Bulk-Boundary Correspondence in Point-Gap Topological Phases.

A striking feature of non-Hermitian systems is the presence of two different types of topology. One generalizes Hermitian topological phases, and the other is intrinsic to non-Hermitian systems, which are called line-gap topology and point-gap topology, respectively. Whereas the bulk-boundary correspondence is a fundamental principle in the former topology, its role in the latter has not been clear yet. This Letter establishes the bulk-boundary correspondence in the point-gap topology in non-Hermitian systems. After revealing the requirement for point-gap topology in the open boundary conditions, we clarify that the bulk point-gap topology in open boundary conditions can be different from that in periodic boundary conditions. On the basis of real space topological invariants and the K theory, we give a complete classification of the open boundary point-gap topology with symmetry and show that the nontrivial open boundary topology results in robust and exotic surface states.

Universal Platform of Point-Gap Topological Phases from Topological Materials.

Whereas point-gap topological phases are responsible for exceptional phenomena intrinsic to non-Hermitian systems, their realization in quantum materials is still elusive. Here, we propose a simple and universal platform of point-gap topological phases constructed from Hermitian topological insulators and superconductors. We show that (d-1)-dimensional point-gap topological phases are realized by making a boundary in d-dimensional topological insulators and superconductors dissipative. A crucial observation of the proposal is that adding a decay constant to boundary modes in d-dimensional topological insulators and superconductors is topologically equivalent to attaching a (d-1)-dimensional point-gap topological phase to the boundary. We furthermore establish the proposal from the extended version of the Nielsen-Ninomiya theorem, relating dissipative gapless modes to point-gap topological numbers. From the bulk-boundary correspondence of the point-gap topological phases, the resultant point-gap topological phases exhibit exceptional boundary states or in-gap higher-order non-Hermitian skin effects.

Nielsen-Ninomiya Theorem with Bulk Topology: Duality in Floquet and Non-Hermitian Systems.

The Nielsen-Ninomiya theorem is a fundamental theorem on the realization of chiral fermions in static lattice systems in high-energy and condensed matter physics. Here we extend the theorem in dynamical systems, which include the original Nielsen-Ninomiya theorem in the static limit. In contrast to the original theorem, which is a no-go theorem for bulk chiral fermions, the new theorem permits them due to bulk topology intrinsic to dynamical systems. The theorem is based on duality enabling a unified treatment of periodically driven systems and non-Hermitian ones. We also present the extended theorem for nonchiral gapless fermions protected by symmetry. Finally, as an application of our theorem and duality, we predict a new type of chiral magnetic effect-the non-Hermitian chiral magnetic skin effect.

Non-Hermitian Skin Effects in Hermitian Correlated or Disordered Systems: Quantities Sensitive or Insensitive to Boundary Effects and Pseudo-Quantum-Number.

There is a common belief in the condensed matter community that bulk quantities become insensitive to the boundary condition in the infinite-volume limit. Here we reconsider this statement in terms of recent arguments of non-Hermitian skin effects-strong dependence of spectra on boundary conditions for the non-Hermitian Hamiltonians-in the traditional Green's function formalism. We find the criterion for quantities to be sensitive or insensitive against the boundary condition in Hermitian correlated or disordered systems, which is characterized by the residue theorem. We also discuss the uncertainty of the quasiparticle energy under the skin effects in terms of non-normal pseudospectra, which can be tested via the sharp optical absorption from the bulk-surface coupling. Our result indicates that pseudo quantum number emerges as a consequence of large nonnormality.

Nosocomial infections caused by vancomycin-resistant Enterococcus in a Japanese general hospital and molecular genetic analysis.

