Background: Remnant lipoprotein induces arteriosclerosis progression. A direct assay of remnantlike particle-cholesterol (RLP-C) using a biochemical automatic analyzer was developed in 2006. In this study, we used intima media thickness (IMT) as an indication of arteriosclerosis and aimed to clarify the significance of serum RLP-C level for arteriosclerosis diagnosis. Methods and Results: A total of 251 individuals who came to our hospital for a medical checkup of the brain were included. The maximum IMT of the distal carotid wall was measured. Arteriosclerosis was defined according to the Research Group of Arteriosclerosis. The associations between arteriosclerosis and serum lipid level abnormality (LDL-C ≥ 140 mg/dL, HDL-C < 40 mg/dL, TG ≥ 150 mg/dL, LH ratio ≥ 2.6, non HDL-C ≥ 170 mg/dL, and RLP-C ≥ 7.6 mg/dL), as well as arteriosclerosis risk factors (age, smoking status, blood pressure, body mass index, HbA1c levels, and eGFR), were investigated. Univariate analysis showed that RLP-C levels ≥ 7.6 mg/dL and HbA1c levels ≥ 6.2% were significantly related to arteriosclerosis, and multivariate analysis also showed that HbA1c levels ≥ 6.2% were significantly associated with arteriosclerosis. A similar analysis in which the subjects were divided according to sex showed that RLP-C levels ≥ 7.6 mg/dL and HbA1c levels ≥ 6.2% were significant predictors for arteriosclerosis in women and men, respectively. Conclusions: RLP-C level measurement is useful for the diagnosis of arteriosclerosis in women.

We evaluated the cytogram patterns and parameters obtained using the hematology analyzer ADVIA2120 for the rapid assessment of patients with systemic inflammatory response syndrome (SIRS) including sepsis. We analyzed the Y mean of sample neutrophils (NeY) and polymorphonuclear leukocytes x (PMNx), which reflect the size and the left shift of neutrophils, respectively. There were significant differences between normal subjects (normal group) (n = 22) and blood-culture-positive patients meeting SIRS criteria (n = 13) in NeY (p < 0.0001) and PMNx (p < 0.05). On the other hand, there were no significant differences in those parameters between the blood-culture-positive patients not meeting SIRS criteria (n = 5) and the normal group. Next, we examined SIRS patients (SIRS group) (n = 33) and granulocyte-colony stimulating factor-treated patients (G-CSF group) (n = 10) with the characteristic cytogram pattern showing high NeY and low PMNx. The SIRS and G-CSF groups showed high NeY (p < 0.0001, both) and low PMNx (p < 0.0001 and p < 0.05, respectively) compared with the normal group. The SIRS group showed significantly low %MONO compared with the G-CSF group (p < 0.01), although there was no significant difference in either NeY or PMNx. In the SIRS group, many severe cases including those with the outcome of death were observed. These results indicate that the parameters of ADVIA2120 represent the presence of large or immature neutrophilic leukocytes in SIRS patients. The ADVIA2120 cytogram patterns and parameters, such as NeY, PMNx, and %MONO, may be valuable tools for the rapid assessment of the disease condition of SIRS patients.

In this study, we explore the effects of deparaffinization on elastic fiber staining and compare the characteristics of deparaffinization reagents. Weak or uneven staining of elastic fibers is sometimes experienced. We focused on deparaffinization insufficiency, which is considered to be the cause of this weak or uneven staining. In this study, we used FFPE of elastic-fiber-rich aorta. We prepared specimens under various deparaffinization conditions; namely, various liquid temperatures and durations of dipping the specimens in reagents. Then, by staining the elastic fibers in the specimens, we observed weak staining of specimens with insufficient deparaffinization and we compared the deparaffinization capability of four kinds of reagents. The results indicate that paraffin remaining in small amounts on specimens was considered to be one of the causes of weak staining of elastic fibers. We found that the liquid temperature of the reagent, not only the dipping duration, greatly affects the deparaffinization process. A saturated hydrocarbon xylene substitute was found to have a higher deparaffinization capability than the other reagents, because the chemical structure of paraffin is closer to this substitute than to xylene and benzene.

