There have been a few studies on the seasonal variation of bloodstream infections or microorganisms isolated from blood cultures. The aim of this study was to clarify the seasonal variation of microorganisms isolated from blood cultures and their relationship with the climate. A total of 30,945 blood cultures over 10 years between January 2005 and December 2014 were included in this study. Blood culture positivity rate (BCPR) was defined as the number of infection- or microorganism-positive blood cultures per 1,000 person-days of hospital admissions, which were analyzed monthly or seasonally. The BCPR was significantly higher in the summer than in the spring, and positively correlated with temperature or humidity, primarily owing to the seasonal variation of gram-negative rods (GNRs) and Bacillus spp. The BCPRs of coagulase-negative staphylococci, Bacillus spp., and Enterococcus spp. positively correlated with temperature, while the BCPRs of GNRs and Candida spp. positively correlated with humidity; however, the BCPR of Staphylococcus aureus negatively correlated with humidity. Overall, the BCPR showed seasonal variations and was associated with temperature and humidity depending on the bacterial strain.

Fractional exhaled nitric oxide (FeNO) is recognized as a marker of acidophilic inflammation in the lower respiratory tract. We can measure FeNO simply and noninvasively. On the other hand, it is reported that the FeNO level is affected when we consume a meal that includes nitric oxide, caffeine, and water. Also, there is very little information about the FeNO level immediately after eating and drinking. We examined the FeNO level immediately after consuming a meal and drink that include nitric oxide and caffeine, and determined the variation of water temperature. After consuming a meal that includes nitric oxide, we found significant decreases in the FeNO level after a minimum of 5 min. We did not find a significant difference after 30 min. The FeNO level significantly increased to the maximum after 1 h. After 2 h, it was high, which did not decrease to the level before the intake. After taking a drink that includes nitric oxide or caffeine, the level became the same as that after consuming a meal with nitric oxide. In the case of water temperature, the FeNO level significantly decreased 5 and 15 min after the intake of 4°C water. However, we did not find a significant difference in the FeNO level after the intake of 37°C water. We suggest that we should avoid FeNO measurement immediately after eating and drinking, and that the level is affected by the temperature of the drink. We consider that various factors are related to FeNO measurement conditions. Moreover, we believe that it is necessary to continue the examination of conditions affecting FeNO measurement in the future.

Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is frequently performed in patients with hematological malignancy. However, the pulmonary function of such patients is often decreased after allo-HSCT. The aim of this study was to clarify the risk factors for decreased pulmonary function after allo-HSCT. The decreased pulmonary function was defined as %FEV1.0, where %FEV1.0 decreased by 10% or more and %FEV1.0 was less than 80% after transplantation. Fourteen clinical factors including sex, body mass index (BMI), blood disease indicated for allo-HSCT, hematopoietic cell transplantation-specific comorbidity index, types of allo-HSCT, myeloablative treatment, total body irradiation, match of blood type, HLA type and sex, existence of consanguinity, antibodies of cytomegalovirus in donors and prophylactic measure of GVHD were analyzed to determine their relationship with decreased pulmonary function after allo-HSCT by univariate and multivariate analyses. The multivariate analysis showed that BMI < 18.5 kg/m², acute lymphatic leukemia, and myeloablative treatment were significant risk factors for the decreased pulmonary function after allo-HSCT. Patients with these factors should be closely followed-up after allo-HSCT.

Accurate prognostic information in palliative settings is needed for patients to make decisions and set goals and priorities. A number of prognostic scoring systems for terminal cancer patients have been developed; however, most of them include subjective or categorical variables that may not account for the intensity or severity of the disease and may be a limitation for making more objective evaluations. In this study, we developed a laboratory prognostic score (LPS) to predict 2-week mortality using routine blood tests and investigated its validity. LPS is the sum of 7 blood indices: C-reactive protein level of ≥ 6.0 mg/dL, albumin level of ≤ 2.7 g/dL, blood urea nitrogen level of ≥ 26 mg/dL, white blood cell count of ≥ 10.2 × 10⁹/L, eosinophil rate of ≤ 0.4%, lymphocyte count of ≤ 0.620 × 10⁹/L, and platelet count of ≤ 183 × 10⁹/L. The optimal cut-off LPS for predicting 2-week mortality was 4, which predicted death within 2 weeks with a sensitivity of 69% and a specificity of 82%. Thus, LPS can be a useful objective prognostic tool for predicting the 2-week mortality of terminally ill cancer patients.

