We developed a vitamin B12 (VB12)-containing formulation for oral administration that resulted in the absorption of VB12 without gastric intrinsic factor (IF). Patients who cannot secrete IF after the removal of their stomachs are at an increased risk of megaloblastic anemia (MA) and thus require continuous, invasive treatment with VB12 administration to improve absorption. A simple and noninvasive method for MA treatment or prevention is desired. We believe that pharmaceutical effort through a drug delivery system can resolve the absorption efficiency of VB12, which is administered orally when there is no IF in the stomach. Liposomes prepared with the thin film method contain charged lipids and were modified with polyethylene glycol on their membrane. The liposomes contained sufficient cyanocobalamin (Cyc) for VB12 therapy. Administering Cyc-loaded liposome (Cyc-L) resulted in a higher Cyc concentration of serum than that of the Cyc solution. Cyc loaded into liposomes is taken up more easily than in solution state without remaining in the ileum even if IF is present. These results indicate that Cyc-L is a useful formulation because it can elevate the concentration of serum Cyc via oral administration. Thus, Cyc-L may improve the quality of life of many patients who have had their stomachs removed.

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To explore the correlation of radiation exposure of the periprostatic area (PPA) with erectile dysfunction (ED) after seed implant brachytherapy (BT), we compared DVH parameters of the PPA obtained from the postplan, considering alterations of the International Index of Erectile Function 6 questionnaire score (IIEF-6) after BT, among 34 patients with IIEF-6 ≧ 22 before BT. We delineated the PPA manually as the extracapsular rind of 3 mm width, which was divided into 36 parts on 12 sectors of the apex, middle and base of the prostate (ROIs). We divided patients into two groups: the non-ED group (n = 23) with IIEF-6≥22 at 12 months after BT, and the ED group (n = 11), who had IIEF - 6 ≤11 at the same time point as the non-ED group. We performed statistical comparison between the non-ED group and ED group for the mean D90 of each ROI (roiD90) and the variables belonging to patients’ backgrounds and DVH parameters. In known variables, there was no significant difference between the ED and non-ED groups in terms of patients’ backgrounds and DVH parameters. The mean roiD90 of the ED group was significantly larger than that of the non-ED group at the middle and apex of left side of the prostate. These findings indicate that that excessive doses on a specific site of the PPA may induce ED due to radiation damage on the pelvic splanchnic nerve passing through the area.

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Chronic myeloproliferative neoplasms carrying the somatic JAK2^V617F mutation ( JAK2^V617F MPN) are characterized by the expansion of neoplastic clones and high immunogenicity. Expression of programmed cell death ligand-1 (PD-L1) in JAK2^V617F MPNs is mainly induced in megakaryocytes, platelets, and monocytes. The JAK2^V617F allele burden indicates the size of clonal hematopoiesis from hematopoietic progenitor cells. Although the importance of T cell-mediated anti-tumor immunity and JAK2^V617F allele burden in the pathogenesis of MPN progression has previously been documented, little is known about the relationship between these factors. We therefore analyzed the phenotype and frequency of PD-1+ CD8+ T cells and the expression levels of PD-L1 in platelets in 26 patients with JAK2^V617F MPN. We found that the frequency of PD-1+ CD8+ T cells inversely correlated with the JAK2^V617F allelic burden. However, the PD-L1 expression levels on platelets had no correlation with JAK2^V617F allele burden or the CD8+ T cell subpopulations. These data indicate that the expansion of clonal hematopoiesis restrains antitumor immunity, resulting in reduced frequency of PD1+ CD8+ T cells, and that the expression level of PD-L1 on platelets may not reflect the JAK2^V617F allele burden or antitumor immunity.

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Lumbar spinal stenosis (LSS) is one of the most common causes of gait disturbance. However, most gait analyses in patients with LSS require a laboratory and do not yield results instantly. Lissajous index (LI) is a method that represents the gait asymmetry visually and numerically based on trunk acceleration data. We investigated the effect of surgery on gait disturbance and assessed whether LI can be useful for the quantitative analysis of gait in patients with LSS. Thirty-two patients were evaluated during a 6-minute walking test with a wearable tri-axial acceleration sensor, preoperatively and at 3 months postoperatively. The distance walked significantly increased from 395.1 ± 60.8 m preoperatively to 455.4 ± 64.4 m postoperatively (p < 0.001). The preoperative LI value increased over time (p < 0.001) and showed a tendency to postoperative improvement. The postoperative LI value was significantly lower than the preoperative value at 1–4 min (p < 0.05) and was much lower at 4–6 min (p < 0.01). Preoperative and postoperative LI changes correlated with clinical scores (p < 0.05). Thus, surgery improves gait symmetry, and LI values can be useful for evaluating gait in patients with LSS.

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