The principle underlying multi-frequency forced oscillation is the forced oscillation technique (FOT). The multi-frequency forced oscillation technique is used to examine patients with respiratory diseases, such as bronchial asthma (BA) and chronic obstructive pulmonary disease (COPD). There have been reports of factors affecting respiratory resistance (resistance) and reactance obtained with FOT, but there have been no reports on the effect of dentures on FOT. Herein, we report the effect of dentures on FOT. This study included 52 patients with removable dentures and 60 patients without dentures. We evaluated multi-frequency forced oscillation in patients with and without dentures and examined the condition of the dentures in the patients with removable dentures. We performed statistical calibration of results of resistance and reactance. The resistance was significantly higher in the without-denture group than in the with-denture group. The resistance and low-frequency reactance were higher in the with-denture group than in the without-denture group, and the high-frequency reactance was higher in the without-denture group than in the with-denture group. In the logistic regression analysis, subjective symptoms in the group with mandibular dentures and the number of mandibular dentures were found to affect FOT. We found higher FOT values in patients without dentures than in those with dentures because there were many BA patients without dentures in this study, and the BA pathognomonic disease state affected the FOT values. Patients with dentures showed higher FOT values, suggesting that higher FOT values are related to unstable dentures.

There are few reports from Japan on the clinical significance of coagulase-negative staphylococci (CNS) detected in blood cultures, and in many situations, laboratories have difficulty determining the significance of CNS detection. In this study, we investigated the time required to detect blood culture (time to positivity) for CNS, the strains detected, methicillin resistance rate, the presence of a central venous catheter (CVC), positivity from multiple blood culture sets, and the clinical departments among 277 cases with CNS-positive blood cultures. We aimed to determine the criteria with high specificity for clinical significance of CNS detection. Of the 277 cases, 67 cases, 8 and 202 were determined to be clinically significant (25.1%), intermediate (2.9%), and contaminant (73.0%), respectively. The average time to positivity was 19 h and 54 min in clinically significant cases, while it was 31 h and 1 min in contaminant cases, which was significantly longer. Proportions of clinically significant cases by clinical departments were 8.4% for the emergency room and >40% for the departments of gastroenterological surgery, general surgery, hematological oncology, metabolism, and endocrine internal medicine. When CNS was detected in blood cultures, “time to positivity of less than 18 h from cases with CVC” was highly likely to indicate clinical significance, and “time to positivity of longer than 30 h from cases without CVC” was highly likely to indicate a contaminant. Adding these criteria to the first report of positive blood culture will lead to a prompt appropriate antimicrobial therapy when needed, and prevent unnecessary antimicrobial therapy.

Background and Aim: The azan–Mallory (azan) stain is used for identifying collagen fibers. There are two conventional methods for azan staining, namely, method I using mordants containing deleterious substances and method II without using a mordant. However, the problem with both staining methods is that the staining time is long, approximately 1 h. To reduce the time required for conventional method II, the effects of staining with microwave (MW) treatment on entering the dye were examined, while maintaining useful staining results for pathological diagnoses. Methods: Using a MW oven (output 700 W), we examined the MW treatment and staining time for each staining solution, and the staining results were compared between conventional methods I and II. Results: For staining with azocarmine G, the staining solution was allowed to stand for 5 min (shaking every 30 s) after MW treatment for 15 s. Mordanting with phosphotungstic acid was achieved after MW treatment for 10 s. For staining with aniline blue-orange G, the staining solution was allowed to stand for 7 min for liver tissue samples and 3 min for kidney tissue samples after MW treatment for 10 s. Staining results of conventional I and II methods were the same, and good staining was obtained. Conclusion: Azan staining that usually takes ≥ 1 h was reduced to approximately 10 min. This is the shortest time among the presently reported azan staining methods. This suggests that with MW treatment, the effects of enhanced molecular motion on the tissue and heating by molecular friction were obtained. In addition, this time reduction method can be used in clinical settings by obtaining rapid staining results useful for pathological diagnoses.

