Health Screening Center Research Articles

False-positive Elevations in Carcinoembryonic Antigen Levels at a Health Screening Center

False-positive Elevations in Carcinoembryonic Antigen Levels at a Health Screening Center

Endometrial thickness cut-off value by transvaginal ultrasonography for screening of endometrial pathology in premenopausal and postmenopausal women.

ObjectiveTo assess the clinical usefulness and diagnostic accuracy of ultrasonographic measurement of endometrial thickness (ET) in women with endometrial hyperplasia or cancer (EH+).MethodsThis retrospective cohort study included 29,995 consecutive women who underwent transvaginal ultrasonography (TVS) for an incidental finding of a thickened endometrium at the health screening and promotion center at Asan Medical Center between 2006 and 2010. Among 959 patients with endometrial abnormalities, 92 patients were included in this study. A total of 867 patients were excluded: 416 were lost to follow-up; 263 did not undergo endometrial biopsy; 155 had endometrial polyps; 17 had submucosal myomas; and 16 had insufficient tissue samples. Endometrial histology was the reference standard for calculating accuracy.ResultsOf the 92 patients, 78 (84.8%) had normal pathology, while 14 (15.2%) had endometrial pathology (EH+), including 5 patients (35.7%) with simple hyperplasia without atypia, 3 (21.4%) with complex hyperplasia, and 6 (42.9%) with endometrial carcinoma, all stage Ia. The area under the receiver-operating characteristic curve was 0.75 (95% confidence interval [CI], 0.593–0.906). The cut-off value for ET was 8 mm, indicating that TVS ET had a fair accuracy in diagnosing carcinoma, had a sensitivity of 100% (95% CI, 62.9–100.0%) and a specificity of 24.3% (95% CI, 15.2–36.3%).ConclusionTVS is useful for detecting EH+, with a cut-off value for ET of 8 mm having a high sensitivity for detecting endometrial pathologies and the ability to identify women highly unlikely to have EH+, thereby avoiding more invasive endometrial biopsy.

Impact of socio-demographic factors, lifestyle and health status on nutritional status among the elderly in Taiwan

BACKGROUND/OBJECTIVESAging is an imperative problem for many countries in this century, and presents several challenges for the maintenance of good nutritional status. This study aims to assess the impact of socio-demographic factors, lifestyle and health status on the nutritional status among the elderly in Taiwan.SUBJECTS/METHODSA cross-sectional study was carried out in Taiwan. Data were obtained from the Mei Jau Health Management Institution, which is a private health evaluation provider with multiple health screening centers in Taiwan and Asia. This study included 7947 adults aged 65 years or above. The data were extracted between 2001 to 2010. Nutritional status was assessed using anthropometric data, biochemical data and dietary intake information.RESULTSAmong the 7947 participants with mean age of 70.1 (SD = 4.5) years, 20.2%, 6.6%, 10.5% and 52.5% experienced underweight, protein malnutrition, anemia and inadequate dietary intake in the past month, respectively. Age was negatively correlated with body weight (r = −0.19, P = 0.02), body mass index (r = −0.41, P < 0.001), albumin level (r = −0.93, P < 0.001) and hemoglobin level (r = −0.30, P = 0.008). Age above 70 years, gender, unmarried status, retirement, lack of education, low family income, smoking, alcohol drinking, sleep duration of 6-8 hours, vegetarian diet, multiple medications, comorbidity and dysphagia were positively associated with malnutrition in older adults.CONCLUSIONSUnderweight and inadequate dietary intake are prevalent among the elderly in Taiwan. Vegetarian diet, multiple medications, comorbidity, dysphagia and lifestyle factors such as smoking, alcohol drinking and sleep duration of 6–8 hours are risk factors for undernutrition in older adults.

