Anti-IL-5/5Ra biologics improve work productivity and activity in severe asthma: a RAPSODI registry-based cohort study.

INTRODUCTION: Severe asthma is associated with a serious disease burden, partially caused by limitations in activity and work impairment. AIMS AND OBJECTIVES: This study aims to relate treatment with biologics targeting IL-5/5Ra to work productivity and activity in the long term in a real-world context. MATERIAL AND METHODS: This is a registry-based multi-center cohort study evaluating data from adults with severe eosinophilic asthma included in the Dutch Register of Adult Patients with Severe Asthma for Optimal DIsease management (RAPSODI). Patients that started with anti-IL-5/5Ra biologics and completed the work productivity and activity improvement questionnaire, were included. Study and patient characteristics were compared between the employed and unemployed patients. Work productivity and activity impairment are related to accompanying improvements in clinical outcomes. RESULTS: At baseline, 91 of 137 patients (66%) were employed which remained stable throughout the follow-up period. Patients in the working age category were younger and had significantly better asthma control (p = 0.02). Mean overall work impairment due to health decreased significantly from 25.5% (SD2.6) to 17.6% (SD 2.8) during 12 months anti-IL-5/5Ra biologics treatment (P = 0.010). There was a significant association between ACQ6 and overall work improvement after targeted therapy (ß = 8.7, CI 2.1-15.4, P = 0.01). The improvement of asthma control of 0.5 points on the asthma Control Questionnaire was associated with an overall work impairment of -9%. CONCLUSIONS: Work productivity and activity in severe eosinophilic asthma improved after starting anti-IL-5/5Ra biologics. Clinically relevant improvement in asthma control was associated with an overall work impairment score of -9% in this study.

Formation of weakly bound, ordered adlayers of CO on rutile TiO2(110): a combined experimental and theoretical study.

The adsorption of CO on the rutile TiO(2)(110) surface was investigated using He atom scattering (HAS), high resolution electron energy loss spectroscopy (HREELS), thermal desorption spectroscopy (TDS), and different types of ab initio electronic structure calculations. The experimental and theoretical results allow to put forward a consistent picture for this rather complicated adsorbate system. At 70 K a (2x1) adlayer with a glide symmetry plane is formed, containing two molecules per unit cell which are tilted in alternate directions by about 20 degrees relative to the surface normal. For this high density phase, the theoretical calculations reveal a substantial repulsion between CO molecules on neighboring lattice sites, in accord with the results of a detailed analysis of the experimental TDS data. The CO binding energy depends strongly on coverage and varies between 0.20 eV for the saturated monolayer and 0.36 eV for isolated molecules. The CO-CO repulsion leads to the desorption of about half of the CO molecules above 70 K and the formation of low density phases. HAS gave no indication of ordered adlayers at these lower coverages. For the internal stretching vibration of the CO molecules a value of 273 meV was determined by HREELS, in very good agreement with the theoretical calculations.

Reaction Pathways Involved in CH4 Conversion on Pd/Al2O3 Catalysts: TAP as a Powerful Tool for the Elucidation of the Effective Role of the Metal/Support Interface.

Temporal Analysis of Products (TAP) investigation on Natural Gas-fueled Vehicle (NGV) catalysts provides information related to the nature of reaction steps involved over noble metals and at the metal-support interface. The determination of accurate kinetic parameters for methane adsorption from single pulse experiments and subsequent investigation of sequential surface reactions from alternative CH4/O2 pulse experiments is the first step toward the establishment of relevant structure/activity relationships which can highlight the importance of the metal/support interface on freshly-prepared and aged single palladium based catalysts.

Intralesional infiltration of corticosteroids in the treatment of localised langerhans' cell histiocytosis of the mandible Report of known cases and three new cases.

