The Yurin Study has been conducted since 2008 to promote health-related training to about 40 independent older adults, mainly through walking and conducting annual anti-aging medical check-up (AAMC). The aim was to prevent aging and rejuvenate the body by evaluating its functional age and identifying the parts that have aged the most.
Muscle age, vascular age, neural age, hormonal age, and bone age were evaluated as the functional age in AAMC. Immune stress, oxidative stress, physical and mental stress, glycative stress, and lifestyle were assessed as risk factors of aging using scores. The analysis outcomes from various perspectives are presented in this paper.
The participants (20) of AAMC—conducted three times between 2012–2014—showed a decrease in HbA1c and skin AGE fluorescence, which are glycative stress indicators. The results of a medication compliance survey (39 participants) conducted in 2016 showed the use of medication for high blood pressure in 21 participants; dyslipidemia in 11; osteoporosis in 10; gastric acid secretion inhibitors in 9; and non-steroidal anti-inflammatory agents, antidiabetic drugs, and sleep-inducing medication in 5 each. Many of those who were on medication had a younger functional age than their actual age. When the results of the 2015 analysis, wherein participants of the Yurin Study who led independent daily lives (43 participants) were compared with those requiring support and visiting a daycare facility (31 participants) and those requiring nursing care and residing in a health care facility for the elderly (19 participants), it was found that the participants of the Yurin Study maintained a younger neural age. An analysis of age-related transitions in plasma amyloid beta (Aβ) 40/42 ratio in 2019 revealed that the elevation in the ratio tended to be higher in the elderly than in the young, middle-aged, and older people.
We expect that the data collected from the AAMC will provide useful information for the promotion of public health.
Objective: We aimed to elucidate the relationships among hyperuricemia, nonalcoholic fatty liver disease (NAFLD), and other lifestyle-related diseases.
Methods: We enrolled 420 subjects who had a complete medical check-up at Tokyo Women’s Medical University between June 2016 and December 2017. Risk factors related to NAFLD or hyperuricemia were analyzed by contingency tables using multivariate logistic regression. Statistical significance was set at p<0.05.
Results: NAFLD was significantly related to homeostasis model assessment-insulin resistance (≥2.5) and hyperuricemia (>7 mg/dL). Central obesity and impaired fasting glucose, which are components of metabolic syndrome (MetS), were significantly associated with NAFLD. MetS was also significantly associated with NAFLD. The following were identified as risk factors for hyperuricemia: sex (male), dyslipidemia (increased low-density lipoprotein cholesterol), hyperinsulinemia, NAFLD, eGFR (<60 mL/min/1.73 m2), and alcohol overuse. Furthermore, central obesity and dyslipidemia (decreased high-density lipoprotein cholesterol and/or high triglycerides) were significantly associated with hyperuricemia.
Conclusions: Hyperuricemia and NAFLD are related to one another, to MetS, and to other lifestyle-related diseases. Thus, effective treatment of NAFLD and hyperuricemia is vital, which requires both medication and lifestyle modification approaches.
Objective: Double-contrast upper gastrointestinal radiography (UGI-XR) has been used for screening gastric cancer worldwide. However, gastric mucosal change after eradication of Helicobacter pylori (H. pylori) on UGI-XR is poorly understood. We investigated gastric mucosal changes after H. pylori eradication on UGI-XR.
Methods: The width of gastric folds and the state of mucosal surface before and after H. pylori eradication were evaluated in 104 subjects by UGI-XR. Gastric mucosal surface (GMS) findings were classified into four types according to the degree of abnormality in the mucosal pattern: A, normal; B, enlarged and mildly irregular-shaped gastric area; C, obviously enlarged with considerable irregular gastric area; and D, irregular rugged mucosal surface.
Results: During a 16.1-months follow-up period, the enlarged folds improved in 62/91 subjects (68%), and the width of the gastric folds decreased from 6.4 mm (mean) to 3.7 mm (p<0.0001). Gastritis change of GMS changed in all types; however, the improvement to type A with normalization of fold width was lower in type C (2.6%, p=0.047) and type D (0%, p=0.029) than in type B (16.1%).