In recent years, various studies have been conducted on the relationship between smoking and olfactory dysfunction. There are many reports showing that smoking is one of the causes of olfactory dysfunction. In this study, we reviewed the cases of 208 patients whose olfaction was examined with a T&T olfactometer, and we compared smokers (n = 51) and non-smokers (n = 157) in terms of the degree of olfactory dysfunction and the improvement in olfaction. The most common diseases of these patients were post-infectious olfactory dysfunction (32.7%), chronic rhinosinusitis (28.4%), idiopathic olfactory dysfunction (19.2%), and head trauma (11.1%). In this study, there were 24.5% smokers over all, 17.6% for post-infectious olfactory dysfunction, 28.8% for chronic rhinosinusitis, and 30.4% for head trauma. Smokers had significantly severe olfactory dysfunction in all diseases (84.3%; p < 0.05). Moreover, 66.7% of the smokers in post-infectious olfactory dysfunction group significantly showed “no improvement or worsening” (p < 0.05). Our results suggest that olfactory dysfunction can be worsened by smoking. In addition, the smokers in post-infectious group significantly showed not much improvement of olfactory dysfunction. Since smoking affects not only olfactory function but also the human body in various ways, smoking cessation had better to be considered seriously.

The serological test for syphilis (STS) for the diagnosis of syphilis has recently been simplified with an automatic analyzer; however, the linearity of a high concentration range and the reduction of the prozone effect due to high concentrations of the target antigen in samples pose a problem. Here, we report the performance evaluation of Accuras-auto RPR, a new reagent-based latex agglutination turbidimetric assay, which eliminates these issues. The repeat accuracy was good. The dilution linearities determined using a high-RPR-concentration sample were 22.4 R.U. for Accuras-auto RPR and 8.1 R.U. for Mediace RPR. Evaluation of the prozone revealed a trend of decreasing RPR in both Accuras-auto RPR and Mediace RPR measurements. The addition of 3000 F.T.U resulted in 1.3 R.U. and 1.0 R.U. positive errors in Accuras-auto RPR and Mediace RPR, respectively, in the chyle sample. The detection limit of Accuras-auto RPR was 0.30 R.U. and that of Mediace RPR was 0.57 R.U. A confirmation test of the correlation using sera from 100 patients revealed that the judgment agreement rate was 93% (24 patients with positive results and 69 patients with negative results); the difference in results could be attributed to differences in reactivities. Accuras-auto RPR demonstrated an improved measurement range compared with the conventional reagent. Moreover, the prozone effect was mild, and thus, usage of Accuras-auto RPR could reduce the retest rate of high-RPR-concentration samples, and it is considered to be a useful reagent for a routine diagnostic test.

In this study, we evaluated the performance of Aerospray 7721, an automated acid-fast staining instrument. Four fixed smear slides from 17 specimens positive for acid-fast bacteria (AFB) were examined by five different methods: that recommended by the Aerospray 7721 manufacturer (original method); two methods using modified decolorizer solutions; a heating method, in which smear slides were heated immediately prior to staining with Aerospray 7721; and the Ziehl-Neelsen method (reference method). AFB counts were consistent between the original and reference methods in 8 of the 17 specimens examined (47.1%); in the remaining nine specimens, bacillus counts obtained by the original method were lower. Five specimens with lower AFB counts were categorized as negative by the original method. The decolorizer solution modifications included (1) changing the concentration of nitric acid from 2 to 1%, and (2) using isopropyl alcohol instead of ethanol. The results obtained by these modified decolorizer methods were similar to those obtained by the original method. Heating the smear slides prior to staining produced results similar to those of the reference method. For each method, AFB counts were compared between experienced (four observers, ≥3 years of experience) and inexperienced (four observers, < 6 months of experience) technologists. Among the inexperienced technologists, the heating method produced the best results, approaching those of the reference method. The results of this study demonstrate that Aerospray 7721 can stain mycobacteria as successfully as the Ziehl-Neelsen method when heat is applied to the smear slides immediately prior to staining and is therefore an appropriate technique for routine mycobacteriological tests.

We performed basic evaluation studies of the 2-MET Plasma・ELISA kit “SML” for plasma metanephrine (MN) and normetanephrine (NMN) measurements based on enzyme-linked immunosorbent assay. According to the results, this kit showed CVs of within-run and between-day precisions of less than 15.0%, and the detection limits were 20.0 pg/mL for MN and 35.0 pg/mL for NMN. No effects from interfering substances were detected, and the dilution linearity was also good. The 2-MET Plasma・ELISA kit “SML” showed good and sufficient basic performance for routine use.

