Comprehensive Medical Check-up Research Articles

The future of inbound medical care as gauged from the foreigners undergoing complete medical examinations in Japan.

Complete medical examinations are a system of preventive medicine unique to Japan. In recent years, Japanese and foreigners have been aware of complete medical examinations. However, the extent to which this concept of comprehensive medical checkup is recognized in different counties is unknown. The National Center for Global Health and Medicine (NCGM) is a facility that has been performing complete medical examinations on inbound visitors since May 2016, and more than 3,500 inbound visitors have been received to date. Based on this track record, the current study analyzed trends in foreigners' demand for medical checkups in Japan. From August 2020 to July 2023, 471 foreign residents in Japan from 22 countries were received. A certain proportion of examinees (approximately 30%) underwent examinations multiple times at a frequency of once a year. In addition, inbound medical visitors resumed starting in January 2023, and 158 inbound examinees were received. Of these, 15.2% of examinees had undergone a complete medical examination at the NCGM before the COVID-19 pandemic. This suggests that inbound medical visitors and foreign residents may regularly undergo complete medical examinations. In order to continue to meet this demand, Japanese medical facilities should enhance their system for receiving such examinees.

Comprehensive Geriatric Assessment of Elderly Adults

The geriatric population is increasing all over the world. Aging people have special health requirements and comprehensive medical checkups prevent physical, functional and mental decline during the aging period. This study aimed to examine the fitness level and identify problems with the well-being of elderly persons. In this context, the study also attempted to determine the relationship between socio-demographic factors and the health status of elderly adults. In this cross-sectional study, 168 elderly adults (≥65 years old) from 12 central villages of Kars, Turkey were examined. The home home comprehensive geriatric assessment was performed by a family physician in participant. In this study group, more than half of the participants reported urinary incontinence problems (51.2%) and a very high rate of generalized pain (58.3%). The most frequently observed chronic disease was hypertension (45.2%). The percentage of chronic dental oral problems was 57.1% in the current study group. Comorbidity and polypharmacy rate among the participants was 19.0%. The reported health problems in order to frequency in the study group were; heart disease: 17.3%, benign prostatic hypertrophy:16.7%, gastric diseases: 16.3%, diabetes mellitus (type II): 13.1%, chronic obstructive pulmonary disease: 11.6%, depression: 10.9%, the audio impairment:10.7%, visual impairment: 8.3%. There was a statistically significant relationship between advanced age, low economic level, low education level, lack of social support, co-morbidities, polypharmacy, depression, and impaired health status. Comprehensive geriatric assessment of elderly adults is essential for managing geriatrics health problems. With the comprehensive geriatric assessment, pre-frail individuals could be detected and early medical care would be planned for this population.

Metabolic dysfunction associated fatty liver disease identifies subjects with cardiovascular risk better than non-alcoholic fatty liver disease.

Cardiovascular disease (CVD) is the main cause of mortality in subjects with non-alcoholic fatty liver disease (NAFLD). We investigated the association between CVD risk and metabolic dysfunction-associated fatty liver disease (MAFLD) or NAFLD and the influence of significant liver fibrosis on the CVD risk. Subjects who underwent a comprehensive medical check-up were recruited (2014-2019). Significant liver fibrosis was defined using NAFLD fibrosis score, fibrosis-4 index, aspartate aminotransferase to platelet ratio index, or FibroScan-aspartate aminotransferase score. High probability of atherosclerotic CVD (ASCVD) was defined as ASCVD risk score > 10%. Of the study population (n=78 762), 27 047 (34.3%) and 24 036 (30.5%) subjects had MAFLD and NAFLD respectively. A total of 1084 (4.0%) or 921 (3.8%) subjects had previous CVD history in MAFLD or NAFLD subgroup respectively. The previous CVD history and high probability of ASCVD were significantly higher in MAFLD or NAFLD subgroup with significant liver fibrosis than in the other groups (all p < .001). In multivariable analysis, MAFLD was independently associated with previous CVD history after adjusting for confounders (adjusted odds ratio [aOR]=1.10, p=.038), whereas NAFLD was not (all p > .05). MAFLD (aOR=1.40) or NAFLD (aOR=1.22) was independently associated with high probability of ASCVD after full adjustment respectively (all p < .001). Significant liver fibrosis was independently associated with previous CVD history and high probability of ASCVD after adjustment in MAFLD or NAFLD subgroup respectively (all p < .05). MAFLD might better identify subjects with CVD risk than NAFLD. Fibrosis assessment might be helpful for detailed prognostication in subjects with MAFLD.

