[in Japanese]

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Objective: Chest X-ray is the most common screening procedure for detection of lung cancer. They play a significant role in both private and public health screening programs. However, if subjects have old inflammatory shadows, such as those due to tuberculosis, this will make it difficult to detect lung cancer.
Methods: Our clinic, MedCity21, was established as an outpatient clinic to provide complete health check-ups aiming at pre-emptive preventive medicine. Examinees with abnormalities detected in chest X-rays are announced by our calling system and invited to our clinic for further examinations (exams). Here, we report the chest X-ray results for the complete health check-ups.
Results: 5,603 subjects who underwent private health screening programs including chest X-ray exams at our clinic between January 1st and December 31st 2015 were enrolled in this study. Abnormalities were detected in X-rays for 230 (4.1%) individuals and 174 (76%) of them underwent a chest CT scan at our clinic. Abnormal shadows, including those for 106 nodules and 17 ground glass opacities, were detected in 156 (89.7%) of these examinees. Four examinees were diagnosed as lung cancer within 12 months of the health check-up. The lung cancer detection rate was 0.07%. The standardized detection ratio: “number of individuals with detected lung cancer” divided by “expected lung cancer presence” was 1.02.
Conclusions: Chest CT scans clarified the details of abnormal lung shadows in 174 examinees. Our findings may contribute to the early prevention and treatment of lung cancer.

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Objective: The aim of the present study was to investigate differences in the seasonal incidence and risk factors of cardio-cerebrovascular events such as acute myocardial infarction and stroke.
Methods: Subjects were 10,450 company employees who underwent a routine health check-up and were followed-up for 1 year.
Results: Twelve such events (acute myocardial infarction [n=5], cerebral hemorrhage [n=2], subarachnoid hemorrhage [n=3], and cerebral infarction [n=2]) were reported. The mean age of those who suffered acute myocardial infarction or stroke was 50.4 years. All were male. There was a seasonal variation in cardio-cerebrovascular events. Bimodal peaks in summer and winter were observed for acute myocardial infarction events. Stroke events were distributed throughout the year, but there were some differences in the risk factors for acute myocardial infarction and stroke. The percentage of those with visceral obesity was higher among acute myocardial infarction patients than stroke patients. The latter had a high incidence of high blood pressure, especially in the case of intracranial hemorrhage. High incidences of smoking and hypercholesterolemia were observed in acute myocardial infarction patients.
Conclusion: Although acute myocardial infarction and stroke occur as a result of common vascular disorders, the seasonal incidence and risk factors for each disease were somewhat different. Bimodal peaks were observed for acute myocardial infarction and stroke events were likely to be distributed throughout the year. Visceral obesity was more common among acute myocardial infarction patients than stroke patients.

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Objective: In blood pressure pulse wave examinations (exams), brachial-ankle pulse wave velocity (baPWV), an indicator of arterial stiffness, is easily measured. In the present study, we examined associations among blood pressure pulse wave exams results and health check-up results, in particular chest X-ray cardiovascular silhouette findings, and verified the significance of this in the early diagnosis of arteriosclerosis.
Methods: In 202 subjects who underwent blood pressure pulse wave exams at our center, we investigated arteriosclerosis risk factors in health check-up results (gender, age, BMI, systolic blood pressure, LDL-cholesterol, fasting blood glucose) and examined correlations with baPWV measurements. In addition, from the X-ray films, we measured the cardiothoracic ratio and aorta diameter, observed whether aortic arch calcification was present or not, and examined associations with baPWV.
Results: Regarding associations of baPWV and risk factors, although no significant correlations were observed for gender, BMI or LDL-cholesterol, there were strong correlations with age, systolic blood pressure and fasting blood glucose. As for chest X-ray findings, while baPWV was strongly correlated with aorta diameter, it was not correlated with cardiothoracic ratio. In addition, baPWV was significantly higher in subjects with aortic arch calcification (n=64) than in those without (n=138).
Conclusion: The findings suggested that there is an increase in baPWV even before vascular morphological abnormalities occur in arteriosclerosis. Blood pressure pulse wave exams should be useful in Ningen Dock as a potential indicator for early diagnosis of arteriosclerosis.

