Effect of mastication evaluation and intervention on body composition and biochemical indices in female patients with obesity: a randomized controlled trial.

BACKGROUND: A limited number of studies have evaluated the masticatory indices of individuals with obesity who only chew their food a few times and for shorter duration or who were provided with an instructional intervention. This study aimed to examine the effects of a 6-month instructional mastication intervention on the body composition and biochemical indices in female patients with obesity. METHODS: Female patients with obesity were randomly classified into a conventional treatment group (CTG; 12 individuals), which only received normal nutritional and exercise guidance, and a mastication intervention group (MIG; 16 individuals), which received an additional mastication guidance. The MIG received guidance on foods requiring increased number of chews and chewing duration, eating techniques, and the proper method of cutting foods. RESULTS: Changes in the masticatory, body composition, and biochemical indices were compared before and after the 6-month intervention. The values of body composition indices decreased significantly in both groups; however, the rate of change in body mass index significantly decreased in the MIG. In addition, the values of biochemical indices were significantly decreased in the MIG compared with that in the CTG, which is attributed to the addition of mastication instruction to female patients with obesity. CONCLUSION: Increasing the number of chews and duration of chewing times for carbohydrates, which are staple foods, possibly contributed to weight loss and improvement of glucose metabolism. TRIAL REGISTRATION: UMIN, UMIN000025875. Registered on 27 Jan 2017.

Heterogeneous reduction in regional wall stress after aortic valve replacement for aortic regurgitation: a distinct feature from aortic stenosis.

Geometric changes caused by volume reduction early after aortic valve replacement (AVR) for aortic regurgitation (AR) may not be uniform, resulting in varying regional end-systolic wall stress (ESS). This study compared changes in regional ESS between AR and aortic stenosis (AS) patients in the early phase following AVR. Computer-tomographic left ventricular (LV) angiography was performed for 10 patients with AR and 13 with AS before and three months after AVR. Regional ESS at the base, middle, and apex levels, each subdivided into four segments, was calculated based on the Janz equation: ESS = end-systolic LV pressure × local cross-sectional area of LV cavity/that of LV wall. Following AVR, median LV end-diastolic volume index fell from 106 to 69 ml/m2 (P = 0.001) in AR and 60 to 46 ml/m2 (P = 0.01) in AS patients. Global ESS also declined in both (AR, 186 to 124 kdyne/cm2, P = 0.02; AS, 187 to 108 kdyne/cm2, P < 0.001, respectively). Regional ESS was reduced in all segments in AS patients, accompanied by left ventricular ejection fraction (LVEF) improvement (71-80%, P = 0.02). In contrast, regional ESS in AR patients was heterogeneously reduced, as regional ESS fell significantly in the antero-septal wall but was unchanged in the infero-lateral wall, and LVEF remained unchanged (65 to 62%, P = 0.42). In the early postoperative phase after AVR, the loading condition of the regional LV wall in AR patients was characterized by a heterogeneous reduction in regional ESS in contrast to a uniform decline in AS patients.

Validation of Earphone-Type Sensors for Non-Invasive and Objective Swallowing Function Assessment.

Standard methods for swallowing function evaluation are videofluoroscopy (VF) and videoendoscopy, which are invasive and have test limitations. We examined the use of an earphone-type sensor to noninvasively evaluate soft palate movement in comparison with VF. Six healthy adults wore earphone sensors and swallowed barium water while being filmed by VF. A light-emitting diode at the sensor tip irradiated infrared light into the ear canal, and a phototransistor received the reflected light to detect changes in ear canal movement, including that of the eardrum. Considering that the soft palate movement corresponded to the sensor waveform, a Bland-Altman analysis was performed on the difference in time recorded by each measurement method. The average difference between the time taken from the most downward retracted position before swallowing to the most upward position during swallowing of the soft palate in VF was -0.01 ± 0.14 s. The Bland-Altman analysis showed no fixed or proportional error. The minimal detectable change was 0.28 s. This is the first noninvasive swallowing function evaluation through the ear canal. The earphone-type sensor enabled us to measure the time from the most retracted to the most raised soft palate position during swallowing and validated this method for clinical application.

Earable Ω (OMEGA): A Novel Clenching Interface Using Ear Canal Sensing for Human Metacarpophalangeal Joint Control by Functional Electrical Stimulation.

