz) and P DC /Ch. of 39mW. These state-of-the-art results lead to TX EIRP of >55dBm and RX sensitivity of

The diagnosis of nodal marginal zone lymphoma (NMZL) can be challenging, with the differential diagnosis including other low-grade B-cell lymphomas, reactive hyperplasia, and even some cases of peripheral T-cell lymphoma (PTCL). PTCL may have a perifollicular growth pattern mimicking NMZL. We and others have noted an atypical distribution of T-follicular helper (T(FH)) cells in some cases of NMZL. This study was prompted by the diagnosis of NMZL in several cases in which a marked increase of T(FH) cells, as determined by staining for programmed death-1 (PD1), had prompted suspicion for a diagnosis of PTCL. We analyzed PD1 staining in 48 cases of NMZL to characterize the extent and pattern of the PD1-positive infiltrate. Three main patterns of PD1 staining were identified: follicular pattern (peripheral, n= 16; central, n = 9; mixed, n = 3), diffuse pattern (n = 4), and a reduced or normal staining pattern in residual follicles (n = 16). A comprehensive analysis of other T(FH) markers was undertaken in 14 cases with a high content of PD1-positive cells that were confirmed as B-cell lymphoma by clonality analysis. We describe in detail 5 of these cases in which PTCL was an initial consideration. This study illuminates the diverse immunohistochemical patterns encountered in NMZL and highlights a diagnostic pitfall important for diagnostic accuracy.

Background: Quantitative evaluation of serum free light chains is recommended for the work up of monoclonal gammopathies. Immunoglobulin light chains are generally produced in excess of heavy chains. In patients with monoclonal gammopathy, κ/λ ratio is abnormal less frequently with lambda chain lesions. This study was undertaken to ascertain if the levels of overproduction of the two light chain types and their detection rates are different in patients with neoplastic monoclonal gammopathies. Methods: Results of serum protein electrophoresis (SPEP), serum protein immunofixation electrophoresis (SIFE), urine protein electrophoresis (UPEP), urine protein immunofixation electrophoresis (UIFE), and serum free light chain assay (SFLCA) in patients with monoclonal gammopathies were examined retrospectively. Results: The κ/λ ratios were appropriately abnormal more often in kappa chain lesions. Ratios of κ/λ were normal in about 25% of patients with lambda chain lesions in whom free homogenous lambda light chains were detectable in urine. An illustrative case suggests underproduction of free lambda light chains, in some instances. Conclusions: The lower prevalence of lambda dominant κ/λ ratio in lesions with lambda light chains is estimated to be due to relative under-detection of lambda dominant κ/λ ratio in about 25% of the patients and because lambda chains are not produced in as much excess of heavy chains as are kappa chains, in about 5% of the patients. The results question the medical necessity and clinical usefulness of the serum free light chain assay. UPEP/UIFE is under-utilized. J Clin Med Res. 2018;10(7):562-569 doi: https://doi.org/10.14740/jocmr3383w

Objectives To develop a transcriptomic signature capable of predicting overall survival (OS) for uterine serous carcinoma (USC). Methods RNAseq data for 58 USC patients were obtained from TCGA. Expression of 73 candidate genes was measured for 67 Augusta University (AU) samples using NanoString technology. Results Analysis of the TCGA RNAseq data identified 73 genes that individually predict prognosis for USC patients and an elastic net model with all 73 genes (USC73) distinguishes a good OS group with low USC73 score from a poor OS group with high USC73 score (5-year OS = 83.3% and 13.3% respectively, HR = 40.1; p = 3 × 10−8). This finding was validated in the independent AU cohort (HR = 4.3; p = 0.0004). The poor prognosis group with high USC73 score consists of 37.9% and 32.8% of patients in the TCGA and AU cohort respectively. USC73 score and pathologic stage independently contribute to OS and together provide the best prognostic value. Early stage, low USC73 patients have the best prognosis (5-year OS = 85.1% in the combined dataset), while advanced stage, high USC73 patients have the worst prognosis (5-year OS = 6.4%, HR = 30.5, p = 1.2 × 10−12). Consistent with the observed poor survival, primary cell cultures from high USC73 patients had higher proliferation rate and cell cycle progression; and high USC73 patients had lower rates of complete response to standard therapy. Conclusions The USC73 transcriptomic signature and stage independently predict OS of USC patients and the best prediction is achieved using USC73 and stage. USC73 may also serve as a therapeutic biomarker to guide patient care.