Association between rosacea severity and relative muscle mass: A cross‐sectional study

Rosacea is thought to be associated with factors involved in metabolic syndrome (MetS). Muscle mass has a beneficial role in preventing MetS, but its link to rosacea remains unknown. We sought to investigate the association between rosacea severity and relative skeletal muscle mass. A cross-sectional study was conducted on subjects who attended a skin check-up program at the Kangbuk Samsung Hospital Health Screening Center between 2014 and 2016. Polarized light photographs of the face were taken and evaluated by two dermatologists. Skeletal muscle mass index (SMI, [%] = total skeletal muscle mass [kg] / bodyweight [kg] × 100) was estimated using a bioelectrical impedance analyzer. A logistic regression model was used to evaluate an association between SMI and rosacea. Of 110 rosacea subjects who were finally enrolled, 17 (15.5%) and 93 (84.5%) were classified as having papulopustular and erythematotelangiectatic rosacea, respectively. Categories of SMI comprised the following tertiles: 22.86-38.40%, 38.41-43.44% and 43.45-80.65%. In severity, compared with mild rosacea (75.5%), moderate rosacea (24.5%) incrementally increased as SMI decreased (Ptrend < 0.01). Severe rosacea was not observed. After adjustment for age and sex, odds ratios (95% confidence intervals) for moderate rosacea comparing SMI tertiles 1 and 2 to the highest tertile (reference) were 5.66 (1.22-26.20) and 4.43 (1.12-17.55), respectively (Ptrend = 0.03). This association was present in women with marginal significance (Ptrend = 0.06), but not in men. Relative muscle mass is negatively associated with an increased risk of more severe rosacea, suggesting that skeletal muscle can have a protective effect on rosacea exacerbation.

Life Course Effects of Socioeconomic and Lifestyle Factors on Metabolic Syndrome and 10-Year Risk of Cardiovascular Disease: A Longitudinal Study in Taiwan Adults.

The objective of the study was to explore the dynamic effects of socioeconomic status (SES) and lifestyle behaviors on the risks of metabolic syndrome (MS) or cardiovascular disease (CVD) in life course. The data of 12,825 subjects (6616 males and 6209 females) who underwent repeated examinations and answered repeated questionnaires from 2006 to 2014 at the Major Health Screening Center in Taiwan, was collected and analyzed. The trajectory of trends in the subjects’ SES and lifestyle mobility over time was observed, and the effects of factors with potential impacts on health were tested and analyzed using multiple logistic regression and a generalized estimated equation model. A 10% increase in MS prevalence was observed over the nine-year period. The average Framingham CVD score for people with MS was estimated to be about 1.4% (SD = 1.5%). Except for middle-aged women, marriage was found to raise the risk of CVD, whereas increasing education and work promotions independently reduced CVD risk for the majority of subjects. However, the risk of CVD was raised by half for young men who had a job or lost a job in comparison to continuously unemployed young men. Physical activity was only found to be advantageous for disease prevention in those aged less than 40 years; increased exercise levels were useless for reducing CVD risk among older men. Alcohol drinking and betel chewing caused increased CVD risk in the old and young subjects, respectively, whereas vegetarian diets and vitamin C/E intake were helpful in preventing CVD, even if those habits were ceased in later life. For middle-aged women, getting sufficient sleep reduced CVD risk. We concluded that SES and lifestyle behaviors may have different effects on health over time, among various populations. Accordingly, suggestions can be provided to healthcare workers in designing health promotion courses for people at different life stages.

Metabolic syndrome and the risk of cholangiocarcinoma: a hospital-based case-control study in China.