(1) Background: A mouth-free interface is required for functional electrical stimulation (FES) in people with spinal cord injuries. We developed a novel system for clenching the human metacarpophalangeal (MP) joint using an earphone-type ear canal movement sensor. Experiments to control joint angle and joint stiffness were performed using the developed system. (2) Methods: The proposed FES used an equilibrium point control signal and stiffness control signal: electrical agonist-antagonist ratio and electrical agonist-antagonist sum. An angle sensor was used to acquire the joint angle, and system identification was utilized to measure joint stiffness using the external force of a robot arm. Each experiment included six and five subjects, respectively. (3) Results: While the joint angle could be controlled well by clenching with some hysteresis and delay in three subjects, it could not be controlled relatively well after hyperextension in the other subjects, which revealed a calibration problem and a change in the characteristics of the human MP joint caused by hyperextension. The joint stiffness increased with the clenching amplitude in five subjects. In addition, the results indicated that viscosity can be controlled. (4) Conclusions: The developed system can control joint angle and stiffness. In future research, we will develop a method to show that this system can control the equilibrium point and stiffness simultaneously.

Bilateral Internal Thoracic Artery Grafting Improves Survival for Severe Left Ventricular Dysfunction and Diabetes.

BACKGROUND: In patients with severe left ventricular (LV) dysfunction requiring coronary artery bypass grafting (CABG), the association between diabetic status and outcomes after surgery, as well as with survival benefit following bilateral internal thoracic artery (ITA) grafting, remain largely unknown.Methods and Results:Patients (n=188; mean [±SD] age 67±9 years) with LV ejection fraction ≤40% who underwent isolated initial CABG were classified into non-diabetic (n=64), non-insulin-dependent diabetic (NIDM; n=74), and insulin-dependent diabetic (IDM; n=50) groups. During follow-up (mean [±SD] 68±47 months), the 5-year survival rate was 84% and 65% among non-diabetic and diabetic patients, respectively (P=0.034). After adjusting for all covariates, both NIDM and IDM were associated with increased mortality, with hazard ratios (HRs) of 1.9 (95% confidence interval [CI] 1.0-3.7; P=0.049) and 2.4 (95% CI 1.2-4.8; P=0.016), respectively. Among non-diabetic patients, there was no difference in the 5-year survival rate between single and bilateral ITA grafting (86% vs. 80%, respectively; P=0.95), whereas bilateral ITA grafting increased survival among diabetic patients (57% vs. 81%; P=0.004). Multivariate analysis revealed that bilateral ITA was significantly associated with a decreased risk of mortality (HR 0.3; 95% CI 0.1-0.8; P=0.024). CONCLUSIONS: NIDM and IDM were significantly associated with worse long-term clinical outcome after CABG for severe LV dysfunction. Bilateral ITA grafting has the potential to improve survival in diabetic patients with severe LV dysfunction.

Intermediate-term outcomes of our original multiple-knot technique using ePTFE sutures for anterior mitral leaflet prolapse.

PURPOSE: To define the outcomes of our original simple chordal replacement technique using ePTFE sutures for mitral regurgitation. METHODS: Between January, 2004 and March, 2014, 38 patients underwent mitral valve repair using our chordal replacement technique for anterior leaflet prolapse. The mitral regurgitation was caused by degenerative disease in 34 patients and infective endocarditis in 4 patients. RESULTS: The follow-up period was 66 ± 37 months and the 5-year survival rate was 95 ± 4%. Two patients had recurrent mitral regurgitation, caused by degenerative change not associated with the procedure. The 5-year rate of freedom from recurrent mitral regurgitation was 94 ± 4%. In the late postoperative period, 15 (42%) patients had a mean pressure gradient > 5 mmHg. Stepwise logistic regression analysis showed that the use of a full ring (odds ratio 8.9; 95% confidence interval 1.2-64; p = 0.031) and a 26 mm annuloplasty (odds ratio 7.5; 95% confidence interval 1.1-50; p = 0.037) were significant independent risk factors for a mean pressure gradient > 5 mmHg. CONCLUSION: The intermediate-term outcomes of our original chordal replacement technique were not inferior to those in previous reports, although a 26 mm annuloplasty was found to be associated with a higher mitral valve gradient at rest.

Simultaneous Measurement of Ear Canal Movement, Electromyography of the Masseter Muscle and Occlusal Force for Earphone-Type Occlusal Force Estimation Device Development.

