In Japan, there are approximately 9,500,000 people in whom the possibility of diabetes mellitus cannot be denied and another 11,100,000 people who are suspected of having diabetes mellitus. Once complications of diabetes progress in a patient, an elevated risk of loss of vision as well as loss of renal function leading to dialysis are inevitable. Strategies to prevent the deterioration of diabetes mellitus include: 1) reduction in the incidence of diabetes by intervention, 2) early diagnosis of the disease and avoiding examinees being left untreated, 3) reducing the number of patients who drop out from medical institutions, and 4) keeping good glycemic control.

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[in Japanese]

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Objective: Hypertension is reported to be a risk factor of cerebral white matter lesions (PVH and DSWMH). We examined other risk factors of white matter lesions using data from brain dock examinees. We also investigated an association between blood pressure level of hypertensive examinees and chronological changes in white matter lesions.
Methods: The subjects were 110 brain dock examinees who visited our clinic in 2011.We studied an association between cerebral white matter lesions and risk factors for atherosclerosis using white matter progression scores (4 stages for both PVH and DSWMH). We also evaluated the chronological progression of white matter lesions and studied an association between blood pressure and progression of white matter lesions.
Results: In a group with white matter lesions, age and levels of SBP, LDL-C, TC and HbA1c were significantly higher than in a group without them. Significant development of white matter lesions was seen in the group with white matter lesions compared to the group without them. In hypertensive examinees, no significant difference was seen in chronological development of cerebral white matter lesions between a well-controlled group (BP < 140/90 mmHg) and a poorly controlled group (BP≥ 140/90 mmHg).
Conclusion: Elderly examinees with high-grade cerebral white matter lesions should be followed up continuously because their white matter lesions develop chronologically. Our findings suggested that cerebral white matter lesions in hypertensive examinees developed chronologically even if their blood pressure had been well controlled. They also suggested that other risk factors besides hypertension were aging, dyslipidemia, diabetes, smoking and metabolic syndrome.

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Objective: HDL cholesterol (HDL-C) levels in smokers are reported to be lower than in non-smokers. On the other hand, drinking is known to increase HDL-C. Moreover, HDL-C has also been found to decrease when weight increases. However, while it has been reported that non-smokers weigh more than smokers and the mutual effects of smoking, drinking and weight gain on HDL-C are not clear. In this study, the objective was to investigate the effects of drinking initiation and non-smoking on weight gain and HDL cholesterol in male smokers.
Methods: The study subjects were 10,765 male smokers whose response was “non- drinking” in an interview in FY 2008, and who had undergone consecutive annual health check-ups at Shinkokai Medical Corporation in FY2008 and FY2009 consecutively, and grouped into five groups by the interview answers in FY2009. The 4,387 people whose response was “non-smoking + non-drinking” two years in a row were group (a). The 5,507 whose response was “smoking + non-drinking” in FY 2009 were group (b). The 278 whose response was “non-smoking + non-drinking” in FY2009 were group (c). The 539 whose response was “smoking + drinking” in FY2009 were group (d). The 54 whose response was “non-smoking + drinking” in FY2009 were group (e). To compare the mean changes from 2008 to 2009, repeated measures ANOVA was conducted by the general linear model.
Results: From FY 2008 to FY2009, body weight and HDL-C in FY2008 and FY2009 both increased significantly in group (c) (“non smoking + non-drinking” Body weight: +1.25 kg, HDL-C: +2.2 mg/dL). In the other groups there was a small amount of weight gain. HDL-C decreased in all groups other than group (c).
Conclusion: In smokers, the influence of non-smoking on weight gain is greater than that of drinking. Thus, drinking may not necessarily lead to an increase in HDL-C.

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Objective: Our clinic performs occupational breast cancer screening. The screening items vary depending on the health insurance association and workplace.　Aiming to achieve breast cancer screening tailored to individual situations, based on screening results, we created a system providing optimal screening for examinees.
Methods: For those undergoing breast cancer screening, we established recommended items for the next screening. These are items recommended for the next year’s screening on the basis of presence or absence of abnormal findings and mammary gland structure seen in images by mammography specialists. They are recorded in a results management system and printed out as a results report after the screening to clarify the items for the next year’s screening. On the day of screening, if the examinee selects items that do not match the recommended items for the next screening, he or she is encouraged to add items or make changes to them through printed explanations or those from the various departments concerned.
Results: The provision of recommended items for the next screening is an educational activity for those undergoing breast cancer screening. Over time, the recommendation of items for the next screening to examinees has been spreading. Encouraging examinees to have additional screening items or make changes to them has been useful in raising the cancer discovery rate. Inputting recommended items for the next screening to the results management system has enabled information sharing not just among doctors but also with nurses, radiologists, medical technologists, reception staff, Information Management and other departments concerned.
Conclusion: The system that we created can provide optimal breast cancer screening for various situations.

