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Takuya Samukawa,1,* Koichiro Matsumoto,2,* Go Tsukuya,1 Chihaya Koriyama,3 Satoru Fukuyama,2 Akifumi Uchida,1 Keiko Mizuno,1 Hironori Miyahara,4 Yutaka Kiyohara,5 Toshiharu Ninomiya,6 Hiromasa Inoue1 1Department of Pulmonary Medicine, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, 2Research Institute for Diseases of the Chest, Graduate School of Medical Sciences, Kyushu University, Fukuoka, 3Department of Epidemiology and Preventive Medicine, Graduate School of Medical and Dental Sciences, Kagoshima University, 4Kagoshima Kouseiren Medical Health Care Center, Kagoshima, 5Hisayama Research Institute for Lifestyle Diseases, 6Department of Epidemiology and Public Health, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan *These authors contributed equally to this work Background: The use of a simple screening questionnaire to detect persistent airflow obstruction (AO) in COPD may facilitate the early, accurate diagnosis of COPD in general practice settings. Objective: This study developed an original persistent AO questionnaire for screening individuals with COPD in a general Japanese population. Methods: A working group was established to generate initial draft questionnaire items about COPD. Eligible subjects aged 40 and older living in Japan were solicited to participate in a health checkup from 2014 to 2015. In study I, 2,338 subjects who fully completed the initial draft questionnaire and who had valid spirometry measurements were statistically analyzed to determine the final questionnaire items as a COPD screening questionnaire (COPD-Q). Persistent AO was defined as a post-bronchodilator FEV1/FVC

Yasuharu Nakashima,1 Masakazu Kondo,2 Hisaaki Miyahara,3 Yukihide Iwamoto11Department of Orthopaedic Surgery, Kyushu University, Fukuoka, Japan; 2Kondo Clinic of Rheumatology and Orthopaedic Surgery, Fukuoka, Japan; 3Department of Orthopaedic Surgery and Rheumatology, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, JapanAbstract: Rheumatoid arthritis (RA) is a chronic, progressive, inflammatory disease associated with joint destruction. Tocilizumab (TCZ) is a humanized monoclonal anti-interleukin-6 receptor antibody that was initially developed for use as an intravenous (IV) infusion. Previous studies have shown that TCZ-IV is an important treatment option in patients with moderate-to-severe RA. A subcutaneous (SC) formulation of 162 mg TCZ that was recently developed and approved provides an additional treatment option for RA patients. In the present review, we provide an update on the efficacy and safety of TCZ-SC, compared with TCZ-IV. The TCZ-SC doses of 162 mg every 2 weeks (q2w) or weekly (qw) were selected based on pharmacokinetic and pharmacodynamic studies. Both TCZ-SC q2w and qw regimens showed equivalent effects to TCZ-IV in most patients; however, the TCZ-SC qw regimen consistently showed a more rapid effect in terms of C-reactive protein normalization. Randomized controlled studies showed that TCZ-SC monotherapy or combined with disease-modifying antirheumatic drugs demonstrated comparable efficacy to TCZ-IV in patients who were both biologic-naïve and refractory to tumor necrosis factor inhibitors. TCZ-SC at both qw and q2w were generally well-tolerated for up to 24 weeks. There was a low rate of withdrawal due to adverse events, and their incidence was comparable with that seen with TCZ-IV. An injection site reaction was seen in approximately 10% of patients who received the subcutaneous formulation. In conclusion, although clinical results are still limited, the currently available evidence suggests that TCZ-SC is a promising treatment for moderate-to-severe RA, both as monotherapy and combination therapy. More data is needed to determine the optimal dosing schedule.Keywords: rheumatoid arthritis, tocilizumab, subcutaneous injection, review

Due to a large number of bursty traffic sources that an ATM network is expected to support, controlling network traffic becomes essential to provide a desirable level of network performance with its users. Admission control and traffic smoothing are among the most promising control techniques for an ATM network. To evaluate the performance of an ATM network when it is subject to admission control or traffic smoothing, we build a discrete-time single-server queueing model where a new call joins the existing calls.In our model. it is assumed that the cell arrivals from a new call follow a general distribution. It is also assumed that the aggregated arrivals of cells from the existing calls form batch arrivals with a general distribution for the batch size and a geometric distribution for the interarrival times of batches. We consider both finite and infinite buffer cases, and analytically obtain the waiting time distribution and cell loss probability for a new call and for existing calls. Our analysis is an exact one. Through numerical examples, we investigate how the network performance depends on the statistics of a new call (burstiness, time that a call stays in active or inactive state, etc.). We also demonstrate the effectiveness of traffic smoothing to reduce network congestion.