BackgroundMetabolic syndrome is regarded as a risk factor for hepatocellular carcinoma. However, no research has been conducted to investigate the association between metabolic syndrome and cholangiocarcinoma (CCA), especially in the Chinese population. Herein, a hospital-based case–control study was carried out in China to explore the association between metabolic syndrome and CCA risk.Patients and methodsIn this study, 303 CCA patients (136 intrahepatic cholangiocarcinoma [ICC] and 167 extrahepatic cholangiocarcinoma [ECC]) were included, who were observed at Peking Union Medical College Hospital (PUMCH), from 2002 to 2014. Healthy controls were randomly selected from the database of PUMPH Health Screening Center. We retrospectively extracted metabolic syndrome and other possible risk factors from clinical records, followed by investigation of the relationship with CCA via calculation of ORs and 95% CIs using logistic regression analysis.ResultsMetabolic syndrome was significantly and positively correlated with all CCA subtypes, with adjusted ORs (AORs) of 0.35 (95% CI =0.29–0.42) and 0.29 (95% CI =0.19–0.44) for ICC and ECC, respectively (both P<0.001). Dyslipoproteinemia harbored a stronger relationship with ICC (OR =3.16; 95% CI =2.12–4.71) than ECC (OR =1.87; 95% CI =1.27–2.77), whereas hypertension harbored a stronger association with ECC (OR =3.09; 95% CI =2.09–4.58) than ICC (OR =2.06; 95% CI =1.32–3.21). Obesity was related to both ICC and ECC, with similar ORs, while diabetes was only related to ICC (OR =4.59; 95% CI =2.78–7.58), but not ECC (OR =0.97; 95% CI =0.49–1.94).ConclusionMetabolic syndrome was significantly related to a 1.86-fold elevated CCA risk.

Association Between Optic Disc Hemorrhage and Renal Function in South Korea.

The purpose of this article is to investigate the relationship between renal function and disc hemorrhage (DH). This retrospective cross-sectional survey was conducted at Kangbuk Samsung Hospital Health Screening Center between August 2012 and July 2013, and a total of 168,044 participants at least 20 years of age who voluntarily visited the health screening center for systemic and ophthalmologic examinations, including fundus photography, were enrolled. All subjects underwent a physical examination and provided samples for laboratory analysis. Digital fundus photographs of both eyes were taken and reviewed. Estimated glomerular filtration rate (eGFR) was calculated from serum creatinine concentration using the Modification of Diet in Renal Disease (MDRD) formula and Cockcroft-Gault (CG) formula. Subjects were stratified by eGFR into quartiles. Among participants, 220 (0.1%) showed DH, and 2376 (1.6%) showed glaucomatous retinal nerve fiber layer defects. The DH group showed higher creatinine and lower eGFR than the non-DH group. A significant trend was observed among higher creatinine, decreased eGFR as obtained by the MDRD and CG formulas, and the prevalence of DH (P for trend ≤0.003, logistic regression analysis). A multiple logistic regression model adjusted for age, sex, hypertension, diabetes, and hyperlipidemia showed that the lowest eGFR quartiles estimated by MDRD and CG were significantly associated with DH compared with the highest eGFR quartile (adjusted odds ratio, 1.96; 95% confidence interval, 1.22-3.14 by CG, 1.86; 95% confidence interval, 1.17-2.96 by MDRD). Renal function impairment was independently associated with a higher prevalence of DH in a South Korean population.

The associations of metabolic syndrome with incident hypertension, type 2 diabetes mellitus and chronic kidney disease: a cohort study

Metabolic syndrome (MetS) has been extensively studied for its long-term health effects, typically through conventional Cox proportional hazards regression modeling of the overall association of MetS with a single outcome. Such an approach neglects the inherent links between MetS-related disease outcomes and fails to provide sufficient insights into the impact of each component of MetS over time. We therefore conducted a retrospective cohort study of 63,680 individuals who received health check-ups at the MJ Health Screening Center in Taiwan from 1997-2005 to study the subsequent risks of hypertension, type 2 diabetes mellitus (T2DM) and chronic kidney disease (CKD) simultaneously for MetS and its components. Multivariate-adjusted hazard ratios (HRs) were calculated using Cox models for multiple failure outcomes. At baseline, MetS was identified in 7835 participants. Over a median follow-up of 3 years, 8252, 1634, and 6714 participants developed hypertension, T2DM and CKD, respectively. The HR for MetS was 2.41 (95% CI 2.29-2.53) for hypertension, 5.17 (95% CI 4.68-5.71) for T2DM and 1.22 (95% CI 1.15-1.31) for CKD. Three MetS components showed the strongest association with each of the outcomes: elevated blood pressure with hypertension (HR = 3.62, 95% CI 3.46-3.79), raised fasting plasma glucose with T2DM (HR = 8.89, 95% CI 7.86-10.06) and elevated triglycerides with CKD (HR = 1.14, 95% CI 1.08-1.21). MetS may help identify individuals with metabolic profiles that confer incremental risks for multiple diseases. Additionally, several components of the syndrome should be considered by clinicians, as they show stronger associations with specific diseases than MetS.

