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Three patients, aged 2 years 0 months, 2 years 2 months, and 6 years 1 month at the time of plain old balloon angioplasty (POBA), developed an aneurysm in the left anterior descending coronary branch after suffering from Kawasaki disease. POBA was subsequently performed due to 99 % stenosis proximal to the aneurysm. There was no restenosis within a few years after percutaneous coronary intervention, and there was no evidence of ischemia, although 75 % restenosis occurred in two patients after 7 years. Although calcified lesions are more likely to occur 6 years after the onset of Kawasaki disease, none of the patients in this study had calcified lesions within 4 years of Kawasaki disease onset, and good results were obtained with POBA alone. POBA can be safely performed in children and is an effective treatment for improving myocardial ischemia if calcification has not progressed. LEARNING OBJECTIVE: Plain old balloon angioplasty (POBA) can be performed effectively and safely for Kawasaki disease coronary artery stenosis in early childhood if calcification is minimal, with little restenosis for at least several years. POBA is a useful tool in the treatment of coronary artery stenosis in early childhood.

Cognitively challenging environments are vital to the welfare of captive animals. However, practical enrichment devices that can facilitate animals’ natural behaviours and accommodate individual variation are still limited. We created two types of feeders to facilitate tool-using behaviour in captive chimpanzees: pounding and dipping feeders. The pounding feeder was inspired by pestle-pounding behaviour observed in wild chimpanzees, and we expected that chimpanzees would pound soft foods. The dipping feeder was designed to stimulate actions similar to ant-dipping behaviours observed in wild chimpanzees. We investigated (1) how chimpanzees acquire tool-using behaviours and (2) the effects of the feeders on chimpanzee behaviour and use of space. The subjects were five chimpanzees housed in the Kyoto City Zoo, Japan. In study 1, conducted between March and May 2014, we introduced the feeders and examined the chimpanzees’ behaviours and the characteristics (length, width, etc.) of any tools they used. In study 2, conducted between September and October 2014, random days were designated when feeders were available (enriched condition) and not available (control condition). In study 1, all adult chimpanzees could use the dipping feeder, and two females could obtain foods from the pounding feeder by hitting the foods several times. The ability to acquire new tool-using behaviours was consistent with ability in existing tool-use behaviours. One infant started to use tools by trial and error. Study 2 showed that under the enriched condition, tool-using behaviours increased, stress-related behaviours decreased, and the use of space changed. These results suggest that these tool-based feeders provided an appropriate challenge for the chimpanzees.