Development and validation of a new scoring system for prognostic prediction of community-acquired pneumonia in older adults

The discriminative power of CURB-65 for mortality in community-acquired pneumonia (CAP) is suspected to decrease with age. However, a useful prognostic prediction model for older patients with CAP has not been established. This study aimed to develop and validate a new scoring system for predicting mortality in older patients with CAP. We recruited two prospective cohorts including patients aged ≥ 65 years and hospitalized with CAP. In the derivation (n = 872) and validation cohorts (n = 1, 158), the average age was 82.0 and 80.6 years and the 30-day mortality rate was 7.6% (n = 66) and 7.4% (n = 86), respectively. A new scoring system was developed based on factors associated with 30-day mortality, identified by multivariate analysis in the derivation cohort. This scoring system named CHUBA comprised five variables: confusion, hypoxemia (SpO2 ≤ 90% or PaO2 ≤ 60 mmHg), blood urea nitrogen ≥ 30 mg/dL, bedridden state, and serum albumin level ≤ 3.0 g/dL. With regard to 30-day mortality, the area under the receiver operating characteristic curve for CURB-65 and CHUBA was 0.672 (95% confidence interval, 0.607–0.732) and 0.809 (95% confidence interval, 0.751–0.856; P < 0.001), respectively. The effectiveness of CHUBA was statistically confirmed in the external validation cohort. In conclusion, a simpler novel scoring system, CHUBA, was established for predicting mortality in older patients with CAP

Pneumonia Caused by Severe Acute Respiratory Syndrome Coronavirus 2 and Influenza Virus: A Multicenter Comparative Study

Background: Detailed differences in clinical information between severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia (CP), which is the main phenotype of SARS-CoV-2 disease, and influenza pneumonia (IP) are still unclear. Methods: A prospective, multicenter cohort study was conducted by including patients with CP who were hospitalized between January and June 2020 and a retrospective cohort of patients with IP hospitalized from 2009 to 2020. We compared the clinical presentations and studied the prognostic factors of CP and IP. Results: Compared with the IP group (n = 66), in the multivariate analysis, the CP group (n = 362) had a lower percentage of patients with underlying asthma or chronic obstructive pulmonary disease (P < .01), lower neutrophil-to-lymphocyte ratio (P < .01), lower systolic blood pressure (P < .01), higher diastolic blood pressure (P < .01), lower aspartate aminotransferase level (P < .05), higher serum sodium level (P < .05), and more frequent multilobar infiltrates (P < .05). The diagnostic scoring system based on these findings showed excellent differentiation between CP and IP (area under the receiver operating characteristic curve, 0.889). Moreover, the prognostic predictors were different between CP and IP. Conclusions: Comprehensive differences between CP and IP were revealed, highlighting the need for early differentiation between these 2 pneumonias in clinical settings

2007年能登半島地震の震源域陸域の地質

Stratigraphy and geologic structure in the onshore epicentral area of the 2007 Noto Hanto earthquake was studied to reveal the relationship between the earthquake source fault and geologic structure. The epicentral area is located in the southern part of the Yamato basin rift-system and thick syn-rift succession is exposed on the Noto peninsula. Exposed Paleogene to Miocene rocks overlying the Jurasic granitic rocks are divided in ascending order into Daifukuji, Ohkadoma, Anamizu, Nawamata, Touge, Sekinohama, Maehama Formations, and Kurosaki Andesite. The Dai-fukuji and Okadoma Formations consist of sedimentary rocks deposited at the Paleogene pre-rifting stage. More than 1,400m thick, Oligocene to lower Miocene andesitic volcanic rocks and fluvial sediments (Anamizu, Nawamata and Toge Formations) were deposited, filling half grabens bounded by ENE-WSW- and NS-trending faults. They are syn-rift sediments formed at the rifting and open-ing stage of the Sea of Japan. Middle Miocene shallow marine sedimentary rocks (Sekinohama and Maehama Formations) unconformably cover the syn-rift succession. A major geologic structure was formed by rifting associated with the opening of the Sea of Japan. The source fault of the 2007 Noto Hanto earthquake trending NE to ENE coincides with the fault bounding the Miocene halft graben, and its eastern end corresponds to the NS-trending fault, a probable transfer fault during the rifting stage