BackgroundSerum free light chain assay is used in the diagnosis and monitoring of monoclonal gammopathic manifestations. For the kappa (κ)/lambda (λ) ratio, there is a 36% false-positive rate in patients without monoclonal gammopathic manifestations and a 30% false-negative rate in patients with monoclonal gammopathic manifestations. This study was undertaken to address the higher false-negative rate in λ chain–associated monoclonal lesions.MethodsResults of serum protein electrophoresis, serum immunofixation electrophoresis, and serum free light chain assays were reviewed retrospectively. The results for serum free light chains in cases of intact immunoglobulin monoclonal gammopathic manifestations only were analyzed.ResultsConcentrations of involved serum free light chains were significantly higher in κ chain–associated lesions than in λ chain–associated lesions. The concentration of uninvolved light chains was significantly higher in λ chain–associated lesions.Conclusionsκ light chains are present in significantly greater abundance than are λ chains in their respective monoclonal lesions. Moreover, κ and λ light-chain levels are not comparable for similar quantitative levels of monoclonal immunoglobulins. The findings warrant a reconsideration of the role of serum free light chain concentrations and involved to uninvolved serum free light chain ratio in designation of myeloma-defining conditions and other diagnostic criteria based on serum free light chain assay.

III–V n-channel MOSFETs based on In x Ga1− x As are evaluated for low-power (LP) technology at a sub-10-nm technology node. Aggressive design rules are followed, while industry-relevant FinFET architecture is selected. We show, for the first time, quantum confinement-related leakage and performance tradeoff done self-consistently in performance evaluation using an in-house developed semiclassical tool. In this paper, we focus on In0.53Ga0.47As as the channel material, as it has been investigated heavily in the literature. Furthermore, it has a bulk bandgap $E_{G}$ similar to that of Ge, another highly studied complementary p-FET channel material. Higher In-content results in lower $E_{G}$ and hence larger band-to-band tunneling (BTBT) current, resulting in more stringent design requirements for LP applications. A comparison is done with the state-of-the-art tensile-Si (t-Si) technology, with roughly 2-GPa stress, under similar constraints ( $L_{G}$ , design rules). Thus, we show that while for 0.75 V operation, In0.53Ga0.47As performance is limited by the BTBT and fails to outperform t-Si, it starts to perform better than t-Si below 0.7 V. $V_{{\rm {DD}}}$ scaling further results in an increased performance gap between the two material systems.

The novel effects of preferred gate metal grain orientation on tunneling FETs (TFETs) have been investigated for the first time. It has been observed that TFETs have preferred gate metal grain orientation to lower work-function variation (WFV) unlike MOSFETs. In the case of TFETs, when the metal gate grain orientation with low work function is dominant, the WFV is effectively suppressed. This brief provides a design guideline for the suppression of TFET WFV.

The body bias dependence of gate-induced drain leakage (GIDL) current for a fin field effect transistor fabricated on a bulk Si wafer (bulk FinFET) is investigated. The local damascene (LD) bulk FinFET is measured under various bias conditions and the effect of the body-bias-induced lateral electric field on GIDL current is evaluated. A lateral electric field shield effect under fin depleted condition is proposed and it is validated by the three-terminal band-to-band tunneling current model. The GIDL current of the bulk FinFET can be reduced by reducing the body bias, and an improvement in retention characteristics is expected.

