Background and Aims : This study investigated whether hypoxic preconditioning (HP) induces ischemic tolerance in an established experimental model of permanent middle cerebral artery occlusion using rats. Methods : Animals were divided into the normoxia (control) and HP groups. HP was performed under normobaric conditions ( 7% O₂ for 2 hours), 14 days before focal cerebral ischemia induction. The infarct volume was evaluated by quantitative histopathology. Immunofluorescence analysis was assessed at 24 hours after HP to examine the effect on proliferating cell and microglia/macrophage activation. Brain microvessel density was assessed 14 days after HP. Furthermore, the expression was evaluated of angiogenesis-related proteins such as hypoxia-inducible factor-1α and vascular endothelial growth factor proteins. Results : Hemisphere infarct volume in the HP group was significantly smaller than in the control group. Vascular endothelial growth factor and proliferating cell nuclear antigen expression was not increased after HP. HP tended to increase vessel density relative to the control group, but this did not achieve statistical significance. Conclusion : HP attenuated the infarct volume in rats. The phenomenon of ischemic tolerance may link HP with vascular remodeling.

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Aim : We introduce our laparoscopic gastrectomy for gastric cancer patients, presenting the procedure and results, and then evaluate the feasibility of laparoscopic gastrectomy. Methods : From April 2006 to May 2010, we performed laparoscopic surgery on 116 patients. We investigated the surgical method and survival. And also we examined operating time, amount of bleeding, length of hospitalization, and complications in the complete laparoscopic surgery group. Results : Previously, we performed laparoscopy-assisted distal gastrectomy and pylorus-preserving gastrectomy, and hand-assisted total gastrectomy and proximal gastrectomy. Since 2009, we have performed complete laparoscopic surgery in every case. One of the 77 stage-IA patients died of a cause other than stomach cancer postoperatively. One of the 18 stage-IB patients had recurrence, but he is still living. There were no other cases of recurrence. The average operating time, amount of bleeding, and hospitalization stay in the complete laparoscopic surgery group were 338 minutes, 104 g, and 10.9 days, respectively. Postoperative complications occurred in 2 of 32 cases (6.3%). Conclusions : We believe that laparoscopic surgery is feasible and constitutes a good option for gastric cancer surgery.

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Background and Objectives : We clarified delivery details of preterm low-birth-weight newborns to find ways to help mothers understand the importance of their experience. Subjects and Methods : Nine mothers delivering low-birth-weight newborns at study facilities and who gave consent within one month of delivery were studied in semi-structured interviews analyzed by applying content analysis as suggested by Berelson. Results : Of the 9, 5 delivered by Caesarean section and 4 vaginally. Their delivery experience yielded 6 categories (i) concern for the child's health, (ii) fear of preterm delivery, (iii) satisfied or dissatisfied with the husband's behavior in a critical delivery, (iv) satisfied or dissatisfied with health care professional behavior during delivery, (v) physical pain during delivery, and (vi) mental and physical pain in threatened preterm delivery. (i) concern for the child's health and (ii) fear of preterm delivery accounted for 80% of all comments, reflecting the mothers delivery experience. Conclusion : Our results suggest a need to better support such mothers, who may suffer subsequent low self-esteem. Retrospectively analyzing such feelings during pregnancy may help them understand their experience early in the puerperal period.

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Background : This study aimed to clarify the characteristics and actual conditions in the home environments of children who are exposed to passive smoking in China and Japan. Methods : Participants included 3- to 5-year-old kindergarteners (including children attending nursery schools) who lived in Osaka, Japan (975 children) and Beijing, China (1,021 children). We conducted a questionnaire survey of their guardians. Results : The questionnaires were collected from 583 households (59.8%) in Japan and 632 households (61.9%) in China. There were at-home smokers in 323 households (55.4%) in Japan and 318 households (50.3%) in China. Passive smoking by children at home was observed in 106 households (18.2%) in Japan and 97 households (15.3%) in China. Conclusions : The results of this survey suggest that a common factor to both countries was that the "number of cigarettes consumed per day" is correlated with an increase in the percentage of children who are exposed to passive smoking. Moreover, the findings suggest that the "number of at-home smokers" in Japan and "children aged 5 years old or older" in China increase the percentage of children who are exposed to passive smoking.

