[Case Report of Occult Breast Cancer with Triple Negative Subtype].

A 61-year-old woman presented at a nearby clinic with a complaint of a mass in the right axilla. Initial imaging examinations, including mammography, ultrasonography, and breast MRI, did not reveal any obvious intramammary lesions, although a swollen lymph node was observed in the right axilla. Fine-needle aspiration cytology confirmed malignancy. Hence, a core needle biopsy was performed. The results indicated a suspected metastasis of invasive ductal carcinoma(ER-, PgR-, HER2-); however, the primary tumor could not be definitively determined. Despite an extensive whole-body examination, the primary tumor remained unidentified. Nonetheless, metastasis of occult breast cancer in the right axillary lymph node was postulated. Subsequent axillary dissection revealed metastases in only one lymph node. Taking the clinical findings into consideration, the patient was diagnosed with right occult breast cancer, and chemotherapy and radiotherapy were planned.

Radiological and histopathological features and treatment response by subtypes of interstitial pneumonia with autoimmune features: A prospective, multicentre cohort study.

BACKGROUND: Patients with idiopathic interstitial pneumonia (IIP) have a favourable prognosis when they have interstitial pneumonia with autoimmune features (IPAF). However, precise IPAF-related findings from high-resolution computed tomography (HRCT) and lung histopathological specimens and the treatment response have not been fully determined. Therefore, this study was conducted to evaluate the relationship between findings on HRCT or lung histopathological specimens and the progression of interstitial pneumonia in patients with IPAF. METHODS: This multicentre cohort study prospectively enrolled consecutive patients with IIP. At the diagnosis of IIP, we systematically evaluated 74 features suggestive of connective tissue diseases and followed them up. HRCT, lung specimens, serum antibodies, and the clinical course were also evaluated. RESULTS: Among 222 patients with IIP, 26 (11.7%) fulfilled the IPAF criteria. During a median observation period of 36 months, patients with IPAF showed better survival than those without IPAF (p = 0.034). While histopathological findings were not related to IPAF, nonspecific interstitial pneumonia (NSIP) with organizing pneumonia (OP) overlap was the most prevalent HRCT pattern (p < 0.001) and the consolidation opacity was the most common radiological finding in IPAF (p = 0.017). Furthermore, in patients with IPAF, the diagnosis of COP or NSIP with OP overlap was associated with a higher increase in %FVC in 1 year than in those with idiopathic pulmonary fibrosis, NSIP, or unclassifiable IIP (p = 0.002). CONCLUSIONS: This study shows the presence of consolidation opacity on HRCT and the diagnosis of COP or NSIP with OP overlap are associated with IPAF and its favourable treatment response in patients with IPAF.

Empowering Community Health Workers in Japan: Determinants of Non-Communicable Disease Prevention Competency.

BACKGROUND: Community health workers (CHWs), hailing from the general populace, play a pivotal role in fortifying healthcare systems, with a primary focus on mitigating non-communicable diseases (NCDs) and elevating overall life expectancy. To assess the aptitude of CHWs in NCD prevention, we introduced the Community Health Workers Perceptual and Behavioral Competency Scale for preventing non-communicable diseases (COCS-N). This study examines the multifaceted interplay of individual and community factors that influence CHWs' COCS-N scores. METHODS: The research design is a secondary analysis using data from a self-administered questionnaire survey of 6480 CHWs residing in municipalities across Japan, which obtained 3120 valid responses, between September to November 2020. The COCS-N was employed as the dependent variable, while the independent variables were individual-related factors, including years of community health work, health literacy, and community-related factors, such as CHWs' sense of community. To ascertain the significance of associations between individual and community factors and CHWs' competency, an analysis of covariance (ANCOVA) was utilized to compare the three groups Q1/Q2/Q3 by low, medium, and high scores on the COCS-N scale. Statistical significance was considered to be indicated by a p-value of less than 0.05. RESULTS: The ANCOVA analysis revealed that three factors were significantly linked to CHWs' competence. These comprised individual factors: "years of CHWs" (mean ± SD Q1: 6.0 ± 6.0, Q2: 7.8 ± 7.0, Q3: 8.2 ± 7.7, p < 0.001) and "health literacy" (Q1: 27.7 ± 6.6, Q2: 30.4 ± 6.9, Q3: 33.8 ± 7.8, p < 0.001), as well as a community factor: "Sense of community" (Q1: 14.8 ± 3.7, Q2: 16.5 ± 3.5, Q3: 18.2 ± 3.6, p < 0.001). CONCLUSIONS: Our finding is that a positive association was derived between COCS-N scores and certain determinants. Notably, "years of CHWs" and "health literacy" in the individual domain, along with the "Sense of community" in the communal context, were firmly established as being significantly associated with CHWs' competency. Consequently, CHWs need training to increase their "health literacy" and "sense of community", to acquire high competency in NCD prevention, which will lead to the empowerment of CHWs and maintain their motivation to continue.

