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Common variable immunodeficiency (CVID) causes granulomatous-lymphocytic interstitial lung disease (GLILD) and has a poor prognosis. We herein report a case of GLILD in a 49-year-old woman with CTLA-4 deficiency-associated CVID. The patient presented with dyspnea that had worsened over the past two years. A laboratory examination revealed hypoglobulinemia and pancytopenia. Chest computed tomography showed diffuse infiltrative and granular shadows in the bilateral interstitium. A flow cytometric analysis of blood cells and genetic testing confirmed CTLA-4 deficiency. We performed video-assisted thoracoscopic surgery for the pathological diagnosis of GLILD and to exclude infection and malignancy. Corticosteroid treatment successfully improved the condition of the patient.

Frailty is a dynamic condition that can worsen or improve. Although previous studies have identified demographic and intrinsic factors associated with transitions in frailty status, less evidence is available regarding associations with daily activities. This longitudinal study examined associations of behavioral factors with incident frailty, adverse events (e.g. residence in a nursing home, hospitalization, and death), and frailty improvement among older adults. The analysis included data from 3,769 independent older adults aged 65 years or more (mean age, 76.3 ± 7.2years; proportion of frail participants, 30.1%) from the Yabu cohort study (baseline, 2012; follow-up, 2017). The Kaigo-Yobo Checklist, a standardized questionnaire, was used to assess frailty status (non-frail or frail) and seven behavioral factors: farming, shopping, exercise, eating habit, intellectual activity, social participation, and smoking. At the 5-year follow-up survey, the proportions of participants transitioning from non-frail to frail, from non-frail to incident adverse events, from frail to non-frail, and from frail to incident adverse events were 16.8%, 13.9%, 15.2%, and 50.1%, respectively. In the analysis of non-frail participants, farming, exercise, intellectual activity, and social participation were associated with lower odds of becoming frail and experiencing adverse events. In the analysis for frail participants, farming, intellectual activity, and social participation were significantly associated with improvement in frailty status, and farming, shopping, and social participation were associated with lower odds of incident adverse events. These findings suggest that farming, healthy daily activities, and social participation help improve and prevent frailty/adverse events.

Objectives Preventing frailty is a crucial issue in aging societies such as Japan. In 2011, we launched an action research project in Yabu City, Hyogo Prefecture, to develop effective community-based strategies to prevent frailty in the elderly. We attempted to introduce community-based frailty prevention classes in every administrative district with the help of the senior workforce at Silver Human Resources Centers. This study aimed to evaluate the effectiveness and the applicability to different communities of this strategy, which will be called the "Yabu model."Methods Using PAIREM (Plan, Adoption, Implementation, Reach, Effectiveness, Maintenance) framework, we evaluated the effectiveness and the applicability to different communities of the Yabu model. To evaluate its effectiveness, we conducted a baseline and follow-up survey of residents aged 65 years or older in 2012 (n=7,287, 90.7% response rate) and 2017 (n=8,157, 85.7%), using a mailed self-administered questionnaire.Results (1) Plan: The idea was to establish a frailty prevention class (60 min/session, once a week) consisting of resistance exercises and nutritional or psychosocial programs (standard course, six months, 20 sessions/course; short course, one and a half months, 6 sessions/course; after the course, residents continued with the activities themselves). We planned to launch three classes in the first year (2014) and then to increase the number of classes by ten each year after the second year. (2) Adoption: Out of 154 administrative districts, 36 (23.4%) held frailty prevention classes between 2014 and 2017. (3) Implementation: The median attendance rate for the standard or short course (number of times each participant attended/number of frailty prevention class sessions held) was 75.0%. (4) Reach: A total of 719 older people participated in the standard or short course. The participation rate in the administrative districts, where each frailty prevention class was held, was 32.8%, while at the city level it was 8.1%. (5) Effectiveness: Propensity score matching after multiple imputations were performed. While the prevalence of frailty in non-participants increased by 13.7% in the five years from 2012 to 2017, it only increased by 6.8% in participants. Compared to non-participants, program participants had a significantly lower prevalence odds ratio of frailty at the time of the follow-up survey (OR=0.65, 95% confidence interval 0.46-0.93). (6) Maintenance: After the standard or short course, 25 out of 26 communities (96.2%) continued the frailty prevention activities once a week.Conclusion The frailty prevention classes were adopted across many districts and lowered the participants' risk of frailty. Moreover, participants continued to engage in frailty prevention activities even after the course. These results indicate the Yabu model's effectiveness and its applicability for a different community.

Introduction: Whole genome sequencing (WGS) of influenza viruses is important for preparing vaccines and coping with newly emerging viruses. However, WGS is difficult to perform using conventional next-generation sequencers in developing countries, where facilities are often inadequate. In this study, we developed a high-throughput WGS method for influenza viruses in clinical specimens with the MinION portable sequencer. Methods: Whole genomes of influenza A and B viruses were amplified by multiplex RT-PCR from 13 clinical specimens collected in Tokyo, Japan. Barcode tags for multiplex MinION sequencing were added with each multiplex RT-PCR amplicon by nested PCR with custom barcoded primers. All barcoded amplicons were mixed and multiplex sequencing using the MinION sequencer with 1D2 sequencing kit. In addition, multiplex RT-PCR amplicons generated from each clinical specimen were sequenced using the Illumina MiSeq platform to validate the performance of MinION sequencer. The accuracy, recall, and precision rates of MinION sequencing were calculated by comparing the results of variant calling in the Illumina MiSeq platform and MinION sequencer. Results: Whole genomes of influenza A and B viruses were successfully amplified by multiplex RT-PCR from 13 clinical samples. We identified 6 samples as influenza type A virus H3N2 subtype and 7 as influenza B virus Yamagata lineage using the Illumina MiSeq platform. The overall accuracy, recall, and precision rates of the MinION sequencer were, respectively 99.95%, 89.41%, and 97.88% from 1D reads and 99.97%, 93.28%, and 99.86% from 1D2 reads. Conclusion: We developed a novel WGS method for influenza A and B viruses. It is necessary to improve read accuracy and analytical tools in order to better utilize the MinION sequencer for real-time monitoring of genetic rearrangements and for evaluation of newly emerging viruses.