Conclusion:H. pylori-induced chronic gastritis changed after H. pylori eradication in 70% of the subjects who underwent UGI-XR, and UGI-XR is useful for evaluating gastric mucosal change after H. pylori eradication. In subjects with type C and type D GMS, the rate of change to a normal mucosa on UGI-XR was low, which suggested earlier H. pylori eradication, prior to developing type C and type D mucosal patterns.
Background: We aimed to evaluate the reliability of different combinations of glycated hemoglobin (HbA1c), fasting plasma glucose (FPG), and 2-h post-challenge glucose level (2-h PG) after a 75-g oral glucose tolerance test (75g OGTT) for diagnosing “prediabetes type,” “diabetes type,” and “normal type.”
Methods: All participants underwent a 75g OGTT and HbA1c measurements. Definitions of “normal type,” “prediabetes type,” and “diabetes type” for FPG were <110 mg/dL, 110≤ FPG <126 mg/dL, and 126 mg/dL ≤ FPG, respectively; those for 2-h PG were <140 mg/dL, 140 mg/dL ≤2-h PG <200 mg/dL, and 200 mg/dL ≤, respectively, while those for HbA1c were ≤6.2%, 6.2< HbA1c ≤6.5%, and 6.5%<, respectively. The prevalence of “prediabetes type,” “diabetes type,” and “normal type” was estimated using seven different combinations, namely, “HbA1c+FPG or HbA1c+2-h PG,” “HbA1c+2-h PG,” “HbA1c+FPG,” “HbA1c alone,” “FPG+2-h PG,” “2-h PG alone,” and “FPG alone.”
Results: The diagnosis of “prediabetes type” required, at minimum, FPG and 2-h PG values, and the inclusion of HbA1c helped minimize day-to-day variation and false positives in FPG and 2-h PG values. In contrast, the diagnosis of the “diabetes type” could be made using “a combination of HbA1c+2-h PG” instead of “HbA1c+FPG or HbA1c+2-h PG,” while the combination of “HbA1c+FPG or HbA1c+2-h PG” appeared reliable for diagnosing “normal type.”
Conclusion: “A combination of HbA1c+FPG or HbA1c+2-h PG” is recommended for the diagnosis of “prediabetes type,” “diabetes type,” and “normal type.”
Objective: To clarify the status and recent changes in long-term trends of atrial fibrillation, participants who underwent a comprehensive health checkup system (Ningen Dock) were surveyed and analyzed.
Methods: Among the participants who underwent Ningen Dock at the Jikei University Hospital during the 9 years from 2010 to 2018, those aged of 30 and over years were selected. There were 57,936 men and 28,094 women subjects in total. Atrial fibrillation was diagnosed by electrocardiogram. The annual rate of change was calculated. Changes in atrial fibrillation prevalence, treatment rates among patients, and attitudes of untreated patients after their first Ningen Dock visit were also investigated as well as auscultation findings.
Results: Overall rates that were already undergoing treatment for atrial fibrillation when they underwent a Ningen Dock were 84.1% for men and 75.0% for women. Of the 82 patients who had not received treatment for atrial fibrillation, 52 patients underwent a Ningen Dock checkup the following year. Of those 52 individuals, 34.6% had regained sinus rhythm either spontaneously or as a result of treatment. The atrial fibrillation treatment rate was 50.0% and the non-treatment rate was only 15.4%. In 22.2% of patients diagnosed with atrial fibrillation by electrocardiogram, no abnormalities were found on auscultation.
Conclusions: Ningen Dock system receiving an explanation of results on the same day effect these high treatment rate, compared with other health checkup.
