Pneumatocele formation in a fatal adult pneumonia patient coinfected with Streptococcus pyogenes emm-type 3 and influenza A: a case report

Background: A pneumatocele is a transient thin-walled lesion and rare complication in adult pneumonia. A variety of infectious pathogens have been reported in children with pneumatoceles. We report the first case of adult pneumonia with pneumatocele formation that is likely caused by Streptococcus pyogenes and coinfection with influenza A virus. Case presentation: A 64-year-old Japanese man presented with a one-week history of fever, sore throat, and arthralgia. He was referred to our university hospital for respiratory distress. He required mechanical ventilation in the intensive care unit (ICU). Bacterial culture detected S. pyogenes in the bronchoscopic aspirates, which was not detected in blood. Although a rapid influenza antigen test was negative, an influenza A polymerase chain reaction (PCR) test was positive. Therefore, he was diagnosed with coinfection of influenza A and group A streptococcus (GAS) pneumonia complicated by probable streptococcal toxic shock syndrome. A chest radiograph on admission showed diffuse patchy opacification and consolidation in the bilateral lung fields. Multiple thin-walled cysts appeared in both middle lung fields on computed tomography (CT). On the following day, the bilateral cysts had turned into a mass-like opacity. The patient died despite intensive care. An autopsy was performed. The pathology investigation revealed multiple hematomas formed by bleeding in pneumatoceles. Conclusions: There have been no previous reports of a pneumatocele complicated by S. pyogenes in an adult patient coinfected with influenza A. Further molecular investigation revealed that the S. pyogenes isolate had the sequence type of emm3

Ultra-High-Resolution Computed Tomography of the Lung: Image Quality of a Prototype Scanner

Purpose: The image noise and image quality of a prototype ultra-high-resolution computed tomography (U-HRCT) scanner was evaluated and compared with those of conventional high-resolution CT (C-HRCT) scanners. Materials and Methods: This study was approved by the institutional review board. A U-HRCT scanner prototype with 0.25 mm × 4 rows and operating at 120 mAs was used. The C-HRCT images were obtained using a 0.5 mm × 16 or 0.5 mm × 64 detector-row CT scanner operating at 150 mAs. Images from both scanners were reconstructed at 0.1-mm intervals; the slice thickness was 0.25 mm for the U-HRCT scanner and 0.5 mm for the C-HRCT scanners. For both scanners, the display field of view was 80 mm. The image noise of each scanner was evaluated using a phantom. U-HRCT and C-HRCT images of 53 images selected from 37 lung nodules were then observed and graded using a 5-point score by 10 board-certified thoracic radiologists. The images were presented to the observers randomly and in a blinded manner. Results: The image noise for U-HRCT (100.87 ± 0.51 Hounsfield units [HU]) was greater than that for C-HRCT (40.41 ± 0.52 HU; P <.0001). The image quality of U-HRCT was graded as superior to that of C-HRCT (P <.0001) for all of the following parameters that were examined: margins of subsolid and solid nodules, edges of solid components and pulmonary ves sels in subsolid nodules, air bronchograms, pleural indentations, margins of pulmonary vessels, edges of bronchi, and interlobar fissures. Conclusion: Despite a larger image noise, the prototype U-HRCT scanner had a significantly better image quality than the C-HRCT scanners

Infectious Pneumonia and Lower Airway Microorganisms in Patients with Rheumatoid Arthritis

The relationship between microorganisms present in the lower respiratory tract and the subsequent incidence of pneumonia in patients with rheumatoid arthritis is unclear. A retrospective cohort study was designed to include a total of 121 patients with rheumatoid arthritis who underwent bronchoscopy at three hospitals between January 2008 and December 2017. Data on patient characteristics, microorganisms detected by bronchoscopy, and subsequent incidences of pneumonia were obtained from electronic medical records. Patients were divided into groups based on the microorganisms isolated from the lower respiratory tract. The cumulative incidence of pneumonia was assessed using the Kaplan–Meier method, and decision tree analysis was performed to analyze the relation between the presence of microorganisms and the occurrence of pneumonia. The most frequently isolated microbes were Pseudomonas aeruginosa, Staphylococcus aureus, and Haemophilus influenzae. Patients whose samples tested negative for bacteria or positive for normal oral flora were included in the control group. The rate of the subsequent incidence of pneumonia was higher in the P. aeruginosa group than in the control group (p = 0.026), and decision tree analysis suggested that P. aeruginosa and patient performance status were two important factors for predicting the incidence of pneumonia. In patients with rheumatoid arthritis, the presence of P. aeruginosa in the lower respiratory tract was associated with the subsequent incidence of pneumonia

