Purpose: The purpose of this study was to clarify the influence of complications of diabetes on the exercise tolerance of patients with heart failure. Methods: The subjects of this study were 69 patients (44 men; mean age: 62.2 ± 13.4 years) who were hospitalized and diagnosed with heart failure between November 2016 and November 2017. The subjects all took part in a cardiopulmonary exercise test. The patients' medical background, indexes obtained from lower-limb muscle strength and the cardiopulmonary exercise test, heart rate response indexes [Δ heart rate (ΔHR)], and autonomic nervous activities were measured, and these individual indexes were compared between the diabetic group and the non-diabetic group. Results: Compared with the non-diabetic group, the peak oxygen uptake (peak!O2) and ΔHR in the diabetic group were significantly lower (13.0 ± 2.2 vs. 14.9 ± 4.4 ml/kg/min and 27.2 ± 11.7 vs. 36.7 ± 14.7 bpm, respectively) (p<0.05). Regarding the autonomic nervous activity during the cardiopulmonary exercise test in the diabetic group, there was a significant decrease of parasympathetic nerve activity and a significant lack of increase in sympathetic nerve activity (p<0.05). Conclusions: Patients with heart failure and diabetes had lower levels of exercise tolerance, as compared with patients without complications. It was suggested that the decrease in heart rate response was due to the decrease of autonomic nervous activity and that this may play a role in reduced exercise tolerance.

We evaluated a swallowing pressure in two cases of mitochondrial myopathy of oculopharyngeal muscle atrophy type (case 1) and facio-scapulo-humeral atrophy type (case 2) . A catheter with three diode transducers each 5 cm apart was swallowed through the nose into the upper esophagus. Firstly a patient was requested to drink 1 ml of water at about five-second intervals, and swallowing pressures were recorded under the condition that the speed of paper recording and catheter pull-through was the same 1 mm/sec . Secondly swallowing pressures were recorded under the condition that the middle transducer was fixed at the level of the upper esophageal sphincter and the speed of paper recording was 5 mm/sec .Thirdly resting pressure of the upper esophageal sphincter was recorded under the same condition of the first recording. The results were as follows: 1) swallowing pressure in the pharynx was low in case 1 and lower in case 2, 2) relaxation of the upper esophageal sphincter was complete in case 2 and incomplete in case 1, 3) resting pressure of the upper esophageal sphincter was rather low in two cases. And the degree of subjective dysphagia was higher in case 1 than case 2. These facts lead to the conclusion that relaxation of the upper esophageal sphincter was more important than peristaltic movement of the pharynx at swallowing .