As a preparatory step for the 2020 Summer Olympics and Paralympics in Tokyo, Juntendo University, in collaboration with Chiba Prefecture, successfully invited the United States National Team, and helped organize their training camp ahead of the World Athletics Championships in Beijing. This was made possible by cooperating with local communities as well as different faculties within the university. The success of the project clearly demonstrated, both in and outside Japan, the potential of Juntendo University in offering a “campsite with an international perspective and readiness.” Efforts in globalizing Juntendo sports are being carried out by integrating expertise in Juntendo University’s sports science, medicine, nursing, and international liberal arts.

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A group including 7 students and 2 faculty members from Indiana University visited Juntendo University Faculty of Heath Care and Nursing on June 10, 2015. First of all, the chairperson of the international relations committee, Prof. Shinobu Sakurai gave a welcoming speech and this was followed by brief, mutual self-introductions. Then Indiana students attended several different lectures such as Chinese language and the Clinical Medicine lecture. In addition, we held an exchange conference with 16 students from Juntendo University and the students had lunch together. There was a welcoming address by the Dean of the Faculty of Health Care and Nursing, Dr. Jun Ueki prior to the meeting. In the conference, an Indiana University nursing school student talked about studying nursing in their university, and the 3^rd year students of Juntendo University gave a talk on their school life and the 4^th year students gave a presentation on nursing status in Japan (Figure-1). This talk mentioned the social status of nurses and nursing education (Figure-2) and working and balance (Figures-3 & 4). After the presentations, the students of both universities exchanged several comments and questions. Then visitors went on a campus tour of Juntendo. Finally, the students enjoyed mixing, conversing and making friends with their young nursing counterparts.

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Four Japanese cultural experience events were held for Juntendo University international students during the April to July 2015 period. Two were international student exchange events with Juntendo University and Tokyo Medical and Dental University (TMDU) and the other two were solo events exclusively for Juntendo students. One of the exchange events between Juntendo University and TMDU was Ohanami, cherry blossom viewing, on April 4^th and the other was a tour of Tateyama (Chiba Prefecture) held on June 12^th and 13^th. Ohanami was hosted by Juntendo University while the Tateyama tour was hosted by TMDU. During the Ohanami event international students walked around in Ueno Park and then attended a party that was held in Century Tower at Juntendo University. Prof. Hideoki Ogawa, CEO of Juntendo University, Prof. Eiki Kominami, President of Juntendo University and Prof. Junji Tagami, Vice president of Tokyo Medical and Dental University also attended the party. The bus tour of Tateyama was an overnight event. International students stayed at TMDU’s Ohga Lodge and enjoyed BBQ on June 12^th. They visited Okinoshima Beach, Tateyama Castle, and Umihotaru Parking Area on June 13^rd. Through the two exchange events, international students from the two universities deepened their friendships and their understanding of Japanese culture.
A Sanuki Udon cooking and eating event was held on June 27^th followed on July 7^th by a Star Festival event, both exclusively for Juntendo international students. Sanuki Udon is a specialty noodle of Sanuki, the old name of Kagawa Prefecture in the island of Shikoku. Sanuki Udon is famous for its hard body and unique style of kneading. After making Udon dough by mixing wheat flour, water and salt, a person steps on the dough to knead it. At this event the international students stepped on the dough and enjoyed eating their hand-made Sanuki Udon. Prof. Hideoki Ogawa, CEO of Juntendo University also attended this event. Star Festival (Tanabata), based on Chinese legend, is celebrated each year on July 7^th. Traditionally Japanese decorate an arrow bamboo with many decorations and strips of paper on which people write their wishes. International students made decorations with Origami paper and wrote their wishes. Some of them wrote their wishes in Japanese with a calligraphy brush. After decorating the arrow bamboo, students visited the Juntendo nursery school and enjoyed the Star Festival event with the children. Female students experienced wearing Yukatas, a kind of kimono that Japanese girls and women sometimes wear in summer, especially at festivals.

