Diagnostic accuracy of magnetically guided capsule endoscopy with a detachable string for detecting oesophagogastric varices in adults with cirrhosis: prospective multicentre study.

OBJECTIVE: To evaluate the diagnostic accuracy and safety of using magnetically guided capsule endoscopy with a detachable string (ds-MCE) for detecting and grading oesophagogastric varices in adults with cirrhosis. DESIGN: Prospective multicentre diagnostic accuracy study. SETTING: 14 medical centres in China. PARTICIPANTS: 607 adults (>18 years) with cirrhosis recruited between 7 January 2021 and 25 August 2022. Participants underwent ds-MCE (index test), followed by oesophagogastroduodenoscopy (OGD, reference test) within 48 hours. The participants were divided into development and validation cohorts in a ratio of 2:1. MAIN OUTCOME MEASURES: The primary outcomes were the sensitivity and specificity of ds-MCE in detecting oesophagogastric varices compared with OGD. Secondary outcomes included the sensitivity and specificity of ds-MCE for detecting high risk oesophageal varices and the diagnostic accuracy of ds-MCE for detecting high risk oesophagogastric varices, oesophageal varices, and gastric varices. RESULTS: ds-MCE and OGD examinations were completed in 582 (95.9%) of the 607 participants. Using OGD as the reference standard, ds-MCE had a sensitivity of 97.5% (95% confidence interval 95.5% to 98.7%) and specificity of 97.8% (94.4% to 99.1%) for detecting oesophagogastric varices (both P<0.001 compared with a prespecified 85% threshold). When using the optimal 18% threshold for luminal circumference of the oesophagus derived from the development cohort (n=393), the sensitivity and specificity of ds-MCE for detecting high risk oesophageal varices in the validation cohort (n=189) were 95.8% (89.7% to 98.4%) and 94.7% (88.2% to 97.7%), respectively. The diagnostic accuracy of ds-MCE for detecting high risk oesophagogastric varices, oesophageal varices, and gastric varices was 96.3% (92.6% to 98.2%), 96.9% (95.2% to 98.0%), and 96.7% (95.0% to 97.9%), respectively. Two serious adverse events occurred with OGD but none with ds-MCE. CONCLUSION: The findings of this study suggest that ds-MCE is a highly accurate and safe diagnostic tool for detecting and grading oesophagogastric varices and is a promising alternative to OGD for screening and surveillance of oesophagogastric varices in patients with cirrhosis. TRIAL REGISTRATION: ClinicalTrials.gov NCT03748563.

Room-temperature chiral charge pumping in Dirac semimetals.

Chiral anomaly, a non-conservation of chiral charge pumped by the topological nontrivial gauge fields, has been predicted to exist in Weyl semimetals. However, until now, the experimental signature of this effect exclusively relies on the observation of negative longitudinal magnetoresistance at low temperatures. Here, we report the field-modulated chiral charge pumping process and valley diffusion in Cd3As2. Apart from the conventional negative magnetoresistance, we observe an unusual nonlocal response with negative field dependence up to room temperature, originating from the diffusion of valley polarization. Furthermore, a large magneto-optic Kerr effect generated by parallel electric and magnetic fields is detected. These new experimental approaches provide a quantitative analysis of the chiral anomaly phenomenon which was inaccessible previously. The ability to manipulate the valley polarization in topological semimetal at room temperature opens up a route towards understanding its fundamental properties and utilizing the chiral fermions.

Landau level splitting in Cd3As2 under high magnetic fields.

Three-dimensional topological Dirac semimetals (TDSs) are a new kind of Dirac materials that exhibit linear energy dispersion in the bulk and can be viewed as three-dimensional graphene. It has been proposed that TDSs can be driven to other exotic phases like Weyl semimetals, topological insulators and topological superconductors by breaking certain symmetries. Here we report the first transport experiment on Landau level splitting in TDS Cd3As2 single crystals under high magnetic fields, suggesting the removal of spin degeneracy by breaking time reversal symmetry. The detected Berry phase develops an evident angular dependence and possesses a crossover from non-trivial to trivial state under high magnetic fields, a strong hint for a fierce competition between the orbit-coupled field strength and the field-generated mass term. Our results unveil the important role of symmetry breaking in TDSs and further demonstrate a feasible path to generate a Weyl semimetal phase by breaking time reversal symmetry.