Objective: We performed this study to assess whether chronic kidney disease (CKD) is associated with major heart abnormalities detected in health examinations.
Methods: Subjects were 9,505 Japanese male adults without a history of renal failure, coronary heart disease (CHD), atrial fibrillation (AF), cardiac hypertrophy, cardiomyopathy, or heart failure. We obtained results of worksite health examinations during 2009-2010. CKD was diagnosed by either dipstick proteinuria ≥1+ or reduced estimated glomerular filtration rate (eGFR) of <60 mL/min/1.73 m². The participants were classified into 4 groups based on proteinuria and eGFR as follows: (i) no CKD (n=8,861), (ii) CKD (proteinuria+/reduced eGFR-) (n=162), (iii) CKD (proteinuria-/reduced eGFR+) (n=432), and (iv) CKD (proteinuria+/reduced eGFR+) (n=50). Heart abnormalities were defined as CHD, AF, left ventricular hypertrophy (LVH), and cardiomegaly using electrocardiography (ECG) and chest X-rays. We analyzed relationships between CKD and these heart abnormalities in consideration of traditional cardiovascular disease (CVD) risk factors.
Results: CKD was significantly associated with the prevalence of ECG-defined CHD, AF and LVH except for radiographic cardiomegaly. The number of traditional CVD risk factors increased with CKD development (p<0.001). Furthermore, the prevalence of CHD increased gradually according to the presence of proteinuria, reduced eGFR and a larger number of other combined CVD risk factors. The multivariate adjusted odds ratios (95% CI) for proteinuria and reduced eGFR were 1.90 (0.90-4.02, p=0.091) and 1.83 (1.03-3.28, p=0.041) for ECG-defined CHD, respectively.
Conclusion: CKD may be a determinant of major heart abnormalities that could serve as an early predictor of CVD-related mortality.

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Objective: Smoking has been reported to be one of the risk factors of myelodysplastic syndrome (MDS). In order to clarify the process of progression to MDS in a certain group of smokers, it is important to identify the initial hematological abnormalities associated with the early stage of MDS in smokers.
Methods: Relationships of hematological parameters such as WBC count, RBC count, Hb, Ht, MCH and MCV with level of smoking were investigated by univariate and multivariate analyses in 234 male workers at a single workplace after obtaining informed consent.
Results: Univariate analysis demonstrated that correlations of smoking-related factors (number of cigarettes per day, duration of smoking [years] and smoking index [defined as number of cigarettes per day x duration of smoking]) with WBC count, Ht, MCH and MCV were significantly positive. Multivariate analysis using age, smoking-related factors, alcohol intake and BMI as explanatory valuables showed that age, alcohol intake and BMI were not confounding variables for smoking-related factors and revealed a remarkable significant positive correlation between each smoking-related factor and MCV.
Conclusion: Smoking-associated macrocytosis, which was demonstrated in the present study, was not due to deficiency of vitamin B₁₂ or folic acid because of no pancytopenia observed but was considered to be a qualitative abnormality of erythrocytes. Taken together with the findings of previous studies concerning smoking-associated functional abnormalities of erythrocytes and leukocytes and the high incidence of MDS in smokers, our results indicate that idiopathic macrocytosis in smokers could be an initial sign of progression to MDS, in which macrocytosis and multi-lineage abnormalities are characteristic findings.