Soy isoflavone genistein attenuates the efficacy of immune checkpoint therapy in C57BL/6 mice inoculated with B16F1 melanoma and a high PD-L1 expression level reflects tumor resistance.

Immune checkpoint therapy has been shown to be an effective therapy for many types of tumors. Much attention has been paid to the development of an effector target would be helpful for immune checkpoint therapy. Genistein has been shown to have an anti-tumor effect both in vitro and in vivo. In this study, we examined the effect of genistein on immune checkpoint blockade therapy against B16F1 melanoma tumors. Mice treated with genistein or anti-programmed death (PD)-1 antibody showed a significant decrease in tumor growth. However, treatment with genistein had no effect on or attenuated the efficacy of immune checkpoint therapy. The percentages of T cell receptor (TCR)ß+CD4+ and TCRß+CD8+ cells and the concentrations of interferon-γ and tumor necrosis factor-α in tumor tissue were not different among the experimental groups. A significant difference was also not found in microbe composition. Interestingly, a high expression level of PD-ligand (L)1 closely reflected the outcome of therapy by genistein or anti-PD-1 antibody. The study showed that a combination of genistein treatment does not improve the effect of immune blockade therapy. It also showed that a high PD-L1 expression level in tumors is a good prediction maker for the outcome of tumor therapy.

Determinants of Self-Rated Health Disparities among Independent Community-Dwelling Older Adults: An Age-Stratified Analysis.

In response to the distinctive healthcare requirements of independent, healthy, community-dwelling older adults in Japan and other developed countries with aging populations, the current study examined the differences in factors associated with self-rated health (SRH) between the following two age groups: young-old (65-74) and old-old (75 and above). Age-stratified analysis was used to provide a comprehensive understanding of the unique health challenges faced by these demographic segments and to inform the development of targeted interventions and health policies to improve their well-being. The results of a cross-sectional study of 846 older adults in Yokohama, Japan, who completed self-administered questionnaires, revealed that high SRH was consistently linked with the low prevalence of concurrent medical issues in both age groups (<75 and ≥75) (ß: -0.323, p < 0.001 in the <75 group; ß: -0.232, p < 0.001 in the ≥75 group) and increased subjective well-being (ß: 0.357, p < 0.001 in the <75 group; ß: 0.244, p < 0.001 in the ≥75 group). Within the ≥75 age group, higher SRH was associated with more favorable economic status (ß: 0.164, p < 0.001) and increased engagement in social activities (ß: 0.117, p = 0.008), even after adjusting for age, sex, and economic status. These findings may inform the development of targeted interventions and policies to enhance the well-being of this growing population in Japan and other developed countries.

The Effects of Black Tea Consumption on Intestinal Microflora-A Randomized Single-Blind Parallel-Group, Placebo-Controlled Study.