This paper reports the design and fabrication of a practical Si nanowire (NW) transistor for beyond 10 nm logic devices application. The dependency of the DC and AC performances of Si NW MOSFETs on NW diameter (DNW) and gate oxide thickness has been investigated. A Si NW device with the scaled DNW of 9 nm and thin equivalent oxide thickness (EOT) of 0.9 nm improved both on-current and electrostatic characteristics. Finally, a Nanowire-On-Insulator (NOI) structure has been proposed to enhance the AC performance of a multiple-stacked NWs structure, which improves DC performance but has the issue of high parasitic capacitance. As a result, the simulated AC performance of a triple-NOI structure was improved by around 20% compared to conventional triple NW structure.

Heat shock protein 70 (HSP70) is involved not only in protein folding, but also in processes of differentiation and cell-cycle progression. Recently, HSP70 has been implicated in mediation of functions of some immunosuppressive agents. To study the role of HSP70 in differentiation of haematopoietic cells, we generated transgenic mice using the human inducible hsp70 gene fused to the mouse H-2K promoter. These mice develop a T-cell deficiency that is characterized by thymic hypoplasia and a significant reduction in peripheral T cells. The total number of thymocytes is about 100-fold less than that in normal mice. The majority of the thymocytes are immature T cells that express neither CD4 nor CD8 molecules, indicating that T cells are affected at an early stage of thymic differentiation. Expression of the transgenic HSP70 was detected both in bone marrow cells and in thymocytes. Furthermore, injection of normal bone marrow cells into the T-cell deficient mice led to the generation of mature T cells indicating that the T-cell deficiency was caused by the action of HSP70 in T cells. The blockage of differentiation occurred only in T cells, both alphabeta- and gammadelta-T-cell receptor (TCR)-bearing cells, but not in B cells, granulocytes, and monocytes. The observations suggest that HSP70 may inhibit a cellular process that is essential for the differentiation of early stage T cells. Further experiments using this model system will widen our understanding of HSP70 and its function on a molecular level.

Triple gate FinFET is emerging as a promising candidate for the future CMOS device structures because of its immunity to short-channel effect. However, the suppression of GIDL is a significant challenge for its application. In this paper, we discuss the characteristics of GIDL on FinFET and extensively analyze the influence of the device technology on GIDL. The analysis is expected to give guidelines to the future development of triple gate FinFET.

As the lithography-driven scaling has been replaced by physically-based scaling, TCAD has become a principal tool for virtual characterization of technology development. This paper describes roles, benefits, capabilities and perspectives of TCAD applications for technology and product development. Emerging challenges in the nanotechnology era are also discussed

Purpose : To determine the accuracy of magnetic resonance (MR) arthrography in the detection and staging of lesions of the acetabular labrum. Materials and Methods : Fifteen hips of 14 patients with chronic hip pain and clinical suspicion of labral lesions were examined with direct or indirect MR arthrography and underwent subsequent arthroscopic evaluation. The study population consisted of six women and eight men aged between 40 and 59 years. Nine arthrograms were obtained intra-articular administration of gadolinium solution, and six involved articular motion exercise after intravenous administration of gadolinium solution. In 14 cases a phased-array pelvic coil was used, and a shoulder coil in one. Fat-suppressed T1-weighted images were obtained in the coronal, oblique coronal and oblique axial planes, and T1-and T2-weighted images were obtained in the axial plane. Labral lesions were graded according to the Czerny classification and evaluated on the basis of presence or absence of a tear and lo-cation (anteroinferior, anterosuperior, superior, posterosuperior, posteroinferior). The findings were then cor-related with the arthroscopic findings. Results : After direct and indirect MR arthography, the findings-based on the Czerny classification -were as follows : stage IA:3; IB:1; IIA:8; IIB:1; IIIA:4; IIIB:0. MR arthrography also showed that seven cases were locat-ed in the anterosuperior portion of the labrum, seven in the superior portion, and three in the posteroinferior portion. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of MR arthrography for diagnosis of the labral tear was 92%, 75%, 92%, 75 %, and 88 %, respectively. Conclusion : In this preliminary study, MR arthrography appears to be a promising imaging modality for accu-rate diagnosis and useful for screening patients with chronic hip pain.