Video-assisted thoracic surgery （VATS） is the mainstream surgical approach for primary lung cancer, but in recent years, single-port VATS and robot-assisted surgery are new options.　Regarding the extent of resection, a phase 3 trial showed that segmentectomy for lung cancers less than 2 cm in size is superior to lobectomy, which has been the conventional standard procedure, and segmentectomy has become one of the standard procedures.　In the future, the prevention of local recurrence during sublober resection will be a topic of discussion.　Transbronchial metallic coil marking developed at Tokushima University can achieve precise lung resection and prevent local recurrence.　We are also developing new visualization techniques to diagnose pleural invasion and lymph node metastasis during surgery.　For advanced lung cancer, we have adopted preoperative treatment with a combination of chemotherapy and immune checkpoint inhibitors, and have obtained good treatment outcomes.　In addition, we conduct preoperative simulations and surgical training to safely perform highly difficult surgeries.

【Introduction】

Salt restriction is important for the treatment of hypertension and there is evidence that reducing salt intake to less than 6 g/day has an effective antihypertensive effect and is expected to reduce cardiovascular events and cardiovascular death.　However, many diabetic patients with hypertension fail to decrease their salt intake sufficiently in clinical practice.

【Objective】

To effectively restrict salt intake in individuals with type 2 diabetes （T2D）, the aim of this study was to clarify the clinical factors that influence estimated salt intake （eSI）.

【Methods】

We continuously enrolled 268 individuals with T2D and assessed their eSI using Tanakaʼs formula through spot urine analysis at Anan Medical Center, Tokushima Japan.　The relationships between eSI and the clinical factors were statistically evaluated.

【Results】

Multivariate analysis including clinical factors and medications used for the determinants of eSI showed positive associations of BMI and duration of diabetes with eSI and showed a negative association of serum uric acid and taking α-glucosidase inhibitor （α-GI） with eSI.

【Discussion】

It is possible that α-GI reduces sodium absorption from the intestine, which leads to decreased urinary sodium excretion, given the fact that α-GI inhibits sodium and glucose absorption from the intestine.　In addition, since the urate transporter-1 promotes reabsorption of uric acid and sodium in the renal tubules, reduced urinary excretion of uric acid may be associated with reduced urinary sodium excretion.

【Conclusion】

In addition to diet and exercise therapy, there is a possibility that oral administration of α-GI contributes to salt reduction in individuals with T2D.

Objective : The purpose of this study is to evaluate effects of nurses’ intervention using a directional speaker, on clinical symptoms of dementia patients with hearing loss.　Methods : Subjects were four hospitalized dementia patients with hearing loss who gave their consent.　Patients’ cognitive function was assessed with Mini Mental State Examination-Japanese （MMSE） during the period of nurses’ intervention with commune.　Nurses who cared for the patients assessed their behavioral and psychological symptoms due to dementia and caregiver’s distress with Neuropsychiatric Inventory-Nursing Home Version （NPI-NH）, and their objective quality of life with Quality of Life of Dementia Japanese （QLDJ）．The assessments were done before, one month after, two months after, and three months after the intervention.　Results : MMSE score was improved in two patients and NPI-NH score in two patients.　QLDJ subscale ‘interacting with surroundings’ was improved in one patient, QLDJ subscale ‘expressing self’ in three patients, and QLDJ subscale ‘experiencing minimum negative behaviors’ in one patient.　Conclusion : It was considered that hearing aid using the commune in dementia patients might affect their cognitive function, objective quality of life, behavioral and psychological symptoms due to dementia, and caregiver’s distress.

Abemaciclib, Selective cyclin-dependent kinase 4 and 6 inhibitor has become available for use in hormone receptor-positive and HER2-negative unresectable or recurrent breast cancer, significantly extending progression-free survival and improving prognosis.　However, caution is necessary as in some cases it may cause drug-induced interstitial lung disease, occasionally leading to severe exacerbations.　The case involves a 75-year-old female who was emergency transported to our hospital due to dyspnea occurring 11 months after initiating abemaciclib + letrozole therapy for hormone receptor-positive, HER2-negative recurrent breast cancer.　Upon arrival, she presented with type Ⅰ respiratory failure with PCO2 : 24．5 mmHg, PO2 : 61．2 mmHg, and CT revealing ground-glass opacities in both lung fields.　Diagnosed with drug-induced interstitial lung disease, she underwent endotracheal intubation followed by steroid pulse therapy.　After three rounds of steroid pulses, symptoms gradually improved, allowing for discharge home with oxygen supplementation.　Despite the development of severe interstitial lung disease in this case, prompt initiation of treatment facilitated successful life-saving intervention.

【Introduction】 Breast neuroendocrine tumors can manifest in various organs of the body, but those with primary origin in mammary glands are rare.　Here, we report a case of multiple breast neuroendocrine tumors in bilateral mammary glands.　【Case】 The patient was a 45-year-old woman with no significant medical, medication, or family history.　One year ago, she noticed a lump in her left breast and visited a local doctor.　Following thorough examination, she was initially diagnosed with bilateral breast cancer and subsequently referred to our hospital.　Breast ultrasonography at our hospital also indicated bilateral breast cancer, and needle biopsy results suggested bilateral breast neuroendocrine tumors.　Surgical intervention involved partial mastectomy with sentinel lymph node biopsy for the right breast tumor and mastectomy with axillary dissection for the left breast tumor.　Final pathological examination results confirmed bilateral breast neuroendocrine tumors based on hematoxylin and eosin staining and immunostaining.　【Conclusion】 This study reports a relatively rare case of multiple neuroendocrine tumors with primary origin in bilateral mammary glands.

　The patient, a woman in her 60s, was undergoing treatment with an anti-PD-1 antibody, an immune checkpoint inhibitor （ICI）, to address lung metastases following hard palate cancer resection.　Four years after initiating treatment, during a visit to an otorhinolaryngologist, her HbA1c levels were found to be slightly elevated without any precipitating factors.　Five days after referral to the endocrinology department, the patient exhibited hyperglycemic symptoms and ketosis.　We ultimately diagnosed fulminant type 1 diabetes.　Immune-related adverse events （irAEs） due to ICI usage manifest throughout the body, including the skin, lungs, and endocrine organs.　Fulminant type 1 diabetes triggered by irAEs progresses with alarming rapidity and poses a significant mortality risk unless diagnosed and treated with insulin expeditiously.　Although irAEs are closely monitored following ICI administration, patients are frequently misdiagnosed with incidental hyperglycemia and managed as type 2 diabetes.　In this case, an irAE was detected due to a slight increase in HbA1c during a routine examination prompted the consideration of an irAE, leading to a swift referral to a specialist department.　Consequently, treatment was initiated before symptoms became severe, allowing the early resumption of the appropriate therapy for the primary disease.