While a variety of pretreatment methods have been considered in recent years involving the use of a mass spectrometer for the direct identification of pathogens from positive blood culture bottles, identification rates have remained unsatisfactory. It was considered that the presence of hemoglobin or other biological proteins might affect the direct identification of pathogenic causes with a mass spectrometer, contributing to a decline in identification rates. For this study, a pretreatment method using semialkaline protease was devised and evaluated to remove biological proteins. Of the blood culture bottles obtained from a clinic, 676 were used, which were shown to be positive for pathogens. The pretreated material was identified directly using a VITEK MS mass spectrometer (BMJ). The same or better results were obtained than those in previous reports; identification rates for Gram-positive bacteria were 99.5% at the genus level and 98.4% at the species level; for Gram-negative bacteria, 99.0% at both the genus and species levels; for fungi, 80% at both the genus and species levels, and 99.1% at all genera levels and 98.5% at all-species levels. The pretreatment method devised here is simple, inexpensive, and requires no special equipment or reagents, and preprocessing can be accomplished by washing alone. Moreover, since no alcohol or formic acid treatments are performed for samples whose pretreatment is completed in the first step, the pretreatment method seems to be highly versatile with potential additional related applications, including in conventional automatic identification equipment and simple identification kits.

Early identification of impaired hearing by newborn hearing screening (NHS) has been shown to improve the prognosis of hearing-impaired newborns. The aim of this study is to investigate the relationship between the automated auditory brainstem response (AABR) and clinical factors in newborns or infants. Univariate analysis showed that congenital malformation syndromes, head and neck deformities, severe asphyxia, artificial ventilation for more than 4 days, administration of ototoxic drugs, and very low birth weight of less than 1,500 g were significantly related to AABR. Multivariate analysis also showed that congenital malformation syndromes, head and neck deformities, and severe asphyxia were significantly associated with AABR. Children with these factors should be examined for AABR as soon as possible for early intervention.

To clarify the risk factors for carriage of metallo-beta-lactamase (MBL)-producing Enterobacteriaceae, we conducted a case-control study by surveying stool specimens from 74 institutionalized patients. MBL-producing Enterobacteriaceae were detected in 14% of the patients (10/74). Compared with controls, the use of a percutaneous endoscopic gastrostomy (PEG) tube was significantly more common (70.0% vs 28.1%, p = 0.009), and the administration of a proton pump inhibitor (PPI) was significantly more frequent (70.0% vs 28.1%, p = 0.009) in carriers. The use of antibiotics in the previous 3 months was not associated with MBL carriage. The average duration of hospital stay in carriers was 26 months, nearly twice as long as that in controls. Multivariate regression analysis revealed that the combination of PEG use and PPI administration was highly associated with MBL carriage [odds ratio (OR) 15.6, 95% confidence interval (CI), 1.4–164.4, p = 0.021]. The relative risks of MBL carriage were 14.7 in the patients using PPI [95% CI, 1.8–121.4, p = 0.013] and 3.9 in the patients with a PEG tube [95% CI, 0.8–19.3, p = 0.098]. After careful infection control activities, we were able to further decrease the detection rate of MBL-producing organisms in stool samples from inpatients with these risks. Our results indicate that the patients using PEG or PPI have a high risk of colonization of the gastrointestinal tract with MBL-producing organisms, and these high-risk groups should be the priority targets for MBL screening in long-term-care patients.

There are few reports on the influence of portions observed in wedge smear specimens prepared from body cavity fluid on cell classification. Therefore, we investigated this influence using the following methods toward the standardization of the classification of cells in body cavity fluid. We studied 100 specimens (66 pleural effusion and 34 ascites specimens), and classified 100 nucleated cells from 5 portions observed (① and ② edge portions, ③ center portion, and ④ and ⑤ latter portions of wedge smear specimens) prepared from body cavity fluid into lymphocytes, polymorphous nuclear leukocytes, and other cells, and compared the appearance ratios of these three types of cells with each other. We also compared the correlation of the appearance ratio between the wedge smear and the Fuchs Rosenthal chamber. The highest median of lymphocytes was in observation portion ② and significantly different from those in ③, ④, and ⑤ (p < 0.01). The highest median of other cells was in portion ⑤ and significantly different from those in ①, ②, and ③ (p < 0.01). The highest correlation coefficient between the wedge smear and the Fuchs Rosenthal chamber was the average of portions ①, ②, ③, ④, and ⑤. In the wedge smear specimens, generally, larger cells are likely seen at the latter portion of the smear, but smaller cells are seen at the center portion. The classification bias disappeared by calculating the average value following observation at the 5 different portions. Thus, we proposed the above-mentioned observation method for the standardization of classification of cells in body cavity fluid.

