Effects of adverse life events on mental health in single older adults in Japan.

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.

Rice farming care as a novel method of green care farm in East Asian context: an implementation research.

BACKGROUND: Green care farms, which offer care for people with dementia in a farm setting, have been emerging in the Netherlands. The aim of this study was to 1) implement green care farms which use rice farming in Japan, 2) explore the positive experiences of rice farming care, and 3) compare the effect of rice farming care to that of usual care on well-being and cognitive ability. METHODS: We developed a new method of green care farm in Japan which uses rice farming, a farming that is practiced all over East Asia. The participants were 15 people with dementia (mean age = 75.6 ± 9.8 years) who participated in a one-hour rice farming care program once a week for 25 weeks. We also collected qualitative data on the positive experiences of study participants after the program. As a reference data, we also collected the corresponding data of the usual care group which included 14 people with dementia (mean age = 79.9 ± 5.8 years) who were attending the near-by day-care. RESULTS: The mean participation rate on the rice farming care group was 72.1%. After the intervention, participants reported experiencing enjoyment and connection during the program. It also changed the staff's view on dementia. The green care farm group showed a significant improvement in well-being but no significant difference in cognitive function compared to the usual care group. CONCLUSIONS: Green care farms by using rice farming is promising care method which is evidence-based, empowerment-oriented, strengths-based, community-based dementia service, which also delivers meaningful experience for the people with dementia in East Asia. TRIAL REGISTRATION: UMIN, UMIN000025020 , Registered 1 April 2017.

Surgical intervention for ischemic mitral regurgitation: how can we achieve better outcomes?

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.

[Functional Mitral Stenosis after Mitral Valve Repair for Degenerative Mitral Valve Regurgitation].

Functional mitral stenosis after mitral valve repair for degenerative mitral regurgitation( DMR) is an evolving concept. Mitral annuloplasty devices stabilize the mitral annulus, reduce leaflet stress and increase leaflet coaptation, which leads to improvement of repair durability at the cost of dynamic and physiological annular movement and diastolic annular area. An elevation in rest and peak transmitral gradient has been observed in some patients with annuloplasty devices, and this elevation may associate with worse prognosis as late atrial fibrillation or lower functional capacity after surgery. In this review, we summarize the current reports describing functional mitral stenosis after mitral valve repair for DMR.

[The development of care farming for elderly people with cognitive impairment to enhance social inclusion: A feasibility study of rice-farming care for elderly people with cognitive impairment].

AIM: The aim of this study was to assess the feasibility of rice-farming care among elderly people with cognitive impairment as a tool for social inclusion. METHODS: Eight elderly individuals with cognitive impairment (7 men, 1 woman, mean age 68.3 years old) participated in the program over 25 weeks. The cognitive function, well-being, and depression were assessed before and after the program period. The degree of participants' independence during the program was also assessed. Semi-structured interviews with the participants and caregivers were held after the program period. RESULTS: The average participation rate was 93.0%. There were no unexpected events, and the subjects carried out farmwork almost independently. Regarding their well-being, two participants who scored below the cut-off criterion of mental health before the study scored above the cut-off after the study. Regarding depression, two participants who scored positive with a two-question case-finding instrument no longer scored positive after the study. Interviews with the participants showed that they enjoyed the program, especially because they had peers, a role, and gained positive emotions. Interviews with the caregivers showed that they had recognized for the first time what people can do with their skills. CONCLUSION: The results of the present study indicate that rice-farming was a feasible method of care with a positive impact on the well-being and depression of elderly people with cognitive impairment and enhanced their social participation, drawing out their individual strengths.

Short- and long-term results of radial artery and saphenous vein grafts in the right coronary system: a propensity-matched study.

