Intranasal levels of lead as an exacerbation factor for allergic rhinitis in humans and mice.

BACKGROUND: Air pollutants are suspected to affect pathological conditions of allergic rhinitis (AR). OBJECTIVES: After detecting Pb (375 µg/kg) in Japanese cedar pollen, the effects of intranasal exposure to Pb on symptoms of AR were investigated. METHODS: Pollen counts, subjective symptoms, and Pb levels in nasal epithelial lining fluid (ELF) were investigated in 44 patients with Japanese cedar pollinosis and 57 controls from preseason to season. Effects of intranasal exposure to Pb on symptoms were confirmed by using a mouse model of AR. RESULTS: Pb levels in ELF from patients were >40% higher than those in ELF from control subjects during the pollen season but not before the pollen season. Pb level in ELF was positively associated with pollen counts for the latest 4 days before visiting a hospital as well as scores of subjective symptoms. Intranasal exposure to Pb exacerbated symptoms in allergic mice, suggesting Pb as an exacerbation factor. Pb levels in ELF and nasal mucosa in Pb-exposed allergic mice were higher than those in Pb-exposed nonallergic mice, despite intranasally challenging the same amount of Pb. Because the increased Pb level in the nasal mucosa of Pb-exposed allergic mice was decreased after washing the nasal cavity, Pb on the surface of but not inside the nasal mucosa may have been a source of increased Pb level in ELF of allergic mice. CONCLUSIONS: Increased nasal Pb level partially derived from pollen could exacerbate subjective symptoms of AR, indicating Pb as a novel hazardous air pollutant for AR.

Potential application of a hydrotalcite-like compound for reduction of toxicity to aquatic organisms via rapid and efficient removal of hydrogen sulfide.

Hydrogen sulfide (H2S) is known to have wide ranging toxicities not only as a gas but also as dissolved forms in aquatic environments. The diversity of aquatic organisms can be severely affected by hydrogen sulfide at very low concentrations, indicating the urgent necessity to develop an efficient method for removal of hydrogen sulfide in water. In this study, the removal capacity for hydrogen sulfide of our originally developed hydrotalcite-like compound composed of magnesium and iron (MF-HT) was investigated and its potential application for reduction of toxicity to aquatic organisms was evaluated. The MF-HT experimentally showed a high adsorption capacity of 146.5 mg/g with a fast adsorption equilibrium time of 45 min, both of which are top-class compared with those of other adsorbents previously reported. In fact, removal of hydrogen sulfide (1.2-152.5 mg/L) at an average rate of >97.6% was achieved in groundwater samples (n = 16) by the MF-HT within 60 min. The toxicities of groundwater, indicated by inhibition rate for microalgae (primary producers) and immobilization rate for crustaceans (secondary consumers), were reduced by 96.1% and 82.5% in 2-fold and 4-fold diluted groundwater, respectively, after treatment with the MF-HT for 60 min. These results indicate that MF-HT has an excellent safety record for aquatic organisms. After clarifying the adsorption mechanism, excellent reusability of MF-HT was also confirmed after regeneration using 1 M Na2CO3 solution. Considering the efficacy, speed, safety and cost of MF-HT, it could be a novel promising material for solving the problem of hydrogen sulfide pollution in the hydrosphere.

Prediction of preterm birth using artificial intelligence: a systematic review.

Preterm birth is the leading cause of neonatal death. It is challenging to predict preterm birth. We elucidated the state of artificial intelligence research on the prediction of preterm birth, clarifying the predictive values and accuracy. We performed a systematic review using three databases (PubMed, Web of Science, and Scopus) in August 2020, with keywords as 'artificial intelligence,' 'deep learning,' 'machine learning,' and 'neural network' combined with 'preterm birth'. We included 22 publications between 2010 and 2020. Regarding the predictive values, electrohysterogram images were mostly used, followed by the biological profiles, the metabolic panel in amniotic fluid or maternal blood, and the cervical images on the ultrasound examination. The size of dataset in most studies was hundred cases and too small for learning, although only three studies used the medical database over a hundred thousand cases. The accuracy was better in the studies using the metabolic panel and electrohysterogram images. Impact statementWhat is already known on this subject? Preterm birth is the leading cause of newborn morbidity and mortality. Presently, the prediction of preterm birth in individual cases is still challenging.What the results of this study add? Using artificial intelligence such as deep learning and machine learning models, clinical data could lead to accurate prediction of preterm birth.What the implications are of these findings for clinical practice and/or further research? The size of the datasets was too small for the models using artificial intelligence in the previous studies. Big data should be prepared for the future studies.