MAFLD Predicts the Risk of Cardiovascular Disease Better than NAFLD in Asymptomatic Subjects with Health Check-Ups.

Metabolic dysfunction-associated fatty liver disease (MAFLD) was proposed to compensate for the conventional concept of nonalcoholic fatty liver disease (NAFLD). We investigated the superiority of MAFLD versus NAFLD in predicting the risk of atherosclerotic cardiovascular disease (ASCVD). A total of 2,144 subjects without a history of ASCVD, who underwent a comprehensive medical health check-up, were selected for the study. The associations between fatty liver status and coronary risk surrogates, such as coronary artery calcium score (CACS), coronary artery disease, quantitative stenosis grade, and 10-year ASCVD risk, were analyzed. MAFLD and NAFLD were identified in 995 (46.4%) and 891 (41.6%) subjects, respectively. Subjects with MAFLD or NAFLD were more likely to be male and had a significantly higher prevalence of central obesity, obesity, hypertension, diabetes, and dyslipidemia (all, p < 0.05) than their counterparts. In terms of coronary risk surrogates, the MAFLD or NAFLD population had a significantly higher proportion of subjects with CACS > 100, coronary artery disease, higher grade of coronary artery stenosis, and higher 10-year ASCVD risk (all, p < 0.05) than their counterparts. Multivariable logistic regression models showed an independent association between MAFLD/NAFLD and coronary risk surrogates (all, p < 0.05). However, NAFLD only, defined as 'NAFLD, but not MAFLD,' was not associated with an increased coronary risk, compared to MAFLD. Although both MAFLD and NAFLD discriminated different ASCVD risks, MAFLD predicted the risk of ASCVD better than NAFLD in asymptomatic subjects who underwent medical health check-ups.

Risk factors for frailty in elderly Japanese people who received Ningen Dock: a cross-sectional study

BackgroundFrailty is a clinical condition characterized by increased vulnerability to adverse health outcomes. Elderly people are screened for frailty as part of preventative care. However, the risk factors for frailty among older adults who undergo Ningen Dock, a comprehensive medical checkup, remain unclear. Thus, this cross-sectional study aims to identify the risk factors for frailty in older adults who received Ningen Dock. The study included 372 participants over 65 years of age who underwent Ningen Dock at the Health Care Center of Gunma Chuo Hospital between April 2019 and March 2020. Frailty was defined using the Kihon Checklist, a basic checklist. Clinical variables were obtained from Ningen Dock records, a vascular function test, and a questionnaire on medication, among others. Multivariate ordinal logistic regression models were used to assess risk factors.ResultsPrevalence for frailty and pre-frailty was 12.6% and 26.6%, respectively. The mean age of participants was 72.0 ± 5.1 years old, and 43.5% were female. Compared with systolic blood pressure (SBP) ≥ 130 mmHg, the odds ratios for the 100–129 mmHg and < 100 mmHg groups were 2.43 (P = 0.020) and 8.95 (P <0.001). The odds ratio for the ≥ 7 medications group medications was 3.64 (P = 0.003) compared to 0–2 medications. Compared with serum iron ≥ 126 μg/dL, the odds ratio for ≤ 85 μg/dL was 2.91 (P = 0.002). The odds ratio for total bilirubin ≤ 0.6 mg/dL was 2.49 (P = 0.011) compared with > 0.6 mg/dL. Compared with an exercise habit of ≥ 4 metabolic equivalents (METs), the odds ratio for < 2 METs/week was 2.45 (P < 0.001). The odds ratio for the cardio-ankle vascular index (CAVI) ≥ 9 group was 1.84 (P = 0.020) compared to < 9.ConclusionsIn older adults who received Ningen Dock, SBP < 100 mmHg, medications ≥ 7, serum iron ≤ 85 μg/dL, total bilirubin ≤ 0.6 mg/dL, exercise habits < 2 METs, and CAVI ≥ 9 were associated with frailty.

