This study sought to investigate the association between preliminary advance care and decision making, and care planning and participation in community activities, among the rural and advanced aged community in Japan in efforts to enhance advance care planning when it is direly needed. Subjects were 920 people aged 40-74 years in rural areas identified by cluster sampling and who had consented to participate in the survey. The 15 survey items included sex, age, experiences of care for the elderly, degree of health anxiety, degree of participation in community activities, and self-measurement of home blood pressure. Univariate analysis and binary logistic regression analysis using a step-wise principle were used throughout the survey. Of the 920 participants, 23.8% and 25.0% had previously made decisions on care planning and advance care planning, respectively, which were mutually associated, although decision making on care planning did not necessarily presuppose advance care planning. Odds ratios were high for decision making on care planning, awareness of care planning, advance care planning, and conversations about medical checkups. Also, odds ratios were high for advance care planning on awareness of care planning, decision making on care planning, and high participation in community activities. The results suggest that to help participants “make a decision” or undertake “advance care planning”, it is important to have opportunities to participate in community activities and/or converse with another resident about medical checkups.

　　Despite measures being instituted to prevent agricultural workplace accidents, fatalities still occur. Also research studies evaluating and analyzing work processes involving agricultural machinery are rare. The objectives of this study were, on a trial basis, to generate and examine the usefulness of a work process sheet based on failure mode and effect analysis (FMEA) for prevention of accidents. FMEA is used in medical and other fields. Subjects were 18 of 38 farmers who were interviewed using the work process sheet generated, were assumed to be using agricultural machinery, were located in Prefecture B (a rural area), and had agreed to participate in the survey. The results show that the ratio of accidents to incidents was 1:8. Also, based on the work process sheet for prevention of agricultural workplace accidents, users of agricultural machinery did not pay attention to 10 of the 28 requisite steps. In particular, “I wear a seat belt” and “I regularly use the two-poster safety frame (folding type)”, were commonly not adhered to. Based on the work environment and occupational background, the development of a simpler and more useful working process sheet from an analysis of objective data is warranted.

Aging, hypertension and diabetes are the three major risk factors that predispose to atherosclerosis. The authors tried to elucidate the terminal clinical pictures of these three major factors in terms of the mechanocardiographical findings and blood chemistry parameters related to nutrition (NBC), which are considered to be useful for the determination of the signifying or trigger risk factors of impending cerebral attacks.
As the terminal clinical pictures of each of these three major factors, increase in peripheral resistance and inclination to low cardiac functions were observed. And in the process of transition to terminal pictures, increase in serum lipids and decrease in albumin, accordingly, increase in lipid/protein ratio were observed. Increase in such ratio is considered to be important for the development of atherosclerosis and low cardiac function.
In rural areas mortality rate of strokes is markedly higher than in urban areas. Such high stroke incidence may be ascribed to the marked increase in cardiac impairments, as compared with the urban hypertensives of the same age groups. The factor of cardiac impairments may be ascribable to different nutritional conditions.
Therefore, for the purpose of prevention against predisposition to strokes, early detection, as well as treatment, of cardiac impairments of elderly people, hypertensives and diabetics are deemed necessary. In this connection, improvement of nutritional conditions is very important.

Total pelvic exenteration (TPE) is sometimes required for radical treatment of locally advanced or recurrent gynecologic cancer [1]. However, TPE with a transabdominal approach requires highly advanced techniques in the case of repeated surgery due to the effects of primary surgery and/or chemoradiotherapy, especially when a transabdominal approach is used. Recent technical advances in transanal/transperineal endoscopic surgery have proved beneficial for complicated surgery in the deep pelvis [2]. Here we introduce our surgical procedure for combined laparoscopic and transperineal endoscopic TPE (TpTPE) for pelvic recurrence of cervical cancer. A 42-year-old woman was diagnosed with vaginal stump recurrence of cervical cancer involving the rectum, bladder, and ureters following hysterectomy and pelvic lymph node dissection as primary surgery and chemotherapy/chemoradiotherapy for previous recurrences. We decided to perform TpTPE with a combined laparoscopic approach. The GelPOINT advanced access platform was fixed through a perineal skin incision around the tightly closed anus, external urethral orifice, and vagina. With sufficient pneumopelvic pressure (12 mmHg), TpTPE was performed under a good surgical view without any effect of the primary surgery. A ureterostomy and sigmoid colostomy were created and a right gracilis muscle flap was used to reconstruct the pelvic defect. The total operative time and estimated blood loss were 887 minutes and 497 mL, respectively. Histopathological examination revealed recurrent cervical cancer invading the rectum, bladder, and bilateral ureters with negative surgical margins. The postoperative course was uneventful except for paralytic ileus. The patient was discharged on postoperative day 18. TpTPE is a technically feasible and effective approach for locally advanced pelvic tumors.

Computed diffusion-weighted MRI is a recently proposed post-processing technique that produces b-value images from diffusion-weighted imaging (DWI), acquired using at least two different b-values. This article presents an argument for computed DWI for prostate cancer by viewing four aspects of DWI: fundamentals, image quality and diagnostic performance, computing procedures, and future uses.
Magnetic Resonance Imaging ; Prostate* ; Prostatic Neoplasms*