Objective: High-density lipoprotein (HDL) is a highly heterogeneous substance in size and composition. There are two main subfractions, large lipid-rich HDL2 and small highly-dense HDL3. It is known that HDL2 cholesterol (HDL₂-C) is inversely associated with being overweight and smoking, while HDL3 cholesterol (HDL₃-C) is associated with drinking, but other factors have not been sufficiently considered. We aimed to clarify the determinants affecting HDL₂-C and HDL₃-C based on anti-aging medical check-up data including adiponectin, vitamins, hormones, as well as general measurement items and in-depth questionnaire data.

 Methods: We studied 536 Japanese individuals who underwent anti-aging health check-ups (men: 285, women: 251, mean age: 62.3 years) at Tokai University Tokyo Hospital from 2006 to 2016.

 Results: Both of HDL₂-C and HDL₃-C were negatively correlated with triglyceride (TG) and sex. Only HDL₂-C was positively correlated with adiponectin and β-carotene, and negatively with BMI. Only HDL₃-C was positively correlated with LDL cholesterol (LDL-C), DHEA-S, vitamin A and vitamin Eα, and negatively with smoking and age. In the sex-specific analysis, HDL₂-C showed a positive correlation with β-carotene for men, and with vitamin Eα for women. HDL₃-C was positively correlated with DHEA-S and negatively with smoking and BMI for men, and was positively correlated with drinking, vitamin A, and vitamin Eα and negatively with aging and estradiol.

 Conclusion: It is suggested that HDL subfractions and sex difference should be taken into consideration as well as the lifestyle habits of medical subjects when giving health guidance on HDL-C.

 We evaluated the clinical performance of the ovarian malignancy marker HE4 and the ROMA model for predicting epithelial ovarian cancer in premenopausal women. The sensitivities of HE4, CA125, and ROMA in the diagnosis of malignant diseases were 40%, 60%, and 80%, respectively. The specificities of HE4, CA125, and ROMA in the benign diseases were 100%, 66%, and 95%, respectively. The AUCs of the ROC curve analysis for HE4, CA125, and ROMA were 0.90, 0.72, and 0.89, respectively. HE4 showed a higher specificity in benign diseases than CA125, and it was considered that the clinical utility of tumor markers in the diagnosis of malignant diseases could be improved by measuring a combination of HE4 and CA125 or using the ROMA value.

 We experienced a case of right lung adenocarcinoma whose tumor growth rate was slow over the past 10 years and was not significantly different from the one previous year by comparative interpretation.

 Since he succeeded in quitting smoking and was followed for about 10 years without any symptoms, he, as a health checkup examinee, was initially reluctant to further examination for lung cancer.

 The decisive factor in connecting this examinee to the outpatient clinic of a respiratory specialist was to convince them of the image change compared to the photograph 10 years ago.

 This was a case in which time-consuming comparative interpretation was important.

 At our institution, we perform upper gastrointestinal (GI) series on 10-15 patients on a daily basis. Upper GI series remains the core of stomach cancer screening.

 The new standard for GI x-ray imaging was formally introduced at our institution in April 2018. For the first two years, there were no cases of stomach cancer identified by upper GI series. In the third year, there were two cases of stomach cancer that were identified after ingesting barium. The second case that was identified in June was early-stage cancer. We identified several areas of improvement through these two cases. First, the primary physician in charge of explaining the results of the examination was uninformed because technicians were unaware of the presence of lesions and did not order additional imaging. Second, we failed to strongly encourage patients to undergo follow-up tests despite their H. pylori-positive status from the previous year. It is important to maintain and improve the imaging skills of radiologists, and to ensure that our physicians are skilled at interpreting upper GI series.

 Not a comprehensive medical checkup detect physical abnormality, but also determine whether its condition that requires lifestyle improvement, re-examination, or an appropriate medical treatment. In order to facilitate between medical checkup and clinical practice, it is necessary to pay attention to the selection of appropriate test items and the format of the result report, which is equivalent to a referral letter. If these are inappropriate, not only will it be difficult to build trust with clinicians, including the family doctors, but the patient will also bear unexpected costs and harms. In particular, we focused on the desired forms of result reports, low-value tests, and the opportunity costs of performing them.

 In Japan, heated tobacco products (HTPs) are rapidly becoming popular and more than 10% of the adult population already used HTPs. Based on the information currently available, the health risk of HTPs is not lower than that of combustible cigarettes. Instead of treating HTPs as an exception (for example, in the Health Promotion Act revised in 2018), we need to strongly promote tobacco control measures and smoking cessation support in every setting.