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Background A sinus of Valsalva aneurysm involving a single cusp is a rare condition, and coronary computed tomography angiography with fractional flow reserve-computed tomography helps evaluate not only the anatomical aspects of the aneurysm and coronary artery but also the physiological details of coronary artery disease. Case summary A 71-year-old woman presented with exertional chest pain and dyspnoea. Enhanced computed tomography revealed an aneurysmal change in the right sinus of Valsalva, and coronary computed tomography angiography revealed diffuse narrowing of the proximal segment of right coronary artery due to mechanical stretching by the large Valsalva aneurysm. Fractional flow reserve-computed tomography revealed a significantly low fractional flow reserve (0.50 in the distal right coronary artery). A modified Bentall procedure was performed with a 21 mm bioprosthetic valve and a 24 mm Valsalva graft conduit for the aortic root aneurysm; mitral valve annuloplasty was performed for mitral valve regurgitation. Post-operative coronary computed tomography angiography revealed no significant stenosis in the proximal segment of the right coronary artery. Furthermore, fractional flow reserve-computed tomography revealed a normalized fractional flow reserve in the distal right coronary artery. The patient experienced relief from chest pain and was discharged 19 days after the surgery. Discussion A right coronary sinus of Valsalva aneurysm, which caused right coronary artery ischaemia, was successfully treated using a modified Bentall procedure. Coronary computed tomography angiography and fractional flow reserve-computed tomography revealed anatomical and functional improvements in the right coronary artery ischaemia post-operatively. [ABSTRACT FROM AUTHOR]

During the Coronavirus disease pandemic (COVID‐19), working conditions became increasingly difficult for social workers, as they had to deal with new challenges and added workloads. This study describes the difficulties faced by social workers of the Self‐Reliance Support System in Japan and clarifies the solution for each difficulty while conducting their duties to support vulnerable people during COVID‐19. To this end, we conducted an open‐ended questionnaire survey and an interview survey. The data were analyzed using qualitative coding. The results showed that the difficulties faced in consultation support work included supporting hitherto socially invisible groups such as sole traders and foreigners. Social workers also faced an ethical dilemma, as they could not provide support to clients who "did not try to solve their problems" or for whom "interventional attempts did not lead to counseling support" and who only sought benefits at the risk of becoming isolated and impoverished. Following this, consultants collaborated to resolve such difficulties while maximizing the use of various local resources. The study's findings clarify that it would be effective to understand the difficulties faced by social workers to obtain hints toward their resolution. [ABSTRACT FROM AUTHOR]

Background: This study tested a hypothesised model of the effects of adverse life events on the mental health of middle‐aged and older adults living alone, as mediated by thought suppression and help‐seeking behaviours, considering gender differences. Methods: A questionnaire survey was conducted on a sample of 1202 (622 men; 580 women) individuals from 247445 residents aged 50–79 in District A of Tokyo. The questionnaire items covered parameters on adverse life events, help‐seeking behaviour, thought suppression, and mental health status. Results: Multiple group structural equation‐modelling analysis revealed that the seriousness of adverse life events, help‐seeking behaviours, and mental health scores were higher in women than in men. No significant gender differences were observed in thought suppression. The findings support all three proposed hypotheses: severe adverse life events will: (a) give rise to help‐seeking behaviours, which will have a positive effect on mental health; (b) intensify thought suppression, which will harm mental health; and (c) inhibit help‐seeking behaviour, especially in single middle‐aged and older adult men. Conclusion: There is a need to develop interventional programs based on the theory of replacement thinking to encourage help‐seeking behaviours in middle‐aged and older adults. [ABSTRACT FROM AUTHOR]

Antenatal maternal mental health status not only predicts postpartum mental status, but also influences family health. In Asia, however, little scientific research has been conducted on antenatal parenting intervention to date, nor has there been much emphasis on fathers in considerations of parenting support. Building upon our past research achievements that showed a strong need for parenting support focusing on the mental health aspect in Japan and Vietnam, we report on the process of adapting an Australian antenatal group-based psychosocial intervention involving fathers into Japanese and Vietnamese public service settings. The intervention was feasible at given sites and well accepted among volunteer couples. The presented processes to ease adaptation may be useful to other health professionals in Asian regions undertaking similar initiatives. (Contains 3 tables.)