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Background: AminoIndex_® Cancer Screening (AICS) is based on AminoIndex_® Technology, which involves multivariate analysis of differences in plasma amino acid concentrations between cancer patients and healthy subjects. It has been developed as a novel cancer screening technique which evaluates the probabilities of seven-types of cancer incidence in examinees and determines whether they require further testing or not. We previously reported the frequency of rank C, the rank that requires detailed examination, among 799 examinees, and the results of detailed examinations. In this study, we report the distribution of AICS ranks, the results of detailed examinations of rank C subjects and positive predictive values for a larger cohort of 5,172 examinees.
Methods: The distribution of AICS ranks, the results of detailed examinations for rank C subjects and positive predictive values were investigated in 5,172 examinees at Mitsui Memorial Hospitals.
Results: One lung cancer patient, 3 gastric cancer patients, 3 colorectal cancer patients, 6 prostate cancer patients and 4 breast cancer patients were found through detailed examination of rank C subjects. The positive predictive values for AICS (lung), AICS (gastric), AICS (colorectal), AICS (prostate), AICS (breast) and AICS (uterine/ovarian) were 0.37%, 0.75%, 1.19 %, 1.80 %, 3.57% and 0 %, respectively. The detection rate of cancer by AICS was 0.33%, which was superior to that of 0.26% reported in the results of the national survey by Japan Society of Ningen Dock in 2015.
Conclusion: These results suggested that AICS could be a useful, novel cancer screening method.

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Objective: To systematically review and analyze studies on specific health guidance in the literature up to now in order to determine its effectiveness as well the degree of improvement resulting from it.
Methods: We conducted a search of the literature using Japan Medical Abstracts Society and PubMed data for studies on specific health guidance from April 2008 to September 2014. From the studies selected, we extracted changes in laboratory values that would be stratification criteria for specific health examinations (SHE) and performed a meta-analysis of the data using weighted mean differences.
Results: Based on the inclusion and exclusion criteria, 7 studies were selected. According to the meta-analysis, differences in changes between the control group and support groups were as below. As compared to the control group, there were significant improvements in the active support group regarding weighted mean changes for the following (95% CI in parenthesis): body weight (kg), -1.31 (-1.67, -0.94); BMI (kg/m²), -0.45 (-0.57, -0.33); abdominal circumference (cm), -1.49 (-2.02, -0.95); systolic blood pressure (mm Hg), -80 (-1.46, -0.13); triglycerides (mg/dL), -7.47 (-13.45, -1.49); HDL cholesterol (mg/dL), 0.88 (0.53, 1.23); fasting blood glucose (mg/dL), -1.72 (-2.84, -0.61); HbA1c (%) -0.06 (-0.10, -0.03). Compared to the control group, there were significant improvements in the support group with motivation regarding weighted mean changes for the following (95% CI in parenthesis): body weight, -1.01 (-1.30, -0.73); BMI, -0.40 (-0.55, -0.26); abdominal circumference, -1.15 (-1.65, -0.64); triglycerides, -6.95 (-11.74, -2.17); HDL cholesterol 0.71 (0.04, 1.37). Versus the control group, there were significant improvements in the following for all support groups together regarding changes (95% CI in parenthesis): body weight, -1.10 (-1.29, -0.92); BMI, -0.42 (-0.49, -0.35); abdominal circumference, -1.29 (-1.62, -0.96); systolic blood pressure, 0.67 (-1.26, -0.07); diastolic blood pressure, -0.45 (-0.88, -0.01); triglycerides -7.17 (-10.56, -3.79); HDL cholesterol, 0.79 (0.49, 1.09); fasting blood glucose, -1.01 (-1.97, -0.04); HbA1c, -0.07 (-0.11, -0.04).
Conclusion: Specific health guidance is effective in improving laboratory values that would be criteria for stratification in SHE. As heterogeneity is observed in some laboratory values, analysis of subgroups according to subject characteristics and health guidance method is needed.

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Objective: We examined the effectiveness of diagnosis of Helicobacter pylori (Hp) infection-induced gastritis by gastro-fluoroscopy, and compared evaluations by the ABC classification with the presence or absence of Hp infection-induced gastritis based on gastro-fluoroscopy findings. We also investigated Hp antibody (Ab) titers and optimum determination levels for the pepsinogen (PG) test to reduce False A group results (Hp infection-induced gastritis in A group of ABC classification).
Methods: In 1,153 examinees who underwent gastro-fluoroscopy together with evaluation by the ABC classification from June 2014 to May 2015, we examined Hp infection diagnoses by distribution and properties of the gastric area image and folds as well as correlations between presence or absence of Hp infection-induced gastritis based on gastro-fluoroscopy findings and HpAb titers and PG levels.
Results: A diagnosis of Hp infection from gastro-fluoroscopy findings was made in 97% of examinees with HpAb more than10U/mL. The proportion of subjects determined to be False A group was 26%. We were able to reduce the figure for False A group in the ABC classification manual by 60% by adding HpAb 3U/mL or over for 60 years old or older and by satisfying one of the conditions: PG I 30 ng/mL or less, PG II 15 ng/mL or more, or PG I/II ratio 4 or less.
Conclusion: In the ABC classification, the cutoff values for the PG test and HpAb titer should be amended in consideration of age to reduce False A group results. Gastro-fluoroscopy provides important information in diagnosis of Hp infection-induced gastritis and should be combined with the ABC classification to achieve effective cancer screening.

