A basic evaluation to determine whether AmpC production could be detected was performed using a wide variety of cephem antimicrobial agents. Results of the antimicrobial sensitivity tests for the detection of AmpC-producing organisms revealed that among the cephem antimicrobial agents evaluated, the detection was superior for CFDN, CDTR, CFPN, and CPDX. Double-inhibition zones affecting the results of the disk diffusion assay formed depending on the type of drug, and this trend was pronounced for cephamycins and oxacephems (10.3–20.7%) and also observed for third-generation cephalosporin antimicrobial agents (0–13.8%). The frequency of the formation of double-inhibition zones was relatively stable (3.4%) for CPDX, the drug used in the AmpC production test. The disk diffusion susceptibility tests performed using colonies harvested from the margins of the inhibition zones formed by strains proven to form double-inhibition zones showed that many of the strains formed smaller inhibition zones. Furthermore, many of these strains did not form double-inhibition zones, and therefore, these observations suggest enhanced AmpC production.

The normal reference ranges of biochemical parameters in newborn infants still remains controversial. One reason for such controversy is the large individual differences. We considered that the individual differences are related to gestational age. Therefore, we divided our subjects into three groups: 22–27 weeks, 28–36 weeks, and 37–41 weeks of gestational age. We determined the clinical reference ranges of 15 biochemical parameters in newborn infants at our hospital. However, we eliminated abnormal analysis data with a clear cause. The age ranges were 0–6 days and 7–27 days after birth. We examined the usefulness of grouping based on gestational age. There was a significant difference in the mean among the three groups. The clinical reference ranges that disregard gestational age were different among the three groups in all the tests. Total protein level was a perfect example showing the difference. At 0–6 days after birth, the range obtained from infants of 22–27 weeks of gestational age was 3.0–5.3 g/dL, whereas that obtained from infants of 37–41 weeks of gestational age was 4.2–6.5 g/dL. Considering the gestational age is useful for estimating the reference range for newborn infants.

The long-term preservation of urinary sediment specimens is difficult, and the microscopic observation of specimens becomes impossible a few hours after collection. Various methods of preserving urinary sediment specimens are currently known, for example, by adding a fixative solution to the urinary sediment specimen, or preserving only urinary casts as the specimen. However, no method of preserving many urinary sediment components as specimens has been established. In this work, I developed a buffer with starch syrup as a new mounting medium for the long-term preservation of urinary sediment specimens. With this mounting medium, many urinary sediment ingredients can be preserved for at least one year or longer at room temperature. It is expected that the use of this mounting medium can have a considerable educational impact in clinical sites and educational facilities or in quality control using the same specimens.

We evaluated the Osaki Study Group (OSG) criteria for liquid-based cytology (LBC) in 52 cases of false positive determined by the conventional method, that is, histopathological analysis, and aimed at improving the diagnostic accuracy of endometrial cytology. Samples were analyzed and classified into benign (29) cases (including hyperplasia without atypia) and malignant (23) cases (including hyperplasia with atypia or more severe stages) on the basis of histopathological findings, and were compared with those diagnosed on the basis of the OSG criteria using SurePath-LBC preparation. The classifications based on the OSG criteria were as follows: “negative”, “atypical endometrial cells of undetermined significance (ATEC-US)”, “cannot exclude atypical endometrial hyperplasia or more severe stages (ATEC-A)”, “hyperplasia without atypia” and “malignancy”. On the basis of the OSG criteria, among the 29 benign cases, 5 (17.2%) were classified into negative, 14 (48.3%) into ATEC-US, 4 (13.8%) into ATEC-A, 6 (20.7%) into hyperplasia without atypia, and 0 into malignancy. On the other hand, among the 23 malignant cases, 1 (4.3%) was classified into negative, and 2 (8.7%) were classified into ATEC-US, 14 (60.9%) into ATEC-A, 0 into hyperplasia without atypia, and 6 (26.1%) into malignancy. Moreover, as for the ATEC classification, because many benign cases diagnosed histopathologically were included in ATEC-US (14/18 cases; 77.8%), many malignant cases diagnosed histopathologically were included in ATEC-A (14/16 cases; 87.5%). It was proved that the classification based on the OSG criteria reflected the histopathological diagnoses appropriately. Although paying sufficient attention to metaplastic changes in samples classified into ATEC is a problem, the use of the criteria is effective for improving the diagnostic accuracy of endometrial cytology.