PURPOSE: The selection of optimal grafts for the right coronary artery remains controversial. This study aims to evaluate the short- and long-term results of radial artery (RA) grafts and saphenous vein grafts (SVGs) to the right coronary artery. METHODS: We reviewed, retrospectively, isolated coronary artery bypass grafts, placed between 1997 and 2007, and compared the long-term results of patients who received RA (n = 110) grafts with those of patients who received SVGs (n = 264) using propensity-score matching for risk. The preoperative predictors of graft occlusion were investigated on a per case basis. RESULTS: Superior survival was noted in the unmatched RA group, but late outcomes after propensity-score matching yielded 91 patient pairs that were similar in the two groups. Graft failure was not correlated with mortality, but showed strong correlation with cardiac events in all patients. The predictors of graft occlusion in the RA group were mild proximal stenosis and low indexing glomerular filtration rates for body surface area, whereas those in the SVG were female gender and off-pump coronary artery bypass grafting. CONCLUSIONS: There were no significant differences in long-term outcomes between the RA and SVG groups. Predictors of graft occlusion differed between the groups. Notably, renal dysfunction impaired radial patency, emphasizing the importance of careful graft selection.

Single-Centre Experience of Off-Pump Multi-Vessel Coronary Artery Bypass Grafting Using Proximal Suture Device.

BACKGROUND: To investigate the results of off-pump coronary artery grafting (OPCAB) with the proximal suture device (PSD) regarding postoperative stroke and graft patency. METHODS: The PSD was used in 376 patients (32.0%), aorta-no-touch OPCAB was performed in 523 patients (45.2%), on-pump beating coronary artery bypass surgery (CABG) (on-beat group) in 125 patients (10.6%) including 51 conversions (conversion rate: 5.4%), and CABG with aortic clamp use (clamp group) in 152 patients. In the PSD group, Enclose II was used in 267 patients (71.0%). RESULTS: The hospital mortality rate was 1.95%. There was no early stroke in the OPCAB group, whereas the early-stroke rate was 0.8% in the on-beat group and 2.6% in the clamp group. The incidences of stroke at one month were: PSD group, 1.6%; no-touch group, 1.1%; on-beat group, 1.6%; and clamp group, 4.6% (p=0.014). The rates of complete revascularisation were higher in the PSD and clamp groups (94.7 and 94.0%, respectively) compared with the no-touch and on-beat groups (81.5 and 84.9%, respectively; p<0.001). The vein graft patency rates were comparable between the PSD and clamp groups. In multiple logistic regression analysis, OPCAB using the PSD did not increase the risk of stroke compared with the no-touch group (adjusted odds ratio [AOR]: 1.40; p=0.594) or on-beat group (AOR: 0.99; p=0.206), but reduced the risk of stroke compared with the clamp group (AOR: 0.19; p=0.005). CONCLUSIONS: Off-pump coronary artery grafting using the PSD was a safe and effective procedure. It led to lower incidences of postoperative stroke and excellent rates of graft patency and complete revascularisation compared with conventional CABG.

Impact of Chronic Kidney Disease on Long-Term Outcome of Coronary Artery Bypass Grafting in Patients With Diabetes Mellitus.

BACKGROUND: The aim of this study was to compare the short- and long-term outcomes of CABG in diabetes mellitus (DM) patients according to eGFR. METHODS AND RESULTS: A total of 573 DM patients receiving CABG between 1997 and 2012 were stratified according to preoperative eGFR: normal or mild chronic kidney disease (CKD), eGFR ≥60 ml/min/1.73 m(2); moderate CKD, eGFR 30-60 ml/min/1.73 m(2); severe CKD, eGFR <30 ml/min/1.73 m(2); and severe CKD requiring hemodialysis (HD). Off-pump and bilateral internal thoracic artery (BITA) grafting rates were 83.4 and 62.3%, respectively. Mediastinitis and in-hospital mortality rates were both 1.4%. On logistic regression analysis, preoperative congestive heart failure and CKD severity were independent predictors of postoperative renal failure and major complications. The mean follow-up period was 5.7 years (range, 0-15.5 years). Estimated 5-year survival (92.9±1.6%, 82.8±3.3%, and 47.3±7.0%, respectively, P<0.001) significantly decreased with declining kidney function. On Cox hazard modeling, CKD severity was an independent predictor of major cerebrocardiovascular events (normal/mild: hazard ratio [HR], 1; moderate: HR, 1.35; severe: HR, 1.83; HD: HR, 2.0, P=0.016) and of overall survival (normal/mild: HR, 1; moderate: HR, 1.65; severe: HR, 5.96; HD: HR, 10.93, P<0.001). BITA grafting was a strong protective factor for overall survival (HR, 0.63; P=0.022). CONCLUSIONS: In DM patients, early- and long-term outcomes after CABG are strongly influenced by CKD progression.

