Recently, the number of pregnant women of advanced maternal age（AMA）has been increasing rapidly. Women of AMA might be facing whether to undergo screening or invasive test to detect whether the fetus has an abnormality. This article summarized maternal-specific risks regarding advanced maternal age and explored the points of primary care for pregnant women and their partners from the result of our two studies.

Our finding suggested that many women aware of pregnancy risks such as Down syndrome related increasing maternal age by surrounding children with Down syndrome and/or handicapped. But, most not aware risks in detail and a few not aware of the risks completely. While women often had discussion about testing with husband, some made individual choices and/or withheld information from husband. Nurses and health professionals need to adequately inform pregnant women about the genetic risk as their age and tests. Also, it is important to support for decision making process of the family.

Recent advances in medical therapies, including percutaneous local therapy, transcatheter arterial therapy, and chemotherapy, have improved the prognosis of hepatocellular carcinoma（HCC）. Percutaneous local therapy started with percutaneous ethanol injection in the 1980s in Japan, and radiofrequency ablation（RFA）is now the norm. We designed balloon-occluded RFA to increase the area of coagulation necrosis compared to standard RFA. In transcatheter arterial therapy, transcatheter arterial chemoembolization, which was developed in the 1970s in Japan, has assumed a prominent role. Recently, drug-eluting beads-transcatheter arterial chemoembolization, which is used in Western countries, has been performed in Japan, and its efficacy must be investigated. In chemotherapy, although the multikinase inhibitor sorafenib is currently recommended as the standard of care worldwide, the response rate for sorafenib therapy is low, at approximately 2-3%. In contrast, the response rate for hepatic arterial infusion chemotherapy, which is used in Japan and Asia, is approximately 30-40%. However, there are no established criteria for the selection of hepatic arterial infusion chemotherapy or sorafenib. We have shown the efficacy of an alternative drug, the iron chelator deferoxamine, in advanced HCC patients, and a clinical trial investigating the efficacy of the oral iron chelator, deferasirox, for advanced HCC is now ongoing.

Fatty acids are important nutrients for various biological reactions. Recent epidemiological evidence suggests that dietary consumption of some PUFAs such as DHA and EPA may modify the risk for certain immune disorders. However, the molecular basis of their actions is still to be clarified. Since long chain fatty acids are hydrophobic molecules, they are solubilized and transported within the cells to exert their cellular functions by specific intracellular lipid binding proteins, the low molecular mass polypeptides of termed fatty acid binding proteins（FABPs）．In this review, we describe the expression and the function of FABPs in immune stroma cells. Stromal cells are important part of immune organs. Recent studies show that fibroblastic reticular cell（FRCs）have important roles in lymph node T cell area. We found that FABP7 is localized in T cell area FRCs and regulates T cell homeostasis in lymph nodes and the spleen. In the liver, FABP7 localizes in Kupffer cells（KCs）and involves in the liver injury process through its regulation of KC phagocytic activity and cytokine production. Our data indicate that FAPBs regulate self defense mechanisms and may be involved in immune homeostasis, possibly by modulating lipid metabolism in stroma cells.

Severe fever with thrombocytopenia syndrome（SFTS）is an emerging tick-borne infectious disease caused by the SFTS virus（SFTSV），a novel phlebovirus reported to be endemic to China in 2011. In Japan, the first SFTS patient was identified during the autumn of 2012；since then, over 140 SFTS patients have been reported. The SFTSV has been identified throughout Japan over the past two years；however, SFTS patients are specifically localized to western Japan. The clinical symptoms of SFTS include fever, thrombocytopenia, leukocytopenia, gastrointestinal symptoms, and various other symptoms, including muscular symptoms, neurological abnormalities, and coagulopathy. SFTS is often accompanied by hemophagocytic syndrome. The histopathological findings are characterized by necrotizing lymphadenitis, with infiltration of the virus-infected cells to the local lymph nodes. Pathophysiological analyses of SFTS include studies regarding the kinetics of cytokine production and immune responses in patients with SFTS and in SFTSV-infection animal models. This article aimed to survey the history of SFTS in Japan and to review the clinical, epidemiological, and virological aspects of SFTS and SFTSV infection.

