During a one-year period between May 2018 and April 2019, 175 Streptococcus pyogenes strains were isolated from 175 patients (age range, 1 month–14 years; median age, 4 years 10 months) in the pediatric department of our hospital. The T serotypes of the isolated S. pyogenes strains, the MICs of 13 antimicrobials (benzylpenicillin, cefditoren, cefotaxime, ceftriaxone, cefepime, meropenem, erythromycin, clarithromycin, azithromycin, clindamycin, tosufloxacin, levofloxacin, and vancomycin), and induction of clindamycin resistance were investigated and compared with those obtained in our five previous investigations (1996, 2001, 2003, 2006, and 2013). The T serotypes of the isolates were as follows: type 1, 64%; type 12, 18.3%; type B3264, 9.1%; and type 4, 2.3%. The isolation rate of type 1 was markedly higher and that of type 12 was lower than those in all five previous investigations. Resistance to erythromycin, clarithromycin, azithromycin, clindamycin, and levofloxacin was seen in 41.7%, 42.3%, 42.3%, 11.4%, and 1.1% of strains, respectively, and two (1.8%) isolates showed inducible clindamycin resistance. None of the strains were resistant to β-lactam antimicrobials or vancomycin. There was a trend of increasing erythromycin resistance rate (1996, 8.6%; 2001, 13.6%; 2003, 20.0%; 2006, 19.6%; 2013, 58.1%; 2018, 41.7%). Approximately half of the strains were found to be macrolide-resistant in more recent investigations. None of the 1,871 isolates, including those from the previous five investigations, included β-lactam antimicrobial- or vancomycin-resistant strains.

To operate a blood collection room, we should meet many requirements including safety, short waiting time, good service quality for patient care, good-quality management of the preanalytical process, and prevention of incidents such as patient misidentification. In our hospital, we hold a meeting once a month to inform every blood sampling staff member of modifications of the operation in the blood sampling room and precautions for preventing incidents. After the meeting, we prepare some questions about the points to take care when sampling, which are distributed to the staff members using an e-learning system. In this study, we analyzed the forms, categories, and response rates of the 136 questions that had been distributed from April 2016 to March 2019. We also conducted a questionnaire survey to study our staff members’ assessment of the questions using an e-learning system. Moreover, we evaluated the effects of the e-learning system by analyzing the incidence rates of inappropriate sampling techniques, which could result in hemolysis or clotting, and those of insufficient confirmation. The results of this study suggest that the questions consisting of images or videos can lead to an increase in the response rates and make the questions easy to understand and useful for effective education. In addition, after the introduction of the e-learning system, the incidence rates of inappropriate sampling and insufficient confirmation decreased significantly. Although some alternative methods are occasionally required, the system is useful as an educational tool to inform every staff member of precautions, modifications of the operation, and sampling techniques. In conclusion, the e-learning system contributed to the improvement of the quality management of the preanalytical process and the prevention of incidents.

It is important to analyze the results of cancer screening at each institution to verify the accuracy and usefulness of the screening. We analyzed the results of breast cancer screening (BCS) of 18,971 individuals at our hospital during the three-year period from April 1, 2015 to March 31, 2018, and reviewed quality control indexes for cancer screening, the final diagnoses of positive cases, the comparative results of mammography (MG) and ultrasonography (US) performed for detailed examinations, and the processes leading to cancer diagnoses. The quality control indexes for each year were as follows: positive rates were 6.3%, 5.0%, and 6.6%; further examination rates were 86.4%, 88.9%, and 84.7%; and positive predictive values were 3.5%, 3.4%, and 2.2%, which met the acceptable guideline values. However, cancer detection rates were 0.20%, 0.17%, and 0.15%, which were lower than the acceptable values. A possible explanation is that the acceptable values were set using patients who underwent MG screening for the first time, whereas our hospital has many repeat patients who are examined every year from the same outside. A comparison between the MG and US results indicated that each the tests complement each other, and thus screening with both tests would be more effective as previously described. Of the 34 breast cancer patients, 12 were graded A in the previous year, and four of those patients had advanced cancer (stage II or III). These results suggest a need for further studies on appropriate screening intervals and the use of both MG and US for screening.

