Continuous-wave 193.4 nm laser with 120 mW output power.

This Letter describes an all-solid-state continuous-wave, deep-ultraviolet coherent source that generates more than 100 mW of output power at 193.4 nm. The source is based on nonlinear frequency conversion of three single-frequency infrared fiber laser master-oscillator power-amplifier (MOPA) light sources.

Portal Vein Thrombosis as a Cause of Undetermined Thrombocytopenia with Liver Dysfunction in a Patient with Eosinophilic Granulomatosis with Polyangiitis.

We herein report a 20-year-old woman who developed eosinophilic granulomatosis with polyangiitis (EGPA) and portal vein thrombosis (PVT). EGPA was diagnosed based on the patient's history of asthma, hypereosinophilia, and mononeuritis complex. Thrombocytopenia and liver dysfunction were observed, necessitating contrast-enhanced computed tomography (CECT), which revealed PVT. Her symptoms soon improved with glucocorticoids and anticoagulation therapy. As patients with EGPA often suffer from asthma, they can be hesitant to undergo CECT. However, if patients with EGPA show uncertain thrombocytopenia with liver dysfunction, a further evaluation using CECT is warranted to detect PVT.

Safe Introduction of Hydroxychloroquine Focusing on Early Intolerance Due to Adverse Drug Reactions in Patients with Systemic Lupus Erythematosus.

Objective This study explored the predictors of hydroxychloroquine intolerance and propose appropriate methods to initiate hydroxychloroquine in patients with systemic lupus erythematosus. Methods This retrospective study registered consecutive patients who were diagnosed with systemic lupus erythematosus and started treatment with hydroxychloroquine between 2015 and 2021. Any adverse events that required dose reduction or cessation of hydroxychloroquine, indicating intolerance to the drug, were recorded for up to 26 weeks after initiation of hydroxychloroquine. Results A total of 130 patients were included. Hydroxychloroquine intolerance due to adverse drug reactions was observed in 28 patients (21.5%), including gastrointestinal symptoms in 15 (11.5%) and cutaneous reactions in 7 (5.4%). Furthermore, the intolerance was observed more frequently in the maintenance group (patients treated daily with <20 mg prednisolone) than in the induction group (7.1% vs. 25.5%, p=0.04), and none of the patients in the induction group developed cutaneous reactions. The initial dose of hydroxychloroquine per ideal body weight was associated with hydroxychloroquine intolerance in a dose-dependent manner. Multivariable analyses revealed that the hydroxychloroquine dose per ideal body weight and higher levels of C4 predicted hydroxychloroquine intolerance. In particular, C4 levels were positively correlated with cutaneous reactions, whereas the dose of prednisolone was negatively correlated with gastrointestinal reactions. Conclusion Low-dose hydroxychloroquine may be optimal for induction in patients with systemic lupus erythematosus who have high C4 levels or are taking low doses of steroids.

Cryoglobulinemic Vasculitis Associated with Monoclonal Gammopathy of Undetermined Significance Developed after Sustained Virologic Response of Hepatitis C.

A 72-year-old woman had a history of chronic hepatitis C virus (HCV) infection previously treated with interferon to achieve a sustained virologic response. Thereafter, she developed polyarthritis and purpura of the lower extremities as well as progressive renal dysfunction with hypertension and proteinuria that had occurred in the last three months. Laboratory investigations revealed seropositivity for cryoglobulin but negative findings for HCV RNA. She was ultimately diagnosed with cryoglobulinemic glomerulonephritis complicated by monoclonal gammopathy of undetermined significance (MGUS) based on the pathological findings of the kidney and bone marrow, indicating that MGUS-induced cryoglobulinemic vasculitis may occur even after HCV elimination.

Appearance of anti-MDA5 antibody-positive dermatomyositis after COVID-19 vaccination.

The direct causes of dermatomyositis, a common autoimmune disease, have not yet been accurately identified, but several studies have linked this condition to various patient-associated and environmental factors, such as viral infections and area of residence. In the present report, we describe our experience with a patient presenting with anti-melanoma differentiation-associated gene 5 (MDA5) antibody-positive dermatomyositis, which developed after vaccination against coronavirus disease 2019 (COVID-19). This patient was simultaneously diagnosed with anti-glutamic acid decarboxylase antibody-positive slowly progressive insulin-dependent diabetes (SPIDDM); her human leucocyte antigen test revealed that she expressed the DRB1*04:05 allele. This is important as this genotype is known to increase susceptibility to both anti-MDA5 antibody-positive dermatomyositis and type I diabetes. To the best of our knowledge, this is the first case of dermatomyositis complicated by SPIDDM identified after COVID-19 vaccination against COVID-19 and presenting with an underlying susceptible genotype. The patient's genetic predisposition may also be important for the development of autoimmune disease after COVID-19 vaccination.

