More than 17% of worldwide infectious diseases are caused by vector-borne diseases. A numerous number of living organisms can act as a vector. In Japan, tick-borne diseases are particularly important because these diseases occasionally lead to a fatal clinical outcome. Severe fever with thrombocytopenia syndrome (SFTS) is a newly identified tick-borne disease caused by phlebovirus in the Bunyaviridae family. Most SFTS patients have been observed in China, South Korea and Japan. SFTS was first identified in 2013 in Japan and reached to 310 cases by 2017 with a high case-fatality rate (7.8%). SFTS transmission cycles between ticks and wild animals have been already established throughout Japan. This review outlines the current epidemiology of SFTS in Japan, with an emphasis on ecology of vector and animals and clinical features of Japanese patients.

Objective: The purpose of this study is to develop a vulnerability scale for university athletes (the Athletic Vulnerability Scale), examine the reliability and validity of the scale, and clarify the basic attributes and related factors concerning the target population.

Design: Cross-sectional design was used. A mixed method was adopted; collecting and analysing both qualitative and quantitative data.

Methods: We surveyed 363 Japanese university athletes (193 males, 170 females; mean age 19.0 years; SD=1.07).

Results: Factor analysis returned 12 items across three factors, with reliability and validity verified. The first factor was “vulnerability due to being denied or ignored from others”, the second was “vulnerability due to inconsistent performance”, and the third was “vulnerability due to low interpersonal evaluation”. Females demonstrated higher vulnerability than males. Vulnerability was associated with depression; people with high vulnerability are at risk of developing maladaptive conditions such as withdrawal and depression.

Conclusions: The findings indicate that people with high vulnerability are at a high risk of developing depression. This study provides athletes and coaches with an accurate tool for measuring vulnerability and identifying mental health risks.

Objective: This study aimed to identify the influence of nursing practice environments and respiratory unit nurses’ demographic characteristics on nurses’ self-rated ability to care for patients with chronic respiratory diseases, particularly COPD.

Design: Cross-sectional study.

Methods: Self-administered questionnaires were sent to 464 nurses in advanced treatment hospitals and other hospitals. A total of 257 nurses (55.4% response rate) returned completed answers. Questions were on areas such as demographic information and the Practice Environment Scale of the Nursing Work Index, which assesses nursing practice environments and self-rated ability across seven areas: “understanding disease”, “understanding patients”, “respiratory rehabilitation”, “helping patients and families”, “protecting the rights of patients and families”, “cooperating with other health workers”, and “being a role model”.

Results: A good relationship between nurses and physicians was positively associated with all aspects of self-rated nursing ability except “understanding disease” and “helping patients and families”. A specialist qualification in chronic care nursing, chronic respiratory nursing, palliative care, or intensive care, or being a certified therapist of respiration, was positively associated with all aspects of self-rated nursing ability except “protecting the rights of patients and families” and “cooperating with other health workers”. The nursing supervisor’s capacity was positively related to “cooperating with other health workers” and “being a role model”. Years of experience in working on a respiratory disease unit was positively associated with “being a role model”.

Conclusions: A specialist qualification and a better relationship with attending physicians enabled nurses to provide high-quality nursing for patients with chronic respiratory diseases.

Objective: Aortic valve stenosis (AS) is becoming more prevalent in the elderly population. The aim of this study was to determine if patients aged ≥80 years are at a higher risk of aortic valve replacement (AVR) for AS, with or without coronary artery bypass grafting (CABG), compared to their younger counterparts.

Materials and Methods: A retrospective review of 539 consecutive patients with AS who underwent AVR between August 2002 and December 2016 at Juntendo University Hospital was performed. These patients were divided into four groups by years of age: <60 (n=58), 60-69 (n=130), 70-79 (n=279), and ≥80 (n=126).

Results: Early mortality and postoperative major complications were similar among the age groups. Thus, an age ≥80 years was not an independent predictor for early mortality or morbidity. Early mortality was 3.1% in patients aged ≥80 years, compared with 0 to 3.5% in the younger age groups. Advanced age significantly and independently impacted prolonged length of stay (PLOS)(p=0.002) and non-home discharge rates (p=0.001). Recovery after AVR was significantly slower in patients aged ≥80 years than in the younger patients. Increasing age was an independent predictor of long-term mortality (p=0.002), but AVR in the very elderly patients was associated with a good late survival of 78% at 5 years.

Conclusions: AVR in patients aged ≥80 years can be performed with low postoperative mortality and morbidity, and excellent long-term survival. We recommend that indications of AVR for AS should not be based on age alone.

　The Tropical Medicine Association of Juntendo University (TMAJU) is a student group of Juntendo University founded by students as well as the chief executive officer (CEO) of Juntendo University, Prof. Hideoki Ogawa, nearly 60 years ago. TMAJU has three missions: “Learning beyond the textbook”, “Creating ties” and “Emphasizing responding as global medical students”. Based on these missions, we have been learning about tropical medicine through daily studying sessions and a study trip to Thailand and Singapore, interacting with medical students in many countries in the South East Asia area. Over a 12-day period, from March 16-27, 2018, the TMAJU 54th South East Asia research team, which consisted of 10 students in their second to fifth years of university and professors from Juntendo University, visited Thailand and Singapore to learn about tropical medicine. We enjoyed valuable experiences learning about tropical medicine and foreign healthcare systems through this trip. We hope that future members of TMAJU will also take part in this great experience and build upon it as years pass.

