Objective A limited series of patients with aneurysms were reviewed retrospectively to analyze strategies for integrating microsurgical and endovascular techniques in the management of complex, surgically incurable aneurysms.
Methods Since 1997, nine patients were managed with a multimodality approach comprising a total of 4 different combinations: (1) coiling after intentional reconstruction of aneurysm neck (n=4); (2) coiling of recurrent aneurysm after clipping (n=1); (3) coiling of aneurysm and parent artery after bypass procedures (n=1); (4) clipping of aneurysm after attempted and incomplete coiling (n=3).
Results Among 9 aneurysms treated with combined therapy,6 aneurysms were large or giant in size and 7 had fusiform, dissecting or multilobulated morphology. Complete angiographic obliteration was achieved in 8 aneurysms (88.9%). Overall,8 patients (88.9%) had good outcomes (Glasgow Outcome Scale score of 4 or 5; mean follow-up,43 mo). One patient had died, possibly due to accompanying silent basilar tip aneurysm rupturing. There were no treatment-associated mortality or severe morbidity.
Conclusion As for complex, surgically in-curable aneurysms, endovascular coiling should be artistically combined with microsurgical clipping and revascularization. Among combined strategies, the intentional reconstruction of aneurysm neck followed by coil embolization, and clipping after attempted and incomplete coiling should be more than often encouraged for these complex aneurysms.

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Background In recent years, the measurement of glycated albumin (GA), a glycation product of albumin, h as been used widely in clinical practice in Japan. Since the half-life of albumin is shorter than that of Hb and its rate of glycation is 10 times faster, GA is a more sensitive indicator than HbA1c in evaluating therapeutic effects. An easy-to-use reagent has been developed to measure GA using biochemical analyz ers. Thus, the measurement of GA, conducted in the same panel such as total cholesterol for health examinations, is expected to improve efficiency and reduce costs in primary screening for diabetes mellitus (DM).
Methods We measured the serum GA value in 970 subjects receiving comprehensive health examinations to determine the optimal cut-off value of GA for diabetes screening. We also investigated the correlation among GA, fasting plasma glucose (FPG), and 2h or peak values of the 75 g oral glucose tolerance test (OGTT). The subjects were divided into four groups, i. e., DM group, impaired fasting glycemia (IFG)group, impaired glucose tolerance (IGT) group, and normal glucose tolerance (NGT) group.
Results The cut-off value for GA was determined to be 14.5%, at which detection sensitivity for DM was 78.5% and non-DM specificity was 69.3%. DM and IGT detection sensitivity of GA were similar to those of HbA1c.
Conclusion We would like to recommend GA for the detection of diabetes together with blood glucose determination.

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Background p53 is the gene for a transcription factor that is activated in response to deoxyribonucleic acid (DNA) damage, and research has revealed that abnormalities of this gene show a high frequency in gastrointestinal cancers.
Methods We investigated the positivity rate of p53 antibodies in serum from 890 subjects, and found seropositivity in 74 subjects vs. seronegativity in 816 subjects.
Results There was little difference between males and females, but there was a trend for the seropositive rate to increase with advancing age from the 30s onwards, peaking among subjects in their 60s. The 5subjects with positive antibody titers and cancer were all men, but there was no correlation between the antibody titer and the presence of cancer.
Conclusion Based on the results of the present investigation, detection of p53 serum antibodies is not an effective cancer screening tool compared with existing tumor markers.

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Background Although p53 and K-ras gene mutations have been frequently identified in lung cancer pa tients, it is obscure whether these mutations are detected in epithelial cells from the patients with chronic bronchitis.
Methods The morning sputum samples were taken from 46 female patients with chronic bronchitis who exposed to smoky coal emissions containing polycyclic aromatic hydrocarbons (PAHs). Epithelial cells were isolated from sputum using laser capture microdissection microscope. Analysis of p53 mutations was carried out using polymerase chain reaction (PCR) and single-stranded conformational polymorphism (SSCP), and K-ras mutation was detected using PCR and denaturing gradient gel electrophoresis (DGGE).
Results Mutations in p53 and K-ras genes were identified in 5 of 46 patients (10.9%). One patient had both a p53 mutation and a K-ras mutation. Three patients had only a p53 mutation, and one patient had only a K-ras mutation.
Conclusion p53 and K-ras mutations are present in epithelial cells from the sputum of patients with chronic bronchitis who were exposed to smoky coal emission but had no evidence of lung cancer, suggesting that these mutations may be associated with exposure to PAHs present in smoky coal emissions.

