Safety and Efficacy of Nontuberculous Mycobacteria Treatment among Elderly Patients

Background and objectives: Incidence rates of pulmonary nontuberculous mycobacterial (NTM) disease have been increasing, especially in the elderly population. Given the limited evidence regarding the safety and efficacy of NTM treatment, this study aimed to evaluate the same among elderly patients. Material and methods: Patients diagnosed with NTM disease at a tertiary hospital from January 2007 to December 2017 were enrolled and data were then retrospectively collected. Data of elderly patients who received antimycobacterial treatment were then analyzed. Results: A total of 161 patients satisfied the diagnostic criteria for NTM disease. There were 40 elderly patients who received treatments. Of the patients, 60% received the guideline oriented standard regimens. Single drug regimens were administered to 22.5% of patients. Only 55.0% of the patients were able to continue any treatment. Treatment-related discontinuation was observed in 44.4% of discontinued or changed patients. There were no significant differences in the characteristics of patients with or without adverse events. Patients who were able to continue the treatment for >12 months had a lower proportion of activities of daily living (ADL) disability (nine in 18, 50.0% vs. three in 22, 13.6%, p = 0.018) and heart disease (six in 18, 33.3% vs. 1/22, 4.6%, p = 0.033). Sputum culture conversion was achieved in 28 out of 40 (70.0%) elderly patients treated, and those who achieved sputum culture conversion had more standard regimens prescribed than those who failed sputum culture conversion (21 in 28, 75% vs. 3 in 12, 25%; p = 0.005). Conclusion: Age may not be an obstacle for receiving the benefits of the treatment of NTM disease with a precise evaluation of patient’s comorbidities. Furthermore, elderly patients without heart disease and ADL disability may have better rate of continuing the NTM treatment. The current study suggested that selecting standard regimens to treat pulmonary NTM is important for elderly patients

Anomalous depth dependency of the stress field in the 2007 Noto Hanto, Japan, earthquake: Potential involvement of a deep fluid reservoir

We have elucidated depth variations in the stress field associated with the 2007 Noto Hanto, Japan, earthquake by stress tensor inversion using high-quality aftershock data obtained by a dense seismic network. Aftershocks that occurred above 4 km in depth indicated a strike-slip stress regime. By contrast, aftershocks in deeper parts indicated a thrust faulting stress regime. This depth variation in the stress regime correlates well with that in the slip direction derived from a finite source model using geodetic data. Furthermore, the maximum principal stress (σ1) axis was stably oriented approximately W20°N down to the depth of the mainshock hypocenter, largely in agreement with the regional stress field, but, below that depth, the σ1 axis had no definite orientation, indicating horizontally isotropic stress. One likely cause of these drastic changes in the stress regime with depth is the buoyant force of a fluid reservoir localized beneath the seismogenic zone