At Takano Hospital, anorectal function tests are carried out to evaluate the anorectal function of patients with fecal incontinence. The aim of this study was to first calculate the normal reference values of anal manometry [functional anal canal length (HPZ) · maximum resting pressure (MRP) · maximum squeeze pressure (MSP)], and the anal canal sensation of approximately 5,000 patients who underwent the test from 2003 to 2009, and then compare the anal pressure of the incontinent patients with that of the non-incontinent patients. The findings revealed that the pressure of the patients with fecal incontinence was significantly lower than that of the non-incontinent patients, that patients with a lower MRP had more severe symptoms of fecal incontinence, that half of the patients with a pressure reading of less than 50 cm H2O had fecal incontinence, and that the anal canal sensation of the incontinent patients was significantly slower than that of the non-incontinent patients. These findings suggest that the above-mentioned tests can be used to objectively evaluate anal function, identify the patients with fecal incontinence, and provide positive feedback to patients to help them become more aware of the optimal anorectal function that they should aspire to attain.
The morbidity and mortality rates of prostate cancer (PC) have been increasing over the years. Screening tests for a prostate-specific antigen (PSA) are essential for early diagnosis. However, differentiation between PC and benign prostatic hyperplasia by a screening test may be difficult. In patients with false-negative and false-positive PSA measurements, oversight, overdiagnosis and overtreatment of PC may occur as disadvantages. Most of the patients were admitted to the department of urology owing to lower urinary tract symptoms and underwent prostate biopsies to differentiate between PC and other diseases. We examined the merits of PSA measurements in those with suspected PC using ROC curve analysis and Bayesian theorem (BT). ROC curve analysis revealed that the cutoff level of PSA was 15.0 ng/mL and the AUC cutoff was 0.73. When the virtual pretest probability is 50%, the post-test probability is improved to 85% in the calculation based on BT. However, when the cutoff level was set at 4.0 ng/mL in those patients, there was no improvement in the post-test probability compared with the pre-test probability. We consider that it may be necessary to determine the cutoff level for clinical medicine apart from that for preventive medicine. If we choose an approach oriented toward preventive medicine for the young and toward practical medicine for the old, PSA measurement with a suitably chosen cutoff level may increase the diagnostic accuracy of PC in clinical and preventive medicines. The analytical use of the Bayesian theorem may enable us to realize the actual power of PSA and, in the future, we expect that the Bayesian theorem will become widely used as one of the powerful methods in many fields.
To identify community MRSA clones, we carried out POT and detected four exfoliative toxin genes (PVL,TSST-1,ETA,ETB) of 69 MRSA strains that have been detected from outpatients. We detected the POT types 106-137-80 and 106-9-80 most often from outpatients. The POT type 106-137-80 was also detected most often from inpatients during the same period. In 2010, we detected “106” in 11.4% of the patients, which increased to 27.4% in 2014. Moreover, we found 19 TSST-1-producing MRSA strains and an ETA-producing MRSA strain, but we found no PVL- and ETB-producing MRSA strains. In this study, we examined CA-MRSA clones and their exfoliative toxin genes. The community-epidemic-causing strain brought to a hospital is of paramount importance, and in the future, it will be necessary to determine the trend of infection to improve the control of hospital infection.
Intra-abdominal masses are histologically diagnosed by biopsy to differentiate among primary malignant and metastatic tumors, malignant lymphoma, and reactive lesions. In this study, to investigate the usefulness of rapid on-site cytologic evaluation (ROSE), the diagnoses of needle biopsy specimens of intra-abdominal masses were compared between cytological and histological examinations of 69 patients in whom ROSE was performed at the time of needle biopsy. The accuracy of the rapid cytodiagnosis based on the histological diagnosis was 91.3%, which is satisfactory. In 15 of 31 patients for whom malignant lymphoma was included in differentiation by ROSE, a portion of the needle biopsy specimen collected on the same day was subjected to flow cytometry to investigate the immunological phenotype, and analyzable results were obtained in 14 patients. Evaluation of cells of intra-abdominal masses by the combination of needle biopsy and ROSE not only enables the evaluation of the collected tissue but also may also provide indications for the need for additional examinations, which may facilitate a highly accurate diagnosis.
