Development and Validation of a Cardiovascular Disease Risk Prediction Model for the Japanese Working Population: The Japan Epidemiology Collaboration on Occupational Health Study.

AIMS: This study aimed to develop a cardiovascular disease (CVD) risk model using data from a large occupational cohort. METHODS: A risk prediction model was developed using the routine health checkup data of 96,117 Japanese employees (84.0% men) who were 30-64 years of age and had no CVD at baseline. Cox proportional hazards regression models were employed to develop a risk model for assessing the 10-year CVD risk. Measures of discrimination and calibration were used to assess the predictive performance of the model and internal validation was used to examine potential overfitting. RESULTS: During a mean follow-up period of 6.7 years (range, 0.1-11.0 years), 422 cases of incident CVD were confirmed. The final model, which included predictor variables of age, smoking, diabetes, systolic blood pressure, and low- and high-density lipoprotein cholesterol levels, demonstrated a good predictive ability (Harrell's C-statistic, 0.796; 95% confidence interval, 0.775-0.817) with excellent calibration between observed and predicted values. Internal validation revealed minimal overfitting. CONCLUSIONS: The developed model can accurately predict the 10-year CVD risk. Because it is based on routine health checkup data, the prediction model can be easily implemented in the workplace. Further studies are required to assess the external validity and transferability of the proposed CVD risk model.

Association of conventional cigarette smoking, heated tobacco product use and dual use with hypertension.

BACKGROUND: Heated tobacco products (HTPs) have emerged as alternatives to conventional cigarettes. However, their health effects remain largely unknown. This study aimed to prospectively explore the association between the use of cigarettes and HTPs and the risk of hypertension. METHODS: This cohort study analysed data from 30 152 workers (82.0% men, mean age 42.9 ± 11.0 years) who were initially free of hypertension, participating in the Japan Epidemiology Collaboration on Occupational Health Study. Participants were categorized into five groups based on their self-reported tobacco product use: never smokers, past smokers, exclusive cigarette smokers, exclusive HTP users and dual users of cigarettes and HTPs. Hypertension cases were identified using three data points from annual health checkup data collected between 2019 and 2021. Cox proportional hazards regression models were used to investigate the association between tobacco product use and hypertension. RESULTS: During a mean follow-up of 2.6 years (range: 0.1-4.0 years), 3656 new cases of hypertension were identified. Compared with never smokers, the risk of hypertension was higher among exclusive cigarette smokers [hazard ratio (HR) 1.26, 95% confidence interval (CI) 1.13-1.41] and exclusive HTP users (HR 1.19, 95% CI 1.06-1.34). There was also a suggestion of increased risk of hypertension among dual users (HR 1.16, 95% CI 0.98-1.38). Furthermore, the risk of hypertension increased with the intensity of cigarette/HTP use in all tobacco product users. CONCLUSIONS: Similarly, both cigarette smoking and HTP use elevate the risk of hypertension. HTPs should not be regarded as less harmful alternatives to traditional cigarettes for preventing hypertension.

Prediction models for differentiating benign from malignant liver lesions based on multiparametric dual-energy non-contrast CT.

OBJECTIVES: To create prediction models (PMs) for distinguishing between benign and malignant liver lesions using quantitative data from dual-energy CT (DECT) without contrast agents. MATERIALS AND METHODS: This retrospective study included patients with liver lesions who underwent DECT, including non-contrast-enhanced scans. Benign lesions included hepatic hemangioma, whereas malignant lesions included hepatocellular carcinoma, metastatic liver cancer, and intrahepatic cholangiocellular carcinoma. Patients were divided into derivation and validation groups. In the derivation group, two radiologists calculated ten multiparametric data using univariate and multivariate logistic regression to generate PMs. In the validation group, two additional radiologists measured the parameters to assess the diagnostic performance of PMs. RESULTS: The study included 121 consecutive patients (mean age 67.4 ± 13.8 years, 80 males), with 97 in the derivation group (25 benign and 72 malignant) and 24 in the validation group (7 benign and 17 malignant). Oversampling increased the benign lesion sample to 75, equalizing the malignant group for building PMs. All parameters were statistically significant in univariate analysis (all p < 0.05), leading to the creation of five PMs in multivariate analysis. The area under the curve for the five PMs of two observers was as follows: PM1 (slope K, blood) = 0.76, 0.74; PM2 (slope K, fat) = 0.55, 0.51; PM3 (effective-Z difference, blood) = 0.75, 0.72; PM4 (slope K, blood, fat) = 0.82, 0.78; and PM5 (slope K, effective-Z difference, blood) = 0.90, 0.87. PM5 yielded the best diagnostic performance. CONCLUSION: Multiparametric non-contrast-enhanced DECT is a highly effective method for distinguishing between liver lesions. CLINICAL RELEVANCE STATEMENT: The utilization of non-contrast-enhanced DECT is extremely useful for distinguishing between benign and malignant liver lesions. This approach enables physicians to plan better treatment strategies, alleviating concerns associated with contrast allergy, contrast-induced nephropathy, radiation exposure, and excessive medical expenses. KEY POINTS: Distinguishing benign from malignant liver lesions with non-contrast-enhanced CT would be desirable. This model, incorporating slope K, effective Z, and blood quantification, distinguished benign from malignant liver lesions. Non-contrast-enhanced DECT has benefits, particularly in patients with an iodine allergy, renal failure, or asthma.

