p53 antibody testing is covered by insurance for three cancers: esophageal cancer, colon cancer, and breast cancer. It is an IgG autoantibody induced in serum against p53 protein mutations caused by p53 gene abnormalities in cancer cells and can be detected even in relatively early stages of cancer. The clinical feature is that it is not affected by age, gender, inflammation, or smoking history. It is useful for early diagnostic aids and post-treatment monitoring.

　Cough is categorized as acute, subacute, and chronic. The three major causes of chronic cough in Japan are cough variant asthma, gastroesophageal reflux disease, and sinonasal-bronchial syndrome. However, patients with unknown causes or ineffective treatment are frequently encountered.

　Difficult-to-treat chronic cough, which is considered refractory, is categorized as follows: 1) unexplained chronic cough in patients with unknown underlying disease and 2) refractory chronic cough in patients with identified underlying disease that remains resistant to appropriate treatment. Furthermore, a new concept of cough, known as cough hypersensitivity syndrome has been proposed to explain the common pathophysiology of treatment-resistant cough, which is independent of conventional underlying diseases.

　Background: Sacubitril/valsartan, a dual-acting angiotensin receptor-neprilysin inhibitor, is used to treat heart failure and hypertension. No studies have investigated its effects on liver function in hypertensive patients with type 2 diabetes, however. This study investigated the effects of sacubitril/valsartan on liver function in hypertensive patients with type 2 diabetes.

　Method: Fifty-seven patients with hypertension and type 2 diabetes (31 men, 26 women; average age, 69.4 years) were enrolled. The effects of sacubitril/valsartan 200 mg/day on various clinical parameters were compared between before and at 6 months after its administration.

　Results: Systolic blood pressure, diastolic blood pressure, and the HbA1c value showed a significant decrease at after administration of sacubitril/valsartan. The AST value showed a significant decrease at after administration (22.1 ± 8.5 IU/L before administration，19.9 ± 6.1 IU/L 6 months at after，p＝0.004). The ALT score showed a significant decrease after administration (21.1 ± 12.9 IU/L before administration，17.0 ± 8.3 IU/L 6 months at after，p ＝ 0.001). The ALP and γ-GTP values showed a significant decrease at after administration. A decrease was also observed in AST, ALT, ALP, and γ-GTP in patients non-alcoholic fatty liver disease, and the decrease in ALT was greater in patients with a high ALT value before administration.

　Conclusion: The results of this study suggest that sacubitril/valsartan improve liver function in hypertensive patients with type 2 diabetes and non-alcoholic fatty liver disease.

　Purpose: Patients with obstructive sleep apnea (OSA) often have gastroesophageal reflux disease (GERD). However, it is controversial whether OSA causes GERD. Therefore, we prospectively investigated whether OSA is an independent factor for the symptoms of GERD.

　Methods: This study investigated the impact of severe OSA on the comorbidity of symptoms of GERD in 170 subjects under 65 years old and 51 subjects 65 years old or older. OSA was diagnosed with polysomnography, and subjects with symptoms of GERD were defined as those with a frequency scale for the symptoms of GERD (FSSG) score ≥8 points.

　Results: The average age and body mass index (BMI) of the subjects (n ＝ 221) were 54.0 ± 13.6 years old and 26.1 ± 5.0 kg/m². Men accounted for 76％ of the subjects. The average apnea hypopnea index of the subjects was 32.8 ± 20.3 events/h, and 46％ of the subjects had severe OSA. The average FSSG score of the subjects was 8.2 ± 7.1 points, and 44％ of the subjects had symptoms of GERD as defined in this study. In subjects younger than 65 years old, the cumulative percentage of time at saturation below 90％ was an independent factor for having GERD symptoms in the multivariate analysis (odds ratio, 1.04; 95％ confidence interval, 1.00-1.08; P ＝ 0.023). Subjects under 65 years old with severe OSA had an odds ratio of 3.00 for the comorbidity of symptoms of GERD (95％ confidence interval, 1.42–6.57; P ＝ 0.004) compared with those without severe OSA, after adjusting for BMI.

　Conclusions: Comorbidity of symptoms of GERD was not uncommon in OSA patients. The effect of severe OSA on the symptoms of GERD was greater in younger subjects than in older subjects.