The precise emotional process of middle-aged individuals after the onset of a first acute myocardial infarction（AMI）is not known. We sought to clarify the contents of middle-aged individuals’experience of having a first AMI. I interviewed with 11 individuals（10 men, 1 woman, aged 39 to 64 yrs）who had a first AMI about their AMI experience in the way of unstructured face-to-face interview. A qualitative phenomenological approach was used to clarify their experiences. Each individual described their psychological process from the point of experiencing the AMI through their recovery. They described facing their own potential death calmly. Their experiences could be classified as progressing through the following three phases over the course of their AMI onset, treatment and recovery. Phase 1：feeling of uncertain about their life and being upset, Phase 2：accepting life prospectively and thinking about self-control, and Phase 3：integrating their outlook for the future and their newly expanded view of life and death. The process of middle-aged individuals from onset to 3 months after a first AMI was very emotionally unstable. The results indicated a necessity for spiritual care promoting self-empowerment for patients with AMI.

A survey of Japanese adult women was performed to clarify the status of urinary incontinence treatment, correlation between vaginal pressure and urinary incontinence, and awareness and implementation of pelvic floor muscle training exercises. Anonymous self-administered questionnaires together with vaginal pressure measurement were conducted from March 2010 to July 2012 for the 88 participants recruited from a hospital.

Based on the survey results, 13 participants（14.8%）were classified as having urinary incontinence and another 33（37.5%）as having a history of urinary incontinence, and 42（47.7%）reported having no urinary incontinence. Among the 13 women reporting urinary incontinence, one was undergoing treatment, two had a treatment history, and 10 had no treatment history. Among those with no history of treatment for urinary incontinence, 50% had a mean onset period of >7 years, which indicated that many women had neglected urinary incontinence for a long time. Among the enrolled participants, 65.9% were aware of pelvic floor muscle training exercises, but only few were regularly performing or had performed these exercises. To examine the association between vaginal pressure and urinary incontinence, maximum contraction pressure, mean contraction pressure, and duration of contraction of the three groups were compared. The group with no urinary incontinence showed the highest values in all items, however, no significant differences were observed among the groups and vaginal pressure levels in all the groups varied widely. The above results highlight the importance of accurate knowledge of women’s urinary incontinence treatment to avoid negligence that could aggravate the condition. In addition, increasing vaginal pressure is not necessarily required for women’s urinary continence, but conscious contraction of the pelvic floor muscles at the time of increased abdominal pressure or just before having the urge to urinate is considered to be more important.

Some congenital malformations can be diagnosed during pregnancy, but many others are suspected after birth and genetic testing is conducted in neonatal setting. Parents have to take care of their children in an uncertain situation until the diagnosis is confirmed. The aim of this study was to clarify the mothers’awareness and its related factors of neonatal care they receive before having genetic testing for their infants with suspected congenital anormaly.

In this cross-sectional study, 59 mothers who have children with Down syndrome completed a questionnaire through family peer support associations. As the results of factor analysis, mothers’awareness of nurses’facilitation of parental attachment consisted of three categories；support to mothers in understanding their baby and information sharing；support for mother-child attachment；nurses’attitude to mothers. Mothers perceived nurses’attitudes to them as positive experiences describing；nurses provided care with non-biased attitude（76%），nurses helped mothers to be aware of their child’s growth（85%），and nurses honored mothers’will in childcare（63%）．However, less than 40% of mothers felt positive about nurses’support for mother-child attachment such as touching and hugging. As the related factors of their awareness, parity and hospitalization in NICU/GCU were significantly associated with support in understanding their baby and information sharing. Timing of nurses’explanation to mothers and respiratory care of infant were associated with nurses’ attitude to mothers. The study indicates that nurses should provide quality information and facilitate parental attachment depending on the infants’symptoms and mothers’background and concerns.

Vasodilators are widely and frequently used for the acute or chronic phases of cardiovascular diseases, including ischemic heart diseases, hypertension, and heart failure. To enable the reliable prevention of such cardiovascular diseases, we attempted to discover foods or food components that induce vasorelaxation of the porcine coronary arteries. In the present study, after extensive screening, we eventually identified fish-derived peptide fragments（FDPFs），which were obtained via the edible enzyme digestion of fish proteins.

