A total of 268 clinical isolates of extended-spectrum β-lactamase (ESBL)-producing Escherichia coli collected from Ehime Prefectural Central Hospital were subjected to antimicrobial susceptibility tests using the disk diffusion method. The rate of ESBL-producing E. coli with nonsusceptibility to both ceftazidime (CAZ) and aztreonam (AZT) increased over the study period. The performance of bla_CTX-M typing using DNA sequencing showed that bla_CTX-M-14 was dominant in periods I and II, but levels of bla_CTX-M-27 and bla_CTX-M-15 significantly increased, in addition to that of bla_CTX-M-14, in period III. The rate of bla_CTX-M-27-positive or bla_CTX-M-15-positive E. coli cells with nonsusceptibility to both CAZ and AZT were higher than that of the bla_CTX-M-14-positive E. coli cells. These data suggest that the increase in the number of ESBL-producing E. coli cells with nonsusceptibility to both CAZ and AZT was due to the increase in the number of bla_CTX-M-27-positive or bla_CTX-M-15-positive E. coli cells. In addition, a D240G amino acid mutation was detected in the bla_CTX-M-27-positive and bla_CTX-M-15-positive strains, suggesting that this mutation led to the increase in the rate of nonsusceptibility to both CAZ and AZT.

Recently, the importance of clinical laboratories has increased, and risk management, including incident analyses, is needed for providing reliable laboratory data. We have taken precautions to ensure the prevention of incidents; however, despite such precautions, similar incidents can sometimes occur. The aim of this study is to clarify the characteristics of recurrent incidents; 212 incidents between April 2009 and April 2016 were analyzed. The numbers of nonrecurrent and recurrent incidents were 129 (61%) and 83 (39%), respectively. The most frequent cause of recurrent incidents (68%) was “insufficient recognition”. Precautions for nonrecurrent incidents included changing laboratory practices, such as discontinuing or simplifying procedures. Precautions for recurrent incidents more frequently involved training medical technologists or calling their attention. The modification of circumstances surrounding medical technologists should be considered to prevent recurrent incidents.

The soluble fibrin (SF) monomer and D-dimer are well recognized for their use as predictive markers of thrombosis or fibrinolysis. We measured SF monomer and D-dimer levels to distinguish deep vein thrombosis (DVT). Furthermore, when the SF monomer and D-dimer levels were high, we performed enhanced CT examination. In our examination, the measurement of SF monomer or D-dimer level revealed DVT in 30% of all the patients in our hospital. However, in some patients, we were unable to find DVT, arterial thrombus, or bleeding even when their SF monomer or D-dimer levels were high. In this study, we examined the SF monomer and D-dimer levels in a preoperative patient by end venous laser ablation (EVLA). We examined the relationship of SF monomer and D-dimer levels with venous thrombus by ultrasonography. The patients in which thrombi were detected by ultrasonography or contrast CT, or those with malignant tumor, pneumonia, or diabetes were excluded from this study. We divided the patients into two groups on the basis of varicose vein size determined from ultrasonography images. The varicose vein size of the dilated group was over 8 mm and that of the nondilated group was under 8 mm. The SF monomer level of the dilated group was significantly higher than that of the nondilated group (p < 0.01). The relationship among the size of the varicose vein, the venous reflux flow, and the thrombus size is known. However, it was suspected that the high SF monomer level indicated the presence of not only thrombi but also venous stasis.

In this study, we analyzed the detection rates of squamous intraepithelial lesions (SILs) using BD SurePath^TM liquid-based cytology (LBC) and conventional cytology with Cervex-Brush^® performed for cervical cancer screening. The split-sample procedure involved direct sampling and spreading with Cervex-Brush^®, followed by the collection of the brush tip in a BD SurePath^TM vial and BD SurePath^TM specimen preparation. SIL detection rates were investigated in two groups: conventional cytology and LBC performed using the split-sample procedure. Split samples were collected from 2,025 women. A SIL was detected in 63 women (3.1%) by conventional cytology [33 cases, low-grade (LSIL); 30 cases, high-grade (HSIL)] and 69 women (3.4%) by BD SurePath^TM LBC (37, LSIL; 32, HSIL). The unsatisfactory rate was significantly higher in the conventional cytology than in the BD SurePath^TM LBC (p < 0.001). The unsatisfactory rate for BD SurePath^TM LBC was 0%. The LBC platform is a standardized LBC system with improved HSIL detection rates and a lower unsatisfactory rate, and is very useful in cervical cancer screening conducted during health check-ups.

