Efficacy and safety of long-acting β-agonist/long-acting muscarinic antagonist combinations in COPD:a network meta-analysis

BackgroundThe place of long-acting β agonist/long-acting muscarinic antagonist (LABA/LAMA) combinations in stable patients with COPD is not well defined. The purpose of this study was to systematically review the efficacy and safety of LABA/LAMA combinations.MethodsSeveral databases and manufacturers’ websites were searched for relevant clinical trials. Randomised control trials, at least 12 weeks duration, comparing a LABA/LAMA combination with placebo and/or monotherapy were included. The data were pooled using a network as well as a traditional direct comparison meta-analysis.ResultsTwenty-three trials with a total of 27 172 patients were included in the analysis. LABA/LAMA combinations were associated with a greater improvement in lung function, St. George's Respiratory Questionnaire (SGRQ) score, and Transitional Dyspnoea Index (TDI) than monotherapies. LABA/LAMA combinations were associated with a significantly greater proportion of SGRQ and TDI responders than monotherapies (OR 1.23 (95% credible interval (CrI) 1.06–1.39), OR 1.34 (95% CrI 1.19–1.50) versus LABAs and OR 1.24 (95% CrI 1.11–1.36), OR 1.31 (95% CrI 1.18–1.46) versus LAMAs, respectively) and fewer moderate-to-severe exacerbations compared with LABAs (HR 0.82 (95% CrI 0.73–0.93)), but not when compared with LAMAs (HR 0.92 (95% CrI 0.84–1.00)). There were no statistically significant differences associated with LABA/LAMA combinations compared with monotherapies in safety outcomes as well as in severe exacerbations.ConclusionsThe combination therapy was the most effective strategy in improving lung function, quality of life, symptom scores and moderate-to-severe exacerbation rates, and had similar effects on safety outcomes and severe exacerbations as compared with monotherapies.</jats:sec

Safety, tolerability and risk benefit analysis of tiotropium in COPD

COPD is a chronic disease and, like many other chronic diseases, there is no treatment to reverse the severity of the disease except for lung transplant. To date, no inhaled medications have been shown to improve survival. Tiotropium bromide is a long-acting inhaled anticholinergic drug for the treatment of COPD that can improve lung function, reduce symptoms and exacerbations, and improve quality of life with once-daily dosing. It was initially approved and marketed in several countries in Europe in 2002 and then approved in the US in 2004. Tiotropium is generally well tolerated with dry mouth being the main adverse effect. Other adverse effects include constipation, tachycardia, blurred vision, urinary retention and increased intraocular pressure. Despite the recently raised concerns about an excess risk of cardiovascular adverse events with inhaled anticholinergic agents, the risk/benefit ratio of tiotropium appears still favorable given the favorable safety profile demonstrated in the UPLIFT study. However, caution should be advised in patients at high risk for cardiovascular disease given the paucity of data in such patients

Empirical Bayesian significance measure of neuronal spike response

Background: Functional connectivity analyses of multiple neurons provide a powerful bottom-up approach to reveal functions of local neuronal circuits by using simultaneous recording of neuronal activity. A statistical methodology, generalized linear modeling (GLM) of the spike response function, is one of the most promising methodologies to reduce false link discoveries arising from pseudo-correlation based on common inputs. Although recent advancement of fluorescent imaging techniques has increased the number of simultaneously recoded neurons up to the hundreds or thousands, the amount of information per pair of neurons has not correspondingly increased, partly because of the instruments' limitations, and partly because the number of neuron pairs increase in a quadratic manner. Consequently, the estimation of GLM suffers from large statistical uncertainty caused by the shortage in effective information. Results: In this study, we propose a new combination of GLM and empirical Bayesian testing for the estimation of spike response functions that enables both conservative false discovery control and powerful functional connectivity detection. We compared our proposed method's performance with those of sparse estimation of GLM and classical Granger causality testing. Our method achieved high detection performance of functional connectivity with conservative estimation of false discovery rate and q values in case of information shortage due to short observation time. We also showed that empirical Bayesian testing on arbitrary statistics in place of likelihood-ratio statistics reduce the computational cost without decreasing the detection performance. When our proposed method was applied to a functional multi-neuron calcium imaging dataset from the rat hippocampal region, we found significant functional connections that are possibly mediated by AMPA and NMDA receptors. Conclusions: The proposed empirical Bayesian testing framework with GLM is promising especially when the amount of information per a neuron pair is small because of growing size of observed network