Iron-induced transferrin receptor-1 mRNA destabilization: A response to "Neither miR-7-5p nor miR-141-3p is a major mediator of iron-responsive transferrin receptor-1 mRNA degradation".

We read with great interest the Divergent Views article by Connell and colleagues disputing our recent publication describing a role for two microRNAs in the iron-mediated regulation of transferrin receptor 1 (TfR1) mRNA stability. Our publication sought to shed light on a long-standing question in the field of cellular iron metabolism, and we welcome commentary and critique. However, there are several critical issues contained in the article by Connell and colleagues that require further consideration. We appreciate the opportunity to reply here.

Regulators of Iron Homeostasis: New Players in Metabolism, Cell Death, and Disease.

Iron is necessary for life, but can also cause cell death. Accordingly, cells evolved a robust, tightly regulated suite of genes for maintaining iron homeostasis. Previous mechanistic studies on iron homeostasis have granted insight into the role of iron in human health and disease. We highlight new regulators of iron metabolism, including iron-trafficking proteins [solute carrier family 39, SLC39, also known as ZRT/IRT-like protein, ZIP; and poly-(rC)-binding protein, PCBP] and a cargo receptor (NCOA4) that is crucial for release of ferritin-bound iron. We also discuss emerging roles of iron in apoptosis and a novel iron-dependent cell death pathway termed 'ferroptosis', the dysregulation of iron metabolism in human pathologies, and the use of iron chelators in cancer therapy.

Regulation of transferrin receptor-1 mRNA by the interplay between IRE-binding proteins and miR-7/miR-141 in the 3'-IRE stem-loops.

Intracellular iron is tightly regulated by coordinated expression of iron transport and storage genes, such as transferrin receptor-1 (TfR1) and ferritin. They are primarily regulated by iron through iron-induced dissociation of iron-regulatory proteins (IRPs) from iron-responsive elements (IREs) in the 3'-UTR (untranslated region) of TfR1 or 5'-UTR of ferritin mRNA, resulting in destabilization of TfR1 mRNA and release of ferritin translation block. Thus high iron decreases iron transport via TfR1 mRNA degradation and increases iron storage via ferritin translational up-regulation. However, the molecular mechanism of TfR1 mRNA destabilization in response to iron remains elusive. Here, we demonstrate that miR-7-5p and miR-141-3p target 3'-TfR1 IREs and down-regulate TfR1 mRNA and protein expression. Conversely, miR-7-5p and miR-141-3p antagomiRs partially but significantly blocked iron- or IRP knockdown-induced down-regulation of TfR1 mRNA, suggesting the interplay between these microRNAs and IRPs along with involvement of another uncharacterized mechanism in TfR1 mRNA degradation. Luciferase reporter assays using 3'-UTR TfR1 IRE mutants suggested that the IREs C and E are targets of miR-7-5p and miR-141-3p, respectively. Furthermore, miR-7 expression was inversely correlated with TfR1 mRNA in human pancreatic adenocarcinoma patient samples. These results suggest a role of microRNAs in the TfR1 regulation in the IRP-IRE system.

Increased levels of renal damage biomarkers caused by excess exposure to trivalent chromium in workers in tanneries.

BACKGROUND: The process for leather material production is carried out in developing countries using a large amount of trivalent chromium [Cr(III)]. Assesment of health risks for millions of workers in tanneries worldwide that are highly polluted with Cr(III) is needed. METHODS: Levels of total Cr and its chemical species in wastewater samples from tannery built-up areas of Bangladesh were investigated. Cr-mediated renal damage was assessed in 100 male tannery workers by epidemiological analysis consisting of questionnaires and measurements of levels of urinary Cr and urinary renal damage markers [urinary levels of total protein and kidney injury molecule-1 (KIM-1)]. RESULTS: High levels of total Cr (mean ± standard deviation = 1,908,762 ± 703,450 µg/L) were detected in wastewater samples from 13 sites of tanneries. More than 99.99% of total Cr in the wastewater was Cr(III), indicating that workers in the tanneries were exposed to large concentrations of Cr(III). Cr levels (mean ± standard, 2.89 ± 4.23 µg/g creatinine) in urine samples from the workers in tanneries were >24-fold higher than the levels in a general population previously reported. Multivariate analysis showed significant correlations between urinary levels of Cr and urinary levels of renal damage biomarkers. Nagelkerke Pseudo R2 values also showed that Cr level is the strongest contributor to the levels of renal damage biomarkers in the workers. CONCLUSION: Our results newly suggest that excess exposure to Cr(III) could be a risk for renal damage in humans.

