Long-term assessment of collagenase treatment for Dupuytren’s contracture:A 10-year follow-up study

BACKGROUND Enzymatic fasciotomy with collagenase clostridium histolyticum(CCH)has revolutionized the treatment for Dupuytren’s contracture(DC).Despite its benefits,the long-term outcomes remain unclear.This study presented a comprehensive 10-year follow-up assessment of the enduring effects of CCH on patients with DC.AIM To compare the short-term(12 wk)and long-term(10 years)outcomes on CCH treatment in patients with DC.METHODS A cohort of 45 patients was treated with CCH at the metacarpophalangeal(MCP)joint and the proximal interphalangeal(PIP)joint and underwent systematic reevaluation.The study adhered to multicenter trial protocols,and assessments were conducted at 12 wk,7 years,and 10 years post-surgery.RESULTS Thirty-seven patients completed the 10-year follow-up.At 10 years,patients treated at the PIP joint exhibited a 100%recurrence.However,patients treated at the MCP joint only showed a 50%recurrence.Patient satisfaction varied,with a lower satisfaction reported in PIP joint cases.Recurrence exceeding 20 degrees on the total passive extension deficit was observed,indicating a challenge for sustained efficacy.Significant differences were noted between outcomes at the 7-year and 10-year intervals.CONCLUSION CCH demonstrated sustained efficacy when applied to the MCP joint.However,caution is warranted for CCH treatment at the PIP joint due to a high level of recurrence and low patient satisfaction.Re-intervention is needed within a decade of treatment.

Long-term outcomes of endoscopic submucosal dissection for undifferentiated type early gastric cancer over 2 cm with R0 resection

BACKGROUND Endoscopic submucosal dissection(ESD)for over 2 cm in size undifferentiated type(UD type)early gastric cancer(EGC)confined to the mucosa is not only challenging,but also long-term outcomes are not well known.AIM To evaluate the long-term outcomes of ESD done for UD type EGCs confined to the mucosa over 2 cm in size and compare the results with those where the lesions were less than 2 cm.METHODS 143 patients with UD type EGC confirmed on histology after ESD at a tertiary hospital were reviewed.Cases with synchronous and metachronous lesions and a case with emergency surgery after ESD were excluded.A total of 137 cases were enrolled.79 cases who underwent R0 resection were divided into 2 cm or less(group A)and over 2 cm(group B)in size.RESULTS Among 79 patients who underwent R0 resection,the number in group A and B were 51 and 28,respectively.The mean follow-up period(SD)was 79.71±45.42 months.There was a local recurrence in group A(1/51,2%)and group B(1/28,3.6%)respectively.This patient in group A underwent surgery while the patient in group B underwent repeated ESD with no further recurrences in both patients.There was no regional lymph node metastasis,distant metastasis,and deaths in both groups.With R0 resection strategy for ESD on lesions over 2 cm,20.4%(28/137)of patients were able to avoid surgery compared with expanded indication.CONCLUSION If R0 resection is achieved by ESD,UD type EGCs over 2 cm also showed good and similar clinical outcomes as compared to lesions less than 2 cm when followed for over 5 years.With R0 resection strategy,several patients can avoid surgery.

Long-Term Mortality of Children with Congenital Heart Disease Admitted to the Departmental University Hospital of Borgou/Alibori from 2011 to 2022

Background: Congenital heart disease is a public health issue due to its incidence and mortality rate. The aim of this study was to investigate the long-term mortality of children with congenital heart disease admitted to the Departmental University Hospital of Borgou/Alibori (CHUD-B/A) from 2011 to 2022. Methods: This descriptive longitudinal study with analytical aims covered 11 years (April 1, 2011 to December 31, 2022). It consisted of a review of the records of children under 15 years of age with echocardiographically confirmed congenital heart disease. This was followed by an interview with the parents to assess the children’s current condition. Data were entered using Kobocollect software and analyzed using R Studio 4.2.2. software. Results: A total of 143 complete files were retained. The median age at diagnosis was 14 months (IIQ: Q1 = 4;Q3 = 60) with a range of 2 days and 175 months, and the sex-ratio (M/F) was 0.96. Left-to-right shunts were the most frequent cardiopathy group (62.9%). Only 35 children (24.5%) benefited from restorative treatment. The mortality rate was 31.5%. Median survival under the maximum bias assumption was 114 months and 216 months under the assumption of minimum bias. Survival was significantly better in children with right-to-left shunts (p = 0.0049) under the assumption of minimum bias. The death risk factors were: age at diagnosis less than 12 months (aHR = 7.58;95% CI = 3.36 - 17.24;p Conclusion: The long-term mortality of congenital heart disease is high and favoured by the absence of restorative treatment. Local correction of congenital heart disease and medical follow-up will help to reduce this mortality.

