Multivessel coronary artery bypass grafting (CABG) utilizing ITA grafts was performed in 110 consecutive patients, ranging in age from 24 to 76 years with a mean of 54±9 years. A mean of 3.2±0.8 grafts per patient was placed with a hospital mortality of 0.9%. Bilateral ITAs (BITA) were used in 87 patients and sequential ITA grafting (SQ-ITA) was carried out in 31, and both BITA and SQ-ITA were used in 8 patients. Noncardiac late death occurred in 1 patient and a 5-year survival rate was 98%. During this follow-up term, 11 (10%) patients underwent low-risk PTCA for ITA anastomotic stenosis (4 lesions), SVG stenosis (5 lesions) and native coronary stenosis (4 lesions) with a success in all. No reoperation has been required so far in this series. Graft patency rates were 97% for BITA with no differences for the left and right ITAs, and 100% for SQ-ITA (both proximal and distal). No sternal infection was encountered in this series, on which we believe mediastinal, sternal and subcutaneous irrigation appeared most effective. In BITA grafting, right ITA was frequently anastomosed to the LAD, passing on the aorta, which will make reoperation through a median sternotomy dangerous to this graft. To improve safety for reoperation, we have covered the ITA graft with an 8mm EPTFE graft or membrane with no side effects on ITA grafts. However, true efficacy of this protective method remains unproved because no reoperations have been required in this series of patients.

In 2018, the OK Project was launched with the aim of sharing with children the essence of spiritual care fostered in hospice and palliative care. The project developed teaching materials, trained certified instructors, and delivered classes. By September 2023, 189 instructors were certified and a total of 720 programs delivered (202 in elementary schools, 88 in junior high schools, 25 in high schools, 78 in universities and vocational schools, and 327 in other schools) with 53,360 participants. Comments from the participants after the classes (freely written) indicated that they found support from their painful experiences, felt relieved after listening to the stories, wanted to be supportive themselves, and wanted to share what they had learned with others. As a follow-up for certified instructors, a place for certified instructors to learn from each other was regularly held online, and an environment was created where they could practice their presentations and provide feedback. OK Project has a potential to contributing to Compassionate Community because children can live in peace while embracing suffering that is difficult to resolve.