We retrospectively analyzed the clinical features and characteristics of 557 patients with blood culture results. Patients were admitted to the emergency department of Chiba Aoba Municipal Hospital between January and December 2015. Of the 557 patients, blood cultures tested positive for bacteria in 75 patients (13.5%). Among the bacteria-positive blood culture isolates, the most common sites of infection were the urinary tract (34.7%), followed by the biliary tract (16.0%) and respiratory tract (10.7%). Among the 78 true-bacteria isolates, those frequently detected were Escherichia coli (28, 35.9%), Klebsiella pneumoniae (7, 9.0%), and Staphylococcus aureus (6, 7.7%); the frequency of isolating Enterobacteriaceae was high. Logistic regression analysis revealed that systemic inflammatory response syndrome (SIRS), diastolic blood pressure (DBP), and total bilirubin (T-Bil) and creatinine (Cr) levels were reliable predictive factors for bacteria-positive blood cultures. Patients with bacteria-positive blood cultures also had poorer outcomes than those with bacteria-negative blood cultures; albumin (Alb) and lactate (Lac) levels were found to be related to hospital mortality. The area under the receiver-operating characteristic curve (AUC) demonstrated that the value predicted using logistic regression analysis employing SIRS, DBP, and T-Bil and Cr levels were accurate (AUC = 0.79 [95% confidence interval: 0.74–0.84]). In the present study, the clinical features of patients with bacteria-positive blood cultures were revealed. These results are helpful for early diagnosis and quick planning for treatment.

We evaluated the changes in the serum inorganic phosphorus (IP) level during whole-blood storage and the effects of hemolysis. During the whole-blood storage at room temperature, the IP level is known to increase owing to the hydrolysis of organic phosphorus. In this study, the evaluation of samples obtained from 10 healthy adults revealed a phenomenon whereby the IP level decreased once prior to its increase in all subjects. This decrease may have been caused by adenosine triphosphate (ATP) synthesis due to glycolysis in red blood cells. The decrease in the IP level was significant, and the maximum decrease rate markedly varied (4–22%). Since the decrease in the IP level during the whole-blood storage at room temperature has not been reported, its details were evaluated using washed red blood cells. As a result, a decrease in the IP level started after about 1 hour, and an increase due to the hydrolysis of organic phosphorus started after about 2 hours. Changes in the IP level are associated with whole-blood storage temperature and glucose concentration. Since changes in the IP level occur early during the whole-blood storage, immediate serum separation after blood collection is necessary. Subsequently, the effects of hemolysis were evaluated using 3 reagents with different measurement principles. The effects immediately after adding the hemolysis solution to the pooled serum slightly differed among the 3 reagents, but the IP level gradually increased during storage at room temperature in the 3 reagents. This increase may have been caused by the hydrolysis of organic phosphorus; thus, the measurement of the IP level in hemolytic serum should be immediately performed.

Recently, the emergence of drug-resistant anaerobic bacteria has been observed worldwide, and antimicrobial susceptibility tests play a significant role in routine examination. In this study, we compared the result of susceptibility tests using the fully automated bacteriological analyzer RAISUS ANY (RAISUS method) with that of the Eiken dry plate (current method) using 111 anaerobic bacterial strains, namely, 68 strains of Bacteroides spp. and 43 strains of Clostridium spp. The results of the comparisons between the RAISUS method and current manual methods were as follows: RAISUS method: 87–100% for Bacteroides spp. and 63–100% for Clostridium spp. with +/−1 difference in each well; and for the current method: 78–100% for Bacteroides spp. and 51–100% for Clostridium spp. with agreement in the CLSI category. On the other hand, discordance of the susceptibility pattern was seen in cefotaxime and moxifloxacin for Bacteroides spp. and clindamycin for Clostridium spp., presumably due to the individual variability in visual judgement. The RAISUS method is a laboratory procedure with high objectivity and might be useful in routine examination.

