Before the development of capsule endoscopy (CE) and balloon enteroscopy (BE), the small bowel could be explored only by poorly effective methods, such as small bowel series. The small bowel was the so-called “Dark Incontinent”. In CE, the sensors are placed on the abdomen using sticky patches and connected by wires to a recording device. A patient swallows a capsule with water at the hospital. The primary use of CE is to examine the small intestine that cannot be seen by other types of endoscopy such as colonoscopy or EGD. Colon capsule endoscopy (Pillcom^® Colon 2) was developed particularly to increase the acceptability and safety of colonic examination. The Agile Patency Capsule is the same size as the PillCam^® capsule and is used to determine whether the PillCam^® capsule can pass freely through the digestive tract. Obtaining a tissue sample is the next logical step once the capsule can be accurately maneuvered around a lesion and thus would prevent the need for a conventional endoscopy and biopsy when an abnormality is diagnosed by CE. Optical biopsy may enable accurate pathological diagnosis. CE is now an invaluable tool for investigating the small bowel since it outperforms other new investigation modalities. However, esophageal, colonic and potentially gastric capsule examinations require further improvement for them to be comparable to or even better than their traditional investigational counterparts.

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Objective: The aim of the current study was to evaluate the significance of phospho-histone H3 (PHH3) in uterine sarcoma by comparing mitotic activity or cellular proliferative capacity between leiomyosarcoma (LS) and carcinosarcoma (CS). Methods: Histology specimens were taken from 22 patients with uterine sarcoma (12 patients with LS and 12 patients with CS). Immunostaining was performed using a monoclonal anti-PHH3 antibody (Upstate Biotechnology; prediluted, polyclonal) and a monoclonal anti-Ki-67 antibody (NICHIREI; prediluted, clone; SP6) and by the simple staining MAX-PO MULTI (NICHIREI) procedure. In addition, mitotic indices were obtained from HE-stained sections. Results: The PHH3 proliferation index ranged from 0.47 to 2.90 (mean, 1.48) in LS, 0.39 to 4.93 (mean, 1.90) in the sarcomatous component of CS, and 0.62 to 8.35 (mean, 3.79) in the carcinoma component of CS. The Ki-67 proliferation index ranged from 14.41 to 70.03 (mean, 37.47) in LS, 16.18 to 60.91 (mean, 39.88) in the sarcomatous component of CS, and 16.36 to 80.61 (mean, 44.49) in the carcinoma component of CS. The mitotic count ranged from 0.10 to 1.38 (mean, 0.62) in LS, 0.10 to 2.38 (mean, 0.76) in the sarcomatous component of CS, and 0.10 to 2.19 (mean, 1.24) in the carcinoma component of CS. Conclusion: The PHH3 expression correlated well with that of Ki-67 and identified MFs precisely. The anti-PHH3 antibody is considered to be useful for the evaluation of the MF index and cellular proliferative capacity.

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Chattering is a troublesome artifact showing parallel vibration against a blade line when we cut hard samples such as uterine myomas. We attempted to clarify what condition easily causes this artifact and how to prevent it. We found that the thinner the section, the faster the velocity of slicing, and the lower the temperature of sample blocks, the easier for chattering to occur. From these results, we consider that chattering may occur depending on the slicing technique. It may also be due to complex factors arising from vibrations of the blade slicing a tissue that is contracted and hardened owing to its dehydration and heating during paraffin infiltration for tissue block preparation. Rehydration of the surface of blocks by wet compress or by using a mist humidifier was effective in preventing chattering. Rehydration can soften a tissue and prevent vibration of the slicing blade.

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In this study, we name artifacts “bamboo blinds”, which include chattering and bamboo-blind-like cracks of a section, and determine the onset mechanism and method of eliminating such bamboo blinds. As a result, in 3-um-thick sections, a few bamboo blinds broke out in a region where fibers densely aggregated, such as collagenous fibers and muscle fibers, but many bamboo blinds occurred in glandular epidermal cells. The larger the thickness of the sections, the faster the velocity of slicing, and the lower the temperature of the sample blocks, the more easily the bamboo blinds broke out. For eliminating bamboo blinds, rehydration on the surface of blocks was effective. From these findings, we consider that bamboo blinds break out because of complex factors such as weakening of tissue cells due to dehydration during the preparation of tissue blocks, existence or nonexistence of qualitative or quantitative interference from fibers and paraffin, and slicing techniques.

