Feasibility of assessment of habitual salt intake using a 24-hour urinary salt excretion self-measuring device.

INTRODUCTION: To assess habitual salt intake, tools are needed to measure 24-h urinary salt excretion repeatedly. We developed and validated a new portable salt monitor, which measures salt excreted per urination and sums the values to provide an accurate estimate of urinary salt excretion over 24 h. METHODS: A previously developed salt monitor was improved with respect to the capacity, volume sensors, and equation for urinary sodium chloride concentration estimation. In 20 healthy Japanese female volunteers, 24-h urinary salt excretion was measured using the salt monitor and a conventional 24-h urine collection method on eight non-consecutive days. RESULTS: In a total of 157 days, there were no fixed or proportional errors between the methods. The mean salt intake over 8 days was 8.5 ± 2.0 g/day for the 24-h urine collection and 8.3 ± 2.3 g/day for the salt monitor, showing a strong correlation (r = 0.912, p < 0.001). At a cut-off value of 6 g, the salt monitor was able to completely classify individuals by habitual salt intake. DISCUSSION/CONCLUSION: The validity of the new salt monitor was confirmed. The device can be considered an alternative to the traditional 24-h urine collection for repeated surveys and for self-management of daily salt intake.

[A Case of Giant Phyllodes Tumor Treated with Breast Reconstruction].

A 62-year-old woman was diagnosed with right breast tumor 2 years ago, which she refused to undergo surgery. The patient experienced a rapid enlargement of the mass over the past 1 month, and visited hospital. The patient was diagnosed with a borderline phyllodes tumor by needle biopsy. Her right breast was occupied by an 18 cm mass. We conducted tumor resection and immediate reconstruction with DIEAP flap. The pathological diagnosis was a malignant phyllodes tumor, and the postoperative radiation to the chest wall was performed. During a year and a half follow up, she has no recurrence and highly satisfied with the reconstructed breast. Phyllodes tumors may recur locally regardless of whether they are benign or malignant, and we need strict follow-up.

[A Case Report of Multiple Endocrine Neoplasia Type 2A(MEN2A)Diagnosed with Medullary Thyroid Carcinoma].

We experienced a case of multiple endocrine neoplasia type 2A(MEN2A)diagnosed with medullary thyroid carcinoma. The patient was a 50s woman who was referred for a thyroid nodule detected in the right lobe during a carotid ultrasound examination. After undergoing a hemithyroidectomy, it was determined that the tumor was medullary carcinoma. RET gene test was performed, confirming a mutation at codon768, leading to the diagnosis of MEN2A. A completion thyroidectomy was performed to remove the remaining thyroid tissue. Postoperatively, the patient is undergoing systemic surveillance.

[A Case of HER2-Positive Metastatic Breast Cancer Achieved a Complete Response to Paclitaxel and Trastuzumab in Combination with Pertuzumab in Fifth Therapy].

We report a case of HER2-positive metastatic breast cancer achieved a complete response(CR)to paclitaxel(PTX) and trastuzumab(HER) in combination with pertuzumab(PER) in 5th therapy. A 69-year-old woman was diagnosed left breast cancer and underwent mastectomy and sentinel lymph node biopsy in January 2011. Pathological examination revealed an invasive ductal carcinoma that was ER 0%, PgR 0%, HER2(3+), Ki-67 67% and node negative. Two years after the operation, she found multiple lung metastases in both lungs. She was administered drug treatment as HER2-positive metastatic breast cancer, but multiple lung metastases got worse after 4th treatment. Weekly PTX, trastuzumab and pertuzumab were administered as 5th therapy. After 2 months, lung metastases diminished significantly. After 44 courses of drug treatment, positron emission tomography computed tomography(PET-CT)scan revealed CR. She wanted to cease treatment, so she continues to get CT scan every half a year and the CR has been maintained.

[Clinical Practice of the Efficiency and Safety of Palbociclib in Patients with Metastatic Breast Cancer].

We aimed to examine the effects of palbociclib and neutropenia in patients with metastatic breast cancer(MBC). From December 2017 to December 2019, 18 patients with estrogen receptor(ER)-positive, human epidermal growth factor receptor 2(HER2)-negative MBC were treated with palbociclib for at least 1 cycle. The most common adverse event(AE) was neutropenia, which occurred in 83% of all cases. With cessation and dose reduction, none of the patients had Grade 4 neutropenia. Palbociclib used in the first- or second-line treatment of MBC showed a higher efficacy than when used as the third-line treatment, which was observed as a longer duration to stay on treatment and higher efficacy.

[Evaluation of health promotion programs using health checkup data and medical receipts].