We previously reported that black tea consumption for 12 wk reduced the risk of acute upper respiratory tract inflammation, and improved secretory capacity in individuals with low salivary SIgA levels (Tanaka Y et al. 2021. Jpn Pharmacol Ther 49: 273-288). These results suggested that habitual black tea consumption improves mucosal immunity. Therefore, in this study we evaluated the effect of black tea intake on gut microbiota, which is known to be involved in mucosal immunity, by analyzing the bacterial flora and the short-chain fatty acids (SCFAs) concentration of feces collected during the above clinical study. The clinical design was a randomized, single-blind, parallel-group, placebo-controlled study with 72 healthy Japanese adult males and females, who consumed three cups of black tea (Black Tea Polymerized Polyphenols 76.2 mg per day) or placebo per day for 12 wk. In all subjects intake of black tea significantly increased abundance of Prevotella and decreased fecal acetic acid concentration. Particularly in the subjects with low salivary SIgA levels, the change over time of total bacteria, Prevotella, and butyrate-producing bacteria, which are involved in normalizing immune function, were higher in the black tea group than in the placebo group. In subjects with low abundance of Flavonifractor plautii a butyrate-producing bacteria, black tea consumption significantly increased salivary SIgA concentration and the absolute number of Flavonifractor plautii. In conclusion, our results suggest that improvement of mucosal immunity via an increase in butyrate-producing bacteria in the gut may partly contribute to the suppressive effect of black tea consumption on acute upper respiratory tract inflammation observed in our previous report.

Proposal of a novel subspecies: Alicyclobacillus hesperidum subspecies aegles.

Alicyclobacillus sp. DSM 11985T was isolated from geothermal soil but had not yet been classified at the species level. The strain produced guaiacol, which is of interest from the viewpoint of food spoilage in the food industry. 16S rRNA gene sequence analysis revealed that strain DSM 11985T was closely related (99.6 % similarity) to Alicyclobacillus hesperidum DSM 12489T. However, strains of A. hesperidum did not produce guaiacol; therefore, we performed the taxonomic characterization of strain DSM 11985T. The results showed that strain DSM 11985T and strains of A. hesperidum showed different phenotypic characteristics in biochemical/physiological tests including guaiacol production. Average nucleotide identity values between strain DSM 11985T and strain DSM 12489T were 95.4-95.9 %, and the in silico DNA-DNA hybridization value using the Genome-to-Genome Distance Calculator between strains DSM 11985T and DSM 12489T was 65.5 %. These values showed that strain DSM 11985T was genetically closely related but separated from strains of A. heparidum. From the above results, a novel subspecies of A. hesperidum, named Alicyclobacillus hesperidum subsp. aegles subsp. nov. is proposed. The type strain is DSM 11985T (=FR-12T=NBRC 113041T).

Personal characteristics associated with handwashing behaviour among Japanese university students studying abroad: Prospective observational studies.

BACKGROUND: Hand hygiene is recommended to travellers to prevent common travel-related illnesses such as diarrhoea and respiratory infection. For effective hygiene promotion interventions, we aimed to identify the personal characteristics associated with handwashing behaviour. METHODS: Prospective observational studies consisting of pre- and post-travel surveys were conducted among Japanese university students studying abroad between 2016 and 2018 (n = 825; 6-38 travel days). Associations of age, sex, study major, and overseas travel experience with handwashing behaviour (5-point scale) were evaluated using ordinal logistic regression models, with adjustment for destination, travel duration, and psychological factors (risk perception of diarrhoea and concern about hygiene). RESULTS: Among the participants in our analysis (n = 629), 28.0 % washed their hands before every meal while abroad. The male sex and no overseas travel experience were associated with decreased frequency of infrequent handwashing, even after adjusting for all potential confounding factors, whereas the study major was not associated. The adjusted odds ratios (95 % confidence intervals) were 0.74 (0.56-0.99) for men vs. women and 0.69 (0.52-0.93) for no overseas travel experience vs. overseas travel experience but not to the current destination. CONCLUSIONS: The lack of overseas travel experience correlated with handwashing frequency in both men and women. In addition to the travel destination, the male sex and no overseas travel experience should be highlighted in pretravel hand hygiene interventions.