A soluble IL-2 receptor (sIL-2R), the circulating form of the IL-2 receptor, localizes on lymphoid and some cancer cells and is used widely as a biomarker for adult T-cell leukemia and non-Hodgkin lymphoma. In this study, we evaluated the performance of a chemical luminescence test reagent LUMIPULSE Presto IL-2R for the measurement of serum soluble IL-2 receptor using an automated immune chemiluminescent system LUMIPULSE L2400. The coefficients of variation for within-run and between-day reproducibilities ranged from 0.7% to 3.3%. Linearity was observed up to about 80,000 U/mL and the lower limit of detection was 2.79 U/mL. A good correlation was observed between Immulyze IL-2R and LUMIPULSE Presto IL-2R. In conclusion, the analytical performance of LUMIPULSE Presto IL-2R seemed acceptable for routine clinical laboratory tests.

We investigated the basic performance of the improved reagent “Nanopia IL-2R” that minimized nonspecific reactions. A satisfactory result in terms of precision was obtained. By a dilution test, we confirmed good linearity to around 4,000 U/mL, but a slight S-formed curve was observed above 4,000 U/mL. No prozone phenomenon was observed up to approximately 110,000 U/mL, and the detection limit was 30.4 U/mL. Concerning the effects of interfering substances, sIL-2R levels decreased slightly in the presence of hemolysis hemoglobin at a concentration of 300 mg/dL or more. A strong correlation was observed between the improved reagent and the conventional reagent, but discrepancies were noted in nine cases. Nonspecific reactions were observed in eight cases (3.4%) examined using the conventional reagent, whereas they were observed in only two cases (0.9%) examined using the improved reagent. In summary, our results suggest that the basic performance of the improved reagent “Nanopia IL-2R” was satisfactory, and the number of nonspecific reactions was reduced in comparison with that using the conventional reagent. However, we need to pay attention to samples with nonspecific reactions in around 1% of patients.

Automated transportation systems and processors are very useful for handling large amounts of blood samples. Processors are commonly used for serum processing, but rarely for citrated plasma processing. In this study, we evaluated the performance of the IDS-CLAS3600 processor and established the optimal conditions for citrated plasma separation. Initially, we aimed to optimize the centrifugation conditions in accordance with the Clinical and Laboratory Standards Institute (CLSI) guideline. We found that 2,600 g for 5 min showed the best performance with less platelet contamination and a shorter processing time. CLAS3600 consists of four main units with the following functions: detecting blood cell layer, cap opening, dispensing and exporting. We evaluated the performance of blood cell layer detection, and we found no significant differences between CLAS3600 measurement and caliper measurement. We further investigated the aspiration point (dummy length) and aspiration speed. Residual platelet number in dispensed plasma was not affected by both the aspiration point and speed; however, a larger dummy length resulted in a lower yield than expected for dispensed plasma. On the basis of these results, we determined the optimal dispensing conditions to be as follows: dummy length, 6 mm; aspiration speed, 90% of that under serum conditions. These conditions were validated using plasma samples with thrombocytosis or polyemia, which were prepared artificially. As a result, we found that contaminating platelets were less than 10 × 10⁹/L. We have been using CLAS3600 for 5 years as the automated processor for the coagulation test, and there has been no error in the aspiration of the blood cell layer. Our established system has contributed to saving human effort and time, and resulted in an effective workstyle.

[Introduction] A reagent for measuring lipase using the synthetic substrate 1,2-o-dilauryl-rac-glycero-3-glutaric acid-(6-methyl-resorufin)-ester (DGGMR), which reacts specifically with lipase, has been developed. However, a high triglyceride (TG) concentration in serum was reported to cause a false negative error for lipase measured by “Cygnus Auto LIP.” Therefore, the purpose of this study was to clarify the effect of serum TG concentration on lipase concentration. [Method] We investigated the correlation between lipase concentration measured by Cygnus Auto LIP or Liquitech Lipase Color II and serum TG concentration. We studied the effect of each lipoprotein fraction on the change rate of lipase concentration. [Results] A high serum TG concentration caused a false negative error for lipase, and there was a significant negative correlation between them (r = −0.867, p ≤ 0.001). When serum TG concentrations exceeded 400 mg/dL, the false negative error for lipase reached 19%. A lipoprotein fraction analysis showed that VLDL had the strongest effect on the false negative error for lipase. [Discussion] Competition inhibition caused by lipoprotein particle size was considered to be a factor for the false negative error for lipase. Although it may have little impact on daily clinical practice, we need to pay attention to this error in serum samples with high TG concentrations, especially high VLDL or high chylomicron concentration.

