Considerations for simultaneous detection of autoantibodies to coagulation factor and lupus anticoagulant

In patients with autoimmune coagulation factor deficiency (AiCFD), the production of autoantibodies that inhibit coagulation factors in the blood reduces the activity of those relevant coagulation factors, resulting in severe bleeding symptoms. Recently, reports of patients with AiCFD have noted the concomitant detection of lupus anticoagulant (LA), a risk factor for thrombosis. LA-positive patients may show bleeding symptoms due to decreased activity of coagulation factor II (FII) caused by autoantibodies against FII, in addition to thrombotic symptoms, a condition termed LA-hypoprothrombinemia syndrome (LAHPS). Anti-FII antibodies in LAHPS cases are frequently cleared antibodies that can be detected using immunological techniques, such as enzyme-linked immunosorbent assay (ELISA). Recently, several cases of coagulation FV inhibitors, known as autoimmune FV deficiency, have been reported. Some of these cases may be complicated by LA, which can cause thrombosis. False-positive results for anticoagulant inhibitors are known to occur in LA cases; therefore, immunological confirmation of antibodies against coagulation factors is recommended. Additionally, acquired hemophilia A (AHA), caused by autoantibodies against FVIII, is a typical acquired hemorrhagic diathesis, although affected patients may present with thrombosis associated with LA. Thus, it is important to remember that hemorrhagic diathesis due to autoantibodies against clotting factors can also result in thrombosis, as demonstrated by the co-detection of LA. When clotting factor inhibitors are detected in LA-positive individuals, it is important to confirm the presence of autoantibodies against coagulation factors using immunological methods, such as ELISA, to avoid false-positive results

Microscopic origin of highly enhanced current carrying capabilities of thin NdFeAs(O,F) films

Fe-based superconductors present a large variety of compounds whose physical properties strongly depend on the crystal structure and chemical composition. Among them, the so-called 1111 compounds show the highest critical temperature T(c) in the bulk form. Here we demonstrate the realization of excellent superconducting properties in NdFeAs(O(1−x)F(x)). We systematically investigated the correlation between the microstructure at the nanoscale and superconductivity in an epitaxial 22 nm NdFeAs(O(1−x)F(x)) thin film on a MgO single crystalline substrate (T(c) = 44.7 K). Atomic resolution analysis of the microstructure by transmission electron microscopy and atom probe tomography identified several defects and other inhomogeneities at the nanoscale that can act as extrinsic pinning centers. X-Ray diffraction and transmission electron microscopy displayed a broad variation of the a-axis lattice parameter either due to a partially strained layer at the interface to the substrate, high local strain at dislocation arrays, mosaicity, or due to composition variation within the film. The electrical transport properties are substantially affected by intrinsic pinning and a matching field corresponding to the film thickness and associated with the Bean–Livingston surface barrier of the surfaces. The thin film showed a self-field critical current density J(c)(4.2 K) of ∼7.6 MA cm(−2) and a record pinning force density of F(p) ≈ 1 TN m(−3) near 35 T for H‖ab at 4.2 K. These investigations highlight the role of the microstructure in fine-tuning and possibly functionalizing the superconductivity of Fe-based superconductors

Effect of combined treatment with bisphosphonate and vitamin D on atherosclerosis in patients with systemic lupus erythematosus : a propensity score-based analysis

Background: Premature atherosclerosis is one of the major complications of systemic lupus erythematosus (SLE). Recently, the biological linkage between atherosclerosis and osteoporosis has garnered much attention. The aim of this study is to explore correlation between the development of atherosclerosis and anti-osteoporotic treatment. Methods: Consecutive patients with SLE (n = 117) who underwent carotid ultrasonography were retrospectively analyzed using propensity scoring. Results: Of the 117 patients, 42 (36%), 27 (23%), and 30 (26%) were receiving bisphosphonates and vitamin D (BP + VD), bisphosphonates alone, or vitamin D alone, respectively. Low bone mineral density was more frequent, and carotid plaque was less prevalent in the BP + VD group compared with other treatment groups. Age (OR = 1.57) and BP + VD treatment (OR = 0.24) were shown by multivariate analysis to be associated with the presence of carotid plaque. In all strata divided using the propensity score, carotid plaque was statistically significantly less prevalent (p = 0.015, Mantel-Haenszel test) in the BP + VD group relative to the other treatment groups. Conclusion: Combined treatment with bisphosphonate and vitamin D may have a role in preventing atherosclerosis in patients with SLE

Cytokine and chemokine multiplex analysis-based exploration for potential treatment and prognostic prediction in large-vessel vasculitis : A preliminary observational study

Large-vessel vasculitis (LVV) is subclassified into two phenotypes; Takayasu arteritis and giant cell arteritis. Although the pathogenesis of LVV is not fully established, IL-6-IL-17 axis and IL-12-IFN-gamma axis play critical roles in the disease development. We aimed to clarify the association between the disease state and cytokine/chemokine levels, to assess disease course as prognosis and to predict regulators in patients with LVV using the blood profiles of multiple cytokines/chemokines. This retrospective analysis comprised 35 LVV patients whose blood were collected, and multiplex cytokine/chemokine analysis with 28 analytes was performed. The differences of cytokines/chemokines corresponding disease status, upstream regulator analysis, pathway analysis and cluster analysis were conducted using the cytokines/chemokines profile. Relapse-free survival rate was calculated with Kaplan-Meier analysis in the classified clusters. In the robust analysis, IL-4, CCL2/MCP-1, TNFSF13/APRIL, TNFSF13B/BAFF, CHI3L1 and VEGF-A levels were significantly changed after treatment. Untreated LVV patients demonstrated activation of NF kappa B-related molecules and these patients are potentially treated with JAK/STAT inhibitors, anti-TNF-alpha inhibitors and IL-6 inhibitors. Cluster analysis in active LVV patients revealed two clusters including one with high blood levels of IL-1 beta, IL-6, IL-17, IL-23 and CCL20/MIP-3. A subgroup of the LVV patients showed activated IL-17 signature with high relapse frequency, and JAK/TyK2 inhibitors and IFN-gamma inhibitors were detected as potentially upstream inhibitors. Blood cytokine/chemokine profiles would be useful for prediction of relapse and potentially contributes to establish therapeutic strategy as precision medicine in LVV patients