Switching to Dupilumab from Other Biologics without a Treatment Interval in Patients with Severe Asthma: A Multi-Center Retrospective Study

Background: Dupilumab is a fully humanized monoclonal antibody that blocks interleukin4 and interleukin-13 signals. Several large clinical trials have demonstrated the efficacy of dupilumab in patients with severe asthma. However, few studies have examined a switch to dupilumab from other biologics. Methods: This retrospective, multi-center observational study was conducted by the Okayama Respiratory Disease Study Group. Consecutive patients with severe asthma who were switched to dupilumab from other biologics without a treatment interval between May 2019 and September 2021 were enrolled. Patients with a treatment interval of more than twice the standard dosing interval for the previous biologic prior to dupilumab administration were excluded. Results: The median patient age of the 27 patients enrolled in this study was 57 years (IQR, 45-68 years). Eosinophilic chronic rhinosinusitis (ECRS)/chronic rhinosinusitis with nasal polyp (CRSwNP) was confirmed in 23 patients. Previous biologics consisted of omalizumab (n = 3), mepolizumab (n = 3), and benralizumab (n = 21). Dupilumab significantly improved FEV1 (median improvement: +145 mL) and the asthma control test score (median improvement: +2). The overall response rate in patients receiving dupilumab for asthma as determined using the Global Evaluations of Treatment Effectiveness (GETE) was 77.8%. There were no significant differences in the baseline characteristics of the GETE-improved group vs. the non-GETE-improved group. ECRS/CRSwNP improved in 20 of the 23 patients (87.0%). Overall, 8 of the 27 patients (29.6%) developed transient hypereosinophilia (>1500/ mu L), but all were asymptomatic and able to continue dupilumab therapy. Conclusions: Dupilumab was highly effective for the treatment of severe asthma and ECRS/CRSwNP, even in patients switched from other biologics without a treatment interval

Features of interactions responsible for antifungal activity against resistant type cytochrome bc1: A data-driven analysis based on the binding free energy at the atomic level.

Quinone outside inhibitors (QoIs), which inhibit the mitochondrial respiratory system by binding to the Qo site of Complex III in fungi, are widely used as pesticides with broad spectrum antifungal activity. However, excessive use of QoIs leads to pesticide resistance through mutation of amino acid residues in the Qo site. Recently, metyltetraprole, a novel QoI that is effective against wild-type and resistant mutant fungi, was developed. Interestingly, metyltetraprole has a very similar structure to other QoIs, azoxystrobin and pyraclostrobin, which do not act on resistant mutants. However, it is unknown how slight structural differences in these inhibitors alter their effectiveness towards fungi with amino acid mutations in the Qo site of Complex III. Therefore, we studied the features of interactions of inhibitors effective towards resistant mutants by quantitatively comparing the interaction profiles of three QoIs at the atomic level. First, we reproduced the binding affinity by the thermodynamic integration (TI) method, which treated explicitly environmental molecules and considered the pseudo-binding pathway. As such, a good correlation (R2 = 0.74) was observed between the binding free energy calculated using the TI method and experimentally observed pIC50 value in 12 inhibitor-target pairs, including wild-type and mutant Complex III in two fungal species, Zymoseptoria tritici and Pyrenophora teres. Trajectory analysis of this TI calculation revealed that the effectiveness against resistant mutant fungi strongly depended on the interaction of constituent parts of the inhibitor disposed near the active center of the target protein. Specifically, the key in the effectiveness against resistant mutant fungi is that the corresponding component part, tetrazolinone moiety of metyltetraprole, traded off Coulomb and van der Waals interactions in response to subtle changes in the binding pose

Locomotive Syndrome is a Risk Factor for the Dropout of Continuous Positive Airway Pressure Treatment in Patients with Obstructive Sleep Apnea Syndrome

Objective: The purpose of this study was to investigate the risk factors linked to patient dropout from continuous positive airway pressure (CPAP) therapy for the treatment of obstructive sleep apnea syndrome (OSAS). Methods: This study included 1191 patients with OSAS at baseline assessment, who were followed for 3 years. We evaluated clinical parameters, indicators related to OSAS treatment, exercise habits and the presence of locomotive syndrome (LS). LS was evaluated by a ‘loco-check’, as established by the Japanese Orthopedic Association. The OSAS patients were categorized at baseline as belonging to an ‘LS group’ or a ‘non-LS group’, and clinical parameters were compared. Results: Eighty-six patients (7.2%) dropped out of CPAP therapy during the 3 year follow-up period. The dropout rate of the LS group was significantly higher than that of the non-LS group. Using a Cox-proportional hazard model, the LS, old age and poor compliance were determined to be significant risk factors for dropping out of CPAP therapy. The hazard ratios (95% CI) of LS, elderly people and poor CPAP compliance were 2.11 (1.31–3.48), 1.80 (1.11–2.94) and 1.61 (1.04–2.47), respectively. Conclusion: LS may be the critical risk factor for dropping out of CPAP therapy among patients with OSAS