In this study, the applicability of rapid bacterial genetic testing of synovial fluid samples or intraoperative periprosthetic samples was investigated. Three different strains of Staphylococcus (methicillin-sensitive Staphylococcus aureus, MSSA; methicillin-resistant Staphylococcus aureus, MRSA; and methicillin-resistant coagulase-negative staphylococci, MR-CNS) were detected in 98 synovial fluid samples and 140 periprosthetic samples from around prosthetic joints by the PCR lateral flow method (PCR-LF), and other bacterial strains were detected by 16S ribosomal RNA (16S-rRNA) sequencing for bacterial identification. The results obtained by the PCR-LF method revealed that 24 synovial fluid samples (MSSA, 5.1%; MRSA, 9.2%; MR-CNS, 10.2%) contained bacterial DNA. Seventy-four samples with negative results of the PCR-LF method were further tested using 16S-rRNA sequencing for bacterial identification. However, a problem with detection sensitivity arose owing to Escherichia coli (E. coli) genome contamination of the enzyme solution used for amplification as well as additional bacteria present in the reagents used in the 16S-rRNA sequencing. Therefore, bacterial infection was tested using Taq polymerase from eukaryotes (E-Taq). Results showed that the direct detection of bacterial genes in samples containing bacterial cells as low as 1 × 10² CFU/mL (50% hit rate) was possible. Bacterial genes were detected and bacterial strains were identified in 19 of 74 samples by 16S-rRNA sequencing combined with the test using E-Taq. The detection rate was 1.5-fold higher by genetic testing than by the culture identification method. Notably, bacterial genes were detected in eight samples (MSSA, 3; MR-CNS, 3; MRSA, 2) that tested negative in the culture identification method and in three periprosthetic samples (MSSA, 2; MR-CNS, 1) intraoperatively collected. Therefore, contamination at the time of sample collection was suspected. In conclusion, the PCR-LF method and 16S-rRNA sequencing combined with the test using E-Taq showed satisfactory sensitivity and may therefore be clinically useful for diagnosing prosthetic joint infection.

Introduction—There are three types of cerebral infarction, namely, atherothrombotic brain infarction, lacunar infarction, and cardioembolic stroke (CES). In particular, CES has a poor prognosis and needs to be diagnosed early. The detection of atrial fibrillation by electrocardiography is useful for discriminating CES. However, some patients have CES without atrial fibrillation on admission. The aim of this study is to determine the usefulness of electrocardiography for the early discrimination of CES in patients. Method—This study involved 125 patients with cerebral infarction, who had sinus rhythm on admission from April 2014 to May 2015. The types of stroke were divided into two, CES and non-CES (i.e., atherothrombotic brain infarction and lacunar infarction). Results—The subjects were 125 patients (female, 49; male, 76) with acute cerebral infarction and sinus rhythm. The average age was 75.6 ± 12.2 years. Forty-two patients had CES and 83 patients had non-CES. The parameters showing a significant difference between CES and non-CES were P duration (128.0 vs 114.0 ms, p = 0.001), QTc interval (438.0 vs 429.0 ms, p = 0.017), V1P positive potential (60.0 vs 40.0 μV, p = 0.006), BNP (182.0 vs 27.2 pg/mL, p < 0.001), and D-dimer (1.59 vs 0.65 μg/mL, p = 0.001). Multivariate analysis indicated that P duration, V1P positive potential, and BNP are independent predictors for the discrimination of CES. The combination of ECG value and BNP level had a high positive/negative predictive value (95.0% and 93.2%, respectively). Conclusion—We suggest that the combination of electrocardiography and plasma BNP level is useful for the discrimination of cardioembolic stroke.