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Background There are annual reports, accumulated over more than 50 years, called the Statistical Survey on School Health, concerning the physical development of Japanese school children. In order to clarify the local differences in Japanese children's BMI and its change over time, we investigated height and weight data of those aged 5 to 17 over a span of 55 years (from 1948 to 2003).
Methods Using the national average and 47 prefectural averages of height and weight data, the BMI was calculated for each age in each year. Then, the BMI difference of prefectural averages compared to the national average was calculated respectively and assigned a color in accordance with the value of the BMI difference. A BMI cross-sectional map of each prefecture was constructed to visualize the physical changes.
Results Excess BW of children is more prominent in northeastern compared to southwestern Japan.
Conclusion We analyzed the Statistical Survey on School Health conducted over a period of 55 years using BMI cross-sectional analysis to estimate Japanese children's physical development. Our results showed that excess BW is more prominent in northeastern compared to southwestern Japan. We suggest that children's physical development exhibits local differences and is affected by regional factors.

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Objective In a placebo-controlled, double-blind study, we examined the effects on blood lipids and safety of mayonnaise containing a plant sterol (PS) in Japanese subjects,40 years and older.
Methods Borderline or mildly hypercholesterolemic Japanese subjects (serum total cholesterol (TC)≥200mg/dl; 40 men and 20 women) were randomly divided into two groups and given 15 g of low-energy mayonnaise with 885 mg of PS IPS(+)-groupl or placebo-mayonnaise without PS [PS(-)group] daily for 12 weeks. Every 4 weeks, fasting blood was tested and subjective symptoms were analyzed.
Results There was no significant change in serum TC and LDL cholesterol (LDL-C) concentrations in the PS(-)-group during the study, while significant decreases were observed in the PS(+)-group at weeks 4,8, and 12 post-compared with pre-ingestion. Further, changes in the serum apolipoprotein B concentration, as well as serum TC and LDL-C concentrations, in the PS(+)-group were significantly lower compared with those of the PS(-)-group at weeks 4,8, and 12. There was no change in the serum concentrations of HDL cholesterol (HDL-C) and TG for the PS(+)-group during the study period, and blood tests indicated normal ranges.
Conclusion The results indicated that PS-containing low-energy mayonnaise decreased serum TC and LDL-C concentrations in borderline or mildly hypercholesterolemic subjects; therefore, the mayonnaise may be helpful in maintaining the health of the Japanese population.

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In 1956 National Taiwan University Hospital (NTUH) initiated the pioneer health screen service pro gram in Taiwan. That was the mile stone. At that time, the entire course was 6 days. Only university hospitals or big medical centers could offer the service, because it was a complex procedure. In 1970s, the course was refined, and was reduced to 3 days.
From 1980 to now, customer-oriented services are arising. The course was reduced to 2 days or even 1day. Small hospitals or even clinic can offer the service, if they are unique in service quality. The most important part of health screen market is customer self pay, because it is not included in the reimbursement of the national health insurance. The manuals are diverse with different programs. The idea of health promotion and health management are ongoing. The current health screen in Taiwan is the business model of fast, and short duration. Three to 7h is the most popular in running.
From July 2003 to June 2006, totally 20,996 subjects were screened in the health management center of NTUH. One hundred and thirty-six subjects (0.65%) were found with cancers. The age-specific prevalence of metabolic syndrome using Asian modified National Cholesterol Education Program, the third adult treatment panel's criteria was 30% in male, and 24% in female. Those subjects with metabolic syndrome had multiple colorectal neoplasia in both proximal and distal colon. Subjects without metabolic syndrome were prone to have colorectal neoplasia in distal colon.
Ningen Dock in Taiwan is still growing. High quality and short duration screen is the trend of evolution. Health promotion programs are under development, and will be integrated to personal medicine.

