Successful Percutaneous Rescue Treatment of Acute Carotid Stent Thrombosis Utilizing a Modified Embolic Protection Device.

Acute Carotid Stent Thrombosis (ACST) is a rare complication of Carotid Artery Stenting (CAS) with a potentially fatal outcome. We report a case of ACST occurring five minutes after the end of a successful CAS procedure that was promptly treated by carotid stent-in-stent implantation using a new percutaneous strategy based on the creation of a modified embolic protection device. Following the procedure, we did not observe brain lesions suggestive of acute cerebral ischemic events at the CT scan performed at 48 hours, as well as no neurological deficits in the following days.

Expression of GLOD4 in the Testis of the Qianbei Ma Goat and Its Effect on Leydig Cells.

The expression pattern of GLOD4 in the testis and its regulatory effect on testicular cells was explored in goats to enhance our understanding of spermatogenesis and improve reproduction in breeding rams. In this study, we demonstrated the localization of GLOD4 in testicular cells using immunohistochemistry and subcellular localization analyses. Subsequently, we analyzed the GLOD4 expression pattern in four age-based groups (0, 6, 12, and 18 months old) using real-time quantitative polymerase chain reaction (qRT-PCR) and protein blotting. Finally, we performed GLOD4 silencing and overexpression studies in Leydig cells (LCs) and explored the effects on cell proliferation, the cell cycle, steroid hormone secretion and the expression of candidate testosterone hormone-regulated genes. GLOD4 was mainly expressed in Leydig cells, and the subcellular localization results showed that the GLOD4 protein was mainly localized in the cytoplasm and nucleus. Silencing of GLOD4 significantly suppressed the mRNA expression levels of the testosterone secretion-related genes CYP11A1, 3ß-HSD, and CYP17A1 and the mRNA expression levels of cell cycle-related genes CDK6, PCNA, and Cyclin E. Moreover, the cell cycle was blocked at the G2/M phase after GLOD4 silencing, which significantly suppressed testosterone secretion. In contrast, GLOD4 overexpression significantly increased the mRNA expression levels of the testosterone secretion-related genes CYP11A1, 3ß-HSD, and CYP17A1 and increased the expression of the cell cycle-related genes CDK6, PCNA, and Cyclin E. Moreover, GLOD4 overexpression promoted the cell cycle from G0/G1 phases to enter the S phase and G2/M phases, promoted the secretion of testosterone. Taken together, our experimental results indicate that GLOD4 may affect the development of cells in Qianbei Ma goats of different ages by influencing the cell cycle, cell proliferation, and testosterone hormone synthesis. These findings enhance our understanding of the functions of GLOD4 in goats.

Sulforaphane's Nuclear Factor Erythroid 2-Related Factor 2 (Nrf2)-Dependent and -Independent Mechanism of Anti-SARS-CoV-2 Activity.

It is well established that Nrf2 plays a crucial role in anti-oxidant and anti-inflammatory functions. However, its antiviral capabilities remain less explored. Despite this, several Nrf2 activators have demonstrated anti-SARS-CoV-2 properties, though the mechanisms behind these effects are not fully understood. In this study, using two mouse models of SARS-CoV-2 infection, we observed that the absence of Nrf2 significantly increased viral load and altered inflammatory responses. Additionally, we evaluated five Nrf2 modulators. Notably, epigallocatechin gallate (EGCG), sulforaphane (SFN), and dimethyl fumarate (DMF) exhibited significant antiviral effects, with SFN being the most effective. SFN did not impact viral entry but appeared to inhibit the main protease (MPro) of SARS-CoV-2, encoded by the Nsp5 gene, as indicated by two protease inhibition assays. Moreover, using two Nrf2 knockout cell lines, we confirmed that SFN's antiviral activity occurs independently of Nrf2 activation in vitro. Paradoxically, in vivo tests using the MA30 model showed that SFN's antiviral function was completely lost in Nrf2 knockout mice. Thus, although SFN and potentially other Nrf2 modulators can inhibit SARS-CoV-2 independently of Nrf2 activation in cell models, their Nrf2-dependent activities might be crucial for antiviral defense under physiological conditions.

