Objective: The purpose of this study was to evaluate the usefulness of dual-energy subtraction (DES) chest X-ray images of soft and bony tissues in improving the detection of lesions and provide patients with clear explanations.

Methods: In the 3 years immediately before and after the introduction of DES, 22,000 and 26,276 patients underwent chest X-ray examination, respectively. We compared the rates of exact examinations requested and cancer detection before and after the introduction of DES. In addition, we surveyed five doctors each for the usefulness of DES in diagnostic and explanatory tasks.

Results: The request rate for a detailed examination increased from 1.92% prior to the introduction of DES to 2.34% post introduction. The cancer detection rate increased from 0.03% to 0.08% post introduction of DES (p<0.05). In the questionnaire for doctors who perform diagnostic reading, all doctors responded that DES was useful as a supporting technique, and 4 out of 5 doctors agreed that DES was useful for explaining the results.

Conclusions: DES imaging of soft and bony tissues improved lesion detection. In addition, DES was useful for improving accuracy, supporting interpretation, and explaining the findings of chest X-ray examinations to patients. As patients can clearly see the lesions on DES images, they may be encouraged to undergo a full examination, and consequently, the cancer detection rate may increase. Moreover, detection of calcifications in the coronary arteries alerts physicians regarding the presence of cardiac disease and is useful in lifestyle guidance.

Objective: The progression of chronic obstructive pulmonary disease (COPD) can be prevented by proper management; therefore, early detection and treatment is crucial. However, 90% of the estimated 5.3 million COPD patients in Japan are undiagnosed. In this study, low-dose computed tomography (CT) scanning, respiratory function testing, and surveys via questionnaires were performed at the same time to screen for COPD and identify the factors contributing to COPD.

Methods: Of the 266 examinees who underwent population based low-dose CT for lung cancer screening, 123 agreed to undergo screening for COPD. Based on the COPD guidelines in Japan, forced expiratory volume (FEV)_1.0％<70% was defined as airflow obstruction. The relationship between air flow obstruction and factors such as sex, age, smoking index, BMI, and percent low attenuation area (%LAA) were studied.

Results: Airflow obstruction was observed in 9 patients. In logistic regression analysis, the following factors were identified as significantly contributing to the presence of airflow obstruction: BMI (p<0.01), smoking index (p<0.05), and %LAA (p<0.05). The receiver operating characteristic curve was created by calculating the predicted values, which was estimated using a regression equation with frequent wheezing (p=0.07) and morning sputum entanglement (p=0.14) as explanatory variables. The area under the curve was 0.942, and the sensitivity and the specificity were 89% and 93%, respectively.

Conclusion: By combining questionnaires and low-dose CT examinations, COPD screening could be possible with a relatively high accuracy.

Objective: To clarify whether butylscopolamine (BS) administration is useful in visualizing the upper gastrointestinal (GI) tract on x-ray examination.

Methods: We included patients who had undergone upper GI x-ray examination from August 2015 to August 2019. To eliminate the bias of gastrointestinal peristalsis, we excluded patients with diabetes mellitus, Parkinson’s disease, anticholinergic drug use, intestinal motility promoter drug use, and previous gastrectomy. To adjust for confounding factors, propensity scores for BS administration adjusted for age, sex, body mass index, height, examiner, and presence or absence of chronic gastritis findings were produced, and propensity score matching was performed to establish the BS and non-BS administration groups. For evaluating visualization, the upper GI tract was divided into 15 areas, and one point was given for each area if poor visualization was present due to poor dilatation. If poor visualization was present due to overlapping of the intestine, one point was given if the area of overlap was the size of the antrum. These points were combined to create a poor visualization score. The poor visualization scores in the BS and non-BS groups were compared.

Results: Of 8,679 cases, 233 patients in the BS group and 235 patients in the non-BS group were included in the analysis. The proportion of patients with a poor visualization score ≥4 was 11.6% (27/233) in the BS group and 20.4% (48/235) in the non-BS group. The score was significantly lower in the BS group (p=0.011).

