Objective: Routine, population-based mammographic screening for breast cancer has been implemented nationally in Japan for the past decade. The objective of this study was to evaluate the knowledge of the general public and of nurses concerning breast screening practices in Japan, especially with regards to the benefits and risks of breast cancer screening.

Methods: In 2014, a questionnaire regarding the benefits and risks of breast cancer screening was administered to women who underwent breast cancer screening and to registered nurses. The questionnaire was distributed to 1,649 women and 1,905 registered nurses.

Results: Completed questionnaires were returned by 1,552 (94.1%) of the screened participants and 1,710 (89.8%) nurses. The majority of the screened participants and registered nurses believed that screening prevented or reduced the risk of developing breast cancer (86% and 62%, respectively); that screening reduced the mortality risk of breast cancer by more than 50% (69% and 60%, respectively); and that 10 years of regular screening for 50-year-old women could prevent ≥ 10 breast cancer deaths per 1,000 women (62% and 61%, respectively).

Conclusions: Women in the target population and registered nurses were aware that earlier diagnosis led to better prognosis, but demonstrated misconceptions regarding other aspects of the benefits and risks of breast cancer screening. In Japan, all women should be educated on both the benefits and risks of breast cancer screening to enable them to make an informed decision on whether to participate in the mammographic breast cancer screening program.

An extremely rare case of true brachial arterial aneurysm due to blunt trauma is reported. A 55-year-old male suffered from blunt trauma in his right upper arm when he was 8 years old. He had noticed a mass in his right upper arm for more than 30 years, however, it grew rapidly to 7×6×5cm within several months. Digital subtraction angiography revealed a large saccular aneurysm of the right brachial artery. The aneurysm was removed and replaced by a saphenous vein graft.

Stretching for the triceps surae muscle in the knee flexed position (medical stretching: MS) and knee extended position (static stretching: SS) were performed and the effect on the dorsiflexion angle of the ankle joint was examined. Five elderly females were selected as subjects. We measured the maximal dorsiflexion angle of the ankle joint in the following leg positions: (1) the maximal dorsiflexion angle in the extended knee position (EDF angle) and (2) the maximal dorsiflexion angle in the 90°flexed-knee position (FDF angle). There was a significant increase in the maximal dorsiflexion angle after MS and SS were carried out (p<0.01), but there was no significant difference between MS and SS. It was concluded that MS for triceps surae is equally effective as SS in increasing the maximal dorsiflexion angle of the ankle joint.

The effects of exercise and dietary therapy on the prevention of diabetic nephropathy (DN) were compared. Thirty-two male OLETF rats were divided into four groups (Ex, Diet, Sed, Pre) . Fourteen LETO rats served as the normal controls. Therapy was conducted for 10 weeks from age 22 to 31 weeks. The Ex group was trained by voluntary exercise, and the Diet group had a restricted food intake resulting in the same BW as that of the Ex group. The Ex developed a significant increase in urinary albumin excretion compared to the Diet group, although significantly less than the Sed group. Blood pressure in the Ex group showed a tendency to be higher during therapy. BW and serum lipids were significantly reduced, and glucose intolerance was improved in both the Ex and Diet groups. There were no differences in the metabolic indices between the Ex and Diet groups. The Ex group showed a significantly heavier kidney weight and a tendency for enlargement of the glomerular area and volume. The protective effect of DN through improvement of the metabolic dis-order by exercise might be offset by exercise-induced renal loads. Control of exercise intensity and blood pressure appear to be important as well as the improvement of glucose intolerance and lipid metabolisms in exercise therapy to prevent an occurrence and development of DN.

Objectives: The purpose of this study was to investigate current fact of cancer outpatients’ opioid pain management and its possible abusive applications and to establish corrective treatments by the palliative care team. Methods: Our palliative care team investigated cancer outpatients’ prescribed opioid clinical records for 4 months in 2014, and the result revealed inappropriate opioid use which could lead to further abuse or dependency. Through this the team recommended attending physicians viable options including decrease of opioid eventually leading to final withdrawal. Results: Among 67 cancer outpatients, the finding of inappropriate opioid use which could lead to further abuse or dependency was in 5 patients (7.4%). The details are as follows: (1) Three patients were treated with opioid analgesia for initial pain relief but the application continued in spite of recovering from a cancer which had been responsible to the pain. (2) Two patients were medicated with opioid for pain but further diagnosis revealed the disease which caused pain was benign. Four out of 5 patients were successfully withdrawn from opioids. Conclusion: In cancer outpatient settings, it can be overlooked or undetected inappropriate use of opioids which may lead to abuse or dependency without a team approach. To prevent opioid abuses, it is imperative to find the cause of pain as accurately as possible.

Congenital quadricuspid aortic valve is a very rare malformation. We report two cases with severe aortic regurgitation due to isolated quadricuspid aortic valve. It consisted of three equal cusps and one smaller cusp, which was identified at the time of valve replacement surgery for severe aortic regurgitation.

We report a rare case of primary cardiac angiosarcoma in the right atrium. A 47-year-old man was admitted to our hospital with cardiac tamponade. Echocardiography and computed tomography revealed a tumor in the right atrial cavity. We performed tumor resection to confirm the histological diagnosis, to prevent tumor embolism, and to increase the possibility of improving the prognosis. The tumor was resected with the right atrial wall and right pericardium. The right atrium was then reconstructed with a bovine pericardial patch. The pathological diagnosis was angiosarcoma. The patient survived only about 6 months after surgical resection, but there was no local recurrence. This report presents a very rare case of cardiac angiosarcoma associated with cardiac tamponade.

Objective: Treatment options for patients with rheumatoid arthritis on maintenance hemodialysis with an inadequate response to biologic agents have not been reported. In this report, we describe two patients who achieved remission after treatment with peficitinib.Methods: Two 69- and 85-year-old patients with rheumatoid arthritis on maintenance hemodialysis were previously treated with biologics and started on peficitinib 100 mg/day after the secondary failure of biologics.Discussion: In the two cases presented here, rheumatoid arthritis was almost in remission and there were no adverse events, although the patients were switched to peficitinib after secondary failure of the biologic agents. Among Janus kinase inhibitors, peficitinib has the lowest renal excretion; therefore, its administration in patients on dialysis is not contraindicated according to the package insert in Japan. The use of biologic agents in patients on hemodialysis has been reported to be associated with a high incidence of infections; therefore, care should be taken to avoid infections when administering Janus kinase inhibitors.Conclusion: Janus kinase inhibitors with low renal excretion, such as peficitinib, may be effective in patients with rheumatoid arthritis on maintenance hemodialysis who have an inadequate response to biologic agents.

A 53-year old female was noted to have an enlarged heart on a medical checkup. A multislice computed tomography study demonstrated a giant coronary artery aneurysm measuring 10 cm in diameter and a coronary arteriovenous fistula, both located below the left atrium. Resection of the aneurysm and ligation of the feeding arteries and arteriovenous fistula were performed under cardiopulmonary bypass. As the native coronary sinus was occluded, we reconstructed the vessels draining from the aneurysm into the right atrium with an autologous pericardial patch to preserve the coronary venous blood flow. To our knowledge this is the first report of an autologous pericardial patch being successfully used to reconstruct the coronary venous flow during surgical treatment of a giant coronary artery aneurysm with a coronary arteriovenous fistula.