Diagnostic thoracentesis is useful in pyothorax diagnosis. Total protein and LD levels can be used to distinguish between exudative and transudative pleural effusion. However, exudative pleural effusion can also have other causes apart from pyothorax, such as pleural malignancy and parapneumonic effusion. Therefore, clinicians depend on their subjective judgment such as transparency and color pattern to distinguish pyothorax from other diseases. With this in mind, we propose several additional useful indications for the diagnosis of pyothorax. We analyzed 168 pleural fluid specimens. pHs were significantly lower in pyothorax cases (6.82 ± 0.11) than in nonpyothorax cases (7.48 ± 0.02). The glucose levels were also significantly lower in pyothorax cases (32.2 ± 19.2 mg/dL) than in nonpyothorax cases (123.7 ± 4.0 mg/dL). The total cell counts were significantly higher in pyothorax cases (25.0 ± 10.0 × 10³/μL) than in nonpyothorax cases (2.9 ± 1.2 × 10³/μL). The neutrophil proportion among different cell types was significantly higher in pyothorax cases (90.9 ± 1.9%) than in nonpyothorax cases (24.5 ± 2.2%). Moreover, total cell count and the neutrophil proportion among different cell types were useful and had the advantage of being rapidly obtained. The criteria of a total cell count ≥ 5.0 × 10³/μL and a neutrophil proportion ≥ 80% can be used to support the diagnosis of pyothorax.

PIVKA-II is a highly specific tumor marker for hepatocellular carcinoma (HCC) and it is useful as an aid in the diagnosis and therapy monitoring of HCC. We evaluated the analytical performance of two newly developed PIVKA-II assays, namely, ARCHITECT (CLIA) and STACIA (CLEIA), in comparison with Picolumi MONO (ECLIA). Both ARCHITECT and STACIA assays showed good correlation with Picolumi, as well as good precision and sensitivity. By performing these PIVKA-II assays in a clinical laboratory at the time of visit, it would be possible to report the test results just before a physician’s examination. The availability of accurate, reliable, and timely laboratory testing and reporting of results of PIVKA-II assay would help improve the management of HCC patient.

It is important to examine the performance of clinical Automatic Analyzers, which users themselves can carry out when the analyzer is introduced. In this study, we evaluated the performance of the LABOSPECT 008α Hitachi Automatic Analyzer. The following were evaluated: precision and accuracy of the sample probe, carry-over of the sample and reagent probe, contamination of the reaction vessel, temperature stability of the reaction vessel, and within-run precision, which showed good performance. Therefore, the introduction of the LABOSPECT 008α, which is a large clinical automatic analyzer, has led to the rapid and accurate measurements of multiple samples and multiple items, which is considered useful for routine analysis. In addition, it is helpful for users to understand the measurement principle and characteristics of automatic analyzers by conducting a performance examination themselves. Hence, it is useful for the maintenance of automatic analyzers and the analysis of abnormal data caused by the analyzers.

We evaluated the performance of the ADAMS Glucose GA-1172 glucose analyzer, which measures glucose on the basis of the amperometric method. Measurement values of the Certified Reference Standard Material JCCRM521 were almost the same as the values certified by JCCRM521. The intraday and interday coefficients of variation were 0.67–2.15% and 0.31–1.02%, respectively. Good linearity was observed for glucose concentrations until 969.3 mg/dL in the dilution linearity test. The correlation between values measured by GA-1172 and LABOSPECT006 was satisfactory. Our results demonstrated that GA-1172 is useful for routine examinations.

Reagents previously used for the measurement of the soluble interleukin-2 receptor (IL-2R) required a dedicated analyzer and could not be used for measurements with a general-purpose automatic analyzer. Recently, the general-purpose reagent “Nanopia IL-2R” based on the Latex turbidimetric immunoassay has been developed; thus, its basic performance was investigated. 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, and hemoglobin. A strong correlation was observed between Nanopia IL-2R and Detamina CL IL-2R (r = 0.972, y = 0.97x + 8.83). However, there were two cases in which one sample showed falsely high values and one sample with falsely low values caused by a nonspecific reaction. In the former, IgM in serum was considered to be a cause of the falsely high value, because the nonspecific reaction disappeared when the sample was treated with DTT that inactivates IgM. On the other hand, recoveries were examined for the latter. Recoveries of sIL-2R in the sample with falsely low values were low. Therefore, the substances that interfere with sIL-2R measurement using “Nanopia IL-2R” were considered to be present in serum. In summary, our results suggest that the basic performance of the newly developed reagent “Nanopia IL-2R” was satisfactory and had sufficient performance for routine examination. However, caution is required for samples with falsely high or low values.