退院時の6 分間歩行距離は退院3 か月後の身体活動量に影響する : 軽症脳梗塞患者における前向きコホート研究

研究論文Original Articles　【目的】本研究の目的は，急性期病院退院後の軽症脳梗塞患者の身体活動量に影響する退院時の要因を明らかにすることであった．【方法】研究デザインは，前向きコホート研究である．軽症脳梗塞患者を対象に身体活動量に関連する要因を退院時に測定し，退院2 週後と3 か月後の身体活動量をオムロン活動量計Active style Pro HJA-750C を用いて測定し，退院後の身体活動量に影響する退院時の要因を検討した．【結果】重回帰分析の結果，退院3 か月後の身体活動量に影響する要因として6 分間歩行距離（β＝ 0.675，p ＜ 0.001）のみが抽出された（自由度調整済みR2 ＝ 0.432，p ＜ 0.001）．【結論】急性期病院退院後の軽症脳梗塞患者の身体活動量には，退院時の6 分間歩行距離が影響することが明らかになった．退院3 か月後の身体活動量の向上には，退院時の6 分間歩行距離を高めることが重要であることが示唆された．【Object】The purpose of this study was to clarify the factors at the time of discharge that affect the physical activity level in patients with minor ischemic stroke after discharge from the acute care hospital.【Methods】This is a prospective cohort study.　We measured factors related to physical activity level at the time of discharge for patients with minor ischemic stroke, and used OMRON\u27s Active Style Pro HJA-750C to measure physical activity level 2 weeks and 3 months after discharge.　We used multiple regression analysis to examine factors at discharge that affect physical activity level after discharge.【Result】As a result of multiple regression analysis, only 6-minute walking distance ( β = 0.675, p <0.001) was extracted as a factor affecting physical activity level 3 months after discharge.【Conclusion】It was clarified that the 6-minute walking distance at the time of discharge affected the physical activity level of patients with minor ischemic stroke after discharge from the acute hospital. These results suggest that it is important to increase the walking distance for 6 minutes at the time of discharge in order to improve physical activity level 3 months after discharge

Direct Laser Writing of Graphene Nanoribbon Thin Films for Supercapacitor Electrodes

Recent developments of low-power electronic devices have triggered interests towards small-scale energy storage. One promising approach is to fabricate micro-supercapaciors (MSCs). In this work, we demonstrate a facile fabrication of MSCs by laser reduction and patterning of graphene oxide nanoribbon (GONR) thin films coated on poly(ethylene terephthalate) substrate through LightScribe technique. We fabricated the in-plane geometry electrodes consisting of reduced GONRs (i.e., graphene nanoribbons, GNRs) with the lateral spatial resolution of approximately 20 µm in addition to the stacked geometry electrodes for comparison. The fabricated in-plane-GNR electrode device showed superior electrochemical properties compared with the stacked-GNR electrode ones. Our impedance measurements supported that this is due to high lateral ion diffusivity along the basal plane of GNRs. In addition, GNR-based in-plane-electrode device also showed a higher capacitance than the graphene-based one, which is due to the more efficient edge effects of GNRs

Efficient Hybrid Simulation for Maxwell-Schrödinger Problems

Abstract-hybrid simulation for Maxwell-Schrödinger problems is necessary to analyze electronic devices based on quantum effects, such as carbon nanotube transistors. However, the computational cost is expensive because we must solve many unknowns to satisfy two governing equations for electromagnetic fields and electrons. In this paper, we will propose a novel method to reduce computational cost by applying the length gauge