Objective: This study aimed to determine whether the number of resected pelvic lymph nodes (PLNs) affects the prognosis of endometrial cancer (EC) patients at post-operative risk of recurrence. Methods: JGOG2043 was a randomized controlled trial to assess the efficacy of three chemotherapeutic regimens as adjuvant therapy in EC patients with post-operative recurrent risk. A retrospective analysis was conducted on 250 patients who underwent pelvic lymphadenectomy alone in JGOG2043. The number of resected and positive nodes and other clinicopathologic risk factors for survival were retrieved. Results: There were 83 patients in the group with less than 20 PLNs removed (group A), while 167 patients had 20 or more PLNs removed (group B). There was no significant difference in patients’ backgrounds between the two groups, and the rate of lymph node metastasis was not significantly different. There was a trend toward fewer pelvic recurrences in group B compared with group A (3.5% vs. 9.6%; p=0.050). Although Kaplan-Meier analysis showed no statistically significant difference in survival rates between the two groups (5-year overall survival [OS]=90.3% vs. 84.3%; p=0.199), multivariate analysis revealed that resection of 20 or more nodes is one of the independent prognostic factors (hazard ratio=0.49; 95% confidence interval=0.24–0.99; p=0.048), as well as surgical stage, high-risk histology, and advanced age for OS. Conclusion Resection of 20 or more PLNs was associated with improved pelvic control and better survival outcomes in EC patients at risk of recurrence who underwent pelvic lymphadenectomy alone and were treated with adjuvant chemotherapy.

Objective: This study aimed to determine whether the number of resected pelvic lymph nodes (PLNs) affects the prognosis of endometrial cancer (EC) patients at post-operative risk of recurrence. Methods: JGOG2043 was a randomized controlled trial to assess the efficacy of three chemotherapeutic regimens as adjuvant therapy in EC patients with post-operative recurrent risk. A retrospective analysis was conducted on 250 patients who underwent pelvic lymphadenectomy alone in JGOG2043. The number of resected and positive nodes and other clinicopathologic risk factors for survival were retrieved. Results: There were 83 patients in the group with less than 20 PLNs removed (group A), while 167 patients had 20 or more PLNs removed (group B). There was no significant difference in patients’ backgrounds between the two groups, and the rate of lymph node metastasis was not significantly different. There was a trend toward fewer pelvic recurrences in group B compared with group A (3.5% vs. 9.6%; p=0.050). Although Kaplan-Meier analysis showed no statistically significant difference in survival rates between the two groups (5-year overall survival [OS]=90.3% vs. 84.3%; p=0.199), multivariate analysis revealed that resection of 20 or more nodes is one of the independent prognostic factors (hazard ratio=0.49; 95% confidence interval=0.24–0.99; p=0.048), as well as surgical stage, high-risk histology, and advanced age for OS. Conclusion Resection of 20 or more PLNs was associated with improved pelvic control and better survival outcomes in EC patients at risk of recurrence who underwent pelvic lymphadenectomy alone and were treated with adjuvant chemotherapy.

Objective: This study aimed to determine whether the number of resected pelvic lymph nodes (PLNs) affects the prognosis of endometrial cancer (EC) patients at post-operative risk of recurrence. Methods: JGOG2043 was a randomized controlled trial to assess the efficacy of three chemotherapeutic regimens as adjuvant therapy in EC patients with post-operative recurrent risk. A retrospective analysis was conducted on 250 patients who underwent pelvic lymphadenectomy alone in JGOG2043. The number of resected and positive nodes and other clinicopathologic risk factors for survival were retrieved. Results: There were 83 patients in the group with less than 20 PLNs removed (group A), while 167 patients had 20 or more PLNs removed (group B). There was no significant difference in patients’ backgrounds between the two groups, and the rate of lymph node metastasis was not significantly different. There was a trend toward fewer pelvic recurrences in group B compared with group A (3.5% vs. 9.6%; p=0.050). Although Kaplan-Meier analysis showed no statistically significant difference in survival rates between the two groups (5-year overall survival [OS]=90.3% vs. 84.3%; p=0.199), multivariate analysis revealed that resection of 20 or more nodes is one of the independent prognostic factors (hazard ratio=0.49; 95% confidence interval=0.24–0.99; p=0.048), as well as surgical stage, high-risk histology, and advanced age for OS. Conclusion Resection of 20 or more PLNs was associated with improved pelvic control and better survival outcomes in EC patients at risk of recurrence who underwent pelvic lymphadenectomy alone and were treated with adjuvant chemotherapy.

Purpose: This study investigated the relationship between the number of days that hospital visits were postponed and changes in clinical parameters due to the spread of coronavirus disease 2019 (COVID-19), after the Japanese government declared a state of emergency in April 2020. Methods: Regarding the status of postponement of appointments, we analyzed the patients who had visited the Nihon University Hospital at Matsudo for more than 1 year for supportive periodontal therapy (SPT) and classified them into low-, moderate- and high-risk subgroups according to the periodontal risk assessment (PRA). Clinical parameters for periodontal disease such as probing depth (PD), full-mouth bleeding score (FMBS), full-mouth plaque score, periodontal inflamed surface area (PISA), and periodontal epithelial surface area (PESA) were analyzed in 2 periods, from October 2019 to March 2020 and after April 2020.Correlation coefficients between days of deferral and the degree of changes in clinical parameters were calculated. Results: The mean age of the 749 patients was 67.56±10.85 years, and 63.82% were female.Out of 749 patients, 33.24% deferred their SPT appointments after April 2020. The average total of postponement days was 109.49±88.84. The number of postponement days was positively correlated with changes in average PD (rs=0.474) and PESA (rs=0.443) in the high-risk subgroup of FMBS, and average PD (rs=0.293) and PESA (rs=0.253) in the highrisk subgroup of tooth number (TN). Patients belonging to the high-risk subgroups for both FMBS and TN had a positive correlation between postponement days and PISA (rs=0.56). Conclusions The findings, the spread of COVID-19 appears to have extended the visit interval for some SPT patients. Moreover, longer visit intervals were correlated with the worsening of some clinical parameters for SPT patients with high PRA.

