Multi-focusing surface-emitting lasers.

Complete control of a beam pattern requires not only projecting a two-dimensional (2D) pattern but also focusing on a three-dimensional (3D) point cloud, which is typically achieved utilizing holography under the framework of diffraction. We previously reported direct focusing from on-chip size surface-emitting lasers that utilize a holographically modulated photonic crystal cavity based on 3D holography. However, this demonstration was of the simplest 3D hologram with a single point and single focal length, and the more typical 3D hologram with multiple points and multiple focal lengths has not yet been examined. Toward direct generation of a 3D hologram from the on-chip size surface-emitting laser, we here examined a simple 3D hologram featuring two different focal lengths with a single off-axis point in each to reveal the fundamental physics. Two types of holography, one based on superimposition and the other on random tiling, successfully demonstrated the desired focusing profiles. However, both types caused a spot noise beam in the far field plane due to interference between focusing beams with different focal lengths, especially in the case of the superimposing method. We also found that the 3D hologram based on the superimposing method consisted of higher order beams including the original hologram due to the manner of the holography. Secondly, we demonstrated a typical 3D hologram with multiple points and focal lengths and successfully showed the desired focusing profiles by both methods. We believe our findings will bring innovation to mobile optical systems and pave the way to developing compact optical systems in areas such as material processing, micro fluidics, optical tweezers, and endoscopy.

On-chip size, low-noise fringe pattern projector offering highly accurate 3D measurement.

Fringe pattern projectors are quite useful for highly accurate three-dimensional (3D) measurement when a projector or LED array is used for illumination. We have fabricated a 0.2 mm × 0.2 mm structured light source, which was an on-chip size surface-emitting laser that utilized a holographically modulated two-dimensional (2D) photonic crystal (PC). This will make possible an extremely compact 3D measurement system that will positively impact mobile systems. However, the fringe pattern tends to cause speckle-like noise that leads to severe positional error in 3D measurement. Here we present a simple approach to projecting a low-noise fringe pattern from our surface-emitting lasers by using a one-dimensional (1D) focusing hologram. This method improves the flatness of the fringe pattern by around four times.

Direct-focusing surface-emitting laser.

Focusing is a fundamental optical technique that has been widely implemented via lenses. Here, we demonstrate direct focusing from a band-edge surface-emitting laser, whose emission area is 200 µm × 200 µm, without any lenses. To achieve this, a phase-modulating layer is incorporated into the laser cavity. This layer acts simultaneously as a lasing cavity similar to that of a photonic crystal laser and as a holographic spatial-phase modulator, which transforms the output beam into a focusing beam by slightly shifting the positions of holes from a periodic square lattice. Beam profiles along the surface normal clearly show that direct focusing occurs with a focal length and focal spot size of 310 µm and 6.1 µm, respectively. The focal length agrees well with the theoretical value, and the focal spot size is 2.0 times the diffraction-limited size, which indicates that the higher transverse modes are sufficiently suppressed. In addition, the power density at the focus is 540 times higher than that at the near-field plane. Interestingly, a focus pattern is also observed in the opposite direction at the near-field plane, which indicates that a converging beam and a diverging beam are simultaneously emitted because of the nature of the in-plane band-edge laser. The conventional beam patterns of semiconductor laser cavities are limited to the regime of two-dimensional projection based on a Fourier hologram. In contrast, we demonstrate the simplest form of a three-dimensional point cloud based on a Fresnel hologram, which is quite useful for micro-sensing applications such as microfluidics, flow cytometry, blood sensors, and endoscopy.

200×200 µm2 structured light source.

3D structured illumination is important in high-speed 3D metrology where beam patterns are roughly categorized into multi-dot and fringe patterns. For example, large-scale multi-dot patterns are utilized for facial recognition in an iPhone X on the basis of an active stereo method, while fringe patterns are utilized in Grey code patterns or fringe projection profilometry including Fourier transform profilometry and the phase shifting profilometry, which is suitable for high-resolution measurement. Among these applications, the light sources include a combination of vertical-cavity surface-emitting lasers (VCSELs) and diffractive optical elements (DOEs), a projector, and so on. Recently, we demonstrated static arbitrary two-dimensional beam patterns without a zero-order beam from needle-tip sized integrable spatial-phase-modulating surface-emitting lasers (iPMSELs). Due to their compactness (they are one order of magnitude smaller than DOE), surface-emitting device, lack of zero-order beam, and ease of switching the beam patterns electrically, iPMSELs will be suitable as an ultra-compact light source for 3D metrology that not only downsizes the conventional light source but also contributes to 3D inspections in narrow spaces such as dental and endoscope examinations. In this context, we have examined two beam patterns (multi-dot and fringe) both without a zero-order beam by using the iPMSELs. In the former, we have demonstrated projection of large-scale dot patterns of more than 10,000 points, which is the same order of magnitude as points in a practical device from a 200×200-µm2 emitter. Since the emitter has approximately 1 mega scattering points, this structure enables 1-mega-pixel images in the wavenumber space, which are comparable to the images of a typical projector emitting several-mega-pixel images from several tens of centimeters. In the latter, we successfully shifted the fringe patterns, which is vital to applying the phase shifting profilometry, despite the superposition of the conjugate ±1st order beam patterns.