A Trajectory Privacy Protection Method to Resist Long-Term Observation Attacks

Users face the threat of trajectory privacy leakage when using location-based service applications, especially when their behavior is collected and stored for a long period of time. This accumulated information is exploited by opponents, greatly increasing the risk of trajectory privacy leakage. This attack method is called a long-term observation attack. On the premise of ensuring lower time overhead and higher cache contribution rate, the existing methods cannot utilize cache to answer subsequent queries while also resisting long-term observation attacks. So this article proposes a trajectory privacy protection method to resist long-term observation attacks. This method combines caching technology and improves the existing differential privacy mechanism, while incorporating randomization factors that are difficult for attackers to recognize after long-term observation to enhance privacy. Search for locations in the cache of both the mobile client and edge server that can replace the user’s actual location. If there are replacement users in the cache, the query results can be obtained more quickly. Simultaneously obfuscating the spatiotemporal correlation of actual trajectories by generating confusion regions. If it does not exist, the obfuscated location generation method that resists long-term observation attacks is executed to generate the real anonymous area and send it to the service provider. The above steps can comprehensively protect the user’s trajectory privacy. The experimental results show that this method can protect user trajectories from long-term observation attacks while ensuring low time overhead and a high cache contribution rate.

Photoelectric State with Long-Term Relaxation in CdTe:(Ag, Cu, Cd) and Sb2Se3:Se Photovoltaic Films

The results of an experimental study of long-term relaxation of the photoelectret state of polycrystalline CdTe:(Ag, Cu, Cd) and Sb2Se3:Se films with an anomalous photovoltaic property are presented. In such films, the residual photovoltage is caused by the separation of photocarriers by the built-in electrostatic field of the near-surface region of space charges and their asymmetric capture by deep levels of impurities or complexes, including impurity atoms and intrinsic defects, both in the bulk and on the surface of crystal grains. It has been shown that in activated films, a two-step exponential temporary relaxation of the initial photovoltage of the order of VAPV ≈ (500-600) V is detected, and only 10% of it experiences long-term relaxation (t ≈ 100-120 min).

“Long-term care”概念辨析

Long-term care（LTC）在国外最早是以救济贫穷个人或家庭为目标。随着人口结构、家庭结构以及社会结构的变化,要求医疗护理模式作出相应的调整,也使LTC的存在有了更充分的理由,因此LTC是社会发展到一定时期的必然产物。迄今为止,我国学术界对＂long-term care＂的中文翻译问题依然没有统一的看法。因此,很有必要就此展开深入研究和讨论。笔者将全面辨析和讨论“long-termcare”概念，并在此基础上探讨“long-termcare”的中文翻译问题，从而进一步廓清“long-termcare”的涵义。

Carbon sequestration rate,nitrogen use efficiency and rice yield responses to long-term substitution of chemical fertilizer by organic manure in a rice–rice cropping system

Combined application of chemical fertilizers with organic amendments was recommended as a strategy for improving yield,soil carbon storage,and nutrient use efficiency.However,how the long-term substitution of chemical fertilizer with organic manure affects rice yield,carbon sequestration rate(CSR),and nitrogen use efficiency(NUE)while ensuring environmental safety remains unclear.This study assessed the long-term effect of substituting chemical fertilizer with organic manure on rice yield,CSR,and NUE.It also determined the optimum substitution ratio in the acidic soil of southern China.The treatments were:(i)NPK0,unfertilized control;(ii)NPK1,100%chemical nitrogen,phosphorus,and potassium fertilizer;(iii)NPKM1,70%chemical NPK fertilizer and 30%organic manure;(iv)NPKM2,50%chemical NPK fertilizer and 50%organic manure;and(v)NPKM3,30%chemical NPK fertilizer and 70%organic manure.Milk vetch and pig manure were sources of manure for early and late rice seasons,respectively.The result showed that SOC content was higher in NPKM1,NPKM2,and NPKM3 treatments than in NPK0 and NPK1 treatments.The carbon sequestration rate increased by 140,160,and 280%under NPKM1,NPKM2,and NPKM3 treatments,respectively,compared to NPK1 treatment.Grain yield was 86.1,93.1,93.6,and 96.5%higher under NPK1,NPKM1,NPKM2,and NPKM3 treatments,respectively,compared to NPK0 treatment.The NUE in NPKM1,NPKM2,and NPKM3 treatments was higher as compared to NPK1 treatment for both rice seasons.Redundancy analysis revealed close positive relationships of CSR with C input,total N,soil C:N ratio,catalase,and humic acids,whereas NUE was closely related to grain yield,grain N content,and phenol oxidase.Furthermore,CSR and NUE negatively correlated with humin acid and soil C:P and N:P ratios.The technique for order of preference by similarity to ideal solution(TOPSIS)showed that NPKM3 treatment was the optimum strategy for improving CSR and NUE.Therefore,substituting 70%of chemical fertilizer with organic manure could be the best management option for increasing CSR and NUE in the paddy fields of southern China.