Photon-counting CT: technical features and clinical impact on abdominal imaging.

Photon-counting CT has a completely different detector mechanism than conventional energy-integrating CT. In the photon-counting detector, X-rays are directly converted into electrons and received as electrical signals. Photon-counting CT provides virtual monochromatic images with a high contrast-to-noise ratio for abdominal CT imaging and may improve the ability to visualize small or low-contrast lesions. In addition, photon-counting CT may offer the possibility of reducing radiation dose. This review provides an overview of the actual clinical operation of photon-counting CT and its diagnostic utility in abdominal imaging. We also describe the clinical implications of photon-counting CT including imaging of hepatocellular carcinoma, liver metastases, hepatic steatosis, pancreatic cancer, intraductal mucinous neoplasm of the pancreas, and thrombus.

Association of conventional cigarette smoking, heated tobacco product use, and dual use with hearing loss: A working population-based study.

INTRODUCTION: Although conventional cigarette smoking has been linked to an increased risk of hearing loss, the association between heated tobacco products (HTPs) and hearing loss is unknown. The objective of this study was to investigate the association between cigarette and HTP use and hearing loss. METHODS: This cross-sectional study examined the data of 7769 employees from five companies (Study I) and 34404 employees from a large company (Study II), all participants in the Japan Epidemiology Collaboration on Occupational Health Study. The participants were categorized into five groups based on their self-reported tobacco use: never smokers, former smokers, exclusive cigarette smokers, exclusive users of HTPs, and those who used both cigarettes and HTPs. Hearing levels were measured using pure-tone audiometry at 1 and 4 kHz frequencies. Separate analyses were carried out for each study, and the results were then combined using fixed-effect models to pool the estimates. RESULTS: The analysis included 42173 participants, with a prevalence of 12.9% for exclusive cigarette smoking, 9.8% for exclusive HTP use, and 5.5% for dual use. The pooled adjusted odds ratios with 95% confidence intervals for unilateral hearing loss at 4 kHz were 1.21 (95% CI: 1.10-1.33) for former smokers, 1.83 (95% CI: 1.64-2.05) for exclusive cigarette smokers,1.46 (95% CI: 1.28-1.67) for exclusive HTP users, and 1.66 (95% CI: 1.41-1.96) for dual users, compared to never smokers. Additionally, the adjusted odds ratios for hearing loss at 4 kHz among exclusive cigarette smokers, exclusive HTP users, and dual users increased with the intensity of cigarette/HTP consumption (all p for trend <0.001). No significant associations were found between exclusive HTP use, dual use, and hearing loss at 1 kHz, apart from exclusive cigarette smoking. CONCLUSIONS: In this cross-sectional study, associations were found between exclusive cigarette smoking, exclusive HTP use, dual use, and hearing loss, particularly at 4 kHz. Further research is needed to confirm these findings.

Blood pressure classification using the Japanese Society of Hypertension Guidelines for the Management of Hypertension and cardiovascular events among young to middle-aged working adults.

