Effects of fan cooling with an air-perfused rucksack on physiological and perceptual strains in young men while running in uncompensable hot environment.

BACKGROUND: Cooling devices reduce thermal strain during pre-, between-, and postexercise. However, their efficacy during moderate/intensity runs in hot conditions with airflow equivalent to the running speed remains unclear. This study assessed physiological and perceptual responses to neck and upper back fan-cooling through an air-perfused rucksack under such conditions. METHODS: Ten young men ran at 60% V̇O2peak for 30 min in 35 °C, 50% relative humidity with (FAN) and without (CON) air-perfused rucksacks with a hood in a randomized order. Headwind equal to running speed was provided in both conditions. The fan-cooling trial consisted of upper back and neck fan cooling with airflow at 4-5 m/s via two fans attached on either side of the rucksack. Rectal and skin temperatures, whole-body thermal sensation, thermal comfort, and changes in body mass were measured. RESULTS: Upper back skin temperature and thermal sensation were significantly lower throughout the exercise in the FAN than in the CON, whereas thermal comfort was significantly higher at 15-40 min in the FAN (all P≤0.05). Heart rate elevation during 30 min of running was attenuated in the FAN compared to that in the CON (P≤0.05). No significant differences in rectal and mean skin temperatures, or total body mass loss were observed between the two trials. CONCLUSIONS: These results indicate that additional fan-cooling on the upper back and neck during running in uncompensable hot conditions with a headwind had limited physiological benefits. However, whole-body-based thermal sensation and comfort are partially improved with the use of an air-perfused rucksack.

Effectiveness of endoscopic ultrasound-guided tissue acquisition with stereomicroscopic on-site evaluation for preoperative diagnosis of resectable or borderline resectable pancreatic cancer: a prospective study.

Background/Aims: To validate endoscopic ultrasound-guided tissue acquisition (EUS-TA) used in conjunction with stereomicroscopic on-site evaluation (SOSE) as a preoperative diagnostic tool for resectable pancreatic cancer (R-PC) and borderline resectable PC (BR-PC). Methods: Seventy-eight consecutive patients who underwent EUS-TA for suspected R-PC or BR-PC were enrolled. The primary endpoint was the sensitivity of EUS-TA together with SOSE based on the stereomicroscopically visible white core (SVWC) cutoff value. One or two sites were punctured by using a 22-gauge biopsy needle for EUS-TA, based on the SOSE findings. Results: We collected 99 specimens from 56 and 22 patients with R-PC and BR-PC, respectively. Based on the SOSE results, we performed 57 procedures with one puncture. The SVWC cutoff values were met in 73.7% and 73.1% of all specimens and in those obtained during the first puncture, respectively. The final diagnoses were malignant and benign tumors in 76 and two patients, respectively. The overall sensitivity, specificity, and accuracy of EUS-TA for the 78 lesions were 90.8%, 100%, and 91.0%, respectively. The sensitivity for malignant diagnosis based on the SVWC cutoff value were 89.5% and 90.4% for the first puncture and all specimens, respectively. Conclusions: The sensitivity of EUS-TA in conjunction with SOSE for malignancy diagnosis in patients with suspected R-PC or BR-PC was 90.4%.

Stereomicroscopic on-site evaluation in endoscopic ultrasound-guided tissue acquisition of upper gastrointestinal subepithelial lesions.

BACKGROUND/AIMS: In stereomicroscopic sample isolation processing, the cutoff value (≥4 mm) of stereomicroscopically visible white cores indicates high diagnostic sensitivity. We aimed to evaluate endoscopic ultrasound-guided tissue acquisition (EUS-TA) using a simplified stereomicroscopic on-site evaluation of upper gastrointestinal subepithelial lesions (SELs). METHODS: In this multicenter prospective trial, we performed EUS-TA using a 22-gauge Franseen needle in 34 participants with SELs derived from the upper gastrointestinal muscularis propria, requiring pathological diagnosis. The presence of stereomicroscopically visible white core (SVWC) in each specimen was assessed using stereomicroscopic on-site evaluation. The primary outcome was EUS-TA's diagnostic sensitivity with stereomicroscopic on-site evaluation based on the SVWC cutoff value (≥4 mm) for malignant upper gastrointestinal SELs. RESULTS: The total number of punctures was 68; 61 specimens (89.7%) contained stereomicroscopically visible white cores ≥4 mm in size. The final diagnoses were gastrointestinal stromal tumor, leiomyoma, and schwannoma in 76.5%, 14.7%, and 8.8% of the cases, respectively. The sensitivity of EUS-TA with stereomicroscopic on-site evaluation based on the SVWC cutoff value for malignant SELs was 100%. The per-lesion accuracy of histological diagnosis reached the highest level (100%) at the second puncture. CONCLUSION: Stereomicroscopic on-site evaluation showed high diagnostic sensitivity and could be a new method for diagnosing upper gastrointestinal SELs using EUS-TA.

