Remarkable progress in cognitive neuroscience has revealed the involvement of the prefrontal cortex and the orbitofrontal cortex in human working memory, but the orbitofrontal cortex is still one of the least understood regions in the human brain. To elucidate the contribution of the orbitofrontal cortex to human working memory, we studied EEG P300 activity in n-back task. We elicited early P3 around 300 ms and late P3 around 360 ms of P300 components in n-back ERP. The amplitudes of the respective peaks changed depending on the working memory load (0-back, 1-back, 2-back, 3-back). We used source analysis to evaluate the orbitofrontal cortex in P3 components. A source model was constructed with the sources seeded from fMRI meta-analysis of n-back task and additional sources in the orbitofrontal cortex and the visual cortex estimated with P100 and late P3 components in the n-back ERP. This source model had more than 99% of GOF (goodness of fit) in n-back ERP. It gave us an insight of brain activity at the positions where sources existed. Early P3 was mainly produced by the dorsolateral prefrontal cortex, the ventrolateral prefrontal cortex, the inferior parietal lobule, the medial posterior parietal and the visual cortex. Late P3 was mainly produced by the medial premotor, the lateral premotor, the frontal pole and the orbitofrontal cortex. The contribution of the frontal pole and the orbitofrontal cortex had peaks around 390 ms which were later than late P3 component. In this study, the method to evaluate the orbitofrontal cortex activity in n-back ERP was provided. Our results elicited the involvement of the orbitofrontal cortex in late P3 component of n-back ERP.

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　摂食，嚥下障害をもつ患者が家庭復帰するには吸引器が必要となるが，市販の家庭用吸引器はやや高額で，行政からも給付されないことが多い．家庭用電気掃除機を利用し，約20分で安価にできる家庭用吸引器の作成法を紹介する．

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我々は,人工鼻の材質が気道内圧に影響するかを検討した.すなわち人工肺,人工喀痰注入ポート,人工鼻,蛇管,人工呼吸器を接続し,人工鼻の両端の圧差および人工鼻患者側の圧力(大気圧との圧差)を差圧計で計測し,この結果より人工鼻患者側の圧力を求めた.測定は人工喀痰注入前,人工喀痰1,2,3,4,5,6,7,8,9,10,11,12mL注入直後の最初の呼気終末期圧時に行った.人工鼻は「ファーマミニ」および「ファーマ人工鼻」を用い,人工喀痰は2% Methyl Cellulose 1500を用いた.
  その結果,ファーマミニでは人工喀痰4mL注入時より圧力増加傾向がみられ,5mL注入時には麻酔器側圧,患者側圧ともに有意に増加し,その後,注入量に応じて圧力が増加した.ファーマ人工鼻群では人工喀痰注入で圧力の変化はなかった.
  人工鼻の取り扱い説明書は,分泌物が溜まった場合は,ただちに新しいものと取り換える必要があると警告されている.しかしこの警告は,すべての種類の人工鼻に共通の記載であり,人工鼻の構造により大きな差があることは認識されていない.医療安全上,製造業者から,より細かい情報の提供が望まれる.

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To secure true causatives from the expectorated sputum in respiratory infectious diseases, a washing method of the sputum has been applied in this department of internal medicine. The purpose is to wash out the contaminants.
In this paper, the author evaluated this method with basic experiments using 233 and 400 specimens obtained from treated and not yet treated respiratory patients with chemotherapy, respectively.
The initial sputum was put in the saline solution in the plate, stirred and broken down into the fine fragments by platinum loop. Several fragments of these were transferred to the next plate and processed as same as above. This procedure was repeated several times. The last fragments were cultured. Nonprocessed sputum was also cultured at the same time in comparison.
The results were studied regarding colony-counts, appearance of the sputum, the number of squamous cells, chronological aspects of sputum collecting, reproducibility of the tests. Long term observation was especially done on chronic respiratory patients.
The results were summarized as follows:
1) Mostly one species, infrequently two species, of “potential pathogens” remained by washing the purulent or mucopurulent sputum. No definite pathogen was obtained from mucous or mucoserous sputum by this method.
2) Microscopically, squamous cells in the purulent or mucopurulent sputum were markedly decreased or disappeared by washing, suggesting the elimination of secretion from upper respiratory tract.
3) Reproducible results were obtained from purulent and mucopurulent sputum. But this was not the case in mucous and mucoserous sputum.
4) It was clear that sputum specimen collected in the morning was preferrable for the etiological test.
5) In most cases in which causative pathogen could be estimated sputum was purulent or mucopurulent and squamous cells were markedly decreased by washing.
6) Long term observations were done in patients with chronic respiratory infection by repeating this technique (method). It was speculated that in those patients one or two species of “potential pathogens” resided in the upper respiratory tract even during symptom free period and that exacerbation could take place by their invasion down to lower respiratory tract.