The efficacy and usefulness of rapid on-site cytologic evaluation (ROSE) with endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) biopsy in our hospital over the past 9 years in 35 patients with pancreatic solid tumors were reported. The centesis of the biopsy specimens was 2.2 times on average and the sampling rate was 100%. The most important diagnostic report was malignancy confirmation; the diagnostic accuracy was 97.1%, sensitivity was 96.3%, and specificity was 100%. The sampling rate, specificity, sensitivity, positive predictive value, and diagnostic accuracy were high. Since the introduction of EUS-FNA, ROSE has contributed to enhancing the collaboration of staff members between the pathological and gastroenterological departments. EUS-FNA with ROSE in this field is now considered to be a useful method of obtaining samples reliably and completing the test with minimal puncture.

In collagen diseases such as systemic lupus erythematosus (SLE), arterial thromboembolism occurs frequently regardless of the conventional risk factors for arteriosclerosis. Measurement of activated platelet–monocyte complexes (aPMCs) involved in the formation of arteriosclerotic lesions is very important, but its clinical utility has not been investigated. In this study, we investigated whether the measurement of aPMCs by flow cytometry analysis is useful as a clinical laboratory tool to predict the risk of arterial thromboembolism in prospective clinical studies of collagen disease patients. We measured the positivity rate of aPMCs in patients with various autoimmune diseases such as SLE, rheumatoid arthritis (RA), polyarteritis nodosa (PN), and mixed connective tissue disease (MCTD). The positivity rate of aPMCs was significantly higher in SLE patients than in other autoimmune disease patients. Furthermore, the SLE patients were classified into the antiphospholipid syndrome (APS)-complicated group and noncomplicated group, and both were compared. The positivity rate of aPMCs was obviously higher in the APS-complicated group. In addition, we divided SLE patients into the following 5 groups according to their complications: cerebral infarction (n = 9), myocardial infarction (n = 3), deep vein thrombosis (n = 5), pulmonary embolism (n = 2), and nonthrombosis (n = 17). The positivity rate of aPMCs was significantly higher in SLE patients with cerebral infarction and myocardial infarction than in those with deep vein thrombosis, pulmonary embolism, and nonthrombosis. The present study showed that the positivity rate of aPMCs determined by flow cytometry analysis could serve as a marker to predict the risk of arterial thromboembolism in SLE patients.

[Objective] In this study, we performed a fundamental investigation of the discrepancy of the results of flow cytometry lymphocyte crossmatch (FCXM) and FlowPRA (One Lambda Inc., Canoga Park, CA, USA) in ABO-incompatible kidney transplantation. [Method] We examined ABO-incompatible kidney transplantation cases with different results between FCXM and FlowPRA. We performed FCXM using untreated serum and absorbed anti-A or anti-B serum. Monoclonal anti-A and anti-B antibodies and anti-mouse IgM were used to confirm the existence of A and B blood group antigens. [Results] The false-positive reaction in FCXM disappeared with the absorbed anti-A or anti-B from recipient serum. Moreover, we detected the blood group A and B antigens on lymphocytes by binding anti-A and anti-B monoclonal antibodies to the lymphocytes. [Conclusion] Anti-A or anti-B antibodies affected the results of FCXM. We consider that we can accurately determine donor-specific anti-HLA antibodies (DSA) or anti-blood group antibodies by this method.