Subtle modulation of ongoing calcium dynamics in astrocytic microdomains by sensory inputs.

Astrocytes communicate with neurons through their processes. In vitro experiments have demonstrated that astrocytic processes exhibit calcium activity both spontaneously and in response to external stimuli; however, it has not been fully determined whether and how astrocytic subcellular domains respond to sensory input in vivo. We visualized the calcium signals in astrocytes in the primary visual cortex of awake, head‐fixed mice. Bias‐free analyses of two‐photon imaging data revealed that calcium activity prevailed in astrocytic subcellular domains, was coordinated with variable spot‐like patterns, and was dominantly spontaneous. Indeed, visual stimuli did not affect the frequency of calcium domain activity, but it increased the domain size, whereas tetrodotoxin reduced the sizes of spontaneous calcium domains and abolished their visual responses. The "evoked" domain activity exhibited no apparent orientation tuning and was distributed unevenly within the cell, constituting multiple active hotspots that were often also recruited in spontaneous activity. The hotspots existed dominantly in the somata and endfeet of astrocytes. Thus, the patterns of astrocytic calcium dynamics are intrinsically constrained and are subject to minor but significant modulation by sensory input

Transformation of the Higher Education Policy-making Process in the 2010s: From Ministry-led to Executive-led Higher Education Policy

This book is composed of the results of the Higher Education Policy Research Project of the Japanese Association of Higher Education Research, which was proposed by the President of the Association, Masayuki Kobayashi, and was carried out by a group of researchers within the association under the leadership of board member Takashi HATA. Research on higher education policy-making has been one of the major topics of interest since the establishment of the Association. Indeed, the association’s mission statement declares, “the establishment of an academic society is becoming an ever more critical issue for promoting cooperation and exchanges among the researchers from different study fields, strengthening the theoretical and methodological basis of research, seeking further deepened and developed research, dissemination of the outcomes of this research and contribution to the solution of practical and policy-related challenges.” This research project aims to study the process of policy-making for higher education in Japan, which has changed rapidly in recent years. This change is occurring not only in Japan but also in Europe and the United States. In order to study from a global perspective, the research project was carried out with the participation of experts studying higher education in the United States, France, and the United Kingdom, and new research results were produced through comparative higher education policy analysis. In the Higher Education Policy Project, members interviewed officials from the Ministry of Education, Culture, Sports, Science and Technology (MEXT), and have been energetically studying the policy-making process, especially the relationship between the official residence and the MEXT. At the same time, they have analyzed the decision-making process of higher education policies in each country. We believe that research that examines the decision-making process of higher education policies in so many countries is unparalleled and offers an unprecedented contribution to higher education research.はじめに… 小林雅之 1 序章　高等教育政策決定過程の変容を探求する－研究の課題… 羽田貴史 3 第1章　2010年代高等教育政策決定過程の変容… 羽田貴史 9 第2章　高等教育政策にかかわる会議体とアクター… 丸山和昭 33 第3章　「高等教育の修学支援新制度」の形成過程－政治と官邸主導による新制度創設… 白川優治 51 第4章　高大接続改革への疑義… 荒井克弘 65 第5章　アメリカの高等教育政策決定過程と大統領府… 塙武郎 83 第6章　フランスの高等教育政策決定過程… 大場淳 97 第7章　イギリスの高等教育政策決定過程と首相官邸－証拠に基づく政策形成（EBPM）の仕組み… 田中正弘 109 おわりに… 羽田貴史 12