Imeglimin for Type 2 Diabetes Mellitus: Its Efficacy and Insight Into the Potential Benefit for Renal and Liver Function.

Introduction Imeglimin is a novel oral antihyperglycaemic drug used to treat type 2 diabetes mellitus (T2DM). In 2022, its clinical use was approved in Japan; however, there is limited data on its practical efficacy. Thus, we retrospectively investigated the clinical efficacy of imeglimin for six months at the National Defense Medical College, Tokorozawa, Japan. Material and methods We conducted a single-center retrospective analysis to elucidate the efficacy of imeglimin in the treatment of T2DM. Ten patients were enrolled, and their biomarkers and geographic data were analyzed. The primary endpoint was the change in HbA1c level at six months after imeglimin treatment compared to the baseline values. Other demographic and laboratory parameters, including sex, age, BMI, renal function, liver function, lipid profile, and transient elastography data, were also analyzed. Results A significant improvement in the HbA1c levels (8.1 % at baseline to 6.9 % at six months after treatment, P value = 0.01) was observed in this study, suggesting that imeglimin is a promising option for treating T2DM. In addition, no negative effects on renal function were observed, and albumin levels tended to decrease from baseline values. Among the nonalcoholic fatty liver disease (NAFLD) cases, liver conditions, especially fat content, tended to improve in this short-term period. Conclusions Imeglimin is suggested to have a beneficial effect not only on glycemic control but also on renal and liver function. However, further studies are required to better understand the long-term efficacy of this drug.

Computational identification and analysis of CNP0269688 as a natural product inhibitor disrupting the interaction between the HIV matrix domain and tRNA.

Our research is dedicated to combating HIV by targeting its Matrix (MA) domain, which is crucial for viral assembly and replication. This strategy specifically aims to interrupt early-stage infection and deter drug resistance by focusing on this essential domain. Due to the MA domain's conservation across different HIV strains, our approach promises broad-spectrum efficacy, which is particularly crucial in regions marked by significant genetic diversity and resistance issues. In our study, we introduce CNP0269688, a natural product that exhibits high affinity for the HIV-1 Matrix. Through detailed molecular dynamics simulations, we have assessed the compound's structural stability and interaction dynamics, particularly its potential to hinder Protein-tRNA interactions. This analysis lays the groundwork for future experimental investigations. Our efforts are steps toward enhancing HIV treatment, reducing viral transmission, and curbing drug resistance, with the ultimate aim of controlling and eradicating the pandemic, thereby contributing significantly to public health and scientific advancement.

Ultrafast Response and Broad Detection Range of a Ternary Cation Perovskite Single-Crystal Thin Film Photodetector for Imaging.

FA-MA-Cs ternary cation perovskite exhibits excellent optoelectronic properties and high stabilities against humidity and light soaking and thus has aroused extensive attention in polycrystalline thin film solar cells. Compared with polycrystalline counterparts, FA-MA-Cs ternary cation perovskite single-crystal thin films (SCTFs) have lower defects, better carrier transport capacity, and stability because of lacking grain boundary defects. However, the immature growth technology of SCTFs restricts digging out its optoelectronic potential. Here, we proposed an improved space-confined method to grow large area FA0.9 MA0.05Cs0.05PbI2.7Br0.3 SCTFs using a tunable heating area to control the nucleation and growth process. Its area reaches 64 mm2 with a thickness of 26 µm. The SCTF exhibits high crystallinity, low defect density, long carrier lifetime, and high moisture resistance stability. Besides, a photosensitive chip based on a planar metal-semiconductor-metal photodetector demonstrates linear response to the three primary colors, with a photosensitive range that is 1.5 times that of protocol 3 wide color gamut. Under high-frequency light sources, the on/off ratio reaches 3.9 × 103, and the response time can be as low as 400 ns. Such ultrafast response speed and broad photosensitive range are successfully achieved for imaging applications.