OBJECTIVES: In a research project on the evaluation of health promotion programs using a health dataset including health checkup data and medical receipts, which was supported by a research grant from the Ministry of Health, Labour and Welfare, the potential preventive factors that influence disease severity and medical expenditure were studied. METHODS: A dataset from a city with a population of 36,544 and a large elderly population (31.1%) was studied using 12 elementary school geographical areas as the basis of classification. A dataset from a company of 4,780 employees was analyzed to determine changes in health checkup data related to metabolic syndrome over 3 years. A simulation model to identify factors that are important for reducing the incidence of complications such as ischemic heart disease and stroke was developed. RESULTS: Geographical analyses showed a negative association between the rate of participation in health checkup and the prevalence of noncommunicable diseases. The percentage of new patients who started pharmaceutical treatment was lower in the health-advice-intervention group (5.2%) than in the nonintervention group (29.6%). A simulation model to identify factors that are important for reducing the incidence of complications was developed using data on health checkup participation, percentage of those who undertook a lifestyle-modification program, and compliance with medical treatment among others. CONCLUSIONS: Various health data including those on health checkup participation, percentage of those who undertook a lifestyle modification program, and compliance under medical treatment over 3 years were helpful in evaluating health promotion programs.

Effect of salt reduction intervention program using an electronic salt sensor and cellular phone on blood pressure among hypertensive workers.

We investigated the effectiveness of a workplace intervention program that utilized self-monitoring of daily salt excretion by an electronic salt sensor and sent personalized e-mail advice via cellular phone. Forty-one hypertensive male workers were assigned to intervention and control groups, then counseled together. Intervention group members were asked to measure daily salt excretion and received e-mail advice. After 4 weeks, a greater decrease of blood pressure (BP) was observed in the intervention group, with significant reductions to daily salt excretion and home BP. The new intervention program is considered useful for BP control among hypertensive workers.

Rechallenge of anti-PD-1/PD-L1 antibody showed a good response to metastatic breast cancer: a case report.

Rechallenge of immune checkpoint inhibitors has been reported for neoplasms other than breast cancer. Reported here is a case of a 55-year old woman diagnosed as having triple-negative right breast cancer with multiple metastases including lung. Atezolizumab and nab-paclitaxel were administered followed by epirubicin-cyclophosphamide. With subsequent eribulin, the overall best response was progressive disease, and curative surgical resection was performed. Three months after surgery (1.5 years after initial response of lung metastasis), right lung metastasis emerged at a site different from baseline. Based on the microsatellite instability-high status, pembrolizumab was administered and showed a good response. The patient has been treated with pembrolizumab, maintaining partial response, for over 9 months, which suggests the benefit of immune checkpoint inhibitors rechallenge in breast cancer.

The blood pressure lowering effect of lactotripeptides and salt intake in 24-h ambulatory blood pressure measurements.

It is well known that the sour milk containing lactotripeptides has a blood pressure lowering effect. The aim of this study was to evaluate the blood pressure (BP) lowering effect of lactotripeptides by monitoring home blood pressure, 24-h ambulatory measurements (ABPM), and daily urinary salt excretion. A total of 30 volunteers were given 200 ml of sour milk twice a day for 8 weeks after a 1-week run-in period. This preparation contained the lactotripeptides valine-proline-proline 2.66 mg and isoleucine-proline-proline 1.38 mg. The study participants had daily measurements of urinary salt excretion determined by an electric salt sensor and home blood pressure for each week during the run-in period, before the 4-and 8-week time points. 24-h ABPM was measured at the end of each week. Mean systolic blood pressure (SBP) during night sleep including base BP at 4 and 8 weeks were significantly lower than baseline values. Mean SBP and diastolic blood pressure (DBP) during night sleep of the 22 participants who belonged to the criteria of hypertension by 24-h ABPM was significantly decreased at 4 and 8 weeks. The change in 24-h mean SBP significantly correlated with mean urinary salt excretion over the three measurement periods. The 22 hypertensive subjects without taking lactotripeptides did not show significant change of blood pressure during 24 hours at 4 and 8 weeks. Our study confirmed the BP lowering effect of lactotripeptides during night-time sleep and showed that a lower intake of salt may increase the BP lowering effect of lactotripeptides through 24 hours in hypertensive subjects.

Tumor thickness and histological features as predictors of invasive foci within preoperatively diagnosed ductal carcinoma in situ.

Small invasion into ductal carcinoma in situ (DCIS) can easily be overlooked in resected breast specimens. To disclose useful markers predictive of invasive foci within preoperatively diagnosed DCIS lesions, a retrospective histopathological comparison was made between postoperatively diagnosed invasive ductal carcinoma with a predominant intraductal component (IDCPIC) (n=43) and pure DCIS (n=82). Through a multivariate logistic regression analysis model, 5 variables (DCIS grade, "tumor thickness," extent of retraction cleft, presence of lymph node metastasis, and HER2 score) were found to be significantly associated with the presence of invasive foci within DCIS; with a cutoff point of 0.315, sensitivity, specificity, positive predictive value, and negative predictive value were 0.93, 0.77, 0.68, and 0.95, respectively. No statistically significant difference was observed in recurrence-free survival between IDCPIC and pure DCIS, whereas the IDCPIC curve showed a slightly earlier decline than the DCIS one. In general, preoperative detection of lymph node metastasis in DCIS patients is elusive because of the extremely tiny metastatic size in most cases; thus, a 4-variable model, without lymph node metastasis, would be the actual working model. Furthermore, tumor "thickness" was found to be the most significant parameter predictive of invasive foci within DCIS. Although IDCPIC and pure DCIS showed similar recurrence-free survival curves, prediction of invasive foci within DCIS necessitates postoperative pathological analysis of surgically resected lesions.