Pediatric allergies in Japan: Coronavirus disease pandemic-related risk factors.

Background: The coronavirus disease 2019 (COVID-19) pandemic impacted various parts of society, including Japanese children with allergies. Objective: This study investigated risk factors for pediatric allergic diseases associated with the state of emergency owing to the COVID-19 pandemic in Japan, including during school closures. Methods: Parents of pediatric patients (0-15 years) with allergies were enrolled and queried regarding the impact of school closure on pediatric allergies compared to that before the COVID-19 pandemic. Results: A valid response was obtained from 2302 parents; 1740 of them had children with food allergies. Approximately 4% (62/1740) of the parents reported accidental food allergen ingestion was increased compared to that before the COVID-19 pandemic. Accidental ingestion during school closures was associated with increased contact with meals containing allergens meant for siblings or other members of the family at home. The exacerbation rate during the pandemic was highest for atopic dermatitis at 13% (127/976), followed by allergic rhinitis at 8% (58/697), and bronchial asthma at 4% (27/757). The main risk factors for worsening atopic dermatitis, allergic rhinitis, and bronchial asthma were contact dermatitis of the mask area (34/120 total comments); home allergens, such as mites, dogs, and cats (15/51 total comments); and seasonal changes (6/25 total comments), respectively. Conclusion: The main factors affecting allergic diseases were likely related to increased time at home, preventive measures against COVID-19, and refraining from doctor visits. Children with allergies were affected by changes in social conditions; however, some factors, such as preventing accidental ingestion and the management of allergens at home, were similar to those before the COVID-19 pandemic. Patients who had received instructions on allergen avoidance at home before the pandemic were able to manage their disease better even when their social conditions changed.

Intracranial Non-Sinus-Type Dural Arteriovenous Fistulas Could Be Curable by Transarterial Embolization or Transvenous Embolization with Liquid Embolic Material.

Objective: Recently, the occlusion rate of transarterial embolization (TAE) for intracranial non-sinus-type dural arteriovenous fistulas (NSDAVFs) has improved after ONYX was introduced. Additionally, when TAE for NSDAVF is unsuccessful, transvenous embolization (TVE) has become available as an alternative treatment. We investigated the factor for the favorable occlusion rate of endovascular treatment for NSDAVF at our institutions. Methods: Two hundred and twenty-seven patients with intracranial dural arteriovenous fistulas (DAVFs) were treated at our institutions between September 2014 and October 2022. The patients diagnosed with NSDAVF in all DAVFs who underwent endovascular treatment were included. The clinical characteristics, angiographical outcomes, and clinical outcomes of patients who underwent endovascular treatment were evaluated. Results: Thirty-eight patients had intracranial NSDAVF (tentorial: 23 cases, parasagittal-convexity: 7, anterior cranial fossa: 6, middle cranial fossa: 2). Our participants' mean age was 64.8 ± 11.3 years, and 31 (81.6%) of them were males. Patients' symptoms were as follows: asymptomatic (24), hemorrhage (10), tinnitus (3), and trigeminal neuralgia (1). TAE and TVE were performed on 35 and 3 patients, respectively. The rate of immediate angiographical occlusion was 84.2% (32/38). The follow-up angiographical occlusion rate in 6 months was 88.5% (31/35). Complications occurred in three cases. There was no morbidity or mortality after 30 days. Conclusion: TAE using the combination of the new microcatheter and microguidewire and TVE in the case of difficult or failed TAE for NSDAVF could achieve high success rates and safety.

An autopsy case of alpha-fetoprotein-producing large duodenal adenocarcinoma.

