Objective : We performed a narrative analysis of the data of diabetes of elderly patients how the Japanese Clinical Practice Guidelines have worked on glycemic control.
Methods : We analyzed two sets of data, one from patients who visited initially during April and June in 2009, 2014 and 2019, respectively, and the other from 168 patients followed for 10 years successively, with analysis on Hb (hemoglobin) A1c and the number of hypoglycemic agents (prescriptions)/patient.
Results : In the first set, the patient numbers were 351, 487 and 572 in each year with a mean age of 68.5, 70.5 and 71.7 years, respectively. The mean HbA1c, 7.3～7.4％, was not significantly different from each year, but prescriptions/patient were greater in 2019 than in 2009, 1.7±1.3 (mean±SD) vs 1.2±1.1. Upon division into Groups 1 to 3 by age, <65 years, 65 to 74 years, and ≥75 years old, respectively, HbA1c was greater in Group 1 than in Groups 2 and 3, and so were prescriptions/patient, especially DPP-4i and SGLT-2i. In the second set, the mean HbA1c was greater with time and so were prescriptions/patient, 1.2±1.1 in 2009 vs 2.1±1.4 in 2019. Upon division into three groups (T1, T2 and T3) by age tertile, with a mean age of 55.7, 66.0, and 75.4 years in 2009, respectively, HbA1c was higher and the fraction of the patients having <7.0％ HbA1c less in T1 than in T3. Prescriptions/patient were greater in T1 than in T3 all through the observation period.
Conclusion : Diabetes control has been at a reasonable level in the elderly patients (≥65 years) but not in the middle-aged.

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Purpose : To identify predictive factors for late rectal toxicity in prostate cancer patient who underwent intensitymodulated radiation therapy (IMRT).
Methods : 415 prostate cancer patients who underwent IMRT between November 2008 and September 2019 were included. All patients underwent definitive radiation therapy with a total prescribed dose of 78 Gy, and 2 Gy per fraction. We analyzed the relationship between late rectal toxicity and the following factors : National Comprehensive Cancer Network (NCCN) risk classification, use of anticoagulants, radiation methods and various dose-volume histogram parameters.
Results : Median follow-up period was 46 months (3-133). Grade ≥2 late rectal adverse events occurred in 8.0％ (n＝33). Univariate analysis revealed that NCCN high-risk group (P＝0.026) and low percentage of bladder wall volume irradictaed 70 Gy or more to total bladder wall volume (BW V70Gy％) were significantly associated with increased rate of Grade ≥2 late rectal toxicity (P＝0.026 and 0.036, respectively). Multivariate analysis showed that both of them were independently accociated with the rate of the toxicity (P＝0.016 and 0.033, respectively).
Conclusion : NCCN high-risk group and low BW V70Gy％ might be predictive factors for Grade ≥2 late rectal toxicity.

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Background : This study attempted to produce a novel graft composed of bone marrow-derived mesenchymal cell (BMC) layer-gelatin sheets for bladder augmentation cystoplasty. Then, we determined if the grafts could reconstruct bladder tissues.
Methods : BMCs harvested from the femurs of green fluorescence protein (GFP)-transfected Sprague-Dawley (SD) rats were adherent and proliferating cells on collagen dishes. The cells were then cultured on temperatureresponsive culture dishes. Following this, the BMCs maintaining cell-cell contacts within the monolayer itself were applied to a gelatin sheet. Two BMC layer-gelatin sheets were overlaid together with the cell sides juxtaposed with one another (bilayered BMC-gelatin graft). Bladder top of SD rats were incised and transplanted with the bilayered BMC-gelatin grafts. Similarly, urinary bladders irradiated with 2 Gy once a week for 5 weeks were also conducted. As control, bilayered acellular-gelatin grafts were used. At 4 weeks after transplantation, the bladders were histologically investigated.
Results : At 4 weeks after transplantation into either normal or radiation-injured urinary bladders, incised regions closed. The closed regions of bladder top had reconstructed tissues that were formed with urothelium, and smooth muscle layers. Within the reconstructed tissues, the thickness of the smooth muscle layers in the bilayered BMC-gelatin graft-transplanted bladders were larger compared to controls. The GFP-positive transplanted BMCs were detected. Some of the cells were simultaneously positive for smooth muscle or nerve cell markers.
Conclusion : This study showed that the bilayered BMC-gelatin grafts that were experimentally produced could reconstruct bladder tissues. The grafts would be developed as grafts for bladder augmentation cystoplasty.

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