Langerhans' cell histiocytosis (LCH) can involve virtually any site and organ of the body, either as an isolated lesion or as a widespread systemic disease. Bone can be involved as a part of generalised disease or as a separate entity, formerly known as eosinophilic granuloma. The clinical cause of localised LCH (LLCH) to bone is generally benign. Solitary bone lesions may resolve spontaneously after diagnostic biopsy in a period of months to years. If treatment is indicated, as in larger lesions with pain, swelling and risk for spontaneous fracture, the disease can be controlled by chemotherapy or local measures such as surgical curettage, low-dose radiotherapy and intralesional injection of corticosteroids. There are no controlled studies in the literature comparing outcomes of these treatment modalities because of low incidence of the disease and general tendency to regress. Three patients (female, 28 months; male, 9 years; male, 15 years) with LLCH of the mandible were treated in an one stage procedure with intralesional injection of 80, 40 and 80 mg methylpredisolone succinate, respectively, as the primary form of treatment. Patients were seen for clinical and radiological evolution 1, 3, 6, 9 and 12 months after treatment, and yearly thereafter. The overall outcome was excellent. The lesions showed clinically and radiologically complete remission approximately 6 months after treatment. There were no complications nor morbidity of the treatment. After a follow-up period of 12 months, the patients are well with no evidence of residual disease on radiographs. Local injection of corticosteroids should be the initial choice of treatment of LLCH of the mandible, because of the favourable treatment outcome in this disease and possible complications and lasting effects of surgery, radiotherapy and chemotherapy.

Cardiac gap junction channels: modulation of expression and channel properties.

In the heart, intercellular gap junction channels constructed from connexin molecules are crucial for conduction of the electric impulse. Cardiomyocytes can be interconnected by channels composed of three types of connexin proteins: Cx40, Cx43 or Cx45. In mammalian hearts, these three isoforms are regionally differently expressed and even between the species differences exist. Each of these channel-types possesses specific properties and are susceptible to modulation by various mechanisms. In this paper we compare the differences in properties of these channels as deduced from studies on transfected cells and isolated cardiomyocytes and discuss the factors involved in modulation of channel properties. Next, we evaluate the consequences of alterations in expression and modulation of channel properties for cardiac function. Therefore, we have compared reports on genetically engineered animals and discuss this information in relation to various pathophysiological disorders.

Comparison of the humoral and cytotoxic T-lymphocyte response to individual HLA class I alloantigens in highly immunized patients.

In order to investigate the correlation between activation of cytotoxic T-lymphocyte precursor (CTLp) and the formation of antibodies to alloantigens, we studied 21 highly sensitized patients waiting for a kidney transplantation. Both antibody reactivity and CTLp frequencies of these patients were determined against 88 individual HLA class I alloantigens. A high or low CTLp frequency against a certain HLA-A or -B alloantigen was not correlated with the presence or absence of the antibodies to that antigen. Mismatched antigens, towards which the patient had not formed antibodies, can induce either a higher or a lower frequency of CTLp compared to mismatches towards which the patients had formed antibodies. The possible implications of this lack of correlation between the T- and B-cell allorepertoires with regard to donor selection for (highly immunized) patients is discussed.

The prognosis of oncologic patients in the pediatric intensive care unit.

OBJECTIVE: To evaluate the predicted mortality rate of oncologic patients in the PICU using the PRISM score and factors that might influence short-term outcomes. DESIGN: Retrospective study. SETTING: Pediatric ICU in a university hospital. PATIENTS AND METHODS: The medical charts of all oncologic patients admitted to the PICU during the period from January 1983 to December 1992 were reviewed. MAIN RESULTS: Over a period of 10 years, 51 oncologic patients were admitted on 57 occasions to the PICU. The mortality was 32%. This is significantly higher than the overall mortality in the PICU (8%). Comparison of observed and predicted mortality, derived from the PRISM score, using chi square goodness-of-fit tests showed a significantly higher observed mortality (x2(5) = 20.1, P < 0.01). Patients admitted for circulatory failure had the highest mortality (47%), followed by those with respiratory failure due to tachypnea/cyanosis (36%), central nervous system deterioration (27%), respiratory failure due to airway obstruction (25%), and metabolic disorders (20%). Of the 31 patients who needed mechanical ventilation, 17 died (55%), and when they needed inotropic support as well, the mortality increased to 69%. The mortality rose to 100% when the patient was admitted with a septic shock, necessitating mechanical ventilation and inotropic support. The median PRISM score was 5 in the survivor group and 18.5 in the non-survivor group; this difference was found to be significant using the Wilcoxon test (P = 0.01). However, some patients with high scores were found in the survivor group, as well as some with low scores in the non-survivor group. CONCLUSION: The decision to treat oncologic patients in a PICU remains difficult and has to be considered on an individual basis. However, oncologic patients do benefit from admission to the PICU. The PRISM score is not suitable for oncologic patients in the PICU, because it underestimates the observed mortality. Other factors like neutropenia, septic shock, the need for mechanical ventilation, and inotropic support should be taken into consideration.