Rotator cuff tear (RCT) is a frequently encountered orthopedic condition with significant pain and functional impairment. The purpose of this study was to determine relationship between tear size and the score of simplified assessment of fatty infiltration of the rotator cuff by ultrasonography. Twenty-two patients who underwent arthroscopic rotator cuff repair and preoperative ultrasonography from August 2018 to August 2019 (17 males; 5 females; mean age, 64.8 ± 11.5) were included in this study. RCT size was found to correlate significantly with the score of simplified assessment by ultrasonography.

[Introduction] In ABO-blood-type-incompatible living-donor liver transplantation, it is important to remove as much blood group anti-A/B-IgG antibodies as possible prior to transplantation. However, there are rare cases suggesting the presence of hyperacute rejection, regardless of the titer of the blood group anti-A/B-IgG antibodies before transplantation. We have developed a new detection method for measuring the titers of blood group anti-A/B-IgG1–4 antibody subclasses to elucidate the immunological mechanism of the blood group anti-A/B-IgG antibodies. [Materials and Methods] The titers of the blood group anti-A/B-IgG antibodies of 20 recipients were measured by the conventional indirect antiglobulin method, and the titers of the total IgG, IgG1–4 subclasses, and C1q-binding antibody were determined by flow cytometry. [Results] From the results of this study, percentage distribution of the blood group anti-IgG1–4 antibody subclasses before liver transplantation was in the order of IgG2 (34.2%), IgG1 (29.1%), IgG3 (20.3%), and IgG4 (16.5%). It was considered that changes in the blood group anti-A/B-C1q-binding antibody and IgG1 and IgG3 were particularly important for the strong rejection in ABO-blood-type-incompatible living-donor liver transplantation. [Conclusion] Results of this study suggest that the above-mentioned detection methods may be useful in ABO-blood-type-incompatible living-donor liver transplantation to prevent humoral rejection.

We conducted research on the amount of antibody against the new coronavirus in 56 medical professionals who were vaccinated with the new coronavirus vaccine “COMIRNATY intramuscular injection” manufactured by Pfizer^©. In this study, we measured the antibody titer in all the samples from the subjects using Lumipulse^®G1200 and SARS-CoV-2 S-IgG measuring reagent (IC) (H.U. Frontier Co., Ltd.). Results showed that all the subjects obtained antibody titers that were higher than the cutoff value (1.0 AU/mL). The lowest antibody titer was 10.5 AU/mL, the highest antibody titer was 227.2 AU/mL, and the median was 62.2 AU/mL. We analyzed the factors that affect the antibody titer, focusing on gender, age, BMI, HBV antibody titer, and drinking/smoking habits. We found that the antibody titer was affected only by age, and the other factors did not show statistically significant differences. We suggest that it is possible to induce antibodies to SARS-CoV2 even in a person with a poor immune response to the hepatitis B vaccine. However, further detailed investigation is needed.

The pathological conditions of patients with pleural effusion samples are (1) heart failure, (2) neoplasticity, (3) pneumonia, (4) pyothorax, (5) tuberculosis, (6) renal failure, liver cirrhosis, and malnutrition (726 patients), and the criteria for judging these samples are cell count and classification of test items, TP ratio, and LD of light standard. A pH of 7.2 was used for judging the need for drainage adaptation and was compared among patients and examined. As for the cell count, its cut-off value based on the Youden index was 1,000/μL, as determined from the ROC curve analysis of the pathological conditions classified into leaky and exudative. In the future, this cut-off value can be used as a reference cell count to distinguish between leaky and exudative pathologies. Cross tabulation for exudative and leaky pathologies showed that exudative cells had a high specificity of 84.6%. The sensitivity was as high as 78.9% for the TP ratio and 84.8% for LD. The characteristics of sensitivity and specificity would be useful for the judgment of exudative and leaky pathologies and the therapeutic effect of drugs on inflammatory diseases. In the ROC curve with a pH of 7.2 obtained using all pathological conditions, the AUC was 0.919 and the Youden index was 76.5% for neutrophils. The value that neutrophils show 75% was considered to be a test that could be used as a substitute for pH measurement using a blood gas analyzer.