Serrated Polyposis Syndrome in a Single-Center 10-Year Experience.

Aims:Serrated polyposis syndrome is a disease that is often missed in the clinical setting and is associated with colorectal cancer. We investigated the prevalence of SPS and the association between colorectal or other cancers in a 10-year, retrospective data analysis.Methods:We reviewed complete colonoscopy data obtained from January 2005 through January 2015 at a health-screening centre. Serrated polyposis syndrome was defined on the basis of the criteria established by the 2010 World Health Organization.Results:Of a total of 53.842 consecutive subjects who underwent complete colonoscopy, 12 (0.022%) patients had serrated polyposis syndrome. All of these cases were under-recognized by the endoscopist or referring physician. The mean patient age was 58.6 years; 67% of the patients were men and 33% were women. No serrated polyposis syndrome patients had a first-degree relative with serrated polyposis syndrome, and no serrated polyposis syndrome patients had colorectal cancer. Two cases (17%) had extra-colonic cancers (prostate cancer and thyroid cancer). Eight cases (67%) had a family history of cancer (stomach, breast, lung, pancreas, prostate and colorectal cancer).Conclusion:Serrated polyposis syndrome was a rare condition in a 10-year database, and it was diagnosed late in all cases. Serrated polyposis syndrome may be associated with an increased risk of extra-colonic cancer.

ANTHROPOMETRICS AND METABOLIC SYNDROME IN HEALTHY KOREAN ADULTS: A 7-YEAR LONGITUDINAL STUDY

Background and Objective&#x0D; Of anthropometric measurements, body-mass index (BMI) and waist circumference (WC) have been used as determinants of obesity. The waist-to-height (WtHR) is simple, easy to calculate, and easy to apply to various age groups, but its wide use is limited because of a lack of studies. This 7-year longitudinal study was performed to identify the usefulness of WtHR compared with BMI and WC for predicting metabolic syndrome (MetS).&#x0D; &#x0D; Material and Methods&#x0D; Of 22,379 people who visited a health screening center over the course of one year, 5,802 men and 3,303 women who consented to the study and had no MetS were followed for 7 years to evaluate the development of MetS. The National Cholesterol Education Program Adult Treatment Panel III criteria were adapted to diagnose MetS. Height, weight, and WC were measured, and traditional reference values for BMI (23 kg/m2 ), WC (men 90 cm, women 80 cm), and WtHR (0.5) were calculated; in addition, other cut-off values were calculated by analyzing receiver operating characteristic (ROC) curves. The relative risk (RR) of developing MetS was calculated by Cox proportional-hazards regression using the cut-off values from traditional obesity references and ROC analysis.&#x0D; &#x0D; Results&#x0D; Ultimately, 1,724 (29.7%) men and 627(19.0%) women were diagnosed with MetS. Among men with BMI &lt;23 and &gt;23, 15.1% and 37.0% developed MetS, respectively, resulting in an RR of 0.393 (95% confidence interval [CI] 0.349-0.443, p &lt;0.001). Among men with WC &lt;90 cm and &gt;90 cm, 25.5% and 51.4% developed MetS, respectively, resulting in an RR of 0.442 (95% CI 0.389–0.502, p &lt;0.001). WtHR had the lowest RR at 0.388 (95% CI 0.350–0.430, p &lt;0.001). Among women with BMI&lt;23 and &gt;23, 10.2% and 35.5% developed MetS, respectively, resulting in an RR of 0.290 (95% CI 0.249–0.319, p &lt;0.001). Among women with WC &lt;80 cm and &gt;80 cm, 13.6% and 39.2% developed MetS, respectively, resulting in an RR of 0.346 (95% CI 0.295–0.407, p &lt;0.001). Among women with WtHR &lt;0.5 and &gt; 0.5, 12.7% and 38.2% developed MetS, respectively, resulting in an RR of 0.341 (95% CI 0.290–0.401, p &lt;0.001).&#x0D; &#x0D; Conclusion&#x0D; &#x0D; The results of this study on middle-aged men and women show that a WtHR of 0.5, along with BMI and WC, has diagnostic value in predicting Mets. More studies with people of various ethnicities and ages should be conducted, and WtHR should be recognized as a potential health-management tool.&#x0D; &#x0D; &#x0D; &#x0D;

