The role of discrimination in the relation between COVID-19 sequelae, psychological distress, and work impairment in COVID-19 survivors.

Perceived discrimination and work impairment are commonly observed in COVID-19 survivors, but their relationship has not been well understood. We aimed to evaluate the role of discrimination in the development of psychological distress and work impairment in COVID-19 survivors. From April 2020 to November 2021, 309 patients were recruited at two designated COVID-19 hospitals in Japan. Participants completed a standardized questionnaire including COVID-19 sequelae, psychological distress, impairments in work performance and perceived discrimination. The majority of participants (62.5%) experienced one or more COVID-19 sequelae. Psychological distress was observed in 36.9% and work impairment in 37.9%. In multivariate logistic regression analyses, COVID-19 sequelae and discrimination were associated with both psychological distress and work impairment. Mediation analysis demonstrated that the direct effect of sequelae on work impairment was non-significant after accounting for psychological distress, suggesting that the effect of sequelae on work impairment was mainly mediated through psychological distress. These findings were replicated in a subgroup analysis limited to patients with mild COVID-19. We conclude that discrimination plays an important role in the development of psychological distress and work impairment, and that both discrimination and psychological distress should be targets of intervention in COVID-19 survivors.

Long COVID occurrence in COVID-19 survivors.

This cross-sectional study aimed to investigate the post-acute consequences of COVID-19. We conducted a self-administered questionnaire survey on sequelae, psychological distress (K6), impairments in work performance (WFun), and COVID-19-related experiences of stigma and discrimination in two designated COVID-19 hospitals in Hiroshima Prefecture, Japan, between August 2020 and March 2021. The prevalence of sequelae was calculated by age and COVID-19 severity. Factors independently associated with sequelae or psychological distress were identified using logistic regression analysis. Among 127 patients who had recovered from COVID-19, 52.0% had persistent symptoms at a median of 29 days [IQR 23-128] after COVID-19 onset. Among patients with mild COVID-19, 49.5% had sequelae. The most frequent symptoms were olfactory disorders (15.0%), taste disorders (14.2%), and cough (14.2%). Multivariate analysis showed that age was an independent risk factor for sequelae (adjusted odds ratios [AOR] for ≥ 60 years vs. < 40 years 3.63, p = 0.0165). Possible psychological distress was noted in 30.7% (17.9% of males and 45.0% of females). Female sex and the presence of sequelae were independent risk factors for psychological distress. Of all participants, 29.1% had possible impairments in work performance. Experiences of stigma and discrimination were reported by 43.3% of participants. This study revealed the significant impacts of Long COVID on health in local communities. A large-scale, long-term cohort study is desired.

Cyclometalated Platinum(II) Complexes in a Cis-N,N Configuration: Photophysical Properties and Isomerization to Trans Isomers.

Synthesis, isomerization, and photophysical properties of novel cis-N,N-cyclometalated complexes [Pt(C∧N)(l-Phe)] (C∧N = benzoquinolinate (1), phenylpyridinate (2), 2-(p-tolyl)pyridinate (3), and 1-phenylpyrazolate (4); l-Phe- = l-phenylalaninate) are reported herein. In solution, the cis forms of the complexes isomerize to their trans forms via an associative mechanism. This cis/trans isomerism barely influences the absorption and luminescence properties of the complexes in solution, except for a characteristic absorption at approximately 340 nm in the absorption spectra of the cis complexes that is not observed for the trans complexes. Interestingly, the cis complexes are spontaneously assembled in a crystalline phase and show bathochromic absorption and emission colors compared with those of the corresponding trans isomers, which are aggregated in an amorphous phase. cis-1 and cis-2 demonstrate hypsochromic luminescence mechanochromism. The influence of the geometrical isomerism on the photophysical properties and the isomerization mechanism are supported by density functional theory calculations.

Progression from normal vessel wall to atherosclerotic plaque: lessons from an optical coherence tomography study with follow-up of over 5 years.