Recently, cancer treatment has made dramatic progress, and patients’ prognoses have improved significantly. On the other hand, the cancer incidence in the reproductive age has been increasing, and more professional attention is being paid to preserving female fertility that could be threatened by cancer treatment. Women generally grow a single follicle per menstrual cycle. To cryopreserve multiple embryos per cycle, women are administered hormones for ovarian stimulation for approximately two weeks. There are mainly two types of controlled ovarian stimulation (COS) protocol for fertility preservation: standard COS (GnRH antagonist protocol) and random-start COS, in which a patient is stimulated on presentation regardless of her menstrual-cycle phase. Here, we aimed to clarify the difference in embryo quality between random-start COS and standard COS. Embryos (cleavage stage) obtained from 17 women each in the two COS protocols were classified into four grades in accordance with the Nagoya University Hospital classification. Grades 3 and 4 embryos were considered high-quality embryos. The percentages of high-quality embryos in the two COS protocols were compared. The percentages of high-quality embryos were 54.2% and 69.0% in the standard COS and random-start COS, respectively, which were not significantly different as determined by Fisher’s exact test (p < 0.05). This result indicates that there were no significant differences in embryo quality between standard COS and random-start COS. We consider random-start COS to be useful for fertility preservation in cancer patients who require early cancer therapy.

Purpose and method: We determined whether the quantitative antigen test (LUMIPULSE SARS-CoV-2 antigen test) can be used as a screening test for asymptomatic patients and as a negative confirmation test at discharge. In this study, we compared the quantitative antigen and RT-PCR tests in hospitalized patients diagnosed as having COVID-19 from whom two nasopharyngeal swabs were collected at the same time (n = 156). We also examined the negative confirmation and estimation of infectivity based on the amount of antigen. Results: The positive agreement rate of the quantitative antigen test was 97.4% (111/114), the negative agreement rate was 42.9% (18/42), and the overall agreement rate was 82.7% (129/156). In the negative confirmation, the cut-off value of the amount of antigen corresponding to a negative finding by the RT-PCR test was 8.82 pg/mL. In the estimation of infectivity, the cut-off value of the amount of antigen corresponding to the Ct value of ≥ 35 was 89.73 pg/mL. Discussion: The cut-off value of the amount of antigen determined by the quantitative antigen test in the negative confirmation of COVID-19 patients was 8.82 pg/mL, which was higher than the cut-off value of 1.34 pg/mL recommended by the manufacturer. Therefore, if 1.34 pg/mL is used as the cut-off value for negative confirmation in COVID-19 patients, the quantitative antigen test may take longer to show a negative result than the RT-PCR test. In addition, the cut-off value of the amount of antigen corresponding to the Ct value of ≥ 35 was 89.73 pg/mL in the estimation of the infectivity of the virus. In estimating the infectivity based on the amount of antigen, further studies including virus culture are necessary.

Aims: In July 2021, the administration of casirivimab-imdevimab, a neutralizing antibody cocktail, was approved by the Ministry of Health, Labor and Welfare of Japan. We aimed to examine the transition of the anti-severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) antibody titer and the clinical course of patients after casirivimab-imdevimab administration. Materials and Methods: High-risk patients with coronavirus disease-19 (COVID-19) infection who did not require oxygen administration on admission were divided into antibody-treated and untreated groups. We measured the titers of anti-SARS-CoV-2 nucleocapsid (N) protein and anti-SARS-CoV-2 spike (S) protein antibodies and compared the clinical courses of both groups. Results: There was no significant difference in the patient background at admission between the two groups. The median times from onset to anti-S seroconversion were 8 and 12 days in the antibody-treated and untreated groups, respectively; it was significantly shorter in the antibody-treated group. The median titers of the anti-S antibody at the time of seroconversion were 125 and 7.8 U/mL in the antibody-treated and untreated groups, respectively; it was significantly higher in the antibody-treated group. There was no significant difference in the anti-N antibody titer transition between the two groups. The median times from onset to recovery were 9 and 14 days in the antibody-treated and untreated groups, respectively; it was significantly shorter in the antibody-treated group. Conclusions: Casirivimab-imdevimab can improve the clinical course of patients with COVID-19. The measurement of titers of anti-S protein antibodies is useful in the evaluation of casirivimab-imdevimab efficacy.

