Annual Medical Check-up Research Articles

Regional variations in cardiovascular risk factors and access to care among US veterans with cardiovascular disease.

It remains unclear whether cardiovascular risk factors and access to healthcare for veterans with cardiovascular disease (CVD) vary among US regions. This study sought to determine the extent of regional variations in cardiovascular risk factors and access to medical care in a cohort of veterans with CVD in the USA. The 2016 Centers for Disease Control Behavioral Risk Factor Surveillance Survey was utilized to identify a cohort of veteran patients with CVD. Participants were classified based on four US regions: (1) Northeast, (2) Midwest, (3) South, and (4) West. We compared demographic data, medical history, and access to care for veterans of each US region. The outcomes of interest included financial barriers to medical care and annual medical checkup. Among the 13 835 veterans, 18.3% were from the Northeast, while 23.5, 37.1, and 21.1% were from the Midwest, South, and West, respectively. Veterans of each region differed significantly with respect to demographic characteristics, prior medical history, and access to care. Rates of financial barriers to medical care were similar across the four regions (7.3 vs. 7.1 vs. 8.0 vs. 6.9%, P = 0.203). Veterans from the West had the lowest rates of medical checkup within the past year (91.7 vs. 89.5 vs. 91.4 vs. 86.6%). On multivariate analysis, the Midwest [odds ratio (OR) 0.69; 95% CI, 0.53-0.89] and West (OR 0.53; 95% CI 0.41-0.68) regions were independently associated with lower rates of medical checkup within the past year compared to the Northeast. In this observational study involving US veterans with CVD, cardiovascular risk factors and frequency of annual medical checkup differed amongst each US region. Further large-scale studies examining the prevalence of impaired access to care and quality of care in US veterans with CVD are warranted.

SUN-LB78 Hyperfunctioning Papillary Thyroid Carcinoma With a BRAF Mutation

Background: Hyperfunctioning papillary thyroid carcinoma (PTC) is a rare tumor and accounts for less than 0.1% of all thyroid tumors. Information about its driver mutations is limited. Our literature search yielded 16 cases wherein a mutational analysis was conducted. Thyrotropin receptor (TSHR) mutations were identified in 11 of these cases. One case revealed a combination of TSHR and KRAS mutations. No mutations were identified in the other four cases. BRAFV600E is a prominent oncogene in PTC; however, hyperfunctioning PTC with this mutation has not yet been reported. Clinical Case: In a 48-year-old man, ultrasonography (US) during an annual medical checkup revealed a nodule at the right lobe of the thyroid gland. He visited the outpatient clinic for further evaluation. Thyroid function tests indicated that he was hyperthyroid with TSH level of 0.01 mIU/L (reference range: 0.05-5.00), free thyroxine level of 1.8 ng/dL (reference range: 0.9-1.7), and free triiodothyronine level of 4.3 pg/mL (reference range: 2.3-4.0). Serum thyroglobulin was 62.1 ng/mL (reference range: <33.7) and TSHR autoantibodies (TRAb) was <0.8 IU/L (reference range: <2.0 IU/L). B-mode US revealed a hypoechoic, heterogeneous nodule with largest diameter of 25 mm, and it had a jagged border and microcalcification. Color Doppler US revealed increased intranodular vascularity. The 99mTc thyroid scintigram revealed a round, right-sided focus of tracer uptake by the nodule with suppression in the remainder of the gland. These findings were consistent with an autonomously-functioning thyroid nodule. The patient underwent total thyroidectomy because fine-needle aspiration cytology revealed a malignant cytological diagnosis. The histopathological diagnosis of the patient was PTC, tall cell variant, pT2, pEx0, pN1b, and M0. Subsequent mutational analysis of BRAF (exon 15), TSHR (exons 9 and 10), GNAS (exons 7-10), KRAS, NRAS, HRAS (codons 12, 13, and 61), and TERT promoter (C250T and C228T) only identified a heterozygous point mutation in BRAFV600E in tissue samples. Conclusion: We report for the first time a case of hyperfunctioning papillary thyroid carcinoma with a BRAF mutation.

