The method of cardioplegic myocardial protection is often controversial for re-cardiotomy after a coronary artery bypass grafting (CABG). A 69-year-old woman with a history of three previous surgeries consisting of closed mitral commissurotomy (CMC), dual valve replacement (DVR), and CABG underwent mitral valve replacement (MVR) and CABG for perivalvular leakage (PVL). As a result, the bilateral coronary ostium and the bypass graft to the right coronary artery (RCA) were totally occluded. The left internal thoracic artery (LITA) graft to the left anterior descending (LAD) coronary artery was the only inflow to the left coronary artery system and the right coronary artery system developed collateral inflow. Cardioplegia was carried out by performing a temporary anastomosis graft on the saphenous vein graft (SVG) in the left anterior descending coronary artery and a new bypass graft in the RCA was used for the administration of cardioplegic solution with no complications. There are various strategies for cardioplegic myocardial protection. The best method should be selected depending on the patient characteristics and condition.

The dawn of Japan’s super-aged society is accompanied by various problems, including increased social security expenditures and greater nursing care burden as well as reduced labor force. Targeting 2025, when Japan’s baby-boomer generation will be aged ≥75 years, the government’s Ministry of Health, Labour and Welfare is promoting the establishment of local comprehensive support and service provision systems (Comprehensive Community Care Systems). Although such comprehensive community care systems will require medical professionals to provide treatment through collaborative interprofessional cooperation with colleagues in other fields, effective cooperation has currently not been established because of a lack of understanding regarding the roles and functions of other occupations. Considering that the promotion of interprofessional-based collaborative learning prior to university graduation will be important for resolving this problem, we organized a workshop for medical students based in Ehime Prefecture and evaluated its usefulness based on questionnaire surveys administered before and after the workshop. Consequently, it was ascertained that pharmacy, medical, and nursing students had a heightened awareness of “the importance of interprofessional collaboration” after the workshop as against before the workshop. Students’ degree of comprehension of the nature of the work in each category increased significantly. These results demonstrate the importance and effectiveness of students familiarizing themselves with the learning and work content of other fields by working with colleagues in different medical fields as observed in this workshop. They also expect that student-led study groups will contribute to promote the comprehensive community care systems.

Background: Poor lifestyle habits may worsen nonalcoholic fatty liver disease (NAFLD), with progression to nonalcoholic steatohepatitis (NASH) and cirrhosis. This study investigated the association between glycemic control status and hepatic histological findings to elucidate the effect of glycemic control on NAFLD. Methods: This observational study included 331 patients diagnosed with NAFLD by liver biopsy. Effects of the glycemic control status on histological findings of NAFLD were evaluated by comparing the following four glycemic status groups defined by the glycosylated hemoglobin (HbA1c) level at the time of NAFLD diagnosis: ≤5.4%, 5.5%–6.4%, 6.5%–7.4%, and ≥7.5%. Results: Compared with the lowest HbA1c group (≤5.4%), the higher HbA1c groups (5.5%–6.4%, 6.5%–7.4%, and ≥7.5%) were associated with advanced liver fibrosis and high NAFLD activity score (NAS). On multivariate analysis, an HbA1c level of 6.5%– 7.4% group was significantly associated with advanced fibrosis compared with the lowest HbA1c group after adjusting for age, sex, hemoglobin, alanine aminotransferase, and creatinine levels. When further controlling for body mass index and uric acid, total cholesterol, and triglyceride levels, the higher HbA1c groups were significantly associated with advanced fibrosis compared with the lowest HbA1c group. On the other hand, compared with the lowest HbA1c group, the higher HbA1c groups were also associated with a high NAS in both multivariate analyses. Conclusion Glycemic control is associated with NAFLD exacerbation, with even a mild deterioration in glycemic control, especially a HbA1c level of 6.5%–7.4%, contributing to NAFLD progression.

