The number of people who have not undergone health examinations is estimated to be more than 20,000,000, but there have been no measures to reach them. The Ijinkai Takeda General Hospital developed a home health management system consisting of the Internet and self-collected blood examination by mail. This system was so designed as to protect information on people undergoing examination and give an explanation before examination as well as consultation after examination. In self-collected blood examination, a device with an accuracy allowing the detection of abnormalities was developed that consists of a plasma separation membrane with a component stabilizer and cooling unit. A health management system that can be safely used by people for health examinations was established.

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For 5 years, we have performed follow-up checkups to improve lifestyle-related diseases. During this period,11,249 patients (3,645 outpatients,7,604 patients undergoing round checkups) underwent follow-up checkups. In particurar, the number of round fellow-up checkups has markedly increased. This is because the opportunity for“intervention” by medical professionals, including public health nurses, has been increased to change behaviors for a better lifestyle, and because a system of health-supporting activities in work places has been established. Follow-up checkups provided the chance to review behavioral changes in individuals undergoing these checkups, and promoted the health enlightenment in offices, contributing to improvement in consciousness toward health.
We compared the results of follow-up checkups in 2001 with the body mass index (BMI). Among the parameters for the follow-up checkup, liver function and glycometabolism readily responded to body weight changes. When these two parameters were compared with the BMI, the effects of the follow-up checkups on improvement in lifestyle were more marked than those of general medical checkups; therefore, maintaining the BMI within the reference range may be extremely important for improving lifestyle-related diseases.

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In “immunological checkups”, the resistance power against carcinogenesis or infection is investigated based on the cytotoxic activity and sub-classification of cells responsible for immunity. In addition, the immunity-activating effects of treatment with immunity-enhancing agents, Sino-Japanese medicines, or an agaricus blazei extract in vitro are determined to enhance the immune capacity and promote health.
Resting venous blood was aseptically collected, and peripheral blood mononuclear cells (PBMC) were collected by specific gravity centrifugation. After anaerobic culture of untreated PBMC (effector cells) and 7 kinds of PBMC treated with an agent or an extract for 24 hours, the effector cells and NK-sensitive K562 cells (chronic myelocytic leukemia cells) were assayed for 4 hours to graph the cytotoxic effects on the target cells, K562 cells.
Furthermore, staining with a monoclonal antibody was performed, and the 7 kinds (9items) of PBMC were measured and analyzed. In addition to the sub-classification of PBMC, the ratio of NK cells in effector cells was calculated, facilitating qualitative analysis of cytotoxic activity. To manage the accuracy, specimens were stored at room temperature, and isolated/treated within 5 hours after blood collection. We used K562 cells that had been cultured by cell passage at approximately 5 × 10⁸ cells/ml 3 days or more after fusion.
Thorough accuracy management and data analysis facilitate examination at the cellular level. In the future, this procedure may be useful in many fields such as prophylactic medicine, evaluation of the response to immunotherapy, and studies on the immune capacity.

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Over a period of two years, we examined the effects of the dietary intake of diacylglycerols in 60 patients (51 males and 9 females) whose body mass index (BMI) was greater than 25kg/m² and/or serum triglyceride level was greater than 150mg/dl. There were no remarkable changes in dietary intake of total calories, lipids, proteins or carbohydrates throughout the examinations. BMI, waist girth, diastolic blood pressure and HbA1c were statistically significantly decreased, and HDL-cholesterol increased at the end of the two-year test period. The high-risk group, having more than 3 factors of the metabolic syndrome, had significantly reduced risks at the end of the test period. Diacylglycerols will be a useful edible food oil for the primary prevention of lifestyle related diseases.

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We compared the detection rate of breast cancer in screening setting by mammography (MMG) and ultrasonography (US) for 47 consecutive cases of breast caners aged between 40 to 49 years old. The diagnoses were made by a combination usage of MMG and US. The detection rates of the cancer by either method were 78.7 and 89.4% for MMG and US, respectively. With regard to 31 asymptomatic cases without palpable mass, the detection rates were 74.2% for MMG and 83.9% for US. The detection rates in 34 cases of the early stage cancer (stage 0 and I) were 76.5% for MMG and 88.2% for US. The detection rates for 13 cases of advanced stage cancer (stage II and III) were 84.6% and 92.3%, respectively. In general, the detection rate for breast cancer by US was higher than MMG. Especially the US screening was advantageous in the detection of early or asymptomatic cases.
By reviewing undetectable cancer by MMG, we found 8 of 10 cases were those with dense breast. In 5 of US negative cases,4 were non-invasive or minimally invasive papillotubular carcinoma.
In summary, we recommend US screening for breast cancer especially for younger generation (age less than 49 years old and more likely to be the dense breast) in combination with MMG which was more sensitive for the detection of non-invasive case.

