In Japan, novel coronavirus infection（COVID -19） was moved to category 5 infection in May 2023.　Although the fatality rate has decreased compared to the early phase of the pandemic, the novel coronavirus（SARS-CoV-2）  is expected to continue to exist among humans with repeated mutations in the future due to its strong infectious ability.

　In addition to COVID-19, other emerging and re-emerging infectious diseases such as H1N1 novel influenza, H5N1 avian influenza, Middle East respiratory syndrome, Ebola hemorrhagic fever（Ebola  virus disease）, Severe fever with thrombocytopenia syndrome（SFTS）  and Zika fever have recently become public concerns.　As a common feature, these infectious diseases are caused by RNA viruses.　In this article, focusing on SARS-CoV-2 and influenza viruses, which are frequently seen in clinical sites in Japan, basic knowledge on the replication process of both viruses and the mechanism of action of antivirals will be reviewed. 

Over the past 20 years, there have been a number of international outbreaks of infectious diseases causing respiratory symptoms.　In particular, COVID-19, caused by severe acute respiratory syndrome coronavirus 2 （SARS-Cov2）, spread rapidly throughout the world, including Japan, due to its high infectivity and had a major impact on peopleʼs health, lives and economic activities.　Numerous studies have elucidated the route of infection and its pathogenesis, and new vaccines and antiviral drugs have been developed in a short time.　By the time the Omicron strain became predominant （July 2022）, the mortality rate of infected people over 80 years old had been reduced to the same level as seasonal influenza, partly due to the weakening of the virus itself.　The public is now more aware of infectious diseases and has a better understanding of infections.　The purposes of this review are to compare the characteristics of infectious diseases that cause respiratory symptoms, such as influenza, community-acquired pneumonia and aspiration pneumonia, and to discuss measures to prevent these diseases.

Computed tomography （CT） is an imaging modality that plays an important role in clinical practice.　It began being used as a clinical device in the United Kingdom in 1972 and has made dramatic progress over the past half century.　The principle is to create a tomographic image by getting X-ray images from multiple directions, to process the information obtained by a computer, and to create an image that allows you to check the detailed internal state and anatomy of the parts of the body.　In the clinical practice in patients with respiratory infections, it is often experienced that CT examinations make the pneumonia detectable, which are difficult to detect with X-ray examinations, and can be used to evaluate the three-dimensional shape, spread, and severity.　In this article, we focus on CT imaging for various viral infections and introduce CT images of COVID-19 pneumonia.

The COVID-19 pandemic also had a major impact on the field of radiation therapy.　In May 2020, the Japanese Society for Radiation Oncology released “Recommendations for Radiation Therapy in the COVID-19 Pandemic”.　The recommendations state that radiotherapy should be considered on a case-by-case basis, whether curative or palliative, and that necessary radiotherapy should be continued as long as possible and initiated without delay, even for patients with COVID-19.　The report also discusses cases in which radiotherapy can be omitted or postponed, the recommended number of treatments, and post-treatment follow-up.　The importance of proper use of personal protective equipment to prevent the spread of infection, as well as temporal and spatial segregation within the radiotherapy department, are also discussed.　At our hospital, we have taken basic infection control measures for both patients and staff, such as avoiding close contact in the waiting area and using hand sanitizers.　Fortunately, there are no clusters in the radiotherapy department, and we have continued to provide radiotherapy without interruption.　In terms of treatment strategy, hypofractionated irradiation is recommended to shorten the number and duration of treatments while maintaining the therapeutic effect by increasing the dose per treatment.　For hospitals, shortening the treatment period per patient can reduce the number of treatments, and for patients, it can reduce the burden of hospital visits, the risk of infection associated with traveling outside the hospital, and the risk of interruption of treatment.　Our hospital has started hypofractionated irradiation for breast and prostate cancers.　We will continue to take thorough measures to prevent infection so that we can continue to provide appropriate radiation therapy.

　We conducted a semi-structured interview with palliative care unit nurses with more than 3 years’ experience in A prefecture in the period from July to November 2022.　Semi-structured interviews were conducted with 10 nurses, using an interview guide to determine their perceptions of patients’ intentions.　The responses of the nurses in the palliative care ward of perceived “intention toward sedation of terminal cancer patients” were categorized as 44 codes, 15 subcategories, and five categories including ［inferring the patient’s intention from the way the patient has spent his/her daily life］, ［inferring the patient’s intention based on the patient’s last moments］, and ［inferring the patient’s intention based on the patient’s last days］.　The following were extracted as “intention” : ［inferring the patient’s intention from what the patient has said in his/her daily life］, ［taking the patient’s preparedness for death, which he/she has fulfilled as a person in the final stage of life, as the intention］, ［taking alleviation of pain as the intention because the terminal stage of life cannot be cured by any means］, and ［taking the best estimated and continued discussion among family and medical personnel as the patient’s intention］.

Purpose : To clarify the aspects brought about when withholding the truth about the prognosis from elderly patients with terminal cancer from the perspective of visiting nurses.　Methods : Semi-structured interviews were conducted with 15 visiting nurses of home visit nursing offices in the Kansai area from May to September 2021, and the obtained data were qualitatively and descriptively analyzed.

Results : Six categories of the aspects brought about when withholding the truth about the prognosis from elderly patients with terminal cancer were identified from the perspective of visiting nurses : ［preventing patients from what they want to do］ etc.

