Objective: The incidence and mortality rates of endometrial cancer are increasing globally, including in Japan. Quality of cancer care is promoted through guideline adherence. This study aimed to establish quality indicators (QIs) for endometrial cancer and explore the factors contributing to treatment nonadherence. Methods: QIs and pattern-of-care indicators (PCIs) were developed using the Research and Development/University of California Los Angeles modified Delphi method. QIs reflect desirable healthcare patterns, whereas PCIs address treatment areas with lacking evidence.Data from the Hospital-Based Cancer Registry and Diagnosis Procedure Combination Survey were used. Patients diagnosed or treated between January 1 and December 31, 2020 were included. The reasons for nonadherence were collected. Logistic regression was used to analyze the factors influencing adherence, including age, body mass index, comorbidities, facilities, and recurrence risk. Results: Of the 35 proposed QI candidates, 8 QIs and 9 PCIs were selected, predominantly focusing on surgical aspects. Adherence rates varied, with peritoneal lavage cytology being the highest (93.1%), and postoperative hormone replacement therapy (HRT) for patients aged <45 years being the lowest (30.9%), when focusing on process indicators. Reasons for nonadherence included patient preference and medical comorbidities as significant factors. Multivariate analysis highlighted age, clinical stage, and Barthel index as significant contributors to nonadherence. Conclusion We developed QIs to comprehensively assess endometrial cancer treatment.Adherence rates are favorable; however, HRT has a low adherence rate. Factors leading to nonadherence include advanced age and incomplete activities of daily living, particularly in advanced stages.

Objective: Cervical cancer rates in Japan (16.0/100,000) exceed the global average rate (11.3/100,000, according to the High/Very-High Human Development Index in 2020). This necessitates the evaluation of care quality and the quality indicators (QIs) for cervical cancer that were developed in 2013 to serve this purpose. This study updated these indicators using current evidence and consensus while longitudinally examining trends in practice patterns. Methods: The revision involved reviewing existing QIs and patterns of care indicators and incorporating new indicators using the modified Delphi method. Adherence to these indicators was assessed using a linked hospital-based cancer registry-based diagnostic procedure combination database covering approximately 70% of patients with cancer in Japan. The longitudinal trends of the existing indicators were evaluated using the linear probability model. Results: Seven new indicators were added to the existing twelve. Two of the new indicators mainly focused on early-stage surgical intervention, while one focused on advanced-stage bevacizumab combination therapy, with adherence rates of 81.7%, 0.8%, and 45.9%.Longitudinal analyses revealed significant improvements with the use of cisplatin in concurrent chemoradiotherapy for advanced-stage cervical cancer (+1%/year), oral anticancer agents as maintenance therapy after primary treatment for early-stage cervical cancer (−0.8%/ year), and hysterectomy for adenocarcinoma in situ in patients above 44 years old (−2%/year). Conclusion The QIs for cervical cancer in Japan have been revised based on 2022 evidence.The existing and new indicators should be continually evaluated to correspond to the latest knowledge. This will facilitate the standardization and promotion of bottom-up improvements in cervical cancer care.

National Institute of Occupational Safety and Health, Japan Step Test (JST) is a valid approach for cardiorespiratory fitness assessment among subjects aged 30-60 years. It estimates maximal oxygen uptake (VO2max) based on the heart rate (HR) index, a combination of HRs during and after exercise. This study assessed the cross-validity of the VO2max estimation using the JST among adolescent university students. A total of 20 healthy male university students were included in this study. Measurements were taken over three days, with cardiopulmonary exercise testing, JST, and the Chester step test (CST) measured on each day. Pearson’s product-rate correlation coefficient or Spearman’s rank-sum correlation coefficient was used for examining the association between measured VO2max and estimated VO2max and between measured VO2max and variables in the JST equation. Bland-Altman analysis was also used to examine the presence and extent of systematic errors between measured and estimated VO2max. Estimated VO2max by the JST showed a stronger correlation with measured VO2max than estimated VO2max by the CST. Moreover, the HR index showed the strongest correlation with measured VO2max in variables of the JST equation. However, estimated VO2max by the JST showed fixed and proportional errors when compared to measured VO2max. It was suggested that the HR index, a combination of HRs during and after exercise, was useful for estimating VO2max among adolescent university students. Estimated VO2max using the JST showed a strong correlation with measured VO2max, however, some estimation accuracy problems such as systematic errors.

［Purpose］This study aimed to evaluate the differences in the immediate postoperative muscle strength around the hip and knee joints, joint range of motion, pain, and mobility between the anterolateral-supine (AL-S) approach, as a form of minimally invasive total hip arthroplasty (THA), and the posterior approach (PA), as a form of small-incision THA.

［Methods］The subjects were 68 patients with hip osteoarthritis who underwent unilateral THA for the first time. Maximal isometric muscle strength around the hip and knee joints, joint range of motion, walking ability, and pain were measured before surgery, and on Day 10, Day 21, and 2 months after surgery.

［Results］Significant interactions were found between the time and the type of surgery for hip abduction, external rotation, and extension strength. Interaction was also found between the surgical approach and the time required to achieve optimal hip extension range of motion.

［Conclusion］The differences in the functional recovery after AL-S approach and PA were most likely caused by differences in muscle damage. Therefore, it is necessary to customize rehabilitation programs according to the characteristics of each approach.

Little is known about early death after admission during the terminal phase in advanced cancer patients. We retrospectively analyzed data from 510 advanced cancer patients who were at the end-of-life between August 2011 and August 2016, and found that 83 patients (16.3%) died within 3 days after admission to our institute. We divided the deceased patients into those who died within 3 days (early death group) and those who died after more than 4 days (non-early death group) after admission. Prevalence of delirium, cancer pain, dyspnea, nausea and vomiting, and fatigue patients showed no significant differences. Mean hydration at the end of life was significantly more per infusion for early death group than non-early death group. Continuous sedation and mean opioid use was significantly less for early death group than non-early death group. The risk factor of age, sex, clinical stage, histological state, overtreatment of chemotherapy, comorbidity had no significant associated with early death. The primary site of cancer, the number of metastatic sites, the consciousness level, and the performance status might be predictors for early death after admission in advanced cancer patients at the end-of-life.

Disused rat hindlimb caused by sciatic neurectomy is characterized by skeletal muscle atrophy and bone loss accompanying alterations in trabecular bone architecture. We studied the time course responses of the two-dimensional architecture of trabecular bone and the relationships between bone loss and muscle atrophy using a unilateral sciatic nerve denervation model of disuse atrophy.
Fischer-344 male rats aged 11 weeks were denervated. The right and left tibiae, soleus and extensor digitorum longus muscle of denervated and control rats were obtained at 1, 3, 7, 10 days and 2, 3, 4, 5, 6, 7, 8, 10 weeks after surgery. Histomorphometric analyses were performed on longitu-dinal sections of proximal tibial metaphyseal secondary spongiosa.
Marked trabecular bone loss and muscle weight loss were observed mainly at 7-10 days and 1-3 days after denervation, respectively. Time courses of the percent decrease in trabecular width and length from 0 day (i, e., thinning rate; TR and fragmentation rate; FR) were not matched at 7-10 days and 5-6 weeks after denervation. The scatterplot for TR; FR showed that the FR changed stepwise with the first threshold between 12-25% of TR.