The first-ever open-heart operation in Bangladesh was performed on the 18th of September 1981. Although a few cases of finger fracture closed mitral commissurotomies were performed in the country in the 1960s and 1970s, full-fledged cardiac surgical services began only in Bangladesh after the establishment of the Institute of Cardiovascular Diseases at Dhaka in 1978. A Japanese team that includes cardiac surgeons, anesthetists, cardiologists, nurses, and technician came to Bangladesh and played an important role in the initiation of such a Bangladeshi endeavor. Bangladesh is a South Asian country with more than 170 million people living only in an area of 148460 square kilometers. Information was sought from the hospital records, old newspapers, books, and memoirs written by some of the pioneers. Pubmed and Internet search engines were also utilized. The principal author had personal correspondence with the available pioneering team members. The first open-heart operation was performed by visiting Japanese surgeon Dr. Komei Saji along with Bangladeshi surgeon duo Prof. M Nabi Alam Khan and Prof. S R Khan. Since then, cardiac surgery in Bangladesh has made a significant progress although it may not be enough to serve 170 million people. In 2019, twenty-nine centers performed a total of 12926 cases in Bangladesh. Remarkable advancement in cardiac surgery has been made in terms of cost, quality, and excellence in Bangladesh, but the country is lagging behind in the number of operations, affordability, and geographical distribution, which needs to be addressed for a better future.

Neuropathological features of frontotemporal dementia and amyotrophic lateral sclerosis (ALS) due to C9orf72 GGGGCC hexanucleotide repeat expansion include early dipeptide repeats, repeat RNA foci, and subsequent TDP-43 pathologies. Since the discovery of the repeat expansion, extensive studies have elucidated the disease mechanism of how the repeat causes neurodegeneration. In this review, we summarize our current understanding of abnormal repeat RNA metabolism and repeat-associated non-AUG translation in C9orf72 frontotemporal lobar degeneration/ALS. For repeat RNA metabolism, we specifically focus on the role of hnRNPA3, the repeat RNA-binding protein, and the EXOSC10/RNA exosome complex, an intracellular RNA-degrading enzyme. In addition, the mechanism of repeat-associated non-AUG translation inhibition via TMPyP4, a repeat RNA-binding compound, is discussed.

Moyamoya disease (MMD), which commonly exhibits moyamoya vasculopathy characterized by chronic progressive steno-occlusive lesions in the circle of Willis with "moyamoya" collateral vessels, has been well known for its unique demographic and clinical features. Although the discovery of the susceptibility gene RNF213 for MMD revealed the factor for its predominance in East Asians, the mechanisms underlying other predominant conditions (females, children, young to middle-aged adults, and anterior circulation) and lesion formation are yet to be determined. As MMD and moyamoya syndrome (MMS), which secondarily produces moyamoya vasculopathy due to pre-existing diseases, have the same vascular lesions despite differences in their original pathogenesis, they may share a common trigger for the development of vascular lesions. Thus, we herein consider a common trigger from a novel perspective on blood flow dynamics. Increased flow velocity in the middle cerebral arteries is an established predictor of stroke in sickle cell disease, which is often complicated by MMS. Flow velocity is also increased in other diseases complicated by MMS (Down syndrome, Graves' disease, irradiation, and meningitis). In addition, increased flow velocity occurs under the predominant conditions of MMD (females, children, young to middle-aged adults, and anterior circulation), suggesting a relationship between flow velocity and susceptibility to moyamoya vasculopathy. Increased flow velocity has also been detected in the non-stenotic intracranial arteries of MMD patients. In a pathogenetic overview of chronic progressive steno-occlusive lesions, a novel perspective including the trigger effect of increased flow velocity may provide insights into the mechanisms underlying their predominant conditions and lesion formation.

Introduction: Healthy life expectancy (HLE) remains the principal target of various health plans. We aimed to identify the areas of priority and determinants of mortality to extend HLE across local governments in Japan.

