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Human immunodeficiency virus-associated vacuolar encephalomyelopathy with granulomatous-lymphocytic interstitial lung disease improved after antiretroviral therapy: a case report
Get PDFBACKGROUND: Vacuolar encephalomyelopathy, a disregarded diagnosis lately, was a major neurological disease in the terminal stages of human immunodeficiency virus (HIV)-1 infection in the pre-antiretroviral therapy (ART) era. Granulomatous-lymphocytic interstitial lung disease (GLILD) was classically identified as a non-infectious complication of common variable immunodeficiency; however, it is now being recognized in other immunodeficiency disorders. Here, we report the first case of GLILD accompanied by vacuolar encephalomyelopathy in a newly diagnosed HIV-infected man. CASE PRESENTATION: A 40-year-old Japanese man presented with chronic dry cough and progressing paraplegia. Radiological examination revealed diffuse pulmonary abnormalities in bilateral lungs, focal demyelinating lesions of the spinal cord, and white matter lesions in the brain. He was diagnosed with GLILD based on marked lymphocytosis detecting in bronchoalveolar lavage, and transbronchial-biopsy proven T-cellular interstitial lung disease with granulomas. Microbiological examinations did not reveal an etiologic agent. The patient was also diagnosed with HIV-associated vacuolar encephalomyelopathy on the basis of an elevated HIV viral load in cerebrospinal fluid. After initiating ART, the brain lesions and paraplegia improved significantly, and interstitial abnormalities of the lungs and cough disappeared. CONCLUSION: This report highlights that even in the post-ART era in developed countries with advanced healthcare services, HIV-associated vacuolar encephalomyelopathy should be considered in the differential diagnosis of a progressive neurological disorder during the first visit. Furthermore, GLILD may represent an HIV-associated pulmonary manifestation that can be treated by ART
Effect of Dust Load on the Cloud Top Ice‐Water Partitioning Over Northern Middle to High Latitudes With CALIPSO Products
Get PDFWe quantified effects of dust load on the cloud top ice cloud fraction (ICF) in terms of the dust extinction coefficient (σext).
We analyzed 3-year data sets obtained from an active satellite sensor over middle to high latitudes in the northern hemisphere for temperatures (T)between 230 and 273 K and σext values between 0.005 and 0.145 km−1. At about 250 K, ICF changed by about 30% in response to the above range of σext,
whereas at extreme T values, ICF was relatively insensitive to σext. Thus, we concluded that ICF was primarily determined by T,with substantial influence of σext at about 250 K, likely due to increased opportunities for freezing as σext increases. Sensitivity of ICF was the lowest both at the largest σext and lowest T and at the smallest σext and highest T, while it was the highest at about 0.03 km−1 of σext and about 250 K.If there are any physical parameters that influence the ICF except temperature (T), how much does this parameter influence ICF in a given T?
Dust particles have been long known as efficient ice nucleating particles. Although previous studies suggested that more dust particles increased ICF, they did not use quantitative parameters of the dust amount, but less-quantitative indicators such as relative dust frequency. Therefore,we used the dust extinction coefficient (σext) as a quantitative parameter of dust amount and examined the relationship between the dust amount and ICF for T between 230 and 273 K.
We observed the following phenomena from satellite data. At about 250 K, ICF substantially depended on σext likely due to increased opportunities for freezing as σext increases. However, at extreme T values, ICF was relatively insensitive to σext. Moreover, we found that sensitivity of ICF was the lowest both at the largest σext
and lowest T and at the smallest σext and highest T, while it was the highest at about 0.03 km−1 of σext and about 250 K. These behaviors of the ICF sensitivity could be understood from characteristics of T (the lower, the easier for freezing) and σext (the larger, the easier for freezing)