Gender Differences of Occupational Stress Associated with Suicidal Ideation among South Korean Employees: The Kangbuk Samsung Health Study.

ObjectiveIn this study, the relationship between occupational stress and suicidal ideation was investigated, focusing on gender differences among Korean employees.MethodsCross-sectional data for 53,969 workers were collected at Kangbuk Samsung Hospital health screening centers. Risk of suicidal ideation was assessed using a self-reported questionnaire examining suicidal ideation during the past year. Occupational stress was measured using 24 items of the Korean Occupational Stress Scale-Short Form (KOSS-SF). Logistic regression analysis was employed to estimate the odds ratios and 95% confidence intervals of the relationships between suicidal ideation and components of occupational stress.Results In multivariable-adjusted models, all job stress contributed to increased risk of suicidal ideation in males. Most subscales, except insufficient job control and organizational system, were risk factors of suicidal ideation in females. Further adjustments for depression markedly attenuated this relationship. However, the effects of insufficient job control and lack of reward on suicidal ideation remained significant in males, and interpersonal conflict remained significant in females.Conclusion The results suggest that occupational stress plays a significant role in increasing risk of suicidal ideation through elevation of depressive symptoms. Gender differences in components of occupational stress associated with suicidal ideation were also observed.

Comparison of the awareness of glaucoma between high-educated and general people in Beijing

Objective To compare the awareness of glaucoma between high-educated and general people and provide theoretical evidences for the focus of health education. Methods A total of 340 people in one work unit who received health examinations in the Health Screening Center in Beijing Tongren Hospital from June 2016 to September 2016 were selected and investigated using a self-designed questionnaire for the awareness of glaucoma. According to the education background, all subjects were divided into the high-educated group (bachelor degree and above) and the general group (below bachelor degree) . Chi-squared test was used to analyze and compare the awareness of glaucoma between two groups. Results The rates of considering themselves as knowing glaucoma in the high-educated group and general group were 6.79% and 6.75% respectively, with no significant difference between the two groups (χ2=0.001, P=0.988) . The rate of correct knowledge of symptoms and treatment of glaucoma in the high-educated group was significantly lower than that in the general group, while the misunderstanding of symptoms and treatment glaucoma in the high-educated group was significantly better than that in the general group (all P<0.05) . The media was the major source to acquire the knowledge in both groups. High-educated people wanted to get glaucoma knowledge through medical consultant (34.57%) , while general people wanted to obtain glaucoma knowledge through media (45.40%) . The difference was statistically significant between the two groups (P<0.01) . Conclusions The awareness of glaucoma in both high-educated and general people are low. There are differences in the knowledge of symptoms, treatment and approach of achieving of glaucoma between high-educated and general people. Special emphasis in the health education for two groups of people is necessary to achieve more effectiveness. Key words: Glaucoma; Health education; Awareness; High-educated people