We intend to develop earphone-type wearable devices to measure occlusal force by measuring ear canal movement using an ear sensor that we developed. The proposed device can measure occlusal force during eating. In this work, we simultaneously measured the ear canal movement (ear sensor value), the surface electromyography (EMG) of the masseter muscle and the occlusal force six times from five subjects as a basic study toward occlusal force meter development. Using the results, we investigated the correlation coefficient between the ear sensor value and the occlusal force, and the partial correlation coefficient between ear sensor values. Additionally, we investigated the average of the partial correlation coefficient and the absolute value of the average for each subject. The absolute value results indicated strong correlation, with correlation coefficients exceeding 0.9514 for all subjects. The subjects showed a lowest partial correlation coefficient of 0.6161 and a highest value of 0.8286. This was also indicative of correlation. We then estimated the occlusal force via a single regression analysis for each subject. Evaluation of the proposed method via the cross-validation method indicated that the root-mean-square error when comparing actual values with estimates for the five subjects ranged from 0.0338 to 0.0969.

Mouthwitch: A Novel Head Mount Type Hands-Free Input Device that Uses the Movement of the Temple to Control a Camera.

We have developed an interface (mouthwitch) for a head-mounted type camera with which pictures can be taken with a head-mounted camera, hands-free, simply by "opening your mouth continuously for approximately one second and then closing it again". This mouthwitch uses a sensor equipped with an LED and photo transistor on the temple to optically measure the changes in the form of the temple that occur when the mouth is opened and closed. Eight test subjects (males and females aged between 21 and 44 years old) performed evaluation tests using this mouthwitch when resting, speaking, chewing, walking, and running. The results showed that all test subjects were able to open and close the mouth, and the measurement results pertaining to the temple shape changes that occurred at this time were highly reproducible. Additionally, the average value for accuracy obtained for the eight test subjects through the verification tests was 100% when resting, chewing, or walking, and 99.8% when speaking or running. Similarly, the average values for precision were 100% for all items, and the average values for recall were 100% when resting or chewing, 98.8% when speaking, 97.5% when walking, and 87.5% when running.

Earable POCER: Development of a Point-of-Care Ear Sensor for Respiratory Rate Measurement.

We have carried out research and development on an earphone-type respiratory rate measuring device, earable POCER. The name earable POCER is a combination of "earable", which is a word coined from "wearable" and "ear", and "POCER", which is an acronym for "point-of-care ear sensor for respiratory rate measurement". The earable POCER calculates respiratory frequency, based on the measurement values over one minute, through the simple attachment of an ear sensor to one ear of the measured subject and displays these on a tablet terminal. The earable POCER irradiates infrared light using a light-emitting diode (LED) loaded on an ear sensor to the epidermis within the ear canal and, by receiving that reflected light with a phototransistor, it measures movement of the ear canal based on respiration. In an evaluation experiment, eight healthy subjects first breathed through the nose 12 times per minute, then 16 times per minute, and finally 20 times per minute, in accordance with the flashing of a timing instruction LED. The results of these evaluation tests showed that the accuracy of the respiratory frequency was 100% for nose breathing 12 times per minute, 93.8% at 16 times, and 93.8% at 20 times.

Earable TEMPO: A Novel, Hands-Free Input Device that Uses the Movement of the Tongue Measured with a Wearable Ear Sensor.

In this study, an earphone-type interface named "earable TEMPO" was developed for hands-free operation, wherein the user can control the device by simply pushing the tongue against the roof of the mouth for about one second. This interface can be used to start and stop the music from a portable audio player. The earable TEMPO uses an earphone-type sensor equipped with a light emitting diode (LED) and a phototransistor to optically measure shape variations that occur in the external auditory meatus when the tongue is pressed against the roof of the mouth. To evaluate the operation of the earable TEMPO, experiments were performed on five subjects (men and women aged 22-58) while resting, chewing gum (representing mastication), and walking. The average accuracy was 100% while resting and chewing and 99% while walking. The precision was 100% under all conditions. The average recall value of the five subjects was 92%, 90%, and 48% while resting, masticating, and walking, respectively. All subjects were reliably able to perform the action of pressing the tongue against the roof of the mouth. The measured shape variations in the ear canal were highly reproducible, indicating that this method is suitable for various applications such as controlling a portable audio player.

[Beneficial Effects of Restrictive Annuloplasty on Subvalvular Geometry in Patients with Functional Mitral Regurgitation and Advanced Cardiomyopathy].

