The higher prevalence of CALs in incomplete KD reflects difficulties in diagnosis and delays in treatment. More timely diagnosis and treatment of incomplete KD patients could further prevent the development of cardiac lesions.

Although the incidence of KD has increased, the incidence of recurrent KD has remained largely unchanged over the past 30 years. Risk factors for recurrence included male sex, young age and initial resistance to immunoglobulin therapy.

Results: In multivariate analyses, patients aged younger than 1 year (OR compared with 1-2-year-olds = 6.57) and those older than 5 years (OR compared with 1-2-year-olds = 4.24), those who received additional intravenous immunoglobulin (IVIG) without the use of steroid (OR = 8.38) and those who received steroid administration with or without the additional use of IVIG (OR = 220.51 and 83.83, respectively), showed significantly higher OR for giant coronary aneurysms. As for IVIG therapy, the additional use of IVIG (OR = 14.84), total dosage of IVIG exceeding 2500 mg/kg (OR compared with 1500-2499 mg/kg = 12.26) and the duration of IVIG administration for more than 3 days (OR = 30.12), were found to significantly increase the risk of developing giant aneurysms in univariate analyses that were adjusted for sex and age. Conclusions:The observation of 53 patients with giant coronary aneurysms due to Kawasaki disease among those included in the nationwide survey presented some risk factors, together with considerations about the associated aneurysms.

IntroductionBased on data obtained before high-dose (2 g/kg) intravenous immunoglobulin (IVIG) therapy prevailed in Japan, children with a history of Kawasaki disease (KD) were highly susceptible to disease recurrence and more likely to develop cardiac sequelae. We aimed to examine the epidemiological features of cardiac complications among patients with recurrent KD following the widespread use of high-dose IVIG therapy.DesignTwo cohorts of patients with recurrent KD retrieved from Japanese nationwide surveys (previous cohort: 1989–1994; recent cohort: 2003–2012) were compared.ResultsOf 1842 patients with recurrent KD in the recent cohort, 3.5% and 5.2% developed cardiac sequelae at the initial and second episodes, respectively, which were markedly decreased compared with those (>10%, respectively) in the previous cohort. Multivariate analyses showed that the risk factors for cardiac sequelae at the second episode were similar between the cohorts. Patients with recurrent KD in both cohorts were more likely to have coronary aneurysms at the second episode than at the initial episode. However, when patients with coronary aneurysms at the initial episode were excluded from analyses, the difference in the proportions of coronary aneurysms between KD episodes disappeared in the recent cohort. Residual rates of previously formed coronary aneurysms were similar between the cohorts (approximately 50%).ConclusionThis study suggests that KD recurrence is no longer a risk factor for developing cardiac complications, unless cardiac sequelae appear at the initial episode. However, residual rates of previously formed coronary aneurysms remain high. Therefore, the importance of carefully managing coronary aneurysms associated with KD remains unchanged.

Preventing falls is important in the elderly. One reason for falling is tripping or stumbling; hence, it is important to improve the crossing motion. This study aimed to compare speed- and accuracy-oriented crossing training and establish a useful training method. To investigate the effects of crossing motion training, we conducted a randomized controlled trial. Twenty healthy elderly individuals (aged 71.7 ± 1.5 years) were randomly assigned to two groups: speed training and accuracy training groups. They practiced initiating their crossing motion faster or more accurately for 12 weeks. Using a three-dimensional motion analysis system, the data on the crossing motion was captured before and after the training period. We set four conditions (normal speed, fast, leaning stance, and leaning stance and fast) and two directions (anterior and lateral) to analyze the crossing motion. The crossing motion of the speed training group became significantly faster compared to baseline (p < 0.05); however, the accuracy of the crossing motion of the accuracy training group was not statistically significant. Speed training in this study had clear effects on crossing motion. It is surprising that crossing motion training from a normal upright stance can also improve swing speed from the leaning stance. We believe that this training is easy and useful in the elderly population.