Rosacea and its association with enteral microbiota in Korean females

Rosacea is a chronic inflammatory dermatosis affecting the face and eyes. An association between systemic comorbidities and rosacea has been reported, but the link to enteral microbiota is uncertain. We aimed to investigate the link between rosacea and enteral microbiota. A cross-sectional study was performed in a sample of Korean women who participated in a health check-up programme at the Kangbuk Samsung Hospital Health Screening Center between 23 June 2014 and 5 September 2014. The gut microbiome was evaluated by 16S rRNA gene and metagenome sequence analyses. A total of 12 rosacea patients and 251 controls were enrolled. We identified links between rosacea and several changes in gut microbiota: reduced abundance of Peptococcaceae family unknown genus, Methanobrevibacter (genus), Slackia (genus), Coprobacillus (genus), Citrobacter (genus), and Desulfovibrio (genus), and increased abundance of Acidaminococcus (genus), Megasphaera (genus), and Lactobacillales order unknown family unknown genus. A link between rosacea and enteral microbiota was observed in this metagenomic study. A large and elaborate study is needed to confirm these findings and to elucidate the mechanisms involved.

Subclinical thyroid dysfunction and risk of carotid atherosclerosis.

BackgroundThe effect of subclinical thyroid dysfunction on vascular atherosclerosis remains uncertain. The objective of this study was to elucidate the association between sustained subclinical thyroid dysfunction and carotid plaques, which are an early surrogate marker of systemic atherosclerosis.MethodsThe study included 21,342 adults with consistent thyroid hormonal status on serial thyroid function tests (TFTs) and carotid artery duplex ultrasonography at a health screening center between 2007 and 2014. The effect of subclinical thyroid dysfunction on baseline carotid plaques and newly developed carotid plaques during 5-year follow-up was determined by logistic regression analyses and GEE (Generalized Estimating Equations), respectively.ResultsCarotid plaques were more common in the subclinical hypothyroidism (55.6%) than the euthyroidism (47.8%) at baseline. However, in multivariable analysis, thyroid status was not a significant risk for the carotid plaques at baseline. Instead, traditional cardiovascular risk factors, such as age (P <0.001), systolic blood pressure (P = 0.023), fasting blood glucose (P = 0.030), and creatinine (P = 0.012) were associated with baseline carotid plaques in subclinical hypothyroidism. In longitudinal analyses of subjects who were followed up for more than 5 years, there was no significant difference in the cumulative incidence of new carotid plaques according to time between subjects with subclinical hypothyroidism and those with euthyroidism (P = 0.392).ConclusionsSustained subclinical thyroid dysfunction did not affect the baseline or development of carotid plaques in healthy individuals.

ASSOCIATION BETWEEN VITAMIN D AND SUICIDAL IDEATION IN KOREAN OLDER WORKERS

There are some studies supporting the association between serum vitamin D level and suicidal idea. Although suicide and vitamin D deficiency are highly prevalent in older persons, only a few studies have been performed in older populations. Our study aims to investigate the association between suicidal ideas and serum vitamin D levels in Korean older workers. From 6,906 Korean workers older than 50 years who attended employee health screenings in the Health Screening Center of one hospital from May 2012 to April 2013, we studied 2,717 subjects who had blood tests for vitamin D and answered the bimodal questionnaire about suicidal idea. Chi-square tests and t-tests were performed to determine differences in serum vitamin D levels and other confounding factors between the participants with and without suicidal idea. Logistic regressions calculated the odds ratios (ORs) of suicidal idea according to serum vitamin D status. We adjusted the regression models for potential confounding variables. From 2,717 participants, 128 (4.7%) had reported having suicidal ideas. The proportions of persons with vitamin D sufficiency (≥20 ng/mL), insufficiency (10–19.99 ng/mL) and deficiency (<10 ng/mL) were 41.3%, 52.3% and 6.4% respectively. No significant difference was found in categorical (χ2 test, p=0.215) vitamin D levels between persons with and without suicidal ideas. The OR of suicidal idea did not show significant differences in the subjects with vitamin D insufficiency (OR=0.753, p=0.127) and deficiency (OR=0.606, p=0.251), compared with the group of vitamin D sufficiency. This lack of association between suicidal idea and vitamin D was consistent after adjustment for confounders (vitamin D insufficiency group: AOR=0.748, p=0.118, vitamin D deficiency group: AOR=0.533, p=0.155). The results from this large cross-sectional study showed that serum vitamin D levels were not significantly associated with suicidal ideas in Korean older workers. Further researches are needed to verify the association between vitamin D and suicidal idea in older adults.

