Clonal Expansion of Multidrug-Resistant <i>Streptococcus dysgalactiae</i> Subspecies <i>equisimilis</i> Causing Bacteremia, Japan, 2005–2021

Incidence of Streptococcus dysgalactiae subspecies equisimilis (SDSE) bacteremia is increasing in the Kyoto-Shiga region of Japan. We retrospectively analyzed clinical features of SDSE bacteremia and conducted comparative genomic analyses of isolates collected from 146 bacteremia episodes among 133 patients during 2005-2021. Of those patients, 7.7% required vasopressor support, and 7.0% died while in the hospital. The prevalence of isolates resistant to erythromycin, minocycline, and clindamycin increased from 8.6% during 2005-2017 to 21.6% during 2018-2021. Our genomic analysis demonstrated that sequence type 525 and clonal complex 25 were predominant in SDSE isolates collected during 2018-2021. In addition, those isolates had acquired 2 antimicrobial-resistance genes, ermB and tetM, via Tn916-like integrative and conjugative elements (ICEs). Phylogenetic analysis revealed clonal distribution of Tn916-like ICEs in SDSE isolates. Our findings suggest that Tn916-like ICEs contributed to the emergence and recent increase of multidrug-resistant SDSE bacteremia in this region of Japan

Microscopic Raman study of graphene on 4H-SiC two-dimensionally enhanced by surface roughness and gold nanoparticles

We present microscopic Raman spectroscopy measurements on single-layer graphene epitaxially grown on 4H-SiC by a thermal decomposition method. We collected spectral data with spatial resolution, which allowed us to obtain two-dimensionally enhanced Raman mapping images. Shallow holes in SiC, which had areas of 5 to 20 µm and depths of 100 nm, enhanced the Raman intensity of the 2D band of graphene. A monolayer of gold nanoparticle (AuNP) aggregates was successfully prepared by dropping and drying a colloidal suspension of AuNPs. The AuNP exhibited 30-fold enhanced the Raman spectra in the wavenumber range of 1550–1700 cm−1. Locally enhanced Raman intensity was also demonstrated using a glass microbead

Hard x-ray intensity autocorrelation using direct two-photon absorption

An intensity autocorrelation measurement is demonstrated to characterize a pulse duration of 9-keV x-ray free-electron laser (XFEL) pulses from a split-delay optical (SDO) system with four-bounce silicon 220 reflections in each branch. XFEL pulse replicas with variable time delays are generated by the SDO system itself. High intensity of >2×1016W/cm2 achieved in a self-seeding operation and careful data analysis allow the measurement with direct two-photon absorption. The autocorrelation trace gave a duration of 7.6±0.8fs in full width at half maximum for a Gaussian assumption. Furthermore, the trace shows good agreement with a simulation of the XFEL pulse shape propagating through the SDO system, irrespective of spectral chirps in the original XFEL pulses. Our results open the door toward direct temporal characterization of narrowband XFELs at the hard x-ray regime, such as self-seeded and future cavity-based XFELs, and indicate a solid way for temporal tailoring of ultrafast x-ray pulses with perfect crystals.Osaka T., Inoue I., Yamada J., et al. Hard x-ray intensity autocorrelation using direct two-photon absorption. Physical Review Research, 4, 1, L012035. https://doi.org/10.1103/PhysRevResearch.4.L012035

A case report of mixed connective tissue disease.

症例は50歳女性で,1991年頃より両肘関節の疼痛とレイノー現象を自覚するようになり前医にて慢性関節リウマチ(Rheumatoid arthritis, 以下RAと略)との診断を受け加療受けるも症状の改善なく,当科を受診した｡典型的な慢性関節リウマチの症状に乏しく,他の膠原病の存在を疑って検索したところ,抗RNP抗体陽性等の所見から,混合性結合組織病(mixed connective tissue disease, 以下MCTDと略)と診断した｡MCTDは初診時に慢性関節リウマチと誤診される例が多く,慢性関節リウマチに非典型的な症状を伴う場合は,MCTDが鑑別診断として重要と考えられた。A 50-year-old woman, diagnosed as rheumatoid arthritis (RA) in 1991, had been treated with Lobenzarit disodium and non steroidal anti-inflammatory drugs (NSAIDs) before administration at our hospital. Despite the treatment with these drugs, her symptoms did not improve. She was admitted to our hospital for her progressive bilateral elbow joint pain and Raynaud's phenomenon. Although abnormal values of laboratory examinations such as an increased ESR (64mm/1hr), increased level of serum IgG (2854mg/㎗) and a positive RA test were shown, the clinical features of classical RA were not clear. There, she was diagnosed as mixed connective tissue disease (MCTD), because of high level of anti-RNP antibody in serum, Raynaud's phenomenom, multiple arthritis and constrictive ventilatory disturbance. Her symptoms and the results of labolatory examinations were clearly improved by glucocorticoid therapy

A case of refractory cutaneous polyarteritis nodosa in a patient with hepatitis B carrier status successfully treated with tumor necrosis factor alpha blockade

We describe a patient with refractory cutaneous polyarteritis nodosa (CPAN) with hepatitis B virus (HBV) carrier status who was successfully treated with tumor necrosis factor alpha (TNF-α) blockade, using etanercept, and we review 5 similar cases. We administered etanercept because of the occurrence of repeated flares despite aggressive therapy. C-reactive protein normalization; prednisolone dose-sparing; and absence of any adverse events, including HBV reactivation with nucleotide analogue administration, or renal dysfunction, have been achieved for 8 months. TNF-α blockade should be considered for intractable CPAN. © 2012 Japan College of Rheumatology.In Press →　出版者照会後に全文を公開

Efficacy and safety of micafungin in empiric and D-index-guided early antifungal therapy for febrile neutropenia ; A subgroup analysis of the CEDMIC trial

Objectives: The D-index is defined as the area over the neutrophil curve during neutropenia. The CEDMIC trial confirmed the noninferiority of D-index-guided early antifungal therapy (DET) using micafungin to empirical antifungal therapy (EAT). In this study, we evaluated the efficacy and safety of micafungin in these settings. Methods: From the CEDMIC trial, we extracted 67 and 113 patients who received micafungin in the DET and EAT groups, respectively. Treatment success was defined as the fulfilment of all components of a five-part composite end point. Fever resolution was evaluated at seven days after the completion of therapy. Results: The proportion of high-risk treatments including induction chemotherapy for acute leukemia and allogeneic hematopoietic stem cell transplantation was significantly higher in the DET group than in the EAT group (82.1% vs. 52.2%). The efficacy of micafungin was 68.7% (95%CI: 56.2–79.4) and 79.6% (71.0–86.6) in the DET and EAT groups, respectively. When we focused on high-risk treatments, the efficacy was 69.1% (55.2–80.9%) and 78.0% (65.3–87.7%), respectively (P = 0.30). There was no significant difference in any of the 5 components between the two groups. Conclusions: The efficacy of micafungin in patients undergoing high-risk treatment was not strongly impaired in DET compared to that in EAT