Treatments for cerebral infarction vary depending on the type of infarction. Thus, it is important to classify it at an early stage. We investigated whether the levels of fibrin monomer complex (FMC), D-dimer, and brain natriuretic peptide (BNP) are useful for the clinical diagnosis of cerebral infarction in patients in the acute phase. We included 190 patients admitted to our hospital with acute-phase cerebral infarction between July 2015 and June 2016. The study patients had the following infarction types: atherothrombotic embolism (AT, n = 81), cardiogenic embolism (CE, n = 41), lacunar infarction (LI, n = 46), and others (n = 22). The levels of FMC, D-dimer, and BNP were measured on admission and compared among the infarction types. Furthermore, the cut-off levels were determined for each marker to calculate % positivity. There were no significant differences in the levels of FMC or D-dimer among AT, CE, and LI patients. On the basis of the cut-off values determined by constructing ROC curves, the rate of FMC-positive patients was significantly higher in CE patients than in AT and LI (non-CE) patients. The rate of D-dimer-positive patients was significantly higher in CE patients than in AT patients but not in LI patients. The level of BNP and the rate of BNP-positive patients were significantly higher in CE patients than in non-CE patients. Our findings demonstrate that the levels of FMC, D-dimer, and BNP are useful indicators for classifying the cerebral infarction type in patients in the acute phase. BNP level was particularly useful in distinguishing CE from non-CE.

We performed basic evaluation studies of urinary metanephrine and normetanephrine measurements using a liquid chromatograph-tandem mass spectrometer. This method showed CVs of within-run and between-day precisions of less than 4.0%, and the dilution linearity was also good. No matrix effect was also detected. In addition, the correlation with high-performance liquid chromatograph for postcolumn derivatization and LC-MS/MS method was good (metanephrine: y = 1.000x + 0.004, r = 0.994, n = 220; normetanephrine: y = 1.014x + 0.017, r = 0.992, n = 220). This study revealed that this method using a liquid chromatograph-tandem mass spectrometer is acceptable in routine tests.

Positive turning reactions to the HCV antibody measured with an S assay kit were observed in some cases after aortic graft replacement (AGR) for aortic dissection. BioGlue used in AGR contains bovine serum albumin (BSA), which has been reported to induce the production of the anti-BSA antibody. Generally, one of the causes of immunoassay kits showing false-positive results is nonspecific reactants including heterophilic antibodies. We hypothesized that the false-positive reactions to the HCV antibody might be induced by the anti-BSA antibody. The subjects were 4 patients with AGR (AGR group) and 10 patients with general surgery (non-AGR group). BioGlue was used only in the AGR group. Both groups were negative for the HCV antibody, as measured with the S assay kit preoperatively, and received blood transfusions during surgeries. In the AGR group, the HCV antibody measured with two assay kits including the S assay kit was positive and the antibody measured with three other assay kits was negative 2 months after AGR, but HCV core antigens were negative. In the non-AGR group, the HCV antibody measured with the S assay kit was negative 2 months after surgery. The anti-BSA antibody titers were considerably higher in the AGR group (219–692 ng/mL) than in the healthy volunteer group (10–85 ng/mL). Therefore, it was proved that the anti-BSA antibody was produced from the BSA component of BioGlue in AGR for aortic dissection. The false-positive reactions to the HCV antibody measured with the S assay kit were due to the anti-BSA antibody. Medical technologists should understand the reaction characteristics of each assay kit for heterophilic antibodies such as the anti-BSA antibody.

We performed basic evaluation studies of the reagent ‘Elia calprotectin’ based on the principle of sandwich fluorescence enzyme-linked immunoassay for the measurement of fecal calprotectin. Results showed that the CVs of within-run precision and between-day precision were less than 7.0% and dilution linearity was also good. In addition, the correlation with ‘Calprotectin Mochida’ used for comparison was good (y = 1.071x + 38.3, r = 0.789, n = 66). Positive and negative concordance rates were also good (87.2%). ‘Elia calprotectin’ showed sufficiently good basic performance for routine use.

In this study, we observed a Gram-positive bacillus from a blood culture, and in a subculture, we found slow-growing colonies on 5% sheep blood agar. Thus, we suspected that these colonies belonged to Nocardia or other related genera. As a result of nucleotide Basic Local Alignment Search Tool (BLAST) analysis of the 16S rRNA gene, a clinical isolate showed a base matching rate of 99.8% with Gordonia sputi. However, Gordonia jacobaea, Gordonia aichiensis, and Gordonia otitidis also showed high base matching rates from 99.4% to 99.7%. Therefore, we newly designed a PCR primer for the secA1 gene and performed BLAST analysis. The base matching rate for G. sputi was 100%, whereas those for G. jacobaea, G. aichiensis, and G. otitidis were 98.8%, 93.3%, and 92.3%, respectively. Thus, the isolate was identified as G. sputi. Gordonia is rare and it is often misidentified using only an identification kit. Thus, it is difficult to identify it in a general laboratory. Since gene analysis newly classified Gordonia spp., it is therefore an effective method for bacterial identification. BLAST analysis of the secA1 gene was a useful tool for identifying G. sputi.