We evaluated the performance of a commercially prepared selective medium, Vi GBS agar, for the screening of Streptococcus agalactiae from vaginal and anorectal specimens from pregnant women. Ninety-seven out of 98 clinical isolates of S. agalactiae grew well on Vi GBS agar and exhibited characteristic red-purple colonies within 24 h of incubation. Few microorganisms that comprise the normal flora of the vagina and rectum grew on Vi GBS agar. Some strains of Enterococcus spp., Streptococcus mitis, Pseudomonas aeruginosa, and Candida spp. grew on Vi GBS agar; however, these colonies were nonpigmented or very small, and could be clearly distinguished from those of S. agalactiae. A total of 287 swab specimens from the vagina and anorectum were directly plated onto Vi GBS subsequent to growth on sheep blood agar/BTB lactose agar biplate media (BA/BTB), and then incubated overnight at 35ºC. Of these, 98.6% (283/287) of the isolates were S. agalactiae and matched those of the conventional culture. Out of the four discrepant results, two false negatives were from specimens with low bacterial counts, and the remaining two were successfully isolated on Vi GBS agar, but not on BA/BTB. Vi GBS agar recovered S. agalactiae from six stool specimens that were artificially mixed, without the inhibition of its growth by Enterococcus from the stool. Our study suggests that direct plating onto Vi GBS agar shows high performance for the screening of S. agalactiae colonization in pregnant women.

PIVKA-II is released from hepatocytes during vitamin K deficiency, vitamin K antagonist administration, or hepatocellular injury. It is used as a tumor marker since it is highly expressed in patients with hepatocellular carcinoma. In this study, we examined the basic performance of the newly improved “Lumipulse Presto PIVKAII-N Eisai” reagent. For this reagent, the anti-MU-3 antibody is used as the primary antibody and a monoclonal antibody is used as the secondary antibody (previously, a polyclonal antibody was used). Moreover, the measurement of PIVKAII in plasma and also in serum became possible. The coefficients of variation of repeatability and reproducibility were 1.8–6.3% and 2.9–5.4%, respectively. A satisfactory linearity was obtained for the dilution test. The correlation with the current reagent was good (r = 0.99). When the measurement range was from 0 to 75,000 mAU/mL, the correlation between the serum and the plasma was strong (r = 1.00). However, the regression formula was y = 0.78x + 231.4, and the slope was slightly lower. The slope was 1.04 at 10,000 mAU/mL or less. In conclusion, this new reagent should be useful for routine examination.

The increased detection of clinically significant antibodies with the decreased detection of insignificant antibodies is ideal in an irregular antibody screening. Recently, it has been reported that the sensitivity to detect irregular antibodies was superior to low-ionic-strength solution-indirect antiglobulin test (LISS-IAT), including 0.8% Cell Screen J -alba-(0.8% CSJ) (also called 0.8% RCD method) rather than LISS-IAT + Ficin method. Here, we compared the two methods in terms of concordance rate, sensitivity, specificity, likelihood ratio, detection sensitivity, and cost per specimen. The polyethylene glycol-indirect antiglobulin test (PEG-IAT) was used as the control in this study. The number of specimens submitted to our laboratory was 1,254. The antibody positivity rates of the LISS-IAT + Ficin method and the 0.8% RCD method were 10.8% and 3.4%, respectively. The concordance rate and κ coefficient of the LISS-IAT + Ficin method for PEG-IAT were 33.2% and 0.086, respectively. The concordance rate and κ coefficient of the 0.8% RCD method for PEG-IAT were 82.1% and 0.705, respectively. The sensitivity, specificity, and likelihood ratio of the LISS-IAT + Ficin method were 82.6%, 90.5%, and 8.69, respectively. The sensitivity, specificity, and likelihood ratio of the 0.8% RCD method were 82.6%, 98.1%, and 42.37, respectively. Furthermore, the detection sensitivity of the 0.8% RCD method was equivalent to that of PEG-IAT, and the costs per specimen of the 0.8% RCD method and LISS-IAT + Ficin method were 717 and 1,234 yen, respectively. These results suggest that 0.8% CSJ is useful as a screening reagent.