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Objective: The clinical value of several imaging examinations is being increasingly recognized. In this study, we investigated the clinical significance of visual inspection and palpation in breast cancer screening on the basis of epidemiological results as well as the views of a population being screened for cancer.
Methods: Of 33,337 women who underwent breast cancer screening between June 2009 and March 2015, 151 who recalled undergoing visual inspection and palpation alone were enrolled. Informed consent was obtained from all participants. Additionally, we conducted a questionnaire survey of the views of a sample population of 4,311 women who underwent breast cancer screening between April 2013 and March 2015.
Results: The recall rate for receiving visual inspection and palpation alone was 0.45% (151 of 33,337 women). Of the 91 women who received a final diagnosis from a breast cancer specialist, 44 (48.4%) had no significant finding of breast disease. Mastopathy and fibroadenoma were detected in 20 (22.0%) and 12 (13.2%) women, respectively. Seven of the 91 women (7.7%) had malignant mammary tumors (carcinoma in 6, sarcoma in 1). Only 4.5% (196 of 4,311) of the women did not wish to undergo visual inspection and palpation by a doctor, whereas 78.0% (3,361 of 4,311) wanted to be able to use any of the currently available screening options.
Conclusions: Visual inspection and palpitation may motivate women to undergo periodic check-ups and may prevent deaths due to breast cancer.

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Objective: To clarify factors associated with the new-onset (DM-new) or remission (DM-rem) of diabetes mellitus (DM).
Methods: The generalized-estimating-equation logistic model (GEE-L) was applied to periodic health check-up data of subjects aged 40-65 as of April 2008, who had repeatedly visited our facility from fiscal 2008 to 2013, to perform a longitudinal analysis of factors associated with DM-new or DM-rem. Diabetic was defined as diabetic type or diabetes according to JDSG-2013, or medication for DM. Also, fasting plasma glucose level less than 110mg/dL and/or HbA1c value less than 6.0% was defined as normal. DM-new and DM-rem were defined, respectively, as shift from normal to diabetic or diabetic to normal (without any medication for DM). Once DM-new or DM-rem had been determined, the subject was excluded from further analyses. Possible explanatory factors associated with DM-new or DM-rem also analyzed included medication with antihyperlipidemic drugs (AHLPD), gender, age, body mass index (BMI), and familial aggregation of DM (FADM).
Results: Of 37,981 and 3,935 subjects determined to be normal and diabetic, respectively, 769 and 421 subjects were observed to shift to DM-new and DM-rem, respectively. GEE-L analyses revealed that all five factors were significantly associated with DM-new, and BMI reduction or FADM had significant positive or negative associations with DM-rem, while there was no significant association between AHLPD and DM-rem.
Conclusion: AHLPD and another four factors raised the risk of DM-new. Although FADM may inhibit DM-rem, AHLPD may not significantly affect DM-rem. BMI reduction was important for remission of DM.

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Background: Previous studies have shown seasonal variation in LDL cholesterol (LDL-C) levels. However, there have been no studies on seasonal variation in LDL-C levels in Ningen Dock examinees.
Subjects: The subjects swere 8,295 men and 6,802 women among Ningen Dock examinees in 2012 who were not going to hospitals for treatment of diabetes, dyslipidemia, hypertension, liver diseases, or malignant tumors.
Results: We first analyzed the data for men. The age-adjusted odds ratios of the subjects with an LDL-C level of >/= 140 mg/dL in each month against July were calculated. The months having the highest and lowest odds ratios were January (odds ratio: 1.89) and July (1.0), respectively. To examine the seasonal variation in LDL-C levels in detail, we compared the average level of serum lipids in summer (June to August) and winter (January to March) after adjusting for confounding factors. LDL-C, HDL cholesterol, and triglyceride levels in summer and winter were 122 mg/dL and 131 mg/dL (p<0.001), 57.1 mg/dL and 58.0 mg/dL (p<0.05), and 131 mg/dL and 129 mg/dL (p=0.441), respectively. When the subjects were divided according to their age, body mass index, or triglyceride levels, LDL-C levels in winter were higher than those in summer in all of the 3 subgroups. Such seasonal variation in LDL-C levels was also observed in women except for those aged >/= 60 year-old.
Conclusion: Ningen Dock data showed seasonal variation in LDL-C levels. Ningen Dock results should be interpreted in consideration of this seasonal variation.

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Objective: Among cases in which cancer was non-detectable in mammography (MMG), in those in which the location occupied by the breast cancer was the cause of non-detection, we examined the positioning of MMG as well as the necessity of breast echography (US).
Methods: For patients in whom cancer was not detected, we compared mammograms over the past 3 years with those taken in the outpatient setting.
Results: We found that positioning was the cause of non-detection. There was a lack of imaging area in the outer region for the craniocaudal (CC) and mediolateral-oblique (MLO) directions.
Conclusions: For patients who have high risk of cancer based on family medical history, we consider it necessary to study positioning and establish a system enabling the combination of US with MMG to be recommended.

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