The initial process of atherosclerotic development has not been systematically evaluated. This study aimed to observe atherosclerotic progression from normal vessel wall (NVW) to atherosclerotic plaque and examine local factors associated with such progression using > 5-year long-term follow-up data obtained by serial optical coherence tomography (OCT). A total of 49 patients who underwent serial OCT for lesions with NVW over 5 years (average: 6.9 years) were enrolled. NVW was defined as a vessel wall with an OCT-detectable three-layer structure and intimal thickness ≤ 300 µm. Baseline and follow-up OCT images were matched, and OCT cross sections with NVW > 30° were enrolled. Cross sections were diagnosed as "progression" when the NVW in these cross sections was reduced by > 30° at > 5-year follow-up. Atherogenic progression from NVW to atherosclerotic plaque was observed in 40.8% of enrolled cross sections. The incidence of microchannels in an adjacent atherosclerotic plaque within the same cross section (6.7 vs. 3.3%; p = 0.046) and eccentric distribution of atherosclerotic plaque (25.0 vs. 12.6%; p < 0.001) at baseline was significantly higher in cross sections with progression than in those without. Cross sections with progression exhibited significantly higher NVW intimal thickness at baseline than cross sections without progression (200.1 ± 53.7 vs. 180.2 ± 59.6 µm; p < 0.001). Multivariate analysis revealed that the presence of microchannels in an adjacent atherosclerotic plaque, eccentric distribution of atherosclerotic plaque, and greater NVW intimal thickness at baseline were independently associated with progression at follow-up. The presence of microchannels in an adjacent atherosclerotic plaque, eccentric distribution of atherosclerotic plaque, and greater NVW intimal thickness were potentially associated with initial atherosclerotic development from NVW to atherosclerotic plaque.

Association Between Visit-to-Visit Variability in Low-Density Lipoprotein Cholesterol and Plaque Rupture That Leads to Acute Coronary Syndrome.

Background: The effect of intraindividual variability in lipid levels on the onset of acute coronary syndrome (ACS) remains uncertain. We evaluated the relationship between intraindividual variability in lipid levels and culprit lesion morphologies by optical coherence tomography (OCT). Methods and Results: Seventy-four consecutive patients with ACS whose cholesterol levels were assessed ≥3 times during outpatient visits before the onset of ACS were enrolled in the study; 222 patients without significant stenotic lesions were used as a control group. Based on OCT findings of culprit lesions, ACS patients were categorized into a plaque rupture ACS (PR-ACS) group (n=44) or a non-plaque rupture ACS (NPR-ACS) group (erosion or calcified nodule; n=30). Visit-to-visit variability in lipid levels was evaluated using the corrected variability independent of the mean (cVIM). Patients with ACS had significantly higher low-density lipoprotein cholesterol (LDL-C) levels and cVIM in LDL-C than the control group. The PR-ACS group had significantly higher mean LDL-C levels and greater cVIM in LDL-C than the control group. The PR-ACS group had a significantly higher cVIM than the NPR-ACS group, despite similar mean LDL-C levels. Multivariate analysis revealed that higher cVIM of LDL-C was an independent predictor of PR-ACS (odds ratio 1.06; P=0.018). Conclusions: In addition to the LDL-C level, greater visit-to-visit variability in LDL-C levels may be associated with the onset of ACS induced by plaque rupture.

Morphological Plaque Characteristics and Clinical Outcomes in Patients With Acute Coronary Syndrome and a Cancer History.