Multidisciplinary approach to assess the toxicities of arsenic and barium in drinking water.

Well water could be a stable source of drinking water. Recently, the use of well water as drinking water has been encouraged in developing countries. However, many kinds of disorders caused by toxic elements in well drinking water have been reported. It is our urgent task to resolve the global issue of element-originating diseases. In this review article, our multidisciplinary approaches focusing on oncogenic toxicities and disturbances of sensory organs (skin and ear) induced by arsenic and barium are introduced. First, our environmental monitoring in developing countries in Asia showed elevated concentrations of arsenic and barium in well drinking water. Then our experimental studies in mice and our epidemiological studies in humans showed arsenic-mediated increased risks of hyperpigmented skin and hearing loss with partial elucidation of their mechanisms. Our experimental studies using cultured cells with focus on the expression and activity levels of intracellular signal transduction molecules such as c-SRC, c-RET, and oncogenic RET showed risks for malignant transformation and/or progression arose from arsenic and barium. Finally, our original hydrotalcite-like compound was proposed as a novel remediation system to effectively remove arsenic and barium from well drinking water. Hopefully, comprehensive studies consisting of (1) environmental monitoring, (2) health risk assessments, and (3) remediation will be expanded in the field of environmental health to prevent various disorders caused by environmental factors including toxic elements in drinking water.

Recurrent Cerebral Infarction Due to Benign Uterine Myoma.

The hypercoagulable state in patients with cancer has been shown to be closely associated with ischemic stroke. However, it is unlikely that benign tumors are related to stroke. The development of benign uterine tumors is common in middle-aged women. Previous studies have shown cases of ischemic stroke with benign uterine tumor, but the causal relationship between these 2 remain unknown. We report a case of recurrent ischemic stroke in a middle-aged woman who had a benign uterine tumor. After excision, there was no recurrence for 2 years. Microemboli detection, clinical course and histological findings support a relationship between uterine tumor and ischemic stroke.

Adsorption of molybdenum by melanin.

BACKGROUND: Melanin is detectable in various sense organs including the skin in animals. It has been reported that melanin adsorbs toxic elements such as mercury, cadmium, and lead. In this study, we investigated the adsorption of molybdenum, which is widely recognized as a toxic element, by melanin. METHODS: Molybdenum level of the mouse skin was measured by inductively coupled plasma mass spectrometry. The pigmentation level of murine skin was digitalized as the L* value by using a reflectance spectrophotometer. An in vitro adsorption assay was performed to confirm the interaction between molybdenum and melanin. RESULTS: Our analysis of hairless mice with different levels of skin pigmentation showed that the level of molybdenum increased with an increase in the level of skin pigmentation (L* value). Moreover, our analysis by Spearman's correlation coefficient test showed a strong correlation (r = - 0.9441, p < 0.0001) between L* value and molybdenum level. Our cell-free experiment using the Langmuir isotherm provided evidence for the adsorption of molybdenum by melanin. The maximum adsorption capacity of 1 mg of synthetic melanin for molybdenum was 131 µg in theory. CONCLUSION: Our in vivo and in vitro results showed a new aspect of melanin as an adsorbent of molybdenum.

Salvage of fetal karyotype information from SNP array data obtained from products of conception with maternal cell contamination.

OBJECTIVE: Maternal cell contamination (MCC) is known to increase the risk of misdiagnosis in prenatal diagnosis as well as in diagnostic tests for the products of conception (POC) from miscarriages. We aimed to develop a data correction method to salvage fetal karyotype information from single-nucleotide polymorphism (SNP) array data for POC with MCC when parental genotype data are available. METHODS: We obtained SNP array data from mixed genomic DNAs of a mother-child pair and used the dataset to assess the accuracy of data correction. We subsequently applied our method to miscarriage specimens with MCC. RESULTS: We adopted a linear interpolation model as a data correction method and implemented the method in an R package, snpsal. We successfully determined the fetal karyotypes of two miscarriage specimens that were previously undiagnosed due to MCC to be normal in one case and trisomy 16 in the other case using snpsal. CONCLUSION: The R package, snpsal, developed in this study facilitates rapid and accurate estimation of the fetal karyotype from SNP array data for POC with MCC. © 2017 John Wiley & Sons, Ltd.

