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Background: Treatments for eosinophilic granulomatosis with poliangiitis (EGPA) were limited to systemic corticosteroid and immunomodulatory agent, which have serious adverse effects. In EGPA patients a reduction of corticosteroid often induces relapses. Aims: The MIRRA trial demonstrated that mepolizumab (MEPO) is a steroid-sparing agent for patients with relapsing or refractory EGPA (NEJM 2017). However, the number of enrolled patients was limited. We report 5 EGPA patients treated with MEPO to confirm the finding. Methods: This is retrospective review of five patients with EGPA treated with MEPO. Results: Case 1-4 were 3 men and 1 female and age of onset were 28-70 yo. Treatment was started with PSL 30-60 mg/day with a gradual tapering. All the cases suffered relapses with PSL tapering, and then PSL were increased. In Case 1-3, MEPO 300 mg/day were added at the time of PSL 9-10 mg/day. In Case 4, MEPO 100 mg/day was added at the time of PSL 7 mg/day and, followed by the increase of MEPO (300 mg/day) after tapering of PSL. Currently, in Case 1, 2 and 4, dose of PSL was tapering to 0.5-4 mg/day and these cases maintain remission. In Case 3, a relapse was observed after reduction of PSL even with MEPO. Case 5 was a male and onset age was 75 yo. Treatment was started with PSL 60 mg/day and MEPO 100 mg/day. A relapse was observed during the reduction of PSL. Both PSL and MEPO (300 mg/day) were increased. After that PSL was reduced to 5 mg/day without any replace. No apparent adverse events of MEPO were found in any cases. Conclusions: Remission was obtained in 5 of 3 cases. Consistent with prior published paper, MEPO is an effective steroid-sparing agent for patients with EGPA.

Background In approximately 30% of children with asthma, the condition persists into adulthood. The longer duration of asthma in these patients is a risk factor for poor asthma control. However, the characteristics of adult patients with asthma that has persisted since childhood are not well documented. Objective We sought to compare the clinical characteristics among patients with adult-onset asthma, patients who outgrew childhood asthma but relapsed, and patients with persistent asthma since childhood. Methods We conducted a cross-sectional study of adult patients with asthma who visited our hospital. We classified them into 3 groups: those with adult-onset asthma (adult-onset), those who had remitted childhood asthma that relapsed (relapsed), and those who had asthma that had persisted since childhood (persistent). The clinical characteristics of these groups were compared. Results A total of 1443 patients were enrolled. The persistent group was younger and included fewer patients with a smoking history. There were statistically significant differences among the 3 groups in the percentages of patients with a family history of asthma and comorbidities of allergic rhinitis and atopic dermatitis. The proportion of patients with severe asthma differed among the 3 groups (31% in the adult-onset group, 34% in the relapsed group, and 40% in the persistent group; P = .015). The values of forced expiratory flow at 75% of vital capacity were lower in the persistent group than the relapsed or adult-onset group. A multivariable logistic regression analysis (dependent variable: severe asthma) in each group revealed that the factors associated with severe asthma differed among the adult-onset, relapsed, and persistent groups. When we established an overall model that included interaction terms of cohort-by-other factors, there was a trend that comorbidity of allergic rhinitis affected the severity of asthma differently in the relapsed group compared with the other groups. Conclusion The clinical phenotype of asthma that persists from childhood to adulthood seems to be a distinct phenotype of adult asthma.

It is unclear whether simultaneous administration of a 23-valent pneumococcal polysaccharide vaccine (PPSV23) and a quadrivalent influenza vaccine (QIV) produces immunogenicity in older individuals. This study tested the hypothesis that the pneumococcal antibody response elicited by simultaneous administration of PPSV23 and QIV in older individuals is not inferior to that elicited by sequential administration of PPSV23 and QIV. We performed a single-center, randomized, open-label, non-inferiority trial comprising 162 adults aged ≥65 years randomly assigned to either the simultaneous (simultaneous injections of PPSV23 and QIV) or sequential (control; PPSV23 injected 2 weeks after QIV vaccination) groups. Pneumococcal immunoglobulin G (IgG) titers of serotypes 23F, 3, 4, 6B, 14, and 19A were assessed. The primary endpoint was the serotype 23F response rate (a ≥2-fold increase in IgG concentrations 4-6 weeks after PPSV23 vaccination). With the non-inferiority margin set at 20% fewer patients, the response rate of serotype 23F in the simultaneous group (77.8%) was not inferior to that of the sequential group (77.6%; difference, 0.1%; 90% confidence interval, -10.8% to 11.1%). None of the pneumococcal IgG serotype titers were significantly different between the groups 4-6 weeks after vaccination. Simultaneous administration did not show a significant decrease in seroprotection odds ratios for H1N1, H3N2, or B/Phuket influenza strains other than B/Texas. Additionally, simultaneous administration did not increase adverse reactions. Hence, simultaneous administration of PPSV23 and QIV shows an acceptable immunogenicity that is comparable to sequential administration without an increase in adverse reactions. (This study was registered with ClinicalTrials.gov [NCT02592486]).

