We introduced active educational methods in medical ethics education and evaluated their effect on medical students. Three methods were used: 1) small-group discussion to clarify the clinical ethical issues, 2) self-study to analyze examples of doctors' explanations to patients, and 3) self-study with videotapes to recognize informed consent. We asked students to write a report on each subject of the three studies. Before grading their reports, we determined a standard answer for each subject and marked their reports according to an absolute standard. We found the mean value and standard error of the students' scores in study 1 were significantly higher than those in study 2 or 3. These results suggest that small-group discussion is an effective educational method and useful in the analysis of clinical ethical issues.

Objectives
The study aims to clarify the difficulties of pregnancy, delivery, and child raising for immigrant women in Japan and their strategies for overcoming them.
Methods
The semi-structured interviews were conducted with 18 immigrant women who have experience of delivery or child raising in Japan. The participants were asked about their experiences and difficulties faced during pregnancy, delivery, and child raising, and how they overcame them. The data were analyzed in a qualitative and descriptive manner.
Results
Seven core categories of difficulties were extracted:«anxiety about child raising»,«problems with relationships with others»,«socio-economic problems»,«anxiety about pregnancy, delivery, and diseases»,«problems caused by illiteracy»,«lack of understanding about Japanese health system»,«choice of the delivery country». Women's«making efforts to manage»is supported by family members and it leads to«use of the Japanese health system». Getting support from friends and neighbors, and the use of an interpreter also leads to this. Some women try to overcome the difficulties by«using a non- Japanese health system»or«doing nothing».
Conclusions
When foreigners access health services, not only literacy but also health literacy, such as understanding medical terms or health systems are necessary. Many immigrant women got support from family and friends to overcome the difficulties. However, some women could not get such support and it is necessary for them to make a support network. Foreign women who take negative strategies and use non-Japanese health systems may be in the process of adjusting to Japanese society. Health providers should not deny such strategies, but understand them as a way of decreasing anxiety.

Fifth-year medical students at the Yamaguchi University School of Medicine must pass an objective structured clinical examination (OSCE) before beginning bedside learning. Because the OSCE is performed over 3 days, examinees on later days are suspected of having an advantage over those tested on early days. In this study, mean values for each day's scores by one examiner were statistically compared in stations of the medical interview to investigate the difference in scores obtained on each of the OSCE days. In addition, for stations at which one student was evaluated by two examiners, their scores for each student were compared statistically in the same manner. We found no significant day-todaydifferences in mean values of the scores over the 3 examination days. However, significant differences were found between the two examiners' scores in 2 of 3 stations for the medical interview. Although there were no differences in scores among participants during the 3-day communication OSCE, examiner's evaluations and formats should be standardized for OSCE stations.

  Dietary management during chemotherapy for cancer can improve a patient's nutritional status through an adequate dietary intake, and increase the therapeutic effect.  In this study, we performed a questionnaire survey of inpatients in chemotherapy about their dietary preferences and changes in their senses of taste and smell, with the aim of producing a ‘chemotherapy menu’, utilizing recipes and foodstuffs to produce a palatable menu for those patients with their appetite diminished. We received responses from 102 out of 109 in patients surveyed (94%). Of the respondents, 66% rerealed that they had a decrease in appetite during chemotherapy, of whom 85% complained of extremely poor appetite. The smell of fish dishes disturbed 29% of the respondents, of whom 62% reported a stronger aversion to hot dishes. The foods easy to eat were found to be fruits, noodles, and soups. Meat and fish dishes, white rice, and stews were difficult to eat. Seasoning with tomato sauce made food difficult to eat for 44% of the respondents, whereas soy sauce was shunned by only 6%. The survey also found that 38% liked the use of Furikake (dried seasoning sprinkles), because it could make the meals palatable.  Based on the survey results, we devised an 8-day ‘chemotherapy menu’. It includes a Japanese style breakfast, with bread as an option, and many foods easy to eat, such as flavoured rice, sushi, noodles, sandwiches, and fruits. We have offered this menu to 47 inpatients, with average eating rates of greater than 70% for both rice and dishes. We will further conduct surveys with a view to producing a ‘chemotherapy menu’ palatable for as many patients as possible.