Background Although patients with a cancer history have a 2 to 3 times higher risk for acute coronary syndrome (ACS), the morphological characteristics of ACS culprit plaque in those patients and their relations with clinical outcomes remain unknown. Methods and Results This retrospective, multicenter, observational cohort study included consecutive patients with ACS who underwent optical coherence tomography-guided emergent percutaneous coronary intervention. Patients were categorized into those without a cancer history, those with a cancer history, and those currently receiving cancer treatment. ACS culprit lesions were classified as plaque rupture, plaque erosion, or calcified nodule using optical coherence tomography. Plaque erosion frequency was significantly higher in culprit lesions of patients with current cancer and patients with cancer history than in those of patients without cancer history (56.3% versus 61.7% versus 36.5%). Calcified nodule incidence was significantly higher in patients without cancer history than in patients with current cancer and patients without cancer history (patients with current cancer: 12.4% versus patients without cancer history: 25.5% versus patients without cancer history: 12.6%, P<0.001). Cancer history was independently associated with nonplaque rupture (plaque erosion or calcified nodule) in ACS culprit lesions (odds ratio, 4.00; P<0.001). Cancer history was independently associated with major adverse cardiovascular events (hazard ratio [HR], 1.98; P=0.002). Nonplaque rupture in ACS culprit lesions was independently associated with major adverse cardiovascular events (HR, 1.60; P=0.011). Conclusions Patients with a cancer history had significantly worse clinical outcomes after ACS than those without a cancer history. Those with a cancer history had significantly higher plaque erosion and calcified nodule incidences in the ACS culprit lesions, which might partly explain their worse clinical outcomes. Registration URL: www.umin.ac.jp/ctr/index.htm. Unique Identifier: UMIN000038442.

Multipoint Lock-and-Key Assembly of Particles with Anisotropic Dents toward Modeling Rigid Macromolecules in a Colloidal Scale.

Multipoint lock-and-key particle assembly, consisting of lock particles with multiple anisotropic dents and rod-shaped particles as key particles, is developed for colloidal modeling application. The lock particles were connected with each other at a key particle as their joint in the presence of depletants, forming rigid colloidal molecules imitating rigid polymers (e.g., polymers containing aromatic rings and intramolecular hydrogen bonds). A single-particle level observation was conducted to visualize the colloidal polymerization of the particle assembly. Motion trajectories of the lock particles observed by optical microscopy indicated that the particle diffusivity was dramatically lowered when the lock particle connected with another one, suggesting that particle diffusion was suppressed by particle assembly formation. Because the kinetic and regioselectivity of colloidal polymerization are assumed to be analogous to those at the atomic scale, the proposed lock-and-key assembly can be a promising colloidal model for atomic-scale polymers associated with their micro-Brownian motion.

Hemodynamic changes during transcatheter atrial septal defect closure predict midterm heart failure deterioration in adults.

OBJECTIVES: To investigate whether hemodynamic changes during balloon occlusion test (BOT) predict future heart failure (HF) deterioration after transcatheter atrial septal defect closure (tASD-closure). BACKGROUND: Midterm HF deterioration can sometimes occur after tASD-closure in adults. Whether hemodynamic changes during tASD-closure can help identify patients at risk is unknown. METHODS: This prospective observational study enrolled 86 consecutive adult patients who underwent tASD-closure. Hemodynamic parameters, including pulmonary capillary wedge pressure (PCWP), were measured at baseline, during BOT, and after tASD-closure. The changes in PCWP during BOT and after tASD-closure were defined as ΔPCWP (Occ-Pre) and ΔPCWP (Post-Pre), respectively. Clinical parameters were evaluated before tASD-closure and during the 3-month follow-up. We assessed the occurrence of HF deterioration (HF requiring hospitalization or additional diuretics) during a 2-year follow-up period and categorized patients into HF (+) and HF (-) groups accordingly. The aforementioned parameters were compared between groups. RESULTS: Midterm HF deterioration occurred in 12 patients (13.9%). Compared to the HF (-) group, the HF (+) group presented a significantly higher ΔPCWP (Occ-Pre) (9.5 ± 4.4 mmHg vs. 3.0 ± 3.3 mmHg; p < 0.001) and ΔPCWP (Post-Pre) (4.0 ± 2.8 mmHg vs. 0.6 ± 1.8 mmHg; p = 0.004). Receiver operating characteristic curve analysis showed that the ΔPCWP (Occ-Pre) cutoff value of 5.5 mmHg had excellent ability to predict HF deterioration (Area under the curve 0.886 [0.779-0.993], p < 0.001; sensitivity 0.917, specificity 0.824). CONCLUSIONS: Increases in PCWP during BOT predict midterm HF deterioration after tASD-closure. Close surveillance may be needed in patients with a ΔPCWP (Occ-Pre) >5 mmHg.