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Objective: Routine direct radiograms of the front chest (chest X-ray radiograms) are normally interpreted by displaying 2 radiograms side-by-side and comparing them (conventional method). However, in the filmless environment in our health and preventive medicine center, we mainly conduct comparative examinations of X-ray radiograms using afterimages produced by paging using rapid wheel scrolling on radiology workstations (afterimage method). A comparative study of the 2 methods demonstrated the utility of the afterimage method.
Methods: In January and February 2011, 20 doctors conducted a comparison of interpreting the chest X-ray radiograms of 20 patients by the conventional method and afterimage method, using a NV-1000 radiology workstation.
Results: At 0.945, the sensitivity of the afterimage method was 1.5 times better than the conventional method. The likelihood ratio for a positive finding was 15.8, 1.8 times that of the conventional method and the likelihood ratio for a negative finding was 0.06, 0.14 times that of the conventional method. The false negative rate of the afterimage method decreased by around 85%. There was hardly any difference between the 2 methods in terms of specificity and interpretation time. The afterimage method was significantly superior with regard to ROC analysis by the pool method.
Conclusion: A comparison of interpreting the X-ray radiograms by the conventional and afterimage methods demonstrated the clear superiority of the latter. While there was a slight problem with reproducibility when taking radiograms, this should be able to be overcome through refinement of the method of taking radiograms and enhancement of radiology workstation functions, which should further raise accuracy. In the future, its is expected that this technique will be widely adopted in health check-ups as well as in the clinical setting, where it should contribute to raising accuracy in the early discovery of lung cancer and a wide range of other diseases, as well as in patient follow-up.

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Objective: To investigate a relationship between outcome of specific health guidance and stages in a transtheoretical model of behavior change, changes in metabolic syndrome risks (MS risks) in subjects before and after specific health guidance were analyzed in relation to stages of behavior change.
Methods: Fifty-three subjects in whom health screening blood tests had been conducted in the final evaluation of specific health guidance from April 2009 to August 2010 were recruited for this study. As for MS risks, 12 of the recommended specific health screening tests (body mass index, abdominal circumference, systolic and diastolic blood pressure, TG, LDL and HDL cholesterol, HbA1c, GOT, GPT, γ-GTP, and UA) were analyzed. The subjects were divided into 3 groups according to stage of behavior change (group A: action and maintenance, group B: preparation, group C: precontemplation and contemplation). Differences in the 12 screening tests among the groups before guidance were analyzed by a multiple comparison method, and improvements due to the health guidance in each group were analyzed by comparing the test results between before and after guidance, using a significance level of 0.10.
Results: Before health guidance, abdominal circumference, GOT, GPT, γ-GTP, and UA tended to be lower in group A than in group B and C. After health guidance, improvements were observed in HbA1c for group A; abdominal circumference, TG, HDL, HbA1c, and UA for group B; and abdominal circumference and LDL for group C. There were improvements in more tests for group B than for group A and C.
Conclusion: Stages of behavior change were related to MS risks and results of health guidance. Before guidance, fewer risks were observed for subjects in the action and maintenance stage, and the best result was observed for those in preparation stage after guidance. These findings are further verification of the importance of knowing stages of behavior change.

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Objective: Examinees not on medication (ENoM) may receive specific health guidance (SHG)if they have positive criteria (PoC) comprising obesity and positive additional risks (PAR) including hypertension, hyperglycemia, dyslipidemia and smoking, but examinees who are on medication (EOnM) for hypertension, diabetes, or dyslipidemia may not, even if they have PoC. This is because they are under the guidance of clinicians. We analyzed examination data for ENoM and EOnM, after a year to see the effects of guidance.
Methods: Our subjects were 3,002 men between 40 and 64 years old belonging to a certain health insurance society who underwent specific health examinations for 2 consecutive years. The diagnosis was conducted for EOnM subjects assuming that they were not on medication and accordingly such subjects with PoC were assumed to be those who should receive SHG. Obesity was taken to represent a state in which waist circumference or body mass index exceeds a reference level.
Results: Disappearance rates for obesity, PAR and PoC indicated by the 2nd year’s data for EOnM with PoC were 8.6%, 7.1% and 14.8%, respectively. These rates were significantly lower than those for ENoM who received SHG (23.3%，15.3% and 34.1%, respectively), but there was no significant difference between them and ENoM who did not receive SHG for personal reasons (8.5%，8.5% and 16.4%respectively ). At the 2nd year, 19.3% of criteria-negative EOnM became criteria-positive, significantly higher than the 9.6% rate for ENoM. For obese examinees, there were high rates of becoming criteria-positive, of 62.2% and 42.2% for EOnM and ENoM, respectively.
Conclusion: SHG is effective in the resolution of obesity and additional risks. It might be better to include EOnM with PoC among recipients of SHG and perhaps obese examinees with no additional risks should receive other special guidance, whether they are on medication or not.

