During the 5^th Science, Technology, and Innovation Basic Plan, the Japanese government proposed a novel societal concept -Society 5.0- that promoted a healthcare system characterized by its capability to provide unintrusive, predictive, longitudinal care through the integration of cyber and physical space. The role of Society 5.0 in managing our quality of vision will become more important in the modern digitalized and aging society, both of which are known risk factors for developing dry eye. Dry eye is the most common ocular surface disease encountered in Japan with symptoms including increased dryness, eye discomfort, and decreased visual acuity. Owing to its complexity, implementation of P4 (predictive, preventive, personalized, participatory) medicine in managing dry eye requires a comprehensive understanding of its pathology, as well as a strategy to visualize and stratify its risk factors.

Using DryEyeRhythm^®, a mobile health (mHealth) smartphone software (app), we established a route to collect holistic medical big data on dry eye, such as the subjective symptoms and lifestyle data for each individual. The studies to date aided in determining the risk factors for severe dry eye, the association between major depressive disorder and dry eye exacerbation, eye drop treatment adherence, app-based stratification algorithms based on symptomology, blink detection biosensoring as a dry eye-related digital phenotype, and effectiveness of app-based dry eye diagnosis support compared to traditional methods. These results contribute to elucidating disease pathophysiology and promoting preventive and effective measures to counteract dry eye through mHealth.

The coronavirus disease 2019 pandemic has uncovered several inherent problems in society. While the demand for telemedicine surged worldwide and some countries responded flexibly, in Japan, most telemedicine services were limited to telephone consultations, and full-fledged telemedicine did not become widespread. In addition, the digitalization process in both medicine and wider society lags behind some other nations. It is necessary to accelerate digital transformation in healthcare to build a sustainable society that is resilient to crises, such as new pandemics. In particular, as Japan is facing an issue of super-aged society, a sustainable care model for people with Parkinson’s disease, dementia, and intractable neurological diseases should be established.

Many neurodegenerative and intractable neurological diseases are progressive; as the disease progresses, patients could become difficult to visit specialists. Although online medical care has many advantages, it does not provide the same quality of information as face-to-face consultations.

However, new technology can overcome the limitations of online medical care. As an evolutionary direction for telemedicine, three-dimensional telemedicine technologies are being developed, which enable online medical treatment to be delivered as if the patient was sharing the same space. Telemonitoring can enable the objective and continuous evaluation of patient information at home through the use of motion capture, wearable devices, and other devices. The advancement of digital transformation in medical care should be a game-changer in accumulating big data and analyzing it using artificial intelligence.

There is a long history of surgical treatment for Parkinson’s disease (PD). Currently, deep brain stimulation (DBS) has been performed as promising treatment option for medically refractory PD. DBS is an adjustable and reversible treatment using implanted medical devices to deliver electrical stimulation to precisely targeted areas of the brain. DBS modulates neurological function of the target region. The most common target for PD is the subthalamic nucleus (STN). DBS is particularly indicated for patients suffering from motor complications of dopaminergic medication such as fluctuations and dyskinesia. Although there is currently no curative treatment for PD, a combination of medical treatment and DBS provide long-term relief of motor symptoms. In this review, I introduce history, mechanism, indication, clinical outcome, complication, long term outcome, timing of surgery, surgical procedure, and current new technology concerning DBS for PD.

Objectives Ischemic mitral valve regurgitation (IMR) in patients undergoing coronary artery bypass grafting (CABG) is associated with worse long-term outcomes. This study aimed to assess the impact of mitral valve repair with CABG in patients with moderate IMR.

Materials This observational study enrolled 3,215 consecutive patients from the Juntendo CABG registry with moderate IMR and multivessel coronary artery disease who underwent CABG between 2002 and 2017.

Methods The CABG alone and CABG with mitral valve surgery (MVs) groups were compared. The propensity score was calculated for each patient. Long-term all-cause death, cardiac death, and major adverse cardiac and cerebrovascular events (MACCEs) were compared.

Results Our database had 101 patients who underwent CABG with moderate IMR. Propensity score matching selected 40 pairs for final analysis. MVs was associated with increased risks of postoperative atrial fibrillation, blood transfusion, and longer hospitalization. Long-term outcomes, including all-cause mortality, cardiac mortality, and the incidence of MACCEs were similar.

Conclusion Surgical treatment of moderate IMR combined with CABG was related to increased risk of several non-fatal short-term complications when compared to CABG alone, with similar long-term outcomes. Further studies are needed to determine the effects of MVs in patients with moderate IMR and severe coronary artery disease.

Objectives The role of autophagy in pancreatic β cells has been reported, but the relationship between autophagy and insulin metabolism is complex and is not fully understood yet.

Design We here analyze the relationship between autophagy and insulin metabolism from a morphological aspect.

Methods We observe the morphological changes of β cell-specific Atg7-deficient mice and Atg5-deficient MIN6 cells with electron microscopy.

Results We find that Atg7-deficient β cells exhibit a marked expansion of the endoplasmic reticulum (ER). We also find that the inhibitory state of insulin secretion causes morphological changes in the Golgi, including ministacking and swelling. The same morphological alterations are observed when insulin secretion is suppressed in Atg5-deficient MIN6 cells.

Conclusions The defect of autophagy induces ER expansion, and inhibition of insulin secretion induces Golgi swelling, probably via ER stress and Golgi stress, respectively.