Objective: We investigated the risk factors before the onset of new myocardial infarction (MI) with abnormal Q waves and sudden cardiac death (SCD) cases detected in multiple medical checkups.

Methods: From April 2018 to March 2021, 10,487 participants (7,242 males and 3,245 females) who underwent complete medical checkups had abnormal Q waves with negative T waves recorded on their electrocardiograms (ECGs). Of the 78 cases, 11 cases of new MI (10 males, 1 female, mean age; 62 years) and one case of SCD were confirmed based on chronological records over the previous 3 years. Risk factors before the onset were investigated in four cases of new MI (3 males, 1 female, mean age; 69 years) and one case of SCD in whom ECG asynchronous chest computed tomography (CT) was performed before the onset.

Results: Before the onset of MI, history of treatment (7 with hypertension, 7 with diabetes), systolic blood pressure 145 ± 10 mmHg, LDL-C 143 ± 35 mg/dL, and the Suita predictive index (Suita score was 55.5±6.5, 10-year probability of developing coronary artery disease was 8.1±4.5) were determined. Increased brightness (calcification) was observed in the coronary artery area related to the estimated MI site. In the case of SCD, the LDL-C level was 188 mg/dL and no treatment was performed.

Conclusions: Patients with MI and SCD had high blood pressure, DM, and LDL-C (some were untreated), and chest CT showed calcified lesions in the coronary arteries.

Objective: To evaluate the sedation level during esophagogastroduodenoscopy (EGD) using midazolam (MDZ) with the Richmond Agitation-Sedation Scale (RASS) and investigate pain and satisfaction levels through a questionnaire to determine the optimal sedation level.

Methods: From April to September 2021, 336 examinees underwent EGD under sedation. The sedative used was 2 mg of intravenous MDZ or 2.5 mg for examinees weighing ≥ 80 kg. The sedation level was assessed using the RASS 1 min after MDZ administration; the examination commenced, after which flumazenil was administered, and the dizziness was confirmed. Pain and satisfaction levels were investigated through a questionnaire.

Results: The proportions of pain, dissatisfaction, and dizziness by RASS score (%) were as follows: RASS 0: pain 47.5, dissatisfaction 33.1, dizziness 2.5; RASS -1: pain 37.6, dissatisfaction 25.6, dizziness 7.5; RASS -2: pain 29.6, dissatisfaction 16.7, dizziness 11.1; RASS -3: pain 13.4, dissatisfaction 9.1, dizziness 13.6; and RASS -4: pain 11.1, dissatisfaction 11.1, dizziness 33.3. As sedation deepened, the proportions of pain and dissatisfaction decreased; however, the pain remained at approximately ≥ 10% from RASS -3. The proportion of dizziness increased as sedation deepened.

Conclusion: RASS -3 with pain, dissatisfaction, and dizziness proportions of approximately 10% was considered the optimal sedation level. However, the effects and reactions to sedatives vary greatly among individuals. In medical check EGD, it is necessary to determine the optimal sedation level individually to avoid excessive sedation.

Objective: Early detection of pancreatic cancer by abdominal ultrasound is dependent on the reliable detection of pancreatic cystic lesions and main pancreatic duct dilatation, which are high-risk stigmata for pancreatic cancer. Here, we aimed to identify future issues in ultrasound screening for pancreatic cancer by understanding the current state of ultrasound screening at our institution and reviewing ultrasound images based on detailed examination results.

Methods: A total of 33,113 abdominal ultrasound examinations were done at our center from April 2016 to March 2021 in a total of 15,784 patients (9,198 men and 6,586 women). Average age was 48.4 ± 9.7 years. We studied a retrospective investigation of the facility’s own inspection reports and detailed inspection results.

Results: Over the 5-year period, 389 patients were identified as having pancreatic lesions (identification rate 2.46%). The number (rate) of patients requiring detailed examination based on screening findings at the time of initial indications was 111 (0.70%) with main pancreatic duct dilatation, 25 (0.16%) with solid lesions, 167 patients (1.06%) with pancreatic cystic lesions, and 10 patients (0.06%) with others. Pancreatic cancer was detected in 4 patients, cancer detection rate was 0.025%, and the positive predictive value was 1.299%. All pancreatic cancers were Stage IA-IIA. Examination findings showed main pancreatic duct dilatation in all cases and solid pancreatic lesions in 2 cases. One of these patients had been examined every year and examination revealed no abnormalities. However, he was diagnosed with pancreatic cancer two years later. Of the 136 patients with pancreatic cystic lesions who underwent thorough examination, 58 (42.6%) had intraductal papillary mucinous neoplasm (IPMN) and 49 (36.0%) had pancreatic cyst.

Conclusion: The relatively early ultrasound findings of pancreatic cancer detected in this study were main pancreatic duct dilatation and solid lesions, which are both high-risk stigmata for pancreatic cancer. For patients who undergo annual examination, even if a thorough examination reveals no abnormalities, it is necessary to recommend a second examination if findings continue to be observed.

Objective: Complete left bundle branch block (CLBBB) is associated with organic heart diseases and a poor prognosis. However, recent reports suggest that CLBBB among the younger population may not be correlated with heart disease; thus, it may carry a favorable prognosis. We aimed to investigate whether a similar trend existed in Japan.

Methods: We investigated 41,303 patients who underwent electrocardiography at the JA Kanagawa Medical Checkup Center in 2021.

Results: CLBBB was identified in 61 patients, of whom 66% were men. The overall prevalence of CLBBB was 0.15%, with rates of 0.18% and 0.11% among men and women, respectively. Prevalence increased with age. Seventeen patients (27.9%) had underlying heart diseases. Underlying heart diseases were observed among female patients > 60 years, indicating an increasing trend with age. Conversely, CLBBB was not observed among female patients < 60 years of age. This pattern was not observed among men, as underlying heart diseases were detected from those in their 40s. No significant difference between men and women was observed in the age of onset of CLBBB. However, regarding CLBBB cases associated with underlying heart diseases, a significant difference between men and women was observed. The median age of onset was 42 years (41-54) for men and 76 years (74-79) for women.

Conclusions: Our findings suggest that CLBBB accompanied by underlying heart disease is rare among younger individuals and tends to increase with advancing age among women. The trend was not observed among men.