Abstract P547: The Relationship Between Alcohol Drinking Before Sleeping(Ne-Zake) or in the Morning(Mukae-Zake) and Sleeplessness Among Farmers

Introduction: Drinking alcohol before sleeping (Ne-Zake) or in the morning (Mukae-Zake) is occasionally seen in Japan although it is well known that drinking alcohol have some negative effects on sleep. There have been studies which indicated that alcohol worsen sleep quality and quantity however few which investigated how alcohol before sleeping and no which noticed on how alcohol in the morning affects. The purpose of this study is to verify the relationship between Ne-Zake and/or Mukae-Zake and insomnia adjusting the influence of quality and frequency of drinking on the relationship. Hypothesis: We assessed the hypothesis that there is a significant association between Ne-Zake and/or Mukae-Zake and sleeplessness but this association can be confounded by quality and frequency of drinking. Method: Seven hundred and forty-six farmers who underwent annual medical checkups were analyzed. Ne-Zake was defined as “drinking as a sleeping aid” and Mukae-Zake was defined as “drinking in order to get calm down or to fix hungover”. Athene Insomnia Scale (AIS) was used to evaluate objective sleeplessness. AIS consists of 8 questions, which were evaluated from 0 (no sleeplessness) to 3 points (severe sleeplessness), asking the sleeping status in the previous 2 weeks. Insomnia was defined by AIS point more than 6. We conducted the multivariable logistic analysis, setting the presence of insomnia as a dependent variable and the presence of Ne-Zake and Mukae-Zake, quantity of alcohol at one time, frequency of drinking, sleeping related diseases (sleep apnea syndrome, restless leg syndrome, narcolepsy, limb movement disorder, depression), gender, and age as independent variables. Results: Among a total of 746 farmers (mean age 59.5 years; 74.1% men), insomnia, Ne-Zake, and Mukae-Zake were observed in 151 (20.2%), 140 (18.8%) and 37 (5.0%), respectively. Adjusted odds ratios (95% Confidence Intervals) of Ne-Zake and Mukae-Zake were 1.75 (1.07-2.88) and 3.01 (1.41-6.42). The association of Ne-Zake was consistent between men and women but that of Mukae-Zake was stronger in men than in women. (P-values for interaction = 0.98 and 0.03, respectively). Conclusion: Both Ne-Zake and Mukae-Zake had statistically positive significant association with insomnia independent of quantity and frequency of drinking. It may indicate that the timing of drinking alcohol has a stronger relationship with insomnia than quantity and frequency of drinking does. The feature of farmers’ lives in which they can decide their life style might give more opportunities to have Ne-Zake and/or Mukae-Zake than groups with well-scheduled working environment. This result can be utilized to improve farmers’ further physical and psychological health related to alcohol by encouraging to pay attention to not only the quantity or frequency of alcohol drinking but also the timing in a day.

SIRT1 as a Potential Biomarker for Obesity.

This cross-sectional study involved 38 healthy subjects (20-30 y old, not suffering any chronic diseases or fever, not taking any medication or treatment, not smoking, not drinking alcohol frequently, not being pregnant, and not breastfeeding). Dietary patterns from 24-h food recall, physical activities fom international physical activity questionnaire (IPAQ), medical data from annual medical check-up, and body compositions were measured using InBody720 and compared with SIRT1 expression from peripheral blood mononuclear cells (PBMCs) samples. Subjects with excessive percentage of body fat (PBF) had a significantly higher body mass index (BMI) (normal: 20.28±2.09, excessive: 23.86±3.71, p=0.023) and VFA (normal: 48.00±9.38, excessive: 79.17±16.14, p=5×1025). The SIRT1 mRNA expression was significantly higher in subjects with excessive PBF (normal: 1±0.43, excessive: 3.68±2.62, p=0.018) and positively correlated with PBF (ρ=0.376, p=0.045). SIRT1 acted as a potential marker for obesity in the evaluated population.