The purpose of this study was to clarify basic principles that create“the best care for the person”using the mentor relationship between an instructor and a nursing student during clinical practice.

A student nurse exhibited indecision with regard to a request from a patient. This episode was visually analyzed by interpretive phenomenology using the Pathways to Excellent Nursing Practice model that was developed by the author in a previous study.

The results generated the following findings. The basic student-instructor relationship cycle that was developed in this study contributed to the student’s growth as a nurse. While repeating the cycle, the issues of the student who exhibited indecision should be identified, and then the student should be advised how to decide for herself. The advice to the student should be found by explaining the nursing care the instructor would perform in the same situation.

These findings were identified as basic principles to create the best care for the person. Furthermore, these should be refined while being utilized in practice.

This study aimed to develop a scale to measure work-related stressors among Japanese midwives working in hospitals and to determine potential demographic and job-related factors that may be associated with burnout.

A mailed self-administered questionnaire survey targeted 839 midwives working at 161 hospitals across Japan. In order to determine the relationship between the Maslach Burnout Inventory（MBI）subscales and work-related stressors, factor analysis and multiple regression analysis were carried out.

Valid responses were obtained from 708 participants（valid response rate：84.4%）with a mean age of 35.2 years. A Midwife Work-Related Stress Scale consisting of 55 items in the following 8 categories was created："poor collaboration between midwives and obstetricians"（factor 1）；"low self-evaluation of own midwifery practice"（factor 2）；"poor co-worker（midwives）support"（factor 3）；"difficult relationships with pregnant women or their families（factor 4）；"excessive workload"（factor 5）；"demand of duties besides midwifery job"（factor 6）；"unsatisfactory performance of care"（factor 7）；and "inadequate management system"（factor 8）．Variables associated with subcategories of the Midwife Work-Related Stress Scale comprised "age", "salary", "work position", "years of midwifery experience", "night work", "number of midwives", and "obstetrics bed capacity". Variables associated with the MBI were "age", "night shift", "poor co-worker（midwives）support", "difficult relationships with pregnant women or their families", and "excessive workload".

The present study confirmed the reliability and validity of the Midwife Work-Related Stress Scale. These findings suggest that an effective strategy for preventing burnout in midwives is to develop educational and supportive systems, reduce the quantitative work burden, and obtain supportive feelings from colleagues and supervisors.

【Background】We report a case of unclassified lung carcinoma diagnosed after the treatment for small cell lung carcinoma.【Case】The patient is a man of 60 years old. The patient was treated with systemic chemoradiotherapy for small cell lung carcinoma developed in the right lower lobe S8（T1bN2M0）．Regardless of achieving complete remission, the patient developed metachronous solitary lung nodule in the same lobe（S10）．The nodule could be controlled for 16 months by chemotherapy against small cell carcinoma. Because the nodule became to be chemotherapy-resistant, the patient underwent surgery. Postoperative pathological examination revealed features of being unclassified carcinoma of the lung. The patient is aliving without recurrence 29 months after the operation.【Conclusion】Although it remains unknown whether the secondary lung lesion is metastatic or second primary lesion, surgery played a role as a curative intent treatment.

We report herein the case of an 83-year-old woman with torsion of the gallbladder. The patient was admitted to our hospital for investigation of abdominal pain and a cholecystitis was subsequently diagnosed by ultrasonography（US）．An abdominal computed tomography（CT）revealed a torsion of the gallbladder. Thus, cholecystectomy was performed. Her postoperative course was unremarkable and she discharged 10 days after surgery. CT is a standard noninvasive imaging technique used for visualizing the gallbladder, the advantage of which include its safety, high sensitivity, specificity, and accuracy with three imaging angles.