The end-diastolic (ED) ratio of blood flow velocity in both common carotid arteries measured by carotid echography is an important indicator of distal internal carotid artery stenosis/occlusion. In this study, the ED ratio was determined as part of a screening test by accurately measuring the blood flow 2 cm or more central to the carotid bifurcation by an ultrasound Doppler technique at an equal ultrasound incident angle of 60 degrees or smaller on both sides. By this method, we detected distal internal carotid artery lesions using an ED ratio of ≥ 1.2 as an index, rather than that of ≥ 1.4 specified in the Cervical Vessel Ultrasound Guidelines. Furthermore, this method was suggested for detecting and locating such lesions using a narrow range of ED ratios from 1.2 to 1.6.

Heparin, which is used as an anticoagulant for blood gas analysis, interferes with the measurement of ionized calcium (Ca²⁺). The IFCC guidelines recommend that the concentration of lithium heparin should not exceed 15 IU/mL and calcium-titrated heparin should be less than 50 IU/mL. The purpose of this study was to evaluate the effect of the following factors in comparison with nonheparinized blood (NH): type of heparin, heparin concentration, and the passage of time until measurement. We measured the Ca²⁺ concentration in venous blood collected from 10 healthy volunteers by using two types of blood gas syringes: low-concentration lithium heparin syringe (LH: Terumo) and calcium-titrated heparin syringe (BH: Becton Dickinson and Company). The Ca²⁺ concentration in LH decreased by about the lower clinically allowable limit (−0.05 mmol/L) at all the heparin concentrations (2.8, 4.7, and 14.0 IU/mL), and also decreased depending on the heparin concentration with the passage of time. The Ca²⁺ concentration in BH decreased by about the clinically allowable limit at 160 IU/mL heparin, which greatly exceeded the recommended heparin concentration. Our results indicate that BH is suitable for Ca²⁺ measurement because Ca²⁺ concentration was less affected in BH than in LH. In order to minimize the effect of heparin and the passage of time on Ca²⁺ measurement, it is essential that we should draw the recommended amount of blood to obtain the recommended heparin concentration, and measure immediately after collection, especially when using LH.

Amyotrophic lateral sclerosis (ALS) is a very progressive disease that leads to respiratory failure followed by death a few years after onset in ~50% of patients. Spirometry is generally essential for respiration control; however, it is virtually impossible to perform in ALS patients because of weakness in their respiratory muscles. Consequently, there is no definitive consensus in introducing forced expiration in spirometry in ALS patients. We analyzed the relationship between changes in lung volume and flow volume (FV) curve in ALS patients (n = 11) to obtain findings that can indicate the possibility of introducing forced expiration. In the course of disease progression, the FV curve (discontinuation of expiration end segment) indicating the disturbance in abdominal breathing appeared first, followed by that (abnormal shape in descending limb) indicating the disturbance in both abdominal and chest breathing, and finally that (low peak) indicating the disturbance in chest breathing, in this particular order. The %FVCs were 100%, 80%, and 50% for the appearance of disturbance in abdominal breathing, that in both abdominal and chest breathing, and that in chest breathing, respectively. These findings should be utilized as a basis for introducing forced expiration in spirometry in ALS patients.

The automatic blood cell analyzer CELL-DYN Sapphire (Abbott) causes the eruption of hemolysis-resistant red blood cells (RRBCs) in the lower part and right lateral of the lymphocyte area of a scattergram. We reviewed the scattergram pattern of RRBCs and its association with erythrocyte malformation. We further divided an RRBC-positive group (156 specimens) into three groups. GroupⅠappears in the lower part of the lymphocyte area. Group Ⅱ appears in the right lateral of the lymphocyte area. Group Ⅲ appears in the lower part and right lateral of the lymphocyte area. We confirmed whether a specimen is significantly different on the basis of the prevalence of erythrocyte malformation in each group and the RRBC-negative group, and a high frequency of erythrocyte malformation was found in the RRBC-positive group (chi-square test, p < 0.01). As for groups Ⅰ and Ⅲ that appeared downward of the lymphocyte area, the number of leptocytes was high. In groups Ⅱ and Ⅲ, which appeared in the right lateral of the lymphocyte area, the number of Howell–Jolly corpuscles was high. In addition, it was considered that acanthocytes were found at a high frequency during the Howell–Jolly corpuscle eruption, and the configuration of cytomembrane changed into acanthocytes after the Howell–Jolly corpuscle enucleation. The eruption of RRBCs suggests erythrocyte malformation, and it was possible to determine the cause of the erythrocyte malformation. Because erythrocytes could be seen under a microscope, we understood the required performance and characteristics of the device to be used and felt the need to count the cells by visual observation if necessary.

