Introduction: Little is known about long-term survivors after complete resection of non-small cell lung cancer. Therefore, this study clarified the characteristics of 10-year-plus postoperative survivors with postoperative recurrence.

Materials and Methods: From January 1999 to December 2010, eleven 10-year-plus survivors had recurrence after lobectomy or greater resection for non-small cell lung cancer in our hospital. We analyzed this population retrospectively.

Results: The mean patient age was 64 years, and ten patients had adenocarcinoma. In the top eight long-surviving patients, recurrence developed within 4 years after surgery, and the recurrence was oligometastatic or dormant. However, there was no correlation between recurrence-free and post-recurrence survival. Patients with oligometastases tended to have received radical local therapy or short-term treatment sequences and to have developed recurrence within a few years after surgery. Driver gene-positive patients tended to have distant and multiple metastases. EGFR-positive, tyrosine kinase inhibitor-treated patients died within 84 months.

Summary: Oligometastatic recurrence cases might be included in the “cured” population; an oligometastatic status might be equivalent to stage III rather than stage IV. Patients with a dormant or oligometastatic state tended to survive longer, while EGFR-positive patients survived only until they became resistant to tyrosine kinase inhibitor (cytostatic) agents. Therefore, cytotoxic agents should be added to the treatment from a long-term perspective.

Background: Kukai is believed to have applied his miraculous power to develop numerous water resources and spread valuable medical knowledge throughout the Japanese islands during the early Heian Period.

Purpose: Kukai’s activities were evaluated by assessing his original documents from the perspective of modern intensive care doctors （intensivists）．

Methods: Medical descriptions in Kukai’s original works, which were re-organized by the Koyasan University Institute of Esoteric Culture, were analyzed by intensivists. In addition, historical sites reported to have been associated with Kukai in Gunma Prefecture were visited to confirm the origin of existing legends.

Results: There are 41 healthcare-related descriptions in Kukai’s original works. Excluding temples and shrines, 12 historical sites in Gunma Prefecture were identified as being associated with Kukai.

Conclusion: There is no definitive evidence showing that Kukai traveled all over the country to spread his medical and civil engineering knowledge. Legends related to Kukai may be attributed to the activities of Koya-Hijiri missionaries and mountain practitioners who followed Kukai’s Esoteric Buddhism teachings. Infectious diseases and water shortages are still serious problems for modern human societies.

Background & Aims: Clinical preceptorship is an effective method for the development of professional nurses. However, being a preceptor can be challenging due to limitations in nurses’ skills and knowledge of mentorship and high pressure in teaching. This study explores the process by which experienced nurses grow as nurse educators through their experience as preceptors, in order to provide effective support to future preceptors.

Methods: Semi-structured interviews were conducted with 12 nurses with four to eight years of experience at a university hospital. Transcripts were analyzed using the modified grounded theory approach.

Results: A total of 24 concepts, 5 categories, and 1 core category were generated from the data analysis. Preceptors grew through the reflection on the failure experience during teaching. Preceptors searched for suitable and personalized teaching methods for preceptees. Atmosphere of the workplace influenced preceptor’s growth process as educators.

Conclusions: Based on these findings, nursing managers and staff need to watch over preceptors without interfering, while creating an atmosphere in which preceptors feel free to consult and provide advice based on their extensive knowledge and experience.

Objectives: The purpose of this study was to clarify the factors related to end-of-life care among the intensive care unit (ICU) nurses and to examine ways to improve care in clinical practice.

Method: A questionnaire survey was conducted with nurses working in ICUs of 27 hospitals. We performed exploratory factor analysis on the practice of end-of-life care in the ICU. Multiple regression analysis was then performed with practice as the dependent variable. The independent variables were organizational structure and personal factors.

Results: End-of-life care at the ICU was divided into the following three categories: unified care provided by all staff in line with the wishes of patients and their families; communication, including information provision for patient-centered care; and environmental and organizational adjustment for best care.

　　Multiple regression analysis showed ICU nurses’ sense of difficulty in providing end-of-life care and whether or not family meetings were held were found to be related to the total score of ICU end-of-life care practice and the three factors of practice.

Conclusion: Factors related to the practice of end-of-life care were ICU nurses’ sense of difficulty in providing end-of-life care and whether or not family meetings were held, suggesting that addressing these may improve the practice.

Biliary fistula, a complication of hepatobiliary surgery, requires attention. Although the usefulness of endoscopic treatment has been reported in recent years, no standard treatment has yet been established. We report two cases of postoperative biliary fistulas treated endoscopically at our hospital in 2021. The patients were aged 78 and 82 years and were both men. Both of them underwent endoscopic retrograde biliary drainage (ERBD) and open drainage, together with closure of their biliary fistulas. There were no short-term and long-term complications. Endoscopic treatment of postoperative biliary fistulas usually takes the form of endoscopic nasobiliary drainage, but this can cause distress and is associated with a risk of accidental removal, especially in older patients. In contrast, ERBD can also provide effective drainage and has no such attendant risks.

A 9-year-old boy with abdominal pain on the right side was referred to our hospital because of suspected acute appendicitis. However, acute appendicitis was not positively suspected from clinical symptoms. Blood examination showed an increase in inflammatory reaction. Abdominal ultrasonography and contrast CT scan revealed omental torsion. He was appropriately diagnosed and improved with conservative treatment. Omental torsion should be differentially diagnosed from acute appendicitis.