Visual evoked potentials (VEPs) are electrical responses in the primary visual cortex to visual stimulation. Although a cathode ray tube (CRT) monitor is often used to record a VEP in hospitals, liquid crystal display (LCD) monitors are affordable and recently replacing CRT monitors in the general market. The purpose of this study was to compare the latency and amplitude of VEP elicited by a CRT monitor with those elicited by LCD monitors in normal subjects. We used a CRT monitor and two LCD monitors with response times of 5 ms and 12 ms, respectively. We standardized the average luminance in each monitor. The latencies of N75, P100 and N145 elicited by both LCD monitors were significantly longer than those elicited by the CRT monitor (p < 0.01). The amplitudes were not significantly different among the three monitors. The delayed latencies elicited by the LCD monitors may be caused by a response time for black to turn to white and for white to black. On the other hand, the standardization of luminance contributed to obtaining similar amplitudes among all monitors. When we substitute a CRT monitor for an LCD monitor, the reference range needs to be updated.

Phrenic nerve injury is prevented by monitoring the diaphragmatic compound motor action potential (CMAP) during cryoballoon ablation for atrial fibrillation. In this study, we recorded CMAPs using the conventional electrode position and the Louis angle position simultaneously and compared the amplitudes of both CMAPs. Both methods showed good correlation. Thus, we conclude that the Louis angle can be used for monitoring CMAPs during cryoballoon ablation.

We investigated parameters related to skin perfusion pressure (SPP) on the plantar skin of hemodialysis (HD) patients and their correlation with diabetes complications. The plantar SPP measured on 348 toes of HD patients was 77.0 ± 17.6 mmHg, and the bilateral mean was 76.4 ± 17.6 mmHg, indicating close to 100% concordance for all data. Multiple regression analysis indicated that age and both systolic and diastolic blood pressures were independent predictive factors. We therefore assume that the calcification of blood vessels and resultant age-related arteriosclerosis affect this process. When performing a clinical assessment of plantar SPP, it appears necessary to consider variations in blood pressure due to the timing of measurements. However, HbA1c and glycoalbumin levels exhibited a significant negative correlation. The diabetic plantar SPP was 73.4 ± 15.2 mmHg, which was significantly lower than the nondiabetic plantar SPP of 79.7 ± 17.5 mmHg (p < 0.05), and in severe cases such as those of patients who had undergone unilateral leg amputation, the plantar SPP was significantly lower, at 34.5 ± 21.3 mmHg (p < 0.01). The results of this study suggest that complications caused by microangiopathy in diabetic HD patients contribute to decreased plantar SPPs.

Background—Aortic valve stenosis (AS) is characterized by a progressive narrowing of the aortic valve. Consequently, in response to the increased afterload, the left ventricle becomes hypertrophic and demonstrates T wave abnormalities in electrocardiography (ECG). We investigated the relationship between the severity of AS and the strain T wave in ECG. Methods and Results—143 patients with moderate to severe AS (mean age, 77.6 ± 8.7 years; number of females 92; mean aortic valve area, 1.07 ± 0.27 cm²) underwent echocardiography and ECG. Patients with the strain T wave (n = 36) showed higher scores for left ventricular hypertrophy (n = 107) (p < 0.001), larger left atrial dimensions (p = 0.001), and more severe left ventricular diastolic dysfunction (p < 0.001) than those without strain T wave. Patients with the strain T wave had a smaller aortic valve area than patients without the strain T wave (p < 0.001). Receiver operating characteristic curve analysis showed that the aortic valve area was 0.94 cm² and the aortic valve area index was 0.57 cm²/m² in the patients with the strain T wave. The incidence of the strain T wave was higher in patients with aortic valve replacement than in those without aortic valve replacement (52.6% vs 21.0%, p = 0.008). Conclusion—Results suggest that the strain T wave in ECG is a useful marker of cardiac function and severity of aortic valve stenosis in patients with aortic valve stenosis.