Impact of anastomotic leakage on long-term prognosis after colorectal cancer surgery

Colorectal cancer(CRC)is one of the most common malignancies in the world.Despite significant improvements in surgical technique,postoperative complications still occur in a fair percentage of patients undergoing colorectal surgery.The most feared complication is anastomotic leakage.It negatively affects shortterm prognosis,with increased post-operative morbidity and mortality,higher hospitalization time and costs.Moreover,it may require further surgery with the creation of a permanent or temporary stoma.While there is no doubt about the negative impact of anastomotic dehiscence on the short-term prognosis of patients operated on for CRC,still under discussion is its impact on the long-term prognosis.Some authors have described an association between leakage and reduced overall survival,disease-free survival,and increased recurrence,while other Authors have found no real impact of dehiscence on long term prognosis.The purpose of this paper is to review all the literature about the impact of anastomotic dehiscence on long-term prognosis after CRC surgery.The main risk factors of leakage and early detection markers are also summarized.

Main factors influencing long-term outcomes of liver transplantation in 2022

Liver transplant(LT)outcomes have markedly improved in the recent decades,even if long-term morbidity and mortality are still considerable.Most of late deaths are independent from graft function and different comorbidities,including complications of metabolic syndrome and de novo neoplasms,seem to play a key role in determining long-term outcomes in LT recipients.This review discusses the main factors associated with late mortality and suggests possible strategies to improve long-term management and follow-up after liver transplantation.In particular,the reduction of drug toxicity,the use of tools to identify high-risk patients,and setting up a multidisciplinary team also for long-term management of LT recipients may further improve survival after liver transplantation.

Survey of <i>C. difficile</i>-Specific Infection Control Policies in Local Long-Term Care Facilities

Introduction: The incidence and severity of Clostridium difficile infection (CDI) has been increasing and long-term care facility (LTCF) residents are at high risk given their age, co-morbidities, and high antibiotic exposure. Infection control policies are crucial for controlling CDI, but there are currently no regulatory guidelines in the United States. Therefore, we evaluated infection control policies in local LTCFs to define the CDI-specific policies and the administrative and staff understanding of CDI, so as to identify perceived barriers for compliance. Methods: IRB approval was sought and exemption granted, all 8 local LTCFs were asked to participate. Each facility was visited by study personnel who interviewed the administrative Infection Control Practitioner (ICP) and 3-4 Licensed Practical Nurses (LPNs) with distinct survey format. Infection control policies were then compared to the SHEA recommendations for CDI in LTCFs. Results: Of the eligible facilities, 75% (n = 6) participated. ICP (n = 6) and LPNs (n = 21) were interviewed. All facilities accept residents with active CDI and 2 had written CDI-specific infection control policies. All facilities had hand hygiene or glove use policies and 2 had policies for the use of sporicidal environmental cleaning. No facility restricted antibiotic use. Each facility has a policy to instruct their staff through in-services, either annually or upon new hire, but 33% (n = 7) LPNs reported no facility-based CDI training. While 80% (n = 17) of LPNs felt comfortable with the facility CDI policies, only 11 accurately restated it. ICPs felt the most relevant barrier to staff compliance was time constraints (n = 4, 67%), however, LPNs felt it was limited knowledge (n = 10, 48%) and poor communication (n = 2, 10%). Discussion and Conclusions: With the increasing incidence and severity of CDI in LCTF, few of the facilities surveyed had CDI-specific policies. Despite CDI-specific training, there is a perceived knowledge and communication gap for staff caring for residents with CDI.