Relationship among clinical characteristics, morphological culprit plaque features, and long-term prognosis in patients with acute coronary syndrome.

Culprit lesions of acute coronary syndrome (ACS) could be classified as plaque rupture (PR), erosion, or calcified nodule (CN). We aimed to determine the relationship among clinical characteristics, morphological plaque features, and long-term prognosis in ACS. Patients with ACS, who underwent pre-intervention optical coherence tomography between April 2013 and July 2018 were retrospectively enrolled, and classified into the three groups based on the culprit lesion morphology. In the 436 patients enrolled, incidences of PR, erosion, and CN in ACS culprit lesions were 46.1, 39.9, and 14.0%, respectively. Plaque erosion was more frequent in men aged < 60 years and CN was more frequent in older adults in both sexes (≥ 80 years) (P < 0.001). Patients with CN had a higher incidence of hemodialysis treatment (P < 0.001) and diabetes (P = 0.003). Multivariate analysis revealed that ST elevation myocardial infarction (STEMI) (P = 0.049) and presence of thin-cap fibroatheroma (TCFA) at the culprit lesion were independently associated with PR; in younger patients (< 60 year), preserved left ventricular ejection fraction and lower incidence of TCFA were correlated with plaque erosion; and older age, non-STEMI, or unstable angina pectoris, higher serum brain natriuretic peptide levels, and lower incidence of TCFA were independently associated with CN. Multivariable analysis revealed that CN (odds ratio [OR] 1.990, P = 0.005), male sex (OR 2.012, P = 0.004), and older age (OR 1.036, P < 0.001) were independently associated with future adverse events during a median follow-up of 757 days. Different patient characteristics and morphological features were associated with the type of culprit lesion in patients with ACS.

Risk Factors for Falls in Patients with Alzheimer Disease: A Retrospective Study of Balance, Cognition, and Visuospatial Ability.

AIM: This study aimed to determine the main risk factors for falls in patients with Alzheimer disease (AD) by comparing balance, cognition, and visuospatial ability between those who have experienced a fall and those who have not. METHODS: Forty-seven AD patients were admitted to a ward for patients with dementia (22 men and 25 women). The balance of patients was evaluated using the Functional Reach Test (FRT), the one-leg standing duration, and the Timed Up and Go (TUG) test. The Mini-Mental State Examination-Japanese (MMSE-J) was used to evaluate cognition. For visuospatial ability assessment, the Clock-Drawing Test (CDT) as well as overlapping figure identification and shape discrimination in the Visual Perception Test for Agnosia (VPTA) were used. The patients were allocated to either the fall group or the nonfall group based on their history of falls in the past year. The relationships between patients' characteristics and evaluation outcomes were compared and examined. Logistic regression analysis was performed using a fall as the objective variable. The area under the curve (AUC) and the cutoff value were calculated. RESULTS: Of the 47 participants, 22 had experienced falls within the past year (46.8%). The results of the FRT, one-leg standing duration, the TUG, the CDT, and the VPTA were significantly lower in the fall group. No significant difference between the MMSE-J scores of the fall group and those of the nonfall group was observed. The results of the logistic regression analysis indicated that falls in AD patients were significantly associated with the FRT. It was found that a shorter FRT distance (cm) had a significant impact on falls. For the FRT, the fall-related AUC was 0.755. At a cutoff value of 24.5 cm, the level of sensitivity was 68.0%, and the level of specificity was 77.3%. CONCLUSIONS: The findings of this study indicate that balance and visuospatial abilities are risks factors for falls in AD patients. In contrast, cognitive impairment was not a risk factor for falls. It was demonstrated that the FRT could be an appropriate risk predictor for falls in AD patients. In particular, falls in AD patients were strongly affected by a reduced dynamic balance.

Prediction of the debulking effect of rotational atherectomy using optical frequency domain imaging.

