n.

襲撃、攻撃。(病気などの)始まり、開始、襲来。着手、手始め

関: affect、commence、commencement、develop、development、developmental、emergence、engender、episode、event、generate、generation、initiate、initiation、institute、mount、occur、occurrence、pathogenesis、start、symptom onset、transpire

WordNet

the beginning or early stages; "the onset of pneumonia" (同)oncoming
play in the starting lineup
the advantage gained by beginning early (as in a race); "with an hours start he will be hard to catch" (同)head_start
a turn to be a starter (in a game at the beginning); "he got his start because one of the regular pitchers was in the hospital"; "his starting meant that the coach thought he was one of their best linemen" (同)starting
a line indicating the location of the start of a race or a game (同)starting line, scratch, scratch line
the beginning of anything; "it was off to a good start"
begin or set in motion; "I start at eight in the morning"; "Ready, set, go!" (同)go, get going
bulge outward; "His eyes popped" (同)protrude, pop, pop_out, bulge, bulge out, bug out, come_out
get going or set in motion; "We simply could not start the engine"; "start up the computer" (同)start up
get off the ground; "Who started this company?"; "We embarked on an exciting enterprise"; "I start my day with a good breakfast"; "We began the new semester"; "The afternoon session begins at 4 PM"; "The blood shed started when the partisans launched a surprise attack" (同)start up, embark on, commence
begin work or acting in a certain capacity, office or job; "Take up a position"; "start a new job" (同)take_up
superimpose a three-dimensional surface on a plane without stretching, in geometry
cause to grow and differentiate in ways conforming to its natural development; "The perfect climate here develops the grain"; "He developed a new kind of apple" (同)make grow
be gradually disclosed or unfolded; become manifest; "The plot developed slowly";
elaborate by the unfolding of a musical idea and by the working out of the rhythmic and harmonic changes in the theme; "develop the melody and change the key"
expand in the form of a series; "Develop the function in the following form"
grow, progress, unfold, or evolve through a process of evolution, natural growth, differentiation, or a conducive environment; "A flower developed on the branch"; "The country developed into a mighty superpower"; "The embryo develops into a fetus"; "This situation has developed over a long time"
gain through experience; "I acquired a strong aversion to television"; "Children must develop a sense of right and wrong"; "Dave developed leadership qualities in his new position"; "develop a passion for painting" (同)acquire, evolve
grow emotionally or mature; "The child developed beautifully in her new kindergarten"; "When he spent a summer at camp, the boy grew noticeably and no longer showed some of his old adolescent behavior" (同)grow
generate gradually; "We must develop more potential customers"; "develop a market for the new mobile phone"
make something new, such as a product or a mental or artistic creation; "Her company developed a new kind of building material that withstands all kinds of weather"; "They developed a new technique"
make visible by means of chemical solutions; "Please develop this roll of film for me"
move into a strategically more advantageous position; "develop the rook"
move ones pieces into strategically more advantageous positions; "Spassky developed quickly"
processing a photosensitive material in order to make an image visible; "the development and printing of his pictures took only two hours" (同)developing
a process in which something passes by degrees to a different stage (especially a more advanced or mature stage); "the development of his ideas took many years"; "the evolution of Greek civilization"; "the slow development of her skill as a writer" (同)evolution
a state in which things are improving; the result of developing (as in the early part of a game of chess); "after he saw the latest development he changed his mind and became a supporter"; "in chess your should take care of your development before moving your queen"
act of improving by expanding or enlarging or refining; "he congratulated them on their development of a plan to meet the emergency"; "they funded research and development"
(music) the section of a composition or movement (especially in sonata form) where the major musical themes are developed and elaborated
a district that has been developed to serve some purpose; "such land is practical for small park developments"
a recent event that has some relevance for the present situation; "recent developments in Iraq"; "what a revolting development!"
put up or launch; "mount a campaign against pornography"
a mounting consisting of a piece of metal (as in a ring or other jewelry) that holds a gem in place; "the diamond was in a plain gold mount" (同)setting
prepare and supply with the necessary equipment for execution or performance; "mount a theater production"; "mount an attack"; "mount a play" (同)put_on
attach to a support; "They mounted the aerator on a floating"
fix onto a backing, setting, or support; "mount slides for macroscopic analysis"