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Objective: Plasma free amino acid (PFAA) profiles indicate a person’s health with regard to nutritional status and disease risks. In this study, we investigated the clinical characteristics of a Japanese subpopulation with low plasma free essential and semi-essential amino acid levels.
Methods: Plasma free essential and semi-essential amino acids were quantified in a total of 10,102 Japanese subjects who underwent a full health check-up. Low plasma amino acid levels were defined as lower than mean - 2×SD (standard deviation) after conversion to standardized values. Then, associations between low plasma free essential and semi-essential amino acid levels and deviations from health indicator reference ranges were analyzed.
Results: Among the 10,102 subjects, 16.6% were classified as the low plasma free essential and semi-essential amino acid levels subpopulation, whose subjects had low levels of one or more plasma free essential and semi-essential amino acids. In this subpopulation, the proportion of subjects who were outside the reference ranges for protein nutrition was significantly higher than in the rest of the subjects. Furthermore, the rates for subjects who were outside the reference ranges for indicators related to various conditions including anemia, cardiovascular diseases and infectious diseases were significantly higher in this subpopulation.
Conclusion: The findings of this study suggest that profiles of plasma free essential and semi-essential amino acids could be a beneficial surrogate marker for health risks associated with reduced quality of life (QOL).

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Complete atrioventricular block is defined as interrupted conduction between the atrium and ventricle. When the block is below the atrioventricular node, the wide QRS complex escape rhythm arises at or below the His bundle with a rate slower than 40 beats/min. Patients with it are generally symptomatic and consult a doctor voluntarily. When the block is at the level of the atrioventricular node, the narrow QRS complex escape rhythm arises from a junctional pacemaker with a relatively preserved heart rate and the symptoms of such patients are mild. However, if atrioventricular block is symptomatic and irreversible, pacemaker implantation should be considered to prevent sudden cardiac death or exacerbation of heart failure.
A 33-year-old woman presented with dyspnea on exertion, but did have any sense of unease about this. She was diagnosed with complete atrioventricular block from electrocardiography in a general check-up. The complete atrioventricular block in this case was proved to be idiopathic and induced latent heart failure. A cardiac pacemaker was implanted and the dyspnea improved. Nearly all patients with complete atrioventricular block present with some degree of symptoms and consult a doctor. However, the severity of symptoms can vary and few patients are found in electrocardiography conducted in general health check-ups. Medical staff engaged in general checkups should pay attention to complete atrioventricular block. Asymptomatic or mildly symptomatic cases are more likely to be young, otherwise-healthy patients with a high junctional escape rhythm. However, such patients may not act on referrals to cardiologists, so they should be encouraged appropriately to receive consultation after the general health check-up.

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We report the unusual case of a patient with a right hepatic artery aneurysm developing 20 years after an omental patch operation for duodenal ulcer perforation. When a 51-year-old man visited our Ningen Dock (health check-up) center, an abdominal ultrasound examination revealed a right extrahepatic artery aneurysm of 13 mm in diameter. As the patient did notice any symptoms, he ignored our recommendation for further examination and underwent Ningen Dock again a year later. As there had been no growth in the aneurysm, it was decided to conduct a follow-up examination each year．After that, the aneurysm grew slowly and was 21 mm in size six years later. He agreed to the treatment recommendation made then and coil embolization was performed successfully.
No other reports of hepatic artery aneurysm developing after an omental patch operation were found in a literature search. This seems to be the first case report. We feel it is of interest regarding aneurysmal behavior and decision making in such a case.

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Objective: To survey awareness of and preference for cervical cancer screening by transvaginal ultrasonography among women being screened for uterine cancer.
Methods: In 3,720 women being screened for uterine cancer, awareness of and preference for cervical cancer screening by transvaginal ultrasonography were surveyed using a questionnaire.
Results: The questionnaire survey revealed that 60.7% (2,258) and 37.6% (1,397) desired screening for gynecologic diseases other than uterine cancer and ovarian diseases, respectively, and 77.7% (2,890) desired uterine cancer screening by transvaginal ultrasonography.
Conclusions: In this study, nearly 80% of women desired screening for uterine cancer by transvaginal ultrasonography. This technique should lead to increased satisfaction among women being screened for uterine cancer.

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