The clinical significance of 25-hydroxyvitamin D (25(OH)D), which is the storage form of vitamin D, has attracted attention. In this study, Elecsys Vitamin D total II based on electrochemiluminescence immunoassay was evaluated. The CV of repeatability and the intermediate precision were 2.4 to 5.4% and 4.1 to 10.6%, respectively. The LoQ at which the CV became 20% was 2.69 ng/mL, and the dilution linearity was also good. No effects of interfering substances were observed up to a final concentration. In the analysis of correlation with other methods, the regression equation and correlation coefficient for LIAISON were y = 0.87x + 2.14 and r = 0.94, and those for LUMIPULSE were y = 0.85x + 4.46 and r = 0.97, respectively, indicating a good correlation. However, one sample was outside the 95% confidence interval of the linear regression slope in the correlation between Elecsys and LIAISON. A similar deviation was observed in the same patient sample during the study period, which was considered to be due to differences in the performance of pretreatment reagents that dissociate 25(OH)D from the vitamin D-binding protein (DBP). In the example of the deviation from the high concentration range, the DBP concentration was about 1,000 μg/mL, and the 25(OH)D concentrations measured using Elecsys as a reagent were closest to those obtained by LC-MS/MS. The results of this study indicate that Elecsys is a good reagent with sufficient performance.

The morphological characteristics of red blood cells (RBCs) in urinary sediments are useful for predicting a bleeding site. Recently, UF-5000, which is a fully automated apparatus for classifying components formed in urine, has been widely used in clinical laboratories, and it can provide morphological information on RBC (RBC-Info.). However, the relationship between RBC-Info. and the microscopic visual examination method has not been reported. In this study, we evaluated the reliability of the RBC-Info. from UF-5000, and the information is compared with visually classified RBC shapes (hump type, donut type, spike type and target type) on the basis of the guidelines on urinary sediment examination procedures (GPI-P4). We showed that the RBC-Info. from UF-5000 is useful for classifying the RBC morphology from glomerular to nonglomerular types. Thus, our results indicate that RBC-Info. can be used in clinical laboratories to estimate RBC shapes in hematuria, similarly to the microscopic examination method.

The Aichi Association of Medical Technologists (AAMT) conducts the Aichi Clinical Laboratory Quality Control Survey (AAMT EQA) to investigate the quality of clinical tests in each laboratory and to correct the differences among laboratories located in Aichi prefecture. Recently, the importance of external quality assessment (EQA) has been increasing with the partial revision of the medical law. Therefore, we reviewed the activities of the immunoserological section from 2016 to 2018, and considered future prospects. The features of the immunoserological section in the AAMT survey are as follows: (1) human pooled sera are used as EQA samples and (2) PIVKA-II is the special target for EQA. However, the use of human pooled sera is restricted owing to ethical issues, which actually causes unexpected reactions in the measurement, and thus may need to be reconsidered. The results of the PIVKA-II survey revealed that differences in the reagents used among participating laboratories was a major problem, as well as other target items. In addition, when evaluating respective reagents, it is also a big problem that a proper judgement is difficult for a small number of groups; thus, it is necessary to develop an optimal method to identically assess every participating laboratory. AAMT also conducts secondary surveys for the participants whose results did not seem to be satisfactory. Furthermore, AAMT provides an opportunity to discuss the results of the survey to improve the quality of laboratory tests for each participant. Indeed, the outcome differs considerably from lab to lab. In the future, the number of participating laboratories in the AAMT survey will be increased. Thus, we need to reconsider the significance of the AAMT regional surveys. Moreover, we would like to work hard to contribute to the improvement of the quality of clinical testing in Aichi.

Consensus about the handling of specimens for coagulation studies was announced in 2016 by The Japanese Society for Laboratory Hematology, Standardization Committee, Coagulation Study Standardization Working Group. We carried out a questionnaire survey to investigate the current status of each facility in the prefecture through the Hiroshima Association of Medical Technologists, Clinical Blood Section (response rate, 63.2%). Concerning blood sampling, the answers were in good agreement. Among the facilities that responded to the survey, 34.2% counted the number of platelets remaining in plasma. As for plasma separation, the facilities that only know the number of revolutions per minute (rpm) were 30.5%, and the facilities where separation lacked centrifugal force were 36.6%. Specimen conservation before coagulation studies was consigned to an outside company by 83.3% of the facilities. In a conservative situation, whole blood conservation is generally carried out. The type of facilities might influence the test results when storage temperature and time are considered. Cold-induced activation may occur owing to cold storage. After blood sampling, immediate plasma skimming is necessary. However, rapid plasma skimming is difficult, and the presentation of a consensus for the conservation by outside trust examination is awaited. Among the facilities surveyed, 88.4% answered that standardization is needed, but the degree of consensus recognition was low (18.3%). We will plan a workshop in the future and try to reach a consensus on the standardization of the handling of specimens for coagulation studies.