Creatinine test strips have been developed in recent years, and the urine protein-to-creatinine ratio (P/C ratio) in random urine specimens can easily be measured by the test strip method. Nevertheless, just like other test items, we often encounter a situation wherein false reactions (false positive, false negative, and false color reactions) in a routine laboratory test deviate significantly from the quantitatively determined values. It has been reported that a false reaction of a creatinine test strip may occur in the presence of hemoglobin or myoglobin, or when patients are taking cimetidine, etc. We investigated the root cause of false reactions using clinical specimens that showed a false reaction in a creatinine test strip method. The semiquantitatively determined creatinine levels in some specimens were higher than the quantitatively determines levels, and we confirmed that this inconsistency occurred owing to the intake of cimetidine, as previously reported. On the other hand, the semiquantitatively determined levels in some specimens were lower than the quantitatively determined levels, and we observed that they often occurred in colored urine or alkaline urine, which are not reported very often. Therefore, we checked the wavelength characteristics of CLINITEK Atlas XL for colored urine, and we examined the color of urine as influenced by alkaline urine pH. As a result, colored urine showed abnormal wavelength characteristics, and a high pH of alkaline urine resulted in a false creatinine level, i.e., lower than the quantitatively determined level. All urine samples over pH 9.0 showed a creatinine level more than 2 ranks lower. This examination suggested that colored urine and alkaline urine were some of the causes that lead to the false lower levels in the creatinine test strip method.

The sensitivities of human metapneumovirus antigen detection kits, which were developed on the basis of immunochromatography technology, were compared. The kits tested were Primecheck^® hMPV, Prorast hMPV, CHECK hMPV, Quick Chaser^® hMPV, and Imunoace^® hMPV. The comparison was performed with 6 strains of human metapneumovirus stocks, namely, one sample each of hMPV subgroups A2a, A2b, and B1 (laboratory strains), and one sample each of nasal aspirate of subgroups A2a, B1, and B2 (clinical specimens), which were confirmed to be hMPV positive by PCR. The minimum concentration detection limits of these kits were compared for each viral strain by investigating the maximum dilution rate of the viral stock giving a positive result. Results showed that the detection limits differed between products, the difference being up to 33 times in all six specimens. Then, the virus gene copy number concentration of each specimen was measured, where the minimum detection sensitivity was expressed as a detection limit copy number concentration, in the range from 10⁶ to 10⁸ copies/mL. When comparing the results of each kit with the geometric mean of all the kits, there were also kits with the lowest or highest dilution showing reactions for all six specimens and with a statistically significant difference. However, I was unable to prove that there is a significant difference in sensitivity performance against hMPV antigens in general between the products.

The endometrial cytological findings of TACAS methods and conventional methods are compared. A split sample method was used. Thirty-one endometrial material samples each were prepared by the conventional and TACAS methods. The results are as follows: (1) In terms of preparation background, the TACAS method showed a significantly cleaner background than the conventional preparation method, and the masking of endometrial cells was significantly minimal. (2) In terms of the number of cells, the TACAS method showed a larger number than the conventional preparation method, but the difference was not statistically significant. (3) In comparison with the conventional preparation method, the TACAS method showed a significantly higher or the same frequency of average cell clumps. (4) In terms of the number of cell clumps with long axes, the TACAS method showed a significantly smaller number than the conventional preparation method. (5) The frequency of cell clumps with axes longer than 301 μm is lower in the TACAS method than in the conventional preparation method, but this difference was not statistically significant. (6) The nuclear brightness in the TACAS method is significantly lower than that in the conventional preparation method. From the above-mentioned results, the following became obvious. (1) The detailed observation of nuclei in overlapping cells is necessary because the TACAS method results in deeply stained nuclei compared with the conventional preparation method. (2) However, the preparation with a clean background and without the masking of endometrial cells can be carried out. (3) The preparation of sufficient number and size of cell clumps that are smeared can also be carried out. (4) Therefore, it is expected that the application of the TACAS method in endometrial cytological diagnosis leads to the improvement of diagnostic precision.

