Background: Coronary artery calcium (CAC) is associated with coronary heart disease risk. In addition, CAC progression is associated with worsening coronary atherosclerosis and predicts future cardiac events. We aimed to investigate risk factors for the progression of CAC in an asymptomatic Japanese population using low dose computed tomography (CT) for lung cancer screening performed during routine health checkup.

Methods: The risk factors for CAC progression were analyzed in 771 asymptomatic subjects who underwent repeated CAC measurement.

Results: Of the 771 subjects, 632 (82.0%) were males with a mean age of 56 years, 208 (27.0%) had a history of hypertension, 299 (38.8%) had dyslipidemia, 81 (10.5%) had diabetes mellitus, and 180 (23.3%) had hyperuricemia. During the observation period, 103 (13.4%) subjects had CAC progression, while 515 subjects (66.8%) showed no calcification. On multivariate analysis, increasing uric acid level was significantly associated with the progression of CAC (odds ratio 1.203, 95% confidence interval 1.045–1.387, p=0.010) in addition to age, sex, and triglyceride level.

Conclusions: The results of this study show that hyperuricemia is associated with CAC progression in asymptomatic Japanese subjects.

Background: Pulse wave velocity (PWV) is an index of arterial stiffness in the descending aorta, whereas cardio-ankle vascular index (CAVI) can reveal ascending aorta and aortic arch stiffness. The number and region of aortic calcifications may affect PWV and CAVI differently.

Methods: We included 221 men and 128 women in this study. Calcifications in the ascending aorta (region A), aortic arch (region B), descending aorta (region C), and abdominal aorta (region D) were visually confirmed using computed tomography, and participants were classified into five groups based on the number of aortic calcifications using the calcium (Ca) score. Correlations of the Ca score with CAVI and arteriosclerosis risk factors were investigated. Further, these factors were compared among the five groups and in the different aortic calcification regions.

Results: CAVI, age, height, systolic blood pressure, pulse pressure (PP), smoking score, and the number of risk factors were significantly correlated with the Ca score in both men and women. We observed significant differences in CAVI, height, hypertension, dyslipidemia, and diabetes among the five groups. In men, higher smoking scores were significantly associated with calcifications in region D than in region B, and higher CAVIs were significantly associated with calcifications in regions C and D than in regions B and D. In women, height and PP were significantly different between regions B and D.

Conclusions: CAVI was correlated with the number and region of aortic calcifications. Many arteriosclerosis risk factors promoted aortic calcification; moreover, height, smoking score, and PP were related to the region of calcification. These findings may facilitate the diagnosis and treatment of arterial stiffness.

Objective: The purpose of our study was to evaluate the detection performance and interpretation of chest radiographs from Japanese subjects by physicians, including radiologists, thoracic physicians, and non-thoracic physicians, using deep-learning-based automatic detection (DLAD).

Materials and methods: In total, 49 radiographs with evidence of nodules, 54 with inflammation, and 91 normal chest radiographs were retrospectively collected. Radiograph classification and lesion-per-patient analysis were performed based on the probability values using the area under the curve. In addition, the lesion-per-patient accuracy was evaluated considering the sensitivity and specificity of the threshold. To study lung nodule detection in chest radiographs with and without DLAD, we retrospectively collected 60 normal chest radiographs and 51 chest radiographs showing nodules. Nine physicians evaluated the chest radiographs without and with DLAD, and the results were compared using jackknife free-response receiver operating characteristic (JAFROC) figures of merit.

Results: The per-patient analysis yielded an area under the receiver operating characteristics (AUROC) of 0.976. The per-annotation analysis produced a specificity of 82.35%, and the average false positive rate per patient was 0.13. According to the reader study, the JAFROC of all groups was 0.79 without DLAD and 0.82 with DLAD.

Conclusion: This study confirms that abnormalities can be detected with high accuracy in chest radiographs of Japanese patients, which is particularly significant because DLAD has been developed without the use of Japanese data. This suggests that DLAD may be useful for doctors globally.

Objective: This study aimed to determine the potential of atypical cell nuclei identified by urinary sediment testing for urothelial carcinoma screening.

