神経免疫疾患は，重症筋無力症，多発性硬化症，ギラン・バレー症候群，慢性炎症性脱髄性多発神経炎（CIDP），自己免疫性脳炎，多発性筋炎など自己免疫の異常を起こし，中枢神経系および末梢神経に障害を起こす疾患で，その症状は多彩である．中でも末梢神経障害，筋疾患に関しては診断，治療の評価に対して筋電図検査は有用である．ギラン・バレー症候群，CIDP などの末梢神経障害を起こす疾患では，神経伝導速度検査が有用である．CIDP では，運動神経伝導速度では，遠位潜時の延長，伝導速度の遅延，時間的分散や伝導ブロックなどの異常が認められる．また，針筋電図などでも神経原性変化が認められる．多発性筋炎や皮膚筋炎などの筋疾患では針筋電図において筋原性変化を認める．さらに，重症筋無力症は反復刺激試験においてwaning 現象を認め診断の一助となる．神経免疫疾患において，特に電気生理学的検査は診断・治療の上で重要である．

　呼吸リハビリテーション（呼吸リハビリ）は中等度から重度COPD 患者に必要な治療とされ，理学療法はその重要な構成要素である．理学療法は主にコンディショニングを目的とした呼吸理学療法と運動機能改善・維持を目的とした運動療法で構成される．呼吸理学療法では呼吸訓練や各種ストレッチ，排痰法などを行う．運動療法では，持久力トレーニングと上下肢の筋力トレーニングを行うが，両トレーニングの併用がより効果的である．4 ～ 6 週間以上の理学療法実施により呼吸困難感や運動機能およびQOL が改善するエビデンスは高いが，効果維持には週2 ～ 3 回の継続が必要である．

　COPD 患者は軽症段階から活動量の低下した生活に陥りやすい．この日常身体活動量はCOPD 患者の死亡率に大きく影響する．加えてCOPD 患者は高齢者の心身機能低下の大きな要因とされているサルコペニアやフレイルを合併しやすい．呼吸リハビリによってサルコペニア，フレイルともに改善効果が認められているが身体活動性に関しては未だ一定の結論は出ていない．今後，いかに日常身体活動量増加に結びつけていくかが，理学療法も含めた現在の呼吸リハビリにおける大きな課題である．

　血清NT-proBNP が医療・介護関連肺炎の予後の予測因子であるかどうかは明らかではない．医療・介護関連肺炎における入院後早期の死亡と血清NT-proBNP 値との関係を調べた．方法として，医療・介護関連肺炎で入院し，入院後30 日以内に死亡した死亡群14 名と生存群101名を対象にPerformance Status， 肺炎の重症度分類（A-DROP），血清アルブミン値， 血清NTproBNP値等を群間比較した．死亡群では生存群に比較して血清アルブミンは低値，血清NTproBNPが高値であった．心不全のバイオマーカーである血清NT-proBNP が死亡群で高値であったことから医療・介護関連肺炎での入院後早期の死亡には心不全の関与が考えられた．

　血清NT-proBNP 値は医療・介護関連肺炎の入院後早期の予後を考える上で参考になる指標と考えられた．

　Background: Visceral fat area is most closely associated with the metabolic syndrome. Computed tomography (CT) and visceral fat meters are available as a means of measuring visceral fat area. CT scans are the gold standard for measuring visceral fat area, but since making the measurements is complicated and limited to measuring facilities, and there is X-ray exposure, they cannot be applied to large numbers of subjects as in medical checkups. The InBody 430 body composition analyzer uses direct segmental multifrequency bioelectrical impedance analysis (DSM-BIA); its design provides increased reproducibility and enables accurate, highly precise measurements. In addition, it may be possible to predict visceral fat area as a function of abdominal girth or of BMI and percent body fat. Moreover, visceral fat area is expected to be related to age and sex.

　Objectives: The purpose of this study was to estimate visceral fat area on the basis of percent body fat measured with the InBody analyzer, age, and anthropometric parameters.

　Methods: A total of 457 (119 male and 338 female) participants were recruited from two towns with quite different environments in Mie Prefecture. Their height, weight, abdominal girth, body composition, and visceral fat area were measured. Body composition was measured with an eightpolar bioelectric impedance analyzer, and visceral fat area was measured with a visceral fat meter. A prediction equation for estimating visceral fat area was obtained by multiple linear regression analysis. Visceral fat area was used as the dependent variable, and age and percent body fat × (abdominal girth)² were used as the independent variables.