Tacrolimus is a macrolide immunosuppressive agent used for many diseases and mainly for organ transplantation recipients. There are considerable individual differences in its absorption and metabolism. In order to monitor both the effectiveness and serious side effects of the drug, therapeutic drug monitoring is essential. In this study, we evaluated the performance of the newly developed reagent “Nanopia TDM Tacrolimus” by latex agglutination turbidimetry. The coefficients of variation (C.V.) for within-run and between-day precisions, in which several persons underwent a preprocessing procedure, were 1.42–5.40% and 2.86–7.00%, respectively. These values seem to be the same as those of conventional reagents. Thus, it is necessary to justify the procedure for and proficiency of the reagent. Linearity was observed up to 26.5 ng/mL, and the quantitation limit was 1.59 ng/mL. These results suggest that the measurement range was sufficient for monitoring the clinical usefulness of the reagent. We confirmed the stability of the reagent within 10 days after opening it. However, the increase in the level of the reagent by 0.1 to 21.5% was observed after 30 days. This tendency was more pronounced in the low level range. One of the explanations for this phenomenon is the agglomeration failure due to the deterioration of the antibodies or the sensitized latex in the reagent over time after opening. By installing a measurement system in an automatic analyzer, the assays provided faster and efficient operation and cost reduction. Moreover, this reagent may be beneficial for routine use.

Anti-Sm antibodies are specifically found in 5–30% of patients with systemic lupus erythematosus (SLE). The anti-Sm antibodies are directed against 7 proteins (BB’, D1, D2, D3, E, F, and G). These proteins constitute the common core of U1, U2, U4, and U5 small nuclear ribonucleoprotein (snRNP) particles. The Sm-BB’ proteins share cross-reactive epitopes with U1-RNP. Although SmB and SmD are the major targets of anti-Sm humoral autoimmunity, anti-SmD antibodies are considered to have the highest specificity for SLE. It has recently been shown that dimethylated arginine residues play an essential role in the formation of major SmD3 autoepitopes and that anti-SmD3 peptide antibodies are exclusively present in sera from SLE patients. The new kit Elia SmDp detects anti-Sm antibodies through the SmD3 synthetic peptide antigen. We evaluated the new kit with Phadia250. The CVs for within-run and between-day precisions ranged from 2.6 to 9.1%. The dilution linearity was maintained at 350 U/mL, and the detection limit was 0.1 U/mL. The concordance rate of positive and negative results was 95.5% between the new kit and the old kit Elia Sm. Therefore, the new kit is useful for a more accurate diagnosis.

The measurement of specific IgE in sera is useful for allergy diagnosis. MAST Immunosystems III (MAST III) is used for the screening of sensitized allergens in patients suspected of having allergy. However, the results of MASTIII do not agree with those of ImmunoCAP, which is used for further investigation. Recently, ViewAllergy has been developed as a multiple-allergen-specific IgE antibody measurement kit by Thermo Fisher Diagnostics K.K., which also manufactures ImmunoCAP. We assessed the basic characteristics of MAST III and ViewAllergy in order to compare their basic performances. From the results of the reproducibility test, the limit of the quantitation test, and the IgE interference study, ViewAllergy showed superior performance to MAST III. The positive concordance rate between these 2 kits for food allergens was low (less than 50%). These results were presumed to be caused by differences in allergen quality, measurement principle, and reproducibility of reagents. In conclusion, ViewAllergy demonstrated sufficient basic performance with superior accuracy as a screening test kit for multiple-allergen-specific IgE antibodies.

Mean corpuscular volume (MCV) is used as an index to confirm the misidentification of patients because the volume varies slightly in each patient, compared with other erythrocyte indices. In this study, we examined how MCV is affected when a smaller amount of blood than the defined amount was collected in an EDTA-2K-added 3-mL blood container, using XN-9000. We measured hematological values in 5 healthy volunteers, using the tubes for 3-mL blood collection, to which 6-level amounts of blood from 0.3 to 4.5 mL were collected individually, and those to which 6-level amounts of EDTA-2K were added so that the same concentration per milliliter of blood was ensured. As a result, it was confirmed that MCV tended to be higher as EDTA-2K concentrations increased in all the samples. In addition, the plasma osmolarity measured when the blood was centrifuged after the measurement of hematological values became higher with the increase in EDTA-2K concentrations. On the basis of these findings, it was suggested that the increase in EDTA-2K concentrations and plasma osmolarity might affect MCV when the amount of collected blood was small. Since an EDTA-2K-added 3-mL blood container has a larger amount of EDTA-2K than a 2-mL container, it was estimated that MCV might be easily affected by the amount of collected blood.