Conclusion: BS administration may improve visualization in upper GI x-ray examination.

Objective: To determine age-specific prevalence and incidence rates of atrial fibrillation (AF) in a general Japanese population.

Subjects and Methods: Age-specific (30–39, 40–49, 50–59, 60–69, 70–79, and 80–89 years) prevalence rates of AF were determined using a dataset of 264,029 subjects (119,595 females and 144,434 males), who underwent an annual health checkup in 2018. Furthermore, age-specific incidence rates of AF (the same age category) were determined using a dataset of 212,433 individuals (94,252 females and 118,181 males) without prevalent AF, who underwent at least one survey out of the subsequent four surveys in the 2013 annual health checkup. The observation period (person-years) for each individual was determined by calculating the period from the date of the initial survey to the first date of AF incidence. Subjects who never experienced AF incidence were administratively censored at the last survey.

Results: Age-specific (30–39, 40–49, 50–59, 60–69, 70–79, and 80–89 years) prevalence rates of AF were 0.01%, 0.02%, 0.08%, 0.44%, 1.31%, and 3.52%, respectively, in females and 0.06%, 0.23%, 0.99%, 2.97%, 5.61%, and 8.10%, respectively, in males.

  There were 350 female and 1,214 male incident AF cases during the period (mean period = 4.2 years). Age-specific (30–39, 40–49, 50–59, 60–69, 70–79, and 80–89 years) incidence rates of AF were 0.07%, 0.03%, 0.48%, 1.06%, 3.06%, and 7.32%, respectively, in females and 0.24%, 0.76%, 2.41%, 4.78%, 7.45%, and 10.22%, respectively, in males.

Conclusions: We determined the age-specific prevalence and incidence rates of AF in Japanese people aged between 30 and 89 years. Our results indicated the need to encourage AF patients to visit clinics for decreasing AF-associated burdens.

Objective: This study aimed to elucidate the clinical features and endoscopic findings in patients with eosinophilic esophagitis (EoE) during a medical check-up.

Methods: This observational study was conducted on patients diagnosed with EoE during a physical examination at the MedCity21, Osaka City University, and randomly recruited age- and sex-matched healthy controls (1:1 ratio). Clinical characteristics, gastrointestinal endoscopic findings, and standard physical examination findings were analyzed using univariate analyses and compared between the patient and control groups, using multivariate logistic regression analyses for items with a p-value of < 0.1. Additionally, the detection rate of unique endoscopic findings in the patient group was also examined.

Results: A total of 94/20,145 participants were diagnosed with EoE, with a 0.47% detection rate. Longitudinal grooves were the most characteristic endoscopic findings of EoE observed in 93% of patients. Univariate analyses showed that the prevalence of alcohol consumption, dysphagia or heartburn symptoms, and serological allergy were significantly higher in the patient group than in the control group. Multivariate analyses indicated that alcohol consumption, dysphagia or heartburn symptoms, history of allergies, and the absence of Barrett’s esophagus were independent risk factors for EoE.

Conclusions: It is critical to evaluate the eosinophil count in the esophageal mucosa of patients with a history of allergic diseases and alcohol consumption, symptoms of choking or heartburn, and the absence of Barrett’s esophagus on endoscopic examination, to improve the EoE detection rate during a medical check-up.

Objective: We studied the standing posterior-anterior (PA) position recommended by the spinal checkup guidelines using lumbar X-ray in the supine anterior-posterior (AP) position AP.

We believed that compared to the supine AP image, the standing lumbar spine image had tilted to the left and right; hence, we examined its usefulness.

Next, we aimed to combine the gradation-processed thoracic and lumbar images to evaluate coronal spinal alignment.

Methods: The study included 60 patients with mild scoliosis with a Cobb angle of 3º or more on standing lumbar X-ray.

We measured and compared the Lumbar Spine Cobb Angle (LSCA) using findings in both standing and supine positions.

Next, from the combined spinal images, we classified the deformity into three types of curve patterns: single curve (SC), double curve (DC), and triple curve (TC); we further investigated the relationship between coronal spinal alignment and standing LSCA.

