Hybrid revascularization by MIDCAB and stent was performed in a 70-year-old man for reperfusion in the treatment of graft stenosis after CABG. The right SVG, which supplied coronary blood flow, was immediately under the median incision site, and was approached safely by the present method. After intervention, bleeding in the left thoracic cavity occurred, but this was treated conservatively. During intervention after cardiac surgery, transient heparinization of blood was performed for prevention of coagulation. Since strong anticoagulative treatment was continued thereafter, the patient was easily bled. Therefore, it appeared preferable to take time after cardiac operation or insert an indwelling drainage tube into the pleural cavity to monitor hemorrhage. The present method appears useful for patients undergoing re-operation or of high risk.

Introduction
 During the course of primary health care activities in Khammouane province of Lao PDR by non- profit organization, international support and partnership for health, an exceedingly high infant mortality rate was recognized in some villages. As thiamine deficiency was strongly suspected for the main cause of the high mortality, the household survey with an emphasis on nutritional aspect and the measurement of thiamine level in the blood of mothers as well as their breast-milk were carried out for the confirmation.
Methods
 The survey was conducted at Sibounhouane sub-district (Group 1) with the highest infant mortality and Hatkhamhieng sub-district (Group 2) with the lowest mortality. Fifty families of the two groups, each consisting of randomly selected 25 families with less than one year old infant(s) were interviewed by using prepared questionnaire. The body weight of both mother and infant was measured and blood and milk were taken from the mother.
Results
 The ethnic minorities of the group 1 consisted of Lao Lum (44%) and Lao Theung (56%), whereas only Lao Lum in the group 2. The economical indicators and the mother's educational level in the group 1 were inferior to those in the group 2. There was no significant difference in the methods of preparing staple glutinous rice, likely to flux thiamine and intake of thiaminases between the two groups. High infant mortality rate was documented in the group 1 whose clinical symptoms were mostly consistent with those of infantile beriberi. The concentration of thiamine in the blood and milk of mothers in both groups were considerably lower and significant reduction of thiamine level was observed in the group 1 than the group 2. Nevertheless, both groups of those infants tended to be inadequately fed with the foods except for breast-milk during their early infantile phase.
Conclusions
 The low concentration of thiamine in the blood and milk of mothers was strongly suggestive that infantile beriberi due to thiamine deficiency was the principal cause of the infant mortality in the study region. We hereby surmise that thiamine deficiency could be extensively prevalent in Lao PDR than the currently studied areas because of their traditional preparing methods of staple dietary rice, postpartum food taboos and intake of thiaminases. For the prevention of infant death due to severe thiamine deficiency, necessary measures including the exchange of information among the institutions concerned, adequate thiamine supplementation and nutritional counseling have to be urgently adopted.

This study aimed to examine the effects of an 8-week physical activity program, which mainly comprised home-based bench-stepping exercise training at the intensity of lactate threshold (LT), on mental health (MH), health-related quality of life (HRQOL), and physical fitness in Japanese returnees from China. Thirty Japanese returnees (63 ± 9 y) participated in the exercise program. Another six subjects were enrolled as the control group. The subjects performed 212 ± 57 min of training, and their daily step counts were increased. Aerobic capacity (LT: 4.5 ± 0.8 vs. 5.5 ± 1.1 METs), lower limb strength (30-s chair stand test [CS-30]: 19.1 ± 5.5 vs. 21.3 ± 5.1 times), and sit-and-reach flexibility (sitting-posture body anteflexion: 36.1 ± 9.4 vs. 39.0 ± 8.4 cm) were significantly increased after the intervention compared with before the intervention. Furthermore, MH, as assessed by the total score of the GHQ-28 (3.4 ± 4.4 vs. 0.3 ± 0.8 points), and the mental component score (MCS) of HRQOL, as evaluated by the SF-36v2 (55.1 ± 11.4 vs. 58.5 ± 10.0), were significantly changed in a positive manner. However, a two-way repeated measures ANOVA (group × period) showed significant interactions for LT and MCS (p<0.05), and a tendency for interactions of CS-30 (p=0.063) and the total score of the GHQ-28 (p=0.098). These results indicate that this bench-stepping exercise program could become a useful health support program for improving physical fitness, as well as MH and HRQOL, in Japanese returnees.

Objective  To explore and extract the elements of educational intervention from sustainable trachoma prevention programs in developing countries particularly in Africa.Methods  Literature review was conducted with the search engine, PubMed, with extracting keywords as “Trachoma, intervention, education, SAFE, hygiene, WASH, sustainable, sustainability, and elimination”. After carefully reading the extracted literature and assessing the sustainability of the interventions conducted in Sub-Saharan Africa, using analytical standpoint determined by the JICA evaluation items on sustainability, the elements of educational interventions were categorized.Result  Twenty-two articles were extracted and 10 articles that specifically state effectiveness and contents of intervention were selected for analysis. Five categories with elements of educational intervention were classified as follows: [Education in school age and community], [Intangible and tangible support], [Guidance of constructing latrines], [Guidance on how to use equipment and resources], and [Continuation of knowledge and skill transfer activities].Discussion  The results of this study suggested the significance of conducting educational intervention, not only the construction but also the management and maintenance of latrines, and the effectiveness of habituation of hygiene behavior to school children by implementing hygiene education at schools which behavior may also diffuse at home. Challenges remained in trachoma prevention effort who are left out of the support, such as unenrolled children who are unable to receive school hygiene education, and/or those who are inaccessible to clean water.Conclusion  Elements for educational intervention in sustainable trachoma prevention were examined in this study. It was shown that continuous holistic efforts should be made for the educational interventions as well as for the improvement of accessibility of clean water and hygiene without leaving people and the least developed countries behind.

Introduction  In low and middle-income countries (LMICs), health care providers known as Community Health Workers (CHWs) are active in preventing and managing Type2 Diabetes Mellitus (T2DM). However, their specific roles and activities have not been academically reviewed. The purpose of this article is to obtain suggestions for effective appointment and utilization of CHWs by categorizing the approach of CHWs on Type2 diabetes prevention and management programs in resource-limited regions.Methods  Original articles published between 2018 to July 2023 on the database of PubMed and Web of Science were searched. Articles that include all the keywords; ‘diabetes’, ‘community health worker(s)’ and ‘each name of LMICs (total of 54 countries or region)’ in the title/abstract were extracted.Results  From the 71 articles extracted, 20 articles from 11 countries/regions were selected for analysis. CHWs’ approaches towards the prevention and management of T2DM were categorized into: recruitment, screening, referral, follow-up, and others. The most common form of approach that CHWs make was a ‘home visit’.Conclusions  CHWs contributed to improved access to T2DM prevention and management using their knowledge of the community and relationships of trust with residents. A diverse approach by CHWs was identified, and they played important roles in primary and secondary prevention. Their roles are essential for high-quality T2DM prevention and management in LMICs facing a shortage of health care workers.