OBJECTIVES: The effects of restrictive mitral annuloplasty (RMA) on subvalvular geometry remains unknown. We evaluated changes in left ventricular(LV) function, severity of mitral regurgitation(MR) and leaflet tethering parameters after RMA and clarified their associations. METHODS: In 44 patients with clinically-relevant functional MR who underwent RMA, distances between papillary muscle( PM) tips and anterior mitral annulus( PM-tethering distance), leaflet angles relative to lines connecting annuli, and interpapillary muscle distance( IPMD) were serially quantified. RESULTS: One month after surgery, LV function and MR severity improved with decreased anterior (34±5 to 30±4 mm) and posterior PM-tethering distance (37±4 to 32±4 mm), anterior-leaflet angle (ALA)[32±8 to 22±7 degree], and IPMD (31±6 to 25±5 mm), while these variables remained abnormal and posterior-leaflet angle (PLA) increased (34±8 to 48±14 degree)[p<0.01 for all]. During follow-up (66±37 months), these effects were maintained in 33 patients without MR recurrence, whereas 11 with it showed worsened tethering with less LV function recovery. Multiple linear regression analyses identified that change in MR severity from baseline to 12-month examination independently associated with corresponding change in IPMD (parameter estimate of 0.100 with standard error of 0.039, p=0.019) and that in posterior PM- tethering distance( parameter estimate of 0.104 with standard error of 0.045, p=0.035), while not with change in PLA. The IPMD change was independently associated with change in LV end-systolic dimension (parameter estimate of 0.299 with standard error of 0.110, p=0.013). CONCLUSIONS: RMA procedure partially relieved leaflet tethering, evidenced by decreased tethering distances and IPMD;the latter was the main determinant of MR. These beneficial effects might be mainly attributed to post-RMA reverse LV remodeling, potentially offsetting the negative effect of augmented PLA in selected patients.

Predictors and Clinical Impact of Functional Mitral Stenosis Induced by Restrictive Annuloplasty for Ischemic and Functional Mitral Regurgitation.

BACKGROUND: There are few reports of the determinants of "functional" mitral stenosis in terms of a residual mitral valve (MV) pressure gradient >5 mmHg following restrictive mitral annuloplasty (RMA) or the effect on long-term outcome in patients with functional mitral regurgitation (MR).Methods and Results:Serial cardiac catheterization and echocardiographic studies were performed in 55 patients with functional MR who underwent RMA using a 24/26-mm semi-rigid complete ring. The mean postoperative (1 month) catheter-measured MV gradient was 3.4±1.6 mmHg, which was independently associated with corresponding cardiac output [standardized partial regression coefficient (SPRC)=0.59] and indexed effective orifice area (SPRC=-0.25). Body surface area (BSA) had the greatest contribution to MV gradient (SPRC=0.38), followed by use of a 24-mm ring (SPRC=0.33) and hemodialysis (SPRC=0.26). Receiver-operating characteristic curve analysis demonstrated an optimal BSA cutoff value of 1.86 m2to predict post-MV stenosis (21% for <1.86 m2vs. 86% for ≥1.86 m2, P=0.002). During follow-up (75±32 months), freedom from adverse events did not differ between patients with (n=16) and without (n=39) an MV gradient ≥5 mmHg (log-rank P=0.24). CONCLUSIONS: Post-RMA MV gradient was determined not only by the degree of annular reduction but also by patients' hemodynamic factors (e.g., cardiac output). Implantation of a 24/26-mm annuloplasty ring for patients with BSA ≥1.86 m2indicated a high likelihood of post-MV stenosis. However, mild MV stenosis did not adversely affect late outcome after RMA.

A Novel Earphone Type Sensor for Measuring Mealtime: Consideration of the Method to Distinguish between Running and Meals.

In this study, we describe a technique for estimating meal times using an earphone-type wearable sensor. A small optical sensor composed of a light-emitting diode and phototransistor is inserted into the ear hole of a user and estimates the meal times of the user from the time variations in the amount of light received. This is achieved by emitting light toward the inside of the ear canal and receiving light reflected back from the ear canal. This proposed technique allowed "meals" to be differentiated from having conversations, sneezing, walking, ascending and descending stairs, operating a computer, and using a smartphone. Conventional devices worn on the head of users and that measure food intake can vibrate during running as the body is jolted more violently than during walking; this can result in the misidentification of running as eating by these devices. To solve this problem, we used two of our sensors simultaneously: one in the left ear and one in the right ear. This was based on our finding that measurements from the left and right ear canals have a strong correlation during running but no correlation during eating. This allows running and eating to be distinguished based on correlation coefficients, which can reduce misidentification. Moreover, by using an optical sensor composed of a semiconductor, a small and lightweight device can be created. This measurement technique can also measure body motion associated with running, and the data obtained from the optical sensor inserted into the ear can be used to support a healthy lifestyle regarding both eating and exercise.