Modeling Long-Term Facilitation of Respiration During Interval Exercise in Humans.

Long-term facilitation (LTF) of respiration has been mainly initiated by intermittent hypoxia and resultant chemoreceptor stimulation in humans. Comparable levels of chemoreceptor stimulation can occur in combined exercise and carbon dioxide (CO2) inhalation and lead to LTF. This possibility was supported by data collected during combined interval exercise and 3% inhaled CO2 in seven normal subjects. These data were further analyzed based on the dynamics involved using mathematical models in this study. Previously estimated peripheral chemoreceptor sensitivity during light exercise (40 W) with air or 3% inhaled CO2 approximately doubled resting sensitivity. Ventilation after a delay increased by 17.0 ± 2.48 L/min (p < 0.001) during recovery following 45% maximal oxygen uptake ([Formula: see text] ) exercise consistent with LTF which exceeded what can be achieved with intermittent hypoxia. Model fitting of the dynamic responses was used to separate neural from chemoreceptor-mediated CO2 responses. Exercise of 45% [Formula: see text] was followed by ventilation augmentation following initial recovery. Augmentation of LTF developed slowly according to second-order dynamics in accordance with plasticity involving a balance between self-excitatory and self-inhibitory neuronal pools.

Addition of In-Play Cooling Breaks During Intermittent Exercise While Wearing Lacrosse Uniforms in The Heat Attenuates Increases in Rectal Temperature.

To reduce the risk of heat-related illness, appropriate body cooling strategies are needed during men's lacrosse competitions in hot-humid environments. The current study investigated whether additional in-play cooling breaks would attenuate the core (rectal) body temperature rise during exercise designed to mimic the activity patterns of a men's lacrosse match while wearing uniform in hot-humid environments. In randomized and counterbalanced order, ten physically active men completed two experimental trials comprising four quarters of 15-min intermittent cycling exercises separated by a 10-min simulated half-time break and two 2-min quarter breaks in a climate chamber (35°C, 50% relative humidity). The two trials included a regular simulated match condition (REG) and a water break time out condition (WBTO) that included additional 2-min breaks 7.5-min into each quarter. Rectal temperature was significantly lower (p=0.017) in the WBTO condition (38.23±0.23°C) compared with the REG condition (38.50±0.46°C) at the end of the 4th quarter. In addition, ratings of perceived exertion, thermal sensation, heart rate and the physiological strain index were significantly lower (all p<0.05) in the WBTO condition compared with the REG condition. The current results indicated that, even when wearing lacrosse uniforms, the implementation of WBTO attenuated the core body temperature elevation only in the latter stages of an intermittent cycling exercise protocol designed to mimic the exercise pattern of a men's lacrosse match. Therefore, WBTO may provide a feasible and effective cooling strategy for lacrosse players to reduce the risk of heat-illness.

Multicenter prospective study of the efficacy of stereomicroscopic on-site evaluation in endoscopic ultrasound-guided tissue acquisition in patients with pancreatic cancer.

OBJECTIVE: In sample isolation processing by stereomicroscopy (SIPS), a technique used to assess the quality of specimens collected during endoscopic ultrasound (EUS)-guided tissue acquisition (EUS-TA), the cutoff value of stereomicroscopically visible white core (SVWC) (≥11 mm) indicates high diagnostic sensitivity. However, the procedure of SIPS is complicated and time-consuming. Therefore, we devised the stereomicroscopic on-site evaluation (SOSE), a new rapid assessment method that is simpler than SIPS and only determines if the SVWC cutoff value is attained. We aimed to examine the usefulness of SOSE in a multicenter, prospective setting. METHODS: Seventy patients from multiple institutions with solid pancreatic masses suspected to be pancreatic cancer were included. EUS-TA was performed using a 22-gauge Franseen needle. SVWCs were measured on-site using stereomicroscopy. The primary outcome was the sensitivity of SVWC cutoff value in EUS-TA with SOSE. RESULTS: The total number of punctures was 214 and SOSE was performed on 150 punctures. The SVWC cutoff value collection rate was 100% per lesion, with 80% in the first pass, 79% in the second pass, and 78% per puncture in all passes. The median time taken to determine the SVWC cutoff value for SOSE was 47 s. The sensitivity of the SVWC cutoff value was 93.2% for histology and 96.6% for cytology + histology. The per-lesion accuracy of pathological diagnosis reached the highest level (98.6%) at the second puncture. CONCLUSIONS: SOSE showed high diagnostic sensitivity and may be a new rapid assessment method for the diagnosis of malignant pancreatic cancer using EUS-TA.