Key role of CYP17A1 in Leydig cell function and testicular development in Qianbei Ma goats.

Reproductive traits are vital economic parameters in goat production, and boosting the reproductive capacity of breeding rams is crucial for enhancing the profitability of goat farming. Currently, research on the reproductive performance of Qianbei Ma goats mainly centers on investigating mechanisms associated with prolificacy and estrous ovulation in ewes, with limited emphasis on ram reproductive aspects. This study used scanning electron microscopy and enzyme-linked immunosorbent assay (ELISA) to profile the morphology of testis and the dynamic changes of Luteinizing Hormone (LH), Follicle-Stimulating Hormone (FSH), and Testosterone (T) in serum at different developmental stages of Qianbei Ma goats. Meanwhile, transcriptome sequencing technology was used to investigate the mRNA expression patterns in testicular tissues at different developmental stages: newborn (0 M), puberty (6 M), sexual maturity (12 M), and physical maturity (18 M). The results showed that the diameter, circumference, and area of the testicular seminiferous tubules gradually increased with age. The levels of T and LH in serum significantly increased from 0 to 6 months after birth (p < 0.05), followed by a stabilization of T levels and a significant decrease in LH levels (p < 0.05). Meanwhile, FSH shows a decreasing trend between 0 and 18 months after birth. A total of 26,437 differentially expressed genes were identified in 6 comparison groups, which involve various biological processes such as immunity, growth, metabolism, development, and reproduction, and are significantly enriched in signaling pathways related to testicular development and spermatogenesis. WGCNA analysis identified 6 regions significantly associated with testicular development and spermatogenesis, and selected 320 genes for constructing a PPI network. Ten candidate genes related to testicular development and spermatogenesis were identified, including TP53, PLK4, RPS9, PFN4, ACTB, CYP17A1, GPX4, CLDN1, AMH and DHH. Of these, the CYP17A1 gene promotes interstitial cell proliferation, and promotes T synthesis. This study provides a theoretical basis and data support for promoting efficient breeding of goats and early breeding of excellent male goats.

Effectiveness of 2-Terminal Perovskite/Perovskite/c-Si Triple-Junction Solar Cells: An Integrated Study with an Emphasis on Methylammonium Bismuth Iodide.

The growing interest in high-efficiency solar energy technologies has driven research on multijunction solar cells to flourish over the last several years. This study sheds light on the optical, structural, and morphological aspects of the (CH3NH3)3Bi2I9 ((MA)3Bi2I9) film by fabricating and analyzing it experimentally. This thorough investigation lays the groundwork for more research into the film's possible uses in solar cell technology. We performed simulations to enhance the efficiency of two-terminal (2T) perovskite/perovskite double junction and perovskite/perovskite/c-Si triple-junction solar cells (TJSC) by using the MA3Bi2I9 material. The power conversion efficiency was greatly increased by using 2T triple-junction solar cells; the increase was around 116.59% from single junction (13.80-29.89%) and 31.91% from double junction (22.66-29.89%). As far as we know, this is the first investigation of the efficacy of MA3Bi2I9 as a top layer in multijunction tandem configurations. This revolutionary approach allows both academics and industry experts to produce cost-effective and efficient tandem solar cells, thereby enhancing earth-based solar energy development.

Pregnenolone 16-Alpha Carbonitrile, an Agonist of Rodent Pregnane X Receptor, Regulates Testosterone Biosynthesis in Rodent Leydig Cells.

