Generally, the adults can manage their own medications of prescribed drugs. However, medication assistance may be required in the elderly. The family plays a medication assistance, in home, which is afraid to be a burden on the family. In this study, we performed questionnaire survey to caregiver using our day-service center so that we study the actual situation of the medication assistance. From the result of the survey, 64% of caregivers were older than 60 years old. Sixty six percents of caregivers felt some kind of burdens for management of medicine, and 70% felt a burden for medication assistances. The multiple regression analysis showed that “the burden about management of the medicine” and “the degree of medication assistances” significantly affected a sense of the burden about medication assistances (p<0.01). In addition, from the free comment on the questionnaire, it was considered that some caregivers foster a sense of the burden about medication assistances by their strong sense of mission. From these results, it is shown that many caregivers felt a burden on medication assistance. It is suggested that the intervention of pharmacists can be reduce the burden of medication assistance.

　　We investigated whether elderly patients who were treated for proximal femoral fracture and who lived with an elderly spouse in the community were able to return home and walk. We identified 85 patients aged over 65 years with proximal femoral fracture treated between January 2007 and December 2013 who were living with only their spouse. We recorded the number (proportion) of patients who were directly discharged to home and the duration of hospitalization, and their walking ability before the injury and at the time of discharge. We also investigated whether dementia and age affected the ability to return home. Thirty-two patients (36%) returned home directly from an acute care hospital, and 35 patients (83%) returned home directly from a rehabilitation hospital. The mean duration of hospitalization was 31 days (range, 17-71 days) at an acute care hospital, and 61 days (range, 5-143 days) at a rehabilitation hospital. The walking ability of all patients was worse at the time of discharge. Dementia and increasing age were each associated with not being able to return home.

We herein describe the findings of a 32-year-old female was known to have had an electrocardiogram abnormalities and had avoided excessive exercise since her high school student days. She suddenly lost consciousness due to ventricular fibrillation (Vf) in July 2007. As a result she was taken to our hospital by ambulance. Emergency coronary angiography demonstrated an anomalous origin of the left coronary artery from the pulmonary artery (Bland-White-Garland Syndrome). She therefore underwent surgery. During the operation, the main pulmonary artery (PA) was transected while on the cardiopulmonary bypass and the left main coronary trunk (LMT) ostium was detected. Antegrade cold blood cardioplegia was induced, and retrograde continuous cold blood cardioplegia was subsequently applied to the coronary sinus, thus obtaining a complete cardiac standstill. The LMT ostium was excised with a cuff of the main PA wall as a button. During further dissection of the LMT distally to the bifurcation, the LMT wall was injured, thus resulting in the need to repair it under deep hypothermic circulatory arrest (DHCA) in order to obtain a bloodless surgical field. During core cooling, the LMT was anastomosed to the left posterolateral wall of the ascending aorta, then the LMT was repaired with a patch consisting of a non-treated autologous saphenous vein (SV) under DHCA. Several surgical techniques for BWG syndrome have been reported. Among these techniques, the direct implantation of the left coronary artery to the ascending aorta is the most physiological and therefore is considered to be the best technique. In this case, direct implantation was accomplished, however, the LMT also had to be repaired.

Inflammatory bowel disease (IBD) is an idiopathic, multi-etiological disease characterized by inflammation and mucosal destruction of the gastrointestinal tract. Despite the remarkable advance in immunomodulating therapies, there still remains a certain population of patients who are refractory to conventional as well as biologic therapies and fail to achieve mucosal healing. To improve the prognosis of those patients, at least 2 types of stem cells have been tested for their potential therapeutic use. Transplantation of hematopoietic stem cells or mesenchymal stem cells have been tested in several clinical studies, but their beneficial effect still remains controversial. In this review, we would like to overview the recent clinical challenges of stem cell-based therapies in IBD and also introduce our new therapeutic plan of intestinal stem cell transplantation for IBD, based on our ex vivo intestinal organoid culture technique.
Biological Therapy ; Culture Techniques ; Gastrointestinal Tract ; Hematopoietic Stem Cells ; Humans ; Inflammation ; Inflammatory Bowel Diseases ; Mesenchymal Stromal Cells ; Organoids ; Prognosis ; Stem Cell Transplantation ; Stem Cells