Using tandem mass spectrometry, we identified four novel peptides with sequential amino-acid sequence（VGPGG, VGPG, GPG and PG）among the FDPFs. These peptides are previously unreported and induced concentration-dependently strong and sustained vasorelaxation. The extents of the relaxation increased as the length of the peptides are longer, suggesting the involvement of the membrane receptor. The most potent and longest peptide, VGPGG induced vasorelaxation without any changes in［Ca２+］i, indicating the decrease in Ca２+-sensitivity of smooth muscle contraction. These findings support the possibility that these FDPFs may be highly promising food components for use in the prevention of cardiovascular diseases. In addition, these novel peptide are also highly soluble in water and therefore might have applications as intravenously injectable medication for the treatment of acute and severe cardiovascular diseases.

A 64-year-old female visited her local hospital in July 2013 with the chief complaint of epigastralgia. She was diagnosed with acute pancreatitis and treatments were started. The next day, worsening of the disease was determined and she was transferred to our hospital. Then intensive treatment was started with continuous regional arterial infusion of protease inhibitors, antibiotics, and continuous hemodiafiltration（CHDF）．Although inflammation improved gradually, on day 34, the patient developed fever. CT scan revealed walled-off necrosis（WON）near the superior mesenteric artery. Conservative treatment with antibiotics administration led to no improvement and therefore, transduodenal drainage and percutaneous transhepatic abscess drainage were performed. On day 84, the pseudo-aneurysm in the WON ruptured, and gastrointestinal bleeding occurred. Hemostasis was achieved by transarterial embolization. The patient made steady progress. Then she was discharged from the hospital on day 192. Here we experienced a case of severe acute pancreatitis that developed various complications and was successfully treated using multimodal therapy. We report our case with a brief review of the literature.

Tarry stool indicates bleeding from diseases in the upper gastrointestinal tract such as peptic ulcers or rupture of varices. A 64-year old man complaining of tarry stool visited a hospital for check-up. Upper and lower gastrointestinal endoscopic examination revealed a submucosal tumor-like protruding lesion at the duodenal bulbus. Obvious bleeding was never seen around this lesion. Because there was a erosion on the polypoid lesion,　we considered that the lesion was the source of bleeding. The resected specimen revealed that tumor size was 30×25mm and histological diagnosis was Brunner’s gland hyperplasia. We report a case of duodenal tumor found by tarry stool.

We experienced a case of carcinoma arising in the reconstructed gastric tube after a radical operation for esophageal cancer. This patient, a 73-year-old man who had undergone haemodialysis for 10 years due to chronic renal failure, underwent subtotal esophagectomy and retrosternal reconstruction by a gastric tube for esophageal cancer 3years earlier. Ⅱc type early cancer of the gastric tube was discovered in the middle part of the stomach by periodic endoscopy in September 2012. Endoscopic biopy showed signet ring cell carcinoma so endoscopic mucosal resection was unable to be indicated for the case. The patient rejected the operation of a resection of the gastric tube, and he was therefore adminis-tered oral UFT. We followed this case by gastroendoscopy every three months and by PET/CT every six months. PET in May 2013 demonstrated metastases of right bronchopulmonary lymph nodes, so we administered only 2 course of CPT-11（bi-weekly drip infusion）added to oral UFT. As of 2 years after the administration of UFT, the patient is still doing well. In July 2014, endoscopy revealed reduction of the Ⅱc lesion and pathological findings of a specimen revealed no residual cancer cells, indicating a partial response to UFT therapy. The prognosis of cancer in the gastric tube is generally poor, but many suvivors have been reported due to early diagnosis. Regular endoscopy every 6 monthes after esophagectomy is necessary to detect the disease in an early stage. Oral uracil and tegafur therapy is considered to be one of treatment option for the patients with early cancer of gastric tube from a standpoint of clinical efficacy and safety.