Discussion : These categories clarified 2 characteristics of the aspects brought about when withholding the truth about the prognosis from elderly patients with terminal cancer : preventing patients from being convinced that they are living their last period, even though they are in their own homes ; and making it impossible for all parties involved, including families and visiting nurses, to devote themselves to parting.　Based on this, the choice to withhold the truth from patients may unintentionally deprive them of the chance for a good end of life, and let home end-of-life care, which further deepens interpersonal relationships in most cases, end before its benefits are fully realized.

　Conclusion : Visiting nurses should support patients and their families for a good end of life that is possible only at home, while understanding these aspects brought about when withholding the truth about the by prognosis from the former.

　We examined the impact of COVID-19 on countermeasure-based breast cancer screening in Tokushima City based on the number of breast cancer screening recipients at our hospital. The number of breast cancer screening recipients at our hospital was 576 in 2019 and slightly decreased to 550 in 2020, but no significant impact was observed.　However, the number of examinees in 2021 clearly decreased to 416.　In 2022, the number of infected patients increased about 10 times from the previous year, but the number of examinees did not change much from the previous year to 412.　Although there were some problems in 2020, such as the cancellation of breast cancer screening, the impact was not that great, and in 2021.　In 2022, the number of examinees remained unchanged from the previous year despite the increase in the number of infected persons.　It is thought that the number of examinees did not decrease so much in 2022 due to the increase in the vaccination rate, progress in infection control measures, and the residentsʼ familiarity with COVID-19.　The number of persons receiving examinations is expected to gradually recover in the future.　The impact of COVID-19 on countermeasure-type breast cancer screening in Tokushima City was temporary and did not have a significant effect.

　　Objective : We compared between the evaluation by the use of 6 Geriatric Assessments （GA） and surgeonʼs preoperative decision of vulnerable cases in lung cancer patients undergoing surgical treatment.

　　Methods : One hundred-ten lung cancer patients who underwent lung resection at Tokushima University Hospital between 2021 and 2023 were included in the study.　GA tools defined by JCOG for use in studies of the elderly : 1） G8 （Geriatric 8） Health status screening tool 2） Instrumental activities of daily living （IADL） scale, （3） Charlson Comorbidity Index （CCI） scale, （4） residential status, （5） Mini-Cog, and （6） Mini Nutritional Assessment （MNA） were completed.

　　Results : Of the 110 patients, 64．5％ were below baseline on at least one of five scales, including MNA, G8, IADL, Mini-Cog, and CCI （n=71）, and 12．7% （n=14） were below baseline on three or more scales.　The G8 and CCI scale items significantly influenced the surgeonʼs preoperative decision to be frail and vulnerable.

　　Conclusions : The medical staffs should examine the status of the surgical patients with lung cancer using comprehensively GA.

　　Mullerian cysts in the posterior mediastinum are cystic lesions that occur near the spine in females, and they are considered relatively rare with few reported cases.　We encountered three cases of Mullerian cysts in the posterior mediastinum.　Case 1 was a 42-year-old female who was diagnosed with a right ovarian endometriotic cyst after surgery in our department.　Case 2 was a 34-year-old female with no previous medical history.　Case 3 was a 40-year-old female with a history of taking low-dose oral contraceptives with no previous medical history.　All cases underwent thoracoscopic resection of cystic lesions, and immunohistochemical staining confirmed the diagnosis of Mullerian cysts in the posterior mediastinum.　The results at our institution suggest that Mullerian cysts in the posterior mediastinum may not be as rare as previously thought.　Additionally, we investigated the relationship between Mullerian cysts in the posterior mediastinum and anti-Mullerian hormone （AMH） in one case.　We report our case, along with the relevant literature.

【Introduction】Familial Mediterranean fever （FMF） is an autoinflammatory disease that is characterized by repeated periodic fever and serositis.　FMF is mainly inherited in an autosomal recessive manner.　While the prognosis of FMF is good with oral colchicine which is recommended to take for avoiding amyloidosis, FMF is associated with many medical and social issues, such as stigma against genetic diseases and infertility due to oral colchicine.　【Case】From year X, a female teenager repeatedly developed fever of 38℃ that continued for ２-３ days and unilateral chest and back pain once a month.　She visited a nearby clinic, however, her symptoms spontaneously disappeared.　She was kept under observation without definite diagnosis.　In May of X+４, she developed fever and right chest pain and referred to our hospital.　By the time she presented to our hospital, symptoms had disappeared and there were no abnormalities in a peripheral blood examination or on whole-body CT or cardiac ultrasound.　Based on her clinical course, we suspected an autoinflammatory disease ; therefore, we performed a genetic examination with informed consent from the patient and her guardian.　The results obtained revealed that heterogenous pathogenic variant in the MEFV gene （M694I）, and, thus, she was diagnosed with FMF.　The oral administration of colchicine was initiated in November of the same year, which resolved fever and chest and back pain.　In X+７, she started a job, which affected her daily life and the regularity with which she took oral colchicine.　Therefore, chest and back pain relapsed.　She expressed concerns about infertility and teratogenicity caused by oral colchicine and received a second opinion and genetic counseling, which improved compliance with oral colchicine.　【Discussion】Adolescent and young adult generation patients have strong phycological stress and anxiety about the future, such as educational plans, employment, marriage, and pregnancy, which need to be considered in their treatment.　Further improvement in awareness of FMF and the establishment of a medical care support system through inter-professional work, including internal medicine, pediatrics, obstetrics and gynecology, clinical genetic staff and clinical psychologists, are needed.