Objective: Elderly people sometimes experience orthostatic hypotension due to decreased baroreceptor responsiveness. We examined postural blood pressure (BP) changes from supine to sitting, and investigated an association with aging or hypertension.
Methods: The subjects were 5,325 men (53±10 [mean± SD] years old) and 3,537 women (52±10 years old) who visited our hospital for health check-ups in 2010. BP was measured in the supine position and then the sitting position after 1 to 5 minutes. Correlations between BP changes and age or supine BP were examined. The subjects were divided into 4 groups based on postural BP changes (group I: ≥10, II: 9~0, III: -1~-9, IV≤-10 mmHg). Each group was further divided into 10-year age ranges, and the prevalence of hypertension, dyslipidemia or glucose intolerance was compared among the groups.
Results: BP had decreased 1 minute after the postural change, and the decrease continued for 5 minutes. Postural BP changes after 1 minute were negatively correlated with age (men: r= -0.201, women: r= -0.180, p<0.001, respectively) and supine BP (men: r= -0.397, women: r= -0.361, p<0.001). In both men and women over 40 years old, the prevalence of hypertension was higher in group IV than in group I, II or III.
Conclusion: BP decreased with a postural change from supine to sitting. The BP decrease was correlated with age and supine BP, suggesting impairment of autonomic nervous regulation induced by aging or hypertension.

View full abstract

Objective: The lower resolution of the transnasal endoscope (TNE) than that of the conventional endoscope (CE) continues to be discussed as a problem of TNE. We examined temporal changes in gastric cancer detection rates using TNE in our health check-up center and assessed the diagnostic capability of TNE.
Methods: We performed 18,032 examinations using TNE in our health check-up center from October 2004 to March 2012, and investigated gastric cancer detection rates and false negative rates in this period. The following models of TNE were used: EG-470N5, EG-530N. EG-530N2, EG-530NW, EG-580NW.
Results: Detection rates of gastric cancer in individual years were 0% (2004, 2005), 0.20% (2006), 0.26% (2007), 0.27% (2008), 0.14% (2009), 0.10% (2010) and 0.23% (2011). The overall detection rate was 0.19%, the rate of early gastric cancer was 82% and the overall false negative rate was 35.3%.
Conclusions: The detection rate of gastric cancer using CE was 0.22% in the same period, not significantly different from the rate for TNE. Also as the false negative rate of 35.3% was almost the same as that of other studies, we consider there is no difference in diagnostic capability between TNE and CE. However, we predict that the detection rate of gastric cancer will gradually decrease and the false negative rate increase in mass screening of the working population because the Helicobacter pylori infection rate has been decreasing in younger people.

View full abstract

Objective: Using MRI, we measured cross-sectional areas at several levels, including the umbilical level, and used the measurements to compute visceral fat volumes. We compared correlations between these areas and volumes in order to determine locations where there was a strong correlation between area and volume.
Methods: Our subjects were 117 males and 95 females who underwent visceral fat MRI examinations and gave consent. Using 1.5T MRI, images were obtained for the abdominal-pelvic area by the LAVA-Flex method (transverse slice thickness 5 mm). Using measurement software, visceral fat areas were calculated for individual cross sections from the diaphragm to the pubis. Regarding visceral fat volume, the total of the visceral fat area was multiplied by the slice thickness of 5 mm. We compared visceral fat areas and volumes for a total of 9 cross sections comprising individual intervertebral disk levels from Th10/11 to L5/S1 and the umbilical level, separately for men and women.
Results: In men, there was a significantly stronger correlation between visceral fat volume and visceral fat area at the L2/3 (r=0.9060) and L1/2 (r=0.9056) levels than at the umbilical level (r=0.8480) whereas for women, the strongest correlation was obtained for the umbilical level (r=0.9560).
Conclusion: Areas for which there were strong correlations with visceral fat volume were obtained at the upper lumbar level in men and at the umbilical level in women.