The rapid identification of acid-fast bacteria for determining a treatment plan and preventing nosocomial infections is critical. The nucleic acid amplification test is used for the rapid identification of acid-fast bacteria. We evaluated the performances of TRCReady with EXTRAGEN (EX) and TRCR MB-Lysis Reagent (TRCR) to detect Mycobacterium tuberculosis complex (TB), Mycobacterium avium (MAV), and Mycobacterium intracellurare (MIN). For the detection of 71 clinical samples targeting TB, the positive and negative concordance rates between EX and TRCR were 33% (2/6) and 100% (65/65), respectively. For the detection of 76 clinical samples targeting MAV and MIN, the positive and negative concordance rates between EX and TRCR were 57% (8/14) and 100% (62/62), respectively. The 10 samples that confirmed a discrepancy between EX and TRCR showed EX-positive/TRCR-negative and smearing test negative. For measuring the dilution series of type strain (Mycobacterium bovis BCG, MAV, and MIN) with TRCReady and for measuring the number of colonies, the detection limits of EX for M. bovis BCG, MAV, and MIN were 30, 60, and 30 CFU/mL, respectively. On the other hand, the detection limits of TRCR for M. bovis BCG, MAV, and MIN were 3,000, 360, and 690 CFU/mL, respectively. Compared with TRCR, EX showed higher performance to detect TB, MAV, and MIN. EX is presumed to be useful for the detection of TB, MAV, and MIN from samples containing a small amount of bacteria.

Olfactory examination is important to evaluate the extent of olfactory dysfunction and the effectiveness of treatment. In this study, we reviewed 1,472 patients who had examined olfaction with T&T olfactometer. The most common illnesses of these patients were chronic rhinosinusitis (56.3%), post-infectious olfactory dysfunction (13.9%), and trauma (4.4%). We divided into two groups; “normosmia to moderate hyposmia” and “severe hyposmia to anosmia”, and compared the severity and the outcome of treatment in each disease. There were more often to have the sever olfactory dysfunction in patients with head trauma significantly (80.5%; p < 0.05). It is significantly more likely to show “no improvement or worsening” (65.9%; p < 0.05) and rarely showed improvement in the patients with head trauma. Olfactory examination has been used by medical technologists since a partial revision in 2015 of the “Law Concerning Medical Technologists, Public Health Laboratory Technologists and Other Related Personnel” but is rarely used at medical institutions. However, olfactory examination is important to suggest the treatment and to bring out the patient’s willingness for undergoing the treatment. We expect that olfactory examination will be used more and contribute to the diagnosis and the outcome of the treatment for olfactory dysfunction.

The epidermal growth factor receptor (EGFR) is activated through self-phosphorylation by extracellular stimuli and transmits the signal to a downward signal pathway. Mutation of the EGFR is suggested to be closely related to the promotion of oncogenesis and metastasis. Anti-EGFR antibody therapy is effective for unresectable, advanced, or recurrent colon cancer, and is covered by medical insurance. However, the effectiveness of the anti-EGFR antibody is not confirmed in a patient who has a mutation of KRAS that resides in the downward signal pathway of the EGFR. Thus, KRAS mutation analyses may be important to predict the effectiveness of the anti-EGFR antibody treatment for a patient with EGFR mutation. Mutations at codon 12 of KRAS from the body cavity fluid of such patient was amplified by PCR and subjected to cloning using a plasmid. The complete discrimination of some mutants was difficult by our hybridization probe (Hybri-Probe) method using a wild-type probe (GGT). Therefore, we employed a mutant-specific probe (GAT) in addition to the wild-type probe, and the complete discrimination of five types of mutant and wild-type alleles was successful. The detection sensitivity (or minimal copy number for the detection) of our Hybri-Probe method was 1.0 × 10³ copy/μL, and the selection sensitivity was GGT:GAT (80:20), or at least 20% of the mutant [GAT] is necessary to discriminate from wild-type alleles [GGT]. Our method is simple, rapid and cheap, and expected to contribute to clinical settings.