Molecular Survey of Hemoglobinopathies in Myanmar Workers in Northeast Thailand Revealed an Unexpectedly High Prevalence of α+-Thalassemia

To provide the molecular information on hemoglobinopathies in the Myanmar population, the study was carried out on Myanmar workers in Khon Kaen Province in northeast Thailand. A total of 300 anonymous Myanmar factory workers were randomly recruited during their annual medical checkup. Hemoglobinopathies were identified using hemoglobin (Hb) and DNA analyses. These identified heterozygous α0-thalassemia (α0-thal) [– –SEA (Southeast Asian) deletion] (n = 5, 1.7%), heterozygous α+-thal (n = 103, 34.3%), homozygous α+-thal (n = 12, 4.0%), heterozygous β-thalassemia (β-thal) (n = 3, 1.0%), heterozygous β-thal with homozygous α+-thal (n = 2, 0.7%), double heterozygous β-thal/α0-thal (n = 1, 0.3%)], heterozygous Hb E (HBB: c.79G>A) with α0-thal/α+-thal (n = 1, 0.3%), heterozygous Hb E (n = 27, 9.0%), heterozygous Hb E with α+-thal (n = 24, 8.0%), homozygous Hb E with α0-thal/α+-thal (n = 1, 0.3%), homozygous Hb E (n = 3, 1.0%) and homozygous Hb E with heterozygous α+-thal (n = 3, 1.0%). No thalassemia defect was found in the remaining 115 subjects (38.4%). Haplotypes associated with Hb E and Hb Dhonburi (or Hb Neapolis) [β126(H4)Val→Gly, codon 126 (T>G), HBB: c.380T>G] are reported. While the proportions of α0-thal, β-thal and Hb E are comparable to those described in neighboring countries, a markedly high prevalence of α+-thal (48.6% in total) is unexpected. The molecular information obtained should provide necessary information for diagnostic improvement and planning of a prevention and control program of severe thalassemia in the Myanmar population.

Customized exercise programs implemented by physical therapists improve exercise-related self-efficacy and promote behavioral changes in elderly individuals without regular exercise: a randomized controlled trial

BackgroundSpecialized, individualized exercise programs that increase self-efficacy (SE) are essential for the development and maintenance of regular exercise. The objective of this study is to examine the effect of customized exercise programs (CEPs) implemented by physical therapists in improving exercise-related SE and promoting behavioral changes among elderly individuals who do not exercise regularly compared with commonly prescribed exercises.MethodsIn this randomized controlled study, the sampling frame consisted of participants in an annual town-sponsored medical check-up. The inclusion criteria were no regular exercise and age of 65–74 years at enrollment. The subjects in the intervention group (CEP group) were instructed to perform individualized exercises prescribed based on an original algorithm. Data collection was performed at baseline and 3, 6, 9, and 12 months after exercise instruction. The primary outcome was SE for exercise at the last time point. Secondary outcomes were SE for exercise, stage of change in exercise behavior, knee pain, and low back pain at each evaluation time point.ResultsFifty subjects (CEP group n = 26; control group n = 24) were randomized. In the CEP group, 25 of 26 subjects were analyzed at 3 months, 26 of 26 subjects were analyzed at 6 and 9 months, and 25 of 26 subjects were analyzed at 12 months. In the control group, 23 of 24 subjects were analyzed at 3, 6, 9, and 12 months. SE for exercise improved 24.0% (CEP group 30.8%; control group 16.7%) compared to baseline. No significant differences were observed in the primary outcome. SE for exercise was significantly lower at 9 and 12 months compared with baseline in the control group. Stage of change for exercise behavior was significantly higher at 3 months compared with baseline in the CEP group and at 6 months in the control group. Knee pain was worse at 3 months compared with baseline in the control group.ConclusionsThis study suggested that exercise instruction with CEPs contributes to the maintenance of SE for exercise and is useful for changing exercise behavior in elderly individuals who do not regularly exercise.Trial registrationUMIN000027240, registered on 03/05/2017.

Effects of pharmacist participation in chronic kidney disease (CKD) network and CKD manual distribution on drug-related kidney injury.