The Japanese Society of Hypertension updated guidelines for hypertension management (JSH2019), changing the blood pressure (BP) classification. However, evidence is sparse regarding the association of the classification with cardiovascular disease (CVD) events among young to middle-aged workers in Japan. We examined this issue using longitudinal data from Japan Epidemiology Collaboration on Occupational Health Study with a prospective cohort design. Participants were 81,876 workers (aged 20-64 years) without taking antihypertensive medication at baseline. BP in 2011 or 2010 was used as exposure. CVD events that occurred from 2012 to 2021 were retrieved from a within-study registry. Cox regression was used to calculate multivariable-adjusted hazard ratios of CVD events. During 0.5 million person-years of follow-up, 334 cardiovascular events, 75 cardiovascular deaths, and 322 all-cause deaths were documented. Compared with normal BP (systolic BP [SBP] < 120 mmHg and diastolic BP [DBP] < 80 mmHg), multivariable-adjusted hazard ratios (95% confidence intervals) of cardiovascular events were 1.98 (1.49-2.65), 2.10 (1.58-2.77), 3.48 (2.33-5.19), 4.12 (2.22-7.64), and 7.81 (3.99-15.30) for high normal BP (SBP120-129 mmHg and DBP < 80 mmHg), elevated BP (SBP130-139 mmHg and/or DBP80-89 mmHg), stage 1 hypertension (SBP140-159 mmHg and DBP90-99 mmHg), stage 2 hypertension (SBP160-179 mmHg and/or DBP100-109 mmHg), and stage 3 hypertension (SBP ≥ 180 mmHg and/or DBP ≥ 110 mmHg), respectively. The highest population attributable fraction was observed in elevated BP (17.8%), followed by stage 1 hypertension (14.1%). The present data suggest that JSH2019 may help identify Japanese workers at a higher cardiovascular risk.

Hepatic and pancreatic extracellular volume fraction analysis using contrast-enhanced CT in patients with diabetes mellitus and pre-diabetes.

PURPOSE: Liver and pancreatic fibrosis is associated with diabetes mellitus (DM), and liver fibrosis is associated with pancreatic fibrosis. This study aimed to investigate the relationship between the hepatic and pancreatic extracellular volume fractions (fECVs), which correlate with tissue fibrosis, and their relationships with DM and pre-DM (pDM). MATERIAL AND METHODS: We included 100 consecutive patients with known or suspected liver and/or pancreatic diseases who underwent contrast-enhanced CT. Patients were classified as nondiabetes, pDM, and DM with hemoglobin A1c (HbA1c) levels of < 5.7%, 5.7%-6.5%, and ≥ 6.5% or fasting plasma glucose (FPG) levels of < 100, 100-125 mg/dL, and ≥ 126 mg/dL, respectively. Subtraction images between unenhanced and equilibrium-phase images were prepared. The liver and the pancreas were automatically extracted using a high-speed, three-dimensional image analysis system, and their respective mean CT values were calculated. The enhancement degree of the aorta (Δaorta) was measured. fECV was calculated using the following equation: fECV = (100 - hematocrit) * Δliver or pancreas/Δaorta. Differences were investigated in hepatic and pancreatic fECVs among the three groups, and the correlation between each two in hepatic fECV, pancreatic fECV, and HbA1c was determined. RESULTS: The pancreatic fECV, which was positively correlated with the hepatic fECV and HbA1c (r = 0.51, P < 0.001, and r = 0.51, P < 0.001, respectively), significantly differed among the three groups (P < 0.001) and was significantly greater in DM than in pDM or nondiabetes and in pDM with nondiabetes (P < 0.001). Hepatic fECV was significantly greater in DM than in nondiabetes (P < 0.05). CONCLUSION: The pancreatic fECV and pDM/DM are closely related.

Should insulin resistance (HOMA-IR), insulin secretion (HOMA-ß), and visceral fat area be considered for improving the performance of diabetes risk prediction models.

INTRODUCTION: Insulin resistance and defects in pancreatic beta cells are the two major pathophysiologic abnormalities that underlie type 2 diabetes. In addition, visceral fat area (VFA) is reported to be a stronger predictor for diabetes than body mass index (BMI). Here, we tested whether the performance of diabetes prediction models could be improved by adding HOMA-IR and HOMA-ß and replacing BMI with VFA. RESEARCH DESIGN AND METHODS: We developed five prediction models using data from a cohort study (5578 individuals, of whom 94.7% were male, and 943 had incident diabetes). We conducted a baseline model (model 1) including age, sex, BMI, smoking, dyslipidemia, hypertension, and HbA1c. Subsequently, we developed another four models: model 2, predictors in model 1 plus fasting plasma glucose (FPG); model 3, predictors in model 1 plus HOMA-IR and HOMA-ß; model 4, predictors in model 1 plus FPG, HOMA-IR, and HOMA-ß; model 5, replaced BMI with VFA in model 2. We assessed model discrimination and calibration for the first 10 years of follow-up. RESULTS: The addition of FPG to model 1 obviously increased the value of the area under the receiver operating characteristic curve from 0.79 (95% CI 0.78, 0.81) to 0.84 (0.83, 0.85). Compared with model 1, model 2 also significantly improved the risk reclassification and discrimination, with a continuous net reclassification improvement index of 0.61 (0.56, 0.70) and an integrated discrimination improvement index of 0.09 (0.08, 0.10). Adding HOMA-IR and HOMA-ß (models 3 and 4) or replacing BMI with VFA (model 5) did not further materially improve the performance. CONCLUSIONS: This cohort study, primarily composed of male workers, suggests that a model with BMI, FPG, and HbA1c effectively identifies those at high diabetes risk. However, adding HOMA-IR, HOMA-ß, or replacing BMI with VFA does not significantly improve the model. Further studies are needed to confirm our findings.

