Evaluation of oral feeding function is extremely important for maintaining health in the elderly, especially to prevent undernutrition, infectious diseases, and aspiration pneumonia. There is a strong need for a method that will easily allow caregivers to evaluate oral feeding function.
We have established an Oral and Food Function Support Promotion Study Group in collaboration with the Taihoku Dental Association and Omachi General Hospital to create a support system comprising communitybased care involving interoccupational cooperation. We designed an oral feeding function evaluation tool comprising eight items to easily screen the oral feeding function of subjects. This evaluation tool was tested and verified in a welfare facility for the elderly, and we report the results of our analysis. Furthermore, we assessed the validity of this system for an oral feeding function tool.
We divided 63 residents into the intervention group and the meal-round nonintervention group. We used the evaluation tool, which used photographs, to assess their oral feeding function．According to the results, the meal round was conducted and linked with the guidance and treatment. The degree of improvement observed was compared between the two groups.
The intervention group showed an improvement rate of more than 51％ in four items, whereas the nonintervention group showed an improvement in two. Moreover, the number of subjects hospitalized due to aspiration pneumonia decreased after the intervention.
We found that the introduction of an evaluation tool and collaboration between interoccupational Interdisciplinary care staff aroused interest and attentive engagement in oral feeding function.

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Objective : To report the safety and efficacy of the lenalidomide-dexamethasone (Rd) regimen for previously treated patients with immunoglobulin light chain (AL) amyloidosis patients in a real-world clinical practice setting at a single amyloidosis center in Japan.
Methods : Clinical data about patient background characteristics and treatment outcomes of patients with previously treated systemic AL amyloidosis who received Rd as salvage treatment at our department were retrospectively collected and analyzed.
Patients : Among the total of 262 AL amyloidosis patients in a single institute, 22 patients who were treated with the Rd regimen between September 2001 and December 2019 after one or more preceding chemotherapeutic regimens fulfilled the inclusion criteria.
Results : The median follow-up period was 41 (range 1-68) months. The median number of previous treatment regimens was 2 (range 1-4). The numbers of patients who achieved complete response, very good partial response, partial response, and no response were 14 (64％), 0 (0％), 2 (9％), and 6 (27％), respectively. Eight patients (36％) experienced grade≥3 adverse events. Toxicity-related treatment discontinuation occurred in four patients (18％). No treatment-related mortality occurred. Four patients died during the observation period, three of whom died due to disease progression. The median overall survival has not yet been reached.
Conclusion : In this study, Rd was shown to be a safe and efficient treatment option for AL amyloidosis patients who were refractory to first-line therapy. These results provide an important insight for clinicians treating AL amyloidosis patients in a real-world clinical practice setting.

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Aim : Takotsubo syndrome (TTS) is identified in 1-3％ of patients with suspected acute coronary syndrome and is a complication of various diseases. This study aimed to clarify the prevalence and clinical characteristics of TTS among patients admitted to the emergency department of a tertiary hospital.
Methods : We conducted a post-hoc analysis of a single-center prospective observational study of all patients admitted to our emergency department between April 2003 and March 2014. The diagnosis of TTS was based on the Mayo diagnostic criteria.
Results : Among 14,178 patients admitted, TTS was diagnosed in 33 patients (male, 36％ ; median age 76 (interquartile range, 70-80) years), with a prevalence rate of 0.23％. The cases without preceding physical illness included 40％ of patients (the primary TTS group), and the cases with preceding physical illness included 60％ of patients (the secondary TTS group). Chest discomfort was the presenting symptom in only 25％ of patients in the secondary TTS group compared to 92％ in the primary TTS group (p＜0.001). The Acute Physiology and Chronic Health Evaluation II scores were higher in the secondary TTS group than in the primary TTS groups (p＝0.002)
Conclusions : The prevalence of TTS among patients admitted to the emergency department was 0.23％. TTS triggered by a physical illness formed a high percentage, and in the majority of these cases chest symptoms were not presenting complaints. Nevertheless, physicians should screen for TTS as part of the assessment of patients admitted to the emergency department.

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Here, a case is presented who showed a quantitative increase in neutralizing antibody after SARS-CoV-2 vaccination but its gradual decrease in 4 months after vaccination. Evidence-based vaccine strategies for SARS-CoV-2 infection are needed to control the future trajectory of the COVID-19 pandemic.

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