Carbapenemase-producing Enterobacteriaceae (CPE) has become a problem worldwide and it is important to grasp the epidemiology of CPE epidemics in the region. We report on CPE surveillance at four medical facilities with the aim of grasping the situation of CPE epidemics in Aichi Prefecture. CPE detection was based on the criteria used at each institution. Of the 5,419 clinical Enterobacteriaceae isolates obtained during the period, 67 strains (1.2%) were identified, three of which produced carbapenemase, and all of these three CPEs were 3 IMP-1 strains. Of these three strains, two also produced CTX-M-type extended-spectrum β-lactamase (ESBL). An OXA-48-like strain was detected among the strains that showed susceptibility to carbapenems, and this strain also produced CTX-M-type ESBL. In this survey, four CPEs were detected, that is, 0.07% of all isolates (4/5,419). We found that CPEs have not been prevalent among clinical Enterobacteriaceae isolates in Aichi Prefecture. However, since an imported CPE isolate that demonstrates nonsusceptibility to carbapenems was detected in this area, the continuing surveillance and standardized criteria for the detection of CPE are needed to detect CPE isolates.

Using identification protocols and sensitivity tests, we evaluated the quality of detection of carbapenem-resistant Enterobacteriaceae (CRE) and carbapenemase-producing Enterobacteriaceae (CPE) strains in Enterobacteriaceae-contaminated samples. Of the 2,339 samples tested, 10 (0.4%) were determined to be contaminated by CPE strains, among which 64 (2.7%) were CRE strains. Of the 64 detected CRE strains, 66% were identified as Enterobacter species. The IMP-6 gene was detected in all CPE strains that were identified to be either K. pneumoniae or E. coli. In agreement with studies suggesting the presence of stealth-type CPE, all the CPE strains detected were also found to be CRE. There were no clear increases in CRE or CPE prevalence observed in our hospital. However, the rapid identification of strains and the deployment of adequate containment measures to prevent outbreaks are of critical importance. K. pneumoniae and E. coli strains that are detected as CRE have an especially high probability of being CPE, requiring a rapid response to such strains when they are identified in a hospital environment.

The prolongation of clotting time such as prothrombin time (PT) and activated partial thromboplastin time (APTT) can be caused by coagulation factor deficiency, coagulation factor inhibitor and antiphospholipid antibody such as lupus anticoagulant (LA). The mixing test is performed to rapidly differentiate these causes of the prolongation of clotting time. We evaluated the usefulness of the mixing test performed in our hospital. The mixing test results were judged using the visual waveform pattern method and the index of circulating anticoagulant (ICA). In all three coagulation-factor-deficient cases, both judgment methods showed a coagulation-factor-deficient pattern. On the other hand, in four out of six LA cases, both judgment methods showed an inhibitor pattern. However, in one LA case (case 8), only ICA showed an inhibitor pattern. Moreover, in another LA case (case 9), both judgment methods showed a coagulation-factor-deficient pattern. The LA activities in cases 8 and 9 tended to be lower than those in the four cases that showed an inhibitor pattern in both judgment methods. In this study, we were able to estimate the causes of the prolongation of clotting time in eight out of nine cases. The mixing test was useful for rapidly differentiating the causes of the prolongation of clotting time. However, the cases with the low LA activity may show a coagulation-factor-deficient pattern in the judgment of the mixing test results, so it seems preferable to conduct an additional test if necessary.

Incidents caused by human errors such as ‘thoughtlessness’ and ‘carelessness’ are likely to occur in a general laboratory because the nature of work frequently involves manual evaluation and input. In this article, we report the incident analysis of the general laboratory of our hospital and discuss examples of the measures taken to prevent such incidents from occurring. Fourteen incidents that occurred between April 2009 and October 2016 (92 months) were analyzed in terms of their influence level, causes, time of incident occurrence, and preventive measures. The main causes of the incidents were mistakes (10 cases), lack of knowledge (2 cases), carelessness (1 case), and insufficient information transfer (1 case). The incidents frequently occurred on Mondays and Tuesdays, during lunch time (11:00–13:30), and during day and night duties. It is important to develop countermeasures to create an environment that minimizes the occurrence of mistakes and to develop simple and easy verification methods.