Comparison of 5-day MTX and 5-day ETP treatment results and early predictors of drug resistance to 5-day MTX in patients with post-molar low-risk gestational trophoblastic neoplasia.

OBJECTIVE: To determine the primary remission rates and predictors of drug resistance in patients with post-molar low-risk gestational trophoblastic neoplasia (GTN) who were treated with a 5-day intramuscular methotrexate (5-day IM MTX) or a 5-day drip infusion etoposide (5-day DIV ETP) regimen. METHODS: Between 1980 and 2014, 166 consecutive patients with low-risk post-molar GTN were initially treated with a 5-day IM MTX or a 5-day DIV ETP regimen. The primary remission rates, changes in chemotherapy due to drug resistance or toxicity, and relapse rates were compared. Furthermore, we analyzed the factors that influenced the development of resistance to MTX. RESULTS: Primary remission rates were significantly higher among the ETP-treated patients than among the MTX-treated patients. Among the 42 patients who required a change in chemotherapy, 23 patients (22.6%) and 4 patients (6.3%) were diagnosed as being resistant to MTX and EPT, respectively. Maternal age and the presence of metastasis did not significantly influence the development of MTX resistance, although higher FIGO scores and pre-treatment human chorionic gonadotropin (hCG) levels of >5×10(4)mIU/mL were significantly more common among patients who developed MTX resistance. Moreover, a <30% decrease in hCG after the first cycles of MTX chemotherapy was significantly associated with the development of MTX resistance. CONCLUSIONS: All patients with low-risk GTN eventually achieved complete remission, although several patients developed drug resistance to the first-line chemotherapy. A <30% decrease in hCG during the first chemotherapy cycle may be an early indicator of drug resistance after commencing a 5-day MTX regimen.

[Distal Aortic Arch Aneurysm, Acute type B Aortic Dissection, and Acute Bilateral Limb Ischemia Treated by Two-stage Total Arch Replacement;Report of a Case].

A 74-year-old female patient experienced sudden and severe pain in her lower back and both legs. Upon examination, her femoral pulses were weak, and her legs were pale. Computed tomography revealed a 66-mm thoracic aneurysm in the distal arch and type B aortic dissection. Stenosis was present from the terminal aorta to the iliac arteries. The left common iliac artery was occluded at its bifurcation, and both lower limbs were ischemic. We performed bilateral axillary-femoral artery bypass, which improved blood flow to both limbs. The next day, it was apparent that compartment syndrome had developed in the patient's left leg. Rehabilitation therapy was effective for the compartment syndrome, the patient's symptoms resolved, and she was discharged. We later performed two-stage total arch replacement, and the subsequent clinical course has been without incident.

[Ascending aorta-abdominal aorta bypass for atypical coarctation with intractable hypertension due to aortitis syndrome; report of a case].

A 63-year-old woman was admitted to our hospital. Aortitis syndrome was diagnosed 12 years ago. She developed intractable hypertension and a computed tomography scan showed coarctation of descending aorta with severe calcificaiton. Her ankle brachial pressure index (ABI) was 0.74 on the right side and was 0.70 on the left side. She underwent a bypass operation with 14 mm-diameter prosthetic graft from ascending aorta to the infrarenal abdominal aorta without using cardiopulmonary bypass. Postoperatively, ABI was 1.22 on the right side and was 1.21 on the left side, and hypertension was well controlled.

Prediction of hemorrhage in placenta previa: Radiomics analysis of pelvic MRI images.