A 74-year-old woman with a history of non-steroidal anti-inflammatory drug (NSAID) use for knee osteoarthritis was diagnosed with anemia during a Japanese comprehensive health check-up. Anemia was detected for 3 consecutive years but was left untreated as she was asymptomatic. She was referred to our hospital for workup of chronic anemia and pedal edema. A gastric ulcer and multiple intestinal ulcers were identified on upper gastrointestinal and capsule endoscopies. She was initially diagnosed with NSAID-induced gastric and intestinal ulcers and we discontinued NSAID therapy. This resulted in an improvement in the gastric ulcer but not the small intestinal ulcers. On further questioning, she reported a family history of consanguineous marriage. The patient underwent further investigations including genetic testing and a transanal double-balloon enteroscopy and was finally diagnosed with chronic enteropathy associated with SLCO2AI (CEAS). In this study, we report a case of CEAS diagnosed in a patient with anemia detected incidentally during routine screening which was differentiated from drug-induced small intestinal mucosal injury after additional investigations.
We describe three cases of submucosal tumor (SMT)-like-shaped low-grade well-differentiated adenocarcinoma with gastric phenotype (LG-WDA-G) arising in the Helicobacter pylori-negative stomach that were revealed during esophagogastroduodenoscopy (EGD) screening. In Case 1, a whitish 7-mm-diameter SMT-like lesion in the fornix of a 42-year-old man was revealed. Dilated-branched vessels and pigmentation were also observed on the surface of the lesion. Biopsy specimens displayed a mild structural variant but no evidence of malignancy. Endoscopic submucosal dissection was performed as a diagnostic treatment. In Case 2, EGD revealed a gentle protrusion 7-mm in size in the fornix of a 49-year-old man. Dilated-branched vessels and prolongation of the intervening part between the crypts were observed at the surface of the lesion. Biopsy revealed adenocarcinoma. Histologically, in both cases, each tumor was located in the deep mucosal layer covered with the non-neoplastic foveolar epithelium formed by irregularly shaped glands composed of slightly atypical glandular cells resembling fundic glands cells. Immunostaining results revealed MUC6 and pepsinogen-I expression. These results confirmed the diagnosis of LG-WDA-G; specifically, gastric adenocarcinoma of the fundic gland type. In Case 3, a 10-mm SMT-like elevated lesion with central erosion was observed on the greater curvature of the middle gastric body in a 66-year-old man. Biopsy specimens showed atypical glands but indefinite for neoplasia. Endoscopic ultrasonography findings showed an isoechoic tumor with several cystic legions in the submucosal layer. According to immunohistochemistry, LG-WDA-G with MUC6, pepsinogen-I, and MUC5AC-positive tumor cells were invading the submucosal layer significantly along heterotopic gastric glands. Additional surgery revealed no lymph node metastasis.
A 44-year-old woman had a positive fecal occult blood test during health screening. A metameric, threadlike cestode extending from the ileocecal valve to the ascending colon was detected via colonoscopy, leading to a diagnosis of tapeworm infestation. Capsule endoscopy (CE) confirmed a cestode extending from the ileum to the ileocecal region. A single dose of praziquantel (120 mg) was administered. Follow-up CE and stool testing for parasitic ova confirmed no recurrence. This case is valuable because part of the cestode could be observed in the small bowel after a positive fecal occult blood test and during colonoscopy.
Most cases of pancreatic cancer are diagnosed during the advanced stage, resulting in a low long-term survival rate. Thus, early detection is important to achieve a favorable prognosis. We present herein a case of stage 0 (in situ) pancreatic adenocarcinoma incidentally detected on routine screening ultrasonography during a health check-up. Slight dilatation of the main pancreatic duct was detected from the body to the tail of the pancreas of an otherwise healthy male patient. Since this finding is a possible sign of pancreatic cancer, the sonographer traced the duct downstream with a magnified image. No pancreatic duct obstruction or nodules were detected. However, the internal line of the main pancreatic duct (MPD) was irregular, and a debris-like faint hypoechoic region was observed within the MPD at the head of the pancreas. Intraductal proliferation of cancer was suspected, and the diagnosis of stage 0 pancreatic adenocarcinoma (high-grade PanIN) was confirmed with pancreatic juice cytology. The patient underwent surgical resection and is currently alive without recurrence 6 years after the surgery.