Reactive urothelial cells (RUCs) in calculi show features of an atypical repair reaction. Therefore, differentiation between RUCs and urothelial carcinoma cells (UCCs) based on morphology alone can be a diagnostic challenge. In this study, we evaluated the diagnostic utility of an anti-vimentin antibody for differentiating RUCs from UCCs. Eighteen calculi patients, 17 urothelial carcinoma patients, and 21 patients without calculi or urothelial carcinoma were examined. Urine cytology slides were prepared using the SurePath™ method, immunoenzyme was stained with the anti-vimentin antibody, and the number of vimentin-positive cell clusters was counted. In terms of vimentin positivity, we comparatively reviewed three items. The first comparison was between RUC and UCC cases. The second comparison was between all cell clusters in RUC and UCC cases. The third comparison was between sites of calculi in RUC cases. In the RUC group, vimentin showed strong staining in 18/18 (100%) cases and 87/202 (43.1%) cell clusters. The UCC group showed positivity for vimentin in 2/17 (11.8%) cases and 2/455 (0.4%) cell clusters. In cases and all cell clusters, the vimentin-positivity rate of RUCs was significantly higher than that of UCCs (p < 0.001). In patients without calculi or urothelial carcinoma, vimentin positivity was found in 2/21 (9.5%) cases and 2/938 (0.2%) cell clusters. In terms of the vimentin-positivity rate of each site in calculi of the RUC group, vimentin was expressed in 34/67 (50.7%) clusters of cells from the renal pelvis and 4/22 (18.2%) clusters of cells from ureter; the renal pelvis had a significantly higher positivity rate (p = 0.007). Our results suggest that the immunoenzyme staining of vimentin in urine cytology can help to distinguish RUCs from UCCs.

The formaldehyde concentration in the air of a working environment must be strictly kept low, and the working room in medical facilities should be equipped with an appropriate ventilation system. On the other hand, organs removed from autopsied corpses are usually fixed and often stored for a long time in a large volume of formaldehyde solution (FA method). After the fixation, it usually takes more than one hour to wash out the formaldehyde from the fixed organs when preparing the blocks of tissues for histological examination. When the washing-out of formaldehyde is inadequate, the exposure of pathologists and medical technologists to formaldehyde will be serious. We developed an alternative method of organ storage in 2-propanol solution after the initial formaldehyde fixation (AL method), and the usefulness of this method was studied. We found that the AL method significantly reduced the formaldehyde concentration in the air in the autopsy room while preserving the quality of morphological structures for hematoxylin and eosin staining, which was comparable to that of the FA method. Some antigens for immunohistochemistry were better preserved by the AL method than by the FA method. In addition, the AL method preserved the nucleic acid quality better than the FA method. We conclude that the 2-propanol storage method for resected organs (AL method) may be useful.

Laboratories accredited with the International Standard ISO 15189 have to be available to meet the needs of all patients and the clinical staff responsible for the care of those patients. Therefore, we think that those laboratories must focus on the importance of service quality for patient care. Additionally, since the requirements of patients are becoming increasingly multifaceted and complicated, it is not easy for medical services to respond to requests and to improve the patients’ satisfaction rating. Thus, for the improvement of patients’ satisfaction, we organized a Committee for the Improvement of Outpatients’ Amenities in April 2006. As part of this effort, we conducted a survey on “blood and urine collection and its waiting room” in October 2014. By using the opinions and results obtained from the questionnaire survey, we tried to improve all of our amenities and services for the comfort of our patients, such as the facilities, the equipment, and the attitude and hospitality of our staff. Because we also carried out a similar survey in 2006, we were able to assess the current survey data in comparison with the previous report and verify the information of the questionnaire survey. A questionnaire survey for business evaluation is a useful method that can be applied to clinical settings. Using the questionnaire survey, we always make an effort to provide good services in our clinical laboratories now and in the future.