It is clinically very important to diagnose the progression of hepatic fibrosis in hepatitis C patients. In recent years, it has become possible to evaluate liver fibrosis noninvasively by quantifying liver stiffness using measurements of shear wave velocity. The performance of ultrasonic inspection degrades with increasing obesity. However, the effect of obesity on the Vs measurement has not yet been thoroughly demonstrated. It is hoped that we can clarify the effect of obesity on the Vs measurement in this study. Patients with chronic hepatitis C were divided into the obese group and the non-obese group, and their Vs values, platelet counts, type IV collagen 7s, hyaluronic acid levels, APRIs, and FIB4 indices for each fibrosis stage were compared. It was demonstrated that the Vs values were higher in obese hepatic C patients. However, there were no significant differences in the indicators of liver fibrosis among all hepatic fibrillation stages. It is important to carefully evaluate liver stiffness not only on the basis of measurements of Vs values, but also by taking other indicators of liver fibrosis into account.

Objective: To evaluate cardiac pump function, it is important to measure local myocardial stretchability noninvasively. The objective of this study is to clarify local myocardial stretchability on the basis of the axial strain rate (aSR) on the ultrasonic beam obtained by the phase-difference tracking method with high-frame-rate ultrasonic imaging. Subjects and Method: Twenty subjects with normal heart and 2 patients with heart disease (anterior septal infarction and dilated cardiomyopathy) participated in this study. Ultrasonic RF signals from the interventricular septum (IVS) and left ventricular posterior wall (LVPW) were obtained at a frame rate of 500–600 Hz, and the phase-difference tracking method was applied to calculate the aSR on the beam axis. The colored aSR was superimposed on the M-mode echocardiography to represent the spatial distribution of aSR. Results: In the healthy subjects, contraction and relaxation of the myocardium transited from the right ventricular side to the left ventricular side in the IVS, and from the epicardial side to the endocardial side in the LVPW. In addition, contraction and relaxation in the LVPW proceeded from the apex to the base of the left ventricle. The distribution of aSR was nonuniform, and the distribution pattern was classified into five types: spotted, multilayered, toned, layered, and repetitive. In the patients with heart disease, the absolute value of aSR was small and the distribution was uniform. Conclusion: This method precisely shows the characteristics of myocardial stretchability and it can provide important information on cardiac pump function.

We examined the basic performance and characteristics of a new D-dimer reagent, LPIA-GENESIS D-dimer (LG-DD), which recognizes an antigen epitope different from those recognized by conventional reagents. The CV values of precision test were from 0.21% to 2.67% for within run, and from 1.86% to 2.80% for 10 days’ between run. A dilution linearity of ≤ 56.3 μg/mL was confirmed. The minimum detection sensitivity was 0.34 μg/mL. The correlation with LPIA-ACE-D-Dimer II (ACE-DD) was y = 0.964x + 0.092 (r = 0.952). When serially measuring each parameter after fibrinogen fibrinolysis, there was no serial increase in any parameter of LG-DD. When serially measuring each parameter after fibrin fibrinolysis, there was a serial increase in each parameter. The values of all parameters of LG-DD were higher than those of ACE-DD. Fibrinolysis was promoted after coagulation-factor-XIII-deficient plasma coagulation, and there were serial increases in all parameters, but their values were lower than those of ACE-DD. This suggests that there is no influence on values in samples coagulated in blood collection tubes. From the results of this study, LG-DD may show a high performance without being affected by coagulation in blood collection tubes and also a high specificity for the D-dimer produced in vivo.

When an emergency patient suspected of having acute-phase cerebral infarction is transported to the emergency room, it is important to diagnose whether he is having a cardioembolic stroke (CE) or a non-cardioembolic stroke (non-CE). Here, using 101 plasma samples derived from such patients who were carried into the emergency center of our hospital from July 2016 to February 2018, we examined the usefulness of the soluble fibrin monomer–fibrinogen complex (SF) or D-dimer measurements during the hospitalization time. Among the 101 patients, 33 had CE and 68 had non-CE. On the basis of interval from the onset to hospitalization [ΔT(hr)], the patients were classified into 2 groups: hyperacute-phase group (ΔT ≤ 4.5) and semiacute-phase group (ΔT > 4.5). Since the SF or D-dimer levels obtained during the hospitalization time did not correlate with the NIH Stroke Scale (NIHSS) or modified Rankin Scale (mRS) score, the SF or D-dimer levels reflected neither the severity on the hospitalization day nor the prognosis on the discharge day. The SF and D-dimer levels in the CE group were significantly higher than those in the non-CE group and not dependent on ΔT. Furthermore, the ROC analysis showed that the highest AUC value was obtained when the SF level in the hyperacute phase was selected as a variable (cut off value, 11.8 μg/mL; AUC, 0.92; specificity, 97%; sensitivity, 87%). We thus concluded that SF determination in the hyperacute phase could be a useful tool for differentiating patients with CE from those with non-CE.