It is important to prepare for continuing medical care and test countermeasures in times of a disaster for patients with epilepsy, mental illness, and heart failure, whose symptoms are expected to be rapidly exacerbated by the interruption of treatment with drugs that require therapeutic drug monitoring (TDM). Here, we show the comparison verification of VITROS XT7600 (hereinafter referred to as VITROS) and Dimension EXL200 (hereinafter referred to as Dimension), which can be used for analysis without water in TDM. The six target items are the following: antiepileptic drugs (phenobarbital, phenytoin, carbamazepine, and sodium valproate), a psychotropic drug (lithium), and a cardiotonic drug (digoxin). We also evaluated the correlation between the instruments and the stability of values after freezing and/or thawing. Among the six items examined in this study, the correlation between VITROS and Dimension instruments was good. However, phenytoin, digoxin, and carbamazepine tended to show lower values in VITROS. There was no significant difference between the measured values before and after freezing and/or thawing. On the other hand, VITROS is superior in terms of processing capability, and TDM measurement using VITROS seems to be useful in times of a disaster for patients with epilepsy, mental illness, and heart failure.

We installed a computer-assisted microscopy system, EUROPattern Cosmic (EPA), in 2016 to solve the problems of complicated steps and visual judgement of the results of conventional indirect immunofluorescence assay for anti-nuclear antibody detection. However, there was a deviation of the judgement matching rate on the predicted antibody titer and chromosome type between visual judgements; thus, full automation was not achieved. The matching rates of the predicted antibody titer using a photo image obtained by EPA and visual judgement were κ factor = 0.762 in 2016 and κ factor = 0.891 in 2019. The κ factor difference improved significantly (p < 0.01). The matching rates of chromosome-type judgment of the speckled pattern, nucleolar pattern, and centromere pattern in terms of the κ factor difference improved significantly (p < 0.05, p < 0.01, and p < 0.01, respectively). The weak positive predicted judgement of the homogeneous pattern and speckled pattern should be improved to “negative”. The development of an updated version of the Auto Predicted Judgement system with improved judgement accuracy is desired.

<Introduction> We investigated the use of xylean Clear-Rite^TM3 as an alternative reagent for tissue delipidation with an auto tissue processor. <Method> Nine breast cancer specimens totally resected from February to June 2017 were used. We prepared specimens for histopathological diagnosis (A) and specimens for routine examination (B). The A specimens were delipidated with acetone in a shaker for three hours, whereas the B specimens were delipidated with Clear-Rite^TM3 and alcohol mixed with a reagent in an auto tissue processor for three hours. Subsequently, we examined the effect of delipidation on the slice graft using the automatic slice device AS-400M and the immunohistochemical staining of ER/PgR/HER2 IHC and HER2 FISH staining. <Results> The A specimens showed higher TG levels than the B specimens (p = 0.0156). In all 154 blocks, the slice success rates with the automatic slice device and the HE stainability were similar. The ER/PgR results were concordant (100%), but the HER2 IHC results in two cases were not concordant（2/9, 22.2%). The A specimens showed a false-positive result. In those two cases, there was no amplification in HER2 FISH. <Conclusion> The mixture solution of xylean Clear-Rite^TM3 as the alternative reagent and alcohol had sufficient delipidation effects. The auto tissue processor enabled rapid delipidation. The risk from exposure to organic solvents was reduced.

Cedar pollinosis is a typical Type I allergic disease. Information regarding the conditions during the pollen dispersion period in a year is reported and utilized in various media to contributing to measures to avoid pre-season pollen. Specific IgE antibody tests to identify the allergen are highly meaningful and important for auxiliary diagnosis. In this study, we measured the number density of pollen dispersed at two sites in our laboratory. With regard to specific IgE antibodies in the peak phase of cedar pollen dispersion from February to April, the positivity rates for the pollen-specific IgE antibody and Dermentophagoides pteronyssinus IgE antibody were examined, and their relationship with the number of dispersed pollen was examined. In the specimens positive for weed pollen, the positivity rates of Japanese cedar-specific IgE and Japanese cypress-specific IgE tended to be high. The pollen prevalence ratio of D. pteronyssinus-positive specimens tended to be higher than the pollen positive rate of negative specimens. It is inferred that D. pteronyssinus is involved in the establishment of pollen sensitization. It is considered that utilizing information on pollen dispersion conditions together with the results of the specific IgE antibody test will be useful for improving the quality of life of persons affected by pollinosis.