Risk Factors for Perforation During Endoscopic Papillary Large Balloon Dilation and Bile Duct Stone Removal.

BACKGROUND: Stone removal using endoscopic papillary large balloon dilation (EPLBD) is extremely effective. However, limited research exists regarding the risk factors for perforation of the duodenal papilla and bile duct, which may be fatal. AIMS: We aimed to investigate the risk factors for perforation during EPLBD + stone removal. METHODS: We included patients who underwent EPLBD + stone removal at four medical facilities between January 2008 and December 2018. We retrospectively analyzed the risk factors for perforation and their relationship between overdilation and adverse events. Overdilation was defined as a ratio of the balloon diameter to the diameter of the bile duct that exceeded 100%. The diameter of the distal bile duct was measured using the diameter of the intrapancreatic bile duct at a point 10 mm toward the liver from the narrow distal segment on a cholangiogram. RESULTS: We included 310 patients (177 males; median age: 79 years [range: 46-102 years]). Perforation occurred in five patients (1.6%). Multivariate analysis indicated that no surrounding-pancreas (half or less of the circumference of the intrapancreatic bile duct was surrounded by the pancreatic parenchyma) was a significant risk factor (perforation rate: 8.3%, p = 0.011, odds ratio: 12.7 [95% confidence interval: 1.8-90.5]). No significant difference was found between the overdilation and non-overdilation groups regarding the occurrence of pancreatitis, bleeding, and cholangitis. Perforation rate in patients with no surrounding pancreas + overdilation was 16.7% (2/12). Patients with perforation underwent conservative therapy, which improved their conditions. CONCLUSIONS: EPLBD + stone removal should be avoided in patients with no surrounding pancreas. Overdilation is not a risk factor for adverse procedural events; however, it should be limited in patients with surrounding pancreas.

[A Case of Completion Gastrectomy for Metachronous Gastric Cancer in the Remnant Stomach after Successful Treatment with ESD].

A 73-year-old man underwent distal gastrectomy, D2 lymphadenectomy, and Billroth Ⅰ reconstruction for Type 3 advanced cancer in the lower corpus lesser curvature in 20XX. After postoperative adjuvant chemotherapy, he self-detected a mass in the left breast. It was diagnosed as breast cancer. He underwent mastectomy and axillary lymphadenectomy 16 months after gastric cancer surgery. After postoperative adjuvant chemotherapy, gastric or breast cancer did not recur. However, periodic upper gastrointestinal endoscopy revealed an 8-mm 0-Ⅱa lesion in the anterior wall of the remnant middle stomach(Group 5)80 months after gastric cancer surgery. Endoscopic submucosal dissection(ESD)was performed, and radical resection was achieved. Periodic upper gastrointestinal endoscopy was performed thereafter; an ectopic 0-Ⅱa lesion was detected in the greater curvature of the remnant middle stomach(Group 5)21 months after ESD. Since this lesion suggested massive submucosal invasion, total resection of the remnant stomach and Roux-en-Y reconstruction were performed. The postoperative course has been favorable, and the patient has been alive without recurrence for 6 months postoperatively. A long period passes before intestinal juice reflux induces progression of a chronic inflammatory gastric mucosal lesion to cancer in the remnant stomach. Thus, long-term endoscopic follow-up may be necessary.

Effects of Half-Time Cooling Using a Fan with Skin Wetting on Thermal Response During Intermittent Cycling Exercise in the Heat.