Methods: The study subjects consisted of 38 health checkup examinees in whom atypical cell nuclei had been found by urinary sediment testing during health checkups. Urologists assessed the presence or absence of urothelial carcinoma. The types of atypical cell nuclei were defined according to “Examination of Urinary Sediment 2010”, a document approved by the Japanese Committee for Clinical Laboratory Standards, as follows: enlarged nuclei, increased chromatin amount, irregular nuclear shape, and enlarged nucleoli. The relationship between these four types of atypical cell nuclei and urothelial carcinoma was determined in a retrospective cross-sectional study.

Results: Among the four types of atypical cell nuclei, irregular nuclear shape had the highest accuracy with a sensitivity of 0.826, a specificity of 0.933, and a likelihood ratio of 12.391. The rates of atypical cell nuclei found in subjects with (n=23) and without (n=15) urothelial carcinoma were as follows: enlarged nuclei, 91% vs. 80%; increased chromatin amount, 100% vs. 93%; irregular nuclear shape, 83% vs. 7%; and enlarged nucleoli, 35% vs. 20%. The irregular nuclear shape had the highest positive predictive value (95%). Multiple logistic regression analysis showed that irregular nuclear shape (odds ratio, 85.30; 95% confidence interval, 7.2–1010.0) was related to urothelial carcinoma (p<0.001).

Conclusion: Urinary sediment testing during health checkups is likely to be useful for urothelial carcinoma screening.

Objective: This study was conducted to clarify the influence of Helicobacter pylori infection status and proton pump inhibitor (PPI) administration on the prevalence of gastric hyperplastic polyps (GHPs).

Methods: The study subjects comprised 3,590 individuals (2,318 males, 1,272 females; mean age 55.1±9.6 years) who underwent medical checkups and in whom H. pylori infection status had been determined. The presence of GHPs accompanied by fundic gland polyps (FGPs) and the degree of gastric mucosal atrophy were investigated endoscopically. The use of antisecretory drugs at the time of examination was also noted.

Results: Seventy-five (2.1%) subjects showed GHPs on endoscopy findings. The prevalence ratios of GHPs in H. pylori-negative, -positive, and post-eradicated subjects were 2.5%, 1.6%, and 1.7%, respectively (p=0.374). GHP prevalence was markedly different between patients with and without PPI administration (21.3% vs. 0.9%, p<0.001). Accompanied FGPs were more frequently observed in patients with GHPs. Multiple logistic regression analysis revealed that PPI usage, older age, and milder gastric mucosal atrophy were significant risk factors for the presence of GHPs, while H. pylori infection status was not a significant factor for their occurrence.

Conclusion: A high prevalence of GHPs was observed in cases of PPI administration irrespective of H. pylori infection status.

Objectives: This study sought to determine the effects of receiving health guidance (HG) from healthcare professionals following thorough health checkups (THCs) by assessing changes in health metrics (anthropometric and biomedical measurements).

Methods: Changes in anthropometric and biomedical measurements were assessed in 1,617 people who received HG following THCs (intervention group). The control group (NHG), comprised of 4,772 people, did not receive HG.

Results: HbA1c of both females and males in the HG group had significantly larger increases than in the NHG group. Females in their 50s had larger increases in systolic blood pressure (SBP) and HbA1c had than those in the NHG group.

  Compared with NHG group age-matched controls, HG males aged >70 years had significantly smaller increases in ALT, HG males in their 40s had significantly smaller increases in diastolic blood pressure (DBP), LDL-C, and γ-GTP and HG males aged <40 years had significantly smaller increases in fasting plasma glucose (FPG).

Conclusions: HG group females in their 50s (menopausal age) and males in their 50s had significantly larger increases in HbA1c than age-matched controls. Although some improvements are needed in HG HbA1c levels, this study supports the beneficial effects of HG after THC since several improved results were achieved in males over the age of 70, in their 40s, and under age 40.

Objective: To investigate the clinicopathological characteristics of superficial non-ampullary duodenal epithelial tumors (SNADETs) detected during endoscopic gastric cancer screening and to determine their association with gastric mucosal atrophy.

Methods: Twelve patients diagnosed as having SNADETs during the 6-year period from April 2015 to March 2021 were included in the study. Data on tumor localization, size, macroscopic type, presence or absence of milk-white mucosa, treatment, and histology were analyzed. The degree of endoscopic gastric mucosal atrophy was compared between patients with SNADETs and 60 sex- and age-matched controls.