INTRODUCTION: Prediction of intraoperative massive hemorrhage is still challenging in placenta previa. Radiomics analysis has been investigated as a new evaluation method for analyzing medical images. We used radiomics analysis on placental magnetic resonance imaging (MRI) images to predict intraoperative hemorrhage in placenta previa. METHODS: We used the sagittal MRI T2-weighted sequence in placenta previa. Using the rectangular region from the uterine os to the anterior wall, we extracted 97 radiomics features. We also collected patient demographics and blood test data as clinical variables. Combining these radiomics features and clinical variables, logistic regression models with a stepwise method were built to predict the risk of hemorrhage, defined as blood loss of > 2000 ml. We evaluated the prediction performance of the models using accuracy and area under the curve (AUC), also analyzing the important variables for the prediction by stepwise methods. RESULTS: We enrolled a total of 63 placenta previa cases including 30 hemorrhage cases from two institutes. The model combining clinical variables and radiomics features showed the best prediction performance with an accuracy of 0.70 and an AUC of 0.69 in the internal validation data, and accuracy of 0.41 and an AUC of 0.70 in the external validation data, compared with human experts (accuracy of 0.62). Regarding variable selection, two radiomics features. 'original_glrlm_LowGrayLevelRunEmphasis,' and 'diagnostics_Image-original_Minimum,' were important predictors for hemorrhage by the stepwise method. DISCUSSION: Radiomics features based on MRI could be used as effective predictive variables for hemorrhage in placenta previa. Radiomics analysis of placental imaging could lead to further analysis of quantitative variables related to obstetric diseases.

Deep learning algorithm for predicting preterm birth in the case of threatened preterm labor admissions using transvaginal ultrasound.

PURPOSE: Preterm birth presents a major challenge in perinatal care, and predicting preterm birth remains a major challenge. If preterm birth cases can be accurately predicted during pregnancy, preventive interventions and more intensive prenatal monitoring may be possible. Deep learning has the capability to extract image parameters or features related to diseases. We constructed a deep learning model to predict preterm births using transvaginal ultrasound images. METHODS: Patients who were hospitalized for threatened preterm labor or shortened cervical length were enrolled. We used images of the cervix obtained via transvaginal ultrasound examination at admission to predict cases of preterm birth. We used convolutional neural networks (CNNs) and Vision Transformer (Vit) for the model construction. We compared the prediction performance of deep learning models with two human experts. RESULTS: A total of 59 patients were enrolled in the study, including 30 cases in the preterm group and 29 cases in the full-term group. Statistical analysis of clinical variables including cervical length showed no significant differences between the two groups. For accuracy, the best CNN model had the highest accuracy of 0.718 with an area under the curve (AUC) of 0.704, followed by Vision Transformer with accuracy of 0.645 and AUC of 0.587. The accuracy of two human experts was 0.465 and 0.517, respectively. CONCLUSIONS: Deep learning models have important implications for extraction of features that provide more accurate assessment of preterm birth than traditional visual assessment by the human eye.

Preliminary Results of Deep Learning Approach for Preoperative Diagnosis of Ovarian Cancer Based on Pelvic MRI Scans.

BACKGROUND/AIM: To predict the pathological diagnosis of ovarian tumors using preoperative MRI images, using deep learning models. PATIENTS AND METHODS: A total of 185 patients were enrolled, including 40 with ovarian cancers, 25 with borderline malignant tumors, and 120 with benign tumors. Using sagittal and horizontal T2-weighted images (T2WI), we constructed the pre-trained convolutional neural networks to predict pathological diagnoses. The performance of the model was assessed by precision, recall, and F1-score on macro-average with 95% confidence interval (95%CI). The accuracy and area under the curve (AUC) were also assessed after binary transformation by the division into benign and non-benign groups. RESULTS: The macro-average accuracy in the three-class classification was 0.523 (95%CI=0.504-0.544) for sagittal images and 0.426 (95%CI=0.404-0.446) for horizontal images. The model achieved a precision of 0.63 (95%CI=0.61-0.66), recall of 0.75 (95%CI=0.72-0.78), and F1 score of 0.69 (95%CI=0.67-0.71) for benign tumor. Regarding the discrimination between benign and non-benign tumors, the accuracy in the binary-class classification was 0.628 (95%CI=0.592-0.662) for sagittal images and AUC was 0.529 (95%CI=0.500-0.557). CONCLUSION: Using deep learning, we could perform pathological diagnosis from preoperative MRI images.

A multimodal deep learning model for predicting severe hemorrhage in placenta previa.