The Influence of Epicardial Fat and Nonalcoholic Fatty Liver Disease on Heart Rate Recovery in Metabolic Syndrome.

Epicardial adipose tissues reflecting visceral fat accumulations of the heart are associated with metabolic syndrome (MetS) and can be a predictor of other cardiometabolic diseases. It can adversely influence autonomic nervous system (ANS) of heart. Heart rate recovery (HRR) is an easy method for measuring ANS dysfunction. The purpose of this study was to determine whether epicardial fat thickness (EFT) and nonalcoholic fatty liver disease (NAFLD) are related to HRR in patients with MetS. We enrolled 772 consecutive patients from a health-screening center who underwent abdominal ultrasonography, treadmill test, and cardiac echocardiography. EFT using echocardiography and HRR by symptom-limited exercise testing was assessed. According to the presence of MetS and NAFLD, patients were classified into the four groups. In NAFLD patients, EFT was higher and HRR was lower, especially in patients with MetS and NAFLD, compared to non-MetS participants without NAFLD (MetS with NAFLD, EFT 7.5 ± 4.4 mm, HRR 31.9 ± 12.7; MetS without NAFLD, EFT 4.9 ± 3.0 mm, HRR 39.5 ± 11.1; non-MetS with NAFLD, EFT 5.9 ± 3.6 mm, HRR 36.6 ± 12.7; and non-MetS without NAFLD, EFT 4.4 ± 3.5 mm, HRR 43.4 ± 14.5, p < 0.001). Patients with severe liver steatosis (LS) showed significantly higher EFT than those with moderate LS (14.2 ± 2.0 vs. 7.5 ± 3.1 mm, P < 0.001), and EFT was positively correlated with severity of LS (r = 0.431, P < 0.001). HRR was significantly correlated with EFT (r = -0.386, P < 0.001) and severity of LS (r = -0.324, P < 0.001). EFT and NAFLD were significantly correlated with HRR in patients with MetS and they may be highly related to increased cardiovascular risk. These results suggest a cross-link among EFT, NAFLD, and cardiac autonomic dysfunction in patients with MetS.

Relationship between Plasma Homocysteine Level and Glaucomatous Retinal Nerve Fiber Layer Defect

ABSTRACTAims: To investigate the association between plasma homocysteine levels and glaucomatous retinal nerve fiber layer (RNFL) defect in South Korean population.Materials and methods: This retrospective cross-sectional study included subjects who underwent screening at Kangbuk Samsung Hospital Health Screening Center between August 2012 and July 2013. Subjects underwent physical examination and provided samples for laboratory analysis of homocysteine. Subjects were divided equally into four quartiles (Qs) based on plasma homocysteine level. Digital fundus photographs of both eyes were obtained. Determination of glaucomatous disc appearance was based on criteria set forth by the International Society of Geographical and Epidemiological Ophthalmology and based on the appearance of the RNFL and optic disc. Multivariate logistic regression models were used to define elevated glaucoma risk with P < 0.2 on univariate analysis.Results: A total of 78,049 subjects were included; 76,093 subjects were male, and 1956 subjects were female. When analyzed by gender, the mean homocysteine level in the male group with glaucomatous RNFL defects (11.05 ± 3.80 µmol/L) was higher than those without RNFL defects (10.81 ± 4.12 µmol/L (P = 0.000, χ2 test). Upon multifactorial logistic regression analysis adjusted for age, gender, creatinine, diabetes mellitus, hypertension, and hyperlipidemia, glaucomatous RNFL defects had a significant correlation with plasma homocysteine level. Based on the Q2 level, the odds ratio (OR) of Q3 was 1.267, while the OR of Q4 was 1.285 (95% CI = 1.067−1.505, 1.081−1.529, respectively, P for trend = 0.001).Conclusion: Our results suggest that homocysteine level is associated with the presence of glaucomatous RNFL defects.