Rare Complication of Takotsubo Cardiomyopathy: Ventricular Septal Perforation with Septal Dissection.

We describe a rare case of takotsubo cardiomyopathy complicated by acute ventricular septal perforation with ventricular septal dissection. The ventricular perforation was successfully closed by repairing the dissecting site with a bovine pericardial patch.

[Analysis of axillary recurrence after breast reconstruction].

In recent years, breast reconstruction is being increasingly performed. Axillary resection is the standard treatment for axillary recurrence after a negative sentinel node (SN) biopsy. Appropriate treatment in the event of a negative SN artifact poses a problem. Case 1: A3 9-year-old woman with right breast cancer underwent Bt+SN (negative)+TE, IMP. Approximately 8 years postoperatively, axillary lymph node recurrence was diagnosed. Axillary resection was performed, and the reconstructed breast was preserved. Case 2: A4 0-year-old woman with right breast cancer underwent Bt+SN (negative)+TE, IMP. Approximately 8 years postoperatively, axillary lymph node recurrence was diagnosed. Axillary resection was performed, and the reconstructed breast was preserved. Case 3: A5 7-year-old woman with right breast cancer underwent Bt+SN (negative)+ TE, IMP. Because the metastatic lymph node was near the reconstructed breast, axillary resection and removal of the reconstructed breast was performed. It is expected that the incidence of axillary lymph node recurrence after breast reconstruction will increase in the future. For axillary lymph node recurrence, surgical resection needs to be performed to achieve a complete recovery. Therefore, it may be necessary to perform surgery without preserving the reconstructed breast.

[A case of hyoid bone metastasis from breast cancer].

A 69-year-old woman had undergone breast conserving surgery and axillary lymph node dissection for left breast cancer 10 years previously. The tumor was positive for estrogen receptor (ER) and progesterone receptor (PgR), and negative for human epidermal growth factor receptor-2 (HER2). Adjuvant tamoxifen and radiation therapy were administered to the conserved breast for 5 years. The patient detected a painless neck mass 1 year previously. Computed tomography (CT) revealed a hyoid bone mass, and fine needle aspiration cytology indicated a diagnosis of adenocarcinoma. Positron emission tomography combined with CT (PET-CT) revealed masses in the pelvis, spine, hyoid bone, and cervical lymph node. For definitive diagnosis, excisional biopsy of the hyoid bone was performed. Immunohistostaining revealed that the cells were CK7 (+), CK20(-), mammaglobin (+), GCDFP-15 (+), ER (+), PgR (+), and HER2 (-). The final diagnosis was multiple bone metastasis(hyoid, pelvis, spine)as well as cervical lymph node metastasis from breast cancer. After diagnosis, the patient was treated with anastrozole and denosumab, and she achieved a partial response. She has experienced progression free survival for 12 months. Metastasis to the hyoid bone is uncommon for breast cancer. We report a case in which hormone therapy was effective after it was selected based on the results of excisional biopsy.

Pilot study of the relation between various dynamics of avatar experience and perceptual characteristics.

In recent years, due to the prevalence of virtual reality (VR) and human-computer interaction (HCI) research, along with the expectation that understanding the process of establishing sense of ownership, sense of agency, and limb heaviness (in this study, limb heaviness is replaced with comfort level) will contribute to the development of various medical rehabilitation, various studies have been actively conducted in these fields. Previous studies have indicated that each perceptual characteristics decrease in response to positive delay. However, it is still unclear how each perceptual characteristic changes in response to negative delay. Therefore, the purpose of this study was to deduce how changes occur in the perceptual characteristics when certain settings are manipulated using the avatar developed in this study. This study conducted experiments using an avatar system developed for this research that uses electromyography as the interface. Two separate experiments involved twelve participants: a preliminary experiment and a main experiment. As observed in the previous study, it was confirmed that each perceptual characteristics decreased for positive delay. In addition, the range of the preliminary experiment was insufficient for the purpose of this study, which was to confirm the perceptual characteristics for negative delay, thus confirming the validity of conducting this experiment. Meanwhile, the main experiment showed that the sense of ownership, sense of agency, and comfort level decreased gradually as delay time decreased, (i.e., this event is prior to action with intention, which could not be examined in the previous study). This suggests that control by the brain-machine interface is difficult to use when it is too fast. In addition, the distribution of the most strongly perceived settings in human perceptual characteristics was wider in regions with larger delays, suggesting this may lead to the evaluation of an internal model believed to exist in the human cerebellum. The avatar developed for this study may have the potential to create a new experimental paradigm for perceptual characteristics.