PrepTutorEJDIC

攻撃,襲撃 / (病気・季節などの)始まり,開始《+『of』+『名』》
(…から…に向かって)『出発する』《+『from』+『名』+『for』(『to』)+『名』》 / 〈事が〉『始まる』,発生する;)…で)始まる《+『with』+『塁』》,(…から)生じる《+『from』+『名』》 / 〈人が〉『活動し始める』,〈機械などが〉動き始める;(…を)始める,(…に)着手する《+『in』(『on』)+『名』》 / 《しばしば副詞[句]を伴って》〈人が〉(…に驚いて)急に動く;《比喩(ひゆ)的に》ぎまりとする,ぎょっとする《+『at』+『名』》 / 《しばしば副詞[句]を伴って》〈物が〉急に動く,飛び出る,噴出する / (試合の)先発メンバーになる / …‘を'『始める』,開始する / 〈人〉‘に'始めさせる / …‘を'生じさせる,引き起こす / 〈機械など〉‘を'『始動させる』 / …‘を'使い始める / 〈獲物〉‘を'狩り出す,飛び立たせる,先発メンバーしとて出す / 〈C〉『出発』,スタート;出発点 / 〈C〉(事業などの)『開始』,着手 / 〈C〉最初,初め,出だし / 〈C〉《a ~》はっと(びっくり)すること,びっくりして飛び上がること / 〈U〉《時にa ~》(…に対する)先発[権],優先[権];機先《+『on』(『over』)+『名』》
(今まではなかったが)…‘を'『生じさせる』,‘を'現す / …‘を'『発展させる』,伸ばす,成長させる / 〈病気・悪習など〉‘に'だんだん感染する,かかりはじめる,‘を'発病させる / 〈資源など〉‘を'『開発する』 / …‘を'十分に考える,〈議論・主題など〉‘を'展開する / 〈フイルム〉‘を'現像する / 〈ないもの・隠れているものが〉『現れる』,明らかになる / (…から…に)『発展する』,発育する《+『from』+『名』+『into』+『名』》 / 〈フイルムが〉現像される
〈U〉〈C〉『発達』,発展,発育,成長;『開発』;進化 / 〈U〉(写真の)現像 / 〈C〉発達(発展)の結果できたもの / 〈C〉開発した土地(地区);(特に)住宅団地(housing development) / 〈C〉(最近の)でき事,新事実
…‘を'『登る』(ascend, climb) / 〈馬・車〉‘に'『乗る』,〈台の上など〉‘に'上がる,乗る / (馬などに)〈人〉‘を'『乗せる』《+『名』〈人〉+『on』+『名』》 / (…の上に)…‘を'『載せる』《+『名』+『on』+『名』》 / (…に)…‘を'据え付ける,はめる,取り付ける,はる《+『名』+『in』(『on』)+『名』》 / 〈劇〉‘に'舞台装置や衣装を用意する / 〈攻撃など〉‘を'仕掛ける;〈作戦など〉‘を'展開する / 『登る』,上がる《+『up』》 / 『馬』(乗用の動物)『に乗る』 / (数・量において)ふえる,(程度において)高まる,強まる《+『up』》 / 乗用の動物,(特に)馬 / 台紙;(宝石などの)台;(顕微鏡用の)スライド板
〈C〉《文》『山』 / 《『M-』》《固有名詞の前に付けて》…『山』

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2013/02/08 09:30:14」(JST)

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UpToDate Contents

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1. 成人スティル病の臨床症状および診断 clinical manifestations and diagnosis of adult stills disease
2. 成人スティル病の治療 treatment of adult stills disease
3. アルツハイマー病の遺伝学 genetics of alzheimer disease
4. Immune-mediated neuropathies
5. 乾癬性若年性特発性関節炎：病因、臨床症状、および診断 psoriatic juvenile idiopathic arthritis pathogenesis clinical manifestations and diagnosis

English Journal

Circadian rhythmicity in emerging mood disorders: state or trait marker?