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Objective: It has been reported that bilirubin has a strong antioxidant action which may help prevent arteriosclerosis. We therefore examined a correlation between lifestyle and serum levels of total bilirubin.
Methods: Subjects were 21,166 persons who underwent an annual medical check-up at our clinic in 2009, whose serum total bilirubin levels were under 2.3mg/dl. We utilized a self-completed health questionnaire concerning lifestyle including details of smoking habit, alcohol consumption, exercise, stress and sleeping. We divided the subjects into 3 groups by BMI (body mass index): under 18.5(skinny), 18.5-25.0(normal), over 25.0(obese). Average serum levels of total bilirubin were compared among the groups.
Results: Serum levels of total bilirubin for non-smokers were significantly higher than those for past-smokers (p<0.01) and present-smokers (p<0.01). This tendency was observed for both genders. Levels of bilirubin were significantly lower in non-drinkers and non-exercisers. However, such tendency was not associated with stress or sleep. Serum levels of total bilirubin in the skinny group were significantly higher than those in the normal and obese groups for both men and women.
Conclusion: Serum levels of total bilirubin were associated with smoking, drinking, exercise and BMI. Therefore, the role of bilirubin in the pathology of lifestyle-related diseases should be examined in a future study.

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Objective: Visceral fat obesity is one of the diagnostic criteria of metabolic syndrome in Japan. In view of the increasing prevalence of this syndrome, it is very important to be able to measure the amount of visceral fat very accurately and easily and in this regard, we have continually reported on the usefulness of a visceral fat examination using X-ray CT in our facilities. In order to examine the usefulness of DUALSCAN, the first medical device to be approved for visceral fat measurement, we compared visceral fat measurements made by this device and X-ray CT in the present study.
Methods: Our subjects were 408 adults (297 males and 111 females). We measured their visceral fat area simultaneously using X-ray CT and DUALSCAN and examined relationships between measurements obtained by these 2 methods and various metabolic syndrome-related parameters.
Results: Visceral fat areas measured by the 2 methods were highly correlated (r=0.891 p<0.0001). However, correlation coefficients between visceral fat area measurements made by DUALSCAN and waist circumference, body mass index, and insulin resistance, which is closely related to metabolic syndrome, and liver function ALT (GPT) were higher than those obtained for X-ray CT. Furthermore, there were significant positive correlations between visceral fat area and accumulation of atherosclerosis risk factors, and brachial-ankle pulse wave velocity (baPWV) for both methods.
Conclusion: Our results showed that DUALSCAN visceral fat measurements were even more closely correlated with the diagnostic parameters of metabolic syndrome than those obtained with X-ray CT. They attest to the usefulness of visceral fat area measurement by DUALSCAN, which would have such additional benefits as no radiation exposure.

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Objective: We compared LDL-C measurement by direct assay with LDL-C calculated by Friedewald's formula (FF) in health check-ups.
Methods: Our subjects were 3,545 people (males: 3,545, females: 1,399,mean age:50.9±6.7)who came to our health check-up center. We evaluated the TG coefficient using statistical analysis.
Results: The Student's paired t-test showed that values measured by D-LDL-C (Direct assay) were significantly higher than those calculated by F-LDL-C (Friedewald's formula). Regression analysis revealed a strong correlation between calculated and measured LDL-C. D-LDL-C was strongly correlated with TC and non-HDL-C. The percentage difference between calculated and measured values [(F-LDL-C - D-LDL-C)/(D-LDL-C) x 100] was significantly correlated with TG, showing a downward deviation with increasing TG levels. The TG coefficient calculated by FF was 0.16±0.06 (SD) and 0.1 calculated by a multiple regression equation from TC, HDL-C and TG values. It was 0.12 from a scatter plot of TG vs. VLDL-C. Statistical analysis showed that when TG was low, the TG coefficient varied widely, whereas when TG was between 100 and 350mg/dL, no significant difference between calculated and measured LDL-C values was observed.
Conclusion: D-LDL-C was highly correlated with F-LDL-C, and D-LDL-C tended to be higher than F-LDL-C with increasing TG levels. The TG coefficient varied widely according to TG levels. Therefore, the calculation of TC using FF should be restored for lipid metabolism management in health check-ups.