The present study investigated the effects of half-time (HT) break cooling using a fan and damp sponge on physiological and perceptual responses during the 2 nd half of a repeated-sprint exercise in a hot environment. Eight physically active men performed a familiarization trial and two experimental trials of a 2×30-min intermittent cycling exercise protocol with a 15-min HT break in hot conditions (35°C, 50% relative humidity). Two experimental trials were conducted in random order: skin wetting with a fan (FAN wet ) and no cooling (CON). During the 2 nd half, a repeated-sprint cycling exercise was performed: i. e., 5 s of maximal pedaling (body weight×0.075 kp) every minute, separated by 25 s of unloaded pedaling (80 rpm) and 30 s of rest. Rectal temperature, skin temperature (chest, forearm, thigh, and calf), heart rate, physiological strain index, rating of perceived exertion, thermal sensation, and comfort were significantly improved in the FAN wet condition (P<0.05). There was no significant difference in the repeated-sprint cycling exercise performance between conditions. The results suggest that skin wetting with a fan during the HT break is a practical and effective cooling strategy for mitigating physiological and perceptual strain during the 2 nd half in hot conditions.

Physical, Physiological, and Technical Demands in Ultimate Frisbee Small-Sided Games: Influence of Pitch Size.

Small-sided games (SSGs) are common drills used in various team sports, but the exercise intensity in ultimate Frisbee SSG has not yet been investigated. To clarify the physical, physiological, and technical demands of ultimate Frisbee SSG, we investigated the influence of pitch size on exercise intensity during SSG. Nine male college ultimate Frisbee players played (3 vs. 3) SSG on small (SSGS: 30 × 15 m) and large (SSGL: 40 × 20 m) pitches; both SSGs comprised of four 4 min periods, interspersed by 5 min of passive recovery. Players' mean heart rate (170 ± 8 and 171 ± 7 bpm), peak heart rate (184 ± 7 and 184 ± 5 bpm), and blood lactate concentration (11.3 ± 4.7 and 11.8 ± 4.6 mmol/L) were similar in SSGS and SSGL, respectively. The total distance covered (1984 ± 166 m and 1702 ± 80 m) and the distance covered during quick (860 ± 112 m and 696 ± 69 m) and high-intensity running (439 ± 95 and 255 ± 44) in SSGL were significantly longer than those in SSGS (p < 0.05). Conversely, the number of accelerations (45 ± 3 and 41 ± 3) and decelerations (44 ± 3 and 40 ± 4), catching errors (2 ± 1 and 1 ± 1), and turnovers (8 ± 2 and 6 ± 2) in SSGS were significantly greater than those in SSGL (p < 0.05). This study suggests that ultimate Frisbee SSG provides high-intensity training, which stimulates the glycolytic pathway. Furthermore, manipulating SSG pitch size effectively modulates the physical demands of SSG.

Altered chemosensitivity to CO2 during exercise.

The effect of exercise on chemosensitivity to carbon dioxide (CO2 ) has been controversial. Most studies have been based on rebreathing to alter inspired CO2 which is poorly tolerated in exercise. Instead, inhaling a fixed 3% CO2 from rest to moderate exercise was found to be well tolerated by seven normal subjects enabling CO2 chemosensitivity to be studied with minimal negative reaction. Results showed that chemosensitivity to CO2 following 5-6 min of stimulation was significantly enhanced during mild exercise (p < 0.01). This motivated exploring how much of the dynamic ventilatory response to mild exercise breathing air could be predicted by a model with central and peripheral chemosensitivity. Chemoreceptor stimulation combined with hypercapnia has been associated with long-term facilitation of ventilation (LTF). 3% CO2 inhalation during moderate exercise led to ventilation augmentation consistent with LTF following 6 min of exercise in seven normal human subjects (p < 0.01). Increased ventilation could not be attributed to hypercapnia or metabolic changes. Moderate exercise breathing air resulted in significantly less augmentation. In conclusion, both peripheral and central chemosensitivity to CO2 increased in exercise with the peripheral chemoreceptors playing a dominant role. This separation of central and peripheral contributions was not previously reported. This chemoreceptor stimulation can lead to augmented ventilation consistent with LTF.

Nafamostat Mesylate is Not Effective in Preventing Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis.