Leydig cells (LCs) in the testes produce the male sex hormone testosterone (T). Several xenobiotics, including clinical drugs, supplements, and environmental chemicals, are known to disrupt T homeostasis. Notably, some of these xenobiotics are known to activate the pregnane X receptor (PXR), a ligand-dependent nuclear receptor. However, it is currently unknown whether PXR is expressed in LCs and whether PXR activation alters T synthesis in rodent LCs. Therefore, in this study, we sought to determine whether PXR is expressed in rodent LCs and whether pregnenolone 16-alpha carbonitrile (PCN), the prototype agonist of rodent PXR, regulates T biosynthesis in rodent LCs. Hormonal as well as protein and gene expression analyses were conducted in rat primary LCs and MA-10 mouse Leydig cells. Results showed that PXR was expressed at the mRNA and protein level in both rat primary LCs and MA-10 cells. Incubation of rat primary LCs with PCN resulted in a significant decrease in T secretion. This PCN-induced decrease in T secretion was associated with decreased protein expression of key steroidogenic enzymes such as 3ß-HSD and CYP17A1. RNA-seq results from MA-10 cells showed that PCN down-regulated the transcripts of steroidogenic enzymes and proteins involved in the T synthesis pathway. Together, these results suggest that PCN, an agonist of rodent PXR, can regulate T biosynthesis in rodent LCs by down-regulating the expression of the steroidogenic enzymes involved in T biosynthesis. Our results are significant as they provide a potential novel mechanism for disruption of testosterone homeostasis by a variety of xenobiotics.

Theoretical evaluation of monolayer MA2Z4 (M = Ti, Zr, or Hf; A = Si or Ge; and Z = P or As) family as promising candidates for lithium-sulfur batteries.

Rechargeable lithium-sulfur (Li-S) batteries have been considered as a potential energy storage system due to their high theoretical specific energy. However, their practical commercial application has been hindered by unresolved key issues. One promising approach to overcoming these challenges is the development of anchoring materials with exceptional performance. In this work, we conducted detailed evaluations of twelve types of MA2Z4 (M = Ti, Zr, or Hf; A = Si or Ge; and Z = P or As) monolayers as potential Li-S battery electrodes through first-principles calculations. Our results indicate that these monolayers can effectively immobilize Li2Sn species, preventing them from dissolving into the electrolyte and preserving intact Li2Sn conformations. The high electrical conductivity of these monolayers can be perfectly retained after S8/L2Sn clusters adsorption. Furthermore, the MA2P4 monolayers demonstrate superior catalytic performance for the sulfur reduction reaction (SRR) compared to the MA2As4 counterparts, whereas the MA2As4 monolayers exhibit lower decomposition energy barriers. Our current work indicates that these MA2Z4 monolayers hold significant promise as electrode materials for Li-S batteries.

Male-Specific Substances Possibly Contributing to Nuptial Flight of the Japanese Carpenter Ant Camponotus japonicus (Hymenoptera: Formicidae).

The nuptial flight of ants usually occurs during certain periods of the year. Alate females and males fly out of their nests to mate simultaneously. In the genus Camponotus, sex-specific chemicals are deposited in the male head; however, their roles in nuptial flight have not yet been clarified. This study aimed to elucidate the functions of male-specific chemicals in the Japanese carpenter ant Camponotus japonicus. First, we identified three chemicals characteristic to the male - methyl salicylate (MS), methyl 6-methylsalicylate (MMS), and methyl anthranilate (MA) - all of which triggered electroantennogram (EAG) responses in both alate males and females. As the relative content of MS was insufficient for GC comparison, we investigated the quantitative changes of MMS and MA in the male head capsules before and after flight under laboratory conditions. The amounts of both compounds were significantly reduced after flight, which suggested that males secrete them during flight. Thereafter, a field trap experiment was conducted in three fields of the Kyoto Prefecture, Japan, during the nuptial flight season in 2021 using MMS and MA as baits. The number of captured alate males was significantly higher than that of the females, suggesting that these compounds primarily attracted males rather than females. Considering the field conditions, if the local concentration of these chemicals is increased by male aggregation, females may be attracted as they also showed EAG responses. Our findings represent a first step toward understanding chemically mediated male lek formation during the process of male aggregation syndrome in this species.