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  小児の 4 週間以上続く咳嗽の原因疾患として，小児科では喘息または咳喘息が多く，一般的な気管支炎や肺炎の他，百日咳，心因性咳嗽なども認められる。一方耳鼻咽喉科では副鼻腔炎が半数を占め，湿性咳嗽を生じていることから後鼻漏の関与が大きいと考えられる。またアレルギー性鼻炎は副鼻腔炎や喘息を合併しやすいという点で咳嗽との関連に注意すべきである。その他に，原発性線毛機能不全，異物，喉頭アレルギー，咽喉頭酸逆流症といったさまざまな疾患が長びく咳を引き起こし，さらには複数の疾患が合併することも少なくない。持続する咳嗽であっても原因疾患に対する治療により多くが改善することから，小児科と耳鼻咽喉科が連携して多方面からアプローチし，的確な診断と治療を行うことが重要である。

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Physical health levels of 95 married couples (group A), who live in the suburbs of big city, and 202 married couples (group B), who live in a local city of Kanto district, were measured using a health questionnaire, the Todai Health Index (THI). The male subject of both groups are workers of private company and the average age is early forties. This research was focused on the effect of smoking and place of residence on subjective complaints. Mean values of scale scores of couples' respiratory symptoms and husbands' digestive symptoms of group A were statistically higher than those of group B by the two-way analysis of variance. But no difference was recognized by the degree of smoking. Interactions existed on the effect of smoking and place of residence on the mean values of scale scores of wives' respiratory and digestive symptoms. These results indicate that respiratory symptoms and husbands' digestive symptoms increase by the modernization, but the effect of smoking habit on respiratory and digestive symptoms were relatively small.

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In recent cognitive neuroscience, a lot of studies of the human working memory were examined, and EEG measurements during n-back task were often used. However, they were almost studied by ERP analysis. In the ERP study, time-locked components can be elicited, but non time-locked components such as the modulated brain oscillatory activity might be lost by an averaging procedure. To elucidate the contribution of the modulations of the brain oscillatory activity to the human working memory, we examined ERD/ERS analysis on the source waveforms during n-back task. Source waveforms were calculated from a source model which was constructed with the sources seeded from fMRI meta-analysis of n-back task and additional sources in the orbitofrontal cortex and the visual cortex estimated with P100 and P360 components in the n-back ERP. Our results suggested the network which included the prefrontal cortex and the parietal lobe had a contribution to human working memory process, and it was mediated by theta oscillatory activity.

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1.市中肺炎の診断
(1) 市中肺炎診断のために胸部レントゲン撮影を行う適切な時期は, 発熱, 咳, , coarsecrackleの4項目を満たす場合である.
(2) 胸部レントゲン写真で見られる異常陰影は, β-グロブリン分画が12%以上の症例では, 細菌性肺炎を否定できる.また, HLA-DR (+) CD3 (+) 細胞率が11.5%以上の場合, 薬剤性肺炎の可能性が高い.
2. Q熱感染症
(1) Q熱肺炎: 市中肺炎におけるQ熱肺炎の頻度は, 1.4% (284例中4例) であり, 臨床症状は, マイコプラズマ肺炎やクラミジア肺炎とほぼ同様であるが, 猫や家畜との接触歴があること, 猫や家畜の繁殖期である2月から6月にかけて好発することが特徴である.
(2) 慢性下気道感染症の感染増悪におけるQ熱の関与: 慢性下気道感染症の急性増悪80例中2例 (2.5%) が, Q熱の急性感染であった.それら症例はQ熱と他の細菌 (Pseudomonas aeruginosaやHaemophilus influenzae) との混合感染であった.
(3) 気管支喘息発作とQ熱感染症: 気管支喘息発作患者89例中6例 (6.7%) にQ熱の急性感染が証明された.Q熱は, 気管支喘息発作の誘因にもなりえることが明らかになった.

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呼吸器感染症に対する化学療法剤の有効性の一指標として, 化学療法剤投与時の肺病巣肉濃度が拳げられるが. 炎症巣の抗生剤を直接測定できないので, 臨床的には喀痰内抗生剤濃度から肺病巣内濃度を推定することが最も容易であると考えられる。しかし, 呼吸器感染症の化学療法にさいして, 喀痰内抗生剤濃度に関する検討は充分におこなわれていないのが現状である。
このたび, 呼吸器感染症の化学療法にさいして, AM-PC, AB-PCの全身および局所投与では, 喀痰内濃度がどの程度維持されるのかを経時的に観察するとともに, 血中濃度との関連についても検討したので, 以下に報告する。

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2003年12月～2004年2月にインフルエンザを疑わせる症状を有してERに自己来院し，迅速診断検査（キャピリア^®️ Flu A, B）を行った119例の患者背景（年齢，性別，インフルエンザ患者との接触歴，予防接種歴），発症から受診までの経過時間，臨床像と判定結果について前方視的に検討した。検査陽性は68例（57.1%）で，患者背景は陽性例と陰性例の間に有意差を認めなかった。発症から24時間以内（1病日）での陽性率は発症24～48時間（2病日）と比較して有意に低率であった。検査陽性に関与する臨床像の多変量解析では最高体温，咳，鼻汁が有意な予測因子であった。ERでも迅速診断検査が頻用されるが，病初期は偽陰性の発生する可能性が高い。したがってインフルエンザの流行期に突然38℃以上の発熱と咳あるいは鼻汁を有して1病日にERを自己来院する患者に対しては，他の感染性疾患を除外したうえで迅速診断検査を行わずに抗インフルエンザ薬を処方すべきと考えられた。

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