Several separation gels added to blood collection tubes have been reported to have the drug adsorption effect. In this study, we compared the degree of impact of each manufacturer’s blood collection tube as shown in the blood drug concentration measurement. During the monitoring of the time-course shifts in the drug concentration of the blood collection tubes containing a separation gel from four manufacturers, three of the eight drugs examined showed decreases in their measured concentrations. Despite the equal volume of a blood specimen added to the blood collection tubes and the same storage conditions, the degree of decrease varied depending on the blood collection tube used. Thus, the difference in the materials of a separation gel was considered as one of the factors affecting measurements. It was inferred that the variance in the degree of decrease in the measured concentration was caused by the differences in the lipophilicity of the separation gel and the drugs. In the case where a blood collection tube containing a separation gel is utilized, it is considered that the examination of the combination of the tube to be utilized and the drug to be measured can contribute to the improvement of the efficiency of blood specimen collection and processing.

Cancer antigen 72-4 (CA72-4) is a tumor marker that has been used for the monitoring of patients with gastrointestinal cancers such as gastric cancer and mucinous ovarian cancer. In this study, we evaluated the analytical performance of ARCHITECT^® CA72-4, which was newly released in January 2021 by Abbott Japan LLC. The analytical performance of this reagent was found to be good with less than 5% CV for both within-run and within-laboratory precisions, and the dilution linearity was confirmed to be also good between 4.3 U/mL and 155 U/mL. The sample was confirmed to be stable for 28 days at 4°C. The correlation between matched serum and plasma samples drawn from the same patients at the same time was n = 102, r = 0.998, y = 0.971x + 0.009, and there was no significant difference observed between the specimen types. The correlation with the control method (Elecsys^® CA72-4, Roche Diagnostics K.K.) for patient serum samples was n = 185, r = 0.989, y = 0.948x − 0.769, indicating that the method can be used without any significant difference in performance from the precedent reagent. However, it is necessary to be careful when interpreting the results of measurements when the measurement reagents are different because some unexpected factors are present.

We evaluated the performance of the glycated hemoglobin analyzer The Lab 001 in capillary electrophoresis. The accuracy results obtained were good, and the correlation coefficient between the HPLC analysis and capillary electrophoresis was 0.996. In addition, it was shown that The Lab 001 can separate and detect mutated hemoglobin and hemoglobin F. Although the mutated hemoglobin and hemoglobin F can affect HbA1c measurement, The Lab 001 can be used for measurement without being affected by these types of hemoglobin.

The objective of this study is to estimate the number of days after the last intake of methamphetamine/HCl in Japanese abusers. Methamphetamine and its metabolite, amphetamine, in residual urine after screening with a drug test kit were analyzed by liquid chromatography-mass spectrometry (LC/MS). As would be expected for this pair of the parent drug and metabolite, there was a linear increase in the ratio (on a peak area basis) of amphetamine to methamphetamine with increasing number of days after the last intake. Although this study was conducted in a limited number of abusers, it was confirmed that the number of days since the last use of methamphetamine can be estimated to some extent by examining the ratio of amphetamine to methamphetamine in the urine of Japanese abusers.

