INTRODUCTION

Heart failure (HF) is a common cause of hospitalization, heart failure-related readmission, poor quality of life, and mortality. It also poses a substantial economic burden. The heart failure clinical practice guideline (HFCPG) was developed to provide evidence-based recommendations on the diagnosis and management of chronic HF with reduced ejection fraction (HFrEF) among adult Filipino patients in the outpatient setting for primary care physicians.

The GRADE approach and an Evidence-to-Decision framework were used to evaluate the evidence and formulate recommendations. The strength and direction of each recommendation were determined through voting, with consensus reached if 75% of all CP members agreed.

The HFCPG provides 19 recommendations and one good practice statement in response to 14 identified clinical questions. Careful history-taking and physical examination, use of chest x-ray to detect cardiomegaly and/or pulmonary congestion, two-dimensional echocardiography for HF diagnosis, and baseline determination of serum sodium, potassium, and creatinine to guide management have been highly recommended; however, the 12-lead electrocardiogram should not be solely used for HF diagnosis. Judicious use of diuretics to relieve congestion, use of selected beta-blockers, renin-angiotensin-aldosterone blockers, mineralocorticoid receptor antagonists, and SGLT2 inhibitors are strongly recommended for the treatment of HFrEF.

HFrEF is a complex condition that requires early recognition and careful management. Guideline-directed medical therapies, particularly the evidence-based pillars of treatment, are recommended, as well as early discussion of palliative care, timely determination of advanced heart failure and the need for referral to higher levels of care.

Objectives: This study investigated the associations between gait velocity and kinematic variables in the first half of the gait cycle according to stroke severity. We performed gait analysis in individuals with stroke, focusing on changes in the center-of-gravity (COG) position on the paretic side in the first half of stance phase.Methods: Gait data of 80 individuals (20 each in Brunnstrom recovery stage: III, IV, V and VI) with stroke acquired using a 3D motion analysis system was retrospectively analyzed. Associations of gait velocity with the COG positions in the anteroposterior directions and vertical increases in the first half of stance phase on the paretic side were compared according to stroke severity, using correlation analysis.Results: Gait velocity showed strong positive correlations with step length on the paretic side at initial contact, the rate of vertical increase in the COG during single-leg stance, and the proportion of single-leg stance time in the gait cycle. The associations between velocity and each kinematic variable differed according to stroke severity. Gait velocity was strongly correlated with the rate of vertical increase in the COG during single-leg stance and the proportion of single-leg stance in severe hemiplegia, while a strong correlation was observed with step length on the paretic side in mild hemiplegia.Conclusion: An upward shift of the COG during single-leg stance was an important factor in gait velocity, and the correlation between gait velocity and the rate of vertical increase in the COG during single-leg stance was stronger when hemiplegia was more severe.

We have experienced a surgeon who had a previous left putaminal hemorrhage and presented with higher brain dysfunctions due to a new right frontal lobe infarction. The patient was a right-handed man in his 50s with inattention, constructive disorder, left hemispatial neglect, and executive dysfunction. The lesions were localized not only in the right inferior and middle frontal gyri but also in deep white matter including the right frontal aslant tract and superior longitudinal fasciculus. The patient gradually resumed work early on with multidisciplinary support and returned to work within 3 months after the onset of the disease. In this case, direct attention training, metacognitive strategy training including time pressure management, and visual search training from the acute stage were successful. Even after the completion of cognitive rehabilitation, an improvement in attention and processing speed was confirmed, suggesting that highly personalized cognitive rehabilitation tailored to higher brain dysfunctions have a lasting effect. However, the improvement of higher brain functions and the resumption of work increased self-awareness and anxiety, leading to a decrease in self-efficacy. Cognitive rehabilitation including metacognitive strategy training, together with psychological support, is important for step-by-step return to work.

Rehabilitation for ocular motility disorder and diplopia after acute cerebral infarction has not been established. In the present case, we describe the course of oculomotor rehabilitation in a patient with left-sided gaze palsy and diplopia due to a stroke in the paramedian part of the left pontine tegmentum. The patient was a right-handed man in his 40s. Cerebral infarction occurred after coil embolization with stenting for an unruptured dissecting aneurysm. He presented with eye movement difficulty resulting from conjugate deviation of the eyes to the right at onset. No other motor-sensory abnormalities were present. Processing speed of Wechsler Adult Intelligence Scale-Fourth Edition was decreased. We performed oculomotor rehabilitation from the acute phase, including fixation, smooth pursuit, saccadic and convergent movements. Visual attention tasks such as visual search and cancellation tasks were applied from 10 days after onset. The oculomotor disorders gradually improved and disappeared by 65 days after onset. The responsible lesion was localized in left paramedian pontine reticular formation and abducens nucleus. Medial longitudinal fasciculus was not involved, which was consistent with the clinical oculomotor findings. The neuropsychological assessments showed that processing speed was improved. Based on the neuropsychological assessments and actual vehicle evaluation, our multidisciplinary team determined that the patient should not refrain from automobile driving. The patient returned to work and resumed driving 86 days after onset. The results suggest that visual attention tasks together with basic oculomotor trainings for ocular motility disorder and diplopia are useful for early return to automobile driving and society.