Acne vulgaris (acne) is a common disease experienced by more than 90% of people and is a chronic inflammatory disease caused by the proliferation of Cutibacterium acnes (C. acnes) due to hyperkeratotic abnormalities and increased sebum secretion. In terms of one’s aesthetics, it has a large psychological effect on the quality of life (QOL). In this research, we aimed to grasp the actual condition of acne treatment in healthy people and epidemiologically investigate and analyze the age-based occurrence of C. acnes. A total of 79 subjects, including 19 teenagers, 20 in their twenties, 20 in their thirties, and 20 in their forties, were sampled and then asked to answer a questionnaire survey. The detection rate of C. acnes in both cheeks was 82.3% of all the subjects. There was no significant difference in the detection rate in terms of age and gender, and C. acnes was detected regardless of age and gender. As for the acne treatment, facial washing was carried out by as many as 50% of the subjects, but 16.4% did not do anything. Medicines prescribed by doctors and drugs purchased at pharmacies were mainly topical agents such as ointments (Clearasil^®︎, PAIR^®︎). The onset time (awareness) was most frequently observed in their teenage years. As reasons for starting the treatment, they felt worried about the scars of acne (30.2%) and they were self-conscious about how they appear to others (27.9%). Regarding acne prevention and treatment, those in their thirties and forties were more knowledgeable than those in their twenties and teens.

The method of measuring serum anti-GAD antibodies has been changed from the RIA method to the ELISA method since December 2015. Along with this change, it is necessary to reconsider the interpretation of the values measured using the ELISA method in comparison with those measured using the RIA method. In this study, the effect of the method used on the diagnosis of SPIDDM was examined. The subjects were 405 patients with type 2 diabetes who underwent anti-GAD antibody measurements using the RIA method from January 2013 to December 2015 and were currently visiting our hospital. All patients were reexamined for the GAD antibody titer using the ELISA method in 2016, and the positive rates of GAD antibodies obtained from both measurement methods were compared. With the RIA method, 28 patients (6.9%) tested positive (1.5 U/mL or more) and were diagnosed as having SPIDDM. Among them, 9 patients tested positive (5.0 U/mL or more) when using the ELISA method, and the positive concordance rate was only 35.7%. However, the negative concordance rate was as high as 99.5%. There was a strong correlation between the values measured using the ELISA and RIA methods. Furthermore, the tendency became significant in patients with titers of 8.0 U/mL or more determined using the RIA method. However, 17 of the 22 patients with titers of less than 8.0 U/mL determined using the RIA method tested negative when using the ELISA method. In summary, there is a divergence between the titers of serum GAD antibodies determined using the RIA and ELISA methods, and the diagnosis of SPIDDM based on the results of the ELISA method needs attention.

At the Kurashiki Medical Center, “the standard of safe blood transfusions for outpatients (standard of our center)” was established and considered to conduct blood transfusions for outpatients. However, the plan could not be realized owing to the lack of space and staff members. In 2014, our center reviewed and started blood transfusions for a limited number of outpatients and space. Currently, it is increasing the number of target patients. We surveyed all cases indicated for treatment (17 cases, 11 patients) between April 2014 and December 2017. The implementation rate of blood transfusions for outpatients was 88.2% (15/17 cases). There were 13 cases of transfusion of red blood cell products and 2 cases of transfusion of platelet products, and no transfusion reactions were observed in all these cases. The compliance rate of our standard was low (33.3%). The important point to consider is that not all staff members were well informed about standard of our center when increasing the number of target patients. It is important to share and improve the knowledge of safe blood transfusion services among all staff members.