INTRODUCTION: Vancomycin-resistant Enterococcus (VRE) is a rare bacterium in Japan, but an outbreak due to nosocomial transmission in medical facilities has been reported in recent years. Here, we report the outbreak of vanA vancomycin-resistant Enterococcus faecium (VREfm) in multiple wards of Nara Prefectural General Medical Center in 2019 and results of the molecular epidemiology analysis. METHODS: An aggressive screening program was conducted after the first VREfm was detected in a patient in the A ward. During the outbreak, 6000 rectal swab samples were screened for VRE by culture. Isolates from 60 patients with VREfm detected were clustered using pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing (MLST). RESULTS: PFGE revealed a cluster consisting of three major clusters and four multi-strains. The first major cluster consisted of 26 isolates, the second consisted of 10 isolates, the third consisted of 6 isolates, and the remaining 4 clusters consisted of 2 isolates. MLST identified an allele profile (ST80) in most clusters of clone types P01-P06 but an allele profile (ST992) in cluster P07. CONCLUSION: Based on the PFGE pattern, this case was considered to be a nosocomial infection due to multiple clones. Later, in addition to screening, sharing of hospital information, cohorting of patients and staff, and strengthening of environmental cleanup were carried out, and horizontal infection was suppressed.

A case of Bordetella trematum and Kerstersia gyiorum infections in a patient with congestive dermatitis.

Bordetella trematum and Kerstersia gyiorum are rare gram-negative bacilli that are not frequently detected in human infections. In this report, we describe a case of a 48-year-old man who presented to our hospital with an infected wound on his leg. Discharges from the cracks of the granulation were collected and evaluated in our microbiology laboratory. Gram staining of the specimen showed polymorphonuclear leukocytes and abundant gram-negative bacilli. Three types of colonies were isolated on blood agar and were identified as B. trematum and Alcaligenes faecalis using VITEK MS. Moreover, K. gyiorum and B. trematum were identified and confirmed via 16S ribosomal RNA (rRNA) gene sequencing. The patient successfully recovered following application of meropenem antibacterial therapy and surgical debridement. This is the first reported case of complex wound infection caused by both B. trematum and K. gyiorum. Identification of B. trematum has recently been made possible by routine bacterial identification using matrix-assisted laser desorption-ionization time-of-flight mass spectrometry (MALDI-TOF MS). However, K. gyiorum isolation is still rare, and species identification requires 16S rRNA sequencing. Thus, this case highlighted the importance of using multiple methods, such as MALDI-TOF MS and 16S rRNA gene sequencing, for identification of rarely isolated species from clinical specimens.

Factors associated with viral clearance periods from patients with COVID-19: A retrospective observational cohort study.

INTRODUCTION: Knowledge is limited on the virologic course of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection, particularly the time taken for viral clearance and the optimal time to discontinue isolation. This study aims to identify the clinical and demographic factors influencing the time taken for viral clearance in patients with COVID-19 to determine the optimal isolation period. METHODS: This two-center retrospective observational cohort study was conducted between March 1 and June 31, 2020. Patients with COVID-19, which was confirmed by real-time reverse transcription polymerase chain reaction, were included. Data were extracted from medical records. The positive duration, which was defined as the period from the day of symptom onset to the negative conversion day, was assessed using a generalized linear model. RESULTS: We included 63 patients. The mean positive duration was 20 days. The positive duration was significantly shorter for patients younger than 30 years of age and those between 30 and 60 years of age than for patients older than 60 years of age. We observed a more scattered distribution of the positive duration in older patients than in younger patients. CONCLUSIONS: Younger patients who recovered from COVID-19 took less time to clear SARS-CoV-2 than older patients; thus, a classification of the isolation periods based on age could be considered. A uniform viral clearance period for older patients may be difficult to determine because of biases such as underlying medical conditions. Further surveillance measures are recommended to determine the viral clearance time and the optimal isolation period.

Topological Origin of Non-Hermitian Skin Effects.

A unique feature of non-Hermitian systems is the skin effect, which is the extreme sensitivity to the boundary conditions. Here, we reveal that the skin effect originates from intrinsic non-Hermitian topology. Such a topological origin not merely explains the universal feature of the known skin effect, but also leads to new types of the skin effects-symmetry-protected skin effects. In particular, we discover the Z_{2} skin effect protected by time-reversal symmetry. On the basis of topological classification, we also discuss possible other skin effects in arbitrary dimensions. Our work provides a unified understanding about the bulk-boundary correspondence and the skin effects in non-Hermitian systems.