Background and Aim of Study.To evaluate predictors of residual left ventricular hypertrophy (LVH) one year after surgical aortic valve replacement (SAVR) in patients with aortic stenosis and clarify the relationship between long-term outcomes and predictors. Methods. We retrospectively reviewed 141 patients who underwent SAVR with a bioprosthetic valve. Left ventricular dimensions and mass index were assessed using serial transthoracic echocardiography. The difference in time course and the pattern of left ventricular mass index (LVMI) regression between patients with and without residual LVH one year after surgery were evaluated. The factors associated with LVMI one year after SAVR and the prognostic impact of these predictors on long-term outcomes were analyzed. Results. Although LVMI one year after surgery showed a significant decrease in patients with and without LVH, greater preoperative LVMI and lesser extent of LVMI decrease resulted in high residual LVMI at one year after SAVR in patients with LVH. The preoperative left ventricular end-diastolic dimension index (p = 0.027) and preoperative left atrial dimension (p = 0.001) were significant determinants of LVMI at one year after SAVR. A cut-off value of 30 mm/m2 or greater for the left ventricular end-diastolic dimension index was optimal for predicting high LVMI one year after SAVR. Overall survival was significantly lower with a left ventricular end-diastolic dimension index ≥30 mm/m2 (p = 0.017 , Log rank). Conclusions. High preoperative left ventricular end-diastolic dimension index and large left atrial dimension were associated with high LVMI one year after surgical aortic valve replacement. Preoperative left ventricular end-diastolic dimension index of >30 mm/m2 could predict adverse outcomes after surgical aortic valve replacement. [ABSTRACT FROM AUTHOR]

The article explores the social relationships and well-being of families with middle-aged hikikomori, individuals experiencing prolonged isolation. It identifies the prevalence of hikikomori in older adults, their demographic characteristics, and the impact on family dynamics. It underscore the challenges faced by these families, emphasizing the importance of addressing isolation among middle-aged hikikomori for community well-being.

In patients with a narrow sinotubular junction, small sinus of Valsalva, or extensibility loss in the aortic root, aortic valve replacement (AVR) with a standard valve is challenging due to limited surgical field. Detailed preoperative measurements of the aortic root render performing AVR using the Perceval valve easy. [ABSTRACT FROM AUTHOR]

Aim: The homebound status is associated with unhealthy factors and physical disability. However, the prevalence of those who may be at an earlier stage of the homebound status ("semi‐homebound") is unclear. This study thus examines the prevalence of semi‐homebound individuals and identifies the associated physical, psychological, and social factors. Methods: A cross‐sectional study invited 1,157 participants aged 65 years and more in rural Japan. The mean age was 74.7 ± 6.8. The survey questionnaire accounted for different parameters, such as age, sex, homebound status, morbidity, instrumental activities of daily living (IADL), and mental health. Ordinal regression analysis examined participants' homebound status; socio‐demographic characteristics; and physical, psychological, and social variables. Results: The prevalence of the homebound status was 0.11 (95%CI = 0.99–0.13), and the semi‐homebound status was 0.30 (95%CI = 0.28–0.33). In the multivariable analysis, the homebound status was negatively associated with IADL (p <.001), mobility (p <.001), being alone during the day (p <.001), depression and anxiety (p <.05), and self‐efficacy for going out (p <.001). Discussion: The prevalence of semi‐homebound individuals was approximately 30%. Homebound and semi‐homebound individuals were associated with older, female, IADL, functional fitness, being alone during the day, depression and anxiety, and self‐efficacy for going out. In the case of psychical, psychological, and social factors, the semi‐homebound individuals revealed that these indicators fluctuated between homebound and non‐homebound. Our findings further focused on semi‐homebound individuals at elevated risks of disability, thereby emphasizing the need for customized intervention. Geriatr Gerontol Int 2021; 21: 1033–1039. [ABSTRACT FROM AUTHOR]

