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We proposed a method for a computer-aided diagnosis system that distinguishes between benign and malignant lesions in gastrointestinal digital radiography. To begin with, the level set method was applied in order to extract a tumor region from the image which was smoothed by the bilateral filter. Next, we selected four image features with the large SN ratio among various image features obtained from a tumor region using the Mahalanobis-Taguchi method, which has been employed mainly in quality engineering. The selected four image features-circularity, irregularity, size, and perimeter-were used as input data for the artificial neural network, which was employed for distinction between benign and malignant lesions. By using 43 regions of interest cropped from the 43 clinical cases, the area under the ROC curve (AUC) of diagnostic accuracy for the classification obtained with this proposed method was 0.970, whereas the average AUC obtained with 7 human observers (3 radiologists and 4 radiological technologist) was 0.941.

Objectives: The article describes the framework of an on-the-job training program for nurses that teaches them how to better advise hospitalized smokers to stop smoking. The purpose of the study was to evaluate the efficacy of the program., Methods: We corducted an on-the-job training program for 4 years aimed at nurses who worked in 2 of 11 wards in our hospital (training wards). The aim of the training program that we developed was to improve nurses' self-efficacy in advising and supporting patients to stop smoking. An average of 40 nurses worked in the two wards at any time during the study period. A self-administered questionnaire was given to nurses working at our hospital before (in 1997) and after (in 2002) the program was undertaken. Changes in cognition and behavior with regard to advice to hospitalized smokers were also compared between nurses working at the training wards and nurses working in the other wards in question, whose number averaged 200 nurses during the period., Results: There were no differences in age distribution, smoking habits and epidemiological knowledge of smoking between the two groups. Self-efficacy in advising and supporting patients to cease smoking was significantly increased among nurses working in the training wards (P=0.02), whereas no significant increase with time was found among nurses working in the other wards (P=0.14). After the program was undertaken, nurses working in the training wards had a significantly higher proportion who always advised hospital smokers to quit according to their predictable stage of change than their counter parts working in the other wards (adjusted odds ratio 2.93, 95% confidence interval 1.27-6.74)., Conclusion: The study indicates the job training program to have improved the nurses' self-efficacy, appearing to change their behavior in advising and supporting patients to cease smoking.

In 1993 there was substantial progress in superantigen research. The following are the main achievements. (i) The life cycle of an exogenous mouse mammary tumor virus, MMTV (SW), has been clearly eluciated. (ii) X-ray crystallography of toxic shock syndrome toxin 1 has been completed. (iii) The involvement of a superantigen encoded by an endogenous mouse mammary tumor virus, Mtv-51, in the development of a B cell lymphoma has been shown in SJL mice. However, there are many unsolved questions. For example, (i) are there endogenous superantigens in man? (ii) is there any role for superantigens in the development of autoimmunity? (iii) what is the three dimensional structure of superantigens encoded by mouse mammary tumor viruses? In the near future superantigens will be exploited for therapeutic purposes in the area of autoimmunity and cancer.

A 55-year-old Japanese man was admitted to our hospital in January 1985 complaining of epigastralgia. Radiologic and endoscopic examinations showed gastric carcinoma, but biopsy specimens taken by surgery showed the histologic pattern of choriocarcinoma. On autopsy, multiple metastatic sites wer observed, and histological examination of the primary and metastatic sites revealed choriocarcinoma. Primary gastric choriocarcinoma may develop from gastric cancer by retrodifferentiation.

A case of a gastric cancer developed 3 years and 11 months after radiotherapy for esophageal cancer is reported. A 76-year-old man with a squamous cell carcinoma of the lower intrathoracic esophagus had received 50 Gy of irradiation as treatment. Thereafter, signs of the esophageal cancer disappeared radiologically and endoscopically, and a pathological biopsy of specimens taken from the site revealed no further cancer cells. The patient remained well for 3 years and 11 months after radiotherapy, at which time he again was admitted to hospital, having been diagnosed as having a gastric cancer. On admission, an upper G-I series showed a shadow defect along the lesser curvature of the upper-middle stomach but no evidence of any stenosis in the lower intrathoracic esophagus. Endoscopically, the mucosal surface of the esophagus was normal, and biopsy specimens taken from the site in the esophagus that had been treated with irradiation 3 years 11 months ago revealed no recurrence of his esophageal cancer. Endoscopical examination of the stomach showed an infiltrative tumor with ulceration, and a subsequent histological examination revealed a poorly differentiated adenocarcinoma. Upon a laparotomy, a metastasis was detected in the perigastric and paraaortic lymph nodes and the cancer had invaded the retroperitoneum. The stomach could not be removed and he died 3 months after the laparotomy.