Diabetes, Prediabetes, and the Risk of a Composite Outcome of Long-term Sickness Absence and Pre-retirement Death Due to Physical Disorders.

BACKGROUND: Diabetes and prediabetes have been linked with morbidity or mortality from cardiovascular disease, cancer, or other physical disorders among working-age populations, but less is known about outcomes directly related to labor loss (eg, Tlong-term sickness absence [LTSA] or pre-retirement death due to physical disorders).This prospective study aimed to examine the association of diabetes and prediabetes with the risk of a composite outcome of LTSA and pre-retirement death due to physical disorders. The present study also examined the associations of severe outcomes (LTSA or death) due to specific physical disorders or injuries/external causes in relation to diabetes and prediabetes. METHODS: Data were derived from the Japan Epidemiology Collaboration on Occupational Health study. A total of 60,519 workers from 12 companies were followed for 8 years. Diabetes and prediabetes were defined based on the American Diabetes Association criteria. A Cox proportional hazards regression model was used to examine the association between diabetes/prediabetes and severe outcomes due to physical disorders or injuries/external causes. RESULTS: The adjusted hazard ratios of severe outcomes due to all physical disorders were 1.22 (95% confidence interval [CI], 1.02-1.45) and 2.32 (95% CI, 2.04-2.64) for prediabetes and diabetes, respectively. In cause-specific analyses, an increased risk was observed for severe outcomes due to cancers, cardiovascular diseases, diseases of the musculoskeletal system, and injuries/external causes in relation to either or both diabetes and prediabetes. CONCLUSION: Diabetes and prediabetes were associated with an increased risk of severe outcomes due to physical disorders or injuries/external causes among Japanese workers.

Effect of Deep Learning Reconstruction on Respiratory-triggered T2-weighted MR Imaging of the Liver: A Comparison between the Single-shot Fast Spin-echo and Fast Spin-echo Sequences.

PURPOSE: To compare the effects of deep learning reconstruction (DLR) on respiratory-triggered T2-weighted MRI of the liver between single-shot fast spin-echo (SSFSE) and fast spin-echo (FSE) sequences. METHODS: Respiratory-triggered fat-suppressed liver T2-weighted MRI was obtained with the FSE and SSFSE sequences at the same spatial resolution in 55 patients. Conventional reconstruction (CR) and DLR were applied to each sequence, and the SNR and liver-to-lesion contrast were measured on FSE-CR, FSE-DLR, SSFSE-CR, and SSFSE-DLR images. Image quality was independently assessed by three radiologists. The results of the qualitative and quantitative analyses were compared among the four types of images using repeated-measures analysis of variance or Friedman's test for normally and non-normally distributed data, respectively, and a visual grading characteristics (VGC) analysis was performed to evaluate the image quality improvement by DLR on the FSE and SSFSE sequences. RESULTS: The liver SNR was lowest on SSFSE-CR and highest on FSE-DLR and SSFSE-DLR (P < 0.01). The liver-to-lesion contrast did not differ significantly among the four types of images. Qualitatively, noise scores were worst on SSFSE-CR but best on SSFSE-DLR because DLR significantly reduced noise (P < 0.01). In contrast, artifact scores were worst both on FSE-CR and FSE-DLR (P < 0.01) because DLR did not reduce the artifacts. Lesion conspicuity was significantly improved by DLR compared with CR in the SSFSE (P < 0.01) but not in FSE sequences for all readers. Overall image quality was significantly improved by DLR compared with CR for all readers in the SSFSE (P < 0.01) but only one reader in the FSE (P < 0.01). The mean area under the VGC curve values for the FSE-DLR and SSFSE-DLR sequences were 0.65 and 0.94, respectively. CONCLUSION: In liver T2-weighted MRI, DLR produced more marked improvements in image quality in SSFSE than in FSE.

Ultra-High-Resolution T2-Weighted PROPELLER MRI of the Rectum With Deep Learning Reconstruction: Assessment of Image Quality and Diagnostic Performance.

