Podiatry Medicine is well known medical field in Europe and the United States, which is a discipline that specializes in foot medical care. In Europe and the United States, it is common to see a podiatrist if there are any symptoms in the foot and they provide specialized medical for foot disease. However, in Japan, even if you feel that your foot hurts, there is no specialized medicine to be provided. In Japan, commonly podiatry medicine is often provided by each clinical field or department related to patient’s symptoms and there was no university hospital in Japan that advocated Podiatry Medicine. As the aging society progresses in the future, maintaining “walking” is one of the important issues to extend the healthy life span. To overcome this issue and to provide specialized medical care for foot patients in Japan, Juntendo Hospital established the “Podiatry Center” to be the first time in Japan. This center comprehensively assesses the symptoms that occur in the foot, similar to podiatry medicine in Europe and the United States (medical treatment for the lower leg to the foot, not including the knee), and provides multidisciplinary treatment from foot care to cutting-edge medical treatment. The center cooperates with many clinical departments such as plastic and reconstructive surgery, dermatology, vascular surgeon, cardiovascular medicine, diabetes medicine, collagen disease medicine, kidney medicine, orthopedics, rehabilitation department, and nurses, prosthetist, and other professions to carry out diagnosis, treatment, and prevention promptly and effectively for the best for patients with foot diseases.

Surgical treatment of ischemic heart disease began in 1945. After 1970, coronary artery bypass grafting (CABG) with cardiopulmonary bypass was developed along with coronary angiography. Juntendo University has been treating ischemic heart disease since 1980, and is actively performing off-pump CABG (OPCAB) since 2002. Besides the age of patients undergoing surgery, complications such as chronic hemodialysis, cerebrovascular disease, and malignancies make it challenging to reduce postoperative complications using OPCAB as graft preservation. OPCAB is technically challenging, and the CORONARY trial did not reveal its superiority over conventional CABG. Furthermore, high revascularization rates and technical differences among surgeons are important concerns. While not widely accepted in Europe and the United States, OPCAB comprises 65% of all stand-alone CABG in Japan. Japan reported a 2.5% hospital mortality rate in 2018, while the US reported 2.2% (according to the American Association of Thoracic Surgeons). In contrast, Juntendo University Hospital has maintained a 1% hospital mortality rate since 1984. To reduce the incidence of remote stroke in CABG patients, Juntendo has been using stroke-free management since 2010. Postoperative atrial fibrillation is 4-5 times more likely to recur than normal sinus rhythm after a 5-year course. In our study, 20% of patients suffered from chronic atrial fibrillation after ten years. Furthermore, left atrial appendage closure or amputation significantly reduces stroke in patients who undergo CABG and develop postoperative atrial fibrillation. Thus, OPCAB is a minimally invasive procedure with fewer complications; prevention of cardiogenic cerebral infarction can help improve remote outcomes.

I studied at the Sleep and Circadian Neurobiology Laboratory, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, from April 2018 to March 2020. At Stanford University, I mainly researched the following themes: (1) sleep basic research using mice (administering compounds with sleep or wakefulness effects to mice and examining their effects), and (2) research on circadian rhythm disorders. There are only a few institutions in the world that can conduct sleep basic research using mice, and Stanford University is a wonderful environment to immerse yourself in research, as it is home to not only psychiatrists but also neurologists and many basic researchers. In this article, I would like to review the experiments I conducted during my study abroad, using mice to verify the effects of natural compounds on wakefulness or sleep. In one study, we evaluated the effects of ginkgolides (A, B, and C) and bilobalide on arousal, locomotion, and core body temperature. The results showed that only ginkgolide B dose-dependently increased the amount of arousal and decreased the amount of NREM sleep in the physiological sleep-wake cycle of mice. In another study, we tested the sleep-inducing effects of sake yeast in mice under an acute insomnia model. We showed that sake yeast dose-dependently increased REM and non-REM sleep, decreased arousal within 6 hours after oral administration of sake yeast, and decreased locomotion and core body temperature in a new cage.

Objective Herpes zoster (HZ) is a common disease, whose most common complication is postherpetic neuralgia (PHN). We conducted this study to compare effects of amenamevir (AMNV) and famciclovir (FCV) on intensities of acute HZ pain and the incidence of PHN, which have not been compared yet.

Methods After approval by the Ethics Committee, we retrospectively investigated adult patients with HZ treated with AMNV or FCV at Juntendo University Hospital between October, 2018 and February, 2020. We compared, between 143 AMNV-treated and 131 FCV-treated patients, pain scores of acute HZ pain evaluated on an 11-point numerical rating scale (NRS) and the incidence of PHN with the Mann-Whitney U test and Pearson’s chi-square test, respectively. The univariate logistic regression analysis was used to identify predictors of PHN.

Results Pain scores during the acute HZ period remained significantly lower in AMNV-treated patients than FCV-treated patients (p = 0.049, 0.011, and 0.016 for Day 3-4, Day 7, and Week 2-3, respectively), although the pain score at Day 0 before treatment didn’t differ between them (p > 0.05). The incidence of PHN didn’t differ between them (9.8% vs. 11.5%, p > 0.05). In the total cohort, the pain score at Week 2-3 was significantly associated with the development of PHN (r² = 0.180, p < 0.00001).