We report an autopsy case of a large duodenal adenocarcinoma that produced alpha-fetoprotein (AFP). The patient was a man in his 70s with diabetes mellitus. He presented with epigastralgia and was referred to our hospital. Upper gastrointestinal endoscopy and abdominal computed tomography revealed a large tumor of 11 cm in diameter in the descending limb of the duodenum. A tumor biopsy showed poorly differentiated adenocarcinoma. Although his carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA19-9) levels were within the normal range, his AFP levels were significantly elevated (42,078.4 ng/mL). Due to vascular invasion, curative resection was not feasible, and chemotherapy was chosen as the treatment option. After gastrojejunostomy was performed to enable oral intake, one cycle of modified leucovorin/5-fluorouracil/oxaliplatin (mFOLFOX6) therapy was administered. However, it proved ineffective, and the patient's anorexia gradually worsened. Ultimately, he succumbed to the progression of cancer cachexia. Autopsy findings revealed a 14-cm-long duodenal carcinoma primarily located in the duodenal bulb, with direct invasion into the stomach, pancreas, and liver. A pathological examination confirmed a diagnosis of poorly differentiated adenocarcinoma with AFP production. Duodenal cancer is rare, and AFP-producing duodenal cancer is even rarer, with only 21 reported cases, including our own. We present this autopsy case of AFP-producing duodenal adenocarcinoma and review the cases reported in the relevant literature.

Standardised 3D-CT lung volumes for patients with acute exacerbation of rheumatoid arthritis-associated interstitial lung disease.

OBJECTIVES: Fibrotic interstitial lung disease (ILD) is a progressive lung disease characterised by loss of lung volume, resulting in a leading cause of death in patients with rheumatoid arthritis (RA). Crucially, acute exacerbation (AE) of ILD shows higher morbidity and mortality with rapid deterioration of the lungs. However, a quantitative assessment for physiological changes at AE has yet to be performed. This study hypothesised that quantitative assessments of lung volume (LV) accurately indicate disease severity and mortality risk in patients with AE-RA-ILD. METHODS: This multicentre cohorts study quantitatively assessed physiological changes of RA-ILD at diagnosis (n = 54), at AE (Discovery-cohorts; n = 20, and Validation-cohort; n = 33), and controls (n = 35) using 3D CT (3D-CT) images. LV was quantitatively measured using 3D-CT and standardised by predicted forced vital capacity. RESULTS: Patients with RA-ILD at diagnosis showed decreased LV, predominantly in lower lobes, compared with controls. Further substantial volume loss was found in upper- and lower lobes at AE compared with those at diagnosis. During AE, decreased standardised 3D-CT LV was associated with a worse prognosis in both cohorts. Subsequently, standardised 3D-CT LV was identified as a significant prognostic factor independent of age, sex, and the presence of UIP pattern on CT by multivariate analyses. Notably, a composite model of age and standardised 3D-CT LV successfully classified mortality risk in patients with AE-RA-ILD. CONCLUSION: Volume loss at AE in patients with RA-ILD was associated with increased mortality. Assessing physiological change using standardised 3D-CT might help evaluate disease severity and mortality risk in patients with AE-RA-ILD.

Evidence of off-label inhalation therapy on pediatric asthma practice in Japan.

BACKGROUND: In Japan, many asthma inhalers do not have formal approval for use in the pediatric population because of the lack of domestic data. In real-world settings, however, numerous off-label medications are prescribed. Currently, the nature of off-label prescriptions of asthma inhalers on pediatric patients in Japan remains unclear. METHODS: Using public open-source national medical claims data, we investigated the real-world descriptive epidemiology of off-label prescriptions for asthma inhalers for pediatric patients. We obtained the number of off-label prescriptions of formulations for patients aged 0-14 years from anonymously summarized prescription data for a 7-year period starting from April 2014. The actual prescription numbers and their chronology over time were then analyzed. RESULTS: In 2019, 143,439 asthma inhalers were used off label in children and adolescents. Overall, 96.1% were inhaled corticosteroids (ICSs) or long-acting beta stimulants (LABAs), and 3.9% were high-dose ICS. Of ICSs and LABAs, 18.8% were off-label prescriptions. The total number of off-label ICS/LABA prescriptions and their percentage relative to the overall formulations gradually decreased but a notable disparity was observed among inhaler types. CONCLUSIONS: There was a surprisingly large number of off-label prescriptions of asthma inhalers in the pediatric population in Japan. The proper use of ICSs/LABAs and expansion of insurance coverage should be advocated to reduce off-label use.