The jerk-locked back averaging (JLA) analytical method is performed by addition-averaging an electroencephalogram (EEG) following the onset of the myoclonus when it appears during measurement using an evoked potential inspection device. We developed original software that can perform JLA analysis from recorded video digital EEGs. In the present study, we aimed to evaluate the efficacy of this software for JLA analysis. Video digital EEGs from an 8-month-old girl with Dravet syndrome (case 1) and an 11-year and 5-month old girl with involuntary movement (case 2) were used. The following protocol was used for the JLA analysis: (1) the video digital EEGs were reproduced, (2) the onset of the rise of the electromyogram associated with myoclonus-like involuntary movement was noted, and (3) the addition-averaging method was applied to the EEG between 140 ms before and after the onset. Since an electronegative wave that was approximately 20–30 μV was present 60 ms before the onset, case 1 was suggested to be cortical myoclonus. In case 2, however, no meaningful electroencephalographic changes were recognized. The JLA analysis of video digital EEGs was useful in the diagnosis of cortical myoclonus. Furthermore, the JLA software that we developed was particularly useful for the diagnosis in infants in whom the measurements are difficult to perform.

The antinuclear antibody (ANA) test is clinically important for the diagnosis of connective tissue diseases (CTDs). A screening test for 8 disease-specific ANAs by chemiluminescence enzyme immunoassay (CLEIA) has recently been developed. However, the commercial reagents had been improved after a previous study because of a prozone-like phenomenon observed in DNA-sensitized particles. In this study, we evaluated the correlation and concordance between the improved reagents (CLEIA-ANA) and the conventional method (ELISA-ANA) and the utility of CLEIA-ANA as the screening test for the 8 disease-specific ANAs by comparing with indirect immunofluorescence assay (IF-ANA). There was a statistically significant correlation between CLEIA-ANA and ELISA-ANA (p < 0.0001). The concordance rate between CLEIA-ANA and ELISA-ANA was 88.2% and the discrepancies might be caused by the differences in solid-phase antigens, measurement environments, and detection sensitivity. The positivity rate of CLEIA-ANA was low in healthy individuals and comparable to that of IF-ANA (1:160) in CTD patients and healthy individuals. The concordance rate between CLEIA-ANA and IF-ANA (1:160) was relatively low (86.3%) in 161 CTD patients. However, in the 19 sera with CLEIA-ANA+/IF-ANA (1:160)−, 14 samples were positive for anti-SS-A antibodies or anti-Jo-1 antibodies, which are frequently overlooked in IF-ANA. Furthermore, CLEIA-ANA was capable of efficiently capturing the 8 disease-specific ANAs in 99 CTD patients who had at least one or more disease-specific ANAs as compared with IF-ANA. In summary, a fully automated CLEIA-ANA is clinically useful as a rapid screening test for 8 disease-specific ANAs, although some ANAs are undetectable by CLEIA-ANA owing to solid-phase antigens or measurement environments.

The dimension RxL tacrolimus (TACR) assay, using affinity column mediated immunoassay (ACMIA), was reported to show a relatively large variation in the low-concentration range. In this study, we evaluated the analytical performance of the improved dimension tacrolimus (TAC) assay. The within-run and between-day precisions were obtained as 3.1–6.2% and 2.8–5.7%, respectively. The limits of quantitation of the TAC and TACR assays were determined to be 1.1 and 2.6 ng/mL, respectively. Dilution linearity was found up to nearly 30.0 ng/mL. In a comparison study, the correlations between the TAC and TACR assays were n = 79, r = 0.959, and y = 1.06x − 0.1. Note that EDTA whole blood samples were used in the measurements, and the influence of EDTA on the measurements was mentioned in the package insert. In the EDTA interference study, the tacrolimus concentration decreased to 42.3% at EDTA-2Na of 3.0 mg/mL, and this decrease was observed in a concentration-dependent manner. The dimension TAC assay showed good analytical performance. Regarding the limit of quantitation, the dimension TAC assay showed better performance in the low-concentration range than the dimension TACR assay. However, it is necessary to pay attention to the amount of blood collected because of the influence of EDTA concentration on tacrolimus concentration.