Validation of a Newly Developed Equation for Estimating Serum Apolipoprotein B: Associations with Cardiovascular Disease Surrogate Markers in Koreans.

PurposeMany clinical guidelines recommend apolipoprotein B (apoB) measurement, particularly in subjects with metabolic syndrome or type 2 diabetes. Recently, we developed a new equation to estimate serum apoB (apoBE). We validated the clinical relevance of apoBE and compared the performance of the equation with conventional lipid measurements and direct measurement of apoB.Materials and MethodsStudy subjects were recruited from patients who visited the Health Screening Center at Kangbuk Samsung Hospital between January and December 2009 for routine medical examinations (n=78125). For analysis of coronary calcium score, we recruited study subjects from the same institution between January 2007 and December 2010 (n=16493).ResultsapoBE was significantly correlated with serum high-sensitivity C-reactive level {r=0.18 [95% confidence interval (CI), 0.18–0.19]} in partial correlation analysis adjusted for age, sex, and body mass index. apoBE was associated with a Framingham risk score indicating more than moderate risk (10-year risk ≥10%), the presence of microalbuminuria, and the presence of coronary artery calcium in multivariate logistic regression analysis. These associations were comparable to those of directly-measured serum apoB [odds ratio per 1 SD 3.02 (2.75–3.27) vs. 2.70 (2.42–3.02) for a Framingham risk score indicating more than moderate risk, 1.31 (1.21–1.41) vs. 1.35 (1.25–1.45) for the presence of microalbuminuria, and 1.33 (1.26–1.41) vs. 1.31 (1.23–1.38) for the presence of coronary calcium score respectively]. These findings were also consistently observed in subgroup analysis for subjects with type 2 diabetes.ConclusionThe associations between cardiovascular surrogate markers and apoBE were comparable to those of directly-measured apoB.

Time-Resolved Quantitative Analysis of the Diaphragms During Tidal Breathing in a Standing Position Using Dynamic Chest Radiography with a Flat Panel Detector System (“Dynamic X-Ray Phrenicography”): Initial Experience in 172 Volunteers

Diaphragmatic motion in a standing position during tidal breathing remains unclear. The purpose of this observational study was to evaluate diaphragmatic motion during tidal breathing in a standing position in a health screening center cohort using dynamic chest radiography in association with participants' demographic characteristics. One hundred seventy-two subjects (103 men; aged 56.3 ± 9.8 years) underwent sequential chest radiographs during tidal breathing using dynamic chest radiography with a flat panel detector system. We evaluated the excursions of and peak motion speeds of the diaphragms. Associations between the excursions and participants' demographics (gender, height, weight, body mass index [BMI], smoking history, tidal volume, vital capacity, and forced expiratory volume) were investigated. The average excursion of the left diaphragm (14.9 ± 4.6 mm, 95% CI 14.2-15.5 mm) was significantly larger than that of the right (11.0 ± 4.0 mm, 95% CI 10.4-11.6 mm) (P <0.001). The peak motion speed of the left diaphragm (inspiratory, 16.6 ± 4.2 mm/s; expiratory, 13.7 ± 4.2 mm/s) was significantly faster than that of the right (inspiratory, 12.4 ± 4.4 mm/s; expiratory, 9.4 ± 3.8 mm/s) (both P <0.001). Both simple and multiple regression models demonstrated that higher BMI and higher tidal volume were associated with increased excursions of the bilateral diaphragm (all P <0.05). The average excursions of the diaphragms are 11.0 mm (right) and 14.9 mm (left) during tidal breathing in a standing position. The diaphragmatic motion of the left is significantly larger and faster than that of the right. Higher BMI and tidal volume are associated with increased excursions of the bilateral diaphragm.

CONSTANCES: a general prospective population-based cohort for occupational and environmental epidemiology: cohort profile

Why the cohort was set up?CONSTANCES is a general-purpose cohort with a focus on occupational and environmental factors.Cohort participantsCONSTANCES was designed as a randomly selected sample of French adults aged...