Renin-angiotensin system (RAS) inhibitors carry a risk of normotensive ischemic acute kidney injury in dehydration and concurrent nonsteroidal anti-inflammatory drug (NSAID) use. Although the estimated number of patients with chronic kidney disease (CKD) is 20000, Fujieda, Japan, has only three nephrologists. On 25 March 2016, we reorganized the CKD network to include pharmacists and distributed a CKD manual. We assessed effects of pharmacist participation in the CKD network and CKD manual distribution on patient hospitalizations because of drug-related kidney injury. Changes in the prevalence of RAS inhibitor-related estimated glomerular filtration rate (eGFR) declines of greater than or equal to 30% and hyperkalemia of greater than or equal to 6.0mEq/L in 129 hospitalized CKD patients, drug prescriptions of 14150 hospitalized patients, and annual medical checkup data in 36042 citizens were investigated before and after pharmacist participation. After pharmacist participation, patient hospitalizations due to RAS inhibitor-related eGFR declines decreased (71.4% to 38.1%, P=.03) and hyperkalemia declined (38.1% to 9.5%, P=.03). Pharmacist participation influenced the decrease in RAS inhibitor-related eGFR declines (P=.03). NSAID prescriptions decreased (13.4% to 11.8%, P=.003) and acetaminophen prescriptions increased (6.6% to 8.0%, P=.002) among 14150 hospitalized patients, whereas RAS inhibitor prescriptions decreased (43.2% to 39.4%, P=.002) among 6930 hospitalized patients with eGFR less than 60mL/min/1.73m2 . A significant number of citizens shifted from CKD stage G3a-3b to G1-2. Pharmacist participation in the CKD network and CKD manual distribution decreased both hospitalizations due to RAS inhibitor-related kidney injury and citizens with CKD stage G3a-3b.

Prevalence of Autoimmune Gastritis in Individuals Undergoing Medical Checkups in Japan.

Objective Based on both endoscopic findings and serum auto-antibody levels, we determined the prevalence of autoimmune gastritis (AIG), which has not been previously reported, in individuals who underwent health checkup examinations in Japan. Methods At total of 6,739 subjects (4,288 males, 2,451 females; mean age 52.1 years) underwent an upper gastrointestinal endoscopic examination as part of an annual medical checkup. Those suspected to have AIG based on endoscopic evidence of proximal-predominant gastric mucosal atrophy were further examined for the presence of anti-parietal cells and anti-intrinsic factor antibodies, with a final diagnosis of AIG made in cases found to be positive for either or both of those factors. Results Of the 6,739 examined subjects, 46 were suspected to have AIG based on the endoscopic findings, of whom 33 were finally diagnosed with AIG, for an overall prevalence 0.49% (females 0.65%, males 0.40%). Seven with AIG also had thyroid disease, including Hashimoto's and Basedow disease, while none with AIG showed anemia in blood test findings. The prevalence of AIG was not different regardless of the H. pylori infection status (negative, positive, post-eradicated). Conclusion In individuals who underwent an upper gastrointestinal endoscopic examination as part of an annual checkup in Japan, the prevalence of AIG was 0.49%. We concluded that it is not uncommon for asymptomatic and healthy individuals to have AIG, and propose that additional studies are needed to clarify its prevalence as well as to establish the criteria used for diagnosis.

Association between speed of sound of calcaneal bone assessed by quantitative ultrasound and sarcopenia in a general older adult population: A cross-sectional study

BackgroundLower calcaneal speed of sound may be related to sarcopenia because sarcopenia and osteopenia/osteoporosis show a linked relationship in older adults. The purpose of this study is to clarify whether the speed of sound of calcaneal bone assessed by quantitative ultrasound is associated with sarcopenia in a community-dwelling older adult population. MethodsThis was a cross-sectional observational study. The participants in the study were recruited from a group of individuals who had registered for an annual town-sponsored medical check-up. The inclusion criteria for participation in the study were (1) aged older than 40 years, (2) living independently, and (3) able to walk without assistance. Those who had nursing care insurance were excluded. Four hundred sixty-seven residents (182 men, 285 women) were registered in the study. Demographic information, fall history, muscle mass index, grip strength, and gait speed were assessed. The speed of sound through the calcaneal bone was evaluated using a CM-200 sonometer. The assessment for sarcopenia is based on the recommendations of the Asian Working Group for Sarcopenia. ResultsSpeed of sound was positively correlated with muscle mass index and gait speed in men, and was positively correlated with grip strength and gait speed in women, when adjusted for age and body mass index. In a multivariate logistic regression analysis adjusted for age and sex and other confounders, speed of sound was independently related with lower gait speed and sarcopenia in women. Speed of sound under 1470.5 m/sec had discriminated for sarcopenia in females. ConclusionWe propose that the speed of sound of calcaneal bone may be used to screen for sarcopenia in women. Sarcopenia should be considered if the speed of sound value is less than 1470.5 m/s in older women.