Transaortic Repair as Bailout Procedure for Left Atrial Tear in Redo Mitral Valve Surgery via Superior Transseptal Approach.

We encountered a tear of the left atrium with severe calcification during redo mitral surgery, and report a technique for its repair. An 82-year-old woman underwent redo mitral valve replacement. The mitral valve was performed via a superior transseptal approach. The atriotomy was closed directly. The roof of the left atrium was found to be torn after aortic de-clamping. There was no remaining intact left atrial tissue on the aortic side. Patch closure was performed using transaortic stitches passing through the subaortic curtain to fix the patch. The left atrial roof and atrial septum were closed with the same patch.

[Off and On-pump Coronary Artery Bypass;Single Institutional Analysis and National Database Analysis Using Propensity Score].

OBJECTIVES: The purpose of this study was to evaluate early and long term surgical results of offpump coronary artery bypass( OPCAB) in comparison with on-pump coronary artery bypass( ONCAB) using single institutional and Japan national database( JACVSD). METHODS: Study 1:In our institution, between 1998 and 2012, 1,030 consecutive patients underwent isolated coronary artery bypass surgery. Using stratification method by propensity scores, early and late surgical results were evaluated. Study 2:In JACVSD, between 2008 and 2010, 24,287 patients who underwent isolated coronary artery bypass were reported. After propensity score matching, 2,955 cases in each group were selected. RESULTS: Study 1:OPCAB significantly reduced intubation period( p<0.001), intensive care unit( ICU) stay( p<0.001), and operative mortality( p=0.022). Kaplan-meier analyses showed there was no statistical difference between OPCAB and ONCAB in major adverse cardiac and cerebrovascular event (MACCE) and mortality. Long term result analyses showed risk of MACCE (p=0.886)and mortality (p=0.437)was similar in both groups. Study 2:Thirty day( p=0.051) and hospital mortality( p=0.053) were less frequent in OPCAB group. Rate of composite( p<0.001), re-bleeding( p=0.004), dialysis( p=0.005), prolonged intensive care unit stay( p<0.001), prolonged ventilation( p<0.001)and gastrointestinal bleeding( p<0.001)was significantly lower in OPCAB after matching. CONCLUSIONS: Both study showed less invasiveness of OPCAB.

Does Age at Operation Influence the Short- and Long-Term Outcomes of Off-Pump Coronary Artery Bypass Grafting?

BACKGROUND: To investigate the relationship between age and both short- and long-term outcomes of off-pump coronary bypass grafting (OPCAB). METHODS AND RESULTS: The 780 patients undergoing OPCAB were divided into 3 groups: 262 aged <65 years (young), 329 aged 65-74 years (early elderly), and 189 aged >75 years (late elderly), and retrospectively analyzed. The follow-up rate was 94.9%, and mean follow-up period was 5.6±3.4 years. In-hospital mortality rates were similar among the groups (0.8% in young, 1.2% in early elderly, and 1.1% in late elderly; P=0.862). In logistic regression analysis, the risk factor for predicting major complications was the New York Heart Association (NYHA) classification (odds ratio: 1.555, P=0.001), and not age. The 10-year estimated rates free from cardiac death (89.6±3.2, 95.0±2.1, and 96.5±2.1%, log rank, P=0.16) and cardiac events (71.8±3.8, 66.8±4.3, and 59.9±7.7%, P=0.61) were not significantly different among the groups. In multivariate Cox models, independent risk factors predicting cardiac events were the NYHA classification (hazard ratio (HR): 1.265, P=0.009), and ejection fraction (HR: 0.986, P=0.016), but not age (young HR: 1.0, early elderly HR: 1.276; P=0.210, late elderly HR: 0.910; P=0.707). CONCLUSIONS: Both short- and long-term cardiac outcomes of OPCAB are not influenced by age at operation.