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Biomechanics is the study of the structure and function of biological mechanics. I went abroad to the Mayo Clinic to learn biomechanics, and participated in the following research.
Because the prediction of rotator cuff extensibility is clinically important for pre-surgical planning for rotator cuff repair, we determined the feasibility of B-mode ultrasound and Shear Wave Elastography (SWE) in predicting the extensibility of the rotator cuff muscle on cadaveric specimens with cuff tears of varying sizes. Eleven fresh frozen cadaveric shoulders were obtained, and the size of the rotator cuff tears was determined as follows: small, medium, large, massive, and intact/no tear. After the SWE modulus of the superficial and deep muscles was measured, the force applied to the supraspinatus tendon and displacement were recorded while the supraspinatus tendon was axially stretched. A regression analysis was preformed to investigate the association between tendon displacement and SWE modulus. There was a significant negative correlation between the displacement of the supraspinatus tendon and the SWE modulus of the superficial and deep muscles. SWE ultrasound may predict the extensibility of the supraspinatus musculotendinous unit, independent of the size of the supraspinatus tendon.

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I experienced a 2-year fellowship in the Laboratory of Echocardiography at San Raffaele Hospital, which is recognized as a leading centre in the world for treatment of coronary artery and structural heart disease. In this report, I will describe the Italian healthcare system, which is unfamiliar to most Japanese people. Italy’s indicators of health system outcomes and high standard of medical care are impressive. Life expectancy is the fifth highest among ‘Organization for Economic Co-operation and Development’ (OECD) countries. In addition, the World Health Organization (WHO) regarded Italy’s healthcare system as the second best in the world in 2000. However, there are some concerns that need to be addressed.
In the second part of this report, I will discuss the Cardio-Thoracic-Vascular Department of San Raffaele Hospital and describe my work in the echo laboratory.

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Since the elderly age 65 and older in Japan accounted for over 25% of the total population in 2013, our country has become the world’s first super aging society. The greatest threat to healthy life expectancy is losing your independence or becoming bedridden, so that you require special assistance or nursing care. The Area Comprehensive Support System, projected by the Ministry of Health, Labor and Welfare, has five formal services, which consist of medical care, long term care, daily life support, housing, and prevention. Coordination of the multidisciplinary liaison team, composed of doctor, nurse, care worker, medical social worker, physical therapist, occupational therapist, speech therapist, social worker etc. is necessary to realize this system. The definition of locomotive syndrome is a condition in which people have functional disorder of movements. Locomotive syndrome is evaluated by using three screening tools which consist of the stand-up test, two-step test and Locomo 25. Two items of locomotion training, One-leg stands and Squats are necessary for preventing this syndrome. Since the prevention of locomotive syndrome might lead to extending our healthy life expectancy, more widespread campaigns to promote awareness for this syndrome should be launched for our society.

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Takotsubo cardiomyopathy is a recently described clinical entity characterized by acute but rapidly reversible left ventricular systolic dysfunction in the absenceof atherosclerotic coronary artery disease. There is typically balloon-like asynergy of the ventricular apical region, ST elevation in multiple leads, and minimal elevation of cardiac enzymes. Pathological features of this cardiomyopathy and guidelines for diagnosis have not been fully clarified.
To clarify pathological features of Takotsubo (ampulla) cardiomyopathy, and the guideline development process, light microscopical examination was performed 9 autopsied cases, and 15 cases that underwent myocardial biopsy or aneurysmectomy (cases were from several institutes in Japan).
Results: 1) Myocardial injury was present, but the incidence was relatively low. Damage of single myocytes or aggregate of single myocytes was observed diffusely throughout the ventricles. 2) Extensive damage of single myocytes included. Lesion were dated based on the following findings: hypereosinophilia, myofibrillar degeneration and myocytolysis. 3) Dated on the following histological findings: hypereosinophilia, myofibrillar degeneration, myocytolysis, cell infiltration → fibroblasts → collagen fibers (fibrosis). 4) The fraction of damaged myocytes was significantly higher in the apical than the basal regions. There was focal myocyte injury, including hypereosinophilia of myocytes, myofibrillar degeneration (contraction band formation), myocytolysis, focal fibrosis, and cell infiltrates.
Discussion: The main pathological findings in autopsied hearts from patients with Takotsubo cardiomyopathy was injury of single myocyte that appeared as myofibrillar degeneration and its sequelae. The guideline development process was clarified.