Methods: HLE according to secondary medical areas was calculated using the Sullivan method. People requiring long-term care of level 2 or higher were considered unhealthy. Standardized mortality ratios (SMRs) for major causes of death were calculated using vital statistics data. The association between HLE and SMR was analyzed using simple and multiple regression analyses.

Results: The average (standard deviation) HLE values were 79.24 (0.85) and 83.76 (0.62) years for men and women, respectively. A comparison of HLE revealed regional health gaps of 4.46 (76.90-81.36) and 3.46 (81.99-85.45) years for men and women, respectively. The coefficients of determination for the SMR of malignant neoplasms with HLE were the highest and were 0.402 and 0.219 among men and women, respectively, followed by those of cerebrovascular diseases, suicide, and heart diseases among men and those of heart disease, pneumonia, and liver disease among women. When all major preventable causes of death were analyzed simultaneously in a regression model, the coefficients of determination were 0.738 and 0.425 among men and women, respectively.

Conclusions: Our findings suggest that local governments should prioritize preventing cancer deaths via cancer screening and smoking cessation measures in health plans, with a special focus on men.

Introduction: This study aimed to assess congenital anomalies among infants from 2011 to 2014 in Fukushima and compare the assessment with that from other geographical regions in Japan.

Methods: We used the dataset of the Japan Environment and Children's Study (JECS), which is a nationwide prospective birth cohort study. For the JECS, participants were recruited through 15 regional centers (RC), including Fukushima. Pregnant women were recruited between January 2011 and March 2014. The Fukushima RC recruited all municipalities in the Fukushima Prefecture, from where we compared congenital anomalies in infants from the Fukushima RC to those in the infants from 14 other RCs. Crude and multivariate logistic regression analyses were also performed, with the multivariate logistic regression analysis being adjusted for maternal age, maternal body mass index (kg/m²), infertility treatment, multiple pregnancies, maternal smoking, maternal alcohol consumption, pregnancy complications, maternal infection, and infant sex.

Results: In the Fukushima RC, 12,958 infants were analyzed, and 324 infants were diagnosed with major anomalies (2.50%). In the remaining 14 RCs, 88,771 infants were analyzed and 2,671 infants were diagnosed with major anomalies (3.01%). Crude logistic regression analysis demonstrated that the odds ratio for the Fukushima RC was 0.827 (95% confidence interval, 0.736-0.929) using the other 14 RCs as a reference. Multivariate logistic regression analysis also demonstrated that the adjusted odds ratio was 0.852 (95% confidence interval, 0.757-0.958).

Conclusions: Fukushima Prefecture was found not to be an area at high risk for the occurrence of congenital anomalies in infants compared nationwide in Japan from 2011 to 2014.

Introduction: Women who experience maternal complications, including pre-eclampsia, have a higher risk of cardiovascular disease development. Although the mechanism remains unclear, there is a hypothesis that pregnancy would be a stress test for cardiovascular disease. This study aimed to investigate whether changes in blood pressure during pregnancy would be associated with developing hypertension, which is a main risk of cardiovascular disease.

Methods: We conducted a retrospective study by collecting Maternity Health Record Books from 735 middle-aged women. Of these, 520 women were selected based on our criteria. 138 were defined as the hypertensive group according to the criteria of receiving antihypertensive medications or blood pressures of >140/90 mmHg at the survey. The rest 382 were defined as the normotensive group. We compared the blood pressures of the hypertensive group with those of the normotensive group during pregnancy and postpartum. Then, 520 women were divided into quartiles (Q1-Q4) according to their blood pressures during pregnancy. After the changes in blood pressure for each gestational month relative to nonpregnant measurements were calculated, the changes in blood pressure were compared among the four groups. Additionally, the rate of developing hypertension was evaluated among the four groups.