BACKGROUND: Endoscopic retrograde cholangiopancreatography (ERCP) is associated with complications such as post-ERCP pancreatitis (PEP). Protease inhibitors, including nafamostat mesylate (NM), have been evaluated for prophylaxis against PEP. AIM: We describe the first multicenter randomized controlled trial assessing the prophylactic efficacy of NM against PEP. METHODS: In this multicenter prospective study, we aimed to enroll 800 patients aged ≥ 20 years with a planned ERCP between December 2012 and March 2019. The primary outcome was the incidence and severity of PEP in patients who did not receive NM (non-NM) versus those who did (NM; 20 mg). Secondary outcomes included the incidence of PEP by NM initiation (pre- and post-ERCP), risk factors for PEP, and NM-related adverse events. RESULTS: Only 441 of the planned 800 patients were enrolled (non-NM: n = 149; NM: n = 292 [pre-ERCP NM: n = 144; post-ERCP NM: n = 148]). Patient characteristics were balanced at baseline with no significant differences between groups. PEP occurred in 40/441 (9%) patients (non-NM: n = 15 [10%]; NM: n = 25 [9%]), including 17 (12%) and eight (8%) in the pre-ERCP and post-ERCP NM groups, respectively. In the NM group, the incidence of PEP was lower in the low-risk group than in the high-risk group. Pancreatic injection and double-guidewire technique were independent risk factors for PEP. NM-related adverse events of hyperkalemia occurred in two (0.7%) patients. CONCLUSIONS: We found no evidence for the prophylactic effect of NM against PEP, regardless of the timing of administration; however, further studies are needed.

Effect of 3% CO2 inhalation on respiratory exchange ratio and cardiac output during constant work-rate exercise.

BACKGROUND: The aim of this study was to examine whether the decrease in respiratory exchange ratio (RER) during constant work-rate exercise (CWE) with 3% carbon dioxide (CO2) inhalation could be caused by the combination of the decrease in CO2 output (V̇CO2) and the increase in oxygen uptake (V̇O2). In addition, we investigated the effect of 3% CO2 inhalation on cardiac output (Q̇) during CWE. METHODS: Seven males (V̇O2max: 44.1±6.4 mL/min/kg) carried out transitions from low-load cycling (baseline; 40w) to light intensity exercise (45% V̇O2 max; 89.3±12.5 W) and heavy intensity exercise (80% V̇O2max; 186.5±20.2 W) while inhaling normal air (Air) or an enriched CO2 gas (3% CO2, 21% O2, balance N2). Each exercise session was 6 min, and respiratory responses by Douglas bag technique and cardiac responses by thoracic bio-impedance method were measured during the experiment. RESULTS: Ventilation for 3% CO2 was higher than for air through the experiment (P<0.05). Steady and non-steady state RER and V̇CO2 for 3% CO2 were less than for air in both light and heavy intensities (P<0.05), but V̇O2 and Q̇ did not differ between the two conditions. CONCLUSIONS: 3% CO2 inhalation induced the decrease in RER during CWE at light and heavy intensities, which was due to the decrease in V̇CO2. The promoted ventilation with 3% CO2 did not lead to the increase in V̇O2. Moreover, 3% CO2 inhalation did not affect Q̇ during CWE at light and heavy intensities.

Effects of air-perfused rucksack on physiological and perceptual strain during low-intensity exercise in a hot environment.

The upcoming Tokyo Olympic and Paralympic Games may be held amid extremely high wet-bulb globe temperature conditions. Many studies have focused on countermeasures to prevent the reduction in exercise performance in the heat. However, cooling strategies for managing heat stress of staff and spectators remain poorly understood. The present study investigated the effects of a lightweight fan cooling device, namely a commercially available air-perfused rucksack, on physiological and perceptual responses during low-intensity exercise in a hot environment. Ten males walked (5.5 km/h, 2.0% gradient) for 60 min in hot conditions (35°C, 50% relative humidity). All participants performed two trials with and without the air-perfused rucksack, respectively. Air was blown onto the upper back and neck via two fans attached on either side of the rucksack. Rectal temperature, neck skin temperature, heart rate, and physiological strain index were significantly lower during walking (P < 0.05) with the rucksack. Additionally, the ratings of perceived exertion, thermal sensation, and thermal comfort were significantly lower (P < 0.05) with the rucksack. These data suggest that the air-perfused rucksack may be effective for managing heat stress of staff and spectators at the Tokyo Olympic and Paralympic Games. ABBREVIATIONS: CON: control trial; ES: effect sizes; FAN: fan cooling trial; HR: heart rate; mTsk: mean skin temperature; pre: pre-exercise; PSI: physiological strain index; RPE: rating of perceived exertion; SD: standard deviation; TC: thermal comfort; Tneck: neck skin temperature; Tre: rectal temperature; TS: thermal sensation.

Frequent FOXA1-Activating Mutations in Extramammary Paget's Disease.