Conclusions Compared with FCV, AMNV was more effective in reducing acute HZ pain, possibly reflecting its unique mechanism of action. However, AMNV didn’t reduce the incidence of PHN possibly due to the multifactorial etiology of PHN.

Objective The present study compared students’ CBT scores during the 2-year period before (“without COVID-19”) and 2-year period during (“with COVID-19”) the COVID-19 pandemic, and analyzed factors associated with poor results.

Materials A total of 530 students (368 males and 162 females), who had taken CBT within the period between 2018 and 2021.

Methods Analysis was performed based on the questionnaire results, and the students’ performance was compared between “without/with COVID-19” to identify the causes of poor CBT scores.

Results The overall mean IRT score was 515.5±85.4. The without and with COVID-19 groups’ scores were 495.7±85.9 and 534.4±80.8, respectively (p<0.01). Among all students, 43 (8.1%) had IRT scores lower than 400 as poor CBT scores; 27 (10.4%) without and 16 (5.9%) with COVID-19, revealing a decrease in the latter. The multivariate analysis of the risk of students having poor CBT scores showed that students with poor performance during the third year (odds ratio:7.02), starting preparation for CBT late (2.19), and not taking any practice examination (4.58) are more likely to have poor CBT results.

Conclusions Due to the COVID-19 pandemic, students spent more time on online home study, and this may have consequently improved their CBT scores. Such learning performance is desirable for medical students, but they have lost the opportunity to gain valuable experiences that they could have acquired through extracurricular activities, such as club activities. In this respect, we cannot simply be pleased by the improvement in students’ CBT scores.

Objective the primary objective was to examine the effect of Bifidobacterium on decreasing the bilirubin level in term neonates delivered by Caesarean Section (CS).

Materials and Methods A total of 153 healthy term neonates delivered by CS were included in this study and were divided into the non-probiotic group (n=99) and probiotic group (n=54) based on the history of probiotics administration. There were no infants who underwent phototherapy. A total of 20 doses of probiotics were given orally from the first day of life. The transcutaneous bilirubin (TcB) levels were measured every day for the first 5 days of life. Data of each infant and mother were gathered from medical records.

Results The bilirubin level per day (day-1 to day-5) in the non-probiotic group was no different from the probiotic group. Differences in bilirubin level between day-5 and day-1, and also between day-5 and day-2 were not different between the two groups. There was a significant (p = 0.03) body weight gain in the probiotic groups with a mean of 36.09 ± 8.23 gram/day. No obvious adverse reactions were seen in both the non-probiotic group and probiotic group.

Conclusions Our findings suggest no significant effects of probiotics on lowering bilirubin levels in the first five days of life. Also, probiotics have a positive effect on body weight gain in healthy term infants, and it is safe to be given to newborns.

Objective Most strains of methicillin-resistant Staphylococcus aureus (MRSA) analyzed to date have been from industrialized countries, with information lacking on the epidemiology of MRSA in other regions of the world. The present study describes the molecular epidemiology of MRSA strains collected at a referral hospital in Surabaya City, Indonesia in 2015-2016. The similarity of strains isolated in Indonesia to known lineages of MRSA was investigated.

Materials Of 45 MRSA strains isolated in Surabaya, 10 were selected by antibiotic resistance patterns and clinical features, while excluding duplicates. Methods: Whole genome sequencing was performed using a next-generation sequencer, and the complete genome sequence of one of these 10 strains was also determined by the PacBio system. The strains were subjected to molecular epidemiological analyses, including the presence of drug-resistance and virulence-related genes, the determination of sequence types and staphylococcal cassette chromosome mec (SCCmec) types and mutual phylogenetic relationships, using standard analytical tools.

Results The molecular types of these MRSA strains showed significant diversity. Complete sequencing of the genome of strain IDSA1 showed that it belonged to the ST239 group, while also having unique mobile genetic elements. Conclusions: Despite the small number of MRSA strains collected in a limited area and over a short period of time, these strains were found to have arisen in many other regions of the world, suggesting that they had migrated into Indonesia through human movement. These strains also showed molecular differentiation after migrating into Indonesia.

An intricate interplay of complex spatio-temporal events underlies brain functions. Therefore, clarifying these dynamic processes is indispensable for revealing the mechanisms of brain functions. Fluorescence imaging is a powerful technique for visualizing cellular and molecular dynamics in the brain. Recent developments in fluorescent indicators and specialized optics have advanced research in the field of neuroscience. In this review, I will exemplify the power and beauty of fluorescence imaging by discussing my work focusing on the molecular dynamics of metabotropic glutamate receptor (mGluR) signaling at the synapse. By developing novel fluorescent indicators for glutamate, inositol 1,4,5-trisphosphate and Ca²⁺ within the endoplasmic reticulum, I succeeded in imaging the spatio-temporal dynamics of synaptic mGluR signaling, which led to the identification of novel mechanisms of mGluR-mediated glutamatergic neurotransmission. These discoveries highlight the importance of the development and application of novel fluorescence imaging techniques for the investigation of brain functions.