The patient is a 71-year-old man who developed a ventricular septal perforation (VSP) with septal dissection after acute myocardial infarction (AMI). Heart failure symptoms were stabilized with intra-aortic balloon pumping and diuretics, and the VSP was closed via a left ventriculotomy approach on day 23 after AMI and day 12 after identification of the VSP. The right ventricular perforation was closed with a single patch of bovine pericardium, and the left ventricular perforation was closed with a double patch using the infarct exclusion technique. The septal dissection cavity was closed with BioGlue surgical adhesive (Artivion, Inc., Kennesaw, GA, USA). The patient's postoperative course was uneventful and he was discharged home on postoperative day 36. His NYHA functional class was I at 1 year and 6 months after surgery.

Background: The need for support focused on frailty and quality of life (QoL) in older adults is increasing. The Kihon Checklist (KCL) is a comprehensive and easy-to-use tool to assess frailty in older adults. Previous studies have shown associations between frailty and QoL; however, few studies have investigated the association between frailty using the KCL and QoL. In this study, the quantitative relationship between the KCL and QoL in community-dwelling older adults was investigated. Methods: This cross-sectional study included from participants in the 2017–2019 baseline survey of a cohort study of community-dwelling older adults in Sapporo, Japan. The World Health Organization-Five Well-Being Index (WHO-5) was used to assess QoL. The KCL was used to assess frailty, and the relationship between frailty and QoL was examined using binomial logistic regression analysis and restricted cubic spline models. Results: Four-hundred participants were included in the analysis. Of the participants, 22.5% had a lower QoL and they were more likely to have frailty than healthy participants (p<0.001). The KCL scores were significantly associated with a lower QoL (p<0.001). Furthermore, the association between the KCL score and QoL was linear, and subscales of activities of daily living, and depressive mood were significantly associated with a lower QoL. Conclusion The KCL, a comprehensive frailty questionnaire, was associated with a lower QoL in older adults. To maintain QoL in community-dwelling older adults, it is necessary to provide them with appropriate support from the stage before they are identified as frail by the KCL.

Background: The need for support focused on frailty and quality of life (QoL) in older adults is increasing. The Kihon Checklist (KCL) is a comprehensive and easy-to-use tool to assess frailty in older adults. Previous studies have shown associations between frailty and QoL; however, few studies have investigated the association between frailty using the KCL and QoL. In this study, the quantitative relationship between the KCL and QoL in community-dwelling older adults was investigated. Methods: This cross-sectional study included from participants in the 2017–2019 baseline survey of a cohort study of community-dwelling older adults in Sapporo, Japan. The World Health Organization-Five Well-Being Index (WHO-5) was used to assess QoL. The KCL was used to assess frailty, and the relationship between frailty and QoL was examined using binomial logistic regression analysis and restricted cubic spline models. Results: Four-hundred participants were included in the analysis. Of the participants, 22.5% had a lower QoL and they were more likely to have frailty than healthy participants (p<0.001). The KCL scores were significantly associated with a lower QoL (p<0.001). Furthermore, the association between the KCL score and QoL was linear, and subscales of activities of daily living, and depressive mood were significantly associated with a lower QoL. Conclusion The KCL, a comprehensive frailty questionnaire, was associated with a lower QoL in older adults. To maintain QoL in community-dwelling older adults, it is necessary to provide them with appropriate support from the stage before they are identified as frail by the KCL.

Background: The need for support focused on frailty and quality of life (QoL) in older adults is increasing. The Kihon Checklist (KCL) is a comprehensive and easy-to-use tool to assess frailty in older adults. Previous studies have shown associations between frailty and QoL; however, few studies have investigated the association between frailty using the KCL and QoL. In this study, the quantitative relationship between the KCL and QoL in community-dwelling older adults was investigated. Methods: This cross-sectional study included from participants in the 2017–2019 baseline survey of a cohort study of community-dwelling older adults in Sapporo, Japan. The World Health Organization-Five Well-Being Index (WHO-5) was used to assess QoL. The KCL was used to assess frailty, and the relationship between frailty and QoL was examined using binomial logistic regression analysis and restricted cubic spline models. Results: Four-hundred participants were included in the analysis. Of the participants, 22.5% had a lower QoL and they were more likely to have frailty than healthy participants (p<0.001). The KCL scores were significantly associated with a lower QoL (p<0.001). Furthermore, the association between the KCL score and QoL was linear, and subscales of activities of daily living, and depressive mood were significantly associated with a lower QoL. Conclusion The KCL, a comprehensive frailty questionnaire, was associated with a lower QoL in older adults. To maintain QoL in community-dwelling older adults, it is necessary to provide them with appropriate support from the stage before they are identified as frail by the KCL.

