Acute symptomatic deep vein thrombosis (DVT) is usually managed by intravenous heparin and oral warfarin. Recently, direct oral anticoagulants (DOAC) have been introduced for the treatment of acute DVT. DOAC may be useful for very elderly patients who live in rural areas, where medical resources are limited. An 83-year-old woman presented to our clinic with left leg edema. Contrast enhanced computed tomography showed massive deep vein thrombosis in her left internal iliac vein. We diagnosed her with acute deep vein thrombosis. Since she refused to be hospitalized, we treated her with rivaroxaban as an outpatient. She had a good clinical course without hospitalization or an adverse event. DOAC may be useful for very elderly patients in rural areas.

Objectives
 The present study aimed to elucidate issues in maternal and child health in suburban areas by comparing the effects of increases in population, economic power, and amount of information on health behaviors among mothers such as pregnancy, childbirth, and child care in village A in the suburbs of Kathmandu between 2001 and 2006.
Methods
 We conducted an interview survey on mothers of children aged 0-12month in village one in Lalitpur district in Nepal. Data from 2001 and 2006 were compared for the educated group, non-educated group, and all subjects.
Results
 The number of mothers in ethnic minorities increased in 2006. The most commonly used facility for pregnancy examinations, delivery, and child illnesses was hospitals, and their use tended to increase from 2001 to 2006 for each type of visit. In addition, the cost of pregnancy examination and delivery increased approximately 7-and 2-fold, respectively. Kaup index increased by one point for the condition of child development. Prevalence of general infections among children decreased.
Conclusion
 Subjects were polarized into the middle class, which included individuals who had increased income by working as migrants abroad, and an economically disadvantaged group which included individuals who had migrated from rural areas. The active use of health services at hospitals among pregnant women and children was attributed to recognition of the safety and comfort of hospitals as well as the consumer culture resulting from growth of the middle class. The economically disadvantaged group was considered to be at high risk with regard to maternal and child health, and was thus thought to require affordable and accessible support. Issues in child care appeared to be shifting from “nutritional improvement” and “infection control” to “nutritional balance”.

There have been very few studies on the expression of Centromere proteins in human salivary gland carcinomas. The purpose of this study was to clarify the correlation between Centromere protein H (CENP-H) expression and clinicopathologic factors in salivary gland carcinomas. The expression of CENP-H mRNA was investigated in 28 human salivary gland tumors (7 pleomorphic adenomas, 3 Warthin tumors, 6 mucoepidermoid carcinomas, 6 adenoid cystic carcinomas, 5 acinic cell carcinomas and 1 malignant myoepithelioma) and 8 normal submandibular glands using real-time quantitative reverse transcription-polymerase chain reaction (RT-PCR). The labeling index of PCNA and Ki-67 were also investigated immunohistochemically in 16 salivary gland carcinomas. The mean expression level of CENP-H mRNA was significantly higher in malignant tumors (0.55 ± 0.68) than normal submandibular glands (0.10 ± 0.029). A significant correlation between the PCNA labeling index and CENP-H mRNA expression was also found (Spearman's correlation coefficient by rank test, P=0.033). We also found a significant correlation between the Ki-67 labeling index and CENP-H mRNA expression in malignant tumors (Spearman's correlation coefficient by rank test, P=0.040). These results indicate that human CENP-H mRNA is closely linked to increased or abnormal cell proliferation in malignant salivary gland tumors.