Coagulation tests using an automated analyzer are popular, but sample processing capacity could decrease when multiple items with different measurement principles are simultaneously measured. Recently, the automated coagulation analyzer “STACIA CN10” has been developed. STACIA CN10 shows improved sample processing capacity through the use of a measuring table independent of each measurement principle. Therefore, we evaluated the sample processing capacity of STACIA CN10. The total assay time for 50 samples was 62 min 58 s with STACIA CN10, which was about 20 min shorter than that (82 min 59 s) with CS-5100. On the other hand, the assay time of each sample was about 3 min 30 s longer on average than that with CS-5100. Therefore, we investigated the sampling interval of both analyzers, and the results showed that the sampling interval of STACIA CN10 was about 30 s shorter on average than that of CS-5100. From these results, it is considered that STACIA CN10 shortened the sampling interval independent of the measuring table and improved the sample processing capacity in the case of continuous measurements of multiple items. STACIA CN10 has better sample processing capacity than CS-5100 and is considered to be useful for routine examinations.

In COVID-19 assay, the polymerase chain reaction (PCR) test is used for a definitive diagnosis. We have introduced the use of the Ampdirect^TM2019-nCoV detection kit (Ampdirect method) for regular examinations, GeneXpert Xpress SARS-CoV-2 “Cepheid” (GeneXpert method), and FilmArray Respiratory Panel 2.1 (FilmArray method) in this sequence for emergency examinations from April 2020. The detection rates of these test methods for 163 samples measured by the GeneXpert method and 493 samples measured by the FilmArray method from their introduction to December 2020 were compared with those measured by the Ampdirect method. The detection rate within 10 days from onset was 90% and above. By focusing on the COVID-19-specialized clinical department and the general clinical department, the tests of 8,416 samples measured from July to December 2020 at our hospital were evaluated. The positivity rates (regular examinations/emergency examinations) were 11.6%/29.9% in the COVID-19-specialized clinical department and 0.13%/3.50% in the general clinical department. The positivity rate of the emergency examinations was higher than that of the regular examinations, and it was considered that the rapid result indicating positivity helped in deciding whether a patient requires admission in a general hospital or transfer to a COVID-19-specialized clinical department, thereby preventing the spread of infection. By using different test methods, we were able to quickly obtain the results and respond to the rapid increase in the number of cases to be tested. Regarding the testing system during the COVID-19 epidemic, it was considered very useful to apply multiple SARS-CoV-2 nucleic acid kits to make the best use of their respective characteristics.

With the recent increase in cases of lifestyle-related diseases, the numbers of patients with nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH) are increasing, which are becoming the main causes of hepatocellular carcinoma and liver cirrhosis. Since NAFLD and NASH have common risk factors with type 2 diabetes, such as obesity and insulin resistance, they appear with high frequency as complications of type 2 diabetes. In this study, we investigated the status of hepatic fibrosis and factors affecting them from the measured M2BPGi levels of type 2 diabetes patients. We also compared them with the FIB-4 index, a currently used hepatic fibrosis scoring system. The M2BPGi levels of all the patients with type 2 diabetes ranged from 0.22 to 4.11 C.O.I. with a median of 0.815 C.O.I. The M2BPGi positivity rate was 38.2% when the cut-off was set at 1.0 C.O.I To verify the factors that affect the M2BPGi level, multiple regression analysis was carried out using the M2BPGi level as the dependent variable and biochemical test results (e.g., blood count and HbA1c level), age, and BMI as explanatory variables. The results showed that high AST level, old age, low albumin level, and high triglyceride levels were the factors significantly associated with high M2BPGi level. The correlation coefficient (r) for the correlation with the FIB-4 index in 169 cases after excluding extreme values was 0.449. The agreement between assessment using M2BPGi level and that using the FIB-4 index was 53.5% (53 M2BPGi-positive cases, 38 M2BPGi-negative cases). There were mismatched cases: 66 cases negative for M2BPGi and positive for the FIB-4 index, and 12 cases positive for M2BPGi and negative for the FIB-4 index. In type 2 diabetes patients, measurement of M2BPGi levels even in FIB-4 index-negative cases is expected to prevent oversight of cases of liver fibrosis.

