イシ リンショウ ケンキュウ ヒッシュウカ ジダイ ノ ソツゴ イガク キョウイク : ゲンジョウ ト カンガエラレル ミライ ダカイサク

Although several advantages and disadvantages in the era obligated to do post-graduate clinical training have been reported, it takes much time to get the peer review of the compulsory postgraduate clinical training from 2006. The purpose of this review is to analyze the influence of compulsory post-graduate clinical training in The Tokushima University Hospital, to anticipate the future crucial problems, and to propose the solution

Stripe antiferromagnetic correlations in LaFeAsO1-xFx probed by 75As NMR

The anisotropy of the nuclear spin-lattice relaxation rate $1/T_{1}$ of $^{75}$As was investigated in the iron-based superconductor LaFeAs(O$_{1-x}$F$_{x}$) ($x = 0.07, 0.11$ and 0.14) as well as LaFeAsO. While the temperature dependence of the normal-state $1/T_1T$ in the superconducting (SC) $x = 0.07$ is different from that in the SC $x = 0.11$, their anisotropy of $1/T_1$, $R \equiv (1/T_{1})_{H \parallel ab}/(1/T_{1})_{H \parallel c}$ in the normal state is almost the same ($\simeq$ 1.5). The observed anisotropy is ascribable to the presence of the local stripe correlations with $Q = (\pi, 0)$ or $(0, \pi)$. In contrast, $1/T_1$ is isotropic and $R$ is approximately 1 in the overdoped $x = 0.14$ sample, where superconductivity is almost suppressed. These results suggest that the presence of the local stripe correlations originating from the nesting between hole and electron Fermi surfaces is linked to high-$T_c$ superconductivity in iron pnictides.Comment: 4 pages, 3 figures, Accepted for publication in Phys. Rev.

^{31}P and ^{75}As NMR evidence for a residual density of states at zero energy in superconducting BaFe_2(As_{0.67}P_{0.33})_2

^{31}P and ^{75}As NMR measurements were performed in superconducting BaFe_2(As_{0.67}P_{0.33})_2 with T_c = 30 K. The nuclear-spin-lattice relaxation rate T_1^{-1} and the Knight shift in the normal state indicate the development of antiferromagnetic fluctuations, and T_1^{-1} in the superconducting (SC) state decreases without a coherence peak just below T_c, as observed in (Ba_{1-x}K_{x})Fe_2As_2. In contrast to other iron arsenide superconductors, the T_1^{-1} \propto T behavior is observed below 4K, indicating the presence of a residual density of states at zero energy. Our results suggest that strikingly different SC gaps appear in BaFe_2(As_{1-x}P_{x})_2 despite a comparable T_c value, an analogous phase diagram, and similar Fermi surfaces to (Ba_{1-x}K_{x})Fe_2As_2.Comment: 4 pages, 5 figure

ヨボウ デキル カシ ノ ムクミ ト ハイソクセンショウ

Virchow triad（（１）blood stasis（, ２）changes in the vessel wall, and（３）hypercoagulability）are the major factors responsible for the development of venous thrombosis. This venous thrombosis leads to the pathogenesis of acute pulmonary thrombo-embolism which is known as“Economy Class Syndrome”. A series of pathogenesis is widely recognized as“Venous thrombo-embolism syndrome”. This syndrome occurs suddenly, and occasionally leads to fatal event. So the basic principle of treatment for this syndrome is to prevent deep vein thrombosis（DVT）. The prevention consists of three crucial treatments. Firstly, to recognize high-risk patients of DVT is initial step. Secondary, anticoagulation, elastic stocking and foot pump are well established treatments. Thirdly, venous filter is applicable for the most highest-risk patients. In this review, we would like to introduce the latest knowledge for“Venous thrombo-embolism syndrome”

A thymoma dramatically responded to PSL

A 76-year-old woman with a history of angina pectoris, hypertension and dyslipidemia was pointed out an abnormal opacity in the right hilar region on routine chest X-ray. Chest computed tomography showed masses in the anterior mediastinum with the invasion of the adjacent ascending aorta, right brachiocephalic vein and right pleura. Histologic examination led to a diagnosis of Masaoka stage IVa thymoma. Three courses of chemotherapy were given, but further tumor progression was seen. Thereafter, the patient was followed without aggressive treatments. One year after the initial diagnosis, she presented with dyspnea and right chest pain. Chest CT revealed right massive pleural effusion with pleural dissemination and much further progression of existing tumors. For the purpose of symptom palliation, a low dose (5 mg / day) of prednisolone was commenced, which unexpectedly led to marked alleviation of patient’s symptoms and dramatic decrease of pleural effusion. To the best of our knowledge, this is the first report of an invasive thymoma responded to low-dose corticosteroid. The present case suggests that corticosteroids, even at low doses, might be potentially effective for invasive thymoma after failure of surgery, chemotherapy and radiotherapy

Diagnostic utility of FeNO for CTVA

A 50-year-old woman was referred to our hospital for further examination of severe constricting pain at the right-side dominant anterior chest. She had medical history of outgrown childhood asthma and allergies to several animals. Chest auscultation revealed no wheezes, rhonchi and other crackles. Laboratory findings showed an eosinophilia and an elevation of total immunoglobulin E. The results of an electrocardiogram, a chest X-ray and a chest CT were unremarkable. A fractional exhaled nitric oxide value remarkably elevated, but the abnormalities in pulmonary function test were modest. Her chest pain was ameliorated after inhaling procaterol. Based on these findings, a diagnosis of chest tightness variant asthma was formulated, and we started treatment with inhaled corticosteroid / long acting β2 agonist. At two-weeks after treatment, her symptom markedly improved and a fractional exhaled nitric oxide value decreased, which led to a definitive diagnosis of chest tightness variant asthma. A fractional exhaled nitric oxide value further decreased to the normal range in consistent with symptom disappearance at 10-months after treatment, indicating the usefulness of fractional exhaled nitric oxide as a promising marker for the diagnosis and clinical improvement of chest tightness variant asthma

Utility of FeNO for diagnosing cough

Cough is one of the most common symptoms seen in clinical practice, however the differential diagnosis is often difficult. The utility of fractional exhaled nitric oxide (FeNO) measurement in the differential diagnosis of the etiology of cough has been reported. NIOX VERO® (NOV) is a new hand-held device that will replace NIOX MINO®, but its diagnostic utility has not been fully elucidated in clinical practice. In this study, the performance of NOV for FeNO measurements was determined. We retrospectively analyzed 243 consecutive patients complaining cough. Among 243 patients, final diagnosis was cough variant asthma (CVA) in 74 (30.5%), bronchial asthma (BA) in 48 (19.8%), post-infectious cough (PIC) in 52 (21.4%), atopic chough (AC) in 24 (9.9%), gastroesophageal reflux disease (GERD) in 10 (4.1%), and Others in 35 (14.4%). FeNO values were significantly higher in CVA and BA as compared to PIC, AC, GERD, and Others. In the multivariate analysis, only FeNO value was identified as independent factors to discriminate CVA and non-CVA other than BA. These findings indicated that FeNO measured by using NOV could be used as a diagnostic marker of intractable cough, especially for the differential diagnosis of CVA from non-CVA