Inspiratory Muscle Training (IMT) can be defined as a technique that aims to improve the function of the respiratory muscles through specific devices. IMT has been shown to improve respiratory muscle strength and exercise endurance, and health related QOL and IMT also has been shown to reduce dyspnea on exertion. Recently, the benefits of IMT have been demonstrated in patients with heart failure (HF), respiratory management in ICU, preoperative period, and cerebrovascular disease.

　The pathologic changes that occur in the lung as a consequence of chronic pulmonar y venous hypertension, pulmonary function test abnormalities, and potential mechanisms for dyspnea including airflow obstruction and/or respiratory muscle dysfunction are discussed. It is worth noting that muscle weakness appears first in the respiratory muscles and then in the musculature of the limbs, which may be considered one of the main causes of exercise intolerance. IMT seems to be a useful intervention to reduce inspiratory muscle metaboreflex in order to increase patients’ exercise tolerance under HF condition.

　A systematic review was necessary to review the effects of IMT on inspiratory muscle weakness. For people with heart failure, IMT by itself, without being combined with other exercise, can improve ease of breathing, increase the amount of distance that they can walk, and improve quality of life. Inspirator y training with higher loads might be helpful for those with respiratory muscle weakness who are unable to do conventional exercise. In this review, new devices for IMT those recently developed and the working mechanism are shown. Further research should be warranted for IMT in the patients with HF and other disease than respiratory diseases.

　With the coming of super-aging society, there are growing number of patients with hypertension and its complicating disease. Hypertension causes cardioand cerebrovascular disease as well as kidney disease. The symptoms of CKD are usually not apparent in the early stages, so most CKD patients are unaware of their condition. Early detection and appropriate intervention during the initial stages of CKD are necessary for the prevention of a further increase in the number of patients with end-stage kidney disease (ESKD). Previously, we reported that urinary vanin-1 was associated with kidney injury in spontaneously hypertensive rats. In this review, will highlight the current knowledge on renal biomarkers including urinary vanin-1.

　Background: The cardio-ankle vascular index (CAVI) has recently been used as a new measure of arterial stiffness. Although associations have been widely reported between the CAVI score and atherosclerotic risk factors (ARFs), such correlations have been investigated in only a few longitudinal studies.

　Objectives: To clarify the relationship between age-related change in CAVI scores with those in ARFs over a 3-year period.

　Methods: A total of 76 men and 41 women were included in the study. The ARFs comprised age, BMI score, weight, abdominal circumference, systolic blood pressure (SBP), diastolic blood pressure (DBP), pulse pressure (PP), number of ARFs (RF score), metabolic score, total cholesterol (T-C), triglycerides (TG), high-density-lipoprotein cholesterol (HDL-C), low-density-lipoprotein cholesterol (LDL-C), fasting blood sugar (FBS), HbA1c, and smoking score. The patients were divided into 3 CAVI index groups based on the CAVI score: a low vascular age group (LVA; below the mean － SD); an equivalent VA group (EVA; within the mean ± SD); and a high VA group (HVA; above the mean ＋ SD). Differences in baseline ARFs among these 3 CAVI index groups were compared. Next changes in the CAVI index at 3 years later was used to classify the patients into 3 CAVI index change (ΔCAVI index) groups: a good group (Group 1: LVA maintained or CAVI index improved); an average group (Group 2: EVA maintained); and a poor group (Group 3: HVA maintained or CAVI index worsened). Changes in the ARFs (ΔARF) between at baseline and 3 years later were then compared among the 3 ΔCAVI index groups.

　Results:

　Comparison of ARFs at baseline among CAVI index groups

　In men, the LVA group showed a lower age and RF score, and a higher BMI score and T-C; the HVA group showed a larger abdominal circumference, SBP, DBP, and metabolic score. In women, the LVA group showed a lower TG and higher smoking score.

　Comparison of ARFs among ΔCAVI index groups

　In men, Group 1 showed a higher SBP and only small increases in SBP and HbA1c. Group 3 showed a high BMI score, weight, abdominal circumference, and large increase in weight and DBP. In women, no significant difference was observed between Group 1 and Group 3.

　Conclusion: In men, obesity, BP, and ARF were the determining factors for the CAVI index, and these factors were associated with its improvement or worsening. In women, TG and the smoking score were the determining factors for the CAVI index, but no factor was associated with its improvement or worsening. The single factor most strongly associated with the CAVI index was SBP in men and TG in women.

　Background: Sleep apnea syndrome (SAS) in train operators poses a serious risk of accidents due to dozing, but its relationship with lifestyle-related diseases remains unclear.

Method: The results of polysomnography on 1,494 train operators for Tobu Railway Co., Ltd. and those of periodic health checkups covering a range of items, including age, BMI, blood pressure, uric acid, and HbA1c , LDL-C, triglyceride, γGTP, eGFR, and serum hemoglobin levels were analyzed. Results: 1) Sleep apnea syndrome was diagnosed in 797 (53.3％) of 1,494 employees, 385 (25.8％) with mild disease, 105 (7.0％) with moderate disease, and 307 (20.5％) with severe disease. 2) The higher the age, the higher the prevalence of SAS. 3) A high correlation was observed between the severity of SAS and the proportion of obese people (BMI ≧ 30) (r ＝ 0.95). 4) In cases of SAS, the proportion of people with hypertension, hyperglycemia, hyperuricemia or polycythemia was significantly higher. 5) Multivariate logistic regression analysis revealed obesity and hyperglycemia as independent risk factors of moderate or severe SAS.

Conclusions: Significant relationships were revealed between SAS and aging, obesity, hypertension, hyperglycemia, hyperuricemia, or polycythemia. Obesity and hyperglycemia, in particular, were identified as independent risk factors for the development of moderate or severe SAS.

　In the present study, we evaluated exercise tolerance using treadmill and arm ergometry or leg crank ergometry in patients with respiratory diseases who were or were not able to walk during their clinical course. We assessed which method made it better to provide the appropriate prescription of rehabilitation to optimize exercise intensity in their clinical recovery course. Between April 2020 and August 2021, we performed treadmill exercise tests in 59 patients with respiratory diseases, in 31 of whom (age 77.1 ± 10.0 yrs; male 24, female 7), oxygen intake (⩒o₂) and anaerobic threshold (AT) were measured using an exhaled gas analyzer and compared between data using a treadmill and arm ergometry or leg crank test. ⩒o₂ peak based on treadmill (9.4 ±2.9 kg/min) was significantly higher than that according to arm ergometry (6.7 ± 1.4 kg/min) (P ＝ 0.02). Although AT measured using treadmill (8.6 ± 2.0 kg/min) was higher than that measured using arm ergometry (6.4 ± 1.0 kg/min), the difference was not significant (P ＝ 0.14). ⩒o₂ peak measured according to leg crank ergometry (8.3 ± 1.3 kg/min) was higher than that measured based on arm ergometry (6.7 ± 1.4 kg/min), but there was no significant difference (P ＝ 0.41). In conclusion, selecting the exercise test method according to the patient's condition could make it helpful to prescribe rehabilitation intensity.