To standardize criteria for morphological classification and to quantify precision in urinary sediment examination, we developed an internal quality control (IQC) system using photos from Examination of Urinary Sediment 2010. Three staff members classify photos on a computer screen, and then the system measures their competence in terms of accuracy rate and predicted value. The aim of this study was to verify the competence of staff members in identifying urinary sediments and the quality improvement of intralaboratory error on competence after introducing the system. In urinary sediment components in which the accuracy rate or predicted value was under 60%, some listed components were different between staff members. An error between staff members was verified in clinical specimens by comparing the chi-square value and the number of positive results in each component. The long-term intralaboratory error showed that there were some components whose error decreased or increased immediately after introducing the system. Moreover, the number of components in which the intralaboratory error was detected decreased from 11 to 7 after using the system. These results indicate that our system quantified staff members’ competence and could have an influence on the intralaboratory error in clinical samples. The IQC system will contribute to standardizing the morphological classification and improving the quality of urinary sediment examination in our laboratory. However, its benefit may be limited for some components systematically identified on the basis of a patient’s background. Therefore, an assessment of those errors is needed using positive rates for those components in clinical specimens.

The concentration method by centrifugation is recommended for tests of acid-fast bacilli including Mycobacterium tuberculosis. However, the concentration method by centrifugation requires expensive biohazard refrigerated centrifuges. Depending on the circumstances of a facility, it is difficult to introduce it. We conducted a basic study to evaluate the “TB-Beads” method, which is a method of concentrating acid-fast bacilli using magnetic beads and requires no biohazard refrigerated centrifuge. Using 50 sputum specimens for which an acid-fast bacillus test was requested at our facility, we compared acid-fast bacillus tests by both the TB-Beads method and the concentration method by centrifugation. The comparison was carried out in smear tests, culture tests, and genetic tests. The concordance rates of the TB-Beads method with the concentration method by centrifugation were 92.0% in the smear tests, 100% in the culture tests and 98.0% in the genetic tests. In the smear tests, the TB-Beads method was less sensitive than the concentration method by centrifugation, but results of the TB-Beads method and the concentration by centrifugation were in high agreement in the culture tests and the genetic tests. The TB-Beads method can concentrate acid-fast bacilli without using a biohazard refrigerated centrifuge, and thus the accuracy of acid-fast bacillus tests can be improved in more facilities.

As the mammalian (mechanistic) target of rapamycin (mTOR) inhibitors, everolimus is an immunosuppressive agent to be used in transplantation. The therapeutic drug monitoring (TDM) of everolimus is essential to prevent acute cellular rejection and to limit toxicity. For therapeutic drug monitoring, pre-everolimus dosing concentrations are measured in whole blood mainly by liquid chromatography tandem mass spectrometry (LC-MS/MS). However, LC-MS/MS for everolimus TDM is not widely used in hospitals owing to either a lack of mass spectrometry instrumentation or resources for assay development. Recently, an everolimus reagent kit for latex particle-enhanced turbidimetric immunoassay (LTIA) has been developed. However, the everolimus concentrations measured by LTIA were lower than those determined by LC-MS/MS. We evaluated the measurement performance of a new everolimus reagent kit by electrochemiluminescence immunoassay (ECLIA). Within-run and day-to-day run reproducibilities were satisfactory. The correlation between values of LTIA and ECLIA was y = 1.24x + 1.48 (r = 0.854). In conclusion, the measurement of everolimus concentration by ECLIA has been proven satisfactory as it provides reliable results for the TDM of everolimus.

Recently, the frequency of detection of ESBL-producing Enterobacteriaceae has been increasing, and several rapid detection methods for ESBLs have been developed. The ESBL NDP test, a colorimetric assay described by Nordmann, is very useful because it can be used to detect ESBLs rapidly and accurately. However, in this method, it is necessary to use 20 mmol/L Tris-HCl lysis buffer (BPERII Bacterial Protein Extraction Reagent, Thermo Scientific), which is a commercially available protein extraction reagent, for the extraction of ESBLs within 30 min. In this study, we modified the NDP test to make it more rapid, easy, and inexpensive by using glass beads for extraction (GB test). Then, we evaluated the efficiency of the GB test in comparison with the NDP test as a screening method for ESBLs by comparing the test results using ESBL-producing Enterobacteriaceae strains and other strains. 112 ESBL-producing strains were phenotypically and genotypically identified, and 109 strains that were susceptible to third-generation cephalosporin were tested. The concordance rate between the NDP test and the GB test was 100%. The sensitivity and specificity of both tests were 94.6% and 100%, respectively. Furthermore, with only 30 s needed for enzyme extraction, the GB test significantly shortened the assay time (p < 0.01) in comparison with the NDP test. In conclusion, we confirmed the high efficiency of the GB test as a screening method for ESBLs because it is more rapid, easier, and more cost-effective than the NDP test.

