Anti-phospholipid syndrome (APS) is defined by both clinical findings (recurrent arterial and/or venous thrombosis and recurrent fetal loss) and laboratory evidence of persistent anti-phospholipid antibodies (anti-cardiolipin antibodies, anti-β2-glycoprotein I antibodies, or LA activity). However, the precise mechanism responsible for arterial and/or venous thromboembolic complications in APS patients remains unclear. To clarify the association between the various types of anti-phospholipid antibodies (aPLs) and thrombotic complications in patients with systemic lupus erythematosus (SLE), we examined the prevalence of aPLs against various phospholipid-binding proteins (β2-glycoprotein I, prothrombin, protein C, protein S, and annexin V). We confirmed that the presence of both anti-β2-glycoprotein I and anti-prothrombin is closely related with arterial thrombosis, and that the presence of anti-protein S is closely related with venous thromboembolism. Furthermore, our in-vitro experiment suggests that anti-β2-glycoprotein I and anti-prothrombin may cooperate to promote platelet activation, and may be involved in the pathogenesis of arterial thrombosis. On the other hand, anti-protein S caused APC resistance, which may represent an important mechanism responsible for the development of venous thrombosis. Furthermore, our study showed that anti-β2-glycoprotein I causes persistently high expression of tissue factor on monocytes, and this may be involved in the pathogenesis of thromboembolic complications.

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Epidemiological data indicate that sleep complaints increase with age. In this study, sleep-wake patterns of the frail elderly were clarified and the factors related to them were analyzed. The subjects were 76 elderly people in a long-term care hospital. Fifty-nine day's sleep-wake patterns were examined through a sleep log recorded by nurses and care workers. The relationship between sleep parameters and sleep-related factors was analyzed. Factors of age, Barthel Index, HDS-R, and frequency of participation in activity care programs were related to the sleep parameters. Results of multiple linear regression analysis revealed that most sleep parameters were influenced by the factor of frequency of participation in activity care. Following this investigation, the effects of activity care on sleep-wake patterns of the frail elderly were examined. The participants were 9 elderly people without dementia and 8 elderly females with dementia. Thirty day's sleep-wake patterns of the participants were examined, and then activity care programs were planned and implemented. Afterwards, 36 or 30-day sleep-wake patterns of the participants were recorded. There was a significant increase of total sleeping hours after the intervention. These findings indicated that there were positive effects of activity care intervention on the sleep-wake patterns of the frail elderly.

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