Equity of access to long-term care among the Korean elderly

The aim of the current study is to examine the extent to which equity in the utilization of longterm care services has been achieved in the Republic of Korea (hereafter Korea), based on the Aday—Andersen Access Framework that takes into consideration a series of variables hypothesized as predictive of utilization. The current study used cross-sectional survey data collected and conducted by the Korea Labor Institute (KLI) between August 1 to December 22, 2006. The sample for this study was 5544 persons who are older than 60 years. The study was extracted from a larger nationally representative cross-sectional survey of 10,255 individuals. The stratified cluster sampling technique was used to draw the survey respondents. A self-administered questionnaire was used to collect the data from the sample. Descriptive and logistic regression analysis was performed examining the relationship between the dependent variable and the independent variables and the relative importance of factors. The results indicate that a universal health insurance system has not yielded a fully equitable distribution of services. The limitation of benefit coverage as well as disparities in consumer cost-sharing and associated patterns of utilization across plans high out-of-pocket payment can be a barrier to health care utilization, which results in inequity and differential long-term care utilization between sub-groups of older adults. Health policy reforms in Korea must continue to concentrate on expanding insurance coverage, reducing the inequities reflected in disparities in consumer cost-sharing and associated patterns of utilization across plans, and establishing a financially separate insurance system for poor older adults. The behavioral responses of physicians to the method of reimbursement, and the subsequent impact on overall rates of utilization and expenditures need to be more fully understood. In addition, further research is needed to identify the nonfinancial barriers that persist for certain demographic subgroups, i.e., those 70 and older, men, lacking social network members, those who have four or more family members, and those who have no schooling.

Predicting and Curing Depression Using Long Short Term Memory and Global Vector

In today’s world, there are many people suffering from mentalhealth problems such as depression and anxiety. If these conditions are notidentified and treated early, they can get worse quickly and have far-reachingnegative effects. Unfortunately, many people suffering from these conditions,especially depression and hypertension, are unaware of their existence until theconditions become chronic. Thus, this paper proposes a novel approach usingBi-directional Long Short-Term Memory (Bi-LSTM) algorithm and GlobalVector (GloVe) algorithm for the prediction and treatment of these conditions.Smartwatches and fitness bands can be equipped with these algorithms whichcan share data with a variety of IoT devices and smart systems to betterunderstand and analyze the user’s condition. We compared the accuracy andloss of the training dataset and the validation dataset of the two modelsnamely, Bi-LSTM without a global vector layer and with a global vector layer.It was observed that the model of Bi-LSTM without a global vector layer hadan accuracy of 83%,while Bi-LSTMwith a global vector layer had an accuracyof 86% with a precision of 86.4%, and an F1 score of 0.861. In addition toproviding basic therapies for the treatment of identified cases, our model alsohelps prevent the deterioration of associated conditions, making our methoda real-world solution.

Long term outcomes of Cohen’s cross trigonal reimplantation for primary vesicoureteral reflux in poorly functioning kidney

BACKGROUND Open ureteric reimplantation by cross trigonal technique described by Cohen is considered a common surgical option for correction of vesicoureteral reflux(VUR). There is a lack of evidence in literature though for what happens to such kidneys, in the long run, particularly those which are poorly functioning.AIM To assess the long-term outcomes of ureteric reimplantation in poorly functioning kidneys in children with unilateral primary VUR.METHODS Children with unilateral primary VUR and a relative renal function of less than 35% who underwent open or laparoscopic ureteric reimplantation between January 2005 and January 2017 were included in the study. Patients who had a follow up of less than five years were excluded. Preoperative evaluation consisted of a voiding cystourethrogram and Dimercaptosuccinic acid(DMSA) scan. In the follow-up period, patients underwent a diuretic scan at 6 weeks and 6 months.Follow up ultrasound was done for change in grade of hydronephrosis and retrovesical ureteric diameter. Subsequent follow up was done at 6 monthly intervals with evaluation for proteinuria and hypertension and any recurrent urinary tract infection(UTI). For assessment of cortical function, DMSA was repeated annually for 5 years after surgery. A paired-samples t-test was used to test the mean difference of DMSA between pre-post observations.RESULTS During this period, 36 children underwent ureteric reimplantation for unilateral primary VUR. After excluding those with insufficient follow-up, 31 were included in the analysis. Most of the patients were males(n = 26/31, 83.8%). Patient’s age(mean ± SD, range) was 5.21 ± 3.71, 1-18 years. The grades of VUR were grade Ⅱ(1patient), grade Ⅲ(8 patients), grade Ⅳ(10 patients), and grade Ⅴ(12 patients). The pre and postoperative DMSA was 24.064 ± 12.02 and 24.06 ± 10.93, which was almost the same(statistically equal, paired-samples t-test: P = 0.873). The median(range) follow-up duration was 82(60-120)mo. One patient had persistent reflux after surgery(preoperative: grade Ⅳ, postoperative: grade Ⅲ), and the very same patient developed recurrent UTI. The difference in the preoperative and postoperative DRF was less than 10% in 29 patients. In one patient, the DRF decreased by 17%(22% to 05%) while in another patient, the DRF increased by 12%(25% to 37%) after surgery. None of the patients had an increase in scarring after surgery. 15% of patients were hypertensive before surgery and all of them continued to be hypertensive after surgery while none developed hypertension after surgery. None of the patients had significant proteinuria(> 150 mg/d) during the follow-up period.CONCLUSION Children with unilateral primary VUR and poorly functioning kidney maintain the renal function over the long term in most cases. Hypertension and proteinuria do not progress over time in these patients.