The use of BD CytoRich^TM Red Preservative (CytoRich Red method) in rapid intraoperative cytodiagnosis can prevent cell degeneration and cell detachment. However, the CytoRich Red method needs a longer preparation time than the conventional method. The purpose of this study is to reduce the preparation time of rapid intraoperative cytodiagnosis by comparing the relationship between gravitational sedimentation time and cellularity. We compared each time with the control time. As a result, regardless of the amount of sampling cells, we found that the minimum gravitational sedimentation time with no significant difference in cellularity was 3 minutes and more than 70% of the relative value. To reduce the preparation time, it is important to understand the change in cellularity with gravitational sedimentation time.

M2BPGi level decreased before and after DAA administration for hepatitis C, and such a decrease was similar in cases of liver cirrhosis and liver transplantation. The reduction rate of M2BPGi level was 45.6% at SVR 12, equivalent to those of ALT, AST and AFP levels. Although a M2BPGi ratio of 2 or more for before and after treatment decreased from 50.1% to 26.2%, the factors related to a M2BPGi ratio of 2 or more were in the order of AST, FIB-4, ALT, and AFP levels before treatment, which changed to FIB 4, ALB, and PLT levels after treatment. These results indicate that M2BPGi is affected by inflammation before treatment; however the effect of fibrosis is reflected rather than affected by inflammation after treatment.

Drug-resistant gram-negative bacilli have recently emerged as a major problem worldwide. The production of extended-spectrum β-lactamases (ESBLs) is an important resistance mechanism of pathogenic bacteria, which impedes the treatment of infections caused by gram-negative bacilli with drugs. Therefore, there is a compelling need to develop rapid detection methods for ESBL-producing bacteria. Herein, we evaluated the performance of a drug-susceptibility measurement instrument, DPS192iX (Eiken Chemical Co., Ltd.) for the rapid detection of ESBL-producing bacteria using various β-lactamase-producing Enterobacteriaceae strains. Seventy-one β-lactamase-producing strains were used for the analysis. The concordance between detection rates (within +/−1 difference in each tube) was >94% for all test agents compared with those obtained by the conventional method. The detection rates of 28 ESBL-producing strains were high: 96% for CTX, 68% for CAZ, 93% for CPR, and 96% for CPDX at 18 hours and 75% for CTX and 96% for CPDX at 5 hours. At 18 hours, all the ESBL-producing strains were detected using at least one of the agents. The results obtained should, however, be carefully examined because they depend on the genotypes of the ESBL-producing strains. Nevertheless, the drug susceptibilities of various β-lactamase-producing Enterobacteriaceae strains can be determined with high accuracy by using DPS192iX in routine tests. In addition, the ESBL-producing strains can be rapidly detected by using DPS192iX. In conclusion, the findings of this study demonstrate that the use of DPS192iX could ensure the proper use of antibiotics and thus contribute to the development of control measures against hospital infections caused by drug-resistant bacteria.

Here, we evaluated the clinical performances of highly sensitive troponin I (hsTnI). The areas under the curve (AUC) obtained by receiver operating characteristic (ROC) analysis for diagnosis of acute myocardial infarction (AMI) were 0.869 for hsTnI and 0.739 for CK-MB. The hsTnI level was significantly higher in the AMI group than in any other disease groups including the angina pectoris and congestive heart failure (CHF) groups. When 26.2 pg/mL was used as the cutoff level for the diagnosis of AMI, the sensitivity and specificity of hsTnI level were 81.7% and 72.6%, respectively. Assessment of the dependence of the positivity for hsTnI in AMI on time of AMI onset showed a 54.2% positivity in a group within two hours from its onset and a 62.2% positivity in a group within four hours from its onset. Although no statistically significant correlation between the level of hsTnI and the degree of coronary artery stricture or position of the stricture in the coronary artery was seen, the patient group with 100% stricture showed a higher hsTnI level than that with less than 100% stricture. We conclude here that hsTnI is excellent for AMI diagnosis, owing to its sensitive and specific response to ischemic myocardial damage.