Topological Phase Transition Driven by Infinitesimal Instability: Majorana Fermions in Non-Hermitian Spintronics.

Quantum phase transitions are intriguing and fundamental cooperative phenomena in physics. Analyzing a superconducting nanowire with spin-dependent non-Hermitian hopping, we discover a topological quantum phase transition driven by infinitesimal cascade instability. The anomalous phase transition is complementary to the universal non-Bloch wave behavior of non-Hermitian systems. We show that an infinite small magnetic field drastically suppresses the non-Hermitian skin effect, inducing a topological phase with Majorana boundary states. Furthermore, by identifying the bulk topological invariant, we establish the non-Hermitian bulk-boundary correspondence that does not have a Hermitian counterpart. We also discuss an experimental realization of the system by using the spin-current injection to a quantum wire.

Classification of Exceptional Points and Non-Hermitian Topological Semimetals.

Exceptional points are universal level degeneracies induced by non-Hermiticity. Whereas past decades witnessed their new physics, the unified understanding has yet to be obtained. Here we present the complete classification of generic topologically stable exceptional points according to two types of complex-energy gaps and fundamental symmetries of charge conjugation, parity, and time reversal. This classification reveals unique non-Hermitian gapless structures with no Hermitian analogs and systematically predicts unknown non-Hermitian semimetals and nodal superconductors; a topological dumbbell of exceptional points in three dimensions is constructed as an illustration. Our work paves the way toward richer phenomena and functionalities of exceptional points and non-Hermitian topological semimetals.

Majorana Multipole Response of Topological Superconductors.

In contrast to elementary Majorana particles, emergent Majorana fermions (MFs) in condensed-matter systems may have electromagnetic multipoles. We developed a general theory of magnetic multipoles for helical MFs on time-reversal-invariant superconductors. The results show that the multipole response is governed by crystal symmetry, and that a one-to-one correspondence exists between the symmetry of Cooper pairs and the representation of magnetic multipoles under crystal symmetry. The latter property provides a way to identify unconventional pairing symmetry via the magnetic response of helical MFs. We also find that most helical MFs exhibit a magnetic-dipole response, but those on superconductors with spin-3/2 electrons may display a magnetic-octupole response in leading order, which uniquely characterizes high-spin superconductors. Detection of such an octupole response provides direct evidence of high-spin superconductivity, such as in half-Heusler superconductors.

Topological superconductors: a review.

This review elaborates pedagogically on the fundamental concept, basic theory, expected properties, and materials realizations of topological superconductors. The relation between topological superconductivity and Majorana fermions are explained, and the difference between dispersive Majorana fermions and a localized Majorana zero mode is emphasized. A variety of routes to topological superconductivity are explained with an emphasis on the roles of spin-orbit coupling. Present experimental situations and possible signatures of topological superconductivity are summarized with an emphasis on intrinsic topological superconductors.

Topological Superconductivity in Dirac Semimetals.

Dirac semimetals host bulk band-touching Dirac points and a surface Fermi loop. We develop a theory of superconducting Dirac semimetals. Establishing a relation between the Dirac points and the surface Fermi loop, we clarify how the nontrivial topology of Dirac semimetals affects their superconducting state. We note that the unique orbital texture of Dirac points and a structural phase transition of the crystal favor symmetry-protected topological superconductivity with a quartet of surface Majorana fermions. We suggest the possible application of our theory to recently discovered superconducting states in Cd_{3}As_{2}.

Crossed surface flat bands of Weyl semimetal superconductors.