Grierson AB1, Hickie IB2, Naismith SL3, Hermens DF4, Scott EM5,6, Scott J7.
International journal of bipolar disorders.Int J Bipolar Disord.2016 Dec;4(1):3. doi: 10.1186/s40345-015-0043-z. Epub 2016 Jan 13.
BACKGROUND: Circadian rhythm disturbances overlap with the symptoms of mood episodes and may trigger or prolong mood symptoms. There is limited research on the role of circadian disturbances in mood disorders in young people and/or first episode cases of unipolar and bipolar disorders.METHODS: Actig
PMID 26763505

The role of childhood trauma in bipolar disorders.

Aas M1,2,3, Henry C4,5,6,7,8, Andreassen OA9,10,11, Bellivier F12,13,14, Melle I15,16,17, Etain B18,19,20,21.
International journal of bipolar disorders.Int J Bipolar Disord.2016 Dec;4(1):2. doi: 10.1186/s40345-015-0042-0. Epub 2016 Jan 13.
This review will discuss the role of childhood trauma in bipolar disorders. Relevant studies were identified via Medline (PubMed) and PsycINFO databases published up to and including July 2015. This review contributes to a new understanding of the negative consequences of early life stress, as well
PMID 26763504

Endophthalmitis following intravitreal injection of anti-VEGF agents: long-term outcomes and the identification of unusual micro-organisms.

Sachdeva MM1, Moshiri A2, Leder HA3, Scott AW4.
Journal of ophthalmic inflammation and infection.J Ophthalmic Inflamm Infect.2016 Dec;6(1):2. doi: 10.1186/s12348-015-0069-5. Epub 2016 Jan 12.
BACKGROUND: While the development of targeted molecular therapy to inhibit vascular endothelial growth factor (VEGF) has revolutionized the treatment and visual prognosis of highly prevalent retinal diseases such as diabetic retinopathy and age-related macular degeneration, each intravitreal injecti
PMID 26758203

Elimination Rate of Serum Lactate is Correlated with Amyotrophic Lateral Sclerosis Progression.

Zhang YJ, Fan DS1.
Chinese medical journal.Chin Med J (Engl).2016 5th Jan;129(1):28-32. doi: 10.4103/0366-6999.172561.
BACKGROUND: Mitochondrial dysfunction plays an important role in the pathogenesis of amyotrophic lateral sclerosis (ALS). We aimed to demonstrate mitochondrial dysfunction in ALS using a lactate stress test and to examine the relationship between mitochondrial dysfunction with motor deterioration.ME
PMID 26712429

Japanese Journal

慢性疾患をもって成人に至る子どもや青年に提供される医療環境 : 現状と課題 (特集慢性疾患をもつ子どもの成人へのtransition)

窪田満
日本医師会雑誌 143(10), 2101-2105, 2015-01
NAID 40020313033

Clinical Scenario 1 Is Associated With Winter Onset of Acute Heart Failure

Hirai Masayuki,Kato Masahiko,Kinugasa Yoshiharu [他]
Circulation journal : official journal of the Japanese Circulation Society 79(1), 129-135, 2015-01
NAID 40020311844

LOH症候群における漢方療法の有用性 (特集 LOH症候群診療 : 最近の進歩)

天野俊康
臨床泌尿器科 = Japanese journal of clinical urology 69(1), 82-87, 2015-01
NAID 40020305382

ホルモン補充療法(テストステロン軟膏)の有用性 (特集 LOH症候群診療 : 最近の進歩)

邵仁哲
臨床泌尿器科 = Japanese journal of clinical urology 69(1), 68-74, 2015-01
NAID 40020305337

Related Pictures

★リンクテーブル★

リンク元	「100Cases 33」「start」「develop」「institute」「development」
拡張検索	「maturity-onset diabetes of the young」

「100Cases 33」

　　[★]

☆case33　頭痛と混乱

■glossary

accompany

vt.