Thirteen Years of Volunteering in Schools

共同研

Mitochonic Acid 5 (MA-5) Facilitates ATP Synthase Oligomerization and Cell Survival in Various Mitochondrial Diseases

Mitochondrial dysfunction increases oxidative stress and depletes ATP in a variety of disorders. Several antioxidant therapies and drugs affecting mitochondrial biogenesis are undergoing investigation, although not all of them have demonstrated favorable effects in the clinic. We recently reported a therapeutic mitochondrial drug mitochonic acid MA-5 (Tohoku J. Exp. Med., 2015). MA-5 increased ATP, rescued mitochondrial disease fibroblasts and prolonged the life span of the disease model “Mitomouse” (JASN, 2016). To investigate the potential of MA-5 on various mitochondrial diseases, we collected 25 cases of fibroblasts from various genetic mutations and cell protective effect of MA-5 and the ATP producing mechanism was examined. 24 out of the 25 patient fibroblasts (96%) were responded to MA-5. Under oxidative stress condition, the GDF-15 was increased and this increase was significantly abrogated by MA-5. The serum GDF-15 elevated in Mitomouse was likewise reduced by MA-5. MA-5 facilitates mitochondrial ATP production and reduces ROS independent of ETC by facilitating ATP synthase oligomerization and supercomplex formation with mitofilin/Mic60. MA-5 reduced mitochondria fragmentation, restores crista shape and dynamics. MA-5 has potential as a drug for the treatment of various mitochondrial diseases. The diagnostic use of GDF-15 will be also useful in a forthcoming MA-5 clinical trial

COVID-19 vaccine effectiveness against severe COVID-19 requiring oxygen therapy, invasive mechanical ventilation, and death in Japan: A multicenter case-control study (MOTIVATE study).

INTRODUCTION: Since the SARS-CoV-2 Omicron variant became dominant, assessing COVID-19 vaccine effectiveness (VE) against severe disease using hospitalization as an outcome became more challenging due to incidental infections via admission screening and variable admission criteria, resulting in a wide range of estimates. To address this, the World Health Organization (WHO) guidance recommends the use of outcomes that are more specific to severe pneumonia such as oxygen use and mechanical ventilation. METHODS: A case-control study was conducted in 24 hospitals in Japan for the Delta-dominant period (August-November 2021; "Delta") and early Omicron (BA.1/BA.2)-dominant period (January-June 2022; "Omicron"). Detailed chart review/interviews were conducted in January-May 2023. VE was measured using various outcomes including disease requiring oxygen therapy, disease requiring invasive mechanical ventilation (IMV), death, outcome restricting to "true" severe COVID-19 (where oxygen requirement is due to COVID-19 rather than another condition(s)), and progression from oxygen use to IMV or death among COVID-19 patients. RESULTS: The analysis included 2125 individuals with respiratory failure (1608 cases [75.7%]; 99.2% of vaccinees received mRNA vaccines). During Delta, 2 doses provided high protection for up to 6 months (oxygen requirement: 95.2% [95% CI:88.7-98.0%] [restricted to "true" severe COVID-19: 95.5% {89.3-98.1%}]; IMV: 99.6% [97.3-99.9%]; fatal: 98.6% [92.3-99.7%]). During Omicron, 3 doses provided high protection for up to 6 months (oxygen requirement: 85.5% [68.8-93.3%] ["true" severe COVID-19: 88.1% {73.6-94.7%}]; IMV: 97.9% [85.9-99.7%]; fatal: 99.6% [95.2-99.97]). There was a trend towards higher VE for more severe and specific outcomes. CONCLUSION: Multiple outcomes pointed towards high protection of 2 doses during Delta and 3 doses during Omicron. These results demonstrate the importance of using severe and specific outcomes to accurately measure VE against severe COVID-19, as recommended in WHO guidance in settings of intense transmission as seen during Omicron