Autonomic dysfunction following spinal cord injury, which includes autonomic dysreflexia, orthostatic hypotension, body temperature dysregulation, bladder dysfunction, and bowel dysfunction, strongly influences the quality of life in spinal cord injury patients. Although understanding the autonomic dysfunction in spinal cord injury patients will improve their health and quality of life, few medical professionals are familiar with the dysfunction and its management. Given the sharp rise in the number of elderly patients with spinal cord injury in recent years, we consider that health professionals should be able to provide proper information on the management of autonomic dysfunctions to patients with spinal cord injury and their caregivers. This paper describes an overview of the autonomic dysfunction commonly found in people with spinal cord injury.

The autonomic nervous system influences numerous ocular functions and disorders. It is well known that various pupillary abnormalities and ptosis are caused by local dysfunction of the autonomic nervous system. Furthermore, ocular symptoms can occur as a manifestation of systemic autonomic dysfunction. Understanding the pathophysiology of the autonomic nervous system is useful for management of patients with various eye diseases.

In humans, the sexual cyclicity of estrus that occurs in animals is not present, and sexuality is sometimes evoked by the imagination. The central site of the libido has long been unclear. We analyzed the site of the libido in healthy male volunteers with the aid of the RigiScan plus™, which can evaluate the erectile state in real time. By evaluating the erectile phenomenon in real time, we could confirm that sexual stimulation was fully transmitted and could identify the phases of sexual activity. In the excitement phase, the occipital lobe is the area specifically activated as indicated by positron emission tomography. We also found that in addition to this area, part of the cerebellar vermis was specifically activated. During the plateau phase, the occipital lobe, which contains the visual cortex, and the temporal lobe, which contains the auditory cortex, became more highly activated than during the excitement phase, and in addition, the ventral striatum (putamen) was specifically activated. Although these findings are interesting and important in the field of sexual medicine, it is supposed that the subjects show interest in sexually stimulating videos and watch them in many imaging analyses of the site of the libido. Regarding sexual interest, we reported that a sex difference existed in visual attention to a sexual video by an eye-tracking system. We also showed that attention to the sexual region in the video depends on the personality characteristics of men. Here, we show recent evidence of sexual libido and interest including our experimental results.

The responses of the body to physical and psychological stress can be broadly classified into: physiological responses mediated by the autonomic nervous system; responses mediated by the neuroendocrine system, including the hypothalamus- pituitary- adrenal axis or neuropeptides; changes in the immune system, which correlate with the autonomic nervous system and neuroendocrine system; and emotional or behavioral changes. Acute responses to stress stimuli result from activation of the sympathetic nervous system. Chronic stress is also believed to exacerbate the condition of patients with deseases which are regarded as psychosomatic disorders in Japan.

A concept similar to psychosomatic disorder that has been proposed in recent years is functional somatic syndromes. It is common for mental disorders to be accompanied by complaints of physical suffering. The term “autonomic nervous disorder” has been widely used for patients with these complaints. Symptomatological classifications are mainly used nowadays, and in the field of psychiatry this disorder is diagnosed as a somatoform disorder. In the DSM-5, this is referred to as Somatic Symptom and Related Disorders, broadly classified into somatic symptoms and conversion disorder. Patients with depression often complain of autonomic symptoms. We give an outline about these diseases.

Objective: Clinical studies reported that the muscle strain of the quadriceps femoris muscles (QF) is most frequent in the rectus femoris (RF) with specific postures. The mechanism underlying the specificity of muscle strain has not been fully understood. We postulated that the physiological and anatomical properties of the muscles constituted a main risk factor of muscle strain.

Materials and Methods: Knee extension torque and surface electromyographic (EMG) signals were measured in 18 healthy adults. Anatomical specimens of QF were obtained from 9 cadavers.

Results: Isometric knee extensor torque was smallest at knee angle of 10° and gradually increased at larger knee angles of 30°, 60°, and 90°. EMG activities during isometric contraction of the three QF muscles were at a similar level during knee flexion at angles from 10° to 30°, 60°, and 90°, except for a slight non-significant increase at 90° in the vastus lateralis (VL) and the vastus medialis (VM). The four muscles of QF had pennate structure, and their muscle fiber length per total muscle length (FL/TML) was not significantly different. In RF, the muscle fibers were more extended with flexed knee joint and extended hip joint than in the other muscles.

Conclusions: The specific high incidence of muscle strain in RF was explained on the basis of physiology and anatomy. In addition, the rationale presented in the present study would be helpful to decrease the incidence of muscle strain by specific exercise to increase the force and extensibility of RF.

Objective: Anticoagulation therapy is commonly used to prevent venous thromboembolism after abdominal surgery. However, bleeding during anticoagulation therapy is a problem, particularly in use of fondaparinux (FPX), for which there is no useful monitoring method. In this study, we examined the usefulness of measurement of the inhibitory activity of activated blood coagulation factor X (anti-Xa activity) for prediction of bleeding.

Subjects and Methods: The subjects were 67 patients who underwent anticoagulation therapy with FPX after surgery for colorectal cancer. FPX (2.5 mg) was subcutaneously administered from Day 1 to Day 5. Measurement of anti-Xa activity were performed on Days 1, 3, 5 and 7 to evaluate the relationship between anti-Xa activity and bleeding.

Results: No symptomatic venous thromboembolism developed in any patient. Bleeding was found in 11 subjects (16.4%). The anti-Xa activity gradually rose after initiation of administration in both the bleeding and non-bleeding groups until day 5. When the anti-Xa activity was compared between the bleeding and non-bleeding groups, the anti-Xa activity was higher in the bleeding group on day 3 (p=0.002).

Conclusion: Careful attention to bleeding is required in anticoagulant therapy with FPX. Measurement of anti-Xa activity may be useful for prediction of bleeding.

As part of an international exchange program at Juntendo University, the exchange of nurses between Korea and Japan began in 2015. We provided clinical training for Korean nurses in the Faculty of Medicine hospital. We looked into Korean nursing education by studying the available literature and collecting information from nurses who were engaged in education in Korea, and compared basic nursing education, the nurse license examination system and specialized nurse education in Korea with those of Japan and the United States. The results revealed the following differences between the three countries.

(1) In Japan, basic nursing education is provided by complex and diverse courses, while in Korea it was unified into a four-year undergraduate program in 2012.

(2) Accreditation of nursing education institutions, the rules governing curricula, and the administration of nurse license examinations are directly performed by nationally-designated organizations in Korea and the United States. Educational institutions in these two countries are required to regularly renew their accreditation.

(3) Education for advanced practice nurses is provided in Master’s degree programs in Japan and Korea, while the United States has shifted from Master’s to Doctoral degree programs.