A questionnaire survey was conducted on the status of blood culture tests at hospitals in the Fukuoka region. The questionnaire included items on the number of beds, status of blood culture tests performed in 2015, instruments used, bottles used, number of days of culture, whether negative bottles were subcultured, methods for skin disinfection at the time of collection, whether a holder was used at the time of blood inoculation, whether the sensitivity of instruments was tested using bacterial fluids directly prepared from positive bottles, and how after-hour orders for blood culture tests were handled. Results of the questionnaire, to which 18 institutions responded, revealed that many institutions were not testing the sensitivity instruments using bacterial fluids directly prepared from positive bottles, were not subculturing negative bottles, and were not using a holder when blood culture bottles were inoculated. Results also revealed differences among institutions in indices commonly used for accuracy control and quality evaluation of blood culture tests, disinfection methods at the time of collection, and methods of handling after-hour orders. These findings enabled us to understand the actual status of blood culture tests in the Fukuoka region.

Since most outpatients have their blood drawn in a blood collection room, biomedical laboratory scientists should offer excellent medical services including collection technique, hospitality, comfort of the waiting room, and suitable waiting time. In this study, we evaluated patient satisfaction with blood collection to improve the quality of our service to patients. We found that hospitality and collection technique had high satisfaction ratings. In contrast, the waiting time had the lowest satisfaction rating. To shorten the waiting time, we next conducted surveys on our staff members. We studied our routine practice, including the time required for blood collection per patient for each staff and the waiting time for each day of the week and for each time of the day. In addition, we reorganized the staff of the blood collection room and changed the education system for beginners. As a result, in the second satisfaction survey conducted in the following year, the percentage of patients who expressed high satisfaction with the waiting time was increased. Additionally, the average waiting time was shortened. These results suggest that our remedial actions were effective. The most important factor for shortening the waiting time might be the use of all blood collection stands during the peak period in the morning. By conducting the satisfaction survey, we were able to determine how patients evaluate our blood collection room, define the issues of concern, and improve our current operation. A patient satisfaction survey improves the quality of our service to patients.

The Okayama Microbial Club (CLUB Saikin), which was organized by 17 medical institutions in Okayama in 2008, conducted a survey on the prevalence of methicillin-resistant Staphylococcus aureus (MRSA), multiple-drug-resistant Pseudomonas aeruginosa (MDRP), and extended spectrum β-lactamase (ESBL)-producing bacteria in facilities that participate in the club from 2011 to 2015. The frequencies of MRSA and MDRP isolation from hospitalized patients decreased from 10.99% to 8.34% and 0.55% to 0.24%, respectively. Despite the downward trend for both bacteria over the 5 years, these frequencies still exceed the national average reported by the Japan Nosocomial Infection Surveillance (JANIS) in 2015, with 6.64% for MRSA and 0.07% for MDRP. In outpatient settings, the prevalence of MRSA increased from 26.25% to 28.69% during the study period, suggesting the spread of MRSA outside of the hospital. The isolation frequencies of ESBL-producing E. coli and K. pneumoniae showed an increasing trend in both inpatient and outpatient settings, suggesting an increase in the number of ESBL-producing-bacteria carriers owing to various risk factors. It is important to continue the survey to strengthen information sharing, cooperation in the community, and for the effective infection control in hospitals with updated information.

We compared the promotion of B. pertussis growth and suppression of contaminating bacteria among 3 types of medium commercially available in Japan (Bordet–Gengou (BG) medium, Bordetella CFDN agar medium, and charcoal agar medium) for the isolation of Bordetella pertussis. For the assessment of growth promotion, clinical isolates of B. pertussis were used. To investigate the growth inhibition of common contaminating bacteria, ATCC strains or clinical isolates were used. Both studies were conducted in accordance with the method of Miles & Misra. When the promotion of B. pertussis growth was assessed, growth was observed up to a dilution of 10⁻⁵ on Bordetella CFDN agar medium and 10⁻⁶ on BG medium or charcoal agar medium. The mean numbers of colonies at a dilution of 10⁻⁵ were 36.5 CFU on BG medium, 20.4 CFU on Bordetella CFDN agar medium, and 40.5 CFU on charcoal agar medium. In the evaluation of inhibition of contaminating bacteria, all of the contaminants grew on BG medium, whereas charcoal agar medium inhibited the growth of all the contaminants. Bordetella CFDN agar medium did not inhibit the growth of Moraxella catarrhalis and large colonies formed, which was considered to have an adverse effect on the isolation of B. pertussis. On the basis of the above results, charcoal agar medium was found to be excellent with regard to both growth promotion and inhibition of contaminants, and thus was considered to be the most suitable medium for the isolation of B. pertussis.