Background: Poor lifestyle habits may worsen nonalcoholic fatty liver disease (NAFLD), with progression to nonalcoholic steatohepatitis (NASH) and cirrhosis. This study investigated the association between glycemic control status and hepatic histological findings to elucidate the effect of glycemic control on NAFLD. Methods: This observational study included 331 patients diagnosed with NAFLD by liver biopsy. Effects of the glycemic control status on histological findings of NAFLD were evaluated by comparing the following four glycemic status groups defined by the glycosylated hemoglobin (HbA1c) level at the time of NAFLD diagnosis: ≤5.4%, 5.5%–6.4%, 6.5%–7.4%, and ≥7.5%. Results: Compared with the lowest HbA1c group (≤5.4%), the higher HbA1c groups (5.5%–6.4%, 6.5%–7.4%, and ≥7.5%) were associated with advanced liver fibrosis and high NAFLD activity score (NAS). On multivariate analysis, an HbA1c level of 6.5%– 7.4% group was significantly associated with advanced fibrosis compared with the lowest HbA1c group after adjusting for age, sex, hemoglobin, alanine aminotransferase, and creatinine levels. When further controlling for body mass index and uric acid, total cholesterol, and triglyceride levels, the higher HbA1c groups were significantly associated with advanced fibrosis compared with the lowest HbA1c group. On the other hand, compared with the lowest HbA1c group, the higher HbA1c groups were also associated with a high NAS in both multivariate analyses. Conclusion Glycemic control is associated with NAFLD exacerbation, with even a mild deterioration in glycemic control, especially a HbA1c level of 6.5%–7.4%, contributing to NAFLD progression.

Background: Poor lifestyle habits may worsen nonalcoholic fatty liver disease (NAFLD), with progression to nonalcoholic steatohepatitis (NASH) and cirrhosis. This study investigated the association between glycemic control status and hepatic histological findings to elucidate the effect of glycemic control on NAFLD. Methods: This observational study included 331 patients diagnosed with NAFLD by liver biopsy. Effects of the glycemic control status on histological findings of NAFLD were evaluated by comparing the following four glycemic status groups defined by the glycosylated hemoglobin (HbA1c) level at the time of NAFLD diagnosis: ≤5.4%, 5.5%–6.4%, 6.5%–7.4%, and ≥7.5%. Results: Compared with the lowest HbA1c group (≤5.4%), the higher HbA1c groups (5.5%–6.4%, 6.5%–7.4%, and ≥7.5%) were associated with advanced liver fibrosis and high NAFLD activity score (NAS). On multivariate analysis, an HbA1c level of 6.5%– 7.4% group was significantly associated with advanced fibrosis compared with the lowest HbA1c group after adjusting for age, sex, hemoglobin, alanine aminotransferase, and creatinine levels. When further controlling for body mass index and uric acid, total cholesterol, and triglyceride levels, the higher HbA1c groups were significantly associated with advanced fibrosis compared with the lowest HbA1c group. On the other hand, compared with the lowest HbA1c group, the higher HbA1c groups were also associated with a high NAS in both multivariate analyses. Conclusion Glycemic control is associated with NAFLD exacerbation, with even a mild deterioration in glycemic control, especially a HbA1c level of 6.5%–7.4%, contributing to NAFLD progression.

The need for palliative care for heart failure patients has been attracting attention, but the system for providing such care is not yet fully established in Japan. Iizuka Hospital is a 1048-bed acute care hospital located in Fukuoka, Japan. The Heart Support Team (HST) was established to provide palliative care for heart failure at the hospital. After the HST was launched in May 2017, 168 referrals for palliative care intervention for heart failure patients by March 2022. Twenty-five (14.8%) met the intervention cases’ additional palliative care treatment criteria. The Integrated Palliative Outcome Scale was administered to 11 consecutive patients from April 1 to 30, 2021. In establishing and operating the HST, the challenge was recruiting, training, and creating a system to sustain the system. Creating the HST in collaboration with staff specializing in palliative care, psychiatric care, and cardiovascular specialists was the first step in establishing a method for palliative care to heart failure patients in an acute care hospital.

A 76-year-old man who suffered from consistent back pain was admitted for anti-hypertensive therapy to strictly manage the early thrombosed acute type A aortic dissection (AAAD). On admission, his blood pressure could not be controlled well ; soon he complained of recurrent severe back pain. The second thoracoabdominal enhanced computed tomography revealed the progression of AAAD from DeBakey type II to type I with thrombosed pseudolumen at the descending thoracic aorta ; therefore, emergent surgical intervention by primary central repair was conducted. Paraplegia was diagnosed eight hours after surgery, then cerebrospinal fluid drainage and intravenous administration of Naloxone were started immediately followed by keeping the systemic blood pressure more than 120 mmHg. However, paraplegia had never improved and been persistent with neurological deficit of the lower extremities. We herein report a complicated surgical case of an AAAD patient with paraplegia and review the complex clinical settings.