In thoracic endovascular aneurysm repair (TEVAR), the common femoral artery is typically used as the standard vascular access. However, in some cases, alternative vascular accesses must be considered, or endovascular treatment may need to be abandoned due to vascular diameter or characteristics. A female in her 70 s presented with saccular aortic aneurysms located at the distal arch and descending aorta, possibly secondary to bacteremia. She had a history of partial arch replacement and ascending aorto-bi-iliac artery bypass for ascending aortic aneurysm, as well as calcified abdominal aortic stenosis, performed five years prior. In this case, we successfully treated the aneurysms with antegrade TEVAR, accessing through the extra-anatomical bypass graft, which was exposed in the epigastric preperitoneal space. This is the first case report of TEVAR using access from an extra-anatomical bypass graft connecting the ascending aorta to the lower extremity.

Objective: With the Internet serving as a major source of medical information, the abundance of pharmaceutical content across media and digital platforms raises concerns about the impact of inappropriate or misleading information on public health. This study aimed to develop a comprehensive, practical evaluation indicator to assess the reliability and quality of pharmaceutical websites, targeting general consumers in Japan.Methods: We systematically reviewed existing domestic and international criteria for health information quality to develop evaluation indicators. Based on this review, a preliminary set of indicators was drafted and refined using a modified Delphi process involving six experts in pharmaceutical and medical communications. This process incorporated established frameworks, including the Health on the Net (HON) Code, JAMA Benchmarks, and the Japanese eHealth Ethics Code. A validated set of indicators was finalized after four iterative rounds of review and feedback.Results: The final tool comprises 16 evaluation items across three categories: (1) Screening Criteria (4 items), which eliminate websites with misleading content, public indecency, or political/religious affiliations; (2) Website Evaluation Criteria (5 items), assessing operational transparency, contact availability, advertisement distinction, and policy disclosure; and (3) Content Evaluation Criteria (7 items), addressing clarity, accuracy, update frequency, source citation, legal compliance, and balanced risk-benefit information. Each item was rated using a primarily binary (yes/no) scale with intermediate options, such as “partially applicable” or “not applicable.” The tool reflects expert consensus and complies with Japan’s ethical and regulatory standards.Conclusion: This tool facilitates the appropriate dissemination of pharmaceutical information and supports users in identifying trustworthy sources. By explicitly incorporating legal compliance and editorial transparency as evaluation criteria, it encourages higher standards among healthcare professionals and information providers, potentially improving the quality of pharmaceutical communication.

Background/Aims: We aimed to clarify the clinicopathological characteristics and causes of Barrett’s esophageal adenocarcinoma (BEA) with unclear demarcation. Methods: We reviewed BEA cases between January 2010 and August 2022. The lesions were classified into the following two groups: clear demarcation (CD group) and unclear demarcation (UD group). We compared the clinicopathological findings between the two groups. Furthermore, we measured the length and width of the foveolar structures, as well as the width of marginal crypt epithelium (MCE). Results: We analyzed data from 68 patients with BEA, including 47 and 21 in the CD and UD groups, respectively. Multivariate analysis revealed long-segment Barrett’s esophagus (LSBE) as the sole significant risk factor for BEA (odds ratio, 12.17; 95% confidence interval, 2.84–47.6; p=0.001). Regarding pathological analysis, significant differences were observed in the length and width of the foveolar structure between cancerous and surrounding mucosa in the CD group (p=0.03 and p=0.00, respectively); however, no significant difference was observed in the UD group (p=0.53 and p=0.72, respectively). Nevertheless, the width of MCE in the cancerous area was significantly shorter than that in the surrounding mucosa in both groups (p<0.05, and p<0.05, respectively). Conclusions LSBE is a significant risk factor for BEA in the UD group. The width of MCE may be an important factor in the endoscopic diagnosis of BEA.

Background/Aims: Endoscopic ultrasound (EUS)-guided pancreatic duct drainage is a well-established procedure for managing pancreaticojejunostomy anastomotic strictures (PJAS) post-Whipple surgery. In this study, we examined the effectiveness and safety of EUS-guided pancreaticojejunostomy (EUS-PJS). Methods: This retrospective, single-arm study was performed at Aichi Cancer Center Hospital on 10 patients who underwent EUS-guided pancreaticojejunostomy through the afferent jejunal loop using a forward-viewing echoendoscope when endoscopic retrograde pancreatography failed. Our primary endpoint was technical success rate, defined as successful stent insertion. The secondary endpoints were early and late adverse events. Results: A total of 10 patients underwent EUS-PJS between February 2019 and October 2023. The technical success rate was 100%. The median procedure time was 23.5 minutes. No remarkable early or late adverse events related to the procedure, except for fever, occurred in two patients. The median follow-up duration was 9.5 months, and the median number of stent exchanges was two. A stent-free state was achieved in three patients. Conclusions EUS-PJS for PJAS management after pancreaticoduodenectomy appears to be an effective and safe procedure with the potential advantages of fewer reinterventions and the creation of a permanent drainage fistula.