Objectives: We have observed white turbidity when a midazolam injection is administered from a lateral tube during the administration of a peripheral parenteral nutrition (PPN) solution. The aim of the current study was to determine how to avoid compound changes when co-administering a midazolam injection and a PPN solution.

Methods: Midazolam solutions were prepared by diluting a midazolam injection with a 5% glucose intravenous infusion. We examined the formulation of the midazolam injection and a PPN solution at the concentrations used in a clinical setting for changes in appearance, pH, and midazolam content in test tubes and during administration conditions.

Results: With a 1/4.8 dilution of midazolam in undiluted solution, clouding occurred. A strong correlation was revealed between the midazolam content as measured through high-performance liquid chromatography and the mixture’s midazolam concentration (R²=0.9918). The capture rate of midazolam infused with PPN solution was 91.0% at a 1/6 dilution, whereas it decreased to <90% at a 1/4.8 dilution.

Conclusions: Our results suggest that the administration of a midazolam injection solution diluted by ≥6-fold with glucose solution or saline from a side tube during the administration of a PPN solution did not cause changes in composition.

Objectives: Proximal stoma creation in neonates results in growth failure and distal intestinal atrophy. “Recycling stool” consists of stool injection from the proximal limb to the distal limb of a stoma. Because this method may prevent distal bowel atrophy and increase body weight, we investigated the effects of recycling stool upon distal intestinal mucosa by generating an ileostomy model in rats.

Methods: An ileostomy was created 5 cm proximal to the cecum in male Wistar/ST rats. Discharged stool or saline was injected into the distal limb, twice per day for 7 days. The intestinal adaptation was assessed by measuring the villus height and counting goblet cell number. Proliferation and apoptosis were analyzed by Ki67 and TUNEL immunostaining.

Results: The ratios of the height of the distal villi (D) to the that of proximal villi (P) were 0.97 (median [range] of D and P length: 421 [240–729] μm and 436 [294–638] μm, P<0.05) in the stool-injected group and 0.81 in the saline-injected group (442 [315–641] μm and 548 [236–776] μm, P<0.05). Compared with the saline-injected group, the stool-injected group showed elevated numbers of goblet cells (3.6 [2.0–7.6] vs. 4.9 [2.4–7.5] cells/100-μm villus length) and Ki67-positive cells (26.8% [13.8%–35.4%] vs. 40.1% [31.2%–45.7%]), along with a reduced number of apoptotic cells (5.0 [2.0–14.0] vs. 4.0 [1.0–9.0] cells/100-μm villus length).

Conclusions: Recycling stool prevented distal intestinal atrophy; this experimental design may facilitate further studies concerning alternative methods to prevent intestinal atrophy and growth failure.

Objectives: Neoadjuvant chemotherapy (NAC) is widely accepted as a potential treatment for advanced gastric cancer (AGC). Laparoscopic gastrectomy (LG) has recently been performed for advanced gastric cancer and could lead to improved adherence to multimodal treatment. In the present study, we compared the feasibility and outcomes of LG in patients with or without NAC in our institution.

Methods: We assessed patients who underwent LG with (n=185) or without (n=1204) NAC between 1997 and 2013. We used propensity score matching to evaluate perioperative short-term outcomes and long-term outcome.

Results: We used propensity score matching by patient background and treatment-rerated factors to establish two groups of 157 patients with or without NAC. There were no significant differences in perioperative short-term outcomes or long-term outcome between the groups.

Conclusions: LG for selected patients with NAC is feasible and safe but has no long-term survival benefit.

Objectives: The most common method of removal of calculi (“stones”) from the common bile duct (CBD) is an endoscopic sphincterotomy. We wished to determine the role of an improved method of sphincterotomy in choledocholithiasis: “radial sphincterotomy”.

Methods: From 2017 to 2018, 54 endoscopic retrograde cholangiopancreatography (ERCP) procedures were undertaken in patients diagnosed with choledocholithiasis. Group 1 (23 patients) received a standard “pull type” sphincterotomy. The sphincterotomy incision in group 1 was made at the 11, 12 or 1 ‘O’ clock directions of a conventional clock depending on the anatomy of the papilla and stone size. Group 2 (31 patients) received a radial sphincterotomy. In this case, several incisions were made in the 11, 12 or 1 ‘O’ clock directions. The main incision was applied to the transverse fold, and other radial incisions were made below the transverse fold, without going beyond the boundaries of the proposed course of the intramural part of the CBD.

Results: Stone size (mm) was classified as ≤5, 5–10, 10–15, 15–20 and >20. In group 1, the stone size was <20 mm in 21 patients, and >20 mm in two patients. In group 2, stones >20 mm were detected in seven patients, and in other cases the size was 15–20 mm. In patients who underwent radial sphincterotomy, post-ERCP pancreatitis was noted in one patient, and bleeding and perforations were not observed .

Conclusions: Our method showed promising results, and deserves more extensive research and worldwide application. We recommend that only experienced endoscopists should undertake this novel procedure.

Objectives: This study aimed to investigate the clinicopathologic features and subtype distribution of invasive breast cancer in elderly women (≥70 years of age).

Methods: This retrospective study of 1,130 women compared the clinicopathologic characteristics and subtype distribution of invasive breast cancer in elderly (≥70 years) versus non-elderly (<70 years) women. Tumors were classified into five distinct subtypes based on the immunohistochemistry status of estrogen receptor (ER), progesterone receptor (PR), Ki67, and human epidermal growth factor receptor 2 (HER2).

Results: The two patient groups did not differ significantly regarding ER and HER2 status. Breast cancers in elderly women were more likely to have negative PR status (40.4% vs. 32.6%, P=0.033) and low Ki67 expression (62.0% vs. 54.4%, P=0.047) than those in non-elderly women. Elderly women were less likely to undergo axillary lymph node dissection and axillary surgery (P<0.001). Consequently, unknown node status was more common in elderly women than non-elderly women (11.1% vs. 1.4%, respectively, P<0.001), while node involvement was less common in elderly women than non-elderly women (26.9% vs. 37.7%, respectively, P<0.001). There was no significant difference in the distribution of subtypes between the two groups.

Conclusions: Breast cancers in elderly women were less frequently node positive and more frequently PR negative and with low Ki67 expression than those in non-elderly women. Moreover, there was no difference in subtype distribution between the two age groups.

Background: Anaerobic threshold (AT) during cardiopulmonary exercise testing (CPET) is not always determinable in patients with heart failure (HF). However, little is known about the clinical features of patients with HF who have indeterminable AT. Therefore, the present study aimed to clarify the clinical features of such patients.

Methods: A total of 70 patients with HF (58 males; age: 68±12 years) who underwent CPET during hospitalization were divided into two groups: determinable AT (n=50) and indeterminable AT (n=20). Physical function, echocardiographic results, and laboratory findings were subsequently determined.

Results: Univariate analyses showed that the indeterminable AT group had significantly higher age and left ventricular ejection fraction, and significantly lower body mass index, calf circumference, handgrip strength, walking speed, serum hemoglobin, and serum albumin than the determinable AT group. Multiple logistic regression analysis identified handgrip strength and walking speed as independent predictive factors for indeterminable AT. Receiver-operating characteristic analyses revealed that handgrip strength of 21.2 kg and walking speed of 0.97 m/s were optimal cutoff values for differentiating patients who were likely to experience indeterminable AT.

Conclusions: The present study identified handgrip strength and walking speed as powerful predictors for indeterminable AT with HF.