WEE1 and PARP-1 play critical roles in myelodysplastic syndrome and acute myeloid leukemia treatment.

BACKGROUND: Myelodysplastic syndrome (MDS) is a clonal bone marrow disorder defined by cytopenia and is associated with an increased risk of transformation to acute myeloid leukemia (AML). The outcome of MDS is poor, so alternative therapeutic approaches are needed to improve survival. The inhibition of the DNA damage response pathway, including poly (ADP-ribose) polymerase-1 (PARP-1), has been approved to treat several cancers. In addition, WEE1, a nuclear kinase, is overexpressed in many cancers. Therefore, a WEE1 inhibitor combined with a PARP-1 inhibitor could inhibit the proliferation of MDS and AML. METHODS: We analyzed whether WEE1 was regulated in the progression of MDS and AML. We also evaluated the efficacy of MK-1775 (WEE1 inhibitor) and talazoparib (PARP-1 inhibitor). RESULTS: PARP-1 expression was higher in the AML cells than in the MDS cells. However, WEE1 expression remained unchanged. MK-1775 or talazoparib alone inhibited MDS and AML cells after 72 h, and cellular cytotoxicity and caspase 3/7 activity were increased. The combined use of MK-1775 and talazoparib produced superior efficacy than either drug alone and SKM-1 colony formation was reduced. Significant cell populations in the sub-G1 phase were found in the cell-cycle analyses. Additionally, γ-H2AX expression and caspase 3 activity were increased. The combined treatment also changed the mitochondrial membrane potential. CONCLUSIONS: The combination of a WEE1 inhibitor and PARP-1 inhibitor had enhanced efficacy and is proposed as a new therapeutic option for patients with MDS or AML. Our findings have clinical implications for a potential novel therapeutic strategy for MDS and AML patients.

Analysis of motility and mucociliary function of tracheal epithelial cilia.

The airway epithelium contains numerous multiciliated cells. The apical surface of multiciliated cells is covered with cilia that move at 15-25Hz. Ciliary movement is not a simple reciprocal movement and distinctly has forward and reverse movements called effective and recovery strokes, respectively. These "asymmetric" ciliary strokes push away the mucus covering the mucosa of the airway epithelium. Mucus flow created by ciliary stroke is important for capturing and expelling dust, pollen, PM2.5, pathogens, and other particles that enter the airways from outside the body. This mechanism for protecting the airways produced by ciliary movement is called mucociliary function. Defects in ciliary motility lead to impairment of mucociliary function, resulting in recurrent airway infections such as bronchitis and pneumonia, and consequently, bronchiectasis. While the analysis of ciliary beat frequency is relatively easy, the analyses of the amplitude, velocities of strokes, and the asymmetric level require specific techniques and tips. In this chapter, we present methods for the analysis of ciliary movements of a group of cilia on the luminal surface of the trachea ex vivo and individually isolated and ATP-reactivated cilia in vitro. In addition, a method for the analysis of mucociliary function is also presented.

Successful Treatment of Metastatic Gallbladder Carcinoma with a High Tumor Mutational Burden Using Pembrolizumab.

