Objective: In breast cancer screening, detection rates for ductal cancer in situ (DCIS) have been increasing with advances in ultrasound (hereafter US) imaging diagnosis technology. Though DCIS with calcifications is readily detected in mammography (hereafter MMG), DCIS without them is difficult to detect with MMG. In the present study, we studied US images of DCIS detected in screening US as well as DCIS US images for cases that could be followed up with more detailed examinations at the hospital affiliated with our facility.
Methods: Among 49 cases of DCIS detected in screening including US between January 2005 and December 2010, we studied images of 29 cases in which it had been possible to detect DCIS in screening US. In addition, among non-detected cases in screening US, we studied US images for 19 cases that could be followed up with detailed examinations.
Results: 65.5% of the masses detected in screening US for DCIS where solid masses. With a mean diameter of 10.0 mm, many of the lesions presenting as solid masses were relatively small in size, were lobular or oval in form and had clear, smooth boundaries. Lesions detected as non-mass lesions were in hypoechoic areas, in all cases. For non-detected cases in screening US and hypoechoic areas, detection was possible through careful observation.
Conclusion: A relatively large number of US images of DCIS showed small masses with clear, smooth boundaries. While non-mass lesions were only seen in hypoechoic areas, in order not to overlook them, they should be examined in comparison with reference findings.

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Objective: While NT-proBNP (N-terminal pro-brain natriuretic peptide) has been clinically established as an important biomarker regarding diagnosis, and evaluation of treatments and prognoses in cardiac failure, it still does not have a clear role in health check-ups. We have introduced NT-proBNP measurement as an option in Ningen Dock, and investigated its significance.
Methods: We targeted 599 persons (362 males, 237 females) who had taken advantage of NT-proBNP measurement between August, 2011, when it was introduced, and October, 2012. Regarding these people, we investigated relationships between age, gender, blood pressure, blood chemistry data, ECG findings, cardiothoracic ratio and NT-proBNP measurements.
Results: NT-proBNP was ≥ 125pg/ml (cardiac disease suspected) in 8.8% of the males and 9.7% of the females．NT-proBNP gradually increased with age, and there was a difference between males and females. A positive correlation was seen between NT-proBNP and serum creatinine, and a negative correlation between NT-proBNP and the 3 parameters of albumin, hemoglobin concentration and LDL-cholesterol. So, we considered that NT-proBNP had increased due to stress on heart muscle caused by such conditions as hypoalbuminemia and anemia. NT-proBNP was also increased when ECG findings were left ventricular hypertrophy and arrhythmia but this was not statistically significant.
Conclusion: NT-proBNP reflects stress on heart muscle. This test may therefore complement cardiac function exams in Ningen Dock, i.e. electrocardiograms and chest X-rays.

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Objective: The purpose of this study was to examine a relationship between smoking and urine pH, a new predictor of chronic kidney disease, and to assess whether smoking and/or drinking are associated with renal dysfunction determined by glomerular filtration rate (eGFR).
Methods: The study was conducted on 78 male current smokers and 79 male life-time non-smokers aged 50-69 years, who underwent a health check-up. The classification of metabolic syndrome (MetS) was applied to subjects whose waist circumference was larger than 85 cm and had at least 1 of 4 metabolic syndrome criteria (MetS+1).
Results: Smokers had a lower urine pH and higher plasma uric acid levels compared with non-smokers after adjustment for drinking and MetS+1. In smokers, there were strong correlations between amount of drinking and urine pH, and drinking and uric acid. In the smoker group, those whose urine pH was less than 6.0 had a significantly lower eGFR compared to those whose urine pH was 6.0 or greater, but there was no difference in MetS factors. The combination of smoking and drinking, especially heavy drinking, was associated with lower urine pH and lower eGFR. The presence of smoking, drinking and MetS+1 together was associated with the lowest urine pH, highest uric acid, and lowest eGFR.
Conclusion: The combined presence of smoking and drinking, especially heavy drinking, was associated with a lower urine pH independently of presence of MetS+1 and was associated with a lower eGFR. These results suggest that smoking is an important contributor to a low urine pH, which in turn may lead to renal dysfunction.