Results: The average age of the participants was 54.8 years (range: 40-85 years) at the time of the study and 25.9 years (range: 18-44 years) at delivery. There were significant differences in blood pressure during pregnancy between the hypertensive group and the normotensive group. Meanwhile, these two groups did not indicate any differences in blood pressure in postpartum. Higher mean blood pressure during pregnancy was associated with smaller changes in blood pressure during pregnancy. The rate of development of hypertension in each group of systolic blood pressure was 15.9% (Q1), 24.6% (Q2), 29.7% (Q3), and 29.7% (Q4). The rate of development of hypertension in each group of diastolic blood pressure (DBP) was 18.8% (Q1), 24.6% (Q2), 22.5% (Q3), and 34.1% (Q4).

Conclusions: Changes in blood pressure during pregnancy are small in women who have a higher risk of hypertension. Levels of blood pressure during pregnancy may be reflected in individual stiffness of blood vessels by the burden of pregnancy. If so, levels of blood pressure would be used to facilitate highly cost-effective screening and interventions for women with a high risk of cardiovascular diseases.

Introduction: In recent years, the activities of female athletes have attracted increasing attention, especially regarding the effect of menstruation on athletic performance. Nevertheless, there are no surveys of these practices among coaches who train non-top-level athletes for general competition. This study aimed to investigate how high school physical education teachers approach the issue of menstruation and the awareness of menstruation-related problems.

Methods: This was a questionnaire-based cross-sectional study. The participants were 225 health and physical education teachers from 50 public high schools in the Aomori Prefecture. Participants were asked to answer a questionnaire regarding whether they talk to their female athletes about menstruation, keep track of their menstrual status, or make adjustments for menstruating students. Additionally, we asked for their views on painkiller use and their knowledge of menstruation.

Results: The participants included 183 men (81.3%) and 42 women (18.7%); data from 221 participants were analyzed after four teachers were excluded. Teachers of female athletes who communicated with students regarding their menstrual conditions and physical changes were predominantly female (p < 0.01). Regarding the use of painkillers for menstrual pain, more than 70% of respondents said that they recommended their active use. Few respondents reported that they would adjust a game because of athletes with menstrual problems. More than 90% of the respondents knew that there was a change in performance due to the menstrual cycle, and 57% of the respondents understood the relationship between amenorrhea and osteoporosis.

Conclusions: Menstruation-related problems are not only issues for top athletes but also important for general competition level athletes. Hence, even in high school clubs, teachers should be educated on how to deal with menstruation-related problems to prevent withdrawal from sports, maximize athletes' abilities, prevent future diseases, and preserve fertility.

Introduction: Pertuzumab and trastuzumab are monoclonal antibodies used for treating HER2-positive breast cancer. These anti-HER2 antibodies may induce infusion reactions (IR), mainly upon first administration. We investigated factors predicting IR in the initial pertuzumab treatment for HER2-positive breast cancer.

Methods: We retrospectively reviewed the medical records of 57 patients who first received pertuzumab-containing treatment in our hospital from January 2014 to February 2021. The frequency of IR during or immediately after pertuzumab administration was examined. We also analyzed patient characteristics that may represent possible risk factors for IR.

Results: The incidence rate of IR was 44% (25/57). Red blood cell count (P < 0.001), hemoglobin (Hb) concentration (P = 0.0011), and hematocrit (P < 0.001) immediately before pertuzumab administration were significantly lower in patients with IR than in those without. In patients with IR, erythrocyte levels immediately before pertuzumab treatment were significantly lower than baseline when having received anthracycline-containing chemotherapy within three months. Logistic regression analysis showed that a decrease in Hb levels was a significant risk factor for IR (log odds ratio = −17). According to the receiver-operating characteristic analysis, a 10% decrease in Hb after anthracycline-containing treatment was the best cut-off value for predicting IR (sensitivity: 88%; specificity: 77%; area under the curve: 0.87).

Conclusions: Our study showed a higher incidence of IR after pertuzumab treatment than in clinical trials. There was a strong association between IR occurrence and erythrocyte levels lower than baseline in the group that received anthracycline-containing chemotherapy immediately before.