Results: The LSCA in the standing position was 6.5º, which was significantly higher than that in the supine position of 3.0º.

The relationship between the three curve patterns and the standing LSCA for DC, TC, and SC were 6.9º, 9.2º, and 3.8º, respectively; the former two are significantly higher than that for SC indicating the progression for spinal alignment deformity.

Conclusions: Lumbar X-ray in the standing PA position is useful.

The progression of mild scoliosis (increased lumbar spine Cobb angle) was significantly involved in the deformity of the upper vertebral body, suggesting an imbalance in spinal alignment.

Objective: Biomarker-based early detection of Alzheimer’s disease (AD) and mild cognitive impairment (MCI) is important for early intervention and prevention of dementia. We previously developed an ‘MCI screening blood test’ involving the testing of triple markers (apolipoprotein A1, transthyretin, and complement protein C3) for the evaluation of cognitive impairment in older adults. In this study, we combined the MCI screening blood test with testing of plasma Aβ40 and Aβ42 levels to evaluate the clinical potential of these five markers in the diagnosis of MCI and AD.

Methods: Through an immunoassay, we measured plasma Aβ40 and Aβ42 levels and triple marker levels in samples of 178 AD, 145 MCI, and 40 cognitively healthy elderly (NDC) patients.

Results: Plasma levels of the triple markers were lower in MCI and AD than in NDC patients. Receiver operating characteristic curve analysis revealed that the composite of triple markers had relative area under the curve (AUC) values of 0.81 and 0.74 in AD vs. NDC and MCI vs. NDC, respectively. The Aβ40/42 ratio had an AUC of 0.71 (AD vs. NDC) and 0.62 (MCI vs. NDC). Furthermore, addition of the triple markers to the Aβ40/42 ratio resulted in AUC values of 0.85 (sensitivity 80%, specificity 85%) in AD vs. NDC and 0.81 (sensitivity 77%, specificity 73%) in MCI vs. NDC.

Conclusion: Blood tests determining these triple markers’ levels and the Aβ40/42 ratio may be useful during routine health checks to evaluate the progression of cognitive impairment in older adults.

Objective: To determine the value of transvaginal ultrasonography with color Doppler for detecting endometrial polyps in gynecologic examinations.

Methods: We compared the number, size of endometrial polyps, and background of endometrial echogenicity diagnosed before (1 April 2013 to 31 March 2016) and after (1 April 2016 to 31 March 2019) the introduction of color Doppler.

Results: Endometrial polyps were found in 47 of 16,089 patients before, and 286 of 17,182 patients after, the introduction of color Doppler. B mode transvaginal ultrasonography detected 33 endometrial polyps whereas examinations combining B mode and color Doppler detected 253 endometrial polyps. The diameters of endometrial polyps diagnosed with color Doppler were smaller than those diagnosed with B mode. Color Doppler imaging increased the number of cases detected in hyperechoic endometrium where endometrial polyps are not recognized easily by B mode. Before and after the introduction of color Doppler, second-stage tests were performed for 29 and 199 patients, respectively. Among them, the number diagnosed with intracavity pathology, which included other endometrial disease, was 26 before, and 150 after, the introduction of color Doppler.

Conclusion: These results suggested that color Doppler was highly useful for detecting endometrial polyps in gynecologic examinations.