P-selectin and PAC-1, which are known as platelet activation markers, require special antibodies, and there are many problems to be solved before putting them into clinical application. On the other hand, the analysis of monocyte-platelet aggregates does not require special antibodies and is highly sensitive. Therefore, we focused on this method and discussed its clinical application. As for the sodium citrate blood and EDTA-2K blood of subjects aged 19 to 32 years, we observed variations in monocyte-platelet aggregate rate (mono-PLT%). Moreover, as for clinical samples (from subjects aged 40 to 74 years; EDTA-2K blood), we observed the mono-PLT% of the sample group whose LDL, TG, and blood glucose levels were normal (Normal) and the sample group whose LDL, TG, and blood glucose levels were abnormal (Abnormal). In the analysis of the sodium citrate blood, mono-PLT% increased, while in the analysis of the EDTA-2K blood, it was stable for a long period of time. The average mono-PLT% of the EDTA-2K blood was 34.0 ± 12.7% (average ± SD). The average mono-PLT% values of the clinical samples were 29.5 ± 12.7% for the Normal and 42.1 ± 19.5% for the Abnormal, which were significantly different (p < 0.05). This method using EDTA-2K does not require special antibodies and is inexpensive and stable for a long time after blood sampling. Moreover, surplus samples can be used for this method. Accordingly, it was considered that this method could be used as a useful platelet activation marker in clinical practice.
Self-monitoring blood glucose (SMBG) meters and point-of-care blood glucose meters are capable of simple and rapid monitoring. Therefore, they are widely used in the medical field. However, in 2011, false hyperglycemia cases caused by juice remaining in the finger have been reported. This time, in order to verify the present case, we examined the reactivities of eleven sugars. Seven types of SMBG meters were included. In the false hyperglycemia cases, it was suggested that they were caused by glucose itself contained in the fruit juice. Furthermore, in devices other than meters using GOD enzymes, reactions with some saccharides were confirmed. Portable glucose meters are obtained by manipulating the features of the meters. Thus, for the user, it is important to fully understand the features of the meters.
We attempted to standardize the liquid-based cytology of sputum using a mucolytic agent and BD SurePathTM and obtained good results. A mucolytic agent, Sputazyme, was added to a whole sputum sample, and all cellular components required for diagnosis were collected by centrifugation. BD SurePathTM specimens were prepared in accordance with nongynecologic procedures. The specimens were classified into 4 categories: negative, pseudo-positive, positive and inappropriate. Dust cells, the presence of which was used as an indicator, were counted at a magnification of ×40 in 10 fields of view, and the average number was calculated. Inappropriate specimens without dust cells were obtained from 17 (16.5%) of 103 subjects, and there were no technical errors, such as drying and excessive smearing. The average number of dust cells was 16.5 in 86 appropriate specimens. Of the 86 appropriate specimens, 82 (95.3%) were categorized as negative and 4 (4.7%) were categorized as pseudo-positive. The homogenization of the whole sputum sample using a mucolytic agent improved cell collection efficiency by centrifugation and enabled the preparation of BD SurePathTM specimens even from mucous samples, thereby contributing to the standardization of specimen preparation.
It is very important for the screening for urinary tract diseases to examine urine samples microscopically. Particularly in patients with hematuria, close observation of the size and shape of erythrocytes is important in distinguishing the glomerular origin from other origins, such as those of the lower urinary tract. In this study, we investigated the accuracy of information on RBCs, including those of the “dysmorphic type”, “isomorphic type”, and “mixed type”, from the UF-1000i (Sysmex), which is an automated apparatus for the testing of urine, and the usefulness of RBC information in the final clinical diagnosis in 631 urine samples. Glomerular-type RBCs examined by clinical laboratory technologists by microscopy examination were found in 49.1% of the dysmorphic type, 39.3% of the mixed type, and 1.2% of the isomorphic type. Clinically diagnosed glomerular diseases were found in 30.7% of the dysmorphic type, 12.1% of the mixed type, and 3.9% of the isomorphic type. Dysmorphic-type RBC is a good supportive marker for distinguishing glomerular disease from other lower urinary tract diseases.
The whole parathyroid hormone (PTH) assay can exclusively measure bioactive 184 PTH, reflecting parathyroid function precisely without the effects of renal function. In this study, we evaluate the performance of the chemiluminescence enzyme immunoassay (CLEIA)-based whole parathyroid hormone (PTH) assay and analyzed variable factors. The performance evaluation demonstrated preferable repeatability and intermediate precision. Serum and EDTA2Na plasma samples showed good correlation, although plasma samples had superior sample storage stability. A high level of rheumatoid factor tended to be associated with the decrease in the whole PTH value. Whole PTH values were approximately 60% of intact PTH values and well correlated with intact PTH. Increased whole PTH values were confirmed after exercise, although the degree of exercise effect varied among individuals. Standing position during blood sampling tended to result in high whole PTH values compared with recumbent position. Decreased whole PTH value was confirmed in the samples obtained from whole blood left at 25 C for 4 hours or more. Whole PTH values were decreased with increasing number of sample transfers to containers. At our hospital, we used a rapid measurement of whole PTH using serum samples to enable the measurement of other parameters simultaneously and reduce the volume of blood sampling. The rapid measurement of whole PTH can precisely reflect parathyroid function and it is considered to be more useful for minimizing the effects of various factors determined in this study.