View full abstract

Objective: We make proposals regarding the assessment of abdominal ultrasound (AUS) screening findings and making diagnoses and follow-up recommendations based on them, from our experience of using “Abdominal ultrasound results categories and follow-up guidelines” by Japan Society of Ningen Dock and “Categorized criteria for abdominal ultrasound cancer screening” (Criteria) by Japan Society of Gastrointestinal Cancer Screening.
Methods: 820 AUS screenings were conducted as initial examinations between November 1, 2011 and February 28, 2013. Sonographers made the categorical assessment (CA), and a physician made diagnoses and follow-up recommendations (f/u). The physician then examined an association between the diagnosis, f/u class, and CA.
Results: The CA made by the sonographer was helpful in the diagnosis and f/u made by the physician. A diagnosis of “suspected tumor” was made for Category 4, and “tumor” for Category 5, and a f/u of “D: Need further tests and/or treatment” was given for both categories. For Category 3, the physician gave a f/u based on the diagnosis. For Category 2, many findings did not require any further tests or treatment, but some non-malignant findings, such as abdominal aortic aneurysm, did. For Category 0, some cases required further tests to rule out cancer.
Conclusions: We propose: 1) Adding further important findings to the Criteria, 2) that a sonographer makes the CA, and 3) the physician refers to the CA in making the diagnosis and f/u. In order to improve the accuracy of AUS in the health check-up setting, it is necessary to enhance the sonographer’s skill and knowledge, and inform the physician concerning the use of CA.

View full abstract

Objective: To clarify the clinical significance of ultrasonographically diagnosed bright pancreas, its relationships with components of metabolic syndrome, serum amylase levels, serum elastase I levels, and endocrine function were examined in apparently healthy subjects who underwent health check-ups.
Methods: We performed a cross-sectional analysis of data obtained from subjects aged 28 to 78 years between April 2010 and March 2011(183 men and 80 women). Exclusion criteria were receiving glucose-lowering drugs and history of pancreatitis. Bright pancreas was defined by positive hepato-pancreatic contrast and blurring of pancreatic outline in an ultrasonographic examination. Pancreatic endocrine function was assessed by homeostasis model assessment of β-cell function (HOMA-β). Insulin resistance was assessed by HOMA of insulin resistance (HOMA-IR).
Results: Waist circumference, systolic blood pressure, diastolic blood pressure, triglyceride, HOMA-IR and fasting plasma glucose were significantly higher (p<0.001), and high-density lipoprotein-cholesterol was lower (p<0.001) in subjects with bright pancreas, suggesting a relationship between it and metabolic syndrome. Furthermore, serum amylase (p<0.001) and elastase Ⅰlevels were lower (p<0.05), and HOMA-β was higher (p<0.05) in subjects with bright pancreas than those without it.
Conclusion: Bright pancreas was associated with the components of metabolic syndrome as well as with serum amylase levels, elastase I levels and pancreatic endocrine-function.

View full abstract

Objective: From the annual changes in the positive rate for parasitological examinations at Center for Multiphasic Health Testing and Services, Mitsui Memorial Hospital, we determined whether continuing parasitological examinations in Ningen Dock would be valuable or not.
Methods: Four thousand six hundred and seventy three subjects who underwent a two-day Ningen Dock at our Center between August 1994 and March 2012 were enrolled. Parasitological examinations were performed on fecal specimens from the subjects by the formalin-ether sedimentation technique.
Results: Of the total of 4,673 parasitological examinations that were carried out, 219 were positive for parasitic worms. The mean positive rate was 4.7%. The positive rate in parasitological examinations rapidly increased, from 2.6% in 1994 to 21.1% in 1999, and then it fell to 5.2% in 2000. After 2000, the trend was flat, with an average of 3.7%. As for the breakdown of the detected parasites, excepting overlap subjects, there were 150 cases of Metagonimus yokogawai, 12 cases of Giardia lamblia, 2 cases of Entamoeba coli, and one case each of Clonorchis sinensis, Trichuris trichiura, and Cyclospora cayetanensis. The results of 8 requests for parasitic body identification were Anisakis spp in 7 cases and Ascaris lumbricoides in 1 case.
Conclusions: Parasites were continuously detected at our center, with a mean rate of 2-3% per year from 2005 onwards and subjects without symptoms were found to have Giardia lamblia category Ⅴ infection. These findings suggest that it will be valuable to continue parasitological examinations in Ningen Dock in the future. Also in consideration of the fact that there will be an increasing number of the elderly among examinees as time goes on, they will be important for preventing opportunistic infections.