Placenta previa causes life-threatening bleeding and accurate prediction of severe hemorrhage leads to risk stratification and optimum allocation of interventions. We aimed to use a multimodal deep learning model to predict severe hemorrhage. Using MRI T2-weighted image of the placenta and tabular data consisting of patient demographics and preoperative blood examination data, a multimodal deep learning model was constructed to predict cases of intraoperative blood loss > 2000 ml. We evaluated the prediction performance of the model by comparing it with that of two machine learning methods using only tabular data and MRI images, as well as with that of two human expert obstetricians. Among the enrolled 48 patients, 26 (54.2%) lost > 2000 ml of blood and 22 (45.8%) lost < 2000 ml of blood. Multimodal deep learning model showed the best accuracy of 0.68 and AUC of 0.74, whereas the machine learning model using tabular data and MRI images had a class accuracy of 0.61 and 0.53, respectively. The human experts had median accuracies of 0.61. Multimodal deep learning models could integrate the two types of information and predict severe hemorrhage cases. The model might assist human expert in the prediction of intraoperative hemorrhage in the case of placenta previa.

The inflammatory macrophages repress the growth of bone metastatic human prostate cancer cells via TNF-α and IL-6 signaling: Involvement of cell signaling regulator regucalcin.

Macrophages in the cancer microenvironments may play a regulatory role in the progression and metastasis of prostate cancer cells. However, the crosstalk between macrophages and prostate cancer cells is poorly understood. This study elucidates whether inflammatory macrophages regulate the proliferation and death of human prostate cancer cells in vitro. The RAW264.7 mouse macrophages were cocultured with PC-3 or DU-145 wild-type cells by using a Transwell chamber in vitro. RAW264.7 cells were cocultured with PC-3 or DU-145 cells in the presence of lipopolysaccharide (LPS). This coculturing blocked the proliferation and accelerated the death of cancer cells. Interestingly, cancer cell proliferation was repressed and death was promoted by the addition of the conditioned medium obtained from RAW264.7 cells treated with LPS. Culturing with LPS mostly augmented the production of tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) in the culture medium of RAW264.7 cells. The effects of the conditioned medium on the proliferation and death of PC-3 or DU-145 cells were blocked by NF-κB or STAT3 signaling inhibitors. Moreover, the effects of the conditioned medium on the proliferation and death of prostate cancer cells were not expressed in regucalcin-overexpressing cancer cells that diminish the levels of NF-κB p65 and STAT3. Culturing with extracellular TNF-α, IL-6, or regucalcin triggered inhibition of the proliferation of PC-3 wild-type cells. The levels of regucalcin in PC-3 cells were elevated by TNF-α or IL-6 stimulation. This study demonstrates that inflammatory macrophages triggered the loss of prostate cancer cells via the signaling process of NF-κB, STAT3, or regucalcin.

A case of carotid-axillary bypass for subclavian steal syndrome in an 83-year-old female undergoing hemodialysis.

INTRODUCTION: Patients undergoing hemodialysis exhibit a high incidence of subclavian steal syndrome. Many cases of endovascular treatment for subclavian artery stenosis were only reported recently; however, the long-term results of surgical treatment are also important. Herein, we report a case of subclavian steal syndrome treated with common carotid-axillary bypass surgery in a patient undergoing hemodialysis. PRESENTATION OF CASE: An 83-year-old woman experienced dizziness and pain in her left hand during hemodialysis. Computed tomography and angiography revealed severe stenosis and calcified lesions in the left subclavian artery. Ultrasonography revealed a retrograde blood flow waveform in the left vertebral artery. The patient was diagnosed with subclavian steal syndrome. We performed common carotid-axillary bypass for lesions that were difficult to revascularize via endovascular therapy. The post-operative course was uneventful, and the dizziness and numbness in the patient's left hand during dialysis disappeared. Post-operative ultrasonography revealed an antegrade blood flow waveform in the left vertebral artery. DISCUSSION: Subclavian steal syndrome is an indication for revascularization in symptomatic patients. Endovascular treatment should be considered the first choice; however, surgery should be considered for patients in whom endovascular treatment is difficult, such as those with severe calcification. We chose common carotid-axillary artery bypass because the subclavian approach is a more familiar technique. Until 1 year post-operatively, the patient had not experienced any symptom recurrence, and the shunt flow was well maintained. CONCLUSION: Common carotid-axillary bypass can be useful for revascularization of lesions for which endovascular therapy is considered difficult in patients with subclavian steal syndrome.