Although a combination test of alpha-fetoprotein（AFP）and protein induced by vitamin K absence or antagonist-II（PIVKA-II）is covered by public insurance in Japan for the screening of hepatocellular carcinoma（HCC）in patients with chronic hepatitis and/or cirrhosis, its diagnostic performance for early-stage HCC is limited. To resolve this, we investigated whether a liquid biopsy of methylated SEPT9 and methylated HOXA1 may complement the diagnostic performance of AFP and PIVKA-II for early-stage HCC. We measured AFP, PIVKA-II, and copy numbers of methylated SEPT9 and HOXA1 in serum from 25 healthy controls, 30 patients with chronic liver disease, and 78 patients with HCC（including 44 patients with early-stage HCC）．Sensitivity and specificity for early-stage HCC were, respectively, 56.8% and 94.5% for the combination of AFP and PIVKA-II；77.3% and 89.1% for the combination of AFP, PIVKA-II, and methylated SEPT9；and 63.6% and 90.9% for the combination of AFP, PIVKA-II, and methylated HOXA1. Having the highest sensitivity and considerable specificity, the combination of AFP, PIVKA-II, and methylated SEPT9 appeared to be the best companion test for detecting early-stage HCC.

Elderly people living with dementia often have some other illnesses and lots of them receive home care services. The purpose of this study is to clarify through a qualitative analysis how community-based care hospital nurses and home-visiting nurses collaborate in practicing dementia care and support hospitalized elderly patients returning home.

The first interview was conducted with twenty-one community-based care hospital nurses, and the results suggested that they were struggling with conflicts related to fulfilling their own role and limitations of ward nursing.

Seventeen home-visiting nurses were the participants of the next interview. Two categories of“sharing the specialty of home-visiting care”and“practicing nurse-to-nurse collaboration” and 9 subcategories including“understanding home-visiting care by hospital nurses”were identified. Hospital nurses need to enhance their understanding of home-visiting care and collaborate with other healthcare professions in order to support elderly patients with dementia returning home.

These results indicated that developing and putting into practical use since early phases after hospitalization a visualized system of nurse-to-nurse collaboration according to process of medical treatment and rehabilitation might be effective to support elderly patients returning their own homes from both the hospital and home care perspectives.

Congenital long QT syndrome is a disorder in which the QT interval on electrocardiography is prolonged due to an abnormality in the genes encoding ion channels in cardiomyocytes, which sometimes results in fatal arrhythmias. We herein report a case of congenital long QT syndrome type 2（LQT2）with a de novo novel nonsense mutation in the KCNH2.

An asymptomatic 13-year-old female client was admitted to Yamaguchi University Hospital for further examination of QT prolongation that was found in a school physical examination. A catecholamine provocation test showed further prolongation of the QT interval. She has been followed up as an outpatient once a year for six years. In this time, there have been no symptoms. When she was 18 years of age, genetic testing was performed for her and her family. As a heterozygous nonsense mutation of KCNH2 c.1490G>A, p.Trp497Ter was found only in the patient, de novo mutation was confirmed. Furthermore, as the association between the variant and long QT syndrome has not been reported, it seemed to be a novel mutation. Although she has remained asymptomatic thus far, she should be followed up carefully because female patients with LQT2 have an increased risk of cardiac events after puberty.

A man with diabetes, hypertension, and atrial fibrillation visited the emergency department for　melena. Emergency upper gastrointestinal endoscopy revealed bleeding from a gastric hyperplastic polyp. Hemostasis was performed with clips, and EMR was performed the next day. The histopathology diagnosis was early gastric cancer in gastric hyperplastic polyp. In cases of major bleeding from gastric hyperplastic polyp, it is important to perform hemostatic treatment in a way that allows for accurate pathological diagnosis.