Extramammary Paget's disease (EMPD) is a neoplastic skin disease of indeterminate origin with an unknown genetic cause. We performed a comprehensive genetic analysis or targeted gene sequencing in 48 patients with EMPD. We identified FOXA1 mutations, a GAS6-FOXA1 fusion gene, and somatic hotspot mutations in the FOXA1 promoter region in 11 of the 48 EMPD patients (11/48, 23%). Additional mutations were identified in PIK3CA (six patients) and in HIST1H2BB, HIST1H2BC, and SMARCB1 (one patient each), but none were found in other frequently mutated genes in cancer. A global gene expression analysis using EMPD clinical samples found the upregulation of PI3 kinase-AKT-mTOR signaling. ABCC11, which is specifically expressed in the apocrine secretory cells and is necessary for their sweat secretion, was upregulated in the EMPD samples. This upregulation suggests that Paget cells originate from apocrine secretory cells. Immunohistochemical staining revealed that FOXA1 expression was prevalent in all of the EMPD samples analyzed and was associated with estrogen receptor expression. Our genetic analysis indicates that EMPD frequently involves FOXA1 mutations. FOXA1 is a transcriptional pioneer factor for the estrogen receptor, and the present results suggest that certain treatments for hormone-dependent cancers could be effective for EMPD.

Rain exacerbates cold and metabolic strain during high-intensity running.

BACKGROUND: Outdoor exercise often proceeds in rainy conditions. However, there are very few studies reporting the physiological effects of cold with rain or wet-cold exposure on humans during exercise. The purpose of this study was to investigate the effects of rain on physiological responses during running exercise at 80% V̇Omax in the cold. METHODS: Twelve healthy men (age: 21.7±3.3 years; height: 1.760±0.085 m; body weight: 68.8±7.1 kg; maximal oxygen consumption: 67.3±5.00 mL/kg/min) exercised on a treadmill at 80% V̇Omax intensity for 60 minutes with rain (RAIN) or not (CON) at 5 °C. RESULTS: Rectal temperature was significantly lower in RAIN than in CON at 10, 40, 50, and 60 minutes (P<0.05). Mean weighted skin temperature was significantly lower in RAIN than in CON during exercise (P<0.05). Oxygen consumption and rating of perceived exertion were significantly higher in RAIN than in CON at 50 and 60 minutes (P<0.05). Plasma lactate was significantly higher in RAIN than in CON at 10 minutes and from 40 to 60 minutes (P<0.05). Plasma norepinephrine levels were significantly higher in RAIN than in CON at 10 minutes and from 40 to 60 minutes (P<0.05). CONCLUSIONS: These results suggest that rain increased heat loss during the early phase of exercise in the cold, then heat production increased and transiently suppressed cold stress. However, with time, body heat loss intensified due to increasing wet area, and then energy expenditure and plasma lactate increased due to cold stress. Therefore, rain may decrease exercise performance and affect sport safety.

A clinical trial to assess the feasibility and efficacy of nab-paclitaxel plus gemcitabine for elderly patients with unresectable advanced pancreatic cancer.

BACKGROUND: The efficacy and safety of nanoparticle albumin-bound paclitaxel (nab-PTX) plus gemcitabine (GEM) in elderly Japanese patients with pancreatic cancer remain unclear. Therefore, we prospectively investigated the tolerability and efficacy of nab-PTX + GEM in Japanese patients aged ≥ 75 years with non-curatively resectable pancreatic cancer. METHODS: We treated eligible patients (n = 27) with nab-PTX + GEM until disease progression, appearance of adverse events, or withdrawal of consent. The primary endpoints included adverse events as well as dosing- and survival-related parameters. RESULTS: The rates of 2-cycle completion were 48.1% for nab-PTX and 55.6% for GEM; the relative dose intensities for the 7th (median) treatment cycle were 65.1% and 74.1%, respectively, whereas the dose-reduction rates were 81.5% and 48.1%, respectively. Grade 3 or higher hemotoxicity was observed in 14 of 27 subjects (51.9%); moreover, 22% experienced grade ≥ 3 peripheral nerve disorder and 1 patient (3.7%) died owing to chemotherapy-related interstitial pneumonia. The disease control rate was 92.6% (25/27), while the median progression-free and overall survival times were 7 and 10.3 months, respectively. CONCLUSION: The nab-PTX + GEM regimen is as efficacious in elderly patients who meet certain criteria as it is in previously reported non-elderly patients. The regimen is feasible with appropriate dose adjustments and attention to adverse events. TRIAL REGISTRATION: Clinical trial registration number: UMIN000018907.