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To elucidate the significance of renal mass detection by abdominal ultrasonography (US)in general health checkup. Thirty-Six renal cell cancer (RCC) and 16 renal benign tumor patients among 462,831 subjects detected by US in general health screening were reviewed in Tokyu Hospital between January 1986 and December 2002. Thirty six RCCs were all treated by surgery (33 nephrectomies including 3 hand-assisted lararoscopic nephrectomies and 3 partial nephrectomies). Only one case was recogmized macroscopic hematuria and 2cases identified microscopic hematuria, preoperatively. Pathological grade of 36 RCCs revealed G1; 25 cases, G2; 10 cases and G3: 1 case. Pathological stage revealed pT1a; 16cases, pT1b; 19 cases and pT3a; 1 case. Mean diameter of detected RCCs was significantly(p=0.0016) smaller in last 18 cases (3.4±1.0), compared with those of initial 18cases (4.8±1.1). All patients showed no eventful recovery and no obvious recurrence sign during mean observation period of 4.5 years. While,16 patients diagnosed renal benign tumor were collected after 1993. Thirteen cases among them were diagnosed angiomyolioma and 2 cases were complicated renal cysts. Last one was renal adenoma diagnosed pathologically by needle biopsy. US screening in general health checkup is thought to be not only useful to discover curative stage of RCC but recently also to detect benign counterpart of renal tumor.

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This study examined the relationship between cardiovascular endurance and the risk factor of arteriosclerosis for the subjects of 252 men. The examination items were the arterosclerotic risk factor index (RFI), VO₂max, age, BMI, SBP, DBP, TG, TC and HDL-C. RFI and the items that positive correlation was admitted were the age, SBP, DBP, TG, TC and BMI. Significant negative correlation with RFI was seen at HDL-C and VO₂max. Moreover, it made 37ml/min/kg, the maintenance goal value minimum of VO2max of the man, as a boundary and it classified into 2 groups of the higher group and the lower group. Then it examined a difference about each item. In the result of the examination, the lower group is significantly greater than the higher group in terms of RFI, age, BMI, DBP, TG and TC. HDL-C was significantly smaller in the lower group. In considering of an influence of aging factor, VO2max and RFI are significantly correlated by analyzing with the partial correlation coefficient. The possibility to make the risk factor of arteriosclerosis will be reduced in keeping the aerobic capacity above the constant standard by this research. Therefore, to make the implementation of the aerobic exercise habitation and to make an effort toward the improvement of cardiovascular endurance will be successful to prevent arteriosclerosis.

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Pulse wave velocity (PWV) has been measured in aorta, and it is recognized that PWV is associated with the atherosclerosis. However, measurement of PWV in aorta was a little complicated.
The present study was conducted to examine the usefulness of noninvasive brachial-ankle pulse wave velocity (baPWV) measurements in the NTT employees who received the human dry dock in our institute. The subjects were 1434 adults (1272 males and 162 females). The baPWV were increased according to the number of atherosclerosis risk factors, including hypertension, diabetes, hyperlipidemia and obesity (p<0.0001).
The systolic blood pressure, age, heart rate, sex, body mass index (BMI) and triglycerides were independent factors for baPWV using multiple regression analysis. The highest correlation coefficient was systolic blood pressure. Heart rate was also highly correlated with baPWV. In addition, BMI was a negative influence factor for baPWV.
These results suggest that the baPWV is influenced by not only age and sex but also blood pressure and heart rate. Furthermore, it is necessary to consider the possibility that baPWV is underestimated in obese subjects.

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Urine protein/urine creatinine (P/C) ratio measured by fully automatic equipment Clinitek ATLAS XL was compared with the urine albumin excretion index (AEI), and pathophysiological changes in dissociation cases of urine P/C ratio and AEI was determined. The fixed quantity value of P/C ratio was significantly correlated with that of measured by Clinitek ATLAS XL. The dissociation between urine P/C ratio and AEI was observed in cases of hypertension, hyperlipidemia, and hypoalbuminemia, and they were complicated with cerebral infarction and heart disease. These results may suggest that atherosclerosis may play an important role in the pathogenesis of the dissociation. Also, the result of urine P/C ratio was higher than AEI was suggested that globulin was excreted more than albumin in that pathological conditions.
In conclusion, urine P/C ratio may detect pathological condition which be not able to detect by AEI, and thus, the measurement of P/C ratio with AEI may be more useful.