Background: Autotaxin is the enzyme responsible for converting lysophosphatidylcholine to lysophosphatidic acid. Recently, it has been reported that serum autotaxin levels correlate with liver fibrosis grade, and autotaxin is useful as a noninvasive liver fibrosis marker. We evaluated the performance of serum autotaxin assay and compared serum autotaxin levels in healthy subjects between genders and age groups. Methods: Autotaxin concentrations were determined using the automated immunoassay analyzer AIA-2000 (Tosoh Co.). Precision, linearity, sensitivity, the effect of interferences of autotaxin assay, and autotaxin sample stability were evaluated. For the comparison of autotaxin levels between genders and age groups, 160 healthy subjects (80 males and 80 females) with normal liver function were recruited. Results: The coefficient of variations of the assay ranged from 1.74% to 4.09%. Linearity was observed up to 8.51 mg/L. The limit of detection was 0.03 mg/L. There was no effect of interfering substances. Sample storage at room temperature for up to 5 days, at 2–8°C for up to 6 days, at −20°C for up to 30 days, and repeated freeze–thawing up to 5 times had no impact on the measured levels of autotaxin. Median autotaxin levels were significantly higher in females than in males (0.82 vs 0.70 mg/L; p < 0.005), but there were no significant differences between age groups. Conclusions: The analytical performance of autotaxin assay is acceptable for routine clinical laboratory tests. Autotaxin levels were higher in females than in males. Therefore, it is necessary to assess autotaxin levels according to gender.

Nowadays, it is necessary that a hospital transfusion unit provides 24-hr laboratory service. Automated immunohematology analyzers with high performance and novel transfusion management systems are being continuously developed for standardization and better quality control of immunohematology tests and for efficient laboratory work. To introduce an automated analyzer, its performance and the conditions of the hospital, such as laboratory personnel and introductory and running costs, must be considered. We have been providing a 24-hr immunohematology service by medical technologists since the opening of our hospital in 1984. Afterward, a transfusion management system and AutoVue^® were introduced, and immunohematological tests outside hospital hours were completely automated. Electronic medical records were introduced later. The AutoVue^® Innova system was upgraded to ORTHO VISION^® in 2016. Two analyzers were introduced and a back-up system was established in case of problems. A questionnaire survey revealed that the burden of the technologists in the laboratory was greatly reduced with the introduction of ORTHO VISION^®. Consumptions of IgG cassettes and reagent red blood cells were reduced by 8–10%. We judged that the performance and operability of ORTHO VISION^® were suitable for our hospital.

Carbapenemase-producing Enterobacteriaceae (CPE) bacteria are increasingly reported worldwide. Rapid detection methods for carbapenem-resistant Enterobacteriaceae (CRE) isolates are necessary since information gained has an important value from clinical and infection control perspectives. A novel chromogenic medium, CHROMagar mSuper CARBA, was evaluated to detect CRE isolates. This study was assessed using 50 isolates with 28 isolates of genetically confirmed CPE (IMP, GES, NDM, KPC, SMB, VIM, OXA) and 22 isolates of non‐CPE (p-AmpC, extended spectrum β lactamase and others). It showed 100% sensitivity and 86.4% specificity for detection of CPE bacteria. The limit of detection ranged between 10¹ and 10³ CFU/mL except for three strains of IMP producers with low-carbapenem MICs. CHROMagar mSuper CARBA performed with high accuracy among the phenotypic methods applied and provided early results.