OBJECTIVE: The aim of this study was to evaluate the impact of ultra-high-resolution acquisition and deep learning reconstruction (DLR) on the image quality and diagnostic performance of T2-weighted periodically rotated overlapping parallel lines with enhanced reconstruction (PROPELLER) imaging of the rectum. MATERIALS AND METHODS: This prospective study included 34 patients who underwent magnetic resonance imaging (MRI) for initial staging or restaging of rectal tumors. The following 4 types of oblique axial PROPELLER images perpendicular to the tumor were obtained: a standard 3-mm slice thickness with conventional reconstruction (3-CR) and DLR (3-DLR), and 1.2-mm slice thickness with CR (1.2-CR) and DLR (1.2-DLR). Three radiologists independently evaluated the image quality and tumor extent by using a 5-point scoring system. Diagnostic accuracy was evaluated in 22 patients with rectal cancer who underwent surgery after MRI without additional neoadjuvant therapy (median interval between MRI and surgery, 22 days). The signal-to-noise ratio and tissue contrast were measured on the 4 types of PROPELLER imaging. RESULTS: 1.2-DLR imaging showed the best sharpness, overall image quality, and rectal and lesion conspicuity for all readers (P < 0.01). Of the assigned scores for tumor extent, extramural venous invasion (EMVI) scores showed moderate agreement across the 4 types of PROPELLER sequences in all readers (intraclass correlation coefficient, 0.60-0.71). Compared with 3-CR imaging, the number of cases with MRI-detected extramural tumor spread was significantly higher with 1.2-DLR imaging (19.0 ± 2.9 vs 23.3 ± 0.9, P = 0.03), and the number of cases with MRI-detected EMVI was significantly increased with 1.2-CR, 3-DLR, and 1.2-DLR imaging (8.0 ± 0.0 vs 9.7 ± 0.5, 11.0 ± 2.2, and 12.3 ± 1.7, respectively; P = 0.02). For the diagnosis of histopathologic extramural tumor spread, 3-CR and 1.2-CR had significantly higher specificity than 3-DLR and 1.2-DLR imaging (0.75 and 0.78 vs 0.64 and 0.58, respectively; P = 0.02), and only 1.2-CR had significantly higher accuracy than 3-CR imaging (0.83 vs 0.79, P = 0.01). The accuracy of MRI-detected EMVI with reference to pathological EMVI was significantly lower for 3-CR and 3-DLR compared with 1.2-CR (0.77 and 0.74 vs 0.85, respectively; P < 0.01), and was not significantly different between 1.2-CR and 1.2-DLR (0.85 vs 0.80). Using any pathological venous invasion as the reference standard, the accuracy of MRI-detected EMVI was significantly the highest with 1.2-DLR, followed by 1.2-CR, 3-CR, and 3-DLR (0.71 vs 0.67 vs 0.59 vs 0.56, respectively; P < 0.01). The signal-to-noise ratio was significantly highest with 3-DLR imaging (P < 0.05). There were no significant differences in tumor-to-muscle contrast between the 4 types of PROPELLER imaging. CONCLUSIONS: Ultra-high-resolution PROPELLER T2-weighted imaging of the rectum combined with DLR improved image quality, increased the number of cases with MRI-detected extramural tumor spread and EMVI, but did not improve diagnostic accuracy with respect to pathology in rectal cancer, possibly because of false-positive MRI findings or false-negative pathologic findings.

High-resolution Diffusion-weighted Imaging of the Prostate Using Multiplexed Sensitivity-encoding: Comparison with the Conventional and Reduced Field-of-view Techniques.

PURPOSE: To compare objective and subjective image quality, lesion conspicuity, and apparent diffusion coefficient (ADC) of high-resolution multiplexed sensitivity-encoding diffusion-weighted imaging (MUSE-DWI) with conventional DWI (c-DWI) and reduced FOV DWI (rFOV-DWI) in prostate MRI. METHODS: Forty-seven patients who underwent prostate MRI, including c-DWI, rFOV-DWI, and MUSE-DWI, were retrospectively evaluated. SNR and ADC of normal prostate tissue and contrast-to-noise ratio (CNR) and ADC of prostate cancer (PCa) were measured and compared between the three sequences. Image quality and lesion conspicuity were independently graded by two radiologists using a 5-point scale and compared between the three sequences. RESULTS: The SNR of normal prostate tissue was significantly higher with rFOV-DWI than with the other two DWI techniques (P ≤ 0.01). The CNR of the PCa was significantly higher with rFOV-DWI than with MUSE-DWI (P < 0.05). The ADC of normal prostate tissue measured by rFOV-DWI was lower than that measured by MUSE-DWI and c-DWI (P < 0.01), while there was no difference in the ADC of cancers. In the qualitative analysis, MUSE-DWI showed significantly higher scores than rFOV-DWI and c-DWI for visibility of anatomy and overall image quality in both readers, and significantly higher scores for distortion in one of the two readers (P < 0.001). There was no difference in lesion conspicuity between the three sequences. CONCLUSION: High-resolution MUSE-DWI showed higher image quality and reduced distortion compared to c-DWI, while maintaining a wide FOV and similar ADC quantification, although no difference in lesion conspicuity was observed.