Results: SNADETs were found in the second part of the duodenum in all patients. The most common macroscopic type was 0–IIa (8 lesions, 61.5%). Milk-white mucosa was found in 12 lesions (92.3%), and its distribution pattern correlated with the histological type. The frequency of open-type gastric mucosal atrophy and the gastric mucosal atrophy scores were lower in the SNADET group than in the control group, but the difference was not significant.

Conclusions: Gastric cancer screening performed as part of the Comprehensive Health Checkup System should include an assessment of the second part of the duodenum. SNADETs tend to occur against a background of non-atrophic gastric mucosa; therefore, if milk-white mucosa is observed during screening, the possibility of SNADETs should be considered.

Objective: Helicobacter pylori infection is a major cause of gastric cancer, and it is important to efficiently identify H. pylori-infected individuals in gastric cancer screening with gastric imaging and gastric cancer risk stratification tests. We evaluated the distribution of H. pylori infection statuses based on double-contrast upper gastrointestinal barium X-ray radiography (UGI-XR) findings obtained through the Comprehensive Health Checkup System.

Methods: Patients who underwent UGI-XR for gastric cancer screening between April 2016 and December 2019 were included in this study. One gastroenterological specialist prospectively classified the patients into three groups based on background gastric mucosal findings on UGI-XR: suspected H. pylori non-infection (group N), suspected active infection (group A), and suspected past infection (group P).

Results: Of the 971 patients (489 men; mean age, 49.8 years) who underwent UGI-XR, 799 (82.3%) were categorized into group N, 84 (8.6%) into group A, and 88 (9.1%) into group P. Of the 84 patients in group A, one was under observation because of old age, and the other 83 required close examination. Of those 83 patients, 44 (53%) were treated for H. pylori eradication, 18 (12%) did not undergo H. pylori eradication, and 21 (25%) had an unknown course. Finally, 43 of the 44 patients who underwent eradication had successful results.

Conclusion: Our results show that it is possible to screen for H. pylori infections with UGI-XR findings and that introducing infected patients to eradication therapy is important for promoting gastric cancer prevention.

Objective: Evaluation of proteinuria is essential for diagnosing and grading chronic kidney disease. However, subjects whose urine dipstick test for proteinuria is positive in annual health check-ups are often diagnosed as negative in quantitative reexamination. We therefore investigated discrepancies between the results of urine dipstick testing for proteinuria and urinary albumin-to-creatinine ratio (U-ACR).

Methods: Urine samples were taken from 18,363 subjects who underwent annual health check-ups in 2018. We compared the results of urine dipstick for proteinuria with U-ACR, and calculated the specificity, sensitivity, and area under the curve (AUC) of the receiver-operating-characteristic curve of urine dipstick for proteinuria for U-ACR by quintiles of urine gravity.

Results: In samples of dipstick (−) for proteinuria, 1.6% presented micro- and overt albuminuria. In samples of dipstick (±) for proteinuria, 94.8% showed normo-albuminuria. In samples of dipstick (1+) and (2+) for proteinuria, the prevalences of normo-albuminuria were 61.7% and 14.6%, respectively. With higher quintiles of urine-specific gravity, the specificity of the dipstick test for proteinuria sharply declined, and AUC values were lower. In the lowest category of urine specific gravity, the specificity of the dipstick test for proteinuria was high, but the sensitivity was low.

Conclusion: Discrepancies were observed between the results of urine dipstick test for proteinuria and U-ACR. In dilute urine, the probability of false-negative results was high. With more concentrated urine, the probability of false-positive results increased. Given these diagnostic pitfalls, urine dipstick test for proteinuria is problematic, therefore, U-ACR is recommended in annual health checkups.

Objective: Atrial fibrillation (AF) is an absolute arrhythmia characterized by irregular heartbeats. Electrocardiographic findings help make a definitive diagnosis of AF. On specific health checkups, electrocardiography may be indicated for persons with hypertension or those in whom arrhythmia is suspected based on an inquiry. Recently, medical specialist systems have been widely applied. Among patients diagnosed with AF in Ningen Dock (comprehensive health checkup), we analyzed patients with hypertension, with irregular heartbeats on auscultation, and diagnosed by medical specialists and clarified the significance of auscultation.