People living near the Ganges River Basin located in northern India show a high incidence of gallbladder cancer, but the onset mechanism for this cancer in this region has not been well defined. Therefore, we conducted a drinking water survey of people living in this region to obtain clues regarding the causes of gallbladder cancer. Samples of Ganges River water, public tap water, public well water from two spots, and well water from four gallbladder cancer patients’ homes were collected in September 2017. Lead levels, bacterial counts, levels of agricultural chemicals, iron, copper, nitrate, nitrite, and chlorine, pH, and hardness were measured using a simple commercial water analysis test kit. The results obtained were then compared with the water quality standards for drinking water in Japan. Of the 10 items, bacteria, iron, and nitrate were present at levels beyond the standard levels. Additionally, three of the four well water samples collected from gallbladder cancer patients’ homes were contaminated with bacteria, and two had iron levels higher than the standard levels. Additional research is needed to clarify whether bacteria in the home well water of gallbladder cancer patients are related to gallbladder cancer risk.

The purpose of this study was to evaluate the effectiveness of laboratory parameters, namely, white blood cell count (WBCc), C-reactive protein (CRP) level, and endotoxin level, in children with bloodstream infection. This retrospective study included 151 cases that were divided into the true positive group (n = 126) and contaminated cultures (n = 25). All samples for bacteriological cultures were collected from children aged 0–18 years who were admitted to the Gunma Children’s Medical Center between April 2012 and March 2017. We defined day 0 as the day of the start of blood culture. CRP levels on day 0 were significantly higher in the true positive group than in the contaminated group. The cut-off CRP level on day 0 was 1.7 mg/dL to differentiate between true- and false-positive (contaminated) cultures. The sensitivity, specificity, and positive predictive values were 55.2%, 78.3%, and 93.3%, respectively. The CRP levels on day 0 may help clinicians in clinical decision making. However, normal levels of CRP should not be used to rule out culture-proven bloodstream infection. In addition, there were significant differences in the increase in CRP level from day 0 to the next day and the increase in WBCc from the previous day to day 0. These indicators seem to be references for the determination of bloodstream infection. In endotoxin assays, positive results were obtained from 9 (75.0%) of 12 patients with bloodstream infection due to Gram-negative bacilli. Endotoxin analysis should be useful as a guide to the initial management of patients suspected of having bloodstream infection due to Gram-negative bacilli.

A number of studies have shown that the amount of HBs antigen (HBsAg) is useful for determining the incidence of hepatocellular carcinoma and the effect of therapeutic strategies. Therefore, the HBsAg concentration can serve as an indicator of treatment efficacy for hepatitis B virus (HBV) infection or in the follow-up of patients with persistent HBV infection. In a clinical setting, reporting the results quickly is extremely important. However, in patients with high HBsAg levels, retesting by manual dilution using conventional methods is essential, which often takes longer to perform than other methods that require automatic dilution. Samples positive for HBsAg at concentrations greater than 250 IU/mL require dilution to decrease the concentration to within the dynamic range of the Abbott ARCHITECT HBsAg assay. The aim of this study is to determine the usefulness of autodilution for the ARCHITECT HBsAg quantitative assay in comparison with manual dilution for the HBsAg method. The reproducibility of autodilution for the ARCHITECT HBsAg quantitative assay is follows. A coefficient of variation (CV) in the range of 2.9 to 4.8% and an intra-assay precision in the range of 6.1 to 7.7% were obtained, which indicated overall good results with dilution linearity. In addition, for samples in which the HBsAg amount is less than 5,000 IU/mL, the correlation was also good in the comparison between the manual dilution for the HBsAg method and the autodilution for the ARCHITECT HBsAg quantitative assay (n = 38, y = 1.0616 x + 54.524, r = 0.983). Hence, autodilution for the ARCHITECT HBsAg quantitative assay leads to labor-saving during routine examination and shortening of the turnaround time in clinical laboratories.