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Purpose : Diagnosis of the presence of local gastric carcinoma and determination of the appropriate method of gastric resection during laparoscopic surgery is difficult. Thus, we examined the efficacy of preoperative three-dimensional computed tomography (3D-CT) in laparoscopic gastrectomy. Method : Using an endoscope, we marked the lesion with a clip, photographed the arterial and portal venous aspects every 0.5 mm, and then created a 3D-CT image. Results : The 3D-CT image showed the presence of local stomach cancer, including its position in relation to circumferential blood vessels. It also revealed lymph nodes greater than 5 mm. Furthermore, it was possible to decide the surgical procedure (distal gastrectomy or pylorus-preserving gastrectomy) based on the 3D-CT image information. Conclusion : Preoperative planning, including determination of the appropriate surgical procedure (stomach excision range and lymph node dissection range) on the basis of 3D-CT image information, contributed greatly to successful surgery.

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Background/Objectives : This study aims to elucidate capabilities municipal public health nurses feel is required for health guidance, their acquisition status and the enthusiasm to acquire them. Subjects and Methods : A questionnaire was conducted in G prefecture of public health nurses with more than three years' experience in providing guidance on preventing metabolic syndrome. Forty-one items in six domains of health guidance capability were rated on a 5-point scale of necessity, achievement and enthusiasm. Results : Questionnaires were distributed to 281 nurses of whom 84 returned valid responses. Items of high necessity and enthusiasm were "Use of communication skills" and "support according to behavior modification stage," and items with low achievement were "development of teaching materials based on scientific evidence." Groups with more years of experience or more nurses with experience in providing preventative guidance scored higher in assessing subjects and providing guidance. Conclusion : It was suggested that to improve the ability of public health nurses to provide preventative guidance it is necessary to plan training sessions that focus on the above items with high necessity and enthusiasm, as well as items showing low achievement, and support public health nurses in consideration of experience, including health guidance.

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Purpose : To elucidate the factors that influence the QOL of cancer patients who have undergone radiotherapy in the outpatient setting. Subjects and Methods : The patient's quality of life (QOL) was investigated by using the QOL evaluation standard FACT-G in 73 cancer patients (mean age 64.2±12.2 yrs SD) who had undergone radiotherapy as outpatients. Results : The mean QOL score was 74.8±17.1 pointy, and a significant difference was seen in about 25 items as a result of examining the factors that influenced the patient's QOL. In addition, a stepwise multiple regression analysis revealed that the factors which influenced the QOL were the operation due to the original disease, social support (excluding the family), tiredness, relapse and the metastasis, PS, uneasiness of presence in descending order of influence. Conclusion : The results revealed the strong influence of psychological, mental and social factors on the QOL score. From the patient of view of nursing support for cancer patients, screening for these factors may allow earlier detection of any decrease in the QOL, or identify when the QOL has already decreased. Furthermore, support should be initiated at as early a stage as possible.

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We report a case of intussusception caused by reversed normal cecum with cecal cancer. A 69-year-old woman admitted for abdominal pain was suspected of having obstruction due to intussusception caused by a tumor based on ultrasonography, computed tomography, and barium enema examinations. At laparotomy, intussusception caused by a tumor with a reversed cecum was identified, and another hard tumor was palpable in the cecum. We suspected cecal cancer and performed an ileocecal resection with lymph node dissection. Histopathologically, the tumors involved cancer and reversal of the normal cecum with submucosal edema, which looked like a tumor. We surmised that repeated intussusception caused by cecum cancer had resulted in the reverse of the normal cecum, which completed the intussusception. Although a great number of intussusception-cases caused by tumors have been reported, the condition caused by reversed normal cecum is rare.

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A gallstone was found in a 69-year-old woman during an upper gastrointestinal tract imaging test in April 2008, and she consulted the Department of Gastroenterology at Ojiya General Hospital. Laparoscopic cholecystectomy was performed in May, and symptoms of a hypoglycemic attack were seen postoperatively. Therefore, she received a detailed examination. The Turner index was elevated at 535. Enhanced computed tomography (CT) showed a 0.5-cm hypervascular lesion in the pancreatic tail. An insulinoma was strongly suspected. Percutaneous transhepatic portal venous sampling (PTPVS) showed a rapid rise in insulin concentration in the splenic vein from a point 1/3 distal to a point 1/3 proximal. Dynamic CT showed a 1.5-cm hypervascular lesion in the pancreatic tail. Angiography and endoscopic retrograde pancreatography revealed no abnormalities. Enucleation of the tumor was performed in July. Pathological examination revealed an islet cell tumor (typical case). Immunohistochemical staining for insulin, glucagon, somatostatin, and synaptophysin was performed. Insulin and synaptophysin were positive. The patient has had no recurrence in the 28 months after surgery.

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