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In this article, we report on the basic analysis of extraintestinal infection of Aeromonas bacteria. Out of 171 cases, there were 21 fatal cases, 5 fulminant cases, and 4 necrosis cases (among these, one case was necrotizing soft tissue infection). The average patient age was 73.3 years, and 86% were older than 60 years. Regarding underlying conditions, in addition to illnesses related to the hepato-biliary-pancreatic system, illnesses that led to decreased immunity, such as diabetes and malignant tumors, were observed at a high rate. This trend was particularly noted in the fatal cases. The clinical diagnoses varied, including hepato-biliary-pancreatic system illnesses, blood poisoning, aspirated pneumonia, abscess infection, and necrotizing soft tissue infection. According to an antimicrobial susceptibility test, the bacteria showed good sensitivity to TAZ/PIPC, CTX, IPM/CS, GM, LVFX, and ST. On the other hand, high resistance to SBT/ABPC and CEZ was also observed. A few strains (4.3%) did not show sensitivity to IPM/CS. Although no trend of multidrug resistance was observed in these bacteria, the expression of some type of resistance mechanism is considered possible. From now, focusing on the antimicrobial resistance of Aeromonas bacteria is considered important.

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We have experienced a case of primary hepatic actinomycosis caused by Actinomyces israelii (A. israelii). A 79-year-old woman with a history of choledocholithiasis was admitted to a hospital with persistent fever as the chief complaint. A liver abscess was revealed by abdominal echo and CT. Branched gram-positive bacilli were detected in the percutaneous abscess drainage. The results of Kinyoun staining were negative. White irregular-shape colonies were observed after six days of anaerobic culture. A. israelii was identified using the ANC identification card (sysmex biomerieux) on VITEK2. The abscess was found to be reduced after drainage and antibiotics (Tazobactum/Piperacillin) administration. Although hepatic actinomycosis is relatively rare, we should keep in mind that these bacteria can cause liver abscess, particularly if the patient has a history of choledocholithiasis or abdominal surgery. It is very important for the detection of anaerobic bacteria such as A. israelii to appropriately transport specimens using an anaerobic porter. If we suspect the involvement of actinomyces bacteria, the culture period should be prolonged.

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We report the cases of four patients presenting with small cell carcinoma of the urinary bladder, which were diagnosed at our hospital between 2010 and 2011, whose clinicopathologies were reviewed. The patients included 3 men and one woman ranging in age from 58 to 87 years (median age: 75.5 years). All the patients complained of macroscopic hematuria. One risk factor is smoking which was observed in one patient. Cystoscopy revealed a papillary bladder tumor, but computed tomography (CT) examination revealed a sessile bladder tumor in our patients. Histologically, all the patients presented with small cell carcinoma and 3 patients exhibited other carcinoma components such as urothelial carcinoma. Three patients had Stage pT2, and one patient had Stage pT1. Follow-up data available for 3 patients revealed a poor outcome at 5 months and 4 months. Small cell carcinoma of the urinary bladder has poor prognosis, and it is important for diagnosis to be based on tumor morphology, as determined by endoscopic findings and CT examination, and on cytology with small cell carcinoma in mind.

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Two cases of non-Hodgkin’s lymphoma of the testis are reported. The ages of the two patients were 78 and 74 years old. One patient has hydrocele of the testis and fine needle aspiration cytology was performed; initially, seminoma was suspected. High orchiectomy was performed in each patient, and microscopic findings of specimens revealed diffuse large B cell lymphoma in both patients, and one patient was positive for CD5. In addition, the two patients were classified as having the nongerminal center B cell type and were placed in the poor-prognosis group. Chemotherapy and radiotherapy are important because testicular malignant lymphoma often results in recurrence and metastasis, and postoperatively, our patients were subjected to R-CHOP therapy and follow-up. It was considered that fine needle aspiration cytology for hydrocele of the testis should be performed in elderly patients to distinguish it from seminoma.

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A comparison of sensitivity was performed among adenovirus antigen detection kits, which were developed on the basis of immunochromatography technology and are routinely used in the clinical setting. The tested kits were QuicknaviTM-Adeno, Quickchaser^®Adeno, Immunocard^®ST AdenovirusⅡ, BD Veritor^TMSystem Adeno, Primecheck^®Adeno, and Imunoace^®Adeno. The comparison was performed with 8 standard strains of adenovirus stocks, namely, types 1–7 and 11, as the subjects for the test. The minimum detection limit of concentration of each kit was determined comparatively for each viral strain by investigating the maximum dilution rate of the viral stock giving a positive result. Thus, the concentration limit differed among viral strains for each kit and among kits for each viral strain, showing even a 50-fold difference in extreme cases. Particularly for adenovirus types 6 and 11, all the tested kits showed poor reactivity. Then, the absolute minimum detection limits were calculated on the basis of the minimum copy number of viral DNA or the minimum detectable infective titer of the subject strains to the culture cells. Greater differences were found in the comparison among viral strains when using the infectivity than when using the gene copy numbers: the infectivity titers of the virus stocks of types 3, 7, and 11 were about 107 times lower than those of other strains, and the sensitivities to types 3, 7, and 11 were found to be apparently higher than those to other types when the infectivity was used for the comparison. Thus, caution is advised in comparisons using the infectivity parameter, and gene copy number could be a preferable alternative.

