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Background: The Japanese Respiratory Society recently updated its prognostic guidelines for pneumonia, recommending that pneumonia severity be evaluated using the sequential organ failure assessment (SOFA) and quick SOFA (qSOFA) scoring systems in a therapeutic strategy flowchart. However, the efficacy and accuracy of these tools are still unknown. Methods: All patients with community-acquired pneumonia (CAP) and healthcare-associated pneumonia (HCAP) who were admitted to the study institution between 2014 and 2017 were enrolled in this study. Pneumonia severity on admission was evaluated by A-DROP, CURB-65, PSI, I-ROAD, qSOFA, and SOFA scoring systems. Prognostic factors for 30-day mortality were also analyzed. Results: This study included 406 patients, 257 male (63%) and 149 female (37%). The median age was 79 years (range 19-103 years). The 30-day and in-hospital mortality rates were both 5%. With respect to the diagnostic value of the predictive assessments for 30-day mortality, the area under the receiver operating characteristic curve (AUROC) value for the SOFA score was 0.769 for CAP patients and 0.774 for HCAP patients. Further, the AUROC values for the SOFA score in CAP and HCAP patients with a qSOFA score !2 were 0.829 and 0.784, respectively, for 30-day mortality. Conclusions: qSOFA and SOFA scores were able to correctly evaluate the severity of CAP and HCAP.

Correlations of heat transfer coefficients from a jacket wall or an immersed cooling coil were obtained for the aerated tower including physical properties of the liquid, viscosity correction term, liquid superficial velocity, and gas superficial velocity. It was also determined that heat transfer coefficients for non-Newtonian liquids could be correlated by the same correlative equations for Newtonian liquids using the apparent viscosity calculated from the flow curve and the local average shear rate defined in this study. As the local average shear rate at the wall surface was much larger than that near the cooling coil, it was more efficient to use a cooling coil for thermal control of the aerated tower.

A method was developed for evaluating the relative rate of conversion of [14C]-citrulline to [14C]arginine in vivo. By this method it was demonstrated that the conversion was almost completely abolished by functional nephrectomy, but not by functional hepatectomy. It was also demonstrated that functional nephrectomy caused a prompt increase in the citrulline concentration in the serum, while functional hepatectomy caused a rapid decrease in it. On the basis of these findings, it was concluded that the kidney was the main organ for synthesis of arginine from citrulline, which is supplied from the liver. Studies using this method also provided evidence suggesting that arginine formation from citrulline might be controlled by insulin and by negative feedback due to dietary arginine. In addition, in vivo experiments and perfusion experiments on isolated kidney showed that guanidinoacetic acid formation from citrulline was remarkable decreased in diabetic rats. Enzymological studies suggested that this decrease might be due to a change in glycine amidinotransferase [L-arginine:glycine amidinotransferase, EC 2.1.4.1] activity.

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