Analysis of Alternative Methods of Environmental Monitoring for Listeria in Food Production Facilities

Validated alternative test methodologies may be used in place of culture-based methods recommended for environmental monitoring programs (EMPs) for Listeria in food production facilities. In order to help guide decisions on which testing method to use to simplify Listeria EMP implementation in food production facilities, alternative methods were compared to the culture-based method in actual EMPs for Listeria. Seventy-two samples collected from two facilities of souzai production businesses that use meat and meat products as ingredients, one facility of processed meat product production business, and one facility of processed meat product and souzai production business were applied to EMPs for Listeria using the culture-based method, 3MTM Molecular Detection System (MDS), and InSite L. mono Glo (InSite). The kappa coefficient in MDS was 0.65 for Listeria monocytogenes and 0.74 for Listeria spp., both of which were deemed substantial compared with the culture-based method. The kappa coefficient in InSite was −0.01 for L. monocytogenes and 0.50 for Listeria spp., which indicated poor and moderate reproducibility, respectively. When the medium of InSite was smeared on agar medium, 7 of the 19 samples tested positive only for Listeria spp. (negative for L. monocytogenes) but L. monocytogenes was cultured, indicating that the sensitivity of detecting L. monocytogenes via fluorescence may be low. MDS was considered a useful alternative for both L. monocytogenes and Listeria spp. as targets, and InSite was not possible as a substitute for detecting L. monocytogenes; however, it is considered a helpful alternative method for detecting Listeria spp. EMPs for Listeria often target Listeria spp. as an indicator of L. monocytogenes. The alternative methods studied in this study are rapid, simple, and useful in EMPs for Listeria. However, the data in this study were a comparatively small sample set and impacted by variability, so more robust comparisons are desirable in the future

Environmental Monitoring of Food Manufacturing Facilities for Listeria: A Case Study

Environmental monitoring programs (EMPs) for food production facilities are useful for verifying general sanitation controls and are recommended as verification measures to ensure that the Hazard Analysis Critical Control Point plan is working effectively. In this study, EMPs for Listeria were conducted at three food production facilities to assess the efficacy of sanitation control and establish effective sanitation control methods. In Facility A, L. monocytogenes was detected in the clean area although in Zone 3, non–food-contact surfaces. To prevent contamination from dirty areas, the cleaning practices in the preparation room were investigated. Normal cleaning combined with disinfection with carbonated hypochlorite water (chlorine concentration, 150 ppm) proved effective. At Facility B, a salad product and its ingredients (pastrami and salami) were positive for L. monocytogenes serotype 3b. The bacterial count was <10/g in all samples. However, when inoculated with L. monocytogenes isolates, the growth of approximately 2 log cfu/g was observed on pastrami after 48 h of incubation at 10°C. The ingredients were commercially purchased blocks that were sliced in a slicer at Facility B and used as salad toppings. Because both unopened blocks were negative for L. monocytogenes, contamination of the slicer was suspected. Sampling of the slicer revealed that contamination by L. monocytogenes serotype 3b was more extensive after use than before use. Therefore, the slicer was disassembled, cleaned, and disinfected thoroughly. In Facility C, L. monocytogenes serotype 4b (4e) was detected in all the dirty, semiclean, and clean areas. The strain was also isolated from the wheels of a smoking cart transported across the zones. Therefore, efforts were made to frequently clean and disinfect the cart. EMPs revealed the presence of Listeria in each facility and allowed remedial measures to be undertaken. Continued monitoring and Plan-Do-Check-Act cycles were considered desirable

Problems of elderly patients on inhalation therapy: Difference in problem recognition between patients and medical professionals

Background: There is no systematic analysis to identify problems involved with instruction on inhalation therapy for elderly patients. We conducted a nationwide questionnaire survey for patients and medical professionals. Methods: A questionnaire survey was conducted of adult patients on inhaled drugs (ages 18–92 years, 820 individuals) and medical professionals (pharmacists or nurses) who provided instruction on inhalation therapy to these patients in 23 institutions in Japan to investigate the technique and the level of understanding (knowledge) of the inhalation therapy. Changes in the recognition of performance of inhalation technique and inhalation knowledge with increasing age were analyzed. Results: According to patients' subjective assessment, there was no deterioration in the performance of the inhalation technique or loss of the knowledge with increasing age. On the other hand, medical professionals' objective assessment revealed a significant loss of both inhalation technique and knowledge with increasing age. Not many elderly patients noticed their own problems themselves, revealing a great perception gap between elderly patients and medical professionals. Thus, there was concern that patients would unconsciously practice the inhalation procedure improperly. On the other hand, in comparison with non-elderly patients, elderly patients were less resistant to continuation of therapy, suggesting that they would be more likely to accept instruction on inhalation therapy. Conclusions: Elderly patients are apt to assume that they “understand well”, therefore, in order to recognize and close the perception gap between elderly patients and medical professionals, it is necessary to provide them with more aggressive (frequent) instructions on inhalation therapy