A blood gas analyzer is a typical instrument for point-of-care testing (POCT) installed in emergency treatment facilities and can rapidly evaluate multiple items. However, responsibility for the management of the equipment and data has been unclear, since the users are field staff members. We have been aiming to establish a system for the efficient operation and centralized management of blood gas analyzers in hospitals, and multidepartmental cooperation is required to achieve this. Therefore, in cooperation with the Department of Clinical Engineering, we revised the management system and consigned the manufacturer of the analyzing device to one company, i.e., RADIOMETER, so that we can share the reagents and materials, and manage the system easily and efficiently. Management was assigned to the Department of Clinical Laboratory. To manage all the equipment 24 hours a day, a management system for blood gas analyzers (RADIANCE) was introduced. Patients’ measurement and quality control data were collectively managed by the clinical examination management system. In addition, environmental improvement and enhancement of the support system for equipment repair and maintenance were carried out and supervised for efficient operation. By unifying the management system in the Department of Clinical Laboratory, we realized a management system with less waste of equipment and reagents. Moreover, it became possible to clarify who is responsible for the equipment and data management. The updating of a unified equipment management system for POCT was considered as one of the areas that medical technologists can greatly contribute in team medical care.

By endoscopic ultrasound-guided fine needle aspiration (EUS-FNA), cytotechnologists obtain and prepare specimens and stain them with Diff-Quik in an endoscopic room. In most facilities, doctors specializing in cytology then diagnose them. Such doctors are dispatched to various facilities, which increases the burden on specialists and laboratories. Here, we propose EUS-FNA as a system in which a cytotechnologist upon discovery of an atypical cell at the site takes a picture of it using a smartphone with an ocular lens. The cytotechnologist then sends the image to a cytology specialist, who then diagnoses it. It was found that pancreatic ductal cancer, anaplastic pancreatic cancer, and solid pseudopapillary tumor (SPT) were all detected from images. In EUS-FNA, a simplified telecytological system using mobile terminals, was found to be effective for on-site cytological diagnosis.

The Fukuoka Association of Medical Technologists in the Chikuho region established a new organization called the Youth Association. We would like to take this opportunity to explain the background and sequence of events leading to the establishment of this Youth Association, the association’s activities and results of studies, and projects and goals for the future. Because of concerns about the future of the association of medical technologists and the lack of successors, we feared that Chikuho’s medical technologists’ activities would soon diminish. With this in mind, we established the Youth Association that focuses on medical technologists in their 20s and 30s. The goals of the establishment of the Youth Association were to focus on attracting medical technologists from the younger generation and to enhance and strengthen connections with other institutions. For this to happen, we hosted study sessions and social gatherings. As a result, we were able to accomplish our primary goals. Thus, considering the future of medical technologists’ activities, the Youth Association was established. This Youth Association became the main factor influencing Chikuho’s association of medical technologists, which led to the revitalization of the medical technologists’ activities. Presently, the membership of the Youth Association is being restructured, and new projects are being planned. We are pushing towards taking our Chikuho activities to the national level and to become one of the examples proving that the younger generation can revitalize the association of medical technologists.

We performed epidemiological analysis of the detection of Chlamydia trachomatis from urine and cervical secretions from 2005 to 2014. The total numbers of specimens were 11,646 from females and 1,926 from males. The positivity rate of female specimens was 6.7% (783/11,646) and that of male specimens was 15.8% (306/1,926). For both males and females, those in their 30s had the highest positivity rate, but the number of those positive for this bacterium decreased with age.

We have encountered an autopsy case of severe acute pancreatitis caused by Clostridium perfringens infection accompanied by pneumoretroperitoneum. A 79-year-old man was admitted to our hospital owing to acute abdominal pain. Computed tomography of the abdomen showed a large amount of gas accumulation in the retroperitoneal space around the pancreatic head and body. He was suspected of having severe acute pancreatitis accompanied by pneumoretroperitoneum or acute pancreatitis followed by perforation of the upper digestive tract. Despite conservative treatment with intense care, he died owing to sepsis and circulatory failure three days after the onset. The autopsy findings revealed massive necrosis and bleeding in the pancreatic head and body. Clostridium perfringens and Enterococcus faecium were isolated by culture of pancreatic and hepatic necrosis tissues. We concluded that the patient suffered from severe acute pancreatitis caused by Clostridium perfringens infection accompanied by pneumoretroperitoneum. Because pancreatitis and sepsis caused by Clostridium perfringens infection develop and worsen rapidly, it is important to start the treatment at an early stage.

