Background: Previous studies have indicated a positive correlation between plasma total protein concentration ([TP]) and sodium−chloride concentration difference ([Na⁺] − [Cl⁻]). This correlation is thought to be a compensatory response to alleviate the plasma pH fluctuations brought about by changes in [TP] by regulating of [Na^＋] − [Cl⁻].

　Objectives: Clinical datasets were examined to ascertain renal involvement in this compensatory response.

　Methods: In total 520,880 clinical datasets of [TP], [Na^＋], [Cl⁻], and creatinine concentration [Cr] from blood tests performed at Saitama City Hospital over a 7-year period were collected. These were divided into six categories based on renal function as assessed by the estimated glomerular filtration rate (eGFR), and the relationship between [TP] and [Na^＋] − [Cl⁻] was examined for each category using a linear regression analysis.

　Result: The ability to regulate [Na^＋] − [C^l−] in response to changes in [TP] decreased with a decline in renal function.

　Conclusion: These results suggest renal involvement in this compensatory response.

　Objectives: Increased plasma homocysteine levels are a risk factor for stress fractures and poor bone quality independent of changes in the bone mineral density. Homocysteine concentrations vary with dietary habits and exercise. This study investigated the changes in plasma homocysteine concentrations in female long-distance runners, who are expected to have large changes in plasma homocysteine concentrations due to diet and exercise.

　Methods: Six female long-distance track and field athletes with high abilities were assessed under similar dietary conditions, with and without endurance exercise. After a restricted exercise period (Res) and an exercise period (Exe), during which transient endurance exercise was performed, blood samples were taken the following morning.

　Results: Compared with Res, Exe was associated with increased plasma homocysteine concentrations (P ＜ 0.01). Significant differences were also obtained for each individual (P ＜ 0.01).

　Conclusions: Endurance exercise increased the morning fasting plasma homocysteine concentrations the next day when the dietary conditions were matched.

　Background: The relationship between job category and the onset of diabetes mellitus (DM) remains to be clarified.

　Objectives and Methods: A total of 3,225 workers whose HbA1c values were less than 6.5％ in 2010 and who had their HbA1c levels checked again in 2015 and 2020 were enrolled in the study. Other factors evaluated as potentially related to the onset of DM comprised BMI, blood pressure, uric acid, LDL-C, and eGFR values. Work categories comprised office workers (O), station workers (S), engineers (E), and train operators (T).

　Results: 1) Of the total, 53 were suspected DM type, 132 were suspected borderline type and 3,040 were normal type in 2020. 2) The rate of DM in S (2.4％) and E (2.3％) was significantly higher than that in O (0.9％) and T (1.5％), respectively (p＜0.01). 3) A slightlyelevated HbA1c level (≧ 5.5) and obesity (BMI ≧ 25) were identified as independent risk factors in both 2010 and 2015 according to the results of multivariate analysis. 4) The odds ratio (OR) for a slightly elevated HbA1c level was significantly high in all job categories both in 2010 and 2015. 5) The OR for obesity was also significantly high in all job categories, except E and O in 2015. 6) The OR for hypertension was significantly high only in S, while that of hyperuricemia was significantly high in T and O only in 2010. 7) No category showed a significantly high OR for dyslipidemia.

　Conclusion: A slightly elevated HbA1c value and obesity were found to be strongly related to newonset suspected DM. However, other risk factors, including hypertension and hyperuricemia, showed significant differences depending on job category and/or the period in which the relationship to the onset of suspected DM was checked.

　Background: Very few studies have evaluated thrombus burden quantitatively in acute pulmonary thromboembolism (APE).

　Purpose: To evaluate thrombus burden quantitatively in APE by contrast-enhanced computed tomography (CECT) and clarify the associations among thrombus burden, thrombus location, and right heart strain, and their changes with direct oral anticoagulant (DOAC) treatment.

　Methods: This study included the 28 PE patients who were treated by DOACs and could be evaluated regularly over time by CECT at St. Marianna University Hospital between January 2015 and May 2017. The proximal PE score was defined as follows. The pulmonary arteries were divided into 18 segments, each scored from 0 to 2 based on the severity of occlusion. The final score was calculated as the sum of each segment. As an index of distal pulmonary embolism, cross-sectional area (CSA) ＜5 mm² (total area of small pulmonary vessels less than 5 mm²) was measured using Image J software. The ratio of the right ventricular diameter to the left ventricular diameter (RV/LV) was also calculated as an indicator of right heart strain.

　Results: The proximal PE score increased significantly with APE severity (non-massive 12.1±7.0, sub-massive 22.2±5.2, massive 28.4±3.9, P＜0.05). On the other hand, there was no significant difference in CSA ＜5 mm² by APE severity (non-massive 367±121, sub-massive 425±138, massive 332±99, P＝0.57). A strong correlation between the proximal PE score and RV/LV at baseline was observed (R＝0.52, P＜0.05), whereas no significant correlation between CSA ＜5 mm² and RV/LV (R＝－0.07, P＝0.71) was observed. Marked improvements were observed after 6-month DOAC treatment in the proximal PE score (baseline, 18.3±8.8 vs. 6 months, 0.4±0.8, P＜0.05), CSA ＜5 mm² (baseline, 379±124 vs. 6 months, 464±127, P＜0.05), and RV/LV (baseline, 1.12 ±0.34 vs. 6 months, 0.93±0.21, P＜0.05). Proximal PE thrombus disappeared in 82％ of the study patients.

　Conclusion: Proximal PE had a greater effect on the severity and right heart strain than distal PE. Both proximal and distal PEs regressed with current DOAC treatment.

　Objective: To determine whether the effects of one year of functional training-specific rehabilitation in the elderly differ according to type of underlying medical conditions.

　Methods: Seventy-six patients were eligible for inclusion in the study. They were classified into 3 groups according to type of underlying diseases as follows: 25 in an internal medicine disease group; 16 in a cerebrovascular disease group; and 35 in an orthopedic disease group. All were required to undergo 3.5 hours of functional training twice a week. Limb skeletal muscle mass, 5-m walking speed, the Timed Up ＆ Go test (TUG) score, and grip strength were measured at the beginning of the program and again at one year later.

　Results: Limb skeletal muscle mass showed a tendency to increase in the internal medicine disease group but showed a significantly increased in the orthopedic disease group. A trend towards a decrease was observed in the cerebrovascular disease group, however.

　The 5-m walking speed showed a significant increase in the internal medicine and orthopedics groups, but not in the cerebrovascular disease group.

　The TUG speed showed a significant increase in the internal medicine and orthopedic groups, but no significant change in the cerebrovascular disease group.

　Grip strength showed no significant change in either group.

　Conclusion: Functional training-specific rehabilitation was less effective in elderly patients with underlying cerebrovascular disease than in those with other types of disease.