The interferon-gamma release assays (IGRA) is an indispensable test for tuberculosis diagnosis in Japan, where many tuberculosis patients still exist. Analysis of results of T-SPOT, which is one type of IGRA, was conducted for about 4 years to verify its clinical usefulness. The determination results of 1,744 cases were as follows: negative, 90.8%; intermediate, 1.9%; positive; 5.8%; and indeterminate, 1.5%. The average age of patients with positive determination was 66.9 years. When comparing the determination results of T-SPOT with those of QuantiFERON (QFT), it was confirmed that there were many clear negative or positive determination results. After QFT was found to show intermediate or indeterminate determination, we examined the cases in which T-SPOT was conducted in the next test. Approximately 80% of the cases were found to be negative in the next T-SPOT after the intermediate determination using QFT, and about 95% were found to be negative in the next T-SPOT after the indeterminate determination using QFT. A comparison was made with acid-fast bacteria test carried out at the same time as T-SPOT. Among 58 patients with T-SPOT positive results, 12 had mycobacterium tuberculosis and 2 had nontuberculous mycobacteria. Mycobacterium tuberculosis was detected in 3 out of 294 T-SPOT negative patients, and 2 patients had taken steroid drugs. Since T-SPOT gives clear negative or positive determinations with few intermediate or indeterminate determinations in many cases, it is considered to be useful for the early diagnosis of tuberculosis. However, it is also necessary to judge the results on the basis of the fact that there are negative determinations in mycobacterium tuberculosis positive cases.

We herein report a case of infectious endocarditis in which Abiotrophia defectiva infection was detected by a blood culture test. The patient was a woman in her twenties, who visited a local physician due to recurring fever and cough. Pneumonia was suspected owing to an increased inflammatory response in a blood test and the presence of infiltrates detected by chest x-ray infiltrates. She was referred to our hospital and she returned home after receiving antibiotics; however, she had an emergency hospitalization due to a positive blood culture test. Echocardiography revealed severe mitral regurgitation with verrucous vegetation, and she was diagnosed as having infectious endocarditis. She received an emergent mitral valve replacement, and treatment with daptomycin and meropenem was started. Gram-positive coccobacilli were detected in her blood culture and streptococci were initially suspected as the infecting organisms. Nonetheless, nutritionally variant streptococci (NVS) were also suspected because no bacterial growth was observed in a subculture on sheep blood agar; therefore, infectious endocarditis was diagnosed. Bacterial colonies indicating α hemolysis were detected in an anaerobic subculture on Brucella HK agar. A. defectiva was identified using an automated microbial identification and antibiotic susceptibility testing system (Vitek2). Taken together, endocarditis caused by A. defectiva was finally diagnosed because it was detected in cultures of vegetation and oral bacteria. NVS are clinically important. Nonetheless, NVS do not grow in usual culture medium. Therefore, it is important to remain aware of the features of NVS as well as the culture medium being used at a particular lab.

We report an adult case of infection by Bifidobacterium breve. A male in his 40s was admitted to our hospital because of general fatigue with frequent vomiting. He was observed to have an inflammatory response (WBC, 13,600 μ/L; CRP, 29.4 mg/dL) on admission and we speculated that this was due to continuing malnutrition or wasting condition because of low levels of albumin, cholinesterase, and triglyceride. In addition, he was observed to have remarkable electrolyte abnormality (Na, 113 mEq/L; K, 6.1 mEq/L; Cl, 67 mEq/L) and a high level of glucose at 1,203 mg/dL. He presented with purulent urine and turbid ascites, and thus a microbiological test was carried out on both urine and ascites samples. Both samples showed branched Gram-positive rods and the strain that grew was found only in anaerobic culture. The identity of the strain was not revealed by biological methods. The strain was identified as Bifidobacterium breve by mass analysis and 16s rRNA gene sequencing. Urine tests on admission showed leukocytes of more than 100/HPF and a score of bacteria 2+. Therefore, urinary tract infection was suspected and SBT/ABPC 6 g/day was administered. Finally, the general condition of the patient improved daily and he was discharged without symptoms on hospital day 90.