Mitral valve repair for medically refractory functional mitral regurgitation in patients with end-stage renal disease and advanced heart failure.

BACKGROUND: Information regarding patient selection for mitral valve repair for chronic kidney disease or end-stage renal disease (ESRD) with severe heart failure (HF) as well as outcome is limited. METHODS AND RESULTS: We classified 208 patients with advanced HF symptoms (Stage C/D) undergoing mitral valve repair for functional mitral regurgitation into 3 groups: estimated glomerular filtration rate ≥30 mL/min/1.73 m(2) (control group, n=144); estimated glomerular filtration rate <30 mL/min/1.73 m(2), not dependent on hemodialysis (late chronic kidney disease group, n=45), and ESRD on hemodialysis (ESRD group, n=19; preoperative hemodialysis duration 83 ± 92 months). Follow-up was completed with a mean duration of 49 ± 25 months. Postoperative (1-month) cardiac catheterization showed that left ventricular end-systolic volume index decreased from 109 ± 38 to 79 ± 41, 103 ± 31 to 81 ± 31, and 123 ± 40 to 76 ± 34 mL/m(2), in the control, late chronic kidney disease, and ESRD groups, respectively. Left ventricular end-diastolic pressure decreased, whereas cardiac index increased in all groups with no intergroup differences for those postoperative values. Freedom from mortality and HF readmission at 5 years was 18% ± 7% in late chronic kidney disease (P<0.0001 versus control, P=0.01 versus ESRD), and 64% ± 12% in ESRD (P=1 versus control) as compared with 52% ± 5% in the control group (median event-free survival, 26, 67, and 63 months, respectively). CONCLUSIONS: Mitral valve repair for medically refractory functional mitral regurgitation in patients with advanced HF yielded improvements in left ventricular function and hemodynamics irrespective of preoperative renal function status. Patients with ESRD showed favorable late outcome in terms of freedom from mortality and readmission for HF as compared with those with late chronic kidney disease. Further studies are needed to assess the survival benefits of mitral valve repair in patients with ESRD and advanced HF.

Modified technique for reconstructing the visceral arteries in thoracoabdominal aortic repair.

We present a modified technique for reconstructing the visceral arteries in thoracoabdominal aortic repair. After the proximal and distal anastomosis of a main tubular graft with four pre-sewn side branches, each visceral artery is cannulated and perfused with 25 °C blood (sum total, 800 mL/min). Then, each side branch is placed around the main graft, forming a gently curved loop around it. Finally, the orifice of each visceral artery is sutured to a side branch. This technique prevents kinking of the side branches and enables hemostasis to be secured with a clear view of all the suture lines.

[Analysis of elderly breast cancer patients aged 90 years and older].

In recent years, although the number of elderly patients with breast cancer is increasing, there are very few reports of breast cancer in elderly patients aged 90 years and older. In this study, we examined breast cancer patients who were 90 years of age or older. Patient background characteristics, clinicopathologic features, and treatment strategies were examined for 9 elderly breast cancer patients aged 90 or older who were treated at our department from January 2000 to December 2012. The median age of the patients was 91 (range, 90-99)years, and complications were reported in 7 patients (77.8%). The median tumor diameter was 4.3 (range, 1.4-6.0) cm, and T4 disease was observed in 6 patients (66.7%). Axillary lymph node status was negative in 6 patients (66.7%). Pathological diagnoses were invasive ductal carcinoma in 8 patients and ductal carcinoma in situ in 1 patient. Seven patients were hormone receptor positive and 1 patient was hormone receptor negative. Human epidermal growth factor receptor (HER)-2 status was negative in 8 patients. Surgery was performed safely in 5 patients and there were no signs of postoperative metastases. Four patients were treated with hormone therapy. The response rate( partial response[ PR] and complete response[ CR]) was 50%. Our findings suggest that when treating breast cancer patients aged 90 years or older, it would be necessary to offer medical treatment considering the possibility of comorbidities and the complications associated with medical treatment.