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Background: Medical education systems adopted by universities usually include methods for school admissions and assessment of the results of postgraduate education. However, in Japan, no studies have been conducted to examine the relationships among students’ scores in admission examinations, their performance in other examinations following admission, and clinical resident training.
Objective: The present study, involving physicians who had complete clinical resident training, aimed to examine the relationships among their scores in admission examinations, those in other examinations following admission, and performance in clinical resident training.
Subjects: The subjects were 37 physicians (21 males and 16 females) who had entered the Faculty of Medicine of Juntendo University between 2006 and 2008 and completed clinical resident training at Juntendo University Hospital.
Methods: The relationships among the results of entrance examinations, academic performance following admission, and the results of evaluation of clinical resident training were analyzed by focusing on specific items.
Results: There was no correlation between scores in entrance examinations and those of evaluation of performance in clinical resident training. Regarding academic performance following admission, scores in OSCEs and performance in clinical clerkship were correlated with many items of the clinical resident training.
Conclusion: It is significantly important to implement education in relation to OSCEs as common achievement tests and clinical clerkship. In addition to OSCEs prior to clinical clerkship, the implementation of undergraduate OSCEs should also be considered, including their methods and evaluation procedures.

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Objective: Despite the key role primary care physicians play in suicide prevention in Japan, successfully managing psychiatric disorders associated with suicide remains a challenge for healthcare practitioners. Postgraduate psychiatry training may be one way to improve the self-rated competence of primary care physicians and their ability to successfully manage these disorders. Previous studies have reported associations between mental health training and greater levels of physician confidence and skill; however, these associations have not been made in reference to specific mental disorders. Our study examined and provided quantitative, disorder-specific associations between postgraduate psychiatry training and confidence levels of primary care internal medicine physicians in managing different mental health disorders. The associations between postgraduate training and the capability of physicians to manage patients with mental health disorders were also evaluated.
Design: Cross-sectional study
Methods: Questionnaires were sent to 4,030 private clinics in Japan. After excluding responses from those working in non-private clinics and those without an internal medicine specialty, 544 responses were included in the analysis. Outcome data were measured by respondent self-report. Adjusted odds ratios of confidence and skillfulness in the management of various psychiatric disorders were calculated.
Results: Experience of postgraduate psychiatry training was significantly associated with greater physician confidence levels in identifying, treating, and following-up of many psychiatric disorders (including schizophrenia and bipolar disorder). Training was also significantly associated with greater self-evaluated competency in providing patient education, psychological therapy, and specialist referrals.
Conclusions: Postgraduate psychiatric training may be important in developing primary care physician self-rated competence in managing psychiatric disorders.

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The present study aimed to examine the relationship of the Japanese translation of the Profile of Mood States second edition (POMS 2®) to the first edition (POMS®). A combined POMS and POMS 2 questionnaire was administered to 248 healthy medical students aged 19 to 24 years. Complete responses were obtained from 186 students (75% response rate). In summary, the test results were:
1) Correlation coefficients between scores on six POMS subscales (i.e., Tension-Anxiety, Depression-Dejection, Anger-Hostility, Vigor-Activity, Fatigue-Inertia, and Confusion-Bewilderment) and those on the corresponding POMS 2 subscales were high for the full-length version (r = 0.996 or above, p < 0.001) as well as for the short version (r = 0.864 or above, p < 0.001). This suggests that POMS 2 and POMS are equivalent on these subscales.
2) Scores on the Friendliness subscale, newly established in POMS 2, were most strongly correlated with those on Vigor-Activity subscale of POMS for both the full and short versions (r = 0.407 and 0.779, respectively, p < 0.001). Friendliness reflects a positive mood as does Vigor-Activity.

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