The TNM Classification of Malignant Tumors (TNM) comprises Stages 1–4 depending on the range and characteristics of skin lesions and the presence or absence of abnormal peripheral lymph nodes or internal organ lesions. Since therapeutic strategies and survival rate differ greatly depending on the stage, early detection and medical treatment are important. We examined the usefulness of the double immunohistochemical technique for the differential diagnosis of mycosis fungoides. The main reason why mycosis fungoides was targeted in this study was that it is positive for CD3 and CD4 T-cell markers, thus leading to the elimination or reduction of CD7. First, CD3 and CD7 were double-stained. After that, the secondary antibodies simultaneously reacted to their corresponding primary antibodies as well. Then two coloring substances with different tones were used to stain CD3 blue and CD7 brown. We let the strong color mask the weak color by having the colors resulting from the simultaneous positive reactions overlap with one another. As a result, only cells with mycosis fungoides appeared blue because of CD3 positive and CD7 negative reactions. Normal cells and cells with inflammation appeared brown because the CD3 positive reaction (blue) was masked by the CD7 positive reaction (brown). This staining method is extremely simple requiring only a short staining time.

We have examined the basic analytical performance of the urine flow cytometer UF-5000 (Sysmex) in comparison with its previous model, UF-1000i, and with microscopic examination (urine sediment). 1,300 urine samples were collected in Kanazawa Medical University Hospital for this study and the rate of concordance, sensitivity, and specificity were calculated as the performance indices to compare their performances. The five essential parameters, namely, red blood cell count, white blood cell count, epithelial cell count, number of cast, and bacterial cell count, and the seven new parameters, namely, pathological cast, crystal, yeast, sperm, hyaline cast, squamous cell, and nonsquamous cell, were used in this study. From the comparison study among microscopic examination and the two analyzers, we found that UF-5000 showed a better performance index than UF-1000i in almost all the parameters. In particular, the performance indices of casts, hyaline casts, and pathological casts were improved in UF-5000 by better classification from mucus as follows. For casts, the sensitivity was 89.4% (77.2% in UF-1000i) and the specificity was 51.9% (48.3%). For hyaline casts, the sensitivity was 84.1% (50.3%). For pathological casts, the sensitivity was 92.9% (78.6%), and the specificity was 73.1% (58.9%). RBC also showed better improvements owing to better differentiation from its interference such as crystals and yeasts. Therefore, the concordance rate was 92.1% (89.7%), the sensitivity was 90.8% (86.7%), and the specificity was 90.3% (88.7%). When we examined 17 samples that showed discrepancy between UF-1000i and UF-5000 in essential parameters, the results of UF-5000 were similar to the results of microscopic examination in 15 samples. We found that UF-5000 shows better performance than UF-1000i owing to the decreased false positivity rate caused by interference particles such as mucus and crystals.

Malignant lymphoma is a lymphocyte-derived neoplastic disease. The incidence of malignant lymphoma is increasing yearly. Increased levels of the soluble interleukin-2 receptor (sIL-2R) in peripheral blood have been found in patients with malignant lymphoma. Measured sIL-2R levels can be used as a biomarker for the diagnosis and follow-up of malignant lymphoma. In this study, we evaluated a newly developed reagent for the measurement of sIL-2R, “STACIA CLEIA IL-2R”. Satisfactory results were obtained in terms of precision, linearity, and sensitivity. No prozone phenomenon was observed, and there was no interference from substances such as free bilirubin, conjugated bilirubin, chyle, rheumatoid factor, and hemoglobin. Strong correlations were observed between serum and heparin lithium plasma samples (r = 0.999, y = 0.98x − 10.51), and between STACIA CLEIA IL-2R and Detamina CL IL-2R (r = 0.995, y = 1.02x − 173.97). However, there are cases of discrepancy in sIL-2R concentrations measured by STACIA CLEIA IL-2R and Detamina CL IL-2R. Analysis of the cause of the discrepancy using dithiothreitol revealed that false-positive results may originate from abnormal IgM in samples when analyzed using the Detamina CL IL-2R reagent. In summary, our results suggest that the newly developed STACIA CLEIA IL-2R reagent is useful for routine examinations.