It has been noted that certain surfaces of Weyl semimetals have bound states forming open Fermi arcs, which are never seen in typical metallic states. We show that the Fermi arcs enable them to support an even more exotic surface state with crossed flat bands in the superconducting state. We clarify the topological origin of the crossed flat bands and the relevant symmetry that stabilizes the cross point. Our symmetry analysis is applicable to known candidate materials of time-reversal breaking Weyl semimetals. We also discuss their possible experimental verification by tunneling spectroscopy.

[A Case of Disseminated Cutaneous Mycobacterium chelonae Infection Successfully Improved with Thermal Therapy].

A 54-year-old female with dermatomyositis treated with cyclosporine and methylprednisolone presented with multiple subcutaneous nodules on her upper and lower extremities on December 2011. The number of lesions gradually increased. She had a history of surgical intervention such as debridement, skin graft of right lower leg due to trauma and subsequent bacterial infection on August 2011. Culture from a skin lesion on June 2012 confirmed Mycobacterium chelonae, which was susceptible to clarithromycin (CAM). We started treatment with CAM, imipenem/cilastatin (IPM/CS) and tobramycin (TOB) for 2 weeks. Then CAM monotherapy was continued, however CAM was discontinued because of liver dysfunction. In September 2012 new nodular lesions were observed on the left arm and right leg. We administrated azithromycin, IPM/CS and TOB. Subcutaneous nodules were partially improved, but new lesions appeared on her right leg. A culture of skin lesion yielded M. chelonae, which was highly resistant to CAM and IPM/CS. Based on the sensitivity test, moxifloxacin was used. However, there was no significant improvement in her skin lesions, so we started thermal therapy on day 57 after admission. She showed an excellent response to thermal therapy, and there has been no recurrence.

Scoring system to predict positive peritoneal cytology in patients with resectable and borderline resectable pancreatic cancer.

BACKGROUND: The aim of this study was to evaluate factors to predict positive peritoneal cytology, whcih would determine the indication for staging laparoscopy in pancreatic cancer. METHODS: A total of 430 patients that underwent pancreatectomy for resectable and borderline resectable pancreatic cancer were retrospectively reviewed. RESULTS: Among 430 patients, 36 had positive cytology (8.4%). Median survival time in negative cytology was 24.7 months, compared with 15.1 months in positive cytology (p = .004). Factors to predict positive cytology in pancreatic cancer according to multivariate analysis were tumor location (body, tail; OR 2.66; 95% CI: 1.21-5.85; p = .015), tumor size ≥30 mm (OR 2.95; 95% CI: 1.35-6.47; p = .007) and radiographic other-organ invasion (HR 2.79; 95% CI: 1.01-7.67; p = .047). Patients were scored 0 to 3 corresponding with these factors. Rates of positive cytology increases in each score were: score 0: 2.9%, score 1: 6.7%, score 2: 18.3%, score 3: 36.8%. CONCLUSIONS: Tumor location (body or tail), tumor size ≥30 mm, and radiographic other-organ invasions were risk factors for positive cytology in pancreatic cancer. This scoring system might be a useful indicator to perform staging laparoscopy to diagnose positive cytology.

Short-term serial circulating tumor DNA assessment predicts therapeutic efficacy for patients with advanced pancreatic cancer.

PURPOSE: We investigated the potential clinical utility of short-term serial KRAS-mutated circulating cell-free tumor DNA (ctDNA) assessment for predicting therapeutic response in patients undergoing first-line chemotherapy for advanced pancreatic cancer. METHODS: We collected 144 blood samples from 18 patients with locally advanced or metastatic cancer that were undergoing initial first-line chemotherapy of gemcitabine plus nab-paclitaxel (GEM plus nab-PTX). Analysis of KRAS-mutated ctDNA was quantified by digital droplet polymerase chain reaction (ddPCR) as mutant allele frequency (MAF). This study investigated pretreatment KRAS-mutated ctDNA status and ctDNA kinetics every few days (days 1, 3, 5 and 7) after initiation of chemotherapy and their potential as predictive indicators. RESULTS: Of the 18 enrolled patients, an increase in KRAS-mutated ctDNA MAF values from day 0-7 after initiation of chemotherapy was significantly associated with disease progression (P < 0.001). Meanwhile, positive pretreatment ctDNA status (MAF ≥ 0.02%) (P = 0.585) and carbohydrate antigen 19-9 (CA19-9) values above the median (P = 0.266) were not associated with disease progression. In univariate analysis, this short-term increase in ctDNA MAF values (day 0-7) was found to be associated with significantly shorter progression free survival (PFS) (hazard ration [HR], 24.234; range, (2.761-212.686); P = 0.0002). CONCLUSION: This short-term ctDNA kinetics assessment may provide predictive information to reflect real-time therapeutic response and lead to effective refinement of regimen in patients with advanced pancreatic cancer undergoing systemic chemotherapy.

