Background/Aims: Endoscopic submucosal dissection (ESD) for superficial non-ampullary duodenal tumors (SNADETs) is associated with a high rate of en bloc resection. However, the technique for ESD remains challenging. Recent studies have demonstrated the effectiveness of S-O clips in colonic and gastric ESD. We evaluated the efficacy and safety of duodenal ESD using an S-O clip for SNADETs. Methods: Consecutive patients who underwent ESD for SNADETs between January 2011 and December 2021 were retrospectively enrolled. Propensity score matching analysis was used to compare patients who underwent duodenal ESD with the S-O clip (S-O group) and those who underwent conventional ESD (control group). Intraoperative perforation rate was the primary outcome, while procedure time and R0 resection rate were the secondary outcomes. Results: After propensity score matching, 16 pairs were created: 43 and 17 in the S-O and control groups, respectively. The intraoperative perforation rate in the S-O group was significantly lower than that in the control group (p=0.033). A significant difference was observed in the procedure time between the S-O and control groups (39±9 vs. 82±30 minutes, respectively; p=0.003). Conclusions The S-O clip reduced the intraoperative perforation rate and procedure time, which may be useful and effective in duodenal ESD.

We conducted a questionnaire survey of 525 persons regarding end-of-life care (EoLC) between November and December 2017. A total of 495 individuals responded (response rate 94.3%). Respondents were grouped into either a medical staff (MS) group or community persons (CP) group. Significant differences were found between the MS and CP groups in implementing a family conference about EoLC (p＜0.05), but not in preparing documents about personal preferences for EoLC. There were significant differences between the groups in medical treatments in EoLC, for example, total parenteral nutrition, enteral nutrition via percutaneous endoscopic gastrostomy, and mechanical ventilation with intubation (p＜0.05). It is important that medical treatment in EoLC should meet the requirements of patients and their families. This study revealed differences in some aspects of EoLC between the MS and CP groups. Individuals should be supported in personally making decisions about their own EoLC.

The purpose of this study was to clarify difficulties and countermeasures in nursing practice for foreign patients with COVID-19 who were non-English native speakers. A questionnaire was collected from 16 nurses in a COVID-19 ward. They cared for 13 non-English-speaking foreign patients from admission to discharge in the ward between May 2021 and June 2021. All nurses reported difficulties in communication related to collecting information from patients and explaining hospital care. For example, they could have simple conversations using a two-way translation device (POKETALK®) but could not understand detailed symptoms or complaints without an interpreter. Not much meaning could be inferred from a patient’s response of “OK”. The nurses reported that it was difficult to explain details of treatments, Japanese customs, and hospital rules. With the help of interpreters, they made hospital manuals and question cards in the patients’ native languages. In nursing care for foreign patients with COVID-19, it was helpful to provide explanations of Japanese customs and hospital rules before admission and to prepare hospital manuals and question cards in patients’ native languages.

A woman in her 80s was being treated for dementia. She lived in a four-generation household of 8 people. Her grandchild contracted COVID-19 and was admitted in another hospital. The 7 other family members were close contacts of the grandchild, and all of them except the woman with dementia developed COVID-19 within 3 days of onset in the grandchild. The woman’s PCR test for SARS-CoV-2 was negative. Her family thought that she could not live alone, but she was denied admission to other hospitals. Finally, she was admitted to our COVID-19 ward with her other family members at the family's request. After admission, she stayed in a room with family members, and COVID-19 treatment for her family and her care were performed with strict infection control measures in place. On hospital day 11, she and 5 family members had negative PCR test results for SARS-COV-2 and were discharged. With the growing number of dementia patients in Japan's aging society, there is the possibility that similar situations will occur increasingly often. This case suggests that recommended infection control measures are effective for preventing the spread of COVID-19 to people staying in the same room.