We report here a case of amoebiasis whereby the detection of Charcot–Leyden crystals in a liver abscess specimen from a 50-year-old male patient with fatigue and nausea as the main subjective symptoms was ultimately the basis of the diagnosis. By microscopic observation of the liver abscess specimen, we observed Charcot–Leyden crystals; thus, stool specimens taken by large intestine endoscopy were examined subsequently. Cysts of an Entamoeba sp. were seen in the iodine-stained stool specimens. Furthermore, histopathological examination of the large intestine tissues taken endoscopically confirmed the presence of an Entamoeba sp. On the basis of these findings, the patient was diagnosed as having amoebiasis caused by Entamoeba histolytica infection. From the present case, it was confirmed that the detection of Charcot–Leyden crystals in liver abscess is a significant basis for suspecting amoebiasis.

We encountered a rare case of infective endocarditis complicated by coronary artery embolism. An 84-year-old male patient had chest pain and was brought to our emergency unit. He had underwent replacement of the aortic valve 4 years ago. In emergent coronary catheterization, coronary emboli were aspirated from the left anterior descending coronary artery. Since the symptoms and laboratory data were not remarkable, infective endocarditis was not suspected initially. However, results of histopathological analysis of the emboli on the 8th hospital day suggested bacterial infection. Thus, infective endocarditis as the cause of coronary emboli was suspected and detailed examinations were carried out. Blood culture showed positive results the next day, and transesophageal ultrasonography demonstrated aortic vegetation. Antibiotic therapy was started, and the clinical course was good thereafter. Infective endocarditis should be suspected in high-risk patients, such as those in the postvalvular replacement state, even when the symptoms are not specific. Gene analysis identified Streptococcus infantarius as the causative organism. Some species of the genus Streptococcus are associated with severe diseases, and thus the precise identification of species is necessary. However, it might be difficult to perform a differential diagnosis of species by conventional biochemical analysis. Therefore, it is recommended to coordinate closely with an institution capable of performing gene analysis for the differential diagnosis of species.

We encountered a 95-year-old male patient with a history of heart failure and gallstone. A contrast-enhanced computed tomography (CT) image obtained by a previous doctor from the patient with chief complaints of vomiting, abdominal bloating, and pain around the epigastric to umbilical region led to the suspicions of the movement of the gallstone into the small intestine and ileus. Thus, he was urgently transported to our hospital for examination. Abdominal X-ray showed no intestinal dilatation findings indicative of ileus. Ultrasonography (US) of the abdomen revealed a strong echo with an acoustic shadow in the small intestine at the left upper abdomen, and distension of the small intestine on the aboral side and the keyboard sign were recognized; thus, gallstone ileus was suspected. Comparison of the CT image taken by the previous doctor with the abdominal US findings at the time of his transfer to our hospital showed that the stone gradually moved, and conservative therapy was started considering his age. On the 24th day of hospitalization, the stone moved to the terminal ileum, and his ileus became mild. On the 30th day of hospitalization, colonoscopy was performed after administering a laxative, and it was possible to observe the stone in the sigmoid colon. After that, he had frequent defecation; thus, we decided to wait for the stone to come out naturally, and he was referred back to the previous doctor. US is considered useful for identifying the location of the obstruction, observing the movement of the gallstone, and selecting the treatment for gallstone ileus.

