The purpose of this narrative review is to examine rehabilitation modalities for patients with heart failure and Frailty who require comprehensive intervention. Ischemic heart disease is the leading cause of death worldwide, accounting for 16% of global mortality. Due to population growing and aging, the total number of heart failure patients continues to rise, a condition known as the heart failure pandemic. Furthermore, frailty has been associated with an increased risk for heart failure and increased morbidity and mortality. The 2021 update of the 2017 ACC expert consensus decision pathway for optimization of HF treatment has become more concerning, citing frailty as one of the 10 most important issues associated with heart failure with reduced ejection fraction (HFrEF). Frailty and heart failure share common pathological mechanisms and are associated with poor clinical outcomes. Most studies of frailty in patients with heart failure primarily focus on physical frailty, and associations between psycho-psychological and social factors such as cognitive dysfunction and social isolation have also been reported. These results suggest that a more comprehensive assessment of frailty is important to determine the risk in patients with heart failure. Therefore, mechanisms of the three domains, including not only physical frailty but also cognitive, psychological, spiritual, and social aspects, should be understood. In addition to interventions in these three domains, nutritional and pharmacological interventions are also important and require tailor-made interventions for the widely varied conditions associated with heart failure and frailty. Although several studies have shown a relationship between frailty and prognosis in patients with heart failure, interventions to improve the prognosis have not yet been established. Further information is needed on frailty intervention by a multidisciplinary team to improve the prognosis.

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Pipe wall thinning is spQradically detected in ferritic steel piping in Japanese BWR plants ． The suitability for c 〔 ンntinued service of wail thinning Pipe is basically evaluated by using the ' ' Ru ！ es on plpe wa ！ l thinn ｛ maDagement for BWR power plants ． " The probabilistic fracture mechanics ( PFM )analy8is was performed in order to con 丘nn the failure probability applied the rule ． Based on the resu ！ t， the issues of thc rule which sh 【 川 ld be solved were clarified ， Key FVor［ts： Pipe Wall Thilming Management

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It is known that there is a large safety margin in the current fatigue damage assessment method for piping of nuclear power plants. One of the evaluation methods in order to rationalize it, there is a flaw tolerance method that estimates the continuable operation period by crack growth calculation assuming initiation of fatigue cracks even when the fatigue cumulative usage factor exceeds 1. It is already standardized by ASME Boiler and Pressure Vessel Code Section XI Appendix L in the United States, but the assumed initial crack shape was based on fatigue damage data and evaluation conditions in the United States. Therefore, in this paper, investigation of domestic fatigue data and evaluation conditions of Appendix L were performed, and the depth and length of the assumed initial crack for the flaw tolerance method were studied for the standardization in Japan. Multiple cracks due to fatigue tend to initiate on the inner surface of piping based on the operating experience. Therefore, assumed initial crack was modeled as an equivalent single crack with priority given to simplicity of the evaluation procedure, where the aspect ratio of the equivalent single crack was determined so that the failure probability of the equivalent single crack was equivalent to that of the assumed multiple cracks. The depth of the assumed initial crack was set as the allowable flaw depth of the JSME Codes "Rules on Fitness for Service for Nuclear Power Plants" to assure the detectability of the crack. Moreover, in order to be able to apply this method over a wide range, the aspect ratio of the assumed initial crack have been developed for many kinds of piping shapes and materials. Finally, residual lives of typical pipes with the assumed initial crack were evaluated assuming virtual loadings that roughly envelope realistic loadings and the continuable operation periods were surveyed.