View full abstract

Objective: To examine the influence of lifestyle-related diseases and smoking on carotid arteriosclerosis and brain aging in middle-aged Japanese subjects.
Methods: We analyzed the findings for 1,132 apparently healthy adults aged 40 to 55 who underwent brain check-ups at our center. Carotid arteriosclerosis was defined as the thickness of intima-media complex of the carotid artery > 1.1mm and brain aging defined by brain atrophy, white matter hyperintensities, cerebral sulci dilatation, ventricular dilatation and/or cerebral infarction detected by MRI. Laboratory data and medical history details concerning diabetes, dyslipidemia, hypertension and hyperuricemia were obtained and used as variables for lifestyle-related diseases, and the Brinkman index was used to quantify smoking habits.
Results: In men, age, dyslipidemia and hypertension were related to carotid arteriosclerosis, and age, diabetes and hypertension were related to brain aging. In women, age, dyslipidemia and hypertension were related to carotid arteriosclerosis, but only age was related to brain aging. Smoking was not a risk factor in this cohort, either in men or women. No significant correlation between carotid arteriosclerosis and brain aging was found.
Conclusion: Age, dyslipidemia and hypertension were risk factors for carotid arteriosclerosis in both men and women, and age, diabetes and hypertension in men, but only age in women, were risks for brain aging. The association of lifestyle-related diseases with carotid arteriosclerosis was stronger than its association with brain aging. Our findings indicate that carotid artery ultrasonolography could be a powerful tool for identifying arteriosclerosis at the early stage in middle-aged subjects.

View full abstract

Objective: Although our center actively follows-up persons told that they need detailed examinations in Ningen Dock health check-ups to see if they have had them or not, we do not carry out such follow-up for those requiring repeat examinations. Also, on checking whether instructions for repeat examinations given in a medical interview during a previous Ningen Dock have been carried out, we have found that many people do not have the examinations. The objective of the present study was to clarify the characteristics of this through a survey of the examination status of persons requiring repeat examinations.
Methods: We conducted an interview survey of 431 persons undergoing a 1-day Ningen Dock in February 2012. Among them were 213 who had been instructed to have repeat examinations 3 or 6 months after the previous Ningen Dock and they were asked the questions in the survey regarding repeat examination.
Results: In the part of the survey on awareness of the importance of Ningen Dock, the response of all examinees was “Undergoing Ningen Dock is useful for preventing disease”. Among persons who received counseling regarding health and nutrition on the day of the health checkup, 56% responded “It changed my health awareness”, and 66% made efforts to improve their lifestyle afterwards, demonstrating the effectiveness of health and nutrition counseling. However, the rate for persons undergoing repeat examinations was only 43% showing that awareness concerning health and the importance of Ningen Dock, and lifestyle improving behavior had not made people more positive regarding repeat examinations. For lipid and glucose metabolism tests whose repeat examination rates were low, examinee-related factors assumed to make people feel that repeat examinations were unnecessary were a lack of subjective symptoms, difficulty in noticing a major change in health condition and perception that it was enough to make efforts towards improving lifestyle.
Conclusion: As repeat examination rates were clearly low, we feel that it is necessary to consider supportive measures that will enable health check-up examinees to manage their own health in a more appropriate manner.