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The methods mainly used for diagnosing alkaptonuria require keeping urine at room temperature or alkalizing urine using 10% sodium hydroxide and observing the color change. However, the change in urine color is ambiguous and it takes a long time to determine. In the case of diluted or acidic urine, it requires one month or more. Even in concentrated or alkaline urine, it takes several days. The addition of sodium hydroxide is known to shorten the time to 4–5 hours. The change in color is attributed to the oxidation of homogentisic acid. We hypothesized that the addition of sodium hypochlorite to oxidize urine might accelerate the time for diagnosis. A case of alkaptonuria was used to compare these methods. We found that sodium hydroxide plus sodium hypochlorite could change urine color within 5 minutes. At present, although almost all patients with alkaptonuria are not diagnosed until they develop symptoms of arthritis or cardiovascular diseases, our method could be applied to the screening and diagnosis of alkaptonuria in the early stage.

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The basic performance of the blood drug measurement reagent "Nanopia^®TDM Teicoplanin" was evaluated using the Viva-E system of a general-purpose automatic analyzer. The coefficients of variation (CVs) for the within-run and between-run reproducibilities ranged from 0.69% to 2.96%. The dilution linearity was maintained at about 100 μg/mL, and the detection limit was 2.00 μg/mL. No effect of interfering substances was detected. The TEIC concentration between the current method and the traditional method (FPIA method) showed a good correlation in 47 samples (r = 0.977, y = 0.959x + 1.849). Therefore, this reagent, which has a good basic performance using the Viva-E system, is useful for the therapeutic drug monitoring of teicoplanin.

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The antinuclear antibody (ANA) test is clinically useful for the diagnosis of connective tissue diseases (CTDs). However, it is widely recognized that positive ANA results are often observed in patients without CTD. Therefore, additional tests for specific autoantibodies are required for ANA-positive patients. Recently, the multiplex immunoassay test using the BioPlex 2200 ANA screen has enabled the simultaneous detection of 13 autoantibodies using a single serum sample. Therefore, in this study, we assessed the utility of the BioPlex assay in comparison with the conventional immunofluorescence (IF) and enzyme-linked immunosorbent assay (ELISA). Sera from 291 patients with CTD were analyzed for ANA and autoantibodies using the BioPlex assay, IF, and ELISA. The positive, negative, and total concordance rates between the BioPlex assay and IF were 89.6%, 64.3%, and 81.1%, respectively, whereas those between the BioPlex assay and ELISA were 94.7%, 85.7%, and 92.1%, respectively. The ANA-positive ratio obtained using the BioPlex assay was mostly higher than that obtained using IF and equivalent to that obtained by ELISA. The positive ratios of 8 specific autoantibodies obtained using the BioPlex assay were similar to the reported prevalence. Out of the 156 samples from patients without systemic lupus erythematosus (SLE), only 8 were positive for anti-dsDNA antibodies (5.1%). The BioPlex assay is an informative and convenient tool for the diagnosis of CTD.

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We evaluated a new fourth-generation HIV test, Lumipulse HIV Ag/Ab assay, for the measurement of the HIV antigen and antibody. Good results were obtained for the within-run precision, between-day precision and prozone phenomenon of high titers. In the detection of HIV infection using four HIV seroconversion panels, Lumipulse HIV Ag/Ab assay detected more quickly than a comparison assay using two samples. In the comparison of the sensitivities to the HIV-1 p24 antigen using WHO International Standard NIBSC, Lumipulse HIV Ag/Ab assay was observed to have a higher sensitivity than Architect・HIV Ag/Ab combo assay. However, we observed negative interference in the chyle test and a positive interference in the rheumatoid factor test. In a correlation test, two samples were unmatched between the Lumipulse HIV Ag/Ab assay and the comparison assay. In this study, although Lumipulse HIV Ag/Ab assay was good for screening HIV infection, it was necessary to judge a positive result carefully.

