[Analysis the Selection of Opioid Analgesics with Mild and Moderate Cancer Pain Patients for Opioid Naïve].

In 2018, the World Health Organization revised its cancer pain therapy, abolishing the three-step pain relief ladder and recommending the use of opioid analgesics(OA)according to the pain intensity. Of opioid naive patients who were admitted to Chibaken Saiseikai Narashino Hospital from July 2015 to June 2017, treatment with weak OA was initiated in 13 patients(WOA group)and low-dose strong OA in 12 patients(SOA group). The numerical rating scale values immediately before the start of OA and 3, 7 and 14 days later were not significantly different between the 2 groups. As for adverse events, the frequency of occurrence(p=0.01)and the prolongation of the last onset date(p=0.02)were significant in the WOA group for constipation. When the factors related to OA selection were analyzed using logistic regression analysis, there was no significance. We reported the analysis results regarding OA selection in OA naive patients.

Novel mechanism responsible for high-level macrolide resistance in Moraxella catarrhalis.

BACKGROUND: High-level macrolide-resistant Moraxella catarrhalis strains have been isolated; however, the underlying mechanism has not been well elucidated. We investigated the role of mutations in the 23S rRNA gene and the L4 and L22 ribosomal proteins using spontaneous erythromycin-resistant mutants and transformants. MATERIALS AND METHODS: The erythromycin-susceptible M. catarrhalis ATCC25238 and clinical isolate Mc19 were used as parental strains. To obtain spontaneous erythromycin-resistant mutants, in vitro stepwise selection was performed using brain-heart infusion agar plates containing various concentrations of erythromycin. The role of the mutations identified in the spontaneous mutants was validated using transformation experiments. RESULTS: We obtained two spontaneous mutants with high-level resistance to erythromycin, S25-32-af10 and S19-256-af10, from ATCC25238 and Mc19, respectively. S25-32-af10 exhibited mutations of Q61R in L4 and Insertion98SRADRIS in L22. S19-256-af10 exhibited three C2611T-mutated alleles in the 23S rRNA gene and G65A in L4. Transformants with single mutations identified in S25-32-af10 or S19-256-af10 showed higher erythromycin and azithromycin minimum inhibitory concentrations (MICs) than those of each parental strain. However, transformants with multiple mutations identified in S25-32-af10 or S19-256-af10 showed macrolide MICs similar to those of each parental strain. CONCLUSION: Our results provide the first evidence suggesting that Q61R in L4 and Insertion98SRADRIS in L22 are involved in the synergistic acquisition of high-level resistance to both 14- and 15-member macrolides, and that C2611T in the 23S rRNA gene and G65A in L4 also synergistically contribute toward conferring high-level 14-member macrolide resistance to M. catarrhalis.