Annuloplasty Ring Size Determines Exercise-Induced Mitral Stenosis Severity after Valve Repair.

BACKGROUND: Patients are occasionally encountered with high mitral pressure gradients after mitral valve repair for degenerative mitral regurgitation (MR), despite the use of a 'truesized' ring based on the anterior leaflet dimension. The study aim was to assess these patients at rest and during exercise, using echocardiography. METHODS: Sixty-seven patients who underwent mitral repair for degenerative disease using a semi-rigid, complete annuloplasty ring were assessed. A truesized ring was always selected for the annuloplasty. Of these patients, 20 were enrolled for exercise stress echocardiography. The indexed ring orifice area (iROA) was calculated by dividing the geometric orifice area of the annuloplasty ring by the patient's body surface area (BSA). Postoperatively, the patients were in sinus rhythm and had less than moderate MR. RESULTS: During peak exercise, seven patients were considered to have severe mitral stenosis (MS), with a mean pressure gradient (mPG) >15 mmHg. The annuloplasty rings used in these seven patients were significantly smaller than those used in the other 13 patients (28.6 ± 1.9 mm versus 33.1 ± 3.1 mm; p = 0.003). The mPG at peak exercise was strongly correlated with the iROA (r = -0.767, p <0.001). CONCLUSIONS: Mitral repair, even following the use of a true-sized ring, may be associated with severe MS when the ring size is relatively small for the patient's BSA. This association was shown to become more prominent during exercise.

Mitral valve regurgitation after atrial septal defect repair in adults.

BACKGROUND AND AIM OF THE STUDY: Mitral valve regurgitation (MR) is known to deteriorate following adult atrial septal defect (ASD) repair in the mid to long-term. The study aim was to identify the risk factors for this deterioration. METHODS: Between 1995 and 2011, a total of 93 consecutive patients (aged > or = 18 years) underwent ASD repair at the authors' institution. Patients who underwent concomitant procedures, other than tricuspid annuloplasty or maze procedure, were excluded; hence, 74 patients were enrolled in the study. MR was evaluated by transthoracic echocardiography shortly after surgery and subsequently on a regular basis in the outpatient clinic. Risk factors for the deterioration of MR were estimated using Cox proportional hazards regression. RESULTS: The mean patient age at surgery was 48.0 +/- 17.1 years, and 20 patients (27%) had atrial fibrillation (AF) preoperatively. The mean follow up was 6.9 +/- 5.5 years. The degree of MR was not unchanged or not improved in 54 patients (73.0%) (group 1), but was increased by one grade in 12 patients (16.2%) (group 2), and by two or more grades in eight patients (10.8%) (group 3). At surgery, all patients in group 3 were aged > 50 years. In group 3, on echocardiography, the average end-diastolic left ventricular dimension was increased from 41.8 mm to 51.8 mm (p = 0.027), and enlargement of the mitral annulus was noted in seven patients. Four of the group 3 patients required reoperation for MR after ASD repair. The Cox proportional hazards model revealed preoperative AF (p = 0.045, hazard ratio (HR): 11.68, 95% confidence interval (95% CI): 1.05-129.48) and Qp/Qs > or = 2.8 (p = 0.015, HR: 9.19, 95% CI :1.53-55.04) to be independent risk factors of new-onset or aggravated MR (by two or more grades) after ASD repair. CONCLUSION: An earlier repair of ASD would be preferable in terms of MR aggravated after ASD repair. For elderly patients with a preoperative high Qp/Qs and AF, mitral valve annuloplasty with ASD repair should considered.