(人)と同行する、(人)に随行する。(もの)に付随する。～と同時に起こる。～に加える(添える、同封する)(with)

slurred n. 不明瞭

強直間代痙攣 tonic-clonic convulsion

　意識消失とともに全身の随意筋に強直痙攣が生じ(強直痙攣期tonic convulsion)、次いで全身の筋の強直と弛緩とが律動的に繰り返される時期(間代痙攣期clonic convulsion)を経て、発作後もうろう状態を呈する一連の発作。

■症例

28歳、女性　黒人　南アフリカ　手術室看護師　ロンドン住在

主訴：頭痛と混乱

現病歴：過去3週間で頭痛が続いており、ひどくなってきた。現在も頭痛が持続しており、頭全体が痛い。友人曰く「過去六ヶ月で体重が10kg減っていて、最近、混乱してきたようだ」。発話は不明瞭。救急室にいる間に強直間代痙攣を起こした。

・診察 examination

やせている。55kg。38.5℃。口腔カンジダ症(oral candidiasis)。リンパ節腫脹無し。心血管、呼吸器系、消化器系正常。痙攣前における神経検査では時間、場所、人の見当識無し。神経局所症状無し(no focal neurological sign)。眼底両側に乳頭浮腫有り。

・検査 investigation

血算：白血球増多

血液生化学：ナトリウム低下

CT：供覧

■キーワード＆着目するポイント

・口腔カンジダ症(oral candidiasis)

・頭痛、精神症状、強直間代痙攣

・眼底両側に乳頭浮腫

・CT 所見

・低ナトリウム血症は二次的なもの

■アプローチ

・口腔カンジダ症(oral candidiasis)　→　細胞免疫低下状態(DM、免疫抑制、AIDSなど) or 常在細菌叢の攪乱(長期の抗菌薬の使用)

　・The occurrence of thrush in a young, otherwise healthy-appearing person should prompt an investigation for underlying HIV infection.(HIM.1254)

　・More commonly, thrush is seen as a nonspecific manifestation of severe debilitating illness.(HIM.1254)

・精神症状、強直間代痙攣　→　一次的、あるいは二次的な脳の疾患がありそう

・頭痛　→　漠然としていて絞れないが、他の症状からして機能性頭痛ではなく症候性頭痛っぽい。

・眼底両側に乳頭浮腫　→　脳圧亢進の徴候　→　原因は・・・脳腫瘍、ことにテント下腫瘍と側頭葉の腫瘍、クモ膜下出血、脳水腫など、そのほか、眼窩内病変、低眼圧などの局所的要因、悪性高血圧、血液疾患、大量出血、肺気腫などの全身的要因 (vindicate本のp342も参考になる)

　・頭痛と脳圧亢進　→　頭蓋内圧占拠性病変、脳炎(IMD.274)

・CT 所見　→　ringformの病変、脳浮腫、脳圧亢進

・低ナトリウム血症　→　脳ヘルニアに続発して起こることがあるらしい。実際には下垂体にトキソプラズマによる病変が形成されることにより起こりうる。

・そのほか出身地、体重減少もHIVを疑わせる点

パターン認識でHIV + 精神症状 + てんかん発作(強直間代痙攣) + 脳圧亢進 + CT 所見 = 一番ありそうなのはToxoplasma gondiiによるトキソプラズマ脳症 cerebral toxoplasosis (トキソプラズマ脳炎 toxoplasmic encephalitis)

■Toxoplasma gondii

　原虫　胞子原虫類

(感染予防学 080521のプリント、CASES p,92、HIM p.1305-)

・疫学：西洋では30-80%の成人がトキソプラズマの感染の既往がある・・・うぇ(CASES)。日本では10%前後(Wikipedia)。

・生活環

　・終宿主：ネコ：ネコの小腸上皮細胞で有性・無性生殖　糞便にオーシストの排泄

　・中間宿主：ヒト.ブタを含むほ乳類と鳥類：無性生殖で増殖、シストの形成

　　　急性期の増殖盛んな急増虫体 tachyzoiteとシスト内の緩増虫体 bradyzoite

・病原、病因 phathogenesis

　・緩増虫体(bradyzoite)、接合子嚢(oocyst)