In this survey, we investigated the acid-fast bacteria test trend at our hospital laboratory and hereby report the findings. The medical facility of Yamanishi Medical Workers Association (Yamanishi MIN-IREN) managed the laboratory data of this hospital for 5 years, from October 2012 and September 2017. The status of acid-fast bacteria detection, age distribution, sex difference, comparison of various test items, rate of drug resistance, patients’ clinical background, and diagnosis as well as treatment of infection by nontuberculous mycobacteria (NTM) were also investigated. In the 5-year period, the positivity rate of the patients tested by acid-fast bacterial culture was 7.0%; among them, 35 (19.1%) patients had tuberculous bacteria, while 148 (80.9%) had NTM. With regard to age, most patients in both groups were aged ≥ 70 years, showing that most of them were elderly people. However, tuberculous bacteria were commonly observed in younger patients, aged 10–30 years. With regard to gender, tuberculous bacteria were predominantly observed in men, while NTM were predominantly observed in women. With regard to the test items, the positivity rate of the patients tested by acid-fast bacterial culture was high, that is, ≥ 90% of patients. In addition to common cold, asymptomatic abnormal X-ray findings were the common factors that prompted patients to visit the hospital for further examination. This survey can be used as a reference for the initial diagnosis and implementing appropriate interventions. Moreover, the status of acid-fast bacterial isolates varied regionally; therefore, the trend within a prefecture should be comprehensively understood for appropriate infection control measures.

Here, we present the case of a patient who was diagnosed as having weak partial D type 15 by genetic examination. The patient was a 44-year-old woman who was referred to our hospital for surgical treatment of uterine myoma. Because of difficulty in RhD blood typing by routine tests, precise examinations of the RhD type were performed. Measurement of anti-D agglutinin titer showed attenuation by 8-tube differences as compared with a control. An anti-D adsorption elution test revealed the presence of the D antigen in her red blood cells. Reactivity with 12 types of monoclonal anti-D antibodies showed a pattern similar to that of partial D category DFR. However, by the direct sequencing of the RhD gene of her white blood cell DNA, we found a mutation of 845G>A (Gly282Asp), leading to a final diagnosis of weak partial D type 15. No anti-D antibody was detected in her serum. Weak partial D type 15 is characterized by both a weak antigenic reaction against RhD and a partial lack of the D epitope, and the production of an allogeneic anti-D antibody has been occasionally reported. In the present case, the serological examination did not discriminate weak partial D type 15 from other types of aberrant RhD. The present case suggests that genetic examination is useful in discriminating weak partial D type 15 from other types of aberrant RhD.

Tympanometry (TM) is a simple test for assessing the function and condition of the eardrum and middle ear. TM of healthy subjects shows results of type A, its peak typically ranging from +100 to −100 daPa. However, a peak is rarely detected on the high-positive-pressure side. In this study, we aim to investigate the clinical background of patients revealing a positive pressure higher than +51 daPa in TM conducted in a clinical laboratory at Kitasato University Hospital. Of the 2,614 ears examined, the tympanograms (TGs) of 15 ears (0.9%) demonstrated a positive pressure higher than +51 daPa. Of these 15 ears, 6 demonstrated a high positive pressure in both ears, 6 only in the right ear, and 3 only in the left ear; additionally, abnormal findings of the eardrum were detected in only 2 ears. Despite conducting TM several times in approximately 4 subjects, high positive pressure was not always detected. Hence, the presence of high positive pressure in this study suggests that several causative factors were responsible other than acute otitis media.

The QRS complex of the pacemaker best resembles a typical left bundle branch block (LBBB) during right ventricle (RV) pacing. The right bundle branch block (RBBB)-like pattern implies an abnormal lead position or perforation of the RV. We performed electrocardiogram (ECG) recording and encountered a case of RBBB-like pattern. An abnormal lead position was ruled out by chest X-ray and echocardiogram examinations, confirming the apical right ventricular lead position. It has been reported that an uncomplicated RV produces an RBBB-like pattern. We investigated the position of the lead in one intercostal space lower than the usual space of the chest electrode, and determined the frontal axis and precordial point of transition. Our patient also showed the RBBB-like pattern in one intercostal space lower than the usual space of the chest electrode. The frontal axis was −30°, the precordial point of transition was between V₁ and V₂, and there was no difference in the reported ECG algorithms. ECG is useful for detecting the abnormal position of the right ventricular lead.