Attitudes towards comprehensive medical checkups among childhood cancer survivors

Attitudes towards comprehensive medical checkups among childhood cancer survivors

Mental Disorders Experienced in Comprehensive Medical Checkup and the Topics of the Japanese Stress Check Program

Mental Disorders Experienced in Comprehensive Medical Checkup and the Topics of the Japanese Stress Check Program

Value of Personal Health/Medical Data and Potential of the Personal Health/Medical Data Market

A full-scale digitization of society is about to begin. Information, along with digital technology, is coming together as the Internet of Things, enhancing efficiency, rationalization and transparency and re-defining relationships. The coming digitalization will provide industry with an opportunity to transform business models and processes and gain competitive advantages. It will also provide a chance for individuals to live richer, more convenient lifestyles. Since information, both personal and industrial, increases in value as accumulated, Big Data has become an invaluable intangible asset. It is therefore important that there exist good quality Big Data in each area. Accordingly, one area that has become of particular interest to industry is personal health/medical information. Medical service is provided only by licensed medical professionals, but related services are expected to possess huge potential. Once enough health/medical information is accumulated as Big Data, individuals’ personal health/medical information can generate customized health/medical advice. At a societal level, it would also contribute to enhancing social welfare and reducing the total medical expenses of a nation. In this research, employing an economic approach, the value of personal health/medical information for individuals is evaluated and the conditions that affect individuals’ interest in receiving customized health/medical advice and willingness to disclose personal health/medical data for customized advice are explored. Since personal data that may include comprehensive medical checkup results and lifestyle information (sleep, meals) is highly sensitive and personal, disclosing such data to an external entity involves risks, including privacy concerns and potential data breaches. Thus, the decision to disclose would be made based on the trade-off between the risks and benefits of receiving customized advice. For the purpose of this research, a survey that includes conjoint analysis is conducted among individuals. Respondents are asked, among others, to what degree the introduction of data protection measures adopted by the entity would alleviate their fear of risk. Those measures include (a) compliance with guidelines stipulated by the government or industry associations, (b) data portability, including a right to request data erasure and (c) the entity's purchase of insurance to provide sufficient financial compensation to data breach victims. The survey results could be a good indication of possible policy agenda in the field of information. For example, the research assumes at least two kinds of constraints that may affect individuals’ decision-making: information asymmetry between the individual and the entity (external constraint); and individuals’ bounded rationality in context of the Economics of Privacy (internal constraint). The outcome would inform future policy for alleviating these constraints. Here is another example. Based on the sensitive nature of the information and possible social welfare contribution, the effective building of health/medical Big Data would be important. A market mechanism solution may need consideration from several aspects, including possible information oligopoly and possible abuse of this superior position. An open Big Data solution that treats Big Data as a public good may also require deliberation from various aspect, including how to incentivize innovation for first movers. The preference of individuals could provide some insight into this policy agenda.

Rapid deterioration of diabetes mellitus with morphological changes to the pancreas

An 82-year-old man was referred to the hospital for further examination of a pancreatic tumour diagnosed on abdominal ultrasonography. He underwent regular comprehensive medical check-up, and a pancreatic tumour was...

