The purpose of this study was to compare the effect between cyclists and noncyclists of pedal rates on ankle, knee, and hip joint torque during pedaling exercises. Six male cyclists (CY) and seven male noncyclists (NC) pedaled at 40, 60, 90 and 120 rpm with a power output of 200 W. The lower limb was modeled as three rigid segment links constrained to plane motion. Based on the Newton-Euler method, the equation for each segment was constructed and solved on a computer using pedal force, pedal, crank, and lower limb position data to calculate torque at the ankle, knee, and hip joints. The average planter flexor torque decreased with increasing pedal rates in both groups. The average knee extensor torque for CY decreased up to 90 rpm, and then leveled off at 120 rpm. These results were similar to NC. The average knee flexor torque in both groups remained steady over all pedal rates. The average hip extensor torque for CY decreased significantly up to 90 rpm where it showed the lowest value, but increased at 120 rpm. For NC, the average hip extensor torque did not decrease at 90 rpm compared with 60 rpm, and was significantly higher than CY at 120 rpm (CY : 28.1 ± 9.0 Nm, NC : 38.6 ± 6.7 Nm, p<0.05) . The average hip flexsor torque for NC at 120 rpm increased significanly from 90 rpm, and was significantly higher than CY (CY : 11.6±2.9 Nm, NC : 22.6±11.8 Nm, p<0.05) . These results suggest that it would be better for cyclists to select a pedal rate of between 90 to 110 rpm to minimize joint torque, and, as a result, reduce peripheral muscle fatigue.

Background/Aims: Difficult biliary cannulation is an important risk factor for post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP). Therefore, this study aimed to identify the factors that predict difficult cannulation for common bile duct stones (CBDS) to reduce the risk for PEP. Methods: This multicenter retrospective study included 1,406 consecutive patients with native papillae who underwent ERCP for CBDS. Factors predicting difficult cannulation for CBDS were identified using univariate and multivariate analyses. Results: Univariate analysis showed that six factors significantly predicted difficult cannulation: ERCP performed by non-expert endoscopists, low-volume center, absence of acute cholangitis, normal serum bilirubin, intradiverticular papilla, and type of major duodenal papilla. Multivariate analysis identified ERCP performed by non-expert endoscopists (odds ratio [OR], 2.5; p<0.001), low-volume center (OR, 1.6; p<0.001), intradiverticular papilla (OR, 1.3; p=0.007), normal serum bilirubin (OR, 1.3; p=0.038), and absence of acute cholangitis (OR, 1.3; p=0.049) as factors significantly predicting difficult cannulation for CBDS. Conclusions Initial cannulation by an experienced endoscopist, early rescue cannulation, or early takeover by an experienced endoscopist should be considered when performing ERCP for CBDS in the presence of factors predicting difficult cannulation.

Objective: In 2013, a cohort study aimed to clarify the positive and negative effects of introducing the human papillomavirus (HPV) testing for population-based cervical cancer screening has been launched in Japan. This study included four screenings during the subsequent 7-year follow-up period. We aim to describe the results of the first round of this study on cervical cancer screening here. Methods: This study began in September 2013 with recruitment completed in March 2016.Women aged 30–49 years were divided into 2 groups: those who received uterine cervical cytology alone in the first year (control group), or those who received a combination of cytology and HPV testing (intervention group), based on their age. After first screening, women with positive result of cytology or positive HPV test required referral. We summarized the results of the first round of cervical cancer screening. Results: Of the 25,074 women who were eligible for the study, 13,845 women (55.2%) were screened with cytology alone; 11,229 women (44.8%) received a combination of cytology and HPV testing. After screening, 407 women (2.9%) in the control group and 1,003 women (8.9%) in the intervention group required referral, respectively. Adding HPV testing increased referral rate significantly (p<0.001). Conclusion After first screening, introduction of HPV testing appears to contribute to significantly higher referral rates, suggesting that the number of colposcopies as a detailed examination may increase. These preliminary findings suggest that if HPV testing is introduced into screening, medical institutions need to be prepared for an increasing number of follow-up examinations.

Background/Aims: This study aimed to examine the synergistic effect of independent risk factors on post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP). Methods: This multicenter retrospective study included 1,273 patients with native papillae who underwent ERCP for bile duct stones in Japan. Independent PEP risk factors were identified using univariate and multivariate analyses. Significant risk factors for PEP in the multivariate analysis were included in the final analysis to examine the synergistic effect of independent risk factors for PEP. Results: PEP occurred in 45 of 1,273 patients (3.5%). Three factors including difficult cannulation ≥10 minutes, pancreatic injection, and normal serum bilirubin level were included in the final analysis. The incidences of PEP in patients with zero, one, two, and three factors were 0.5% (2/388), 1.9% (9/465), 6.0% (17/285), and 12.6% (17/135), respectively. With increasing risk factors for PEP, the incidence of PEP significantly increased (1 factor vs. 2 factors, p=0.006; 2 factors vs. 3 factors, p=0.033). Conclusions As the number of risk factors for PEP increases, the risk of PEP may not be additive; however, it may multiply. Thus, aggressive prophylaxis for PEP is strongly recommended in patients with multiple risk factors.

Drug therapy is necessary to treat metastatic and recurrent breast cancer. In Japan, two types of cyclin-dependent kinases (i.e., CDK4/6 inhibitors) are covered under the national healthinsurance system: palbociclib (since December 2017) and abemaciclib (since November 2018). Although there are many reports on the use and side effects of palbociclib in clinical practice, there are few such reports on abemaciclib. Therefore, we investigated the rate of neutropenia and associated background factors in patients taking abemaciclib. Of the 39 patients taking abemaciclib recruited for the study, 22 satisfied the inclusion criteria. Of these, 7 developed Grade 3 or higher neutropenia and had a significantly lower body weight and body mass index (BMI). Furthermore, the white blood cell and neutrophil counts before administration were significantly lower in the expression group compared with the non-expressing group. To predict the development of Grade 3 or higher neutropenia, the receiver operating characteristic (ROC) curve was used to calculate a BMI cut-off value of 23.9 (specificity 85.7%, sensitivity 73.3%, area under the ROC curve 0.80). Based on this cut-off value, BMI was divided into two groups (<23.9 and ≥23.9) and Fisher's exact test was performed. Patients with a low body mass index were more likely to develop Grade 3 or higher neutropenia as a result of increased dosage per kilogram body weight, while among patients with BMI < 25, those with BMI < 23.9 were at high risk of developing Grade 3 or higher neutropenia. Accordingly, caution is required in the treatment of such patients.