There is no internal quality control (IQC) procedure for counting the percentage of immature granulocytes (IGs) on blood smears. We developed an IQC application to assess an examiner’s performance and to standardize criteria for IG classification. The application allows examiners to decide the cell type on the basis of digital photo images of IGs on computer monitors and quantitatively assesses their performance. We used reference images downloaded from the website of the Japanese Society for Laboratory Hematology (JSLH). Three examiners performed IQC for 70 days. Their results were compared between the first and second half periods (35 days for each period). Next, blood films including IGs were defined as positive for each cell type and interobserver variations were analyzed using the number of positive findings. In the IQC results, the rate of agreements between JSLH and examiners increased. The median was close to 100% and the level of variation decreased in each cell type. In patients’ samples, the level of significance of variation caused by the difference in the examiner could not be statistically confirmed for each cell type except for metamyelocytes (p < 0.01). The IQC improves the accuracy and repeatability of IG classification and suppresses the interobserver variation of recognition of IGs on patients’ smears of clinical blood samples. In this study, we concluded that IQC for IG classification using reference images improves the quality and standardizes the criteria of this test.

Group B Streptococcus (GBS) is a causative bacterium for meningitis and sepsis in neonates, and GBS screening of all pregnant women at 35–37 weeks of gestation is recommended to prevent neonatal GBS infection. We have used a culture method employing a selective enrichment medium with subculture to a selective separation medium for GBS screening since 2015, to improve detection efficiency. However, GBS selectivity may be reduced by the overgrowth of other bacterial species other than GBS during the culture process. To investigate this possibility, the detection of GBS at various bacterial concentrations by coculturing of Escherichia coli (E. coli), Candida albicans (C. albicans), Enterococcus faecalis (E. faecalis) and Streptococcus pyogenes (S. pyogenes) was evaluated using three commercial sets of selective separation and enrichment media. Using < 3 × 10¹ colony forming unit (CFU)/mL of GBS, all three media sets detected GBS cocultured with E. coli, C. albicans, and S. pyogenes after 24 h, but at < 3 × 10⁵ CFU/mL of GBS, colonization was not detected using the sets with cocultured E. faecalis after 24 or 48 h. These results show that the overgrowth of E. faecalis in the culture process reduces the sensitivity of these sets for GBS detection, indicating that although all three media sets are reliable and sensitive for GBS detection, additional culture may be necessary when E. faecalis contaminates vaginal and anorectal clinical specimens.

The H wave has been used as an established electrophysiological measure in the evaluation of spasticity. However, before intrathecal baclofen (ITB) therapy, the H wave could not be elicited to assess its efficacy. Also, after ITB therapy, the H wave could not be elicited to assess quantitatively the treatment efficacy. Therefore, we evaluated whether the F wave is an effective parameter for evaluating the efficacy of ITB therapy in the treatment of spasticity. Furthermore, we examined the association between the F wave parameters and the features of the clinical presentation of spasticity. In this study, we used data from 11 legs of 7 patients with spastic paralysis. These patients were aged 3–11 years when they visited the Department of Pediatric Neurology of Tottori University Hospital to participate in the ITB trial. We examined F wave parameters including persistency, F/M, difference between the maximum and minimum amplitudes, number of inflection points, the area, and variation coefficient of the area. We used the Ashworth scale score (AS) to average knee extension and flexion as well as ankle dorsiflexion. F/M and the area were significantly decreased (p < 0.01, p < 0.05) after treatment. Furthermore, before ITB therapy, we observed a significant correlation between scores on the AS and the number of inflection points (r = 0.618, p < 0.05) and a strong negative correlation between scores on the AS and the area (r = −0.763, p < 0.01). It is expected that F/M and the area will be useful for assessing the treatment efficacy in the future.

The basic performance and clinical utility of LZ Test ‘Eiken’ KL-6, a test kit using a new anti-KL-6 antibody with latex agglutination turbidimetric immunoassay as the measurement principle, were evaluated. A basic performance study of the LZ Test ‘Eiken’ KL-6 showed favorable results for all parameters, including precision and linearity. A favorable correlation with a conventional test method was also shown using a regression equation of y = 0.987x − 15.8 (correlation coefficient r = 0.975). The reference range was 118 to 397 U/mL, which was similar to that of the conventional method. Its capability to diagnose interstitial pneumonia and discriminate it from other diseases was also found to be similar to that of the conventional method. In conclusion, the LZ Test ‘Eiken’ KL-6 was found to be useful in clinical practice.