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Objective: To examine whether the blood hemoglobin level is independently associated with insulin resistance after adjustment for each component of metabolic syndrome and severity of fatty liver in apparently healthy subjects who underwent health check-ups.
Methods: We performed a cross-sectional analysis using the data obtained from subjects who underwent health check-ups between April 2011 and March 2011(1,112 men and 1,385 women). Subjects taking medication for hypertension, dyslipidemia, or diabetes mellitus were excluded. Insulin resistance was assessed by the homeostasis model assessment of insulin resistance (HOMA-IR). Severity of fatty liver was ultrasongraphically evaluated in semiquantitative manner. Correlations between HOMA-IR and metabolic syndrome components and severity of fatty liver were examined by regression analysis.
Results: Univariate analysis showed that the blood hemoglobin level was positively correlated with HOMA-IR both in men and women (men: r=0.293, p<0.001, women: r=0.175, p<0.001). After adjustment for age, smoking, metabolic syndrome components and severity of fatty liver, multivariate regression analysis showed that blood hemoglobin level was significantly correlated with HOMA-IR in both men and women (men: β=0.104, p<0.001, women: β=0.052, p=0.008).
Conclusions: Blood hemoglobin levels were independently associated with insulin resistance after adjustment for metabolic syndrome components and severity of fatty liver in subjects undergoing health check-ups.

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Objective: Various studies have been conducted on differences in detection rates and characteristics of breast cancer between first and repeat mammography (MMG) screenings. The objective of the present study was to clarify the importance of recommending examinees to undergo MMG screening at Ningen Dock facilities by examining differences in breast cancer detection rates and characteristics, with the aim of reducing future breast cancer mortality rates.
Subjects and Methods: Subjects were 5,113 women (first screening group 847, repeat screening group 4,266) in whom a final diagnosis was made in MMG screenings conducted in 2010 and 2011 at our facility.
Results: Cancer was discovered in 8 subjects in the first screening group (detection rate 0.94%) and in 14 subjects in the repeat screening group (detection rate 0.33%). Thus, the detection rate in the first screening group was 2.85 times that in the repeat screening group. The rate for Stage II cancer in the first screening group was 0.47%, higher than that in the repeat screening group of 0.05%. Also, there was a greater tendency towards invasive cancer in the first screening group than in the repeat screening group with rates of 0.94% and 0.23%, respectively.
Conclusion: As compared to the repeat screening group, the cancer detection rate in the first screening group was higher and there were greater tendencies towards Stage II cancer and invasive cancer in this group. Therefore, with a view to reducing breast cancer mortality rates, it is considered necessary to make sure that examinees do not forgo repeat examinations by making them aware of the importance of discovering cancer when it is still at the non-invasive or early stage.

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Objective & Methods: The influence of sleep duration on lifestyle and metabolic disorders was evaluated by analyzing questionnaire responses and general health data from persons undergoing health check-ups. Questionnaire items included daily living habits, self-efficacy, family support and medical support.
Results: Responses to 200 questionnaire items were analyzed by the Spearman test to evaluate correlations with sleep duration, Responses regarding 38 items showed significant correlations with sleep duration. In factor analysis conducted to determine common factors among these 38 variables, the 8 factors of eating habits, favorite meals, family support, self-efficacy, self-evaluation, exercise habit, weight control were determined. Any items regarding medical support were not determined. Three medical record items - 2-hour blood glucose after 75 g oral glucose load, HbA1c, and body fat percentage - were negatively correlated with sleeping duration. Ordinal logistic regression analysis performed using sleep duration as a dependent variable and the above 41 significant variables as independent variables revealed that 7 variables (in short sleepers: often have a dinner after 9 o’clock, often have no breakfast, often have between-meal snacks, do not drink much, have less family support, less regular lifestyle and higher HbA1c) were selected as significant dependent factors The odds ratio for persons with HbA1c ≥ 6.2% who sleep less than 6 hours to those who sleep more than 6 hours was 2.046.
Conclusions: Short sleepers had high HbA1c levels and characteristic lifestyles and self-efficacies