Publications from Japan have been on the decline, and this tendency is expected to continue as the country's population decreases. During the novel coronavirus disease (COVID-19) pandemic, it was discovered that Japanese medical trainees published much fewer papers than trainees from other nations. This issue must be addressed by the entire Japanese medical community.

Trainees have the potential to contribute to the medical community through their publishing process presenting fresh perspectives and communicating accurate information to the public through the use of social media. Furthermore, trainees themselves would benefit as they would become more enhanced by deeply and critically considering the contents and the trends of publications worldwide, which would promote further implementation of evidence-based medicine.

Therefore, medical educators and students should be motivated and encouraged to write by offering enough instructional and publication opportunities. Such measures would be to (1) train students in "medical writing" as part of the medical curriculum; (2) encourage medical students and trainees to submit of manuscripts, especially in the section of the letters, opinions, and case reports; (3) guarantee trainees time and resources to write; (4) provide as constructive reviews and comments as possible as an educational opportunity for trainees; and (5) motivate trainees to write.

Such hands-on training would necessitate significant efforts of the trainees, instructors, and publishers. However, if we cannot invest in fostering future resources now, we may not be able to hope for increase in the amount of research published from Japan. The future lies in everybody's hands.

Public health ethics is a discipline dealing with ethical issues relating to public health. As a branch of medical ethics, it also deals with clinical and research ethics. The core issue of public health ethics is to balance the conflict between individual liberty and the public good. Because of the coronavirus disease 2019 (COVID-19) pandemic, deliberation based on public health ethics is required to reduce social disparities and increase community cohesion. This study presents three public health ethics challenges. The first is to introduce an egalitarian liberal approach to public health concerning social and economic issues experienced by vulnerable populations both domestically and globally. I then propose alternative and compensatory public health policies that serve the principles of justice. Second, public health ethics must ensure procedural justice in all public health policy decisions. For example, when deciding to implement public health policies, including restrictions on individual liberties, the decision making process must be open to the public. Third, citizens and students must be educated on public health ethics. The public must be provided with an open forum to deliberate on ethical issues related to public health as well as the appropriate training to do so.

The ongoing Russo-Ukrainian War and the Great East Japan Earthquake and the subsequent accident at the Fukushima Daiichi Nuclear Power Plant in Japan have many similarities, such as mass evacuation, family separation, difficulty in accessing necessary medical care, and reduced health priorities. Although several studies have reported concerns about the short-term health impacts of the war on patients with cancer, little has been noted about the long-term effects it may cause. Given the experience of the Fukushima accident, it is important to establish a long-term support system for patients with cancer in Ukraine.

Various studies have reported the vaccine's efficacy against coronavirus disease 2019; however, there has been little discussion regarding the test frequency since the emergence of the Omicron strain. In this context, the United Kingdom has abolished its free testing program. Our analysis revealed that the decrease in case fatality rate was heavily influenced by vaccination coverage rather than the testing frequency. However, the effectiveness of testing frequency should not be underestimated and therefore needs further validation.

Hikikomori, a severe form of social withdrawal, has long been examined in Japan. Hikikomori-like incidents have also lately been described in many other countries but not in Denmark or any other Scandinavian country thus far. The reason for this is unknown. However, looking at existing research and global attention and its relevance to psychiatric practice today, hikikomori appears as a syndrome that cannot be confined solely to the field of some countries or cultures. Rather, it emerges as a phenomenon that may also concern many aspects of a modern society like the Danish. In the light of considerable quality research on hikikomori in Japan and with increasing international awareness and experiences, the author hereby calls on the health and research community to draw crucial interest to Scandinavian countries, such as Denmark.

Angina bullosa hemorrhagica (ABH) is an underrecognized, benign condition of the oral mucosa. A 26-year-old female patient with type 2 diabetes mellitus presented with sudden-onset painless blood blisters on her soft palate. ABH was clinically diagnosed based on the clinical presentation and spontaneously resolved. Some medical conditions, including diabetes mellitus, hypertension, and inhaled steroids, can be a risk factor of ABH. Clinicians should be aware of ABH and consider the possibility of an associated underlying condition.