Positron Emission Tomography (PET) using ¹⁸F labelled fluorodeoxyglucose (a radioactive glucose analog) has been playing an important role in clinical oncology covering 40％ of about 700,000 nuclear medicine imaging procedures performed in a year in Japan. For about the past decade, most PET images have been obtained through dual-modality PET/CT imaging that is performed with physically combined PET and CT systems. This supports the intrinsic fusion images of function (PET) with anatomical images (CT). PET/CT images are indispensable for precise diagnosis, localization, treatment planning, and evaluation of treatment effects and recurrence of cancer. The first, fully-combined PET/CT systems were commercialized in 2001 after clinical tests performed by a group headed by David Townsend in 1998 at the University of Pittsburg Medical Center. This article commemorates the first and early efforts which took place at Gunma University Hospital towards a clinically meaningful integration of PET and CT imaging. Namely, we review the origins of the Gunma approach to place PET and CT devices side by side, which enabled combined PET and CT images to be used for clinical diagnosis of brain diseases. The authors acknowledge Prof. Teruo Nagai for establishing this pioneering trial. Two episodes which made this excellent trial known in the international nuclear medicine communities are described together with acknowledgement of the scientific fairness shown by Drs. Townsend and Beyer, pioneers of modern PET/CT.

　　Declining of population and aging of local residents are progressing throughout Japan. This tendency is apparent in remote highland areas with limited industrial activity and severe natural environments. The upstream area of the Watarase River have these industrial and environmental factors as do other remote areas in Japan. In addition, this area has special factors such as the Ashio Copper Mine Industrial Pollution, the closure of the Ashio Copper Mine, and complicated municipal divisions. In this survey, we investigated the demographic trends and medical services in three municipalities in the upstream area of the Watarase River. We identified that the population decline and aging in this area are more rapid than in the whole of Japan or Gunma Prefecture, and that it is becoming gradually difficult to give adequate medical services to injured and sick people in the areas. It is highly possible that there are many similar areas in Japan, and such areas are expanding further in the future.

　　Dry mouth (xerostomia) is an unpleasant symptom caused by decreased moisture in the oral cavity. Saliva has many functions, such as lubrication, food mass formation, disinfection, remineralization, and protection of the oral mucosa. However, dry mouth not only deteriorates these functions and worsens the oral environment but can also adversely affect the quality of life, by leading to infection, dysphagia, and nutritional disorders. The causes of dry mouth include the autoimmune disease Sjögren’s syndrome; radiation therapy to the head and neck region directly affecting the salivary glands; side effects of medications such as antihypertensive drugs, psychiatric medications, and anti-allergy drugs; and stress. If a triggering disease (e.g., diabetes and anemia) is identified, treatment should be aggressive; if a drug side effect is suspected, countermeasures should be taken, including drug reduction, in cooperation with the prescribing physician. Dry mouth is treated by prescribing salivary gland stimulants, artificial saliva, salivary gland massage, and moisturizers. However, these are all symptomatic treatments, and the development of curative treatments is needed.

　　Clinicians must have a correct understanding of this disease and respond to it appropriately to prevent it and extend the healthy life expectancy of the population. This article describes the basic and clinical aspects of dry mouth.

Background & Aims: Nursing education in Japan requires learning about cultural competence. This study aimed to clarify the intercultural learning and changes nursing students experienced from participating in joint classes with international students.

Methods: The joint lessons were conducted in four stages, and reports from all stages were analyzed. Data were analyzed qualitatively and inductively. Learnings about different cultures were extracted and categorized.

Results: Across all learning stages, 44 subcategories and 21 categories of intercultural learning were extracted. Through repeated contact, the nursing students gained concrete knowledge and became aware of the differences between themselves and the international students. As the study progressed, the nursing students gained more concrete knowledge, increasing the level of abstraction and grasping the overall structure of intercultural understanding.

Conclusions: As the nursing students had more intercultural contact, their intercultural learning changed in the following order: “prediction,” “notice,” “comparison and evaluation,” and “understanding at a more abstract level.” Exposure to different cultures is an effective way to improve the cultural competence of nursing students.

　　The Rapid Response System (RRS) was introduced to Gunma University Hospital in 2014. We conducted a survey to clarify the status of and identify problems with this system. The results indicated that the number of RRS activations was still low, but increasing, and the number of unexpected cardiac pulmonary arrests (CPAs) had not decreased. To increase the number of RRS activations, we have adopted RRS training in nursing education, which has led to an increase in the number of activations by nurses. A review revealed that there were CPA cases in which signs of severe deterioration were overlooked. Thus, efforts should be made to identify such cases and increase the number of RRS activations.

　　A 61-year-old woman came to our hospital with a chief complaint of orbital pain. She was　admitted to our hospital with a diagnosis of small intestinal obstruction based on a simple contrast-enhanced computed tomography(CT) scan that showed mass-like wall thickening of the small intestine and dilatation of the intestinal wall at the mouth. Subsequently, small intestine endoscopy was performed, which revealed a whole circumferential elevated lesion in the jejunum. Biopsy results showed adenocarcinoma, and the diagnosis of small intestinal cancer was made. No metastasis was evident, and a partial resection of the small intestine was performed by laparotomy. Surgical findings showed that the tumor was located 50 cm from the Treitz ligament on the anorectal side. The tumor was resected at a distance of at least 5 cm from the tumor on the oral and anal sides, and the mesentery was dissected in a fan shape with the root of the SMA (superior mesenteric artery) branch of the J1a (first jejunal artery) at the apex. The patient had no postoperative problems. Cancer of the small intestine is extremely rare, and standard surgical technique has not been established to define the extent of bowel resection and lymph node dissection. According to previous reports, the most common lymph node dissection is that of the middle lymph node. One year after surgery without adjuvant chemotherapy, the patient is doing well with no signs of recurrence.

　　Primary small bowel cancer is a rare cancer, and standard treatment has not been established. We report a case of primary small bowel cancer with a review of the literature regarding the extent of dissection and treatment.

　　This study analyzes the meaning of work during treatment based on the narratives of middle-aged patients with breast cancer undergoing postoperative adjuvant chemotherapy. The study found that work means “a purpose in life,” “connections with people at work,” and “time to forget about illness.” Moreover, work occupies an important place in the patients’ lives, and they feel fulfilled by it. Notably, when patients consider retiring due to various side effects of treatment, work signifies “leaving my way of life to my children,” “taking responsibility for the results I have built,” and “being useful to people at work.” This corresponds to generativity, which in turn is in consonance with the developmental tasks of midlife and the care acquired through this generativity. We believe that the present study, as clarified by the three participants, represents a new perspective for future outpatient nursing.