Whether predicting the rotational atherectomy (RA) effect based on the position of optical frequency domain imaging (OFDI) is accurate remains uncertain. The aim of this study was to evaluate the predictive accuracy of OFDI in identifying RA location and area. Twenty-five patients who underwent RA with OFDI were included. On pre-RA OFDI images, a circle with the dimension of a Rota burr was drawn at the center of the OFDI catheter. The area where the circle overlapped with the vessel wall was defined as the predicted ablation area (P-area), and the actual ablated area (A-area) was measured. The predictive accuracy of OFDI was evaluated as follows: overlapped ablation area (O-area: overlapping P- and A-areas) divided by P-area = %Correct-area, and A-area - O-area divided by A-area = %Error-area. Cross-sections were separated into four categories based on the median values of %Correct- and %Error-area. Among 334 cross-sections, RA effects were confirmed in the predicted location in 87% of them. The median %Correct- and %Error-areas were 43.1% and 64.2%, respectively. Floppy wire, narrow lumen area, OFDI catheter close to the intima, and large arc of calcium were independently associated with good prediction (high %Correct-/low %Error-areas). Non-left anterior descending lesions, OFDI catheter far from the wire, and OFDI catheter and wire far from the intima were associated with irrelevant ablation (low %Correct-/ high %Error-areas). The accuracy of the OFDI-based predictions for RA effects was acceptable with regard to location, but not high with regard to area. Wire types, target vessels, and OFDI catheter and wire positions are important determinants for accurately predicting RA effect using pre-procedural OFDI.

Interactions Between Hydrated Cerium(III) Cations and Carboxylates in an Aqueous Solution: Anomalously Strong Complex Formation with Diglycolate, Suggesting a Chelate Effect.

Interactions between hydrated Ce3+ and various carboxylates are of fundamental interest. Anomalously strong interactions with Ce3+ occur when diglycolic acid (DGA) is added into a Ce3+ aqueous solution, unlike various other carboxylic acids. Herein, the complex-formation constants of Ce3+ with these acids are evaluated via absorption and emission spectra. Hydrated Ce3+ emits fluorescence with unity quantum yield; however, addition of various carboxylates statically quenches the fluorescence when Ce3+-carboxylate complexes form because the fluorescence lifetime is constant irrespective of the carboxylate concentration. In the observed static quenching, the complex-formation constants obtained from the absorption and emission spectra (K abs and K em) agree well. The binding of Ce3+ by the conjugate Lewis bases, i.e., carboxylates, is approximately inversely proportional to the pH. Adding DGA into the system also statically quenches the fluorescence, but far more efficiently, even in a much weaker solution. We rigorously deduce K abs and K em of Ce3+ with DGA without any approximation using comparable concentrations. Careful fittings provide equivalent K em and K abs values, and by varying the pH and ionic strength, we confirm that this equivalence is an inherent property of the Ce3+-DGA system. The Lewis acid-base theory cannot explain why DGA binds to Ce3+ ∼1000 times more strongly than the other carboxylates. This anomalously strong binding may be due to a chelate effect caused by the DGA's central oxygen atom, which forms a five-membered ring with the conjugate Lewis bases of DGA; double chelate rings can also form, while bis-deprotonated DGA binds to Ce3+, facilitated by the central oxygen. Therefore, DGA enables efficient quenching through the chelate effect when it binds to Ce3+.

Concomitant Use of Rosuvastatin and Eicosapentaenoic Acid Significantly Prevents Native Coronary Atherosclerotic Progression in Patients With In-Stent Neoatherosclerosis.