Objective: We investigated whether elderly patients treated for a proximal femoral fracture would be able to return home.Patients and Methods: The subjects of this study were 834 patients. We defined the acute care hospital group as patients who returned home from the acute care hospital and the kaihukuki group as patients who were transferred from an acute care hospital to a rehabilitation hospital. We recorded the proportion of patients who returned home. We also analyzed walking ability and the Barthel index (BI) of patients.Results: After 2013, the proportion of patients who returned home from the acute care hospital fell below 20%. The proportion of patients who returned home from the kaihukuki hospital stayed within the 75–85% range. The BI before injury and at discharge was 86 and 76 points, respectively, in the acute care hospital group. The acute care hospital group included patients who walked without an aid before the injury or when leaving the hospital. In the kaihukuki group, the BI before an injury, at admission, and at discharge from the rehabilitation hospital was 85, 56, and 74 points, respectively. In the kaihukuki group, the ability of patients to walk recovered more slowly than that of patients in the acute care hospital group.Conclusion: Walking ability and BI are important factors for determining whether patients with a proximal femoral fracture are able to return home.

BACKGROUND: Ezetimibe-statin combination therapy has been found to reduce low density lipoprotein cholesterol levels and the risk of major adverse cardiovascular events (MACEs) in large trials. We sought to examine the differential effect of ezetimibe on MACEs when added to statins according to the presence of diabetes. METHODS: Randomized clinical trials with a sample size of at least 50 participants and at least 24 weeks of follow-up that compared ezetimibe-statin combination therapy with a statin- or placebo-controlled arm and reported at least one MACE, stratified by diabetes status, were included in the meta-analysis and meta-regression. RESULTS: A total of seven trials with 28,191 enrolled patients (mean age, 63.6 years; 75.1% men; 7,298 with diabetes [25.9%]; mean follow-up, 5 years) were analysed. MACEs stratified by diabetes were obtained from the published data (two trials) or through direct contact (five trials). No significant heterogeneity was observed among studies (I 2=14.7%, P=0.293). Ezetimibe was associated with a greater reduction of MACE risk in subjects with diabetes than in those without diabetes (pooled relative risk, 0.84 vs. 0.93; P heterogeneity=0.012). In the meta-regression analysis, the presence of diabetes was associated with a greater reduction of MACE risk when ezetimibe was added to statins (β=0.87, P=0.038). CONCLUSION: Ezetimibe-statin combination therapy was associated with greater cardiovascular benefits in patients with diabetes than in those without diabetes. Our findings suggest that ezetimibe-statin combination therapy might be a useful strategy in patients with diabetes at a residual risk of MACEs.
Arm ; Cholesterol, LDL ; Diabetes Mellitus ; Ezetimibe ; Follow-Up Studies ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors ; Male ; Myocardial Infarction ; Population Characteristics ; Sample Size ; Stroke

Kawasaki disease (KD) is an acute febrile vasculitis predominately affecting infants and children. The dominant incidence age of KD is from 6 months to 5 years of age, and the incidence is unusual in those younger than 6 months and older than 5 years of age. We tried to identify genetic variants specifically associated with KD in patients younger than 6 months or older than 5 years of age. We performed an age-stratified genome-wide association study using the Illumina HumanOmni1-Quad BeadChip data (296 cases vs. 1,000 controls) and a replication study (1,360 cases vs. 3,553 controls) in the Korean population. Among 26 candidate single nucleotide polymorphisms (SNPs) tested in replication study, only a rare nonsynonymous SNP (rs4365796: c.1106C>T, p.Thr369Met) in the lymphoid enhancer binding factor 1 (LEF1) gene was very significantly associated with KD in patients younger than 6 months of age (odds ratio [OR], 3.07; p(combined) = 1.10 × 10⁻⁵), whereas no association of the same SNP was observed in any other age group of KD patients. The same SNP (rs4365796) in the LEF1 gene showed the same direction of risk effect in Japanese KD patients younger than 6 months of age, although the effect was not statistically significant (OR, 1.42; p = 0.397). This result indicates that the LEF1 gene may play an important role as a susceptibility gene specifically affecting KD patients younger than 6 months of age.
Asian Continental Ancestry Group ; Child ; Genome-Wide Association Study ; Humans ; Incidence ; Infant ; Lymphoid Enhancer-Binding Factor 1 ; Mucocutaneous Lymph Node Syndrome* ; Polymorphism, Single Nucleotide ; Vasculitis