With increasing global life expectancy, the significance of geriatric assessment parameters has increased. Sarcopenia is a crucial assessment parameter and is defined as the age-related loss of muscle mass and strength. Sarcopenia is widely acknowledged as a risk factor for postoperative complications in diverse advanced malignancies and has a detrimental effect on the long-term prognosis. While most studies have primarily concentrated on the correlation between sarcopenia and advanced cancer, more recent investigations have focused on the relationship between sarcopenia and early-stage cancer. Endoscopic submucosal dissection (ESD), which is less invasive than surgical intervention, is extensively employed in the management of early-stage cancer, although it is associated with complications such as bleeding and perforation. In recent years, several reports have revealed the adverse consequences of sarcopenia in patients with early-stage cancer undergoing ESD. This literature review briefly summarizes the recent studies on the association between sarcopenia and ESD.

Parathyroid hormone (PTH) and fibroblast growth factor 23 (FGF23) each play a central role in the pathogenesis of chronic kidney disease (CKD)-mineral and bone disorder. Levels of both hormones increase progressively in advanced CKD and can lead to damage in multiple organs. Secondary hyperparathyroidism (SHPT), characterized by parathyroid hyperplasia with increased PTH secretion, is associated with fractures and mortality. Emerging evidence suggests that these associations may be partially explained by PTH-induced browning of adipose tissue and increased energy expenditure. Observational studies suggest a survival benefit of PTHlowering therapy, and a recent study comparing parathyroidectomy and calcimimetics further suggests the importance of intensive PTH control. The mechanisms underlying the regulation of FGF23 secretion by osteocytes in response to phosphate load have been unclear, but recent experimental studies have identified glycerol-3-phosphate, a byproduct of glycolysis released by the kidney, as a key regulator of FGF23 production. Elevated FGF23 levels have been shown to be associated with mortality, and experimental data suggest off-target adverse effects of FGF23. However, the causal role of FGF23 in adverse outcomes in CKD patients remains to be established. Further studies are needed to determine whether intensive SHPT control improves clinical outcomes and whether treatment targeting FGF23 can improve patient outcomes.

This study aimed to examine characteristics of physical functions, physical activity, and cognitive functions among community-dwelling older people who stopped driving automobiles. Participants were 589 community-dwelling older people (age: 65–89, 71.4 ± 5.1 years; 403 men, 186 women). The participants underwent nine physical assessments—hand grip strength, knee extension strength, timed up-and-go test, chair stand, one leg standing with open eyes, functional reach, vertical jump, preferred gait speed, maximal gait speed—and were evaluated for physical activity; and five cognitive assessments—the Mini-Mental State Examination (MMSE), Logical Memory I and II (WMS-R LM-I, LM-II) subtests of the Wechsler Memory Scale-Revised; and Trail Making Test A and B (TMT-A, TMT-B). They were divided into current driver (379 men, 169 women) and driving cessation (24 men, 17 women) groups. Among men, the driving cessation group had poorer vertical jump, TMT-A, and TMT-B results, while women had poorer hand grip strength, one leg standing with open eyes, WMS-R LM-II, and LM-II results, and longer inactivity time, compared with the current driver group and adjusted for covariates (P < 0.05 for all). The findings suggest driving cessation among community-dwelling older people is significantly associated with poorer physical functions, physical activity, and cognitive functions compared with those in current drivers.

In order to develop the health care system for the elderly we need to analyse fundamentally the phenomenon that the average age of population in each community is rapidly becoming older, as well as we have to grasp life conditions and health needs of old people. We investigated the rate of increase or decrease of population, rate of the elderly living by themselves and the index of the aging of population of each community, classified these communities into several types, and presented the points necessary to develop a community-based comprehensive health care for the elderly as to each type by considering the meanings the indices of health care, medical care and social welfare of the communities disclose.

Recently, while the medical technology developed remarkably on the one hand, the soscial need for preventive medicine largely increased on the other. In Japan, it is an urgent problem of the medical education how to create effective methodology and technology of the preventive medicine that can attract students who generally prefer to become professionals in clinical medicine.
Since 1978 we have practiced an educational programme in which each student looks after one family picked up from the agricultural district for one year, caring for the health of the family members and helping them out of health problems, if there are any. In this way students can learn primary health care and community health of their own will.
Compared with the traditional method, this method is effective in making the students understand with real interest the meanings of comprehensive primary health care through concerning themselves in the health care of a family as “a socio-economical-psycho-complex”.

In a farm village of Shimane Prefecture we conducted an investigation on the difference of nutrition between young, middle-aged and old generations. The result showed that nutrition was below the necessary level in the old generation, with many foods being scantily taken. Irrespective of generation the diet was of Japanese style. It will be necessary to guide people to the improvement of dietary life according to generations.
The dietary life of bedridden people and of those who attend to them was the worst of all. Some social measures to improve the situation, as well as the repletion of primary health care for old people are urgently required.
Women in rural communities generally have concrete demands for improvement of the dietary life. It is important to carry out the improvement in harmony with the actual condition of life in the community and the demand of inhabitants.