We investigated the antimicrobial susceptibility of Streptococcus agalactiae (GBS) isolated from patients living in Okinawa Prefecture, particularly the isolation rates of Group B Streptococci with reduced penicillin susceptibility (PRGBS) and multidrug-resistant GBS. A total of 10,870 GBS isolates were derived from various clinical samples between 2014 and 2016. We found that the susceptibility rates (%) to benzylpenicillin (PCG) were significantly lower than those reported by JANIS, 78.9 vs. 94.3 in 2014, 78.1 vs. 93.1 in 2015, and 81.0 vs. 94.2 in 2016 (p < 0.01). PRGBS were frequently isolated from respiratory samples (2016: 56.3%) and patients aged ≥ 60 years old (p < 0.01). Furthermore, the isolation rates of PRGBS differed among various facilities, and PRGBS were resistant to multiple antimicrobial agents including cephalosporins, erythromycin, and levofloxacin. In 2016, 94.4% of PRGBS were multidrug-resistant. In this study, the GBS isolated in clinical settings in Okinawa showed low sensitivity to PCG, and PRGBS showed multidrug resistance. Additional analyses using serological and genetic methods are required to obtain more detailed information of GBS in Okinawa.

Incidents and accidents cannot be easily avoided in a pathology department because the pathologic specimen preparation process involves many steps that are mostly done manually. Misidentification of a pathologic specimen directly leads to misidentification of a patient or medical malpractice and has a considerable impact on both the patient and the medical practitioner. With the relocation to a new hospital in May 2019, both hardware and system aspects were reviewed to minimize errors in various steps of surgical specimen processing, namely, specimen reception, dissection, embedding, sectioning, staining, and confirmation. In histopathologic specimen processing, which requires considerable manual work, double-checking at each step is important as a measure to prevent mistakes. Since the operating room and the pathology laboratory are adjacent to each other, double-checking at the time of specimen submission to clinics and our department has become possible. In addition, bar code management has been introduced, and improvements have been made in the system so that images of the cut sample can be easily confirmed in each step of specimen processing. As a result, all these measures taken were effective in preventing specimen sampling errors that could lead to medical accidents, producing highly accurate specimens, improving the working environment, and shortening the working time.

Histopathological diagnosis plays an important role in the final diagnosis in medical care, and it is the duty of the medical technologist in charge of histopathological examination to ensure the good quality of histopathological specimens, which is the basis of this diagnosis. However, in histopathological examinations, differences between individuals and facilities are likely to occur depending on the staining method and skill. In particular, the color tone of a specimen is difficult to standardize because of the color preference of histopathologists. The Pathological Accuracy Management Working Group of the Japanese Association of Medical Technologists (JAMT) started the external quality control project in 1972 to confirm that specimens suitable for diagnosis are correctly prepared, unify the concept of specimen preparation processes, and share information for good-quality diagnostic specimens. In the meantime, JAMT has conducted a questionnaire survey on 26 histopathological examinations following 25 dyeing surveillances, including 13 secondary surveillances and 16 photo surveillances. Dye surveillance has been discontinued since 2011, and now only photo surveillance is conducted under external quality control. JAMT has varied the presentation method of the questionnaire to confirm the status of many facilities and to obtain minimum knowledge. Along with the revision of the Medical Care Law in 2017, it is expected that the facilities under external quality control would diversify, and JAMT will make further improvements and contribute to high-quality histopathological diagnosis.

The anti-Co^b antibody, an antibody against low-frequency antigens, is known to cause hemolytic transfusion reactions. Here, we report a rare case involving the anti-Co^b antibody. A 75-year-old man was admitted to our hospital for endarterectomy of the right femoral artery. Preoperative examinations for blood typing and irregular antibodies revealed that his blood type was type A and he was positive for RhD. He also showed a positive result in an irregular antibody examination; thus, identification of the antibody was performed. The presence of the irregular anti-Co^b antibody was suspected because all the red blood cell reagents used were Co (b+), which explains the positive result for our patient’s serum. Then, we requested confirmation of the typing of the irregular antibody at the Kyushu Block Center of the Japan Red Cross, and the irregular antibody was proved to be the anti-Co^b antibody at a later date. Although there was a request for four units of packed red blood cells for use during surgery, we did not have an anti-Co^b reagent. Therefore, four units of packed red blood cells, which were negative in a cross-matching test, were prepared. Although two units of red blood cells were transfused during the operation, no obvious adverse reactions were observed. From our experience, it is necessary to consider the presence of an irregular antibody to low-frequency antigens when the result of a random antibody screening examination does not match the pattern on the antigen table.