Symmetry-protected Majorana fermions in topological crystalline superconductors: theory and application to Sr2RuO4.

Crystal point group symmetry is shown to protect Majorana fermions (MFs) in spinfull superconductors (SCs). We elucidate the condition necessary to obtain MFs protected by the point group symmetry. We argue that superconductivity in Sr2RuO4 hosts a topological phase transition to a topological crystalline SC, which accompanies a d-vector rotation under a magnetic field along the c axis. Taking all three bands and spin-orbit interactions into account, symmetry-protected MFs in the topological crystalline SC are identified. Detection of such MFs provides evidence of the d-vector rotation in Sr2RuO4 expected from Knight shift measurements but not yet verified.

Radiographic duodenal invasion is associated with poor prognosis and early recurrence in patients with pancreatic ductal adenocarcinoma.

BACKGROUND: The prognostic impact of radiographic duodenal invasion (rDI) of pancreatic ductal adenocarcinoma (PDAC) has yet to be fully elucidated. This retrospective study aimed to investigate the prognostic and clinicopathological significance of rDI in patients with PDAC after pancreatoduodenectomy (PD). MATERIALS AND METHODS: We retrospectively analyzed 223 consecutive patients with resectable (R) and borderline resectable (BR)-PDAC that underwent up-front PD between 2002 and 2018. rDI was assessed by preoperative multi-detector row computed tomography. RESULTS: Ninety-three (42%) patients with PDAC had rDI, and all of them had pathological DI (pDI). The rDI(+) group had larger tumor size, BR-PDAC was more common, there was higher serum CA19-9 level, and microscopic lymphovascular invasion was more common than in the rDI(-) group. rDI was associated with significant reduction in overall survival (OS) (P < 0.001) and recurrence-free survival (RFS) (P < 0.001). In multivariate analysis, rDI was an independent prognostic factor in OS [hazard ratio (HR) = 0.52; 95% confidence interval (CI) 0.38-0.73, P < 0.001] and RFS [HR = 0.56; 95% CI 0.40-0.78, P = 0.001]. rDI was also an independent risk factor for early recurrence within 12 months [odds ratio (OR) = 0.36; 95% CI 0.18-0.73, P = 0.005]. rDI had positive correlation with liver recurrence (P = 0.024). CONCLUSION: Biological aggressiveness of PDAC with rDI implies short OS and early recurrence with frequent liver metastasis. Aggressive perioperative chemotherapy is recommended to improve prognosis, especially for R-PDAC patients with rDI.

Symmetry protected topological order and spin susceptibility in superfluid 3He-B.

We here demonstrate that the superfluid (3)He-B under a magnetic field in a particular direction stays topological due to a discrete symmetry, that is, in a symmetry protected topological order. Because of the symmetry protected topological order, helical surface Majorana fermions in the B phase remain gapless and their Ising spin character persists. We unveil that the competition between the Zeeman magnetic field and dipole interaction involves an anomalous quantum phase transition in which a topological phase transition takes place together with spontaneous symmetry breaking. Based on the quasiclassical theory, we illustrate that the phase transition is accompanied by anisotropic quantum criticality of spin susceptibilities on the surface, which is detectable in NMR experiments.