Background: Peritoneal metastasis secondary to breast carcinoma is rare. In effusion cytology, cell block (CB) immunocytochemistry is useful for determining the primary sites of metastatic adenocarcinomas in ascites fluid. Herein, we report two cases of breast carcinoma with peritoneal metastasis diagnosed by ascites cytology. Case 1: A 40-year-old woman underwent left total mastectomy for invasive ductal carcinoma. Two years and ten months later, abdominal computed tomography demonstrated massive ascites. Ascites fluid cytology showed isolated neoplastic cells with eccentrically located atypical nuclei and intracellular mucin, consistent with poorly differentiated adenocarcinoma. CB immunocytochemistry of ascetic fluid showed that the tumor cells were positive for GATA3, GCDFP15, and E-cadherin, but negative for ERα and PgR, confirming a diagnosis of peritoneal metastasis of invasive ductal carcinoma of the left breast. Case 2: A 50-year-old woman was previously diagnosed as having an invasive lobular carcinoma of the left breast and was treated by left total mastectomy. One year and seven months later, imaging findings revealed ascites and a cytology test was performed. In ascites cytology specimens, atypical cells forming loosely cohesive small clusters had enlarged nuclei and showed an intracytoplasmic lumen. CB immunocytochemistry of ascites fluid showed immunoreactivity for GATA3, ERα, and CA15-3, but immunonegativity for carletinin in atypical cells. A diagnosis of peritoneal metastasis from invasive lobular carcinoma of the left breast was made. Conclusion: CB immunocytochemistry in conjunction with conventional cytological smearing is useful for the cytological diagnosis of breast cancer cells in ascites.

Squamous cell carcinoma (SqCC) of the breast is rare and generally aggressive associated with rapid progression. We report a case of SqCC of the breast with a favorable prognosis. The patient was a woman in her 60s. The breast dynamic magnetic resonance imaging (MRI) showed a mass as a “delayed rim enhancement”, on which fine-needle aspiration cytology (FNAC) was performed. The FNAC smear was cellular and contained necrotic debris, lymphocytic inflammatory cells, and a few mesenchymal fragments. Although most of the cells appeared as clusters, some appeared as single keratinizing cells. A large cell (70-μm-diameter) with a giant nucleus and a thick cytoplasm was protruded from periphery of a large cluster consisting of tumor cells of various sizes. Immunocytochemical staining of small clusters distinguished between the clusters consisting only of p40-positive cells and those with both p40-positive and p40-negative cells. In large clusters consisting of streaming arrangements of uniform tumor cells, the positivity for p40 showed a biased distribution to one side. Histopathologically, she was diagnosed as having SqCC arising in the breast. Transitional features from adenocarcinoma (AC) to SqCC were sporadically observed. Immunohistochemically, ER/PR/HER2 was negative. The Ki-67 positivity rate was 55%. SqCC of the breast showed distinctive cytological findings such as keratinizing cells with marked atypia and cell clusters containing portions transitioning from AC to SqCC. We considered that FNAC as an investigation method for small breast lesions is useful for the early diagnosis of SqCC and therapeutic planning.

Myeloid sarcoma is an extramedullary lesion consisting of either differentiated or nondifferentiated myeloblasts. We encountered an unusual case in which we detected abnormal cells in urinalysis precipitate, which differed from normal blood and epithelial cells. The monocyte precursor could not be identified in routine screening, but further investigation of the literature led to its identification, which led to the diagnosis of myeloid sarcoma. The detection of monocyte precursors in urinalysis precipitate is rare and thus its identification is difficult. However, in our case, we successfully identified the precursor.

There are few reports of nontechnical skills defined for medical technologists (MTs). Our laboratory has defined nontechnical skills for MTs and tried to improve them. In this study, we aimed to investigate our attempt at improving nontechnical skills. In October 2013, our working group, including 10 MTs, collected 395 skills from 65 MTs and decided on 27 “nontechnical skills for MTs,” which were considered from 6 viewpoints: situation awareness, decision making, communication, teamwork, leadership, and stress management. A monthly skill was reported to all MTs through leaflets, in-hospital e-mails, and bulletins. A self-evaluation was conducted every 6 months for 24 months, which showed gradual improvement and strengths or weaknesses in each of the 6 viewpoints depending on MTs’ years of experience and assigned sections. The MTs’ nontechnical skills can be improved through clarification and organizational activities.