A woman in her 70s presented with gallbladder carcinoma with liver metastases and peritoneal dissemination. After standard chemotherapy failed, a liver biopsy was performed. A FoundationOne CDx analysis showed that the tumor mutational burden (TMB) was high (34 mutations/megabase). Treatment with pembrolizumab, which is an immune checkpoint inhibitor (ICI), resulted in a partial response, and there were no significant immune-related adverse events. According to recently published reports, the frequency of TMB-high biliary tract cancer (BTC) is 3.4-4%, which makes it extremely rare. In conclusion, ICIs may be effective in patients with TMB-high BTC.

Low billing rates for pediatric sedation fee on magnetic resonance imaging.

BACKGROUND: The 2018 revision of social insurance in Japan allows additional fees to be calculated for pediatric magnetic resonance imaging (MRI) that must be performed under sedation. The number and trend of actual claims since this revision was established is unknown. The aim of this study to investigate the use of the additional fees and any regional differences in the use. METHODS: To analyze the claims of additional fees for pediatric sedated MRI after the fiscal year (FY) 2018, the actual claims in inpatient and outpatient practice was analyzed using publicly-available data from the Ministry of Health, Labour and Welfare (MHLW). We analyzed the calculation rate for all MRI scans. Annual changes in the actual number and calculation rate were analyzed. The ratio of the number of additional fees to the overall number of pediatric radiological procedures was used to examine the geographic disparity. RESULTS: The number of calculations from FY 2018 to FY 2020 was available. In FY 2020, only 1347 additional fees were calculated, corresponding to 0.35% of the total number of MRI scans. The number of fees showed a decreasing trend. Most cases were in the 0-4 year age group; however, there were a few cases in the 10-14 year age group without such a decrease. The relative number of calculations by prefecture showed an up to 14-fold disparity. CONCLUSIONS: The requirements for sedation for pediatric MRI are strict, but they are not fully utilized. Measures such as relaxing the requirements for the fee are needed to make MRI-related sedation safer.

A case of advanced breast cancer with Gitelman syndrome.

Gitelman syndrome (GS) is a rare, mostly autosomal recessive disease this is a salt-losing tubulopathy caused by mutation of genes encoding sodium chloride (NCCT) and magnesium transporters in the thiazide-sensitive segments of the distal nephron. We encountered a 45-year-old female who has suffered from whole-body weakness because of hypokalemia for 8 years and diagnosed with Gitelman syndrome clinically. She visited the hospital with a complaint of an unrelieved hard mass of the left breast. The tumor was diagnosed as human epidermal growth factor receptor 2 (HER2)-positive breast cancer. We herein report this first case of a breast cancer patient with Gitelman syndrome who developed other neoplasms including colon polyp, adrenal adenoma, an ovarian cyst, and multiple uterine fibroids and provide a review of the pertinent literature.

Carotid artery stenting for stenosis after carotid artery replacement: An illustrative case report.

Background: There are few reports on the treatment of carotid artery stenosis after arterial vessel replacement. We report and discuss an illustrative case of carotid artery stenting (CAS) performed for stenosis after carotid artery replacement. Case Description: A woman in her 20s experienced injury to the right carotid artery during an operation for removal of a carotid body tumor 6 years before presentation. The right common carotid artery and internal carotid artery were replaced with an artificial vessel graft at that time. Intraluminal stenosis in the graft was not identified 3 years after surgery; however, 4 years after surgery, stenosis was recognized at the non-anastomotic site inside the artificial vessel graft. Subsequently, antiplatelet therapy was initiated. The stenosis was noted to progress gradually in follow-up appointments. Therefore, we decided to intervene because of the patient's young age and the risk of long-term hemodynamic stress. Angiography revealed pseudo-occlusion in the artificial vessel. Percutaneous transluminal angioplasty was performed for stenosis with distal protection; subsequently, CAS was performed. The patient was discharged without neurological deficits 4 days after the operation, and no apparent restenosis was observed as of the 1-year follow-up. Conclusion: Stenosis after cervical artery replacement can be safely treated with CAS. Inflation pressure and stent should be selected according to the pathology of the stenosis.