Image Quality and Lesion Detectability of Pancreatic Phase Thin-Slice Computed Tomography Images With a Deep Learning-Based Reconstruction Algorithm.

OBJECTIVE: To evaluate the image quality and lesion detectability of pancreatic phase thin-slice computed tomography (CT) images reconstructed with a deep learning-based reconstruction (DLR) algorithm compared with filtered-back projection (FBP) and hybrid iterative reconstruction (IR) algorithms. METHODS: Fifty-three patients who underwent dynamic contrast-enhanced CT including pancreatic phase were enrolled in this retrospective study. Pancreatic phase thin-slice (0.625 mm) images were reconstructed with each FBP, hybrid IR, and DLR. Objective image quality and signal-to-noise ratio of the pancreatic parenchyma, and contrast-to-noise ratio of pancreatic lesions were compared between the 3 reconstruction algorithms. Two radiologists independently assessed the image quality of all images. The diagnostic performance for the detection of pancreatic lesions was compared among the reconstruction algorithms using jackknife alternative free-response receiver operating characteristic analysis. RESULTS: Deep learning-based reconstruction resulted in significantly lower image noise and higher signal-to-noise ratio and contrast-to-noise ratio than hybrid IR and FBP ( P < 0.001). Deep learning-based reconstruction also yielded significantly higher visual scores than hybrid IR and FBP ( P < 0.01). The diagnostic performance of DLR for detecting pancreatic lesions was highest for both readers, although a significant difference was found only between DLR and FBP in one reader ( P = 0.02). CONCLUSIONS: Deep learning-based reconstruction showed improved objective and subjective image quality of pancreatic phase thin-slice CT relative to other reconstruction algorithms and has potential for improving lesion detectability.

Metabolic syndrome and the risk of severe cancer events: a longitudinal study in Japanese workers.

BACKGROUND: Metabolic syndrome (MetS) is associated with cancer risk; however, little is known regarding its relationship with the risk of cancer-related premature death and long-term sick leave (LTSL), which can lead to a substantial loss in working years. The present study aimed to quantify the all-site and site-specific associations between MetS and the risk of severe cancer events (a composite outcome of LTSL and mortality due to cancer) in a large working population in Japan. METHODS: We recruited 70,875 workers (59,950 men and 10,925 women), aged 20-59 years, who attended health check-ups in 2011 (10 companies) and 2014 (2 companies). All workers underwent follow up for severe cancer events until March 31, 2020. MetS was defined in accordance with the Joint Interim Statement. Cox regression models were used to quantify the association between baseline MetS and severe cancer events. RESULTS: During 427,379 person-years of follow-up, 523 participants experienced the outcome consisting of 493 LTSLs of which 124 eventually resulted in death, and 30 deaths without taking LTSL. The adjusted hazard ratios (HR) (95% confidence intervals [CI]) for composite severe events due to all-site, obesity-related, and non-obesity-related cancer among those with vs. without MetS were 1.26 (1.03, 1.55), 1.37 (1.04, 1.82), and 1.15 (0.84, 1.56), respectively. In cancer site-specific analyses, MetS was associated with an increased risk of severe events due to pancreatic cancer (HR, 2.06; 95% CI, 0.99-4.26). When mortality was treated solely as the endpoint, the association was significant for all-site (HR, 1.58; 95% CI, 1.10-2.26), and obesity-related (HR, 1.59; 95% CI, 1.00-2.54) cancer. Additionally, a greater number of MetS components was associated with a greater risk of both severe cancer events and cancer-related mortality (P trend < 0.05). CONCLUSION: Among Japanese workers, MetS was associated with an increased risk of severe cancer events, especially those due to obesity-linked cancer.

Diagnostic accuracy of MRI for evaluating myometrial invasion in endometrial cancer: a comparison of MUSE-DWI, rFOV-DWI, and DCE-MRI.

