Objectives: Bone fractures affect the activities of daily living and lower quality of life, so investigating preventative measures is important. We developed novel stimulation equipment that combined a vibration stimulus with a shaking stimulus for preventing osteoporosis (one of the causes of bone fractures). We aimed to investigate the effect of this equipment on ovariectomized mice.

Methods: Oophorectomy of 8-week-old female mice was done. The stimulation group was stimulated for 10 consecutive weeks.

Results: The stimulation group showed significantly higher values (p<0.05) for osteoid thickness, osteoid volume-to-bone volume ratio and mineral apposition rate than those in the non-stimulation control group. The stimulation group showed significantly higher values (p<0.05) compared with the non-stimulation for expression of bone morphogenetic protein-2, interleukin-1β, interleukin-6 and myogenic determination gene in quadriceps femoris muscles (QFMs).

Conclusions: These data suggest that cytokine secretion by QFMs carried a humoral factor throughout the body via the blood and blood vessels and acted on bone and various organs. Development of this stimulation method and its clinical application, new methods for preventing and treating osteoporosis could ensue.

Objectives: Patients who have undergone pancreaticoduodenectomy (PD) may experience a long-term decrease in quality of life because of postoperative pancreatic dysfunction (such as digestive and absorption disorders) and fatty liver as a result of combined resection of the duodenum, gallbladder, and bile duct. The present study investigated the usefulness of pancrelipase for the prevention of pancreatic dysfunction after PD.

Methods: The data from 73 patients who underwent PD in a single institution were analyzed. Patients who underwent PD during 2007–2011 were administered the low-titer pancreatic enzyme preparations berizym^® and pancreatin^® (first period group), while patients who underwent PD during 2012–2017 were administered the high-titer pancreatic enzyme preparation pancrelipase (second period group). The following measures of the nutrition status were examined before and after PD: serum albumin concentration, total lymphocyte count, serum total cholesterol concentration, body mass index, controlling nutrition status (CONUT) index, Onodera’s prognostic nutrition index (PNI), and liver computed tomography values.

Results: The second period group had significantly higher serum albumin concentrations at 3 and 6 months postoperatively, serum total cholesterol concentrations at 1 month postoperatively, and Onodera’s PNI values at 3 and 6 months postoperatively than the first period group. The CONUT index values at 6 months after PD were significantly lower in the second period group than in the first period group.

Conclusions: Pancrelipase is useful in improving the nutrition status and preventing fatty liver after PD.

Objectives: Venous thromboembolism (VTE) is often a problematic complication in patients with gynecological cancer. Despite increasing opportunities to use direct oral anticoagulants (DOACs) to treat VTE, there are no reports on the therapeutic outcomes of DOACs in patients with gynecological cancer; however, there are some studies on cancer patients in general. We retrospectively examined the efficacy and safety of using DOACs to treat VTE in such patients.

Methods: The study cohort comprised 43 patients with gynecological cancer and VTE who received treatment between May 2005 and April 2016. They were divided into two groups: DOACs used (DOAC group, n=21) and only unfractionated heparin (UFH) and warfarin used (standard group, n=22). The rates of improvement and recurrence of VTE and incidence of adverse events were compared between these groups.

Results: At 6 months, the VTE of 85% of patients in the DOAC group and of 75% in the standard group had improved (p=0.59). No recurrences of VTE occurred in the DOAC group; where VTE recurred in 12.5% of patients in the standard group. Adverse events occurred in three patients in the DOAC group (15.3%) and one in the standard group (7.7%). Chemotherapy significantly impacted improvement in VTE (p=0.01).

Conclusions: Rates of VTE improvement and of recurrence of VTE and adverse events did not differ significantly between the study groups.

Objectives: Few studies to date have investigated the prognostic significance of Ki67 expression as a continuous variable in breast cancer. This study aimed to evaluate the impact of Ki67 expression as a dichotomous or continuous variable on outcomes in estrogen receptor (ER)+ and human epidermal growth factor receptor 2 (HER2)– breast cancer.

Methods: Survival analysis was performed to estimate the likelihood of distant recurrence and death in retrospective data from 794 patients with ER+/HER2– breast cancer. We assessed the relationship between outcomes and two Ki67 cutoffs, 14% and 20%, and the Ki67 labeling index as a continuous variable.

Results: In univariate analysis, T stage, lymph node involvement, histological grade, progesterone receptor status, and Ki67 expression at the two cutoffs and as a continuous variable were identified as significant prognostic factors for distant disease-free survival (DDFS) and overall survival (OS). There were no statistical differences in DDFS and OS between women with Ki67 expression of <14% and 14–<20%. Multivariate analysis showed that Ki67 expression ≥20% was an independent prognostic indicator for DDFS. Regarding the risk of distant metastasis, the 20% cutoff was more reliable than 14%. We also found that Ki67 expression as a continuous variable was an independent prognostic factor for DDFS and OS in multivariate analyses.

Conclusions: High Ki67 expression is associated with a survival disadvantage in patients with ER+/HER2– breast cancer, indicating that these patients might have a higher risk of recurrence after primary treatment and might therefore benefit from individualized treatment.

Objectives: The clinical role of sputum Gram stain for rapid etiologic pathogen diagnosis in patients with community-acquired pneumonia (CAP) remains an unresolved controversy. Variability in protocols and reporting of diagnostic performance in different studies has hampered assessments of clinical utility and interpretation. Since the last meta-analysis published in 1996, several reports and resources to accurately evaluate the diagnostic accuracy of sputum Gram stain have become available. Therefore, we will conduct a systematic review and meta-analysis of the clinical validity and utility of sputum Gram stain.

Methods: We will search PubMed, Ovid MEDLINE, Embase, and The Cochrane Controlled Register of Trials (CENTRAL) databases from inception through July 30, 2018, with no language restriction and perform a full-text evaluation of potentially relevant articles. We will include prospective and retrospective studies that assess sputum Gram stain in adults (aged ≥18 years) with CAP. Two reviewers will independently extract data and rate each study’s validity with standard quality assessment tools. We will subsequently perform standard and latent-class random-effects model meta-analyses to quantitatively synthesize the diagnostic accuracy and yield. Finally, we will assess the totality of evidence by the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach for diagnostic tests and strategies.

Results: Results of the analysis will be submitted for publication in a peer-reviewed journal.

Conclusions: This systematic review and meta-analysis will provide a 30-year synopsis of clinical evidence on sputum Gram stain in patients with CAP.