Long-term radiofrequency electromagnetic fields exposure attenuates cognitive dysfunction in 5×FAD mice by regulating microglial function

We have previously found that long-term effects of exposure to radiofrequency electromagnetic fields in 5xFAD mice with severe late-stage Alzheimer’s disease reduced both amyloid-βdeposition and glial activation,including microglia.To examine whether this therapeutic effect is due to the regulation of activated microglia,we analyzed mic roglial gene expression profiles and the existence of microglia in the brain in this study.5xFAD mice at the age of 1.5 months were assigned to sham-and radiofrequency electromagnetic fields-exposed groups and then animals were exposed to 1950 MHz radiofrequency electromagnetic fields at a specific absorption rate of 5 W/kg for 2 hours/day and 5 days/week for 6 months.We conducted behavioral tests including the object recognition and Y-maze tests and molecular and histopathological analysis of amyloid precursor protein/a myloid-beta metabolism in brain tissue.We confirmed that radiofrequency electromagnetic field exposure for 6 months ameliorated cognitive impairment and amyloid-βdeposition.The expression levels of Iba1(pan-microglial marker)and colony-stimulating factor 1 receptor(CSF1R;regulates microglial prolife ration)in the hippocampus in 5xFAD mice treated with radiofrequency electromagnetic fields were significantly reduced compared with those of the sham-exposed group.Subsequently,we analyzed the expression levels of genes related to mic rogliosis and microglial function in the radiofrequency electromagnetic fields-exposed group compared to those of a CSF1R inhibitor(PLX3397)-treated group.Both radiofrequency electromagnetic fields and PLX3397 suppressed the levels of genes related to microgliosis(Csf1r,CD68,and Ccl6)and pro-inflammatory cytokine interleukin-1β.N otably,the expression levels of genes related to mic roglial function,including Trem2,Fcgr1α,Ctss,and Spi1,were decreased after long-term radiofrequency electromagnetic field exposure,which was also observed in response to microglial suppression by PLX3397.These results showed that radiofrequency electromagnetic fields ameliorated amyloid-βpathology and cognitive impairment by suppressing amyloid-βdeposition-induced microgliosis and their key regulator,CSF1R.

Safety and Quality of Care Evaluation in Japanese Long-Term Facilities Focused on the Activity Condition and Cognitive Function of Residents

Objective: Currently, standards for evaluating long-term care facilities do not exist in Japan. This study aimed to evaluate the quality of healthcare services in Japan’s long-term care facilities and identify the structural and process indicators associated with the facilities’ outcome indicators. Methods: This retrospective study assessed changes in residents’ abilities to participate in physical activities, their cognitive function, and their vulnerability to injuries. From 2012 to 2013, we collected information on the healthcare services at 1067 long-term care facilities registered with Japan’s Welfare, Health and Medical Care Information Network in the Welfare and Medical Service Agency. We examined 12 structural indicators, 26 process indicators, and 7 outcome indicators. We used multivariate linear regression models adjusted to analyze relationships between outcome indicators and structural or process indicators. Results: Residents’ activity and cognitive function indicators either improved by 80% - 90% or were maintained for one year. The Geriatric Functional Independence Measures, the Barthel Index, and holding conferences related to care were all considered activities of daily living. Three adverse events—tumbles and falls, behavioral problems, and aimless wandering or leaving the facility without permission—were factors that restricted residents’ behavior and number of residents per care staff member. Conclusions: Maintaining or improving levels of independence and cognition in daily living requires a care process system that enables ongoing monitoring of residents’ activities of daily living and cognitive functioning. Ensuring the safety of residents and improving the quality of care in long-term care facilities without securing adequate care staff are not possible.