Relationship of Helicobacter pylori Infection with Gastric Black Spots Shown by Endoscopy.

Objective The recently reported endoscopic finding of black spots is defined as black pigmentation in gastric mucosa. We attempted to clarify the relationship between the Helicobacter pylori infection status and black spot occurrence. Methods The study subjects were 1,600 individuals who underwent an annual medical checkup and whose H. pylori status could be determined. Upper endoscopic examinations were performed in all, and the presence of black spots in the stomach as well as the degree of gastric mucosal atrophy were determined. Results Among the 1,600 enrolled subjects, 784 underwent eradication for H. pylori, of whom 144 were originally H. pylori-positive and 672 H. pylori-negative. Black spots in the stomach were observed in 156 (9.8%). The rate of prevalence of black spots in the H. pylori-positive and H. pylori-negative subjects was 2.1% and 1.5%, respectively, while that in subjects after undergoing eradication of H. pylori was 18.2%. A multiple logistic regression analysis demonstrated that an older age and post-eradication status were significant factors for black spot occurrence, while proton pump inhibitor treatment showed a tendency to be a risk factor. In subjects with post-eradication status, a higher grade of gastric mucosal atrophy was a significant risk factor for the occurrence of black spots. Conclusion H. pylori post-eradication status and an older age were significant factors related to the appearance of black spots, and a higher grade of gastric mucosal atrophy was also a significant risk factor in subjects who had undergone successful eradication.

Analyzing Factors Associated With Decisional Stage of Adoption for Colorectal Cancer Screening Among Older Korean Americans Using Precaution Adoption Process Model.

Introduction: For Korean Americans (KAs), colorectal cancer (CRC) screening rates remain lower than the national target. This study aimed to examine factors predicting decisional stage of CRC screening adoption among older KAs using the precaution adoption process model. Method: Convenience sampling was employed to recruit KAs aged 50 to 75 years from the Atlanta metropolitan area in the United States. A total of 433 KAs completed a cross-sectional survey that collects information on sociodemographics, CRC screening history, a physician's recommendation, knowledge, self-efficacy, and decisional balance pertaining CRC screening, and precaution adoption process model stage. Results: Higher scores of decisional balance (odds ratio [OR] = 1.34), having a physician's recommendation (OR = 8.61), and having regular annual medical checkups (OR = 4.44) were significantly associated with higher decisional stage compared with lower stage, controlling for other variables. Discussion: Intervention research should incorporate consideration of individuals' decisional stage to move KAs forward from not engaging the screening to maintaining regular participation in CRC screening.

A study on associations and influence of health determinants on systolic and diastolic blood pressure

Background: The aim of the study was to assess the prevalence of hypertension among Indian urban educated population and evaluate the association of various modifiable and non-modifiable risk factors on the development of systolic blood pressure (SBP) and diastolic blood pressure (DBP).Methods: The retrospective study comprised of medical data obtained from 175 individuals who had undergone routine annual medical check-up during the period 2016 -2017. The data was analysed and interpreted using summary statistics, correlations and linear regression analysis. Most of the variables were measured values.Results: Out of 175 reports analysed, 40 (22.9%) individuals comprising of 29 males and 11 females were found to be hypertensives. Isolated systolic hypertension was present in 4 (2.3%) individuals, isolated diastolic hypertension in 26 (14.9%) individuals and in 10 (5.7%) individuals both systolic and diastolic blood pressure was raised. Significant correlations were observed. Multiple linear regression showed significant positive influence of DBP, age and BMI on SBP whereas serum vitamin D level and left ventricular cardiac ejection fraction was negatively influencing SBP (R²=0.638, p=0.000). furthermore, multiple regression analysis with DBP as the dependent variable showed SBP, and serum vitamin D level to be the significant influencing determinants (R²=0.602, p=0.000).Conclusions: The present study on the Influence of modifiable and non-modifiable risk factors on development of SBP and DBP improves knowledge for better preventive strategies.