The number of deaths due to malignant neoplasms is increasing in Japan. Among them, colorectal cancer is the top cause according to a 2015 site-specific morbidity prediction. Therefore, 645 lesions determined by colonoscopy in our hospital between April 2014 and September 2015 were analyzed retrospectively. This analysis was carried out as a site-specific study, but it did not recognize the uneven distribution between benign and malignant cases. In terms of age, the rates of malignancy increased with increasing age (60s: 4.1%, 70s: 5.8%, and 80s: 19.3%). In terms of size, the rates of malignancy increased with increasing size (less than 5 mm: 0%, 5–10 mm: 1.8%, 10–20 mm: 13.9%, and 20 mm or larger: 62.5%). In terms of type, the number of Is-type lesions is overwhelmingly large, but the rate of malignancy was lower than 1.4%. Cases of more than 1 type of lesion have a high rate of malignancy (78.6%). Particularly at the ascending colon, the rate of malignancy was considered to be high. Colorectal serrated lesions were studied and divided into three types, namely, hyperplastic polyps (HP), sessile serrated adenoma/polyps (SSA/P), and traditional serrated adenoma (TSA). There was no significant difference in the size and type, but SSA/P showed a clear localization, which does not exist only on the right side of the colon. In terms of the presence or absence of simultaneous colorectal cancer merger, the merger to not only TSA and SSA/P but also HP was observed.

Previously, we studied human error associated with incidents related to the characteristics of action of medical technologists by duality analysis. This time, we studied human error associated with incidents related to two groups by duality analysis. The two groups are new members with instructors and new members only in a work area. The new members need more experience. However, we also have to pay attention to instructors who have a high work load and on their way of teaching. The instructors tend to lose their concentration when somebody talks to them. Therefore, we have to stop talking to instructors when they are teaching or working. Moreover, the instructors have to confirm the results after they have finished teaching or working. We suggest that, to prevent incidents, the instructors should also review their work.

Although it is relatively easy to diagnose mixed- phenotype acute leukemia (MPAL) by flow cytometry, morphological findings for effective differentiation of MPAL from acute myeloid leukemia (AML) are unknown. Here, we analyze the morphological characteristics of Philadelphia chromosome (Ph)-positive MPAL, which tends to have biphenotypic or bilineal markers. A 60-year-old female with high fever and purpura was admitted to our hospital. She suffered from anemia and thrombocytopenia, and blast cells were found in her peripheral blood. Bone marrow examination revealed small lymphoid and large blasts with few granules, and the blasts were weakly positive (6%) for myeloperoxidase (MPO) and were categorized as M1 (French-American-British Classification; FAB Classification). Such blasts had dual myeloid (CD13 and 40% MPO) and B lymphoid (CD19 and CD79a) markers, as determined by FCM and had minor BCR-ABL, as determined by real-time PCR analysis. Therefore, she was diagnosed as having Ph+MPAL. Mixed small and large blasts including a small number of MPO+ cells appeared to be characteristic of Ph+MPAL.

We herein report the case of an 81-year-old male having disseminated cryptococcosis caused by Cryptococcus neoformans. The patient receiving steroid treatment for bullous pemphigoid developed multiple erythematous skin nodules with ulceration. We observed capsulelike forms of a yeast fungus by Gram staining of the cutaneous tissues, and then C. neoformans was isolated using the same tissue specimens. The smear method with glass slide stamping for each other was applied when performing Gram staining, since this pathogen seemed to grow in the dermal layers of cutaneous tissues. This site of growth of the pathogen might underlie the difficulties in detecting the fungus by Gram staining in previous reports. The fungal capsules could be clearly found on the Gram-stained tissue degraded by a simple approach. We confirmed the reduction in the intensity of the halo image on the Gram-stained tissues using a heated isolate, which might have capsule degeneration, as compared with that using the nonheated isolate. He was diagnosed as having disseminated cryptococcosis on the basis of the results of both histopathological and microbiological examinations and the positivity for the serum cryptococcal antigen. Although this disease entity is uncommon, we should determine the primary site, its involvement with the central nervous system and bloodstream, and the dissemination sites because of its poor outcomes.