Fluorodeoxyglucose-positron emission tomography/computed tomography-positive ear lesions responsive to immunosuppressive therapy in a patient with otitis media with antineutrophil cytoplasmic antibody-associated vasculitis.

A 74-year-old woman presented with vertigo, left-beating nystagmus, and auditory disturbance 4 months prior, in whom a former physician suspected Meniere's disease. Her signs and symptoms mildly improved with a moderate dose of glucocorticoids, which was eventually tapered. Fluorodeoxyglucose (FDG)-positron emission tomography (PET)/computed tomography (CT) was performed 12 days prior to routine examination. Remarkable FDG uptake was observed in the surrounding areas of the bilateral Eustachian tubes and left middle ear, which was only partially detected on magnetic resonance imaging. The patient also tested positive for myeloperoxidase-antineutrophil cytoplasmic antibody (ANCA). She was admitted to our hospital and diagnosed with otitis media with ANCA-associated vasculitis (OMAAV) based on the classification criteria. Four months after immunosuppressive therapy, the abnormal ear findings were not observed on follow-up FDG-PET/CT. The clinical course of this case suggests that FDG-PET/CT can detect occult ear involvement better than do other modalities in patients with OMAAV. In addition, FDG-PET/CT-positive ear lesions responded to immunosuppressive therapy. Therefore, FDG-PET/CT can help distinguish OMAAV from other ear diseases with non-inflammatory aetiologies and detect occult treatment-responsive OMAAV lesions in the clinical setting.

Disseminated Mycobacterium abscessus infection with osteoarticular manifestations as an important differential diagnosis of inflammatory arthritis: A case report and literature review.

This case report describes a 52-year-old immunocompromised man diagnosed with disseminated Mycobacterium abscessus complex (MABC) infection. The patient had a history of malignant lymphoma and presented with fever and polyarthritis that lasted 3 weeks. Upon initial evaluation, blood and synovial fluid cultures from the swollen joints were negative. Reactive arthritis or rheumatoid arthritis was suspected as the cause of inflammatory synovitis in multiple joints. Administration of prednisolone followed by an interleukin-6 inhibitor improved the fever, but polyarthritis persisted, and destruction of the left hip joint was observed. Two months later, M. abscessus was detected in a blood culture and right shoulder joint synovium, leading to a final diagnosis of disseminated MABC infection. The joint symptoms resolved with combined antimicrobial therapy using amikacin, azithromycin, and imipenem/cilastatin. To date, 12 cases of disseminated MABC infection with osteoarticular manifestations have been reported. A total of 13 cases, including the present case, were reviewed. Seven patients had bone involvements, five had joint involvement, and the remaining one had bursa involvement. All the cases with joint involvement, except for our case, presented with monoarthritis. MABC infection is diagnosed based on the demonstration of MABC itself. Clinicians should keep disseminated MABC infection in mind as a possible cause of persistent arthritis. As demonstrated in our case, multiple replicate cultures of blood or specimens from the affected sites may be needed to detect it.

Seasonal Influence on Development of Antineutrophil Cytoplasmic Antibody-Associated Vasculitis: A Retrospective Cohort Study Conducted at Multiple Institutions in Japan (J-CANVAS).

OBJECTIVE: To clarify seasonal and other environmental effects on the onset of antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV). METHODS: We enrolled patients with new-onset eosinophilic granulomatosis with polyangiitis (EGPA), microscopic polyangiitis (MPA), and granulomatosis with polyangiitis (GPA) registered in the database of a Japanese multicenter cohort study. We investigated the relationship between environmental factors and clinical characteristics. Seasons were divided into 4 (spring, summer, autumn, and winter), and the seasonal differences in AAV onset were analyzed using Pearson chi-square test, with an expected probability of 25% for each season. RESULTS: A total of 454 patients were enrolled, with a mean age of 70.9 years and a female proportion of 55.5%. Overall, 74, 291, and 89 patients were classified as having EGPA, MPA, and GPA, respectively. Positivity for myeloperoxidase (MPO)-ANCA and proteinase 3 (PR3)-ANCA was observed in 355 and 46 patients, respectively. Overall, the seasonality of AAV onset significantly deviated from the expected 25% for each season (P = 0.001), and its onset was less frequently observed in autumn. In ANCA serotypes, seasonality was significant in patients with MPO-ANCA (P < 0.001), but not in those with PR3-ANCA (P = 0.97). Additionally, rural residency of patients with AAV was associated with PR3-ANCA positivity and biopsy-proven pulmonary vasculitis. CONCLUSION: The onset of AAV was influenced by seasonal variations and was less frequently observed in autumn. In contrast, the occurrence of PR3-ANCA was triggered, not by season, but by rural residency.