This study aimed to clarify patterns of poverty among single older men and examine this population's help‐seeking preferences. Semi‐structured interviews were conducted with 83 older single men in poverty. Three main patterns of poverty were identified: lifelong, job turnover, and retirement. A common characteristic among these patterns indicated that they did not recognize their difficulties as problems. Furthermore, we identified five groups of help‐receiving preferences: independent, resignation, mutual‐aid, other‐oriented, and seeking. Among these, the independent and resignation groups were influenced by past experiences of failing to seek help, which was characteristic of the lifelong pattern type. Furthermore, the mutual‐aid and seeking groups were oriented toward positive help‐seeking, which was characteristic of the job turnover and retirement pattern types. However, neither group actively sought help for social isolation or lack of social support, suggesting that it would have been challenging to establish social relationships early on in life. Thus, it is important to establish initiatives that enable older people to understand their current state and to think about their future depending on three patterns of poverty. [ABSTRACT FROM AUTHOR]

Optimal timing of open-heart surgery for the treatment of patients with cerebral hemorrhage remains controversial because systemic heparinization may lead to catastrophic bleeding. Several recent reports have shown that patients who undergo open-heart surgery.within a few weeks of cerebral hemorrhage have a much lower risk of exacerbated bleeding than previously considered. Herein, we report a case of left atrial myxoma and large hemorrhagic embolic stroke, which was successfully operated on with no exacerbation of cerebral hemorrhage. Careful assessment of time-course changes in cerebral hemorrhage by neurological imaging and adjustment of anticoagulation can help prevent the exacerbation of postoperative cerebral hemorrhage and neurological deterioration. < Learning objective: Evaluation of hemorrhagic activity is equally or more important than hemorrhagic size to prevent postoperative hemorrhagic deterioration in patients with preoperative cerebral hemorrhage. Careful assessment of time-course changes in cerebral hemorrhage by neurological imaging and adjustment of anticoagulation can help prevent the exacerbation of postoperative cerebral hemorrhage and neurological deterioration. Early open-heart surgery can be performed if the hemorrhage is judged as inactive, even if it is large.> [ABSTRACT FROM AUTHOR]

This study aimed to clarify patterns of poverty among single older men and examine this population's help‐seeking preferences. Semi‐structured interviews were conducted with 83 older single men in poverty. Three main patterns of poverty were identified: lifelong, job turnover, and retirement. A common characteristic among these patterns indicated that they did not recognize their difficulties as problems. Furthermore, we identified five groups of help‐receiving preferences: independent, resignation, mutual‐aid, other‐oriented, and seeking. Among these, the independent and resignation groups were influenced by past experiences of failing to seek help, which was characteristic of the lifelong pattern type. Furthermore, the mutual‐aid and seeking groups were oriented toward positive help‐seeking, which was characteristic of the job turnover and retirement pattern types. However, neither group actively sought help for social isolation or lack of social support, suggesting that it would have been challenging to establish social relationships early on in life. Thus, it is important to establish initiatives that enable older people to understand their current state and to think about their future depending on three patterns of poverty. [ABSTRACT FROM AUTHOR]

Open in new tab Download slide Open in new tab Download slide OBJECTIVES The actual underlying mechanisms of acute type A aortic dissection (AAAD) are not well understood. The present study aimed to elucidate the mechanism of AAAD using computational fluid dynamics (CFD) analysis. METHODS We performed CFD analysis using patient-specific computed tomography imaging in 3 healthy control cases and 3 patients with AAAD. From computed tomography images, we made a healthy control model or pre-dissection model for CFD analysis. Pulsatile cardiac flow during one cardiac cycle was simulated, and a three-dimensional flow streamline was visualized to evaluate flow velocity, wall shear stress and oscillatory shear index (OSI). RESULTS In healthy controls, the transvalvular aortic flow was parallel to the ascending aorta. There was no spotty high OSI area at the ascending aorta. In pre-dissection patients, accelerated transvalvular aortic flow was towards the posterolateral ascending aorta. The vortex flow was observed on the side of the lesser curvature in mid-systole and expanded throughout the entire ascending aorta during diastole. Systolic wall shear stress was high due to the accelerated aortic blood flow on the side of the greater curvature of the ascending aorta. On the side of the lesser curvature, high OSI areas were observed around the vortex flow. In all pre-dissection cases, a spotty high OSI area was in close proximity to the actual primary entry site of the future AAAD. CONCLUSIONS The pre-onset high OSI area with vortex flow is closely associated with the future primary entry site. Therefore, we can elucidate the mechanism of AAAD with CFD analysis. [ABSTRACT FROM AUTHOR]