A rare special subtype of breast carcinoma, adenoid cystic carcinoma, is characterized by the presence of a dual-cell population. Although breast adenoid cystic carcinoma is triple-negative (neoplastic cells are devoid of estrogen receptor, progesterone receptor, and human epidermal growth factor receptor 2 expression, and excess basal cell markers) and has basal-like features, the malignancy exhibits an indolent clinical behavior. Identification of this type of cancer is challenging, as its imaging features are not specific. This malignancy can be diagnosed on the basis of the characteristic features observed in fine-needle aspiration (FNA) cytology. In the present case report, an 81-year-old female patient in whom left breast cancer was suggested on the basis of a mammographic abnormality (mass) without microcalcifications was admitted to the Department of Breast Surgery for further examination and treatment. Her radiologic examinations including CT, MRI, and ultrasonography revealed a tumor nodule measuring 12 mm in diameter in the C-area of the left breast. Small and large cell clusters were collected around the mucous material, suggesting adenoid cystic carcinoma. Subsequent histopathological and immunohistochemical (CEA, CK7, c-kit, p63, and α-SMA) examinations of the core-needle biopsy (CNB) specimen and the resected tumor confirmed the cytological diagnosis. Cancer cells were slightly positive for ER and negative for PgR and HER2. No recurrence and metastasis were found after 16 months of follow-up.

Bone metastasis in lung cancer patients is common; however, metastasis to the patella is very uncommon. We report a case of lung squamous cell carcinoma with metastasis to the patella detected by synovial fluid analysis. The patient was a 79-year-old man. He was diagnosed as having lung squamous cell carcinoma (T2aN2M0, stage IIIA). He noted pain on his left knee, and various examinations were performed with the suspicion of infectious arthritis. Puncture fluid analysis included a quick Giemsa staining, and squamous cell carcinoma cells were detected. Patellar metastasis of lung cancer was diagnosed following diagnostic imaging. When lung cancer patients complain of pain on a knee, it is important to consider the metastasis of malignant cells in a general survey.

We report a case of melanuria with dark-yellow urine. Dark-yellow urine normally indicates blood in urine, bilirubinuria, or urobilinuria. In this case, because no abnormal values for red blood cells, bilirubin, and urobilinogen were detected by a semiqualitative urine test, we suspected melanuria on the basis of clinical diagnosis. Then, the urine sample was found positive for melanin using the Thormählen test. To confirm melanuria, we quantified melanin marker by high-performance liquid chromatography (HPLC). The result showed that 4 melanin markers, namely, 5-S-CD, PTCA, PDCA, and 4-AHP, were detected by HPLC. Importantly, melanuria did not always appear in the urine. The dark-yellow color changed to yellow or straw-colored a few days after the treatment with the immune checkpoint inhibitor. The intermittent appearance of melanuria may reflect the progression of melanoma or the destruction of melanoma cells by the anti-cancer treatment, especially the immune checkpoint inhibitor. Thus, these results suggest that the detection of melanin in dark-yellow urine by performing the Thormählen test could be useful for determining the progression of melanoma and the response to treatment.

The patient was a woman in her fifties who underwent aneurysm clipping for an unruptured right internal carotid artery aneurysm with intraoperative monitoring of visual evoked potentials (VEPs). Although the VEP waveform in the stimulated right eye flattened while the blood flow was blocked with a temporary clip in suction decompression, it was promptly restored upon the release of the blocked blood flow. Only the VEP waveform in the stimulated right eye flattened in this case, which likely reflects malnutrition to the optic nerve caused by a decline in blood flow to the ophthalmic artery that branches from the right internal carotid artery due to suction decompression. VEP monitoring is effective for preventing the postoperative disturbance of visual function; therefore, continuous monitoring of VEP is required by temporarily blocking the blood flow with a temporary clip.

We encountered the case of a patient with IgM type monoclonal gammopathy whose IgM value was measured to be falsely low without notification by an error code using a turbidimetric immunoassay (TIA) system. Although the true IgM value might be about 2,800 mg/dL as indicated by protein fraction electrophoresis, the value was 420 mg/dL in the original assay. Assay by sample dilution was carried out, but the values remained low up to 10-fold dilution. The reaction curve suggested that the generation of abnormal turbidity in the first reaction at a low dilution was responsible for the problem. No error code appeared in any dilution series of the patient’s serum. Measurements of IgG and IgA were also affected and the values were falsely low. Given that we reported the case of another patient with IgM monoclonal gammopathy whose IgM was falsely low as determined by TIA, we strongly recommend to suspect a false result and conduct further tests to collect information, such as the albumin-to-globulin ratio, or protein fraction electrophoresis in IgM monoclonal gammopathy. Regarding the TIA system, the construction of a retest logic, improvement of reagents, and installation of an abnormal reaction detection mechanism are necessary.