・感染経路

　1. オーシストの経口摂取

　2. 中間宿主の生肉中のシストの経口摂取

　3. 初感染妊婦からの経胎盤感染。既感染なら胎盤感染しないらしい(HIM.1306)

　(4)移植臓器、輸血。確率は低い(at low rate)(HIM.1306)

・病態

　1. 先天性トキソプラズマ症　congenital toxoplasmosis

　　　①網脈絡膜炎、 ②水頭症、 ③脳内石灰化、 ④精神・運動障害

　2. 後天性トキソプラズマ症　acquired toxoplasmosis

　　(1) 健常者

　　　・多くは不顕性感染。発熱、リンパ節腫脹、皮疹(rash)

　　　・(少数例)筋肉痛、暈疼痛、腹痛、斑状丘疹状皮疹(maculopapular rash)、脳脊髄炎、混乱(HIM.1308)

　　　・(まれ)肺炎、心筋炎、脳症、心膜炎、多発筋炎

　　　・網膜、脈絡叢に瘢痕や、脳に小さい炎症性の病変を残すことあり(CASES)。

　　　・急性感染の症状は数週間で消失　筋肉や中枢神経系に緩増虫体が残存

　　(2)HIV 感染者、臓器移植例、がん化学療法例

　　　シスト内緩増虫体→急増虫体→播種性の多臓器感染

　　　AIDSでは、トキソプラズマ性脳炎が指標疾患 AIDS-defineing illness(CASES)

・治療

　(日本)アセチルスピラマイシン、ファンシダール(感染予防学 080521)

■トキソプラズマ脳炎 toxoplasmic encephalitis、トキソプラズマ脳症 cerebral toxoplasosis

・症状

　発熱、頭痛、混乱ｍ、痙攣、認知の障害、局所神経徴候(不全片麻痺、歯垢、脳神経損傷、視野欠損、感覚喪失)(CASES)

・画像検査

　(CT,MRI)多発性、両側性、ring-enhancing lesion、特に灰白質-白質境界、大脳基底核、脳幹、小脳が冒されやすい(CASES)

・鑑別診断(臨床症状・画像診断の所見で)

　リンパ腫、結核、転移性脳腫瘍(CASES)

・病歴と画像所見からの鑑別診断

　リンパ腫、結核、転移性腫瘍

？

このCTがcerebral toxoplasmosisに特徴的かは不明

□最後に残る疑問

　AIDSでWBC(leukocyte)の数はどうなるんだろう？？？AIDSの初診患者ではWBCが低い人が多いらしいし()、HIVはCD4+ T cellとmacrophageに感染して殺すから、これによってB cellは減るだろうし、CD8+ T cellも若干減少するだろうからWBCは減るんじゃないか？！好中球はAIDSとは関係ない？好中球は他の感染症に反応性に増加している？ちなみに、好酸球は寄生虫(原虫)の感染のために増える傾向にあるらしい(HIMのどこか)。

葉酸拮抗剤である。

サルファ剤と併用され、抗トキソプラズマ薬、抗ニューモシチス・カリニ薬として相乗的に働く。

ST 合剤

SMX-TMP

スルファメトキサゾール・トリメトプリム合剤 sulfamethoxazole and trimethoprim mixture

□AIDSの定義(http://en.wikipedia.org/wiki/CDC_Classification_System_for_HIV_Infection_in_Adults_and_Adolescents)

According to the US CDC definition, one has AIDS if he/she is infected with HIV and present with one of the following:

A CD4+ T-cell count below 200 cells/μl (or a CD4+ T-cell percentage of total lymphocytes of less than 14%).

or he/she has one of the following defining illnesses:

01. Candidiasis of bronchi, trachea, or lungs
02. Candidiasis esophageal
03. Cervical cancer (invasive)
04. Coccidioidomycosis, disseminated or extrapulmonary
05. Cryptococcosis, extrapulmonary
06. Cryptosporidiosis, chronic intestinal for longer than 1 month
07. Cytomegalovirus disease (other than liver, spleen or lymph nodes)
08. Encephalopathy (HIV-related)
09. Herpes simplex: chronic ulcer(s) (for more than 1 month); or bronchitis, pneumonitis, or esophagitis
10. Histoplasmosis, disseminated or extrapulmonary
11. Isosporiasis, chronic intestinal (for more than 1 month)
12. Kaposi's sarcoma
13. Lymphoma Burkitt's, immunoblastic or primary brain
14. Mycobacterium avium complex
15. Mycobacterium, other species, disseminated or extrapulmonary
16. Pneumocystis carinii pneumonia
17. Pneumonia (recurrent)
18. Progressive multifocal leukoencephalopathy
19. Salmonella septicemia (recurrent)
20. Toxoplasmosis of the brain
21. Tuberculosis
22. Wasting syndrome due to HIV

People who are not infected with HIV may also develop these conditions; this does not mean they have AIDS. However, when an individual presents laboratory evidence against HIV infection, a diagnosis of AIDS is ruled out unless the patient has not:

undergone high-dose corticoid therapy or other immunosuppressive/cytotoxic therapy in the three months before the onset of the indicator disease
OR been diagnosed with Hodgkin's disease, non-Hodgkin's lymphoma, lymphocytic leukemia, multiple myeloma, or any cancer of lymphoreticular or histiocytic tissue, or angioimmunoblastic lymphoadenopathy
OR a genetic immunodeficiency syndrome atypical of HIV infection, such as one involving hypogamma globulinemia

AND

the individual has had Pneumocystis carinii pneumonia
OR one of the above defining illnesses AND a CD4+ T-cell count below 200 cells/μl (or a CD4+ T-cell percentage of total lymphocytes of less than 14%).

□AIDSのステージング

Revised World Health Organization (WHO) Clinical Staging of HIV/AIDS For Adults and Adolescents (2005)

http://en.wikipedia.org/wiki/WHO_Disease_Staging_System_for_HIV_Infection_and_Disease_in_Adults_and_Adolescents

■参考文献

HIM = Harrison's Principles of Internal Medicine 17th Edition

CASES = 100 Cases in Clinical Medicine Second edition

IMD = 内科診断学第2版

「start」

　　[★]

vi.
vt.

始める(begin)。(仕事などを)始める、～に取りかかる。(旅行など)にでかける
(討論・話題など)の口火を切る、(苦情などを)言い渡す、持ち出す、(うわさを)流す。(賞賛・舞踏などを)先にたってする、煽動する、主唱する。
(子を)宿らせる
(機械を)指導させる。(火事などを)起こす。使い始める
(競争で)～にスタートの合図を欠ける、スタートさせる。先発メンバーにする
(人を)旅行に行かせる。(商売・店などを)(人)に始めさせる、身の立つようにしてやる。～の初期の面倒を見る。(ねじ・釘などを)あらかじめ少し打ち込んでやる
(～を)(初任給～で)雇う(at)
(目的語と現在分詞を伴って)始めさせる、～の原因になる
(獲物を)飛びだたせる、狩り出す
(船材・釘などを)ゆるませる、そらせる、はずれさせる、曲がらせる。

n.

関: begin, commence, commencement, initiate, initiation, institute, launch, mobilize, mount, onset, outset, undertake

「develop」

　　[★]

vt.

発達/発育させる、発展させる(from, into)。(生)発生させる、進化させる
(議論・思索などを)展開する(evolve)、詳しく説く
(新しい物を)創り出す。(資源・土地を)開発する、(宅地を)造成する、(鉱山などを)開く
(潜在力・けいこうなどを)発現/顕出させる、発揮する。(新事実などを)明らかにする。
(事故・火災などを)起こす

vi.

関: buildup, deployment, development, developmental, emergence, engender, evolution, expand, exploit, exploitation, generate, generation, growth, occur, occurrence, onset, transpire, unfold

「institute」

　　[★]

vt.

(会、制度、法政などを)設ける、策定する

treatment with a bisphosphonate should be instituted when bone disease is identified.

(調査を)始める

The risk of side effects and the possibility of developing an infection with a drug-resistant organism or with more harmful, invasive bacteria make it more reasonable to institute an empirical short course of treatment if symptoms develop.