The Epstein–Barr virus (EBV), a human herpes virus, is a causative agent of infectious mononucleosis (IM). Although IM is diagnosed on the basis of clinical manifestations, it is difficult to differentiate it from tonsillitis in children with atypical clinical findings. Recently, cell-free EBV DNA has been detected in the plasma of patients with IM. An 18-year-old man was examined by a doctor at a local clinic for complaints of pyrexia and sore throat. Because he was considered to suffer from bacterial tonsillitis, he was given β-lactam antibiotics. Afterwards, he was transferred to a local hospital with the chief complaints of continuous fever for 3 days, sore throat and erythematous rash. The results of his blood tests on admission included the following: leukocyte count, 20,200/mm³ (69% lymphocytes, 0.0% atypical lymphocytes); transaminase levels, within the normal range; and C-reactive protein (CRP) level, 0.2 mg/dL. To differentiate between IM and tonsillitis, we performed a polymerase chain reaction (PCR) assay of EBV using blood lymphocyte and plasma samples, which showed positivity for the virus. Therefore, the patient was diagnosed as having acute IM. PCR assay of EBV using plasma samples is an advantageous method for the rapid and accurate diagnosis of infectious mononucleosis in cases lacking the typical clinical manifestations.

We report a case of bilateral testicular malignant lymphoma. The patient was a 72-year-old man. He visited our hospital with a chief complaint of indolent swelling of the left scrotal content. Since bilateral testicular tumors and retroperitoneal lymph node metastasis were suspected on the basis of imaging examination findings, bilateral high orchiectomy was performed. On the basis of histopathological examination, the patient was diagnosed as having diffuse large B-cell lymphoma. In the ultrasonography of this patient, the boundaries between the hypoechoic areas indicating the lesions and the normal tissue were relatively clear. The continuity of the tunica albuginea was maintained in the right testis. On the other hand, the hypoechoic areas with unclear boundaries were scattered in patches, the continuity of the tunica albuginea was disrupted, and the outline was irregular in the left testis. It was considered that these findings reflected the degree of necrosis of the testicular tissue and the infiltration of the tumors into the tunica albuginea and epididymis. The color Doppler method showed abundant blood flow in both testes, which suggested bilateral malignant lymphomas. Therefore, it is important to observe the outline of the testis and the continuity of the tunica albuginea as well as the inner part of the testis and to evaluate the blood flow by the color Doppler method when performing ultrasonography of the scrotal content.

We report a case of sepsis due to Capnocytophaga canis, which was reported to be a novel species of the Capnocytophaga genus in 2016. A 67-year-old female with a medical history of splenectomy was admitted to our hospital with fever and general malaise. Her fever lasted three days from the day after a cat bit her both hands, and her laboratory data and physical examination on admission showed sepsis and disseminated intravascular coagulation (DIC). Only anaerobic bottles of blood culture were positive 24 h after the start of culture, and various sizes of Gram-negative bacilli having sharp ends were observed in the smear of anaerobic blood culture fluid. The strain grew over 4 days after starting the cultivation with subcultures, and it was identified as Capnocytophaga canimorsus using a biochemical identification kit (identification probability, 99%).On the other hand, in nucleotide sequence analysis, the 16S rRNA and gyrB gene sequences of the present strain showed relatively low identities (96.9% and 75.5%, respectively) to the C. canimorsus type strain (ATCC 35979). In contrast, the sequences of 16S rRNA and the gyrB gene showed extremely high identities of 99.8% and 99.5% between the present strain and the C. canis type strain (LMG 29146), respectively. C. canis is considered to be a low-pathogenicity bacterium isolated from the oral cavity of dogs in previous reports, but our case showed severe sepsis due to C. canis following a cat bite.

The patient was a 30-year-old man. In July 2015, he was diagnosed with testicular cancer and treated with cisplatin-based chemotherapy (bleomycin etoposide, and platinol (BEP)). During the chemotherapy courses, typical renal tubular epithelial cells (RTECs) were found by urine sediment microscopy. The increased shed RTECs in urine was an evidence of nephropathy, which could be caused by the BEP chemotoxin to kidney. Because the BEP chemotherapy failed in the initial treatment, the patient was treated with radiation therapy further. After the radiation therapy, some pear- and spindle-type RTECs were found by urine sediment microscopy. These atypical shapes of RTECs could be caused by a side effect of radiation. In such a finding, pear- and spindle-type RTECs could be an evidence of radiation nephropathy. For an early diagnosis of radiation nephropathy, the pear- and spindle-type RTECs in urine sediment microscopy report could offer a valuable information to physicians for a differential diagnosis.