Aim: To maintain the frequency of going out and to improve homebound status among older adults, specific barriers need to be identified. Hence, this study developed a scale to measure barriers to going out. Methods: A preliminary study was carried out to collect items for the scale. We conducted semi‐structured interviews with five homebound older adults, and created 14 items as a draft barrier scale. The main study included 2273 older adults and their cohabitating family members in rural Japan. For older adults, the questions included demographic characteristics, responses to the draft scale and variables to examine its validity. For family members, the questions included demographic characteristics, their relationship with the older adult and their assessment of their older relative's willingness to go out. We used data from 892 pairs for our analysis. Results: We selected nine items through the criterion group strategy, and confirmed the unidimensional structure of the scale through factor analysis. The results showed significant relationships between the scale and older adults' self‐efficacy about going out, their health locus of control, the frequency of going out and their reluctance to go out as assessed by family members. We carried out a receiver operating characteristic analysis to determine the scale's cut‐off point. Our multivariate analysis showed that the scale had a significantly stronger association with homebound status than with other variables. Conclusion: We developed a highly reliable and valid scale on barriers to going out among community‐dwelling older adults and confirmed its usability. Geriatr Gerontol Int 2021; 21: 238–244. [ABSTRACT FROM AUTHOR]

Background Ruptured subvalvular pseudoaneurysm is a rare but significantly fatal complication of infective endocarditis. We report a successful surgical case of ruptured subvalvular pseudoaneurysm with infective endocarditis. Case summary A 46-year-old man presenting with high fever was admitted to a local hospital. Physical examination revealed small erythema and petechiae on his lower limbs. Transthoracic echocardiogram did not show any visible vegetation and valvular disease; however, magnetic resonance imaging (MRI) showed multiple acute cerebral infractions, and methicillin-susceptible Staphylococcus aureus was detected in the blood culture. Infective endocarditis was suspected, and an antibacterial medication was initiated. Twelve days later, he suffered from a sudden cardiogenic shock due to cardiac tamponade. Bloody pericardial effusion (1600 mL) was drained, and his condition improved substantially. Transoesophageal echocardiography after pericardial drainage revealed severe mitral regurgitation and a subvalvular aneurysm at the posteromedial side of the mitral annulus; these were not detected at the time of admission. He was transferred to our hospital for surgery; however, since fresh cerebral bleeding was observed in MRI, the surgery was delayed. Three weeks later, after confirming that the blood culture was negative for any growth, patch repair of the subvalvular pseudoaneurysm and mitral valve repair were performed. Post-operatively, no complication or arrhythmia was observed; he was discharged 25 days later. Discussion We report a rare case of successful delayed surgery for a ruptured subvalvular pseudoaneurysm at the posteromedial side of the mitral annulus, which presented complications for infective endocarditis by S. aureus. [ABSTRACT FROM AUTHOR]

Ischemic mitral regurgitation (MR) is a common complication of myocardial infarction. Left ventricular (LV) dysfunction and distortion of the subvalvular apparatus are the main contributors to ischemic MR. Coronary artery bypass grafting alone, mitral valve replacement, and mitral valve repair, with or without subvalvular procedures, have been performed for moderate-to-severe ischemic MR. Several randomized studies on the surgical treatment of ischemic MR have been performed; however, the optimal surgical strategy remains controversial because none have demonstrated a clear survival benefit. Since the mechanisms of ischemic MR are complex and multifactorial, comprehensive preoperative assessment of LV function and geometry (both global and regional), mitral valve configuration, viability testing, and exercise echocardiography are needed. A better understanding of this complicated disease and of the advantages and limitations of each procedure may help us devise more effective patient-specific surgical treatment strategies and achieve better outcomes. [ABSTRACT FROM AUTHOR]

