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.

　咳嗽は急性，遷延性，慢性咳嗽に分類される．本邦では，咳喘息，胃食道逆流症，副鼻腔気管支症候群が慢性咳嗽の3 大原因であるが，原因が不明であるものや治療効果のない症例も多々経験する．

　治療困難とされる難治性慢性咳嗽には，原因疾患が不明である場合と，もしくは原因疾患が存在するものの，その治療に抵抗性である場合の2 つにわけることができる．原因が不明である場合をunexplained chronic cough（UCC），原因疾患が同定されても，適切な治療下でも改善しない治療抵抗性の慢性咳嗽をrefractory chronic cough（RCC）と定義されている．また新しい咳嗽の概念として，従来からの原因疾患によらない“ 治療抵抗性の咳嗽の共通病態を説明する概念” cough hypersensitivity syndrome（CHS）が提唱された．

　HFpEF （heart failure with preserved ejection fraction）は，左室駆出率が正常もしくは保持されているものの，左室拡張機能低下を有する心不全である．HFpEF は，心不全患者の約半数を占めており，加齢，女性，高血圧，左室肥大などの複数の発症要因からなる．HFpEF の生命予後は，左室駆出率が低下したHFrEF （heart failure with reduced ejection fraction）と同様に不良である．

　HFpEF の確立した治療法としてSGLT2 阻害薬の効果が海外の大規模臨床研究で，明らかにされてきているが，今でもHFpEF の予防法や治療法の確立は重要な課題である．心不全に対する運動療法は，左室拡張能を改善させ，生命予後改善効果が実証されている．特に，運動療法は，左室拡張機能を改善させると考えられている．Pressure-Volume Loop 理論を基に，左室拡張末期圧容量関係を侵襲的に求めることで，心筋stiffness を直接算出することができる．本総説では，日本臨床生理学会総会で発表した内容を発展させて，心力学理論を用いて心臓リハビリテーションの左室拡張能に及ぼす効果について概説する．

　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.