Colorectal cancer (CRC) is an important public health problem. Both hereditary and environmental factors interact to result in sequential occurrence from adenoma to adenocarcinoma. In terms of natural history of CRC development and progression, three strategies are available to improve its outcome. Identification of modifiable risk factors and adopting a healthy diet and lifestyle, named as primary prevention, can decrease the occurrence of CRC. For asymptomatic high-risk population, early detection by screening can greatly increase survival and even reduce the incidence, which is called secondary prevention. In symptomatic patients who are diagnosed as CRC at later stage, tertiary prevention through surgery, chemotherapy, target or immune therapy, aims to prolong survival and improve life quality. Although tertiary prevention is the current standard of clinical practice, the effects of primary and secondary prevention are obviously better than tertiary prevention from preventive medicine viewpoints. In the era of precision medicine, further challenges in CRC prevention and screening program should move beyond one size fits all and embrace more personalized program. My practice in Ningen Dock show integrated approaches to combine primary and secondary prevention is the best way to optimize the efforts for improving CRC prevention and survival.

  This article is introducing Taiwan health care system, which include the evolution of Taiwan medical facilities and medical system. Health check up system and national health insurance system also in the loop of discussion. We use public nationwide data analysis and information for your reference.

  Metabolic syndrome (MetS) is a constellation of interrelated metabolic risk factors that appear to promote the development of type 2 diabetes and cardiovascular disease (CVD). MetS may be a systemic manifestation of adipose tissue inflammation with ectopic lipid accumulation in the liver and skeletal muscle which is related to many other complex pathophysiological mechanisms including insulin resistance, endothelial dysfunction and oxidative stress. In this review, longitudinal associations between baseline high-sensitivity C-reactive protein (hs-CRP) as well as serum uric acid, both of which are known to be associated with MetS from cross-sectional studies, and incidence of MetS are discussed. In conclusion, hs-CRP and uric acid are significant predictors of incident MetS. However, hs-CRP should be evaluated two or more times at baseline because the level of hs-CRP widely fluctuates then. Our findings suggest that hypouricemic agents may be useful for reducing risk of MetS and CVD in patients with hyperuricemia.

Aims: Small-dense low-density lipoprotein (sdLDL) and malondialdehyde LDL (MDA-LDL) are considered more atherogenic than LDL. However, information on the major determinants of sdLDL cholesterol (sdLDL-C) and MDA-LDL levels in Japanese subjects without diabetes is limited.

Methods: This study included 870 non-diabetic subjects with a body mass index (BMI) <30 kg/m². All subjects underwent an annual health check-up that included sdLDL-C and MDA-LDL analyses.

Results: When subjects were stratified into four groups according to homeostasis model assessment of insulin resistance (HOMA-IR), sdLDL-C and MDA-LDL levels increased significantly, relative to the reference, with increasing HOMA-IR values, whereas LDL-C levels showed no consistent increase with increasing HOMA-IR. Multiple linear regression and logistic regression analyses revealed that LDL-C and triglyceride (TG) levels were major determinants of sdLDL-C levels, whereas LDL-C, sdLDL-C and high-density lipoprotein cholesterol (HDL-C) levels were major determinants of MDA-LDL levels.

Conclusions: Our data suggest that an increase in the LDL-C level and insulin resistance may lead to an increase in sdLDL-C levels and that increases in the LDL-C and sdLDL-C levels may lead to an increase in MDA-LDL in Japanese subjects without diabetes.

Objective: To evaluate the usefulness of ¹⁸F-fluorodeoxyglucose (¹⁸FDG) positron emission tomography/computed tomography (PET/CT) in identifying advanced colorectal neoplasms (ACNs) in asymptomatic individuals.

Methods: The authors retrospectively searched databases for 495 consecutive subjects who had undergone PET/CT and colonoscopy for cancer screening between August 2012 and March 2016 and their records were reviewed, including those for fecal occult blood tests (FOBT). The maximum standardized uptake value (SUVmax) was determined and receiver operating characteristics analysis was performed to identify the SUVmax with a high probability of diagnosing ACN.

Results: Eleven subjects had 12 foci with focal colorectal uptake of ¹⁸FDG. Among the 12 foci, 8 were determined to be ACNs and 4 were found to be non-advanced lesions. Seven abnormalities were missed by PET/CT: four laterally spreading tumors (LSTs) and three advanced neoplasms that were 10 mm or smaller in diameter. The detection rate, sensitivity, specificity, positive predictive value, negative predictive value and accuracy for the detection of ACNs by PET/CT were 1.2%, 50%, 99%, 64%, 99%, 98%, respectively. When the optimal cut-off value was 7.3, the sensitivity and specificity were 87 and 100%, respectively. The combination of PET/CT with FOBT increased the detection rate to 2.2% and the sensitivity to 79%.

Conclusions: The present study suggests that PET/CT could identify ACNs in asymptomatic individuals with 7.3 as the optimal cut-off value of SUVmax, but it might fail to detect LSTs as well as small advanced neoplasms.

  Hematological malignancies have seldom been mentioned as a target of Ningen Dock. Positron-emission tomography (PET) using 18-fluoro-deoxyglucose is known to be highly sensitive in detecting various kinds of malignancies and has increasingly been added to Ningen Dock examinations. We describe the clinical course of a 59-year-old woman who was incidentally diagnosed with follicular lymphoma using PET in a routine health check-up exam. She was treated with 6 cycles of immunochemotherapy, resulting in complete remission. During an observation period of 93 months from presentation, there was no relapse.

  Although the efficacy of PET in cancer screening is widely established, the frequency that malignant lymphoma is detected in PET is lower than for other common cancers. Malignant lymphoma is the major type of hematological tumor. PET-based screening has certain problems, one of them cost-effectiveness. It may also lead to overtreatment of low-grade lymphoma and produce false negative results. However, if lymphoma is suspected from the findings, an immediate histological diagnosis is needed to determine the treatment policy.