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There is growing evidence that local and systemic inflammation plays a role in the initiation and progression of atherosclerosis. Patients with acute coronary syndrome have increased CRP levels before onset.
However, the significance of CRP measurement has not been confirmed in healthy Japanese subjects and patients with atherosclerotic diseases.
Since 2000, we have started to measure hs-CRP using BN-II (Dade-Behring Co., IL, USA) in more than 3000 subjects annually.
The upper-limit of the normal range of hs-CRP is 1.0 mg/l in Japanese. Careful consideration is required in interpreting hs-CRP values. Aging, obesity, and smoking increase the values, while weight reduction, and a moderate intake of alcohol reduce the values.
The accumulation of numbers with regard to each component of metabolic syndrome indicates the elevation of hs-CRP in a stepwise manner. Patients with arrhythmia such as atrial fibrillation show elevated values.
A prospective study on Japanese in the Tokyo area indicated a 22% increase in cardiovascular events in high hs-CRP subjects compared to normal hs-CRP groups. The usefulness of the determination of hs-CRP with plasma lipids is confirmed when predicting high-risk subjects.

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As carotid ultrasonography is an easy, immediate, and non-invasive diagnosing modality that does not involve radiation exposure, it has gained considerable recognition for use in the screening of carotid atherosclerosis even in asymptomatic subjects. Carotid plaque may be defined when the maximum of the IMT measured at the several arterial segments surpasses a certain cut-off value, and, although not always, has a focal protrusion. The size, number, surface morphology, and echogenicity of such carotid plaque may provide useful information for estimating the likelihood of future ischemic cerebrovascular events. Although significant luminal narrowing (≥70% stenosis) of carotid arteries that may increase the incidence of stroke will rarely be encountered in the setting of Ningen Dock, the presence of carotid atherosclerosis may also indicate an increased likelihood of the presence of coronary artery stenosis or future cardiac events. In addition, visualization of the presence of plaque may also increase the subjects' motivation for making lifestyle modifications, such as smoking cessation. Due to its non-invasive nature, carotid ultrasonography has become reasonable and feasible modality for the diagnosis of early atherosclerosis in the setting of general health screening or Ningen Dock.

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Background and Purpose The presence of microalbuminuria is a risk factor for advanced renal failure and atherosclerotic diseases. In the current study, we investigated the association between albuminuria, insulin resistance, and carotid atherosclerosis.
Methods and Results We analyzed data from 3674 individuals (female 1228, male 2446) who underwent general health screening. Microalbuminuria was defined as a urine albumin to urine creatinine ratio, termed the albumin excretion index (AEI), of 30 and 299 mg/g; macroalbuminuria was defined as an AEI ≥300 mg/g. The prevalence of micro- and macroalbuminuria was 11.7% and 1.5%, respectively. When compared to the lowest AEI quartile (AEI <4.5 mg/g), the highest AEI quartile (AEI≥150 mg/g) was found to be associated with metabolic syndrome (MetS) with an odds ratio of 5.7 (95% CI 1.7-19.3) in women and 3.9 (95% CI 2.9-5.3) in men after adjusting for total cholesterol (TC) and smoking status. In addition, after adjusting for sex, age, TC, smoking status, systolic BP, and fasting glucose, the highest AEI quartile was associated with carotid plaque with an odds ratio of 1.33 (95% CI 1.06-1.67).
Conclusion Our data show that the presence of albuminuria in individuals undergoing general health screening, even when it is below the cut-off value for “micro-” albuminuria, is a risk factor for MetS and carotid plaque.

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Background It has been widely recognized that insulin resistance not only plays an important role in the pathophysiology of diabetes but in all lifestyle related disease that are closely associated with cardiovascular disease.
Methods Measurement of fasting immunoreactive insulin (F-IRI) was performed to examine its signifi cance and usefulness as an index of insulin resistance in subjects in Ningen Dock.
Results The value of F-IRI increased as the number of risk factors for atherosclerosis increased, and we observed a stronger correlation between the value of F-IRI and BW than the degree of diabetes. We also found that there was a very strong correlation (correlation coefficient exceeding 0.9) between F-IRI and homeostasis model assessment of insulin resistance (HOMA-IR), which is the index of insulin resistance used most widely at present. Furthermore, we identified that the value of F-IRI changes in correlation with changes in the BW and that visceral fat accumulation is one of the independent factors affecting FIRI. Finally, we examined the effect of lifestyle itself, namely exercise, drinking, and smoking, on the value of F-IRI, and found that exercise and drinking are independent factors associated with F-IRI.
Conclusions These results indicate the significance of measuring F-IRI as the most convenient index of insulin resistance, and also indicate its usefulness for the guidance of subjects in Ningen Dock from the viewpoint of the prevention of lifestyle related disease.

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