We report a rare case of Meigs syndrome caused by ovarian metastases from sigmoid colon cancer. A 55-year-old woman was admitted to our hospital for investigation of genital bleeding. Colonoscopy showed type2 tumor in sigmoid colon. CT scan demonstrated bilateral pleural effusion and a right ovarian tumor with mixed cystic and solid portions. A laparotomy was performed based on the suspicion of colon cancer with ovarian metastasis or synchronous cancers of the colon and ovary. A sigmoidectomy with D3 and bilateral oophorectomy with hysterectomy were performed. Ovarian metastasis of colon cancer was diagnosed by immunostaining. The postoperative course was uneventful, pleural effusion decreasing remarkably. The patient discharged on 14 postoperative day. She underwent postoperative chemotherapy consisting of bevasizumab and XELOX in outpatient clinic. She is still alive without any evidence of recurrence 14 months postoperatively. When we encounter female patients who have a pelvic tumor with pleural effusion and ascites, we need to guess Meigs’ syndrome. It is necessary for the patients to have close examination of the alimentary tract. We may not make a wrong diagnosis of this syndrome as terminal stage of carcinomatosa of colorectal cancer.

We reported a rare case of early duodenal bulb cancer which occurred in the pyloric ring vicinity. The patient was a 77-year-old man with upper abdominal distention after meals as the chief complaint. We performed an upper gastrointestinal endoscopy, an upper gastrointestinal series and an enhanced abdominal CT examination. These examinations revealed an approximately 3cm mass lesion in the duodenal bulb. Although endoscopic biopsy revealed Group 3, it was difficult to resect the mass lesion by endoscopic therapy. Furthermore, the mass lesion had malignant possibilities, we decided to perform surgery. Because we confirmed the mobile mass lesion in the duodenal bulb during operation, we performed a necessary distal gastrectomy. However, we were not able to confirm the swelling of neighboring lymph nodes. Macroscopically, the tumor was 1.5cm in stalk and was 2.0×2.0×1.0cm in size, at the duodenal bulb. Microscopic diagnosis was well differentiated tubular adenocarcinoma of the duodenum, limited with in mucosal layer.

Duodenal varices（DV）are the most common of ectopic varices. Although bleeding from DV is rare, it is difficult to control bleeding and sometimes fatal. We have encountered four clinical cases of ruptured DV. Case 1：A man in his 80s presented with a history of partial gastrectomy with Billroth-II reconstruction and LC due to chronic hepatitis C. We performed single-balloon endoscopy and injected 67% N-butyl-2-cyanoacrylate（NBCA）for DV on the afferent loop with red plug. Case 2：A woman in her 40s with primary biliary cirrhosis complained of tarry stool and anemia. We performed endoscopic injection sclerotherapy（EIS）with 67% NBCA for spurting bleeding point in duodenum. Case 3：A man in his 50s with liver cirrhosis（LC）due to chronic hepatitis B complained of tarry stool. We performed endoscopic variceal ligation（EVL）and balloon-occluded retrograde transvenous obliteration（B-RTO）for DV. Case 4：A man in his 60s with alcoholic LC complained of tarry stool. We performed EIS with 67% NBCA for DV. We added EVL, clipping, and argon plasma coagulation after EIS to control bleeding. To control bleeding was achieved in all cases.

Case 1：A 72-year-old woman visited us with a complaint of right axillary lymph node swelling. Breast cancer metastases to the axillary lymph nodes were suspected. Even with mammography（MMG），ultrasound（US），computed tomography（CT），and magnetic resonance imaging（MRI），the primary lesion could not be identified. Axillary lymph node biopsy revealed invasive lobular breast carcinoma. She was diagnosed with latent breast cancer and underwent mastectomy and axillary lymphadenectomy. Case 2：A 60-year-old woman visited us with a complaint of right axillary lymph node swelling. Despite various examinations, including MMG, US, CT and MRI as in Case 1, the primary lesion could not be identified. Axillary lymph node biopsy revealed invasive ductal breast carcinoma, leading to a diagnosis of latent breast cancer. She underwent mastectomy and axillary lymphadenectomy. Postoperatively, both patients have remained recurrence-free for two years to date. Latent breast cancer develops at a low incidence, 0.3－1% of all breast cancers, and therapeutic strategies are determined on an individual basis at each institution. While insufficient treatment increases the possibility of recurrence and metastasis, excessive therapy should be avoided. Therefore, determining the optimal therapeutic strategy can be challenging. We advocate accumulating more cases to establish systematic therapeutic guidelines.