Primary malignant pericardial mesothelioma with difficult antemortem diagnosis: A case report.

BACKGROUND: Primary malignant pericardial mesothelioma (PMPM) is an extremely rare malignant tumor, and it is difficult to diagnose definitively before death. We present a case in which PMPM was diagnosed at autopsy. We consider this case to be highly suggestive and report it here. CASE SUMMARY: A 78-year-old male presented with transient loss of consciousness and falls. The transient loss of consciousness was considered to result from complications of diastolic dysfunction due to pericardial disease, fever with dehydration, and paroxysmal atrial fibrillation. Ultrasound cardiography (UCG) and computed tomography showed cardiac enlargement and high-density pericardial effusion. We considered pericardial disease to be the main pathogenesis of this case. Cardiac magnetic resonance imaging and gadolinium contrast-enhanced T1-weighted images showed thick staining inside and outside the pericardium. Pericardial biopsy was considered to establish a definitive diagnosis, but the patient and his family refused further treatment and examinations, and the patient was followed conservatively. We noticed a thickening of the pericardium and massive changes in the pericardium on UCG over time. We performed an autopsy 60 h after the patient died of pneumonia. Giemsa staining of the autopsy tissue showed an epithelial-like arrangement in the pericardial tumor, and immunostaining showed positive and negative factors for the diagnosis of PMPM. Based on these findings, the final diagnosis of PMPM was made. CONCLUSION: PMPM has a poor prognosis, and early diagnosis and treatment are important. The temporal echocardiographic findings may provide a clue for the diagnosis of PMPM.

Endoplasmic reticulum-mediated induction of interleukin-8 occurs by hepatitis B virus infection and contributes to suppression of interferon responsiveness in human hepatocytes.

The events in the immune response to hepatitis B virus (HBV) remain unclear. We analyzed the direct influence of HBV on gene expression in human hepatocytes under immunodeficient conditions using a human hepatocyte chimeric mouse model. HBV-infected or non-infected chimeric mouse livers were collected, and gene expression profiles were compared. Since IL-8 was the most significantly up-regulated gene at 8 weeks after HBV infection, we focused on IL-8 and found that HBx and the large HBs (L-HBs) protein induce transcription of IL-8 via endoplasmic reticulum stress. This stress induces IL-8 transcription via NFAT activation and contributes to suppression of interferon responsiveness in HBV-infected human hepatocytes. In the present study, we identified a novel regulatory mechanism in which the L-HBs protein activates IL-8 via endoplasmic reticulum stress, suggesting a key role for IL-8 in the immune response to HBV and a potential new target for antiviral treatments of HBV infection.

Ship-in-bottle synthesis of the mixed-layered compounds of clay silicate/zirconium phosphate.

An attempt was made to synthesize artificial mixed-layered compounds between montmorillonite silicate and α-zirconium phosphate using a ship-in-bottle approach. The interlayer cations of montmorillonite were first exchanged with hydroxy-zirconium oligomeric cations, which were then subjected to a reaction with phosphoric acid or phenylphosphoric acid to develop α-zirconium phosphate layers (Zr(R-OPO3)2; R = H, C6H5) between the clay silicate layers. The attempt of the reaction with phosphoric acid failed; hydroxy-zirconium cations were removed out of the interlayer space, forming α-zirconium phosphate outside of montmorillonite. The phenylphosphate derivative, montmorillonite/Zr(C6H5OPO3)2, with a regular mixed-layered structure has been successfully obtained, showing a basal spacing corresponding to the sum of the thicknesses of the individual layers. When a polyvinyl alcohol (PVA) aqueous solution was used in the preparation of the hydroxy-zirconium exchanged montmorillonite, PVA was incorporated with hydroxy-zirconium complex cations between the silicate layers. The resulting compound can adsorb phosphate ions. Although this is not a mixed-layered compound in the context of this study, the selective and reversible phosphate ion exchange properties are worth noting for future study.