Berlin blue staining is a method of detecting trivalent ions in a specimen. The staining solution must be prepared immediately prior to use. We examined the effects of different storage conditions on the dyeability and changes in absorbance of the staining solution to clarify its convenient storage conditions. The storage conditions were at room temperature or 4°C and without light, and under cryopreservation (−80 and −20°C). The absorbance of the cryopreserved solution was maintained at its initial value, but those of the other solutions increased depending on the storage conditions. The cryopreserved solution showed no change in color tone and staining strength up to 1 year. It caused no false positive results. However, for the solutions that were not cryopreserved, their color tone changed from blue to green, their staining strength decreased, and they caused an increase in the number of false positive results. The freezing speed and cryopreservation temperature did not affect the results. The absorbance changes showed that trivalent ferric salts were generated over time and reacted with potassium ferrocyanide, then free iron ferrocyanide (Berlin blue) was generated in the solutions without cryopreservation. Thus, it seems very likely that the concentration of potassium ferrocyanide, which binds to iron ions in tissues, decreased, and therefore the dyeability of the solution weakened. The change in color tone from blue to green might be due to the change in the molecular weight of the Berlin blue dye. When the solution was frozen, these reactions ceased so that there was no change in absorbance or dyeability. These results indicate that the cryopreservation of the staining solution is convenient and useful for Berlin blue staining.

The liquid-based cytology (LBC) manual preparation is more complicated than conventional processing. Therefore, improvements to the manual cell-washing process for SurePath^TM are required. We examined whether LBC preparation using an automated cell-washing centrifuge (MC480LBC) affects the number of cells on a slide. The function of MC480LBC was investigated using the following parameters: (A) number of cells at different CytoRich red solution volumes (1–3 mL), (B) number of cells at different relative centrifugal forces (600 and 800 g) and times (5 and 10 min), (C) number of cells at different cell concentrations in CytoRich red solution, (D) level of contamination, and (E) effect of the number of washing times on the number of cells. All slides were stained by the Papanicolaou method and cells in sediment were counted. The results showed that the volume of the CytoRich red solution did not affect the number of cells on the slide (p = 0.779). There was no significant difference in the number of cells regardless of relative centrifugal force and times (p = 0.863), nor did cell morphology show any changes, such as spindle-shaped or elongated cells. Furthermore, the cell concentration in the CytoRich red solution had no significant effect on cell count (low concentration: p = 0.826, high concentration: p = 0.779). No slides showed any contamination. However, when centrifugal cell washing was performed three times or more, the number of cells on a slide was clearly decreased in comparison with those after the first and second washings (p = 0.001). Our findings indicate that MC480LBC can facilitate cell washing in the manual SurePath^TM method as long as the number of washing times follows the manufacturer’s instructions.

Skin perfusion pressure (SPP) measurement has been used for the selection of therapeutic methods and the evaluation of the efficacy of treatment of critical limb ischemia (CLI). The aim of this study is to evaluate whether continuous measurement may affect the SPP results. Twenty-four healthy volunteers (age range, 23 to 67; mean age, 40.8 ± 13.5 years; 11 men, 13 women) were included in this study. The dorsum pedis with the anterior tibial artery and the plantar with the medial plantar artery, which are the dominant blood vessels were selected as the regions for SPP measurement. SPP was measured continuously and intermittently five times. The differences in SPP results were not statistically significant both in the measurement region and methods as determined by one-way layout analysis of variance (p-values ranged between 0.838 and 0.960). The CV values of the SPPs measured in the dorsum pedis and plantar were 7.4% and 8.5%, respectively. A small number of cases that showed high CV values (15% or over) were distributed in each measurement group. On the basis of the results, we found that continuous measurements of SPP using the Nahri MV monitor SRPP may not affect the SPP results. However, other variable factors that may affect the SPP results should be further investigated.

With coagulation tests, obtaining results rapidly is of critical importance as information from these tests is used by clinicians treating severe trauma patients and patients requiring thrombolytic therapy when, for example, deciding whether to provide blood transfusions or determining patient prognosis. However, if tests are carried out in line with the “Consensus guidelines on coagulation test specimen handling” [2016; Japanese only], the time required to obtain results is actually increased, whereas shortening that time is necessary. Paying particular attention to TAT, we compared CP3000 from Sekisui Medical Co., Ltd., and CS-2000i from Sysmex Co., Ltd. Plasma samples from 15 volunteers were obtained and assayed using both analyzers for those tests that happened to be required on a random day. The time from the start of analysis to obtaining all results was 21 min and 20 s on the CP3000 and 53 min and 52 s on the CS-2000i. From these results, we found that even if the centrifugation conditions were changed to 2,000 g and 10 min, as per the 2016 guidelines, the time from sample arrival to final results was shortened. By using CP3,000, even when following the latest guidelines, results can be obtained more quickly than with the previous assay method even during busy periods when large numbers of samples arrive at the laboratory concurrently.