OBJECTIVES: To compare the image quality of high-resolution diffusion-weighted imaging (DWI) using multiplexed sensitivity encoding (MUSE) versus reduced field-of-view (rFOV) techniques in endometrial cancer (EC) and to compare the diagnostic performance of these techniques with that of dynamic contrast-enhanced (DCE) MRI for assessing myometrial invasion of EC. METHODS: MUSE-DWI and rFOV-DWI were obtained preoperatively in 58 women with EC. Three radiologists assessed the image quality of MUSE-DWI and rFOV-DWI. For 55 women who underwent DCE-MRI, the same radiologists assessed the superficial and deep myometrial invasion using MUSE-DWI, rFOV-DWI, and DCE-MRI. Qualitative scores were compared using the Wilcoxon signed-rank test. Receiver operating characteristic analysis was performed to compare the diagnostic performance. RESULTS: Artifacts, sharpness, lesion conspicuity, and overall quality were significantly better with MUSE-DWI than with rFOV-DWI (p < 0.05). The area under the curve (AUC) of MUSE-DWI, rFOV-DWI, and DCE-MRI for the assessment of myometrial invasion were not significantly different except for significantly higher AUC of MUSE-DWI than that of DCE-MRI for superficial myometrial invasion (0.76 for MUSE-DWI and 0.64 for DCE-MRI, p = 0.049) and for deep myometrial invasion (0.92 for MUSE-DWI and 0.80 for DCE-MRI, p = 0.022) in one observer, and that of rFOV-DWI for deep myometrial invasion in another observer (0.96 for MUSE-DWI and 0.89 for rFOV-MRI, p = 0.048). CONCLUSION: MUSE-DWI exhibits better image quality than rFOV-DWI. MUSE-DWI and rFOV-DWI shows almost equivalent diagnostic performance compared to DCE-MRI for assessing superficial and deep myometrial invasion in EC although MUSE-DWI may be helpful for some radiologists.

Basic assessment on adding platelet measurement to legal health checkup in Japan: A cross-sectional and 20-year longitudinal study.

Background: In Japan, health checkups for workers are legally compulsory. Considering legal health checkup items are important for Japanese workers' health problems. To date, the legal health checkup items for blood cell counts include only red blood cell counts and hemoglobin but not platelet counts. This study aimed to investigate the significance of measuring platelets in workers by showing the association between the FIB-4 index (FIB-4), which can be easily calculated from factors including platelet counts and viral hepatitis infection. Method: Both cross-sectional and longitudinal analyses were conducted on the comprehensive medical examinations of male workers. In fiscal year (FY) 2019, a logistic regression model was applied to 12,918 examinees. For 13,459 examinees (mean age = 47.5 ± 9.3 SD), FY2000 was set to be followed until FY2019. A total of 149,956 records between FY2000 and FY2019 were analyzed cross-sectionally, and 8,038 men who were consecutively examined to FY2019 at the longest were analyzed longitudinally. Receiver operating characteristic (ROC) curve-area under the ROC curve (ROC-AUC) and Cox proportional methods were used to examine the association between platelet-related indices and viral hepatitis infection. Results: Logistic regression showed that the risk of FIB-4 ≥ 2.67 was mostly associated with hepatitis C virus antibody (HCVAb) positivity [odds ratio (OR) = 2.51, 95% confidence interval (CI) = 1.08-5.86], while negatively associated with body mass index (BMI) (OR = 0.54, 95% CI = 0.30-0.97), and not associated with the presence of fatty liver. To detect HVC Ab positivity, ROC-AUC showed more effectiveness in FIB-4 than in the AST/ALT ratio (0.776, 95% CI = 0.747-0.773 vs. 0.552; 95% CI = 0.543-0.561). The Cox analysis showed that the risk of FIB-4 ≥ 2.67 was closely associated with hepatitis B virus surface antigen (HBsAg) [hazard ratio (HR) = 3.1, 95% CI = 2.0-4.6] and HCV Ab positivity (HR = 3.2, 95% CI = 2.0-5.0). Conclusion: Our results suggest that it might be worth considering that usage of information on platelets in legal health checkups could be some help not to overlook workers with hepatitis virus carriers as a complementary countermeasure, although further investigations are needed into its practical application.

Significance of Fib4 index as an indicator of alcoholic hepatotoxicity in health examinations among Japanese male workers: a cross-sectional and retrospectively longitudinal study.