Phosphorus Changes and Sorption Characteristics in a Calcareous Soil Under Long-Term Fertilization

Knowledge of phosphorus(P)behavior in long-term fertilized soils is essential for programming fertilization practices and for sustaining environmental quality.The long-term(1984-1997)effects of various fertilization treatments on P changes and sorption isotherms as well as the relationship of soil properties to P sorption and P forms were evaluated in an Ustic Isohumisol,a calcareous soil,on the Loess Plateau,China.Compared to 1984,after 13 years of crop production,total soil P in the no-P treatments(control and N treatment)decreased by 5%-7%,but in the phosphorus fertilizer alone(P), nitrogen and phosphorus fertilizers in combination(NP),manure alone(M),and nitrogen and phosphorus fertilizers and manure in combination(NPM)treatments,it increased by 22%,19%,28%,and 58%,respectively.Residual fertilizer P was found mainly in NH_4Ac-soluble P(Ca_8-P),followed by NaHCO_3-soluble P(NaHCO_3-P),and NH_4F-soluble P (A1-P).Phosphorus sorption in the soils with different fertilization practices fit the Langmuir equations.Phosphorus sorption capacity in the no-P treatments increased,whereas it decreased in the P-included treatments(P,NP,and NPM treatments).Phosphorus sorption maximum(Q_m)was significantly and negatively correlated to inorganic P including NaHCO_3-P,Ca_8-P,NaOH-Na_2CO_3-soluble P(Fe-P),and Al-P(P≤0.01).Moreover,long-term fertilization increased soil organic carbon in the NP,M,and NPM treatments and decreased pH in the NP and NPM treatments.Thus,the ability of the soil to release sorbed P to the environment increased under long-term P fertilization.

Effect of Long-Term Fertilization on Organic Nitrogen Forms in a Calcareous Alluvial Soil on the North China Plain

In order to illustrate the change of nitrogen (N) supply capacity after long-term application of manure and chemical fertilizer, as well as to properly manage soil fertility through fertilizer application under the soil-climatic conditions of the North China Plain, organic N forms were quantified in the topsoil with different manure and chemical fertilizer treatments in a 15-year fertilizer experiment in a Chinese calcareous alluvial soil. Soil total N (TN) and various organic N forms were significantly influenced by long-term application of chemical fertilizer and manure. TN, total hydrolysable N, acid-insoluble N, amino acid N and ammonium N in the soil increased significantly (P < 0.05) with increasing manure and fertilizer N rates, but were not influenced by increasing P rates. Also, application of manure or N fertilizer or P fertilizer did not significantly influence either the quantity of amino sugar N or its proportion of TN. Application of manure significantly increased (P < 0.05) hydrolysable unknown N, but adding N or P did not. In addition, application of manure or N fertilizer or P fertilizer did not significantly influence the proportions of different soil organic N forms.

Potential Legal Issues and Care Implications during Care-Prevention Gymnastic Exercises for the Elderly Using Pepper in Long Term Health Care Facilities

In Japan, the shortage of personnel is a problem in long-term care nursing and rehabilitative care prevention. Nevertheless, Japan has taken measures to compensate for these shortages by promoting medical and nursing care activities using robotic technologies, and employing human resources from overseas. The purpose of this study was to determine potential legal issues and subsequent implications for care during prevention gymnastic exercises for the elderly using Pepper in long-term health facilities. The application program of Care-Prevention Gymnastics Exercises for Pepper (Pepper with CPGE) was made by the Xing Company Japan. Currently, care workers become intermediaries for the safe use of Pepper with CPGE. However, it was realized that some legal issues may arise if Pepper with CPGE alone will carry out these preventive care programs for the elderly without the presence of care workers as intermediaries. In this situation, using Pepper with CPGE alone to conduct care prevention gymnastics will require safety measures to prevent these possible practice issues and anticipate implications for care. In this regard, determining detailed target levels of rehabilitation exercise demands and environmental setting safety become essential factors. The use of humanoid robots in healthcare is expected to influence more practice protocols in contemporary and futurist rehabilitative human care. The identification of possible safety issues in performance and environmental situations, and implications for care are critical to ensure safe and valuable rehabilitative health care practices for the elderly population.