P0225THE PRESENCE OF SIMPLE RENAL CYST IS ASSOCIATED WITH INCREASED RISK OF ALBUMINURIA IN YOUNG ADULTS

Abstract Background and Aims It is well-known that the prevalence of simple renal cyst increases with age. However, simple cysts are occasionally found in adults younger than 40 years of age. This cross-sectional study evaluated the clinical significance of simple renal cysts in young adults, focusing on the associations with hematuria and albuminuria. Method Adults younger than 40 years who received a comprehensive medical checkup from January 2005 to December 2013 were included. Simple renal cysts were identified by ultrasonography. Results Among 5832 subjects, renal cysts were found in 276 (4.7%). Subjects diagnosed with polycystic kidney disease (n=5) or medullary sponge kidney (n=1) were excluded from the analyses. A single cyst and multiple cysts were found in 234 (4.0%) and 42 (0.7%) subjects, respectively. The locations of single cyst were cortex in 187, medulla in 26, and parapelvic region in 21. Age (odds ratio [OR], 1.07; 95% confidence interval [CI], 1.02-1.12 per 1-year increment, P = 0.002), systolic BP (OR, 1.01; 95% CI, 1.00-1.02 per 1-mmHg increment, P = 0.006), and hypertension (OR, 1.85; 95% CI, 1.24-2.76, P = 0.003) were independent predictors of the presence of simple cyst. The presence of cysts was not associated with increased prevalence of hematuria. While, the subjects with cysts had higher prevalence of albuminuria than those without cysts (11.3% vs. 4.5%, P &amp;lt;0.001). Multivariate analyses of albuminuria revealed that the presence of simple renal cyst was associated with a 2.30-fold increase in the prevalence of albuminuria (95% CI 1.512-3.519, P &amp;lt;0.001) independently of other risk factors. The location of the cysts was not related to the prevalence of albuminuria. Conclusion The presence of simple renal cysts was independently associated with increased prevalence of albuminuria. The causal relationship between renal cysts and albuminuria needs to be elucidated in further studies.

Sarcopenia Is Independently Associated with the Degree of Liver Fibrosis in Patients with Type 2 Diabetes Mellitus.

Background/AimsSarcopenia is associated with liver fibrosis in patients with nonalcoholic fatty liver disease and chronic hepatitis B. We investigated the association between sarcopenia and hepatic fibrotic burden in patients with type 2 diabetes mellitus (T2DM).MethodsPatients with T2DM who had received a comprehensive medical health check-up were recruited. Muscle mass was assessed using computed tomography. Fibrotic burden was assessed using the fibrosis-4 index (FIB-4). The study population was divided by quartile stratification of the lumbar skeletal muscle index (LSMI).ResultsAmong 309 patients with T2DM, 75 (24.3%) had sarcopenia. These patients were significantly older and had higher FIB-4, whereas they had significantly lower body mass index (BMI) and LSMI than patients without sarcopenia (all p<0.05). The LSMI showed a significant negative correlation with the FIB-4 when analyzed in terms of quartile stratification (p=0.003). Multivariate analysis showed that female sex and higher BMI were independently associated with a reduced risk of sarcopenia (odds ratio [OR], 0.388; 95% confidence interval [CI], 0.199 to 0.755 and OR, 0.704; 95% CI, 0.618 to 0.801; all p<0.05), whereas a higher FIB-4 was independently associated with an increased risk of sarcopenia (OR, 1.817; 95% CI, 1.180 to 2.797; p=0.007). Among patients with a BMI <25 kg/m2 (n=165), those with sarcopenia (n=54, 32.7%) had a significantly higher FIB-4 than those without (n=111, 67.3%; 1.66 vs 1.38, p=0.004).ConclusionsSarcopenia is independently associated with fibrotic burden in patients with T2DM. Further studies should investigate whether the improvement of sarcopenia can ameliorate liver fibrosis in patients with T2DM.

Analysis of the Outcomes of the Fundus Examinations after Observation of the Specific Physiological Indicators of Glaucoma in Comprehensive Medical Check-ups

Analysis of the Outcomes of the Fundus Examinations after Observation of the Specific Physiological Indicators of Glaucoma in Comprehensive Medical Check-ups

Associated factors for and progression rate of sacroiliac joint degeneration in subjects undergoing comprehensive medical checkups.