Blood specimens should be transported to the laboratory as soon as possible and analyzed after adequate preanalytical treatments such as centrifugation. However, specimen transportation to the laboratory often takes a long time, especially for inpatient specimens. Since we considered that we should evaluate the turn-around time (TAT) in the laboratory as the time from sample collection to the reporting of test results rather than as the time from sample arrival to the reporting of test results, we investigated the time from inpatient specimen collection to specimen arrival at the laboratory. The mean transportation time was 91 ± 51 min, which was far longer than we had expected. We next examined the effect of transportation time on the test results at 4°C and room temperature. The blood glucose level decreased by 5.6% to 15.4% in 2 h and gradually decreased thereafter until 6 h. The plasma hANP level decreased by 8.4% to 24.4% at 4°C and by 18.9% to 41.3% at room temperature over 6 h. The serum potassium level increased by 26.8% to 28.2% at 4°C over 6 h. The serum lactate dehydrogenase level tended to increase at 4°C and room temperature, but the amount of increase varied widely depending on the specimen. The inorganic phosphate level decreased by 9.1% to 16.7% at room temperature over 6 h. The results of this study revealed the actual transportation time and the actual effects on test results.

In patients with haematological malignancies, immune function decreases owing to the reduction in the number of normal blood cells, and chemotherapies mainly using a carcinostatic agent make such patients immunocompromised. In isolates from other departments, 59.6% were gram-negative bacilli. In separating bacteria in the Haematological Malignancy Department, 46.0% were gram-positive cocci. Most importantly, there were Staphylococcus and Coryneform bacteria, and the Streptococcus mitis group, which are part of the normal flora of the skin. In the comparison by the sensitivity test, the MICs indicating the insensitivities of Escherichia coli to Levofloxacin (LVFX) and of Pseudomonas aeruginosa to Cefepime (CFPM), Meropenem (MEPM), LVFX were 20.8%–33.3% higher in the Haematological Malignancy Department than in other departments. In addition, the proportions of ESBL-producing bacteria such as E. coli and Klebsiella pneumoniae were 15% to 20% higher in the Haematological Malignancy Department than in other departments. Until now, we have never detected multidrug-resistant bacteria in blood culture, but considering the results of this survey, we should pay attention to the susceptibility of detected bacteria from future haematological malignancies, and to know the trend of resistant bacteria, we also concluded that it is necessary to continue blood culture surveillance.

As a senior JICA volunteer, I was sent/dispatched to the independent state of Samoa for two years with the goal of improving the operations of the National Hospital clinical laboratory. This assignment not only taught me about how things actually work in developing countries, but I also had many experiences that I would never have had in Japan. On the basis of my experiences, I want to think about the contributions that Japanese medical technicians can make to the development of clinical laboratories in developing countries. It is my wish that many Japanese medical technicians will have the opportunity to work abroad.

Background: In recent years, the development of molecular targeted drugs for lung cancer has been remarkable, and drugs are selected according to the gene mutations determined from cancer cells. For this reason, to carry out cancer treatment, cancer cells must be reliably and properly collected, and then accurately assessed by genetic analysis of the presence or absence of gene mutations. There have been requests from pulmonologists to pathological laboratories for rapid on-site cytologic evaluation (ROSE). However, such requests could not be met owing to factors such as insufficient time on the part of the cytotechnologists. Objective: We attempted to introduce ROSE by cytotechnologists during bronchoscopy using Total Quality Management (TQM) activities. Method: We provided the necessary time by improving the work flow in a pathological laboratory. Then, we compared the reduction time of routine work and the spend cytotechnologists’ time of ROSE. Result: The reduction time of routine work significantly surpassed the spend cytotechnologists’ time of ROSE. Conclusion: We achieved our goal, which is to allow cytotechnologists to perform ROSE in all cases during bronchoscopy of suspected lung cancer patients using TQM activities.