The invasive lobular carcinoma histiocytoid variant (histiocytoid breast carcinoma; HBC) is a rare variant that apparently shows apocrine differentiation. We report a case of HBC that exhibited a highly cellular smear pattern in fine-needle aspiration cytology (FNAC). The patient was a woman in her 80s. FNAC revealed numerous tumor cells in a mass in her left breast. The tumor cells were observed as loosely cohesive cellular clusters or scattered single cells. These cells with an abundant foamy cytoplasm and a low N/C ratio resembled histiocytes and occasionally showed an apocrine-like appearance with a rich granular cytoplasm. Histopathologically, she was diagnosed as having the invasive lobular carcinoma histiocytoid variant (HBC). Immunohistochemically, the tumor cells were positive for p120, GCDFP-15, CD68, and androgen receptor, and negative for E-cadherin, adipophilin, ER, PgR, and HER2. The Ki-67 positivity rate was 2%, and p53 stained weakly (5–10%). Alcian blue diffusely stained the tumor cells. The diastase-resistant PAS reaction was positive in the prominent eosinophilic granular cytoplasm but was negative or partially positive in the slightly eosinophilic foamy cytoplasm, which was more strongly positive for GCDFP-15. HBC showed a close resemblance to pleomorphic invasive lobular carcinoma (PILC) in its smear pattern and mucin-positive cytoplasm, but the nuclear atypia, Ki-67 positivity rate, and HER2 and p53 expression levels were considered useful for distinguishing HBC from PILC. The apocrine features of HBC were incomplete in the sense that adipophilin was negative.

We report the case of a 60-year-old female with bacterial meningitis caused by Streptococcus gallolyticus subsp. pasteurianus. The patient originally had ulcerative colitis and occasionally bloody stool as well. She was admitted to the hospital with the chief complaints of fever and headache. She was diagnosed as having bacterial meningitis and initially treated with ceftriaxone (CTRX) and vancomycin (VCM). Although Enterococcus species was suspected as the causative bacterium on the basis of culture results using the patient’s cerebrospinal fluid, S. gallolyticus subsp. pasteurianus was identified instead using VITEK2 after three days of hospitalization. After we determined the drug susceptibility of the bacterium, the antibiotics were changed to benzylpenicillin (PCG), followed by ampicillin (ABPC), and finally changed back to CTRX. Then, her condition improved rapidly and she was discharged after 18 days of hospitalization. This particular type of bacterium is indigenous in the intestinal tract. Because she was originally suffering from ulcerative colitis, it is speculated that the bacterial cells entered the cerebrospinal fluid from the gastrointestinal tract. The appearance of the colonies of this bacterial species is very similar to that of Enterococcus spp. In addition, these two types of bacteria belong to the Lancefield classification Group D. It is, therefore, very difficult to distinguish them from each other. For the correct identification of this bacterial species, it is necessary to use automatic identification devices and/or genetic analysis.

We have conducted emergency blood preparation and transport simulation for a total of 5 times since 2007 and improved the system. In this simulation, we conducted “emergency” procedures, in which we manually prepared the product labels and delivery notes for 4 units of red blood cell products requested (2 units in 2014) without using the blood transfusion management system, and “urgency” procedures, in which we performed blood-type/cross-match tests and prepared the product labels and delivery notes through the blood transfusion management system to transport the products. In order to improve the system, we took the following measures: presented a flowchart, marks were indicated on the delivery notes for the items necessary to be filled out, one each of the necessary items was placed in plastic sleeve, the items to be confirmed were presented when delivery was requested, and papers on which a lab technician would need to fill out for the items to be confirmed was prepared. The time required for the “emergency” procedures in this simulation was 9.6 ± 2.2 minutes for the first time, followed by 7.7–7.8 ± 0.8–1.6 minutes from the second to the fourth times, and 5.5 ± 0.8 minutes for the fifth time. The process time was shortened and individual variation was reduced. The time required for the “emergency” procedures during on-call was less than 10 minutes in all simulations. For the “urgency” procedures, the process time was also shortened gradually from 9.0 ± 8.9 minutes for the first and second times to 6.6 ± 3.2 minutes after the third time. Individual variation was reduced as well.

Half a year has passed since we started a blood collection support system that prioritizes patients’ clinical schedule. We therefore investigated and evaluated the turnaround time (TAT) from reception on patients’ arrival for blood and urine collection to reporting examination results in order to confirm the time spent for medical examinations before consultation. Targeting 7,000 patients whose blood samples were drawn in September 2016 at the central blood collecting room, we selected urgent test items and counted the turnaround times of each analyzer. TAT for the urine test was 30 min or shorter and those for blood tests in most of the requested items were one hour or shorter. Consequently, this survey result confirm our common observation in the hospital that the time required for examination before consultation is one hour or shorter.