Associated factors for and the natural course of sacroiliac (SI) joint degeneration in the normal population are unknown. The purpose of this study was to determine associated factors for and the progression rate of SI joint degeneration. We enrolled 553 healthy middle-aged subjects who underwent the first and second comprehensive health screening at an interval of 5.9years (range 3.0-10.7years). The medical checkup included blood tests and whole-body computed tomography. We investigated associated factors of SI joint degeneration, the relationship of the laterality of degeneration between the SI and L4/5 facet joint, L5/S facet joint, and the natural course of SI joint degeneration over time. At the first checkup, 70 subjects (12.7%) showed substantial degeneration (type 2 or 3) of the SI joints. Multivariate analysis revealed that female sex; pubic symphysis degeneration, L4/5, and L5/S facet joint degeneration; high body mass index; and several blood parameters were associated factors for SI joint degeneration. Laterality of SI joint degeneration was significantly more frequent than that of L4/5 or L5/S facet joint degeneration. Kaplan-Meier survival analysis revealed that the progression rates of SI joint degeneration from type 0 (no degeneration) or type 1 (slight degeneration) to substantial degeneration amounted to 3.4% and 35.5% after 10years, respectively. We found substantial SI joint degeneration in 12.7% of healthy middle-aged subjects and considered it to be part of the normal aging process. There may be individual factors associated with its occurrence. These slides can be retrieved under Electronic Supplementary Material.

Biomarkers and their relative contributions to identifying coronary artery stenosis based on coronary computed tomography angiography in asymptomatic adults

BackgroundCoronary computed tomography angiography (CCTA) has emerged as an important, non-invasive imaging modality for the assessment of coronary vascular disease. However, CCTA as a screening tool still has issues with radiation exposure and cost in asymptomatic adults. In this study, we investigated the relationship between cardio-metabolic biomarkers and coronary artery stenosis on CCTA in asymptomatic, apparently healthy adults. MethodsData for this cross-sectional study were obtained from 306 subjects who underwent a comprehensive medical check-up including CCTA. A 128-slice CT device was used to detect earlier stages of coronary stenosis, which was defined as > 25% luminal reduction in the most severe stenosis in the calcified segments of the coronary arteries. ResultsOn multivariate analysis, after adjustment for age, only γ-glutamyl transferase (GGT) was significantly and independently associated with CCTA stenosis (OR 1.006, 95% CI 1.001–1.011, P = .026). In a subgroup analysis of 103 subjects with brachial-ankle pulse wave velocity (baPWV) data, baPWV was significantly associated with CCTA stenosis (OR 1.005; 95% CI 1.003–1.008, P < .001). ConclusionsGGT and baPWV were associated independently with the presence of CCTA stenosis in apparently healthy adults. Further research is needed to re-confirm on these findings.

Laparoscopic Treatment of Mesenteric Cysts: Report of Two Cases With a Literature Review

IntroductionMesenteric cysts are rare intra-abdominal masses. They do not show classic clinical findings and are detected incidentally during imaging because of their absent or nonspecific clinical presentation. We herein report 2 cases of mesenteric cysts that were successfully diagnosed and resected through a laparoscopic approach.Case presentationIn a 35-year-old man underwent a comprehensive medical checkup at another hospital, during which ultrasound incidentally revealed a cystic mass in his right retroperitoneum. The patient was referred to our hospital for surgical treatment. He was asymptomatic and his medical history was unremarkable. Physical examination revealed no palpable abdominal mass, and all laboratory test results were within normal ranges. Contrast-enhanced computed tomography showed a 7.2-cm-diameter smooth-surfaced, well-demarcated mass behind the right colon without a contrast effect (Fig. 1). We considered the cyst to be benign and localized in the mesentery of the ascending colon. In one patient, the cyst was located in the mesentery of the ascending colon and removed via a right hemicolectomy; in the other patient, the cyst was located in the sigmoid mesentery, which was completely resected through the operative wound under an open procedure after laparoscopic mobilization of the sigmoid mesentery. We chose the laparoscopic approach in both cases because the cysts were considered benign, noninfectious, and nonhemorrhagic. Histologic examination revealed cystic lymphangioma in both cases.ConclusionFor mesenteric cysts, laparoscopy could be a preferred approach in properly selected patients.