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Objective: To ensure proper recommendation of medical consultation after primary screening of the uterine cervix, a follow-up study of persons examined at Kariya Toyota General Hospital was carried out.
Methods: The results of 7,065 primary cervical screenings conducted from April 2010 to March 2011 and the follow-up status of examinees requiring further consultation were analyzed.
Results: Eighty-six (1.2%) of the 7,065 persons who underwent screening were recommended to have further consultation and 57 underwent examination, 50 of them at our hospital and 7 at other hospitals. Biopsy exams on 28 revealed 17 cases of cervical intraepithelial neoplasia (4 with CIN3, 6 with CIN2, 7 with CIN1) and there were 11 without dysplasia. Twenty-four underwent detailed cytology only without biopsy and the details of 5 were unknown. Operations on 6 revealed 4 CIN3, 1 CIN2 and 1 tubular cancer with CIN1.Of 29 who were thought not to have had further examination, 13 came back for our next our primary cervical screening and 6 were recommended to have further consultation.
Conclusion: Eighty-six of 7,065 examinees screened for uterine cervical cancer required further consultation, Gynecologists examined 57 of them and 29 were thought not to have been examined. Of them, 13 underwent our next primary cervical screening and 6 were recommended to have further consultation. Thus, it is important to provide proper follow-up after primary cervical screening.

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Objective: We evaluated transnasal upper gastrointestinal (GI) endoscopy using mechanized water jet cleaning for observation area against manual cleaning, regarding procedure time and degree of nasal discomfort.
Subjects and Methods: Two hundred forty six patients were enrolled in the study. The outcomes included procedure time and patient nasal discomfort (grade: 0, no discomfort; 3, severe discomfort), as assessed by a questionnaire, for a manual cleaning group (62 patients) and a mechanized cleaning group (184 patients).
Results: The mean procedure time was 561±123 seconds in the manual cleaning group compared with 503±98 seconds in the mechanized cleaning group. The mean procedure time was significantly reduced in the mechanized cleaning group vs. the manual cleaning group (p = 0.0002). No (grade 0) and mild nasal discomfort (grade 1) were reported by 83.9% and 16.1% of the patients in the manual cleaning group and 86.4% and 13.6% in the mechanized cleaning group, respectively. No patients reported moderate to severe nasal discomfort. There was no significant difference in nasal discomfort between the groups (p = 0.624).
Conclusions: Although there was no difference in nasal discomfort between the groups, the use of mechanized water jet cleaning during transnasal upper GI endoscopy resulted in a significantly shorter procedure time during examinations compared with manual cleaning, and it is therefore considered to be useful.

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Objective: Our purpose was to clarify changes in attitude regarding Ningen Dock (health check-up) items deemed to require further detailed examination or treatment that resulted from encouragement to receive consultation regarding such items by telephone 3 months after undergoing Ningen Dock, as well as issues needing to be addressed in giving encouragement.
Methods: We investigated 3,806 subjects who underwent our Ningen Dock from April to September 2010. Overall a total of 1,309 Ningen Dock items required further examination or treatment. Three months after Ningen Dock, by telephoning up to 3 times, we were able to identify 1,127 items for analysis and divided them into an “examined/treated group” and a “not yet examined/treated group”. The not yet examined/treated group was further divided into 3 subgroups; no change in attitude, decline consultation, and newly receiving consultation.
Results: The rate for subjects who had already received consultation was 63.5%. In the results of telephone encouragement, the top rates for decline was hearing test (28.6%) and for newly undergoing was abdominal CT (30.8%). No subject declined to be examined for cancer. As the rate for newly receiving consultation was only 8.2%, subjects should be encouraged to undergo further examination or treatment on the day of Ningen Dock.
Conclusion: We were able to clarify changes in attitude towards having further examination or treatment with regard to Ningen Dock check-up items as well as problems in the way of encouraging people to receive consultation regarding such items.

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