Plasma cell leukemia (PCL) characterized by a large proportion of plasma cells in the peripheral blood is found at a low frequency in plasma cell neoplasms (PCNs). PCL is an aggressive and refractory disease, so that early diagnosis is important to improve treatment outcome. Here, we report that following an inconclusive result obtained using an automated hematological analyzer, leukocyte classification by microscopic examination was helpful in the early diagnosis of PCL. The patient was a 75-year-old man admitted to our hospital with suspicion of acute renal failure and acute heart failure. Leukocyte classification of peripheral blood using an automated hematological analyzer was not possible because of scatter results. Therefore, we performed leukocyte classification by microscopic examination. Forty-two percent of myeloma cells were observed to have unevenly distributed axle-like nuclei in the smear preparation of peripheral blood. On the basis of these findings of the smear preparation, bone marrow examination was performed on the same day. As a result, the diagnosis of myeloma cells was confirmed. Also, in the subsequent additional inspection, M-bows composed of anti-IgG, anti-lambda, and anti-Bence Jones protein antibodies were detected by immunoelectrophoresis. These findings supported the diagnosis of PCL, and chemotherapy was started. In the case of abnormal patterns of leukocyte classification obtained using an automated hematological analyzer, rapid confirmation by microscopic examination is important.

We present here a case of AML-cuplike complicated by fibrinolytic advanced disseminated intravascular coagulation. A woman in her 30s visited another hospital for pharyngeal pain and fever. Her blood examination results showed leukocytosis, anemia and thrombocytopenia. Since acute leukemia was suspected, she was referred to our hospital. A complete blood count at our hospital showed leukocytosis (40.7 × 10⁹/L) and 96.6% blast cells. The cuplike blast population was 11.2% in the peripheral blood. The results of coagulation tests showed fibrinolytic advanced disseminated intravascular coagulation (DIC) (FDP level, > 150 μg/mL; D-dimer level, > 150 μg/mL; SFMC level, 52.4 μg/mL; TAT level, 58.9 ng/mL; and PIC level, 17.2 μg/mL). In bone marrow smears, blast cells were the majority, but cuplike cells were hardly seen. Flow cytometric analysis revealed that the blast cells were positive for CD13, CD33, and MPO and negative for CD34 and HLA-DR. Chromosomal analysis revealed a normal karyotype, and FLT3-ITD was detected by polymerase chain reaction (PCR). On the basis of these results, the patient was diagnosed as having AML-cuplike. There was a very small cuplike blast population in the bone marrow in this patient. Thus, the observation of not only bone marrow smears, but also the peripheral blood smears was important for the diagnosis of AML-cuplike. Since the coagulation and fibrinolysis changes of AML-cuplike are not fully understood, the accumulation of many cases is necessary.

A 53-year-old healthy male presented with slight fever and right chest pain. Three days later, his limbs felt cold and he had arthralgia. He was admitted to our hospital when he was judged to be in a severe state at his local hospital owing to a weak radial arterial pulse. He had systemic cyanosis, and pneumonia was detected by X-ray examination. A rapid urinary detection kit for Streptococcus pneumoniae showed a positive result. Accordingly, he was diagnosed as having acute infectious purpura fulminans (AIPF) caused by pneumococcal pneumonia. He recovered from sepsis and DIC because of early diagnosis and appropriate treatment. Therefore, we were able to save him. However, the purpura became worse without showing any improvement, and soon after, blisters formed, which progressed to skin peeling and dry necrosis on his extremities. Although he underwent debridement surgery for the necrotic tissues several times, he had his limbs amputated except the left arm. This is a rare case of fulminant pneumonia caused by S. pneumoniae in a healthy male. It was a case in which close collaboration with a clinic is very important while keeping in mind that there is a possibility of developing severe pneumococcus infection even in the absence of immunodeficiency such as splenectomy.

Hematoidin crystals are formed when bleeding occurs in a closed environment and may be observed in cerebrospinal fluid and urine. The crystals appear rhombic needle-shaped or granule-shaped and their color is from yellowish brown to reddish brown. Particularly in the cerebrospinal fluid, hematoidin crystals are a useful indicator for the differential diagnosis of blood contamination by aspiration biopsy or the presence of old blood from intracranial bleeding. It is important to detect these crystals because their appearance can provide useful information on the bleeding time. We report a case in which hematoidin crystals were observed in a cervical abscess.