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The reference value of PCT within the reference range was estimated in 177 dialysis patients who did not have bacterial infection and in 143 dialysis patients who had bacterial infection among 183 dialysis patients, and the significance of the reference value in such patients was evaluated. PCT values were transformed to a normal distribution, and the normalized mean ± 2x standard deviation was calculated. As a result, the reference maximum was 0.76 ng/mL in the former (n = 177) and 0.72 ng/mL in the latter (n = 143). The median PCT value of 0.26 ng/mL before dialysis decreased to 0.21 ng/mL after dialysis. There was no significant difference in the removal rate of PCT between polysulfone and polymethyl methacrylate membranes, and the removal rate was increased by adding the beta 2 microglobulin column Lixelle^®. In the multiple regression analysis of Log₁₀PCT, patient age, levels of beta 2 microglobulin and CRP, and reticulocyte count remained as explanatory variables. In conclusion, the reference value of PCT in dialysis patients was defined as "less than 0.7 ng/mL", in comparison with “less than 0.05 ng/mL” in normal subjects. The PCT value in dialysis patients without infection may represent a certain aspect of chronic minute inflammation, in addition to the poor removal rate of PCT using a high-performance membrane.

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In recent years, a high frequency of dysplasia or adenoma of pyloric glands has been reported, and it has become necessary to differentiate between pyloric glands and fundic glands. Anti-MUC antibodies have been used as markers of pyloric glands. However, the anti-MUC antibody is not specific to pyloric glands; they also react with human duodenal Brunner’s glands or mucous neck cells. Therefore, by Alcian blue staining, we compared fundic glands, pyloric glands, and duodenal Brunner’s glands. Results showed that, by Alcian blue staining, the mucous neck cells of fundic glands were stained, whereas pyloric glands and duodenal Brunner’s glands were not stained. In this paper, we report that Alcian blue staining is useful for identifying the mucous neck cells of fundic glands.

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We studied human error in incidents related to the characteristics of action of medical technologists by duality analysis. The number of human-error-related incidents was 348 within nine years (2004–2012). The causes were absence of confirmation, mistaken idea, and wrong judgement made by self, among which the most important cause is absence of confirmation. By duality analysis, we can classify the incidents related to the characteristics of action of medical technologists on duty into five groups. The group with the most number of problems is composed of medical technologists with long experience and who have shown quality work. However, they are very important workers in the laboratory. To minimize the causes of such incidents, we suggest that they keep a record of their work, and technical management should be practiced daily. Therefore, reeducation on confirmation procedures and improvement of work amount are needed immediately.

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Several reports have described that the accuracy and precision of serum calcium measurement were improved after upgrading the water purification apparatus used in the laboratory. These improvements might have been brought about owing to the supply of high-quality water. Therefore, we distributed a questionnaire on the purification system and management of water purification apparatus and the accuracy and precision of serum calcium measurement to 117 clinical laboratories in the Kanto-Koshin area of Japan. Satisfaction with the accuracy and precision of serum calcium measurement was higher in the laboratories using reverse osmosis and electro-deionization than in those using the reverse osmosis and deionization system (RO/DI). Furthermore, in the laboratories using RO/DI, dissatisfaction with serum calcium measurement was higher in those using the methyl xylenol blue (MXB) method than in those using other methods. These responses suggested that the water quality significantly affects the accuracy and precision of serum calcium measurement, and the standardization of water quality for clinical laboratories is important for the improvement of the state of the art in serum calcium measurement.

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Endoscopy for gastric cancer has been used for more than 20 years in Japan. However, it is not necessarily used ‍for ‍early examination, such as during x-ray medical check-up. To evaluate the contribution of esophagogastroduodenoendoscopy (EGD) to gastric cancer medical examination, we compared endoscopical and pathological diagnoses by dividing participants of this study into two groups: 1,346 ‘Ningen Dock’ (ND; medical check-up) subjects and 6,315 general practice (GP) patients, and the usefulness of EGD was shown. Gastric adenocarcinoma was detected in 0.7% (10 of 1,346 subjects; peak age = 60 years) of ND subjects and 3.8% (283 of 6,315 patients; male:female = 4.3%:2.8%, peak age = 70 years) of GP patients. Among the ten ND subjects (0.7%), the distribution of the diagnoses based on endoscopy results was 80% early cancer, 10% advanced cancer, and 10% noncancer. In contrast, in the GP group, only 51.7% showed detectable early cancer. In addition, the age at which cancer was detected was 10 years younger in the ND group than in the GP group. The percentage of patients in whom endoscopy was used for mass screening reached 9.1%. Also, in ND, the combined use of endoscopic diagnosis and biopsy diagnosis is important given the 10% noncancer cases. Therefore, for the early detection and treatment of gastric cancer, it is important to improve the EGD consultation rate by ND, which will contribute to the reduction in mortality rate.

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