PS02.157: ESOPHAGEAL SQUAMOUS CELL CARCINOMA IS ASSOCIATED WITH CHRONIC DISEASES AS WELL AS UNHEALTHY LIFESTYLES

Abstract Background Cancer and other chronic diseases such as cardiovascular disease, diabetes, chronic kidney disease, and respiratory disease share common risk factors, including aging and unhealthy lifestyles (eg, smoking and alcohol misuse). Although the recent prospective cohort large-scale study showed chronic diseases contributed to more than one fifth of the risk for incident cancer and more than one third of the risk for cancer death, the relation between esophageal squamous cell carcinoma (ESCC) and non-cancer chronic diseases (NCCD) still remain unknown. The aim of this study is to assess the independent and joint associations of major NCCD and ESCC. Methods From April 2011 to March 2017, 406 consecutive patients with ESCC diagnosed pathologically were enrolled. Their medical records as to patients’ background, the reason for their consultation, lifestyles, and medical history were investigated retrospectively in detail. Results As to the reason for their consultation, 45 patients (25.3%) were diagnosed at annual medical checkup (no symptoms), 125 (70.2%) consulted a doctor for any symptoms such as dysphagia, and 8 (4.5%) had other reasons. As to lifestyles, 304 (78.1%) were drinkers of alcohol (daily amount of alcohol consumption &gt; 20g) and 302 (77.4%) were smokers (Brinkman index &gt; 200), respectively. As to the medical history related to cancer or gastrointestinal diseases, 25 (6.8%) had a history of laryngopharyngeal cancer, 20 (5.1%) had a history of gastric cancer, 2 (0.5%) had a history of breast cancer, one (0.3%) had a history of sclerodema, and one (0.3%) had a history of esophageal achalasia. Of the 406 ESCC patients, 305 were early ESCC and the remaining 101 were advanced ESCC. As to the medical history in patients with advanced ESCC, 22 (21.8%) had a history of cancer of other organs, and 48 (47.5%) had NCCD including hypertension (35 patients), diabetes (18 patients), and hyperlipidemia (12 patients). Conclusion NCCD is an overlooked risk factor for ESCC, as important as two major lifestyle factors combined (drinkers of alcohol and smokers). General physicians who follow up NCCD patients should pay attention to the coexistence of ESCC. Disclosure All authors have declared no conflicts of interest.

Plasma tyrosine and its interaction with low high-density lipoprotein cholesterol and the risk of type 2 diabetes mellitus in Chinese.

Aims/IntroductionMetabolomic markers have the potential to improve the predicting accuracy of existing risk scores for type 2 diabetes mellitus. The present study aimed to test the associations between plasma tyrosine and type 2 diabetes mellitus with special attention to identifying possible cut‐off points for type 2 diabetes mellitus, and its interactive effects with low high‐density lipoprotein cholesterol (HDL‐C) and/or high triglyceride for type 2 diabetes mellitus.MethodsFrom 27 May 2015 to 3 August 2016, we retrieved the medical notes of 1,898 inpatients with type 2 diabetes mellitus as the cases, and 1,522 individuals without diabetes as the controls who attended annual medical checkups from the same tertiary care center in Jinzhou, China. Logistic regression analyses were carried out to obtain odds ratios (ORs) and 95% confidence intervals (CIs). Restricted cubic spline analysis nested in the logistic regression analysis was used to identify possible cut‐off points of tyrosine for type 2 diabetes mellitus. The additive interaction was used to estimate interactions between high tyrosine and low HDL‐C in type 2 diabetes mellitus patients.ResultsThe OR of tyrosine for type 2 diabetes mellitus did not increase until 46 μmol/L and after that point, the OR rapidly rose with increasing tyrosine in a nearly linear manner. If 46 μmol/L was used to define high tyrosine, high tyrosine was associated with an increased OR of type 2 diabetes mellitus (adjusted OR 1.88, 95% CI 1.44–2.45). The presence of low HDL‐C greatly enhanced the ORs of tyrosine for type 2 diabetes mellitus from 1.11 (95% CI 0.82–1.51) to 54.11 (95% CI 33.96–86.22) with significant additive interaction.ConclusionsIn Chinese adults, tyrosine >46 μmol/L was associated with increased odds of type 2 diabetes mellitus, which was contingent on low HDL‐C.