Methods: In 514 patients diagnosed with AF based on electrocardiography findings during Ningen Dock for nine years, we examined the auscultation findings obtained by 25 physicians.

Results: Of these patients, 92 (17.9%) had hypertension, and auscultation revealed irregular heartbeats in 400 patients (77.8%). The proportion of patients diagnosed with irregular heartbeats by three cardiology specialists was 92.9%. The proportion of patients diagnosed with irregular heartbeats by eight Ningen Dock specialists was 90.4%, almost equal to cardiology specialists’ data. The data were significantly higher than those of non-specialists (p<0.001). On the other hand, five physicians who were non-Ningen Dock specialists had a diagnosis rate of <70%.

Conclusions: From the auscultation results, the significance of specialists in health checkups was confirmed.

Objective: We investigated the frequency of medical history in persons who underwent comprehensive health checkups (Ningen Dock). By comparing with the data from the National Data Base (NDB), we clarified the significance of the Ningen Dock system in identifying people who needed treatment and referrals to a medical institution.

Methods: A total of 8,872 individuals underwent Ningen Dock in 2019 were included in this. According to their medical history, we analyzed 207 diseases obtained from self-reported questionnaires and interviews with public health nurses. Participants with these diseases were divided into two groups: those receiving treatment and those not receiving treatment despite previous disease indications. The number of participants and rate for each group were calculated. Furthermore, we compared the rate of participants under treatment with those who have consulted a hospital/clinic per population with the data from the NDB. Some of the individuals whose medical information were obtained from the NDB may have had their blood pressures and lipid profiles tested through a legal physical examination. The diseases diagnosed by the items examined only using Ningen Dock without any legal health checkups included hyperuricemia and gout (7.3% in Ningen Dock; 1.0% in NDB, p<0.001), together with other digestive system diseases (5.5%; 1.3%, p<0.001). The rates of angina pectoris/myocardial infarction, which frequently revealed subjective symptoms, were significantly higher in the NDB (1.8%) than in Ningen Dock (0.7%; p<0.001).

Conclusions: The treatment rate of diseases that showed less subjective symptoms and was examined using Ningen Dock was significantly higher than that of the NDB.

Objective: Self-rated health concerning healthy life expectancy is used in the Comprehensive Survey of Living Conditions. The subjective health status of serious-disease-free persons undergoing the Ningen Dock may not be influenced by disease-related factors. This study, thus, aimed to clarify what improves self-rated health in such cases.

Methods: Participants were 8,857 persons aged 20–89 years (males: 65%, 53.4±10.8 years) who underwent the Ningen Dock at Jikei University Hospital in 2019 and responded to a questionnaire. The relationship between 16 factors and self-rated health, stratified by sex, was examined using age-corrected linear regression analysis.

Results: Nine factors were related to self-rated health: absence of diabetes mellitus treatment, low heart rate, low alcohol consumption, balanced diet, exercise for ≥30 min, sufficient rest by sleep, low stress, presence of someone to approach for worries, and having hobbies.

Conclusions: The results are consistent with eight previously reported factors. Further, low heart rate was a newly identified factor of self-rated health in this study. In particular, participants with a heart rate of 45–49 beats per minute reported good subjective health status.

  A 69-year-old asymptomatic male was found to have high brain natriuretic peptide (BNP) levels (284.8 pg/mL) at a health check-up. He was referred to the cardiology department, and no abnormal findings were found on the electrocardiogram and echocardiogram. Palpitation and shortness of breath appeared three days after consultation. He then developed atrial fibrillation, and laboratory testing revealed a free tri-iodothyronine, free thyroxine, thyroid stimulating hormone (TSH), and TSH receptor antibody level of 5.56 pg/mL, 1.64 ng/dL, <0.01 μIU/mL, and 5.7 IU/L, respectively. He was treated with thiamazole (10 mg/day), which alleviated his symptoms and decreased the BNP to 20.5 pg/mL. Since the patient was asymptomatic and presented with an elevated BNP only, it was difficult to diagnose Graves’ disease. Heart diseases and hyperthyroid states, including Graves’ disease, should be considered in patients with high BNP levels, even when they are asymptomatic.