　Results: The visceral fat area, abdominal girth, and BMI values of the female participants were skewed in the smaller direction, and their age distribution showed a peak in the 20s-30s age range and in the 60s-70s age range. The percent body fat values of the female participants yielded an almost perfect bell-shaped curve. The distribution of the visceral fat area values of the male participants did not describe a clear bell-shaped curve, but the distributions of their percent body fat values and abdominal girth values yielded almost perfect bell-shaped curves. The ages of the male participants showed a peak in the 20s-30s range and in the 60s-70s range, and the distribution of their BMI values was skewed in the smaller direction. Of the parameters tested, percent body fat × (abdominal girth)² showed the highest correlation coefficient with visceral fat area. Multiple regression gave the prediction equations to estimate visceral fat area using age and percent body fat × (abdominal girth)²; their coefficients of determination (R²) were 0.763 and 0.875 in male and female participants, respectively.

　Conclusion: Visceral fat area can be estimating using the formula obtained based on data that have been acquired with an existing body composition analyzer.

　背景：国民健康栄養調査によると，Body Mass Index (BMI) 18.5 kg/m² 未満の低体重者の割合が，20 歳代の女性では増加している．母親の低体重は出生時低体重児や早産のリスクが増加し，低出生体重児は将来生活習慣病リスクが高くなる．またコホート研究により，BMI が20.0 ～ 25.0 kg/m² で死亡リスクが最低で，BMI 20.0 kg/m² 未満の低体重では死亡リスクが増大することが示された．

　目的：BMI 20.0 kg/m² をカットオフ値として食後血糖値と血漿インスリン推移を調べた．

　方法：健康な若年女性を対象に米飯食のおにぎりを摂取させ，食後血糖値と血漿インスリン推移を調べ，BMI 20.0 kg/m² 未満の低体重群とBMI 20.0 kg/m² 以上群で比較した．

　結果：BMI 20.0 kg/m² 未満の低体重群の食後30 分血糖値と60 分血糖値がBMI 20.0 kg/m²以上群の血糖値より有意に高かったが，血漿インスリンに有意差は認められなかった．

　結論：健康な若年女性を対象に米飯食のおにぎりを摂取させた結果，BMI 20.0 kg/m² 未満の低体重群の食後1 時間血糖値が有意に高く，低体重の若年女性では生活習慣病のリスクが懸念された．

　Objectives: This study aimed to investigate the substrate metabolism response to moderateand high-intensity equicaloric exercises in endurance-trained men.

　Methods: Ten male endurance-trained runners (mean ± standard error: age, 22 ± 1 years; body mass index, 19.3 ± 0.7 kg/m²; ⩒O_2max, 64.1 ± 2.1 mL/kg/min) performed a graded exercise test on a treadmill to determine the exercise intensity at which elicits maximal fat oxidation (Fat_max) and subsequently completed two equicaloric exercises (53 min at Fat_max and 30 min at 65％⩒O_2max). Substrate oxidation rates during exercise and 2-h post-exercise recovery period were determined using indirect calorimetry. Blood samples were collected before exercise; immediately post-exercise; and at 30 min, 1 h, and 2 h post-exercise to determine plasma noradrenaline, serum growth hormone (GH), and free fatty acid (FFA) concentrations.

　Results: Mean Fat_max was observed at 37.3 ± 4.6 ％⩒O_2max. Fat oxidation volume during exercise was significantly higher in the Fat_max trial than in the 65％⩒O_2max trial (15.2 ± 1.5 g vs 8.5 ± 0.7 g, P ＜ 0.01). No significant difference in fat oxidation occurred in the post-exercise recovery period. Serum GH and plasma noradrenaline concentrations were higher at 65％⩒O_2max than at Fat_max immediately post-exercise (P ＜ 0.05). However, there was no difference in serum FFA levels between exercise intensities.

　Conclusions: Exercise at Fat_max oxidized more fat than exercise at 65％⩒O_2max when matched for energy expenditure during exercise in endurance-trained men.