Increased Serum Uric Acid over five years is a Risk Factor for Developing Fatty Liver

The prevalence of fatty liver disease (FLD) is increasing. To clarify risk factors for developing FLD, we analyzed a database from healthy Japanese adults who had annual medical check-ups in 2004 and reexamined in 2009. We used the fatty liver index (FLI) to classify participants as FLD (FLI ≥60), borderline FLD (30≤ FLI <60), and normal liver (FLI <30). Subjects with hepatitis B or C virus infection and subjects with FLD at the baseline were excluded. The cumulative incidence of FLD from normal liver and from borderline FLD over five years were 0.65% (52/8,025) and 12.9% (244/1,888), respectively. After multiple adjustments, higher serum uric acid (SUA) (OR:1.92; 95% CI:1.40–2.63) and increased SUA change (OR:3.734; 95% CI:2.57–5.42) became risk factors for developing FLD from normal liver, as well as younger age and higher body mass index. The risk factors for developing FLD from borderline FLD were similar. Not only higher baseline SUA but also increased SUA change became independent risks for developing FLD.

Influence of the Degree of Gastric Mucosal Atrophy on the Serum Lipid Levels Before and After the Eradication of Helicobacter pylori Infection.

Objective To clarify the influence of the degree of gastric mucosal atrophy on the serum lipid levels before and after the eradication of Helicobacter pylori infection. Methods The subjects were individuals who underwent an annual detailed medical checkup. Serum anti-H. pylori IgG antibody detection and upper endoscopic examinations were performed in all subjects. Gastric mucosal atrophy was evaluated by the classification of Kimura and Takemoto. The serum levels of total cholesterol, high-density lipoprotein cholesterol (HDLC), low-density lipoprotein cholesterol (LDLC), LDLC/HDLC ratio, and triglycerides were compared among the different degrees of gastric mucosal atrophy in H. pylori-positive subjects. In addition, changes in those serum lipid levels during a two-year period were compared among H. pylori post-eradication cases that showed different degrees of gastric mucosal atrophy prior to eradication. Results In subjects with higher degrees of gastric mucosal atrophy, the serum levels of total cholesterol, LDLC, and triglycerides were elevated. Furthermore, the LDLC/HDLC ratio in subjects with moderate and severe grades of gastric mucosal atrophy was significantly higher than in subjects with mild atrophy. In subjects with higher degrees of gastric mucosal atrophy, the serum level of LDLC and the LDLC/HDLC ratio were decreased following eradication of H. pylori. Conclusion Lipid metabolism is influenced by the degree of gastric mucosal atrophy present before the eradication of H. pylori, and the favorable effects of such eradication are significant in patients with higher degrees of atrophy.

Prevalence of intestinal parasites among food handlers attending public health laboratories in Khartoum State, Sudan

Background: Infections by intestinal pathogens especially protozoans and helminths are considered to pose a real health problem, particularly in the tropics. They cause considerable morbidity and mortality rates in developing countries. The high prevalence of these infections is closely correlated with poverty, poor environmental hygiene, and impoverished health services. This study aimed to detect prevalence and frequency of parasitic infections among food handlers in Khartoum Sudan. Methods: Three hundred and fifty Food-handlers, attending public health laboratories in Khartoum, Sudan, for an annual medical check-up, were screened for intestinal parasites by four laboratory techniques viz. direct faecal examination, formal-ether concentration, Baermann technique and agar culture method. Results: The infection rate was 23.7% by Formol-Ether Concentration technique, followed by direct saline stool preparation (7.1%). Out of 83 positive samples the infection rate among different nationalities was as follows: Sudanese 68 (81.9%), Ethiopians 13 (15.7%), Syrians 2 (2.4%) and Egyptians 0 (0%). Intestinal parasites were more prevalent among males (73; 25.1%) than female food handlers (10; 16.9%). Three protozoans, nematodes, two tap worms and one trematode worm were detected among infected population: their frequency were as follows: Entamoeba histolytica (7.4%), Entamoeba coli (6.86%), Giardia lamblia (6%), Schistosoma mansoni (1.40%), Necator americanus (1.43%), Hymenolepis nana (0.68%), Strongyloides stercoralis (0.68%), Taenia saginata (0.57%), Ascaris lumbricoides (0.57%) and Trichostrongylus species (0.29%). Conclusion: The overall prevalence of protozoan infections among food handler in Khartoum state, Sudan was 20.26% while the helminthic infections was 5.97%. Formol-ether concentration technique is better for detection of intestinal parasites than the direct faecal smear technique. Likewise, Barmann’s technique confirms detection of nematodes worms especially hookworms.