From Cognitive Function to Treatment Efficacy in Obsessive-Compulsive Disorder: Insights from a Multidimensional Meta-Analytic Approach.

Meta-analysis is a statistical tool used to combine and synthesise the results of multiple independent studies on a particular topic. To this end, researchers isolate important moderators and mediators to investigate their influence on outcomes. This paper introduces a novel approach to meta-analysis, known as multidimensional meta-analysis (mi-MA), to study memory performance in those with obsessive-compulsive disorder (OCD). Unlike traditional meta-analyses, mi-MA allows researchers to extract multiple data points (e.g., using different measures) from single studies and groups of participants, facilitating the exploration of relationships between various moderators while avoiding multicollinearity issues. Therefore, in the first instance, we outline the use of the mi-MA approach to quantify the impact of complex models of memory performance in individuals with OCD. This approach provides novel insights into the complex relationship between various factors affecting memory in people with OCD. By showcasing the effectiveness of mi-MA in analysing intricate data and modelling complex phenomena, the paper establishes it as a valuable tool for researchers exploring multifaceted phenomena, both within OCD research and beyond.

Role of 6mA in the Regulation of Metabolic Biosynthesis in Sorghum Callus.

Plant cell culture technology helps to obtain natural plant-derived metabolites. The callus of sorghum, a prominent cereal crop, possesses various metabolites with potential health benefits. However, the epigenetic mechanism regulating metabolic biosynthetic capabilities in sorghum remains unknown. Therefore, we conducted N6-methyladenine (6mA) methylome analysis using transcriptome profiling and metabolome analysis to investigate the role of 6mA alterations in two calluses having different biosynthetic capacities, which were derived from immature sorghum embryos. Our findings indicate that the 6mA upregulation within gene bodies is crucial in transcriptional activity potentially mediated by the DNA demethylase SbALKBH1. Furthermore, 6mA was significantly enriched in genes involved in the biosynthesis of flavonoids and isoflavonoids. This could serve as a novel source of bioactive compounds for human health. Thus, 6mA could play an essential role in flavonoid biosynthesis in the sorghum callus.

Research on the impact of technology mergers and acquisitions on corporate performance: an empirical analysis based on China's pharmaceutical industry.

There is intense competition among pharmaceutical companies with the rapid growth of the global pharmaceutical industry. In recent years, China has continuously increased the reform of the medical system. Technology mergers and acquisitions (M&A) in China's pharmaceutical industry have emerged in this complex policy and economic background. This paper conducts an empirical study from the dual perspectives of financial performance and innovation performance, based on unbalanced panel data of Chinese listed pharmaceutical firms from 2012 to 2022. The impact of technology M&A on firm performance is analyzed in terms of the heterogeneity of firm characteristics. Meanwhile, the relationship between R&D investment in technology M&A and firm performance is examined. The results show that technology M&A can promote the performance of pharmaceutical companies, and R&D investment has a mediating effect on the impact of technology M&A on corporate performance. Based on the above findings, this study enriches the relevant literature on technology M&A in the pharmaceutical industry, provides warnings and suggestions for pharmaceutical companies to improve corporate performance through technology M&A, and provides reference materials for future policy formulation.

Intercalating Architecture for the Design of Charge Density Wave in Metallic MA2Z4 Materials.

We present a novel approach to induce charge density waves (CDWs) in metallic MA2Z4 materials, resembling the behavior observed in transition metal dichalcogenides (TMDCs). This method leverages the intercalating architecture to maintain the same crystal field and Fermi surface topologies. Our investigation reveals that CDW instability in these materials arises from electron-phonon coupling (EPC) between the d band and longitudinal acoustic (LA) phonons, mirroring TMDC's behavior. By combining α-MA2Z4 with 1H-MX2 materials in a predictive CDW phase diagram using critical EPC constants, we demonstrate the feasibility of extending CDW across material families with comparable crystal fields and reveal the crucial role in CDW instability of the competition between ionic charge transfer and electron correlation. We further uncover a strain-induced Mott transition in ß2-NbGe2N4 monolayer featuring star-of-David patterns. This work highlights the potential of intercalating architecture to engineer CDW materials, expanding our understanding of CDW instability and correlation physics.