The electrocardiographic findings at the acute phase of takotsubo syndrome are similar to those of acute coronary syndrome. Therefore, coronary angiography is required to differentiate between the two. We experienced treating a patient with takotsubo syndrome diagnosed on the basis of coronary angiography findings. The patient showed mildly elevated levels of myocardial enzymes and troponin T in serum. The transthoracic echocardiography findings were hypokinesis at the apex wall, hypercontraction at the base of the heart, and decreased left ventricular ejection fraction, which are typical patterns at the acute phase. Furthermore, when we examined the temporal characteristics of the electrocardiographic findings, the wide range of ST elevation at chest leads without the mirror image in the early stages and the negative T wave changes during ST recovery were the common features, and temporal changes in the electrocardiographic findings in takotsubo cardiomyopathy were observed. When coronary angiography cannot be performed, the time-course observation of changes in the electrocardiographic findings as well as biochemical test results and transthoracic echocardiography were useful for the diagnosis of takotsubo syndrome.

With the advancement of magnetic resonance imaging (MRI), magnetic resonance cholangiopancreatography (MRCP) can now be used to obtain high-resolution images of the pancreatic and biliary ducts. MRCP, which is an imaging method based on hydrographs, is less invasive and has gained clinical significance. It uses heavily T2-weighted MRI pulse sequences that show high-intensity signals in fluids within the biliary and pancreatic ducts. Therefore, its capability to extract images of the pancreatic duct is affected by the quantity of fluids within the pancreatic duct, which may vary depending on the circadian rhythm. The circadian rhythm of human exocrine pancreatic secretion was observed even without food intake (Wakasugi et al., 1987). We investigated the effect of the circadian rhythm of the pancreatic secretion on the image extraction capability of MRCP. On the basis of a report, we took MRCP images of the pancreatic duct of healthy volunteers three times a day: once between 6:00 and 8:00 (medium pancreatic secretion), once between 12:00 and 14:00 (peak secretion), and once between 18:00 and 22:00 (minimum secretion). We evaluated the MRCP images visually and in terms of the signal intensity. From the results of this study, however, we were not able to establish an association between the image extraction capability of MRCP and the circadian rhythms in human exocrine pancreatic secretion as pointed by Wakasugi et al.

Background: Pericardial effusion (PE) is one of the most frequent complications of catheter ablation (CA). Furthermore, there are not many institutions that confirm PE immediately before CA. We thus assessed the impact of PE confirmation immediately before CA. Subjects and Methods: We enrolled a total of 327 patients (mean age, 64.0 ± 13.4 years; 70.3% male) who underwent CA between April 2019 and September 2019. We confirmed PE immediately before and after CA by transthoracic echocardiography. There were 48 patients who were found to have PE after CA, and they were divided into two groups: no change in PE before and after CA (no-change group), and PE occurred after CA (PE group). We evaluated the number of cardiac events using the chi-square independence test. Results: There were 24 patients in each group. Three patients experienced cardiac events in the no-change group and 10 in the PE group. In addition, the number of cardiac events was significantly larger in the PE group than in the no-change group (p < 0.05). Conclusions: Cardiac tamponade can be caused by a small amount of PE. However, it is difficult to determine whether the PE was caused by CA. Therefore, we suggested that it is important and useful to check for PE immediately before CA to determine whether PE is caused by CA.

Methotrexate (MTX) is a key drug in the treatment of rheumatoid arthritis, but it sometimes causes hematopoietic disorders with morphological abnormalities of bone marrow cells, which may be difficult to distinguish from myelodysplastic syndrome (MDS). Originally, bone marrow biopsy should not be carried out in the initial diagnosis, but in practice, samples are occasionally obtained and submitted for analysis. However, since there is little detailed information in the literature on how much morphological abnormalities appear in the initial diagnosis, we analyzed the morphology of bone marrow cells from 12 patients treated with MTX. As a result, seven patients were found to have more than one lineage of morphological abnormalities, and three of them had more than 10% of ring sideroblasts. If the history of MTX use is not known, there is a risk that such finding would lead to the diagnosis of MDS; therefore, a detailed check of drugs taken that may affect results is necessary at the time of diagnosis.