Molecular epidemiology of drug-resistant pneumococci: toward an international approach.

An international multicenter study was undertaken to investigate the epidemiological dynamics of penicillin-resistant pneumococci. We compared the molecular epidemiological characteristics of 205 penicillin-resistant isolates originating from The Netherlands, Thailand, United States, Spain, Greece, Poland, Cuba, Germany, Finland, United Kingdom, South Africa, Hungary, Portugal, Croatia, and the Czech Republic. Eighty-four distinct restriction fragment end labeling (RFEL) types were observed. Twenty-eight genetic types were shared by two or more strains. Five genetic clusters consisted of strains originating from different countries, illustrating dissemination of penicillin-resistant pneumococci among countries. The strains displaying the two predominant RFEL types corresponding with the pandemic clones 23F and 9V were found in 10 and 6 different countries, respectively. This clearly demonstrates the pandemic behavior of these two clones. Twelve out of the 28 genetic clusters contained two or more serotypes. This finding indicates frequent horizontal transfer of capsular genes. Within distinct RFEL types, identical penicillin binding protein (PBP) genotypes were often observed, suggesting a high frequency of horizontal transfer of penicillin resistance genes. The most predominant PBP type was found in 15 distinct RFEL types, comprised 44% of the entire collection, and was observed in 11 countries. The vast majority of the strains belonging to the pandemic clones 23F and 9V shared this predominant PBP type. We hypothesize that the clones 23F and 9V are responsible for the worldwide increase of penicillin-resistance, because they serve as a genetic reservoir for susceptible pneumococci to acquire penicillin resistance.

The smallest detectable difference of mandibular function impairment in patients with a painfully restricted temporomandibular joint.

Mandibular functions such as speech, laughing, yawning, mastication, and taking a large bite may be impaired if temporomandibular disorders exist. The Mandibular Function Impairement Questionnaire is a validated instrument that scores perceived difficulty of representative mandibular functions in relation to jaw complaints. However, the reliability of the Mandibular Function Impairment Questionnaire has never been adequately tested. Generalizability and decision studies are currently proposed to assess the reliability of a measurement device. The smallest detectable difference is the smallest statistically significant amount of change to be detected with a measurement device. The purpose of this study was to assess the reliability of the Mandibular Function Impairement Questionnaire in terms of the smallest detectable difference. Twenty-five consecutive patients with painfully restricted temporomandibular joints completed the Mandibular Function Impairement Questionnaire on two separate measurement days, one week apart, using two consecutive sessions per day. Spearman's r was calculated for test-retest reliability. Variance components such as patients, measurement days, repetitions, and all their interactions were analyzed in the generalizability study. In the decision study, the smallest detectable difference was calculated for different days and repetitions. Spearman's r varied from 0.69 to 0.96. The between-patient variance and the error variance contributed 81% and 19% to total variance, respectively. The Mandibular Function Impairment Questionnaire is a reliable instrument for the assessment of mandibular function impairment. The minimal amount of change to be detected is 14 units on a scale of 0 to 68. Reliability in terms of the smallest detectable difference increases if the measurement is repeated twice on two separate days: The smallest detectable difference improves to 10 units.

Amorphous-amorphous transition in glassy polymers subjected to cold rolling studied by means of positron annihilation lifetime spectroscopy.