  Early detection of pancreatic cancer is difficult; therefore, it is not uncommon for it to be diagnosed at an advanced stage, even among individuals who undergo annual Ningen Dock examinations. Here, we describe a case of early-stage pancreatic cancer diagnosed 9 years after an abnormality was identified by Ningen Dock. The patient was a 64-year-old man who had been undergoing Ningen Dock every year since 2004. In his 2011 Ningen Dock, his CA19-9 levels were elevated, and an abdominal contrast-enhanced computed tomography examination was performed. An intraductal papillary mucinous neoplasm of the pancreas (pancreatic IPMN) was discovered. Follow-up with the gastroenterology department was conducted in parallel with Ningen Dock. In March 2020, pancreatic magnetic resonance imaging (MRI) showed irregular narrowing of the main pancreatic duct in the head of the pancreas and endoscopic ultrasonography (EUS) and endoscopic retrograde cholangiopancreatography (ERCP) were performed. Cancer cells were identified in the pancreatic juice and pancreatic duct scraping cytology, and the patient was subsequently diagnosed with pancreatic head carcinoma, T1N0M0 Stage IA. After receiving neoadjuvant chemotherapy, the patient underwent surgical treatment on June 15, 2020, and the resected specimen was diagnosed with pancreatic cancer of IPMN origin. Notably, the pancreas had not been visualized on the patient’s January 2020 Ningen Dock abdominal echography, which had been carried out just before the MRI that led to the diagnosis. To increase the early detection rate of pancreatic cancer in Ningen Dock, it is advisable for physicians to take note of how visible the pancreas is on the abdominal echography and recommend pancreatic examination through MRI or a second abdominal echography for examinees with risk factors, such as a family history of pancreatic cancer and pancreatic cysts, and for those whose pancreas was not adequately visualized.

Objective: A pandemic of the coronavirus disease (COVID-19) has been present since December 2019. On April 16, 2020, Japan declared a nationwide state of emergency, forcing people to voluntarily isolate themselves and raising concerns about the adverse effects of COVID-19 on the health status of the population. This study aimed to investigate changes in health status during the COVID-19 epidemic by comparing the outcome with the results of previous health examinations.

Methods: Changes in health were identified using test results and a questionnaire for specific health checkups that tested health performance and lifestyle. 16,581 subjects (12,445 males and 4,136 females) underwent occupational checkups from March to May every year between 2017 and 2020. Changes were compared separately for males and females between 2017 and 2018 (Δ18–17), 2018 and 2019 (Δ19–18), and 2019 and 2020 (Δ20–19).

Results: For both men and women, test values of Δ20–19, which was significantly higher than Δ18–17 and Δ19–18 without significant differences between Δ18–17 and Δ19–18 were systolic blood pressure and fasting triglyceride levels. As a characteristic lifestyle change in 2020, the number of people with sufficient sleep time increased significantly compared to previous years.

Conclusions: An increase in sleep time due to the effects of the COVID-19 pandemic was observed, and a significant increase was observed in systolic blood pressure and fasting triglyceride levels. Therefore, it remains important to continually undergo medical examinations to check one’s health condition even during a pandemic.

Objective: To enhance the health instruction of examinees in the comprehensive health checkup system, we provided health instruction education that incorporates role-playing to those who have no experience in health instruction (inexperienced people). Additionally, we standardized the content and increased the number of instructors.

Methods: The study involved 14 research participants, including six with prior experience in health instruction (experienced people) and eight inexperienced participants. The theme of the role-play revolved around the issues perceived by inexperienced people, and this was repeated seven times. Initially, the inexperienced people observed the role-plays of the experienced people. Following this, they participated in the role-plays, alternating between the roles of instructor, examinee, and observer. The ideas and recommendations raised in the previous workshop were incorporated as examples for the subsequent rounds. After each role-play, the participants exchanged opinions, and the experienced people shared their success stories and their knowledge of instruction. Furthermore, a questionnaire survey was conducted to determine their level of understanding and satisfaction with the contents of each workshop. After the completion of all the workshops, the degree of achievement was confirmed, quantified, and evaluated based on the academic society’s health instruction skill checklist.

Results: Prior to the workshop, the inexperienced participants expressed their concerns about receiving instructions on life improvement. However, after the workshop, they said that they were glad to learn about specific instruction methods. The results of the questionnaire revealed that the degree of understanding was an average of 8.9 points, while the degree of satisfaction was an average of 9.1 points (out of 10 points). Furthermore, the average results of the 10 people who underwent the skill assessment were 78.1 and 75.8 points for experienced and inexperienced people, respectively. These results met the achievement criteria (50 points or more out of 80 points).

Conclusions: By organizing regular workshops that incorporate role-playing, even inexperienced people can now implement standardized health instructions.