The activated partial thromboplastin time (APTT) test is one of the laboratory tests for screening for coagulation disorders, and it is known that coagulation tests including the APTT test are affected by blood collection and centrifugation conditions. Therefore, it is recommended that clotting time assays be performed in accordance with the “Consensus on standardization of sample preparation for clotting time assays” proposed by the Japanese Society of Laboratory Hematology-organized Working Group for Standardization of Sample Preparation for clotting time assays. In our case, the prolongation of APTT was frequently observed, and most patients did not have anticoagulant therapy or a condition that could cause the prolongation of APTT. Since there was no abnormality in the reagents or equipment, and the sample preparation was in accordance with the consensus, the possibility of a defective blood collection tube was considered, and APTT prolongation was not observed when a different lot of blood collection tubes was used. We inquired from the manufacturer and they replied that the citric acid concentration was more than twice the normal level due to human error during the manufacturing process. In conclusion, it is necessary to consider not only abnormalities in reagents and equipment but also unexpected tube failure when APTT prolongation is frequently observed. Furthermore, thorough adherence to the consensus on the standardization of sample preparation for clotting time assays will lead to early resolution when an unexplained abnormal clotting time is encountered.

Rapid diagnostic tests by antigen detection for diagnosing COVID-19 are widely used because they can be conducted easily and inexpensively. In this study, we compared the diagnostic performance of the SARS-CoV-2 antigen qualitative test kit “Quick Navi^TM-COVID19 Ag” compared with that of the nucleic acid amplification test. As a result, both tests showed a concordance rate of 99.3%. Thirty cases showed both negative antigen qualitative and positive nucleic acid amplification test results. In many of the 30 cases, the Ct value tends to be high, and the amount of virus may be lower than the minimum detection sensitivity of the antigen qualitative test, and thus the results of the nucleic acid amplification test may not match those of the antigen qualitative test. On the other hand, seven cases showed both positive antigen qualitative and negative nucleic acid amplification test results. In all these seven cases, COVID-19 was confirmed to be negative, but a false positive result of the antigen qualitative test was obtained, the cause of which was not identified. From the above, it was clarified that “Quick Navi^TM-COVID19 Ag” has sufficient performance as a SARS-CoV-2 antigen qualitative test. However, since false negative and positive results, which depend on the performance limits of the immunochromatography method, cannot be avoided, we should use it with sufficient attention to the characteristics of the test method.

Clinical laboratory technicians (CLTs) perform laboratory tests in hospitals and clinics. To date, no study has examined the status of CLTs engaged in clinics in Tottori Prefecture. In this study, we aimed to investigate the status of CLTs who were engaged in conducting physiological tests in the clinics in Tottori Prefecture and examined the potential employment of the CLTs at these clinics. A survey was conducted by sending questionnaires to 421 clinics with questions regarding the employment status of the CLTs, type of staff engaged in physiological testing, physiological test equipment, average number of physiological tests per type conducted every month, and the possibility of future employment of CLTs at these clinics. A total of 115 general medical offices participated. Physiological tests were conducted in 102 clinics. Of these, eight clinics (7.8%) employed CLTs. The number of physiological tests conducted was significantly higher in clinics that employed CLTs than in those that did not. Moreover, the number of electroencephalography tests conducted was significantly higher in clinics that employed more than two CLTs than in those that employed only one. Correspondence analysis revealed that more ultrasonography, electroencephalography, and electromyography tests were performed in clinics where a CLT was employed than in clinics that did not. Additionally, the employment of CLTs was under consideration by the employers in clinics where a CLT conducted polysomnography. Our results suggest that new CLTs should be employed in clinics where a large number of physiological tests are conducted.

Vaccines against new coronavirus infections have been reported to be useful in preventing the onset and aggravation of new coronavirus infections (COVID-19). A notification from the Ministry of Health, Labor and Welfare approved intramuscular injection for COVID-19 vaccination by dentists in April 2021 and clinical laboratory technicians and emergency life-saving technicians in June 2021 as a special exception. At