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Objective To identify factors associated with pneumomediastinum during management of connective tissue disease (CTD)-related interstitial lung disease (ILD). Methods Patients diagnosed with pneumomediastinum after the initiation of corticosteroid therapy for their CTD-ILD were enrolled. The baseline characteristics of patients who developed pneumomediastinum after the initiation of corticosteroid therapy (n=13, all occurring within 120 days) were compared to those of patients who did not develop pneumomediastinum (n=49). A multivariate logistic regression analysis was performed to identify factors associated with pneumomediastinum. A receiver operating characteristic (ROC) curve analysis was also performed to assess the predictive performance. Results The body mass index (BMI) [odds ratio (OR) (95% confidence interval (CI)) 0.482 (0.272-0.853)] and serum lactate dehydrogenase (LDH) [OR (95% CI) 1.013 (1-1.025)] levels at baseline were identified as independent factors associated with pneumomediastinum after corticosteroid initiation. The optimal cut-off points of the BMI and LDH levels for predicting pneumomediastinum development, as estimated by the Youden index, were 20.2 kg/m 2 and 378 U/L, respectively. LDH showed a sensitivity of 61.5% and the highest specificity of 87.8%. Importantly, combining these markers resulted in the highest sensitivity of 100% and a specificity of 71.4%. Conclusion A low BMI and high serum LDH levels at baseline are useful predictive factors for pneumomediastinum development in CTD-ILD patients.

Objectives: The primary objective is to reveal the effect of hydroxychloroquine (HCQ) treatment on corrected QT (QTc) interval in patients with systemic lupus erythematosus (SLE). The secondary objective is to investigate factors that affect QTc prolongation.Methods: SLE patients who had electrocardiograms between 2015 and 2020 were recruited and assigned to two groups based on whether they were treated with HCQ (HCQ group) or not (control group). Change of QTc before and after HCQ administration in the HCQ group was measured and compared with the control group. Patients treated with HCQ were further divided into two groups based on presence or absence of QTc prolongation and the characteristics were compared.Results: In total, 126 patients were recruited, of whom 42 were treated with HCQ. In the HCQ group, the mean QTc significantly increased (P < 0.001), while there was no significant difference of mean QTc in the control group. Moreover, those in the HCQ group with QTc prolongation showed a significantly higher proportion of hypertension and longer SLE duration compared to those without QTc prolongation.However, the multiple logistic regression analysis showed that there were no significant differences among them. Conclusion:HCQ could induce QTc prolongation in SLE patients. It might be better that the possibility of QTc prolongation was taken into consideration when HCQ was administered in the patients with longer disease duration of SLE and coincidence of hypertension.

Objectives We compared large vessel vasculitis (LVV) clinical features between age groups. Methods We retrospectively examined clinical features and therapies in 41 LVV patients at our hospital from January 2010 to March 2020. We compared two patient groups, elderly (≥50 years) and young (&lt;50 years). Results Of all patients, 29 were elderly and 12 were young. In the younger group, upper extremity symptoms (p &lt;.05), bruits (p &lt;.01), and cardiovascular complications (p &lt;.01) were more common. Of the elderly group, 7 (24%) met classification criteria for giant cell arteritis while none of the younger group met these criteria; however, 10 (83%) of the younger group and 3 (10%) of the elderly group met the ACR classification criteria for Takayasu arteritis (p &lt;.01). In the elderly group, 16 patients (66%) met no criteria (p &lt;.01). There were no significant differences in laboratory findings but imaging showed a significantly higher incidence of head and neck artery lesions in the younger group (p &lt;.05). The younger group was more likely to receive additional tocilizumab (p &lt;.01) and cardiovascular complications were more likely to occur in younger patients (p &lt; .01). Conclusion LVV clinical features differed between elderly- and young-age-onset groups.

Keywords： salt related cognitive impairment, exercise, hemodialysis, swallowing exercises, salivary gland massage 〈Abstract〉 We examined the saltiness sensitivity of 128 hemodialysis patients who underwent outpatient maintenance dialysis at our facility and 30 healthy subjects using salt impregnated filter paper with various salt concentrations. All of the healthy subjects exhibited normal salt taste recognition, but 42 (32.8％) hemodialysis patients (16 and 26 with moderate and severe salt taste recognition disorder, respectively) were judged to have salt related cognitive impairment. Twenty one of the patients with salt related cognitive impairment were subjected to swallowing exercises and salivary gland massages for 10 minutes before each dialysis session, and 11 (52.4％) demonstrated improved to normal salt taste recognition one month later, and 15 (71.4％) did so 3 months later. However, there were no significant changes in weight gain during dialysis or salt intake in these patients.