Misregulation of mitochondrial 6mA promotes the propagation of mutant mtDNA and causes aging in C. elegans.

In virtually all eukaryotes, the mitochondrial DNA (mtDNA) encodes proteins necessary for oxidative phosphorylation (OXPHOS) and RNAs required for their synthesis. The mechanisms of regulation of mtDNA copy number and expression are not completely understood but crucially ensure the correct stoichiometric assembly of OXPHOS complexes from nuclear- and mtDNA-encoded subunits. Here, we detect adenosine N6-methylation (6mA) on the mtDNA of diverse animal and plant species. This modification is regulated in C. elegans by the DNA methyltransferase DAMT-1 and demethylase ALKB-1. Misregulation of mtDNA 6mA through targeted modulation of these activities inappropriately alters mtDNA copy number and transcript levels, impairing OXPHOS function, elevating oxidative stress, and shortening lifespan. Compounding these defects, mtDNA 6mA hypomethylation promotes the cross-generational propagation of a deleterious mtDNA. Together, these results reveal that mtDNA 6mA is highly conserved among eukaryotes and regulates lifespan by influencing mtDNA copy number, expression, and heritable mutation levels in vivo.

Pharmacological mechanisms of Ma Xing Shi Gan Decoction in treating influenza virus-induced pneumonia: intestinal microbiota and pulmonary glycolysis.

Background: Influenza virus is one of the most common pathogens that cause viral pneumonia. During pneumonia, host immune inflammation regulation involves microbiota in the intestine and glycolysis in the lung tissues. In the clinical guidelines for pneumonia treatment in China, Ma Xing Shi Gan Decoction (MXSG) is a commonly prescribed traditional Chinese medicine formulation with significant efficacy, however, it remains unclear whether its specific mechanism of action is related to the regulation of intestinal microbiota structure and lung tissue glycolysis. Objective: This study aimed to investigate the mechanism of action of MXSG in an animal model of influenza virus-induced pneumonia. Specifically, we aimed to elucidate how MXSG modulates intestinal microbiota structure and lung tissue glycolysis to exert its therapeutic effects on pneumonia. Methods: We established a mouse model of influenza virus-induced pneumoni, and treated with MXSG. We observed changes in inflammatory cytokine levels and conducted 16S rRNA gene sequencing to assess the intestinal microbiota structure and function. Additionally, targeted metabolomics was performed to analyze lung tissue glycolytic metabolites, and Western blot and enzyme-linked immunosorbent assays were performed to assess glycolysis-related enzymes, lipopolysaccharides (LPSs), HIF-1a, and macrophage surface markers. Correlation analysis was conducted between the LPS and omics results to elucidate the relationship between intestinal microbiota and lung tissue glycolysis in pneumonia animals under the intervention of Ma Xing Shi Gan Decoction. Results: MXSG reduced the abundance of Gram-negative bacteria in the intestines, such as Proteobacteria and Helicobacter, leading to reduced LPS content in the serum and lungs. This intervention also suppressed HIF-1a activity and lung tissue glycolysis metabolism, decreased the number of M1-type macrophages, and increased the number of M2-type macrophages, effectively alleviating lung damage caused by influenza virus-induced pneumonia. Conclusion: MXSG can alleviate glycolysis in lung tissue, suppress M1-type macrophage activation, promote M2-type macrophage activation, and mitigate inflammation in lung tissue. This therapeutic effect appears to be mediated by modulating gut microbiota and reducing endogenous LPS production in the intestines. This study demonstrates the therapeutic effects of MXSG on pneumonia and explores its potential mechanism, thus providing data support for the use of traditional Chinese medicine in the treatment of respiratory infectious diseases.