Hepatocyte growth factor and carotid intima-media thickness in relation to circulating CD34-positive cell levels

BackgroundHepatocyte growth factor (HGF) may act as a possible biochemical index for vascular damage, although evidence for the association between HGF and carotid intima-media thickness (CIMT) is limited. Since both HGF and circulating CD34-positive cells play an important role in endothelial repair, circulating CD34-positive cell levels may influence the association between HGF and CIMT.MethodsWe conducted a cross-sectional study of 269 elderly Japanese men aged 60–69 years who had undertaken an annual medical checkup from 2014 to 2015.ResultsThe median value for circulating CD34-positive cells was 0.93 cells/μL. Among the study population, 135 men showed low circulating CD34-positive cell levels (≤ 0.93 cells/μL). By multivariable linear regression analysis, HGF was found to be significantly positively associated with CIMT only to participants with low circulating CD34-positive cell levels, with a multi-adjusted β of 0.26 (p = 0.005) and 0.002 (0.986) for low and high circulating CD34-positive cell levels, respectively. In addition, a significant interaction was observed between HGF and circulating CD34-positive cell levels (low and high) on CIMT (multivariable p value of 0.049). A positive association exists between HGF and CIMT in elderly Japanese men, limited to participants with low circulating CD34-positive cell levels.ConclusionA positive association exists between HGF and CIMT in community-dwelling elderly Japanese men, which is limited to participants with low numbers of circulating CD34-positive cells. Our findings indicate that circulating CD34-positive cell levels could determine the influence of HGF on CIMT in elderly Japanese men.

Abstract 243: Familial Hypercholesterolemia Screening at a Large Corporate Clinic in Japan

Background and Aims: Familial hypercholesterolemia (FH) is a high risk of developing premature coronary artery disease even in heterozygotes. It is reported that the diagnostic rate in Japan and the United States is extremely low compared with the Netherlands and a few countries. The diagnostic criteria of FH vary from country to country. Using the JASb(Japan Atherosclerosis Society) diagnostic criteria, it has been shown that sensitivity and specificity in patients who visited lipid clinics are high, but those in the general population are not clear. In this study, we tried to screen FH in a clinic of a large Japanese corporation. Methods: During the period from July 1, 2014 to October 31, 2017, we extracted patients suspected of FH with LDL-C≧180mg/dL or with a family history of CAD at annual and follow-up medical checkup. In the extracted patients, family history of premature CAD and Achilles tendon thickening were evaluated. For patients to which additional information was added, FH diagnosis by JAS diagnostic criteria and by Dutch criteria were performed. Results: A total of 3,3136 medical checkups were set for about 6,300 subjects, and a total of 2,8108 visits were made (the examination rate was 84.8%). Among them, 328 patients with suspected FH were extracted due to LDL-C of 180 mg/dL or more, or family history of CAD. Among subjects additional information was obtained as of November 2017, 43 (19.6%) were diagnosed as FH on JAS criteria, and the number was higher than predicted from the estimated prevalence of FH. On the other hand, there were 24 patients who were "Definite" or "Probably" in Dutch criteria and 211 patients with LDL-C≧190 mg/dL. LDL-C of patients diagnosed as FH by JAS diagnostic criteria was 206.6 (45.3) mg/dL, while patients who did not meet the criteria also had high LDL-C values as 201.4 (18.6) mg/dL. 26.8% of patients who met the diagnostic criteria of FH had not received statin at the time of evaluation. Conclusion: The number of patients satisfying the JAS criteria was more than predicted from the prevalence, suggesting the possibility of over-diagnosis. On the other hand, there were many patients who do not satisfy the diagnostic criteria even when LDL-C is very high.

P37 - The usefulness of an annual medical check-up in people living with HIV: a French multicenter experience

P37 - The usefulness of an annual medical check-up in people living with HIV: a French multicenter experience