N-terminal pro B-type natriuretic peptide (NT-proBNP) is a useful biomarker for the diagnosis and/or management of chronic heart failure. Here, we show the results of the evaluation of a new instrument for serum NT-proBNP assay, HISCL-5000® (Sysmex). We performed fundamental evaluations of the NT-proBNP assay using HISCL-5000®, namely, intra- and inter-assay variances, linearity for serially diluted samples and effects of several substances. The coefficients of variance (CVs) for intra- and inter- assays using control samples were between 0.9 and 2.4%. In a linear regression analysis of the serially diluted samples, we obtained a constant linearity between 0 and 34,434 pg/mL (r2 = 0.997, p < 0.001). There is no significant interference (less than 10%) by the existing direct bilirubin, conjugated bilirubin, hemoglobin, chylous fluids, and rheumatoid factor on the measurements of NT-proBNP. Furthermore, we evaluated the consistency of this assay with another electro-chemiluminescence immunoassay for NT-proBNP (EClusys®analyzer, Roche Diagnostics KK, Tokyo, Japan) using 112 serum samples. Although the absolute values obtained by HISCL-5000® measurements tend to be lower than those obtained by ECLusys® measurements (linear regression equation: y = 0.85x + 183.2), they were considered consistent with each other (correlation coefficient of 0.99). These results indicate that HISCL-5000® can be applied to serum NT-proBNP measurements for routine use in the laboratory.
Methicillin-resistant Staphylococcus aureus (MRSA) remains a significant problem associated with hospital-acquired infections. Thus, we implemented a survey of the MRSA carrier in inpatients over 70 years of age, and we identified the risk factors associated with MRSA colonization and evaluated the efficiency of the surveillance. The surveillance was conducted using 394 inpatient samples obtained between April and June 2013. The total number of MRSA colonizations was 39 (10.7%), and the carriage rate of MRSA of inpatients in welfare facilities (20.7%) was significantly higher than that in homes (6.0%) in this surveillance. Being an inpatient in welfare facilities was the only significant risk factor for MRSA carriage. Surveillance the following year, average number of patients with MRSA are decreasing. This means that surveillance was considered effective in preventing hospital-acquired infections. In conclusion, we concluded that MRSA surveillance implementation and/or precautions against contact transmission for inpatients in welfare facilities will lead to better infection control.
Drug susceptibility testing is extremely important in tuberculosis (TB) treatment but it takes a long time to produce results, which is a disadvantage. Thus, new rapid drug susceptibility testing methods based on genetic diagnosis have been developed one after another. In this work, we introduce “Jenosu color® · Rif TB” (NIPRO Co., Ltd.) and examined its utility for detecting the RFP resistance gene directly using this material. The detection rates of TB using this kit were 98% in smear-positive specimens and 78.8% when using materials other than sputum or culture. We determined the presence of the RFP resistance gene and the matching rates of drug susceptibility testing; the sensitivity matching rate was 100% and the resistance matching rate was 82.5%. The results of this study reveal that this kit is useful in the presence or absence of the effect of RFP administration, for changing the method of treatment, and for the prevention of nosocomial infection. It is considered to contribute to the treatment of TB.
In September 2012, we started using tap water for hand washing in operating rooms instead of sterilized water. With this change, we conducted bacterial contamination surveys of tap water sampled from each of the seven faucets at two hand wash stations and reviewed the appropriate method for water quality control. Formerly, we tested for general bacteria and E scherichia coli, but this time, we tested for heterotrophic bacteria as well. Heterotrophic bacterial concentrations exceeded the desired value of 2,000 CFU/mL while no general bacteria or E. coli was detected. Among heterotrophic bacteria, Sphingomonas pausimobilis and Methylobacterium spp. were dominant. We then cleaned the water outlet of the faucets, made sure to run water before use, and measured chlorine level. Even after these steps, a significant number of heterotrophic bacteria were detected despite a sufficient chlorine level. This indicated the presence of chlorine-resistant bacteria. Heating sterilization but not chlorination seemed to be more effective. Since we started performing 65°C heat treatment, the heterotrophic bacterial concentration has been 2,000 CFU/mL or lower. The improvement of water for hand washing has been achieved by thoroughly reviewing the conventional method. This study shows that the cleanliness of water for hand washing will be maintained by continuous tests for heterotrophic bacteria.