Observational retrospective single-centre study in Japan to assess the clinical significance of serum daptomycin levels in creatinine phosphokinase elevation.

WHAT IS KNOWN AND OBJECTIVE: Daptomycin-induced creatinine phosphokinase (CPK) elevation is reported to be associated with its trough level (Ctrough ; breakpoint of 24.3 µg/mL). However, even with high-dose treatment (ie, > 8 mg/kg), the safety of daptomycin treatment is widely demonstrated with low or no significant incidence of CPK elevation or other adverse effects, despite the possibility of Ctrough above 24.3 µg/mL. Therefore, we questioned the clinical significance of Ctrough levels of 24.3 µg/mL. In this study, we retrospectively evaluated the significance of Ctrough in the clinical setting, in addition to completing a retrospective safety assessment of daptomycin utilizing electronic health records. METHODS: Patients who had received daptomycin treatment for > 4 days from July 2011 to June 2015 were enrolled. Serum daptomycin levels, including Ctrough and peak (Cpeak ), were measured by high-performance liquid chromatography equipped with a photodiode array. To evaluate the safety, patients' characteristics and relevant laboratory test values were reviewed retrospectively using an electronic medical record system. RESULTS AND DISCUSSION: A total of 52 therapeutic cases for 46 patients were identified; of these, Ctrough and Cpeak levels were measured in 27 and 28 cases, respectively, and 6 patients received multiple courses of daptomycin treatment. The median age of the 52 patients was 68 years (range: 19-88 years), and 14 patients initially had an estimated creatinine clearance of less than 30 mL/min. Seven cases indicated a Ctrough of above 24.3 µg/mL; however, none of these presented CPK elevation, which meets with the study definition for abnormality. Furthermore, of the two patients with abnormal CPK elevations, only one patient had a measured Ctrough (of 10.9 µg/mL). Their CPK abnormalities were temporal and did not result in treatment discontinuation. The other four patients discontinued daptomycin treatment due to suspicions of adverse effects. Of the discontinued patients, two had measured Ctrough levels; these were 8.6 and 8.1 µg/mL. All patients with abnormal CPK elevation or treatment discontinuation exhibited Ctrough levels lower than 24.3 µg/mL. In this study, two patients receiving high-dose daptomycin (ie, 9.4 and 10.0 mg/kg) had observed Ctrough levels similar to patients who received doses of daptomycin < 9 mg/kg. WHAT IS NEW AND CONCLUSIONS: The safety of daptomycin treatment was suggested in this study. Ctrough level of 24.3 µg/mL was not suggested as a significant clinical index for the incidence of CPK elevation, adverse effects or treatment discontinuation. Thus, acceptable tolerability towards higher Ctrough levels than 24.3 µg/mL was also suggested, though further studies are required. On the other hand, low levels of daptomycin in blood were unexpectedly observed in two cases, despite the high-dose treatments. Accordingly, the monitoring of serum daptomycin levels may also be useful to assess cases in which subtherapeutic levels were achieved.

Disseminated cryptococcosis in a patient taking tocilizumab for Castleman's disease.

Infections occur more frequently in patients receiving biologics. However, cryptococcal infection is uncommon in patients receiving tocilizumab, an interleukin-6 inhibitor, in contrast to patients receiving tumor necrosis factor-α inhibitors. In this report, we describe a case of disseminated cryptococcosis in a 55-year-old man who was receiving tocilizumab every 2 weeks along with daily prednisolone and cyclosporine for Castleman's disease. He initially developed cellulitis on both upper limbs, and his condition worsened despite antibacterial therapy. Chest X-ray scanning and computed tomography demonstrated bilateral pulmonary infiltration. Cryptococcus neoformans was detected in blood, skin, and sputum cultures. He was diagnosed with disseminated cryptococcosis, and successfully treated with liposomal amphotericin B for a week followed by oral fluconazole for 11 months. The findings of this study indicate that cryptococcosis should be considered during the differential diagnosis of infection in patients receiving tocilizumab, especially in the presence of other risk factors for infections or a short tocilizumab dosing interval.

Capnocytophaga canimorsus bacteremia presenting with acute cholecystitis after a dog bite.

Capnocytophaga canimorsus is part of normal gingival flora of dogs and cats. The organism can cause septicemia, meningitis, and endocarditis in humans after contact with dogs or cats. In spite of the frequency of gastrointestinal symptoms in C. canimorsus infection patients, specific gastrointestinal disease or clinical images have not been reported. We report a case of C. canimorsus bacteremia presenting with acute cholecystitis in elderly woman. She suffered from general fatigue and right upper abdominal pain. She had leukocytosis and abnormal liver function tests. She showed abnormal findings of the gallbladder by abdominal computed tomography and ultrasonography. She was diagnosed with acute cholecystitis without gallstones and was administered with antibiotics. C. canimorsus was isolated from blood cultures. A history of an insignificant wound secondary to a dog bite was elicited. She recovered completely with antibiotic treatment. This case revealed that C. canimorsus bacteremia can be presented with acute cholecystitis, suggesting that C. canimorsus could cause cholecystitis. And this cholecystitis can be treated with antibiotics without operation. Physicians seeing patients with acute cholecysitis should ask questions regarding animal contact.