Objective: To determine the safety and efficacy of dose-dense (dd) paclitaxel (PTX) and carboplatin (CBDCA) in treating advanced or recurrent endometrial cancer. Methods: Women aged 20–75 years with histologically confirmed endometrial cancer, the International Federation of Gynecology and Obstetrics (FIGO) stage III disease with some residual tumor, FIGO stage IV disease, recurrence after front-line curative treatment, or recurrence after second-line chemotherapy or radiotherapy were enrolled in this study. PTX (80 mg/m2) was administered intravenously (IV) to every participant on days 1, 8, and 15, and CBDCA (area under the curve of 5) was administered IV on day 1 once every 3 weeks until the disease progressed, unacceptable adverse events occurred, or consent was withdrawn. The primary endpoint was the response rate (RR), while the secondary endpoints were progression-free survival, overall survival, and adverse effects. Results: Forty-eight participants were enrolled, and 46 were eligible to receive treatment. The patients' median age was 61 years (range, 43–76 years). Twenty-two participants had experienced recurrence, and the remaining patients had primary advanced endometrial cancer. There were 10 cases of serous carcinoma, 3 cases of endometrioid carcinoma G3, 2 cases of carcinosarcoma, and 2 cases of clear-cell carcinoma according to histology. Twenty-nine participants (63.0%) received ≥6 cycles of chemotherapy. The RR (complete, 13 cases; partial, 20 cases) was 71.3% (95% confidence interval: 59.0%–84.5%). Conclusion The dd PTX with CBDCA is feasible and available as a treatment option for advanced or recurrent endometrial cancer.

A 57-year-old man was admitted with high fever and chest discomfort associated with aortic valve infective endocarditis. An echocardiogram showed severe aortic valve regurgitation. An emergent operation was performed. The aortic valve was destroyed and an annulus abscess was observed. Aortic valve replacement was performed. There was a large amount of pleural effusion in both chest cavities. Bilateral chest drainage was performed. Cardiopulmonary bypass weaning was performed uneventfully. The operation was finished without any mechanical support required. However, respiratory failure was observed to progress rapidly immediately after the operation. A postoperative X-ray showed bilateral pulmonary edema. Re-expansion pulmonary edema was diagnosed. Because oxygenation was not improved in ventilator settings, venovenous extracorporeal membrane oxygenation (V-V ECMO) was installed. Respiratory support with V-V ECMO was needed for 17 days postoperatively. It took 36 days before the patient was removed from the ventilator. V-V ECMO successfully managed bilateral re-expansion pulmonary edema.

A 57-year-old man presented with a one-month history of dyspnea. Computed tomography revealed a pulmonary embolism, and echocardiography revealed multiple linear floating thrombi in the right atrium. An urgent surgical thrombectomy was performed, and most of the thrombi in the right atrium and bilateral pulmonary arteries were removed under cardiopulmonary bypass. The thrombi in the right atrium adhered to the linear Chiari networks. The patient was treated with rivaroxaban uneventfully and subsequently discharged on postoperative day 26. Herein, we report a case of right atrial thrombi and pulmonary embolism likely augmented by the Chiari network, which was successfully treated with surgical thrombectomy.

In this study, we investigated the effects of severe hemolysis (hemoglobin [Hb] > 500 mg/dL) in blood specimens by classifying them into non-hemolysis, hemolysis (Hb ≤ 500 mg/dL), and severe hemolysis. Investigated items were total protein (TP), albumin (ALB), total bilirubin (T-Bil), direct bilirubin (D-Bil), aspartate transaminase (AST), alanine aminotransferase (ALT), lactate dehydrogenase (LD), alkaline phosphatase (ALP), gamma-glutamyl transferase (γ-GT), creatine kinase (CK), amylase (AMY), cholinesterase (ChE), blood urea nitrogen (BUN), creatinine (Cre), sodium (Na), potassium (K), chloride (Cl), calcium (Ca), uric acid (UA), triglycerides (TG), total cholesterol (T-Cho), high-density lipoprotein cholesterol (HDL-C), lowdensity lipoprotein cholesterol (LDL-C), and C-reactive protein (CRP), and actual clinical test results were used. Based on the results, we were able to classify the error relationships into three groups according to hemolysis status. Group A shows an error between non-hemolysis and hemolysis, and an even stronger error in severe hemolysis (T-Bil, AST, LD, Na, K, Ca, and UA). Group B showed no error between non-hemolysis and hemolysis, but errors in strong hemolysis (ALB, D-Bil, ALT, γ-GT, CK, AMY, TG, T-Cho, HDL-C, and LDL-C). Group C shows no errors in either hemolysis or strong hemolysis (TP, ALP, ChE, BUN, Cre, Cl, and CRP). Among these, the Group B classification was a new finding. In situations where the measurement of hemolyzed specimens is unavoidable, it is important that clinical laboratory technologists be aware of its impact and provide the results in a way that can be used in clinical practice.