The Japan Society of Gynecologic Oncology (JSGO) guideline for the treatment of uterine body neoplasm are revised from the 2018 guideline. This guideline aimed to provide standardized care for uterine body neoplasm, indicate appropriate current treatment methods for uterine body neoplasm, minimize variances in treatment methods among institutions, improve disease prognosis and treatment safety, reduce the economic and psychosomatic burden on patients by promoting the performance of appropriate treatment, and enhance mutual understanding between patients and healthcare professionals. The guidelines were prepared through the consensus of the JSGO guideline committee, based on a careful review of evidence from the literature searches and the medical health insurance system and actual clinical practice situations in Japan. The main features of the 2023 revision are as follows: 1) The Guidelines Formulation Committee members were asked to understand Minds' medical guideline development method in advance. 2) The clinical question (CQ) was changed to Patient, Intervention, Comparison, Outcome format as much as possible. 3) Introduced the "body of evidence," which summarizes the results of research reports collected for the CQs by outcome and study design, and the strength of evidence for each body of evidence was rated from levels A to D. 4) Introduction of systematic reviews in some CQs. 5) The strength of evidence, the balance of benefits and harms, value and hope for patients, and clinical applicability were considered while drafting recommendations. Herein, we present the English version of the JSGO guidelines 2023 for the treatment of uterine body neoplasm.

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: To examine the effectiveness of progestin re-treatment for recurrent endometrial intraepithelial neoplasia (EIN), atypical endometrial hyperplasia (AH) and endometrial cancer (EC) following initial fertility-sparing treatment. Methods: A comprehensive systematic review and meta-analysis were conducted by an Expert Panel of the Japan Society of Gynecologic Oncology Endometrial Cancer Committee. Multiple search engines, including PubMed/MEDLINE and the Cochrane Database, were searched in December 2021 using the keywords “Endometrial neoplasms,” “Endometrial hyperplasia,” “Endometrial intraepithelial neoplasia,” “Fertility preservation,” “Progestins,” AND “Recurrence.” Cases describing progestin re-treatment for recurrent EIN, AH and EC were compared with cases that underwent conventional hysterectomy. The primary outcomes were survival and disease recurrence, and the secondary outcome was pregnancy. Results: After screening 238 studies, 32 with results for recurrent treatment were identified. These studies included 365 patients (270 received progestin re-treatment and 95 underwent hysterectomy). Most progestin re-treatment involved medroxyprogesterone acetate or megestrol acetate (94.5%). Complete remission (CR) following progestin re-treatment was achieved in 219 (81.1%) cases, with 3-, 6- and 9-month cumulative CR rates of 22.8%, 51.7% and 82.6%, respectively. Progestin re-treatment was associated with higher risk of disease recurrence than conventional hysterectomy was (odds ratio [OR]=6.78; 95% confidence interval [CI]=1.99–23.10), and one patient (0.4%) died of disease. Fifty-one (14.0%) women became pregnant after recurrence, and progestin re-treatment demonstrated a possibility of pregnancy (OR=2.48; 95% CI=0.94–6.58). Conclusion This meta-analysis suggests that repeat progestin therapy is an effective option for women with recurrent EIN, AH and EC, who wish to retain their fertility.

In order to promote regional cooperation in palliative care, we developed a regional cooperation clinical pathway for home palliative care that offers simple support and is easy to use. We then administered a questionnaire survey to 14 healthcare professionals with various specialties who were involved in the introduction of the pathway, and we revised the pathway on the basis of the survey results. The revised pathway was then tested in 13 patients who were discharged from 3 designated cancer care hospitals in Toyama City to home care, and another questionnaire survey was conducted afterwards in the same manner. The mean overall score on the questionnaire was 2 in seven, 3 in seven (on a scale of 0 to 3) at the time of introduction, whereas the score after trial use was 1 in one, 2 in four, 3 in five. We believe that more innovative approaches to the implementation of such pathways are required.

We reported the case of a 9-year-old girl who complained of irritability with sounds, headache, nausea and ease of fatigability, who was successfully treated with the Kampo formulation, ryokito. Her irritability with sound occurred following bilateral ear pain. Her headache, nausea and antipathy towards smells appeared in conjunction with aggravation of this pain symptom. We recognized this patient as having a Ki-distribution imbalance, and so prescribed ryokito as a decoction. Following her use of this formulation, her complaints improved remarkably within about 8 weeks.

The number of senile eye cataract cases increases year by year. Recent developments in new operation techniques have brought more safety and ease i.e. ultrasonic phacoemulsication and lens replacement. However, some complications of these techniques result in troublesome outcomes. In this paper the authors report a female patient aged 74 years old who suffered from severe photophobia after cataract surgery, which was successfully treated with the Kampo formulation, ryokeikansoto. Such troublesome cases tend to be neglected to in medical journal publications when the background of the complaint is unknown.

A 67 year-old women who suffered from painful palms and soles with burning sensation for 2 years was treated. At first, she visited the department of dermatology and then consulted our department. The authors considered these symptoms as already being described in the great classic Kinkiyoryaku (Chin Keiu Yao Lueh). We then prescribed shokenchuto, which resulted immediate clinical improvement. The authors have again realized that the classical textbook is based on proper clinical observations that are useful today.

Reitakutsukito, a Kampo formulation which is described in the textbook Ranhitsu-Hizou, has been well known as a suitable formulation for sinusitis related signs and symptoms.
We reported previously three cases, i.e. chronic headache, bronchial asthma and bronchial amyloidosis with sinusitis, successfully treated with this formulation. Here we report on a clinical trial of reitakutsukito for 5 cases in which the chief complaints were pre-menstrual disorder, chronic headache, anorexia, finger dysesthe sia and chronic cough accompanied with sinusitis. We attempted to make clear the sho for this Kampo formulation by means of administering this formulation alone, or with concomitant use of supportive formulations.

We developed a percutaneous left ventricular assist system (PLVAS) using a centrifugal pump. PLVAS is the transseptal left atrial-femoral artery bypass to unload the left ventricle using a centrifugal pump. This PLVAS can be implanted through the inguinal vessels under fluoroscopy and also in 2 cases additional transesophageal echocardiogram guiding was performed. This PLVAS was applied to 6 patients with profound heart failure and refractory cardiogenic shock. The implantation of PLVAS required 30-60 minutes. The PLVAS assist flow was maintained at 3.0-4.0l/min. One patient with acute myocardial infarction survived and has been doing well for more than 1 year. The complications directly related to this procedure were minimal. PLVAS appears to be useful for patients with severe heart failure and may be useful as a short-time support or bridge to other more aggressive forms of life support.

Myocardial revascularization combined with valvular surgery were performed on 8 patients between 1986 and 1990. There were 4 males and 4 females (mean age=60.6 years). Mitral valve replacement was performed in 3 patients, aortic valve replacement in 2, and double valve replacement in 3. There were no operation death, but one late death was seen. No angina attack was evident and NYHA functional class was improved in all patients in survivers. Coronary angiography should be performed in all adult patients who have valvular disease and those with significant artery disease should undergo bypass grafting concomitant with valvular surgery.