We report a case of pulmonary chromoblastomycosis caused by the viscous species Exophiala dermatitidis in a patient with nontuberculous mycobacterial (NTM) disease. Two years after the end of treatment for NTM disease, the patient coughed purulent sputum and developed chest pain. A sputum Gram staining test showed the patient to be positive for filamentous fungi. Colonies were isolated after culturing in a chromogenic Candida medium for 72 h and unstained viscous colonies were detected. Microscopic examination of these viscous colonies revealed a yeast-like fungus that was speculated to be a dimorphic fungal species of the Exophiala genus. It was identified to be Exophiala dermatitidis after analysis using a MALDI Biotyper and ITS region sequencing analysis. Because the same fungus was repeatedly detected in the sputum and exacerbation of the right middle lobe infiltration shadow was consistent with the deterioration of subjective symptoms, the patient was diagnosed as having pulmonary chromoblastomycosis. When colony viscosity was compared after culturing in chromogenic Candida agar, Sabouraud agar and CP-added potato dextrose agar, viscosity was first detected in the CP-added potato dextrose agar after 48 h of culture and after 72 h in the other two media. Because it takes time for the colonies of E. dermatitidis to turn black in color, early detection of the viscous colonies of E. dermatitidis becomes possible by using CP-added potato dextrose agar. Furthermore, it is important to test for colony viscosity during colony isolation.

A woman in her seventies developed sudden cardiac pain during hospitalization for rehabilitation purposes after orthopedic surgery. Laboratory tests showed elevated alkaline phosphatase, C-reactive protein, and CA19-9 levels in serum, suggesting the presence of a biliary disease. Ultrasonography revealed a heterogeneous hyperechoic region in the gallbladder, which showed no blood flow signal with color Doppler, and a heterogeneous hyperechoic region protruding from the gallbladder to the left hepatic lobe. Three days after the symptom onset, computed tomography revealed enlargement of the gallbladder along with the thickening and partial disappearance of the gallbladder wall. In the liver, a low-density area, which was considered to indicate fluid retention, was observed with an abscess around the gallbladder. On the basis of these findings, acute cholecystitis and gallbladder perforation with intrahepatic rupture were suspected; however, conservative treatment was opted considering the patient’s age. Ultrasonography of the liver, which was performed 14 days after the symptom onset, revealed the disappearance of the heterogeneous hyperechoic region in the gallbladder, but disruption of the gallbladder wall was confirmed. The possibility of gallbladder hemorrhage and perforation due to a neoplastic lesion was also considered, but subsequent evaluations did not show inflammatory reactions and liver function deterioration. The imaging findings showed improvements; therefore, the patient was only followed up. In acute cholecystitis, hemorrhagic cholecystitis and gallbladder perforation are signs of aggravation, and their prompt diagnoses are important. Ultrasonography is the first imaging test of choice when cholecystitis is suspected, and careful observation is necessary to not overlook findings indicative of aggravation.

An influenza virus rapid antigen detection test (RADT) based on the immunochromatography technique is prevalently used as the point-of-care testing (POCT) in many clinical settings. It is well known that this RADT kit sometimes shows false-negative results. On the other hand, a false-positive result also occasionally occurs. We encountered the case of a patient whose clinical nasal swab specimen was positive for both A and B influenza antigens as determined with the RADT kit used for rapid influenza diagnosis. However, the patient was found not to have influenza virus infection because the specimens were confirmed to be negative by virus isolation and genetic detection by PCR. Moreover, the RS virus was isolated from the specimens. Thus, we considered it as a case with a false-positive reaction occurring in the RADT kit. We considered the double-positive and false-positive cases as very interesting and explored the reasons for such cases. We hypothesized as follows: there was/were some material(s) other than the antigen in the specimen and it/they reacted with the mouse anti-influenza antigen monoclonal antibody used in the RADT kit, and it/they acts/act as if it/they was/were the influenza antigen exhibiting the two reaction lines that appeared at the A and B sites on the immunochromatography sheet of the kit. To prove it, the RADT kit was used again after the pretreatment of the specimen with an excess amount of the purified mouse IgG for the IgG to competitively react with the antibody on the reaction lines. As a result, the reaction became negative. These findings strongly suggest that the false-positive result was caused by the reaction of some material in the specimen with the mouse antibody used in the RADT kit.