Objective: Universities support student clubs because the social and educational experiences acquired through the extracurricular activities are considered important to promote their humanity. In this study, we examined membership of clubs by medical students at Juntendo University over the 30-year Period of Heisei.

Materials: We studied 2,899 students (2,087 men and 812 women) who graduated from Juntendo University within the 30-year Heisei Era.

Methods: We divided the 30-year Heisei Era into 3 periods (1: 1989 to 1998; 2: 1999 to 2008; and 3: 2009 to 2018) and investigated changes in the number of club members during each period.

Results: At Juntendo University, 89% of all medical students were members of clubs and 11% did not belong to any club. During Period 1, the number of students who belonged to sporting clubs was overwhelmingly large (744, 80.2%), while only 74 students (8.0%) belonged to non-sporting clubs and 110 students (11.8%) were not members of any club. During Period 2, the variety of non-sporting clubs increased and the number of students participating in non-sporting clubs increased significantly to 116 (12.6%)(p<0.01). During Period 3, the number of students who did not belong to any club decreased significantly to 83 (7.8%)(p<0.01).

Conclusion: Most medical students at Juntendo University belonged to clubs. While sporting clubs have been dominant to date, it is expected that the variety of non-sporting clubs will increase in the future.

Background: Motor rehabilitation may be rarely disrupted by psychiatric disorders including conversion disorder and catatonia. The amobarbital or diazepam interview can be implemented for both the diagnosis and treatment of these disorders. We report two typical cases presenting with motor paralysis influenced by psychiatric disorder that were effectively diagnosed and treated using the diazepam interview in convalescent rehabilitation.

Cases: Case 1 was a 32-year-old man. He experienced severe paralysis and sensory disturbance of the right arm and leg while at work, and then received conservative treatment for stroke. One month later, after the diazepam interview, he rapidly recovered almost entirely from his paralysis and sensory disturbance, which led to a diagnosis of conversion disorder. Case 2 was a 42-year-old man. After becoming an alcoholic, both legs had gradually become severely paralyzed. Two months later, he was uncommunicative and refused rehabilitation and nursing care. He briefly became communicative during the diazepam interview, and was diagnosed with delusional depressed state with stupor. Six months later, both legs remained spastic and paralyzed. Although he was subacute with combined degeneration of the spinal cord, taking conversion disorder overlap into consideration, we conducted the diazepam interview again; he immediately recovered slight voluntary extension and flexion of both legs.

Conclusions: We describe two motor disturbance cases influenced by psychiatric disorders. For both patients, the diazepam interview was shown to be an effective method for the diagnosis and treatment of a psychiatric disorder. Our findings suggest that the diazepam interview could be appropriate for use in the rehabilitation area when conducted correctly.

In endurance athletes with intense joint loading, cartilage metabolism (degradation of type II collagen) is enhanced compared with non-athletes and non-endurance athletes. Recently, we have revealed that glucosamine, a functional food, exerts a protective action on cartilage metabolism in not only osteoarthritis patients but also endurance athletes (such as soccer players) by suppressing the degradation of type II collagen. In this review, to demonstrate these findings, the following topics will be presented: 1. Biomarkers for cartilage metabolism; 2. Evaluation of cartilage metabolism in endurance athletes by using biomarkers for cartilage metabolism; 3. Chondroprotective action of glucosamine on endurance athletes.

　In this review, we summarize the current status and provide future perspectives on surgery, perioperative treatment, and prognostic factors based on genetic and epigenetic alterations in colorectal cancer (CRC).

　Surgery is still the mainstay of treatment for CRC for definitive management and potential cure at an early stage, and effective palliation in advanced cases. Local control and survival have significantly improved in surgical cases because the indication for surgery and perioperative treatment has changed. Based on the results of some randomized control trials, laparoscopic surgery is now considered to be a standard treatment option for advanced colon cancer. The most recent development is robotic surgery using the da Vinci ^® surgical system, which consists of a patient-site cart, a surgeon console, and a vision system. This system provides 3 dimensions high definition (3D HD) vision of a clear and magnified operative view and converts the surgeon’s hand movements into smaller, more precise movements of tiny instruments inside the body. Thus, da Vinci ^® technology allows surgeons to perform complex procedures through a few small wounds, similarly to conventional laparoscopic surgery.

　Genetic effects such as mutations and chromosome instability involve changes in the DNA sequence of a gene, whereas epigenetics refers to potentially heritable changes that are linked to DNA methylation or histone methylation, but do not involve changes in the DNA sequence. Genetic and epigenetic changes are linked with each other and can lead to cancer development and progression. Many recent studies have examined the relationships of these changes to diagnosis, treatment and prevention of CRC.