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A scheduled health promotion program “Try 13 Weeks” was planned and performed at the HOKKAIDO Health Care and Research Center from June 2002 to December 2003. The program aimed to help improve inadequate life style of 134 participants, such as no routine exercise practice and/or too much food intake, and to reduce their risks of lifestyle-related diseases. The staff of “Try 13 Weeks” program consisted of a cardiologist, registered nurses, exercise trainers and administrative dieticians. The individual advice program to facilitate appropriate eating habit with a feasible scheme of daily life for 13 weeks was made for each participants. After the 13-week program significant improvements were achieved in 67%of the participants with obesity,77% of those with hypercholesterolemia,71 % of those with hyper-tri-glyceridemia, and in 60% of male, and in 77% of female subjects with impaired fasting glucose. To have let participants notice repeatedly throughout the program that their daily life style directly links to the disease risk and that it can be modified by their own effort seemed to be the key factor. However, further accumulation of program experience would certainly be necessary.

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We investigated the significance and usefulnese of our questionnaire by analyzing questionnaire sheets answered at medical checkups for workers engaged for long hours. The subjects were 4,275 male workers who consulted our health control center in 2002, with a mean age of 48.5±9.0 years. Based on the daily working time including overtime work, they were divided into 3 groups, a group with a daily working time of more than 12hours, a group with a daily working time of 8 to 12 hours, and a group with a daily working time of less than 8 hours. In our questionnaire, we selected 18 items with respect to the working style, lifestyle, favorites/habits, and physical/mental complaints, and analyzed the characteristics of workers engaged for long hours. Five hundred males worked for more than 12 hours per day. This group showed a younger age and a higher proportion of workers engaged in personal business, compared to the remaining 2 groups. In addition, in this group, a larger number of workers reported that recent changes in the work contents had made their job hard, and the number of holidays per month was smaller (p<0.001). Their lifestyle was characterized by a short duration of sleep, the absence of regular exercise, meals taken irregularly, having a meal before retiring, and smoking (p<0.001). Furthermore, complaints included general malaise, difficulty in going to work in the morning, poor personal relations in the work place, the absence of persons whom they can consult in troubles, and discomfort in their daily life (p<0.007).
It has been indicated that long-hour working is a risk factor for cerebrovascular/cardiovascular diseases; there were many problems in the workers engaged for long hours, suggesting the importance of questionnaires in evaluating the working state and daily life.

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We reported present status and prospects of Helicobacter pylori (H. pylori) eradication therapy in Seirei Preventive Health-Care center.
Endoscopy and rapid urease test were performed to diagnose ulcer and H. pylori infection at the same time. Anti-ulcer therapy was followed for 2-3 months by eradication therapy. Endoscopy was performed again to make sure that the ulcer was healed. Also,13C-urea breath test was examined to diagnose H. pylori eradication.
Eradication therapy was performed on 193 patients with ulcer disease from November 2000 to October 2003.158 of these patients were male, and 35 were female. The average age was 54.0 years old.73 had gastric ulcer,91 had duodenal ulcer, and 29 had gastro-duodenal ulcer.
Success rate was 85.5%. Diarrhea was the main side effect, but they were all mild. Success of eradication therapy was not associated with life-style (for example, drinking and smoking).
Although recurrence rate was high (47.4%) in eradication-failure patients, it was very low (3.2%) in eradication-success patients. Eradication therapy is a very effective treatment, because it can reduce the recurrence of ulcers. We recognize that the basic pathological cause of ulcer is H. pylori infection, but not psychological stress, drinking, smoking and non-steroid anti-inflammatory drugs. We hope that second-line eradication therapy will be established as early as possible in near future.

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It is known that Helicobacter pylori (Hp) infection is deeply related to the occurrence of peptic ulcer and gastric cancer. We studied the feasibility of urea breath test known as a noninvasive examination to screen Hp infection in medical checkup. People visited our hospital for the purpose of medical checkup were enrolled in this study. Their expirations before and 20 minuets after taking the tablet containing 100mg of ¹³C-urea were collected. Hp infection was confirmed when additional values of 1.3C in the expiration after taking ¹³C-urea measured by infrared spectroscopic-analyzer increased more than 2.5‰. Urea breath tests were carried out in 472 people (369 males and 103 females). Hp positive rate was 94.5% (446/472) in all, 95.3% (353/369) in male and 85.9% (93/103) in female. Hp positive rate in male and female of gastric ulcer and duodenal ulcer were 96.2%,91.8% and 94.8%,94.1% respectively. Hp negative rate was achieved in 85.9% (383/446) after eradication. Hp negative rate in male and female of gastric ulcer and duodenal ulcer were 85.2%,93.3% and 84.5%,87.5% respectively. In gastric cancer, positive rate was 86.7%(13/15). Nowadays, it has been demonstrated that atrophic gastritis and intestinal metaplasia arose from Hp infection were important factors of the occurrence of peptic ulcer and gastric cancer. Urea breath test was not only easy but also useful for gastrointestinal examination the same as endoscopy or roentgenography in medical checkup.

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