Urinary albumin assay is performed to identify indexes for the early detection and treatment of diabetic nephropathy, and it has enabled the evaluation of urinary albumin level using even spot urine values. In recent years, qualitative and semiquantitative urinary albumin assays have been performed. These methods can be performed rapidly within a facility even at the clinic level, and their reliabilities are reasonable compared with those of quantitative examinations. Qualitative and semiquantitative examinations show favorable results in other research studies as well in terms of correlation with quantitative examination. In this study, we conducted a comparative analysis to determine the coincidence rates of the results of both examinations in our hospital. We were able to obtain good correlations from test results of both laboratory procedures, as we report here.

The main liquid-based cytology (LBC) methods that are generally used in Japan are the ThinPrep (TP) method, SurePath (SP) method, and TACAS (TAC) method. Their preparation procedures, manufacturing principles, and reagents are different from each other. Therefore, because of differences in cellular quantity and shape, the cytological findings of the 3 LBC methods that use various types of cell material are compared. In terms of cellular quantity for use in diagnosis, SP has a significantly higher cellular quantity than TAC and TP, and TAC has a significantly higher cellular quantity than TP in the lungs, thyroid gland, endocervix, and endometrium. SP and TAC have a significantly higher cellular quantity than TP in the mammary gland and effusion. SP has a significantly higher cellular quantity than TAC and TP in urine. As for the state of nuclear chromatin and cytoplasmic maintenance, urine showed no significant difference among the 3 LBC methods. On the other hand, in other materials, SP and TAC were maintained more significantly than TP. As for the background of inflammation, in urine, SP levels decreased more significantly than TAC and TP levels, and in other materials, SP and TAC levels decreased more significantly than TP levels. As for the ratio of diagnostic impossibility, urine had no significant difference among the 3 LBC methods. On the other hand, in other materials, SP and TAC levels were significantly higher than TP levels. From the above-mentioned results, although they are the same LBC methods, because their preparation procedures, manufacturing principles, and fixative solutions are different, differences in cellular quantity and shape became obvious.

We studied abnormal late potentials elicited by high-frequency stimulations in a case of neuropathy. The patient was a male aged 16 years and 5 months, who presented with muscular weakness and atrophy in the right hand. He showed no sensory abnormalities except for slight hypopallesthesia. Initial examination revealed reduced compound muscle action potential (CMAP) in the right ulnar nerve, reduced F-wave appearance ratio in both the median and right ulnar nerves, induction of abnormal late potentials in the right median and ulnar nerves with high-frequency stimulations, and induction of abnormal late potentials in the right ulnar nerve immediately after an exercise test. Needle electromyography revealed long-duration polyphasic potentials and high-amplitude motor unit action potentials in the right abductor pollicis brevis. In terms of amplitude, we classified the abnormal late potentials into repetitive discharges, small repetitive discharges and fasciculation-like waves. The appearance and amplitude of repetitive discharges decreased after intravenous immunoglobulin (IVIg) therapy. As his grip strength improved with treatment, the repetitive discharges in the right median nerve and the small repetitive discharges in the right ulnar nerve decreased. In this patient, axonal neuropathy was suspected on the basis of the decrease in the amplitude of CMAP and the reduced F-wave appearance ratio in the right ulnar nerve. In the patient, the change of late potentials correlated well with the improvement of the clinical symptoms.

T-lymphoblastic lymphoma (T-LBL) is a malignant tumor of precursor T-lymphocyte origin, which differentiated to T-lymphocytes. The tumor is often formed in lymph nodes or extranodal organs. Respiratory disorder may develop as a complication of mass displacement, and early diagnosis and treatment are necessary. Terminal deoxynucleotidyl transferase (TdT) is usually present in 90–95% of T-LBL patients, and it is used as an essential marker in the diagnosis. We experienced treating a case of TdT-negative T-LBL. LBL is uncommon epidemiologically, and it was atypical to have a TdT-negative case; therefore, it was a very uncommon case. If the case is atypical, it is important to diagnose it comprehensively, which includes the search for other markers and clinical information.