435-P: Elevated One-Hour Post-Challenge Glucose Levels Associated with Increased Arterial Stiffness

We reported a positive correlation between brachial-ankle pulse wave velocity (baPWV) and one-hour post-challenge glucose (1-h PG). Furthermore, the subpopulation defined by 1-hour PG beyond 183 mg/dL (corresponded to Impaired glucose tolerance range of 2-h PG) in normal glucose tolerant (NGT) subjects. These findings suggested that if NGT subjects convert to higher 1-h PG levels from a normal 1-h PG range they will develop arterial stiffness. To address this issue, we initiated a clinical study that included 40 NGT subjects (23 men and 17 women, mean age 60.9 ±9.7 years), with a comprehensive medical check-up was performed on each subject at Kan-etsu Chuo Hospital every year. In addition, over the 9-year period these individuals were annually assessed by a 75-g oral glucose tolerance test (OGTT) and for atrial stiffness by baPWV. Based on the 75-g OGTT, NGT subjects alone were selected according to the 2006 WHO criteria. NGT subjects in this study were identified as individuals having a normal range of all measured parameters. In this population, there was no significant correlation between baPVW and all measured parameters. One-h post challenge glucose (1-h PG) in 28 subjects was below 154 mg/dL and their baPWV was not changed (1266.4 ±125.42 cm/sec from 1243.62 ±108.1) after nine years. On the other hand, 1-h PG in the rest of 12 subjects was significantly increased to 160.33 ±4.73 from 124.67 ±20.13 and their baPVW was also significantly elevated to 1489.33 ±41.05 from 1255.01 ±64.08 after nine years. We found that rapid blood glucose change in NGT could be a risk factor for arterial stiffness and we would like to point out the possibility for physicians to select high-risk subjects by 75g-OGTT with the evaluation of 1h-PG. Taken together, we found that rapid blood glucose change could be a risk factor for arterial stiffness. Disclosure S. Okada: None. J. Okada: None. E. Yamada: None. T. Saito: None. M. Yamada: None.

Genome-wide association study of right-sided colonic diverticulosis in a Korean population

Diverticulosis results from complex interactions related to aging, environmental factors and genetic predisposition. Despite epidemiologic evidence of genetic risk factors, there has been no attempt to identify genes that confer susceptibility to colonic diverticulosis. We performed the first genome-wide association study (GWAS) on susceptibility to diverticulosis in a Korean population. A GWAS was carried out in 7,948 healthy individuals: 893 patients and 1,075 controls comprised the test set, and 346 patients and 305 controls comprised the replication set. Diverticulosis was diagnosed by colonoscopy during comprehensive medical check-ups, and single-nucleotide polymorphisms (SNPs) related to diverticulosis were detected with the Affymetrix Axiom KORV1.1-96 Array. In all, 9 SNPs were identified in three SNP aggregates in the test set (P < 10−3, within 200 kb) after adjusting for sex. All the SNPs were replicated in the replication set (P < 0.05). Three SNPs were near the WNT4 gene, four near the RHOU gene, and two in the OAS1/3 genes. The top SNP associated with right-sided colonic diverticulosis was rs22538787, located near the WNT4 gene [combined set, P-value = 3.128 × 10−6, odds ratio = 1.415 (95% confidence interval: 1.223–1.637)]. These 9 novel SNP alleles associated with the WNT4, RHOU, and OAS1/3 genes are possibly involved in the underlying genetic susceptibility to right-sided diverticulosis. Our results provide basic knowledge about the development of diverticulosis in an Asian population.