BACKGROUND: Fib4 index (Fib4) is clinically used as a noninvasive marker of liver fibrosis. In this study, we aimed to preliminarily investigate whether Fib4 can be used to detect individuals who need assessment for alcoholic liver disease (ALD) in the general population by clarifying the detailed association of Fib4 with alcohol consumption and gamma-glutamyl transferase (GGT) among male workers. METHODS: We analyzed data sets on the comprehensive medical examinations of male workers as cross-sectional and retrospectively longitudinal studies. We enrolled 10 782 males (mean age: 52.2 ± 10.2 years) in FY2019 and 7845 males (mean follow-up: 12.6 ± 6.7 years) who could be consecutively followed up for 20 years from FY2000 to FY2019. Data were evaluated using logistic regression and COX proportional analysis. RESULTS: In the cross-sectional setting, the rate of Fib4 ≥ 2.67 in heavy drinkers (≥ 40 g of ethanol/day) was increased dose dependently in those over 65 years old, and that of body mass index ≥ 30 kg/m2 was increased in those over 60 years old, but not in those with fatty liver. The odds ratio (OR) (95% confidence interval [CI]) for heavy drinking was 4.30 (95% CI = 1.90-9.72), and GGT ≥ 200 IU/L was considerably high (OR = 29.05 [95% CI = 17.03-49.56]). In the longitudinal setting, heavy drinkers and those with GGT ≥ 200 IU/L at 10 years after the baseline showed an increased risk for Fib4 ≥ 2.67 (hazard ratio = 2.17 [95% CI = 1.58-2.98] and 7.65 [95% CI 5.26-11.12], respectively). CONCLUSIONS: The development of Fib4 ≥ 2.67 after 10 years was associated with heavy alcohol drinking and GGT level ≥ 200 IU/L. Therefore, Fib4 combined with GGT could indicate high risk of ALD. However, clinical examinations and course observations are essentially needed.

Metabolic Syndrome and the Increased Risk of Medically Certified Long-term Sickness Absence: A Prospective Analysis Among Japanese Workers.

BACKGROUND: Metabolic syndrome (MetS) has been associated with various chronic diseases that may lead to long-term sickness absence (LTSA), but there is lacking information on the direct association between MetS and LTSA. The present study aimed to investigate the all-cause and cause-specific associations between MetS and the risk of medically certified LTSA among Japanese workers. METHODS: We recruited 67,403 workers (57,276 men and 10,127 women), aged 20-59 years from 13 companies in Japan during their health check-ups in 2011 (11 companies) and 2014 (2 companies), and we followed them for LTSA events (≥30 consecutive days) until March 31, 2020. MetS was defined according to the Joint Interim Statement. A Cox proportional hazards regression model was used to estimate hazard ratios (HRs) and its 95% confidence intervals (CIs) for LTSA associated with MetS and its components. RESULTS: During 408,324 person-years of follow-up, 2,915 workers experienced LTSA. The adjusted HR for all-cause LTSA was 1.54 (95% CI, 1.41-1.68) among those with MetS compared to those without MetS. In cause-specific analysis, HRs associated with MetS significantly increased for LTSA due to overall physical disorders (1.76); cardiovascular diseases (3.16); diseases of the musculoskeletal system and connective tissue (2.01); cancers (1.24); obesity-related cancers (1.35); mental, behavioral, and neurodevelopmental disorders (1.28); reaction to severe stress and adjustment disorders (1.46); and external causes (1.46). The number of MetS components were also significantly associated with increased LTSA risk. CONCLUSION: MetS was associated with an increase in the risk of LTSA due to various diseases among Japanese workers.

Heated tobacco product use and abnormal glucose metabolism: a working population-based study.

AIMS: We aimed to assess the cross-sectional association of heated tobacco product (HTP) use with prediabetes and diabetes. METHODS: The present analysis included 8950 workers from 5 companies (Study I) and 31,341 workers from another large company (Study II), who participated in the Japan Epidemiology Collaboration on Occupational Health Study. The participants were divided into five groups: never smokers, past smokers, exclusive HTP users, dual users of cigarettes and HTPs, and exclusive cigarette smokers. Diabetes and prediabetes were defined according to the fasting blood glucose and HbA1c levels and self-reported diabetes treatment, using the American Diabetes Association criteria. We analyzed the data of Study I and II separately, and then pooled these estimates using the fixed-effect models, with adjustment for a wide range of covariates. RESULTS: In this study that included 40,291 participants (mean age, 46.6 years; men, 84.3%), about half of the current tobacco-related product users reported using HTPs. Exclusive HTP users had higher odds of prediabetes (pooled odds ratio 1.36; 95% CI 1.25-1.47) and diabetes (1.68; 95% CI 1.45-1.94) than never smokers. Similarly, dual users also had increased odds of prediabetes (pooled odds ratio, 1.26; 95% CI 1.13-1.39) and diabetes (1.93; 95% CI 1.63-2.29). The strength of these associations was comparable to that of cigarette smokers. We observed significantly higher HbA1c and fasting blood glucose levels among both exclusive HTP users and dual users compared to never smokers. CONCLUSION: HTP use was associated with an increased likelihood of prediabetes and diabetes. Prospective studies are warranted to confirm the cross-sectional association.