Is playing ma-jong, chess and cards associated with a lower incidence of shoulder pain in Chinese elderly adults? The cross-sectional and longitudinal evidence from CHARLS.

BACKGROUND: The association between playing Ma-jong, chess and cards (PMCC) and shoulder pain among elderly adults in China remains unclear. The present study aimed to examine the association based on a nationally representative large-scale survey. METHODS: The study used two waves of data from China Health and Retirement Longitudinal Study (CHARLS) in 2015 and 2018. All subjects met the inclusion criteria were classified based on the results of the CHARLS wave questionnaire. Logistic regression models were conducted to analyze the cross-sectional and longitudinal association between PMCC and shoulder pain. Odds ratios (OR) were reported to indicate the strength of the association. RESULTS: In total, 8125 participants aged over 60 years (48.3 % male; mean age 67.9 ± 6.4 years) were enrolled in a cross-sectional association study in 2015, and further 6861 elderly adults were followed up in 2018. The overall prevalence of shoulder pain in the cross-sectional population was 15.6 %. In the non-PMCC and PMCC groups, the incidence of shoulder pain was 16.6 % and 10.7 %, respectively (P < 0.001). In the fully adjusted model, the results showed a significant association between PMCC and shoulder pain (OR: 0.798, 95 % CI: 0.662-0.963, P = 0.018). In the longitudinal analysis from 2015 to 2018, the incidence of new-occurrence shoulder pain in non-PMCC and PMCC groups was 22.1 %, and 18.5 %, respectively (P = 0.004). In the fully adjusted model, compared with the non-PMCC group, the risk of the occurrence of shoulder pain for individuals with PMCC was lower (OR: 0.832, 95 % CI: 0.709-0.975, P = 0.023). CONCLUSIONS: PMCC is associated with lower incidence of shoulder pain, which provides evidence for PMCC as a potential protective factor in the occurrence of shoulder pain.

Primary Diffuse Large B-Cell Lymphoma of the Breast with MYC and BCL2 Rearrangements with Terminal Deoxynucleotidyl Transferase Expression: A Case Report.

Introduction: Primary breast lymphoma represents only 1% of non-Hodgkin lymphomas. The most common histology is diffuse large B-cell lymphoma. When dual translocations of MYC and BCL2 or BCL6 occur, it is referred to as "high-grade B-cell lymphoma with rearrangements of MYC and BCL2 and/or BCL6" according to the 4th edition of the WHO classification of hematolymphoid tumors. The expression of tdt in this type of malignancy is exceptional. Case Report: This is a case of a 54-year-old woman presenting with a rapidly growing painless mass. Ultrasound-guided core biopsy of the breast mass showed infiltrate of medium-sized neoplastic lymphocytes which stained as CD79a-positive B cells co-expressing CD10, BCL2, tdt, and MYC. Ki-67 is positive in 80%. There was rearrangement of MYC and BCL2 at FISH. Positron emission tomography (PET) scan was negative elsewhere. Final diagnosis was a DLBCL of the breast with tdt expression. She was treated with 6 cycles of R-hyperCVAD/MA (R = rituximab, C = cyclophosphamide, V = vincristine, A = cytarabine, D = dexamethasone, M = methotrexate) and intrathecal chemotherapy (IT CT). Restaging PET shows resolution of all avid uptake. We did a review of literature showing the importance of giving an intensive chemotherapy regimen, high-dose methotrexate, cytarabine, and IT CT for central nervous system (CNS) prophylaxis. Conclusion: Primary DLBCL of the breast with rearrangement of MYC and BCL2 and tdt expression is an aggressive disease not very well studied that needs to be treated with an intensive CT and CNS prophylaxis. Stem cell transplant could be given after first remission.