We encountered a patient with a false high concentration of creatine kinase-MB (CK-MB) protein. In this patient, despite a low total CK activity of 14 U/L, the CK-MB protein concentration was as high as 177.2 ng/mL. However, the troponin T concentration was lower than the cut-off value. Also, there were no abnormalities in the CK isozyme pattern and reaction time course in this patient as determined by the CK-MB mass assay. Furthermore, no dilution linearity was confirmed. In this patient, the IgM concentration was high and the CK-MB protein concentration did not decrease after the heat inactivation test. In the dithiothreitol treatment and human anti-mouse antibody (HAMA) absorption test, the measured values in this patient’s serum were significantly reduced. In conclusion, the abnormally high CK-MB protein concentration in this patient was revealed to be due to a nonspecific reaction caused by IgM-HAMA.

We report a case of a 77-year-old male with chronic interstitial pneumonia, who was on prednisolone and cyclosporine. On a regular visit, he complained of sputum production and general fatigue, and was initially diagnosed as having bacterial pneumonia on the basis of clinical and imaging findings. However, an in-hospital examination revealed an elevation of plasma β-D-glucan levels; thus, he was admitted to the hospital on the same day with suspected deep-seated mycoses. Subsequently, Aspergillus nidulans was detected from sputum cultures, and the patient was subsequently diagnosed as having invasive pulmonary aspergillosis (IPA) on the basis of clinical findings and serum test findings. He was administered antifungal drugs including micafungin, voriconazole, and itraconazole, after which he recovered. In general, the clinical course of IPA is acute and has a poor prognosis. Thus, rapid diagnosis and early initiation of appropriate antifungal agents are crucial in treating IPA. In this case, a prompt result of the β-D-glucan test owing to an in-hospital examination led to an early diagnosis of IPA and immediate appropriate antifungal therapy.

The patient was an 11-month-old boy who had no epileptic history. He showed poor lip color and sursumvergence after hot bathing as the first seizure attack. Three days later, he showed repetitive seizure attacks and he was brought to our hospital. We observed right temporal onset focal seizure in electroencephalography (EEG) recording. Therefore, he was administered carbamazepine. Two months later, he had seizure attacks again for three days after bathing, and carbamazepine was switched to phenobarbital. We suspected that bathing precipitated seizure, and thus he was given a shower instead of a hot bath. Although he was taking a shower, the number of seizures was not reduced. We tried to perform video-EEG recording during his bathing in an EEG room to capture a seizure attack and we successfully recorded his seizure after taking a bath. The EEG showed right temporal rhythmic slow waves in the ictal period and generalized slow waves, which later finally attenuated. This epileptic seizure was defined as right temporal onset focal seizure with dyscognitive and autonomic symptoms. We considered that it was a type of reflex epilepsy, and the precipitant was wiping up following hot bathing. It seemed difficult to perform EEG recording during bathing; however, we were able to record the time of his specific seizure by replicating the circumstances that could induce the usual attacks. It is important to capture seizures by video-EEG recording especially in children to contribute to correct diagnosis and treatment.

Advancements in science and technology and the considerable development of transportation and communication technologies have ushered an age in which people, along with information, frequently travel across countries, thereby advancing globalization. As a result, medical institutions that do not actively participate in medical tourism have increasing numbers of foreign patients. Therefore, it has become necessary to train individuals so that they will possess international knowledge, language skills, response skills, and research ability, on the premise of possessing specialized knowledge and skills as biomedical laboratory scientists (BLSs). To do so, it is very important to enrich the international exchange activities carried out by organizations, particularly those of the Japanese Association of Medical Technologists (JAMT). With this background, in 2018, the JAMT launched a working group for the internationalization of young BLSs (Young WG) and the improvement of their response skills. The first mission of Young WG was to hold the International Young BLS Forum during the 68th JAMT Congress in May 2019. The aim of this forum was to discuss the future images of BLSs with young BLSs of Japan, Korea and Taiwan. As a discussion theme during this forum, we focused on the use of artificial intelligence (AI) in the medical field for quality control, genomic medicine and telemedicine. Here, we outline our journey from the launching of Young WG to the hosting of the 1st International Young BLS Forum during the 68th JAMT Congress and put together discussions on the use of AI in the medical field for quality control, genomic medicine and telemedicine.