In this study, polycarbonate (PC) and polystyrene (PS) are subjected to plastic deformation by means of cold rolling and the resulting variation of the free volume and its subsequent time evolution after rolling is investigated by means of positron annihilation lifetime spectroscopy (PALS). The value of the long lifetime component that is attributed to the decay of ortho-positronium (tau(o-Ps)) and its intensity (I(o-Ps)) are used to characterize, respectively, the size and the concentration of the free-volume holes. In addition to the PALS experiments, the effect of plastic deformation on the dynamic tensile modulus is investigated. The PALS results show that both for well-aged PC and PS an increase of tau(o-Ps) and a decrease of I(o-Ps) occur upon plastic deformation. During the subsequent aging, tau(o-Ps) tends to return to the value assumed before plastic deformation, while I(o-Ps) remains constant with time. These results corroborate the idea of an amorphous-amorphous transition, rather than that of a "mechanical rejuvenation" as proposed in the past to explain the ability of plastic deformation to reinitiate physical aging. Finally, a linear relation between the size of the free-volume holes and the dynamic tensile modulus is found, which suggests that the stiffness of amorphous glassy polymers is fully determined by their nanoscopic structure.

Pyrrolizidine alkaloids from Senecio jacobaea affect fungal growth.

We investigated the growth-reducing effects of pyrrolizidine alkaloids (PAs) from Senecio jacobaea on nine plant-associated fungi (five strains of Fusarium oxysporum, two of F. sambucinum, and two of Trichoderma sp). Fungal growth was monitored on water agar media containing different concentrations of monocrotaline, retrorsine, or a purified extract of PAs from S. jacobaea. The growth rate of six strains was inhibited by PAs at the highest test concentration (3.33 mM), with the magnitude of the inhibition (7-35%) being dependent upon the specific fungus-PA interaction. In general, the PA extract caused the largest inhibition. However, the fungi isolated from S. jacobaea were positively affected by the PA extract (7-9%). Retrorsine N oxide was as effective as retrorsine in its inhibition of mycelium growth.

A comparison of salmeterol and formoterol in attenuating airway responses to short-acting beta2-agonists.

In vitro data suggest that salmeterol, contrary to formoterol, can partly antagonise the effect of short-acting beta(2)-agonist rescue medication. To explore whether this occurs in vivo, we compared the effects of increasing doses (200-3200 microg) of fenoterol on the recovery of methacholine induced bronchoconstriction as well as PD(20) methacholine in 23 asthmatic patients, during two-week treatment periods with placebo, and standard doses of salmeterol or formoterol in a double blind, double-dummy, crossover study. Salmeterol showed a slightly higher propensity for the development of bronchodilator tolerance. The recovery of methacholine induced bronchoconstriction was more complete during regular use of formoterol relative to salmeterol. During regular use of both long-acting beta(2)-agonists the bronchoprotective efficacy of fenoterol was attenuated, but this was more pronounced during salmeterol than during formoterol. The mean maximum increase in PD(20) metacholine after the highest dose of fenoterol was 3.97 DD during placebo, 2.47 DD during formoterol (p<0.001) and 1.81 DD during salmeterol treatment (p<0.001). We conclude that in asthmatic patients the efficacy of short-acting beta(2)-adrenoceptor agonists can be significantly attenuated during regular use of long-acting beta(2)-agonists. In this respect, differences were observed between salmeterol and formoterol that may represent the expression of partial antagonism by salmeterol.

Microvascular endothelial cells remodel cultured adult cardiomyocytes and increase their survival.

We investigated the paracrine effect of cardiac microvascular endothelial cells (MVEC) on cultured adult rat cardiomyocytes (ARC). ARC were exposed for 8 days to serum-free medium (CM) conditioned by MVEC. Controls were grown in FCS or FCS-free medium. Protein synthesis of CM-stimulated ARC increased twofold versus 5% FCS-stimulated cells until day 8. Seventy-nine percent of CM-treated myocytes survived, whereas only twenty-four percent of FCS-free ARC retained viability. The phenotype of myocytes exposed to CM was different from control. Analysis by confocal laser microscopy of CM-stimulated myocytes showed actin staining throughout the whole cell body up to the peripheral extensions, with concomitant appearance of myomesin in a cross-striated pattern. The reexpression of fetal alpha-smooth muscle actin determined immunohistochemically and by Western blot increased from day 6 in CM-treated cells, whereas ARC grown in up to 20% serum were negative. These effects could not be mimicked by any of the other cardioactive substances tested here, indicating a novel trophic factor in CM.