Aims: This study aimed to clarify the association between chronic stressors, stress coping and depressive tendencies among older adults. Methods: We carried out a survey with 500 participants aged in their 70s, who were randomly selected from the basic resident register. Of these, 304 residents responded to the survey (60.8%). Results: Findings from a factor analysis and cluster analysis revealed five groups of chronic stressors: physical, economic and interpersonal stressor; physical and economic stressor; interpersonal stressor; physical stressor; and low stressor. The factor analysis revealed four factors of coping: cognitive coping, support‐seeking, positive problem solving and escape–avoidance. Furthermore, a multiple logistic regression analysis showed that both physical, economic and interpersonal stressor, and physical and economic stressor had negative associations with depressive tendencies. With respect to stress coping, positive problem solving had a positive association with depressive tendencies, whereas escape–avoidance had a negative association with depressive tendencies. Conclusions: For older individuals, the more complex the overlapping chronic stressors that are experienced, the higher the depressive tendencies. Furthermore, although older individuals selectively use various coping strategies, they do not alleviate the stress responses induced by chronic stressors. Geriatr Gerontol Int 2020; 20: 297–303. [ABSTRACT FROM AUTHOR]

The article discusses the issue of middle-aged Hikikomori individuals who have withdrawn from society for extended periods. It emphasizes the need for support methods that address the unique circumstances of middle-aged Hikikomori people and presents a case study of a 43-year-old man who reconnected with society after 26 years of withdrawal. The turning point for this individual was realizing his own and his parents' aging, which motivated him to seek support.

OBJECTIVES This study aimed to evaluate whether cardiac magnetic resonance imaging (MRI)-derived right ventricular (RV) assessment can facilitate risk stratification among patients with ischaemic cardiomyopathy who underwent surgical ventricular reconstruction (SVR). METHODS We retrospectively analysed 53 patients who underwent SVR. The patients were preoperatively evaluated using cardiac MRI. Cine-MRI was acquired for left ventricular (LV) and RV volume. Gadolinium-enhanced MRI was performed to evaluate LV scarring. The mid-term (median, 58 months) risk factors of all-cause mortality and major adverse cardiac events were analysed. RESULTS A significant reduction in LV end-diastolic and end-systolic volume index and an increase in LV ejection fraction were observed early after SVR. RV end-diastolic volume index (RVEDVI) and RV end-systolic volume index (RVESVI) decreased after SVR (preoperative versus postoperative: RVEDVI, 71 ± 24 vs 62 ± 17 ml/m2, P  = 0.006; RVESVI, 44 ± 26 vs 37 ± 16 ml/m2, P  = 0.033), but RV ejection fraction did not change (preoperative versus postoperative: RV ejection fraction 40.8±14.6 vs 42.0±11.0%, P  = 0.067). At follow-up, 25 deaths and 31 major adverse cardiac events occurred. After adjustment for age, creatinine level and preoperative mitral regurgitation grade, the Cox-hazard model indicated that RVEDVI [ P  = 0.006, hazard ratio (HR) 1.03, 95% confidence interval (CI) 1.01–1.05] and RVESVI [ P  = 0.007, HR 1.02, 95% CI 1.01–1.04] were significant predictors for all-cause mortality. As for major adverse cardiac events, RVEDVI (P  = 0.007, HR 1.03, 95% CI 1.01–1.05), RVESVI (P  = 0.002, HR 1.03, 95% CI 1.01–1.04) and RV ejection fraction (P  = 0.018, HR 0.97, 95% CI 0.94–0.99) were significant. CONCLUSIONS RV parameters were more sensitive than LV parameters for predicting worse outcomes following SVR. Preoperative assessment of RV volume and function using cardiac MRI may improve the risk stratification of SVR. [ABSTRACT FROM AUTHOR]

Key points: Feasibility and transferability of care farms in urban areas have not previously been explored in Asia.The aim of this study is to examine the feasibility of an Dementia‐friendly care farm in urban areas.The results suggest that care farm programs are feasible even in urban areas, and may have positive impacts on participants' mental health, cognitive function and interpersonal interaction. [ABSTRACT FROM AUTHOR]

The article discusses a study that examines long-term effects of rice-farming care on cognitive function and mental health of elderly people with cognitive impairment. Highlights include rice-farming care performed once a week between April and October 2016, physical activities that are essential to rice farming and group work for problem-solving, and the use of the Mini-Mental State Examination to assess cognitive function.