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Objective: With a view to improving the follow-up examination system at our facility, since 2008 we have been sending follow-up exam recommendations to examinees considered to require medical treatment or more detailed exams. Also, beginning in 2010, we conducted a partial revision of the system for recommending follow-up examinations. In this study, we examine the effectiveness of the revised system.
Methods: The subjects were examinees to whom recommendations for follow-up exams were sent from April 2009 to March 2011. Comparisons were made for 22 of 38 examination items in the old and new systems with regard to numbers of recommendations sent, numbers of responses received and response rates by examination item.
<Change in new recommendation system> When no response is received to a recommendation for a follow-up exam sent together with a results report, a further recommendation is sent 2 months later.
Results: The new recommendation system increased response rates for all examination items. The changes in response rates were +22.7 for chest CT scans, +20.1 for mammography and +18.1 for cervical cancer screening. Under the category of lifestyle disease-related exams, while the changes in rates for diabetes testing, and renal function/uric acid testing were +9.1 and +7.6, respectively, these differences were still statistically significant. The increases in response rates for lifestyle disease-related testing and gynecologic exams were prominent.
Conclusion: It was effective to send a recommendation again 2 months later when no response was received the first time it was sent. Keeping the difference in health awareness between men and women in mind, the provision of disease- and testing-related information together with appropriately timed recommendations for follow-up exams would be another means of raising exam rates.

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Objective: To assess the effectiveness of the follow-up system in our Ningen Dock facility and examine future issues, we investigated the degree of understanding of the system and consultation rates among examinees requiring further examinations.
Methods: The subjects were 3,313 persons who visited our Ningen Dock facility for annual health check-ups from June 2009 to February 2011. To determine an effective and highly accurate auto list-up system, we analyzed response rates to a questionnaire, tracking rates of examinees requiring further examinations and consultation rates by clinical examination group.
Results: Overall response and tracking rates were 38.8 to 61.1% and 66.5 to 82.8%, respectively. The consultation rates for those requiring further examinations differed by examination group, with the highest and lowest rates observed for doctor’s physical examination (67.9%) and hepatitis virus test (42.0%), respectively.
Conclusion: We have to increase the number of repeat examinees for health check-ups and expand the out-patient department for examinees requiring further examination to increase tracking rates and improve the quality of the follow-up system of our Ningen Dock facility. In addition, the inclusion of graphics and images in reports to examinees to help explanation of abnormalities, and active involvement of doctors may also increase the number of examinees undergoing further medical examinations.

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Objective: The radiology department conducted an independent program with the objective of providing examinees with better hospitality. This program was in addition to the efforts by our Ningen Dock facility overall to improve hospitality.
Methods: Members of a conduct monitoring committee selected from radiology department staff determined monthly and weekly hospitality-related themes and each of the 26 people in the department was appointed as a hospitality evaluator for a month at a time in rotation. Observing staff in the daily work of radiological examinations, evaluators noted staff with excellent behavior with respect to individual hospitality themes, etc. in their evaluations. The levels of overall awareness and behavior were raised through mutual observation of each other’s hospitality and the effects were confirmed through the comments of health check-up examinees and questionnaires at the time of examinations.
Results: Fifteen persons were cited as showing excellent behavior. As for breakdown by age group, 2 of 8 persons in their 20s were excellent, 3 of 4 persons in their 30s, 6 of 10 persons in their 40s and 4 of 4 persons in their 50s showing that staff with many years of experience accounted for a large proportion of them. The results of the questionnaire regarding hospitality at the time of examinations were nearly all “good” or “acceptable”. As for comments of examinees, the proportion of positive comments increased and as a result of continuing the program, the proportion of praise exceeded that of complaints and requests for improvement.
Conclusion: Efforts to improve hospitality in consideration of the situation in an individual department were effective in improving hospitality. In order to further raise the level of service provided, it will be necessary to continue such activities in the future.

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