Lifestyle and psychosocial factors and a decline in competence in daily living among Japanese early elderly people: from an age-specified community-based cohort study (NISSIN project)

BackgroundTo let the early elderly live well, understanding how lifestyle and psychosocial factors related to a decline in competence in daily living is important.MethodsWe investigated the associations between lifestyle and psychosocial factors at age 64 years and a decline in the Tokyo Metropolitan Institute of Gerontology Index of Competence score of ≥ 2 points at age 70 years among the participants in comprehensive medical check-ups living in a city in Japan. Multivariable logistic regression analyses were performed separately for men and women.ResultsOf the 1113 eligible men and 1203 eligible women, 110 men and 80 women showed a deteriorated competence in daily living during the 6 years. In men, risk was increased with ≥ 2 nighttime awakenings (multivariable odds ratio [mOR] 2.14, 95% confidence interval [CI] 1.19–3.86) and living alone (mOR 4.68, 95% CI 1.22–18.0), whereas risk was significantly decreased with a medium or fast gait (mOR 0.37 and 0.21, 95% CI 0.21–0.67 and 0.08–0.58) and high academic achievement (mOR 0.32 and 0.43, 95% CI 0.19–0.53 and 0.25–0.72). In women, risk was decreased with high life satisfaction (mOR 0.39, 95% CI 0.16–0.91) and participation in community activities (mOR 0.50, 95% CI 0.29–0.86) but increased with depressive mood (mOR 1.86, 95% CI 1.09–3.18).ConclusionLiving alone for men and low life satisfaction for women at age 64 years were markedly associated with the risk of a subsequent declining competence in daily living.

Predictors of Discordance in the Assessment of Skeletal Muscle Mass between Computed Tomography and Bioimpedance Analysis.

Computed tomography (CT) and bioimpedance analysis (BIA) can assess skeletal muscle mass (SMM). Our objective was to identify the predictors of discordance between CT and BIA in assessing SMM. Participants who received a comprehensive medical health check-up between 2010 and 2018 were recruited. The CT and BIA-based diagnostic criteria for low SMM are as follows: Defined CT cutoff values (lumbar skeletal muscle index (LSMI) <1 standard deviation (SD) and means of 46.12 cm2/m2 for men and 34.18 cm2/m2 for women) and defined BIA cutoff values (appendicular skeletal muscle/height2 <7.0 kg/m2 for men and <5.7 kg/m2 for women). A total of 1163 subjects were selected. The crude and body mass index (BMI)-adjusted SMM assessed by CT were significantly associated with those assessed by BIA (correlation coefficient = 0.78 and 0.68, respectively; p < 0.001). The prevalence of low SMM was 15.1% by CT and 16.4% by BIA. Low SMM diagnosed by CT was significantly associated with advanced age, female gender, and lower serum albumin level, whereas low SMM diagnosed by BIA was significantly associated with advanced age, female gender, and lower BMI (all p < 0.05). Upon multivariate analysis, age >65 years, female and BMI <25 kg/m2 had significantly higher risks of discordance than their counterparts (all p < 0.05). We found a significant association between SMM assessed by CT and BIA. SMM assessment using CT and BIA should be interpreted cautiously in older adults (>65 years of age), female and BMI <25 kg/m2.

Liquid Biopsy Potential Biomarkers in Prostate Cancer.

Prostate cancer (PCa) is the second most common cancer in men worldwide with an incidence of 14.8% and a mortality of 6.6%. Shortcomings in comprehensive medical check-ups in low- and middle-income countries lead to delayed detection of PCa and are causative of high numbers of advanced PCa cases at first diagnosis. The performance of available biomarkers is still insufficient and limited applicability, including logistical and financial burdens, impedes comprehensive implementation into health care systems. There is broad agreement on the need of new biomarkers to improve (i) early detection of PCa, (ii) risk stratification, (iii) prognosis, and (iv) treatment monitoring. This review focuses on liquid biopsy tests distinguishing high-grade significant (Gleason score (GS) ≥ 7) from low-grade indolent PCa. Available biomarkers still lack performance in risk stratification of biopsy naïve patients. However, biomarkers with highly negative predictive values may help to reduce unnecessary biopsies. Risk calculators using integrative scoring systems clearly improve decision-making for invasive prostate biopsy. Emerging biomarkers have the potential to substitute PSA and improve the overall performance of risk calculators. Until then, PSA should be used and may be replaced whenever enough evidence has accumulated for better performance of a new biomarker.