Preterm birth (PB) is a common complication of pregnancy and is associated with neonatal morbidity and mortality. The major cause of PB has long been considered to be the presence of acute chorioamnionitis (aCAM), which is characterized by neutrophil infiltration into the chorioamniotic membranes induced by bacterial infection. However, recent studies have revealed that PB often occurs in the absence of aCAM and bacterial infection. Attention has focused, therefore, on sterile inflammation as a possible cause. Sterile inflammation has been implicated in various conditions, including cancer, diabetic kidney disease, cardiovascular disease, and pulmonary disorders, and it is also suspected to play a role in the pathogenesis of many obstetric complications, such as PB, infertility, recurrent pregnancy loss, and preeclampsia. Sterile inflammation is induced by such endogenous molecules as high mobility group box 1 (HMGB1), IL-1α, IL-33, heat shock protein, and S100 protein, which are released as a result of tissue and cellular damage in the absence of infection. Exogenous particles like nanoparticles, silica, and asbestos also facilitate sterile inflammation. Collectively, these molecules are called alarmins. Recent studies have suggested that alarmins (particularly HMGB1, IL-1α, and cell-free fetal DNA) are closely associated with the occurrence of PB without apparent infection. Moreover, innate immune cells, such as dendritic cells, macrophages, and invariant natural killer T (iNKT) cells, are also considered to be important players in PB caused by sterile inflammation. The immunostimulatory activity of dendritic cells and macrophages in the placenta is enhanced by stimulation with alarmins, and these cells may activate downstream effector cells, iNKT cells, NK cells, neutrophils, and T cells, leading to excessive sterile inflammation and PB. This review focuses on the role of inflammation in PB, and particularly the mechanisms by which sterile inflammation causes PB.

The increased incidence of multiple concurrent medical conditions in elderly people means that this population is also at increased risk for polypharmacy and the adverse drug events (ADEs) it can lead to. The problem of polypharmacy cannot be solved without identifying and eliminating the inappropriately prescribed combinations of medications that lead to ADEs, of course, but the causes of polypharmacy also include factors related to daily life, such as patients' activities of daily living and the circumstances in which they live. Therefore, doctors cannot be expected to take full responsibility for protecting their patients from polypharmacy without the help of other medical staff. Pharmacists can play an important role in this respect by collaborating with other medical staff to identify unnecessary medication and to implement efforts to improve medication adherence.

IMPELLA^® (Abiomed) is a catheter-type left ventricular assist device (LVAD) with a built-in micro axial flow pump that removes blood from the left ventricle and delivers it to the ascending aorta. Use of this device for severe heart failure has recently increased. Here, we report a case of intracerebral hemorrhage occurring during the introduction of IMPELLA support which was successfully treated by craniotomy. The patient was a 23-year-old man who was admitted to another hospital with the diagnosis of low cardiac output syndrome associated with dilated cardiomyopathy. He was treated with respiratory management, including noninvasive positive pressure ventilation, and circulatory management with inotropic drugs and an intra-aortic balloon pump. His respiratory and circulatory condition worsened, however, and he was transferred to our hospital for advanced heart failure treatment. After admission, an IMPELLA CP was inserted via the right femoral artery and his hemodynamics were stabilized. However, weaning from the IMPELLA CP failed due to a lack of cardiac recovery, and ventricular support was escalated from the IMPELLA CP to IMPELLA 5.0 via the right subclavian artery. On the 36th day after admission, the patient suddenly developed intracerebral hemorrhage in the temporal and parietal lobes with midline shift, and craniotomy was performed under IMPELLA support. The postoperative course was good and he was able to walk with assistance. He was transferred to a rehabilitation hospital on the 105th day of hospitalization. Few reports of IMPELLA-related hemorrhagic stroke have appeared, and the incidence is not precisely known. To our knowledge, craniotomy under IMPELLA support has not been previously reported, and the accumulation of additional cases is required.