We herein report the case of an 84-year-old who developed pneumonia after drowning in a rice field. Besides Aspergillus fumigatus, many pathogens previously not reported in drowning-associated pneumonia (such as Pseudomonas fluorescens, Pseudomonas putida, Nocardia niigatensis, and Cunninghamella sp.) were isolated from his sputum. He received sulbactam/ampicillin, trimethoprim/sulfamethoxazole, voriconazole, levofloxacin and liposomal amphotericin B, but died due to respiratory failure. Because the patient had drowned in a contaminated stagnant rice field and had multiple lung cavities, zygomycosis was suspected. This report provides invaluable information for the consideration of zygomycosis after an individual drowning in a rice field, even in an immunocompetent patient.

Background: In the 2015/2016 season, the quadrivalent influenza vaccine (QIV) became available in Japan. We evaluated the immunogenicity of simultaneous administration (SIM) of QIV and 23-valent pneumococcal polysaccharide vaccine (PPSV23). Methods: This study was a randomized, non-inferiority, open label trial conducted at a single center in Japan. A total of 162 adults aged ≥65 years were randomly assigned to either the SIM group (received injections of PPSV23 and QIV simultaneously) or sequential administration (SEQ) group (received injection of PPSV23 at 2 weeks post-administration of QIV). Pneumococcal IgG titers of serotype 23F, 3, 4, 6B, 14, and 19A were assessed. This trial was registered with the ClinicalTrials.gov, number NCT02592486. Results: A total of 81 and 76 patients were evaluated in the SIM and SEQ groups, respectively. We found that the response rate of serotype 23F in the SIM group (77.8%) was not inferior to that in the SEQ group (77.6%) (difference, 0.1%; 90% confidence interval, -10.8% to 11.1%). IgG titers at 4–6 weeks after vaccination did not show significant differences between the two groups in all serotypes. H1N1, H3N2, and B Phuket strains of influenza did not show differences in the odds ratios for seroprotection rates between the two groups. No significant differences were found in adverse reactions. The results at 6 month after vaccination will be reported at the congress. Conclusion: The SIM of PPSV23 and QIV showed an acceptable immune response compared to that of SEQ, without an increase of adverse reactions.

We herein report the case of an 84-year-old who developed pneumonia after drowning in a rice field. Besides Aspergillus fumigatus, many pathogens previously not reported in drowning-associated pneumonia (such as Pseudomonas fluorescens, Pseudomonas putida, Nocardia niigatensis, and Cunninghamella sp.) were isolated from his sputum. He received sulbactam/ampicillin, trimethoprim/sulfamethoxazole, voriconazole, levofloxacin and liposomal amphotericin B, but died due to respiratory failure. Because the patient had drowned in a contaminated stagnant rice field and had multiple lung cavities, zygomycosis was suspected. This report provides invaluable information for the consideration of zygomycosis after an individual drowning in a rice field, even in an immunocompetent patient.

As for the Al–Si hyper-eutectic alloys with phosphorous addition, the primary Si size is dependent on the holding temperature relative to the “Critical Temperature Line for Grain Refinement”, which was discovered by the authors. If the holding temperature falls under this line, the size will be coarsened. Cooling rate is also said to be influential to the size of primary Si crystal, however, it is unknown which stage of cooling rate is preferential. The difference between the liquidus temperature measured with phosphorous addition and the liquidus temperature measured without phosphorous addition,is not clearly understood still. To understand these problems shown above, the thermo-analysis measurements were performed during the cooling of hyper-eutectic Al–Si alloys with and without phosphorous addition, under various cooling rates, in relation with liquidus temperature, primary Si size, etc. The results obtained are as follows: The two liquidus temperature lines of hyper-eutectic Al–Si alloys were obtained according to the alloys with phosphorous and without phosphorous, the latter shows fairly low temperature but the former shows almost the same temperature line with equilibrium diagram. This means that we can use the equilibrium diagram of hyper-eutectic Al–Si alloy as a “Imaginary Practical Phase Diagram of Hyper-eutectic Al–Si Alloy with phosphorus addition”. As for the relation between cooling rate and primary crystal size, the cooling rate above the liquidus temperature seems to be more influential to the primary crystal size, compared to the cooling rate between the liquidus line and eutectic line which is not influenced by phosphorous.

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