View full abstract

Objective: To determine factors that bring about ST-T changes after 10 years in subjects with high voltages in their resting electrocardiogram (ECG) initially, we examined the contribution of blood pressure (BP), serum lipids and fasting plasma glucose (FPG).
Methods: The subjects were 194 male health check-up examinees (51 ± 7 years old) who visited our hospital in both 2000 or 2001 and 2010 or 2011, in whom high voltages had been observed in the resting ECG in 2000 or 2001. They were divided into 3 groups according to their ECG findings after 10 years: those with newly detected ST-T changes in addition to high voltages (n = 22, group I), those with high voltages (n = 83, group II) and those with other findings (n= 89, group III). BP, serum lipids and glucose tolerance were compared among the 3 groups and subjects with a normal ECG (n = 74, group C, 51 ± 7 years old).
Results: Systolic BP in group I was no different from the other groups in 2000 or 2001 but had increased after 10 years to a level higher than in group III or C. There had been no change in serum lipids and there was no difference among the groups in this respect. FPG was increased but there was no different among the groups in this regard. The prevalence of hypertension in group I was higher than in group C in 2000 or 2001, and higher than in group II, III and C in 2010 or 2011 (p<0.05).
Conclusion: Our findings suggest that in subjects with mild hypertension and high voltages in their ECG initially, further elevation of BP brought about ST-T changes and therefore, BP control seems to be important.

View full abstract

Objective: With breast cancer screening being recommended more and more these days, an optimal screening procedure, through modality selection or combination of modalities, needs to be established to enhance the accuracy of screening. In this study, we examined the details of breast cancer identified in breast cancer screening in our hospital and conducted a clinical study of diagnostic accuracy for modality combination, which also considered screening interval.
Methods: The subjects of the study were 86 persons with a definite diagnosis of breast cancer in opportunistic and population-based breast cancer screening in our hospital between June 2009 and March 2013 and from whom informed consent was received. For combined mammography and ultrasonography screening, we compared cancer detection rates and clinical stages at diagnosis, conducted a current status survey on the subjects who received screening every year, and examined the usefulness of combined screening by the two methods.
Results: Of 86 subjects with breast cancer, 20 (23.3%) underwent combined mammography and ultrasonography screening in addition to clinical breast examination. By both methods, it was determined that detailed examination would be required for 65% (13/20). However, cancer was not detected in 20% (4/20) by ultrasonography and 15% (3/20) by mammography. Of the subjects who received screening every year, only 21.4% habitually received combined screening and regarding clinical stage, 63.6% (7/11) had ductal carcinoma in situ.
Conclusion: This study suggested that combined mammography and ultrasonography screening performed every year would reduce the non-detection rate of infiltration cancer.

View full abstract

Background: AminoIndex^TM Cancer Screening (AICS) is a novel cancer screening test that has been recently developed and is now in practical use for evaluating the probability of six types of cancers (lung, gastric, colorectal, prostate, breast and uterine/ovarian). The AICS test is based on “AminoIndex Technology”, which involves the multivariate analysis of the plasma free amino acid (PFAA) concentration between cancer patients and healthy controls. In this study, the validity of the AICS rank classification was assessed through a comparison of the distribution of AICS values for the developed theoretical pattern and the pattern seen in practice in Ningen-Dock.
Methods: The AICS test was assessed in 799 subjects (494 men, 305 women, average age: 59±11) at Mitsui Memorial Hospital. The frequencies of AICS rank C (recommended for detailed examination) and the distribution of AICS values were compared with the theoretical values defined during development.
Results: The frequencies of rank C in examinees of 6.8%, 3.0%, and 3.8% for AICS (colorectal), AICS (breast), and AICS (uterine/ovarian), respectively, were not significantly different from the theoretical frequency (5%), and the distribution of AICS values obtained in practice was equivalent to the theoretical values. The frequencies of rank C for AICS (lung), AICS (gastric), and AICS (prostate) in the examinees of 10.1%, 10.8%, and 11.3%, respectively, were significantly higher than the theoretical values, and there was a significant difference in the distribution of AICS values obtained in practice and the theoretical values.
Conclusion: As the frequencies of AICS ranks were virtually equivalent to the theoretical frequencies, our findings suggested that AICS would be applicable as a novel cancer screening test.

View full abstract