A 74-year-old male presented to our hospital with high-level carcinoembryonic antigen (CEA) revealed during a routine medical checkup. Positron emission tomography–computed tomography revealed fluorodeoxyglucose-avid lesions in the hypopharynx and the right lobe of the thyroid gland, leading to his referral to the Department of Otorhinolaryngology. A lesion in the right piriform fossa was diagnosed as hypopharyngeal carcinoma, but a tumor in the thyroid gland could not be confirmed. Several days after the initiation of chemotherapy for hypopharyngeal carcinoma, the patient developed fever, and blood tests revealed elevations in C-reactive protein (CRP; 19.17 mg/dL) and procalcitonin (PCT; 47.90 ng/mL) levels. The blood culture sample showed negative results after 5 days of incubation. As the serum PCT level remained high at 37.57 ng/mL despite the abatement of fever and CRP level reduction, a tumor in the thyroid gland was suspected as medullary thyroid carcinoma (MTC). Further investigation revealed elevations in the serum CEA and calcitonin levels. In addition, scintigraphy scan revealed a lesion in the right thyroid lobe more slightly ¹²³I metaiodobenzylguanidine-avid than that in the left. Eventually, the patient underwent total thyroidectomy and lymphadenectomy, and his serum PCT level decreased to below the cutoff value within 2 days after surgery. The thyroid tumor of this patient was diagnosed as MTC on the basis of histopathological examination results. Thus, this case suggests that the high serum PCT level could be attributed to MTC.

We report a case of therapy-related myeloid neoplasm that resulted in acute promyelocytic leukemia in a patient following therapy for breast cancer. Chromosome analysis did not reveal t(15;17), but fluorescence in situ hybridization and polymerase chain reaction analysis showed a PML/RARA fusion gene, which is a masked t(15;17), demonstrating the importance of genetic analysis. Furthermore, an alkylating agent was used during therapy for breast cancer, and the deletion of the long arm of chromosome 7 was detected, which was previously described for this agent. Generally, in cases of t(15;17), the prognosis for t-MN is good, but in this case, the deletion of the long arm of chromosome 7 resulted in a poor prognosis, suggesting that the evaluation of chromosome abnormalities is essential in the assessment of patients with t-MN.

We report a case of fatal endocarditis caused by Aerococcus urinae isolated by blood culture, which was timely identified by MALDI Biotyper. A seventy-year-old male with chronic cystitis and aortic valve replacement was admitted to our hospital for suspected urinary tract infection. By blood culture on admission, we isolated a gram-positive coccus that grew in clusters and produced alpha-hemolysis on blood agar. The result of analysis by MALDI Biotyper indicated A. urinae. He died on the 26th hospital day complicated by cardiogenic brain infarction. A. urinae is an aerobic gram-positive coccus that appears in cluster form on gram staining and grows as an alpha-hemolysis colony on blood agar. Thus, it could be misidentified as alpha-hemolytic streptococci and staphylococci. Previous reports indicate that A. urinae is associated with urinary tract infection and bacteremia. It should be emphasized that it potentially causes serious infective endocarditis.

Malignant pleural mesothelioma (MPM) is uncommon, and bilateral lesions are particularly rare. We present a case of MPM with characteristic clusters diagnosed by the cytological examination of bilateral pleural effusion. A 52-year-old male with bilateral pneumothorax had a tumor shadow in the left pulmonary apex measuring up 25 mm by computed tomography. Thoracoscopic partial resection of the left lung revealed multiple plaques indicating tumor dissemination, and hemorrhagic pleural effusion in the left thoracic cavity. Intraoperative pleural cytology showed epithelioid mesothelial cells arranged in large spherical and papillary clusters, mixed with scattered sheetlike mesothelial cells with chronic background inflammation. Despite seeing small mononuclear mesothelial cells in the large clusters, we suggested MPM. Histopathologic examination revealed the proliferation of epithelioid tumor cells with glandular and tubulopapillary structures in the fibrous thickened visceral pleura and peripheral lung. Immunohistochemistry showed positive staining for calretinin, D2-40, and WT-1. The patient was diagnosed as having MPM. Later pleural cytology following thoracoscopic partial resection of the right lung again showed mesothelial cells in spherical and papillary clusters, which were also diagnosed as MPM. The large spherical and papillary clusters in the pleural effusion were critical to the cytological diagnosis of MPM.

The patient was a 40-year-old male who was admitted to our hospital because of pain in his left chest in 201X. He was diagnosed as having multiple myeloma from the results of bone marrow examination. There was no significant difference between the qualitative and quantitative urine test results when he was hospitalized. Large polynuclear macrophages and casts were observed during urine sediment examination, which suggested myeloma kidney due to multiple myeloma. Thus, there is a possibility of merging of myeloma kidney and it is important to detect this.