A 70-year-old male came to our hospital’s Hematology Department suffering from platelet depletion. He presented with hypothyroidism, high blood pressure, chronic obstructive pulmonary disease, and hyperuricemia. A pathologic diagnosis of diffuse large B-cell lymphoma (DLBCL) was made on the basis of the reconstitution of the immunoglobulin heavy chain JH. The abnormal cells in the bone marrow were blastlike cells and a few phagocytes. Flow cytometry is useful for examination owing to the differential diagnosis of cells and the determination of a therapeutic strategy and prognosis. The immunophenotypes of the lymphoma cells were CD1a−, CD2−, CD3−, CD4+, CD5+, CD7−, CD8−, CD10−, CD11b−, CD13−, CD14−, CD19+, CD20+, CD25−, CD33−, CD34−, CD36+, CD38+, CD41−, CD56−, HLA−DR+, IgG−, IgA−, IgM−, IgD−, κ−, and λ−. It was difficult to decipher the results of flow cytometry when CD19 of pan-B-cell markers and CD4 of T-cell markers were positive. R-CHOP was performed. Results showed that complete remission was achieved. We experienced a rare case of CD4-positive DLBCL.
Although infected abdominal aneurysm is a rare disease, it has a high mortality rate; therefore, rapid identification of the pathogen is required. A 63-year-old women presented our hospital for abdominal pain, diarrhea, and nausea. She was diagnosed with impending ruptured infected abdominal aneurysms by computed tomography scan, and an emergency operation was performed. Blood and aneurysm wall culture were submitted. She received latamoxef before surgery, and two days after surgery, ceftriaxone and vancomycin. Although blood culture was negative, Campylobacter fetus subsp. fetus was isolated from the abdominal wall specimen. Therefore, the antibiotics were changed and meropenem was administered for 9 days after surgery, she was discharged. Levofloxacin administered for 14 days as outpatient treatment. Our study reveals that Campylobacter fetus subsp. fetus must be considered as a possible pathogen in cases of infected aneurysms.
A fat absorption test is essentially important for diagnosing malabsorption syndrome. We report the cases of two patients in whom a fat absorption test was useful for diagnosing or ruling out malabsorption syndrome. Patient 1, a 60-year-old male, was admitted with loss of body weight even with sufficient amount of feeding. The fat absorption test revealed that his fat absorption rate was 0% (the normal range is 97 to 100%); thus, we diagnosed him as having malabsorption syndrome. After the oral administration of pancrelipase (LipaCreon®) and a digestive enzyme preparation (TOUGHMAC®-E), the fat absorption rate was improved to 63.9%. Patient 2, a 60-year-old male, was admitted with emaciation. The fat absorption test revealed that his fat absorption rate was 97.8%. Thus, the fat absorption test was useful for ruling out malabsorption syndrome. A fat absorption test using an automated analyzer with surface-active agents has applicable precision with good reproducibility as long as we apply an appropriate procedure. Since the fat absorption test employs only conventional equipment and laboratory techniques, it can be carried out in any hospital. Thus, the fat absorption test is useful for diagnosing or ruling out malabsorption syndrome in daily clinical practice.
Fully automatic blood transfusion systems are useful for solving problems such as individual differences in aggregation judged and dispensing errors. Here, we report the basic performance evaluation of the ORTHO VISIONTM Analyzer (VISION), which is a fully automatic blood transfusion system. Correlations of blood type tests and irregular antibody screening tests were determined using the VISION and ORTHO AutoVue® Innova System (Innova). The effects of coexisting substances, cross-matching tests, stability of blood cell reagents, and room temperature were analyzed using VISION. The rate of concordance of blood type tests in both devices was 99%. There was only one mismatch case in the reverse test. The irregular antibody detection rate was 72% for VISION (56/78), which was superior to 64% (50/78) for Innova. The intra-assay precisions of irregular antibody screening tests were all within a grade difference. In coexisting substances tests, the contrast abnormality was detected in more than 3.7 mg/dL of hemoglobin by Ficin method, and there are cases wherein a nonspecific reaction occurred with a total globulin amount of 3,600 mg/dL or more. In the cross-matching test by the LISS-IAT method, in the case of an antibody of clinical significance, only the corresponding antigen-negative blood was matched. The red blood cell reagent was confirmed to be stable for 8 days (Dia antigen). At low room temperature influenced on incubation and centrifugation, as the result, the detection rates of the cold-reactive antibodies were increased. VISION was able to conduct a test of basic transfusion in safety, accuracy and high sensitivity.