Objective: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variant B.1.1.529 (Omicron) was first detected in Japan in November 2021. In Osaka, public health centres subsequently increased active case finding and encouraged self-isolation. This study investigated the effectiveness of these countermeasures. Methods: Cases targeted for analysis were persons who had neither recently travelled abroad nor had contact with foreign tourists but tested positive for SARS-CoV-2 between 24 November 2021 and 4 January 2022 and were suspected or confirmed to have the Omicron variant. We performed a descriptive analysis and calculated the reproduction number (R) for each generation using the branching process method. Genomic sequencing data were analysed to plot a haplotype network. Results: A total of 251 cases were analysed. The median age was 30 years, and 46% (115/251) were in their 20s or younger. The first Omicron case in Osaka was detected on 21 December 2021. Local public health centres conducted health monitoring and contact tracing. We analysed R, using information from six clusters, including 42 pairs with a clear relationship between the case and the infected contact (infector–infectee pairs); the clusters had 19, 21 and 2 cases in each subsequent generation. The basic R (t = 0) was estimated to be 3.2, and subsequent generations (t = 1, 2) of R decreased to 1.1 and 0.1, respectively. The haplotype network showed that these cases constituted a monophyletic group with others detected around Osaka, indicating that these case-related clusters had been contained and were not involved in the nationwide Omicron waves. Discussion: Active case finding and self-isolation were found to be effective in limiting the spread of an emerging novel variant.

A 24-year-old man was admitted due to fever for two days. He had undergone modified Bentall operation at the age of 18. Transthoracic echocardiography (TTE) showed no findings of infective endocarditis (IE), and he was treated with a course of antibiotics. On the next day, he suffered from aphasia and right hemiplegia, and computed tomography (CT) showed left cerebral infarction due to left middle cerebral artery embolism. The emergent endovascular reperfusion was done, but mild subarachnoid hemorrhage occurred. The following day, TTE showed vegetations and aortic annular abscess, and MSSA was confirmed by blood culture. He was transferred to our institution for surgical treatment for IE. High fever continued, and inflammatory response was recurrent, because the infection was not under control. In addition, multiple systemic thromboembolisms were revealed by contrast-enhanced CT. He recovered to the level of moving his limbs slightly, but he could not speak. We did aortic homograft root replacement and coronary bypass grafting 6 days after the cerebral infarction. His postoperative course was uneventful and he was transferred to rehabilitation hospital on postoperative day 31. He reintegrated into society without neurological complications, and there are no recurrent infections and have been no structural valve deteriorations of the homograft in 5 years.

A 66-year-old female patient was diagnosed with unstable angina and atrial fibrillation, and underwent coronary artery bypass grafting, pulmonary vein isolation, and left atrial appendage closure. After the surgery, only a small amount of pale blood drainage was observed from the drain, which is a normal occurrence following surgery. However, approximately 15 h after surgery, the drain discharged 300 ml of serous fluid per 4 h. A large amount of fluid continued to be drained, amounting to 500-900 ml per day. It continued to be serous even after resuming oral intake, differing from the typical course of lymphorrhea accompanied by chylothorax. Based on a biochemical test result and characteristics of the drainage fluid, lymphorrhea was suspected; therefore, we started a fat-restricted diet and subcutaneous injections of octreotide, as in the case of chylothorax. However, drainage continued. Finally, lymphangiography using Lipiodol was performed for diagnostic and therapeutic purposes, and the lymphorrhoea improved.

A 60-year-old woman was treated with oxycodone extended-release tablets for the cancer pain due to cervical cancer, and oxycodone was continued for abdominal pain due to radiation enteritis, laparotomy, small bowel obstruction, and constipation even after the cancer had been cured with chemoradiotherapy. The patient experienced severe drowsiness, and the opioid analgesics dose was gradually reduced. The dose was reduced by switching from oxycodone extended-release tablets to morphine powder. The patient’s drowsiness, constipation, and abdominal pain improved with reduction in opioid dosage, but she developed malaise, sweating, and agitation. These symptoms improved with morphine powder; thus, she was diagnosed with opioid withdrawal syndrome. We attempted to further reduce the dose gradually over a period of four years, but withdrawal symptoms reappeared when morphine powder was discontinued. Therefore, at present, we are administering her small doses of morphine powder. Though inappropriate use of opioid analgesics should be strictly avoided, in some cases, long-term use under careful specialist supervision may be necessary before discontinuation of opioid analgesics.

Hepatolithiasis is the presence of calculi within the intrahepatic bile duct and has various causes, including liver operations. In the presented case, intrahepatic stones were detected in the patient 30 years ago. Three years ago, before visiting our hospital, at the age of 68, a choledojejunal anastomotic operation was performed for the distention of the common bile duct. Intrahepatic calculi also occurred postoperatively. Percutaneous transhepatic biliary drainage and lithotripsy were conducted, but the intrahepatic stones reoccurred. This treatment was performed three times in total, last year. In the patient, hepatobiliary enzymes were elevated over the past year. To prevent hepatolithiasis recurrence, the patient visited the Kampo medicine outpatient department for inchingoreisan and shigyakusan treatment. Prior to treatment, the patient experienced abdominal discomfort in the hypochondrium. Upon treatment, a transient hepatic enzyme elevation occurred, which was assumed to be a paradoxical healing response, and drug administration was suspended. The prescription was resumed after 3 months, upon stabilization of elevated liver enzyme levels. Ten years after treatment, the patient’s condition was stable, without intrahepatic stone recurrence and apparent elevation of hepatobiliary enzymes. Inchingoreisan is reported to suppress calculi. Shigyakusan, free of the occasionally liver-damaging Scutellariae Radix, was also reported to be effective for hypochondrium discomfort. In conclusion, the combination of these treatments is suggested as a useful therapy in this case of hepatolithiasis.