BACKGROUND: In-stent neoatherosclerosis (NA) is a risk for future cardiovascular events through atherosclerotic progression in non-stented lesions. Using optical coherence tomography, this study assessed the efficacy of intensive therapy with 10 mg/day rosuvastatin plus 1,800 mg/day eicosapentaenoic acid (EPA) vs. standard 2.5 mg/day rosuvastatin therapy on native coronary plaques in patients with NA.Methods and Results:This was a subgroup analysis of the randomized LINK-IT trial, which was designed to compare changes in the lipid index in NA between intensive and standard therapy for 12 months. In all, 42 patients with native coronary plaques and NA were assessed. Compared with standard therapy, intensive therapy resulted in greater decreases in serum low-density lipoprotein cholesterol concentrations and greater increases in serum 18-hydroxyeicosapentaenoic acid concentrations, with significantly greater decreases in the lipid index and macrophage grade in both NA (-24 vs. 217 [P<0.001] and -15 vs. 24 [P<0.001], respectively) and native coronary plaques (-112 vs. 29 [P<0.001] and -17 vs. 1 [P<0.001], respectively) following intensive therapy. Although there was a greater increase in the macrophage grade in NA than in native coronary plaques in the standard therapy group, in the intensive therapy group there were comparable reductions in macrophage grade between NA and native coronary plaques. CONCLUSIONS: Compared with standard therapy, intensive therapy prevented atherosclerotic progression more effectively in native coronary plaques in patients with NA.

Luminescence of mononuclear Pt(ii) complexes with glycolate: external stimuli-induced excimer emission changes to oligomer emissions.

The emission properties and external stimuli-induced emission changes of novel mononuclear platinum(ii) complexes [PtII(4R2bpy)(gl)] (R = H (1), Me (2), tBu (3); 4R2bpy: 4,4'-disubstituted-2,2'-bipyridine; Hgl-: glycolate) were investigated. In solution, all complexes showed orange (λem: 617-623 nm) and green (λem: 488-495 nm) emissions at room temperature and 77 K, respectively, and the emission change is caused by a rigid chromic effect. X-ray crystallography of a red-emitting yellow trihydrate crystal of 1 (1R; λem: 663 nm) and an orange-emitting yellow anhydrate crystal of 3 (3O; λem: 560 nm) revealed the presence of weak π-π interactions between 4R2bpy moieties. When 1R was cooled to 153 K, the emission gradually turned to yellow (λem: 550 nm) owing to the restriction of inter-complex contacts after excitation. Exposing 1R to MeOH vapor rendered yellow-emitting yellow anhydrate crystals (1Y; λem: 558 nm), with the color remaining almost unchanged. Heating 1R gave orange-emitting orange anhydrate crystals (1O; λem: 597 nm). Consequently, the dehydration processes turn an excimer emission of 1R into two types of oligomer emissions (1Y and 1O). A green-emitting yellow 3.5 hydrate crystalline powder of 2 (2G; λem: 531 nm) was reversibly converted to an orange-emitting orange anhydrate powder (2O; λem: 564 nm) upon heating and exposure to H2O vapor, and the behavior is derived from switching between the monomer and an oligomer states. The crystal 3O exhibited an oligomer emission without responsiveness to external stimuli.

Evaluation of Activities of Daily Living/Instrumental Activities of Daily Living to Accurately Determine Severity of Moderate and Severe Alzheimer's Disease: Comparison of Assessments by Receiver Operating Characteristic Curve and Discriminant Analyses.

AIM: The aim of this study was to determine Activities of Daily Living/Instrumental Activities of Daily Living (ADL/IADL) evaluations that will enable better understanding of the severity of Alzheimer's disease (AD). METHODS: AD patients were evaluated by Functional Independence Measure (FIM), Hyogo Activities of Daily Living Scale (HADLS), and Assessment of Motor and Process Skills (AMPS) to identify the assessments that will enable highly precise discrimination of AD Clinical Dementia Rating (CDR) 2 (moderate) and CDR3 (severe) using receiver operating characteristic (ROC) curve and discriminant analyses. RESULTS: The participants were 75 AD patients (CDR2 = 50, mean age = 80.3 ± 5.9 years; CDR3 = 25, mean age = 78.3 ± 9.0 years). The evaluation methods consisted of FIM, HADLS, and AMPS. The results were divided into FIM-M, FIM-C, HADLS-ADL, HADLS-IADL, AMPS-motor skills, and AMPS-process skills. The values for the area under the curve (AUC) were compared by ROC curve and discriminant analyses. AUC values for FIM-C and AMPS-process skills were 0.956 and 0.947, respectively. With these two evaluations only, values ≥0.9 were shown. Moreover, the AUC of the discrimination score (combination of the FIM-C and AMPS-process skills) was significantly higher than those for FIM-M, FIM-C, HADLS-ADL, HADLS-IADL, and AMPS-motor skills. CONCLUSIONS: The results demonstrated that evaluation by FIM-C and AMPS-process skills methods was useful for discriminating between CDR2 (moderate) and CDR3 (severe) AD. Moreover, the results indicated that these two evaluation methods enabled more accurate determination of severity and the spared capabilities of AD patients.

Effects on activities of daily living and instrumental activities of daily living independence in patients with Alzheimer's disease when the main nursing caregiver consciously provides only minimal nursing care.

[Purpose] We investigated whether the activities of daily living and instrumental activities of daily living independence in patients with Alzheimer's disease are positively affected by the main nursing caregiver consciously aiming to provide only minimal nursing care. [Participants and Methods] The participants comprised 105 patients (men: 46, women: 59, mean age: 80.1 ± 6.7 years). We conducted interviews to establish whether the main nursing caregivers consciously aimed to provide only minimal nursing care (care consciousness), and participants were thus divided into two groups. Hyogo Activities of Daily Living Scale scores of the groups with and without care consciousness were compared by dementia severity. [Results] In patients with mild Alzheimer's disease, activities of daily living and instrumental activities of daily living independence in the group with care consciousness were significantly higher than in the group without care consciousness. In patients with moderate Alzheimer's disease, instrumental activities of daily living independence was significantly higher in the group with care consciousness than in the group without care consciousness. [Conclusion] Thus, positive effects on the activities of daily living and instrumental activities of daily living independence are observed when the main nursing caregivers consciously aim to provide only minimal nursing care to patients with Alzheimer's disease.

Impaired Cholesterol-Uptake Capacity of HDL Might Promote Target-Lesion Revascularization by Inducing Neoatherosclerosis After Stent Implantation.

Background We evaluated the importance of high-density lipoprotein (HDL) functionality for target-lesion revascularization in patients treated with coronary stents using a rapid cell-free assay system to evaluate the functional capacity of HDL to accept additional cholesterol (cholesterol-uptake capacity; CUC). Methods and Results From an optical coherence tomography (OCT) registry of patients treated with coronary stents, 207 patients were enrolled and their HDL was functionally evaluated by measuring the CUC. Follow-up OCT was performed (median duration, 24.5 months after stenting) to evaluate the presence of neoatherosclerosis. Clinical follow-up was performed to assess target-lesion revascularization for a median duration of 42.3 months after stent implantation. Neoatherosclerosis was identified in 37 patients (17.9%). Multivariate logistic regression analysis revealed that a decreased CUC was independently associated with neoatherosclerosis (odds ratio, 0.799; P<0.001). The CUC showed a significant inverse correlation with incidence of target-lesion revascularization (odds ratio, 0.887; P=0.003) and with lipid accumulation inside stents, suggesting that neoatherosclerosis contributes to the association between CUC and target-lesion revascularization. Conclusions Impaired HDL functionality, detected as decreased CUC, might lead to future stent failure by provoking atherogenic changes of the neointima within stents. Both quantitative and qualitative assessments of HDL might enable the improved prediction of clinical outcomes after stent implantation.

Successful Triple Combination Immunosuppressive Therapy with Prednisolone, Cyclosporine, and Mycophenolate Mofetil to Treat Recurrent Giant Cell Myocarditis.

A 59-year-old man with a history of giant cell myocarditis was admitted to our hospital with recurrent giant cell myocarditis triggered by a 1 mg/day taper in his prednisolone dose. During the initial episode, he had undergone rescue implantation of a temporary left ventricular assist device followed by the administration of dual immunosuppressive therapy with prednisolone and concomitant cyclosporine. Triple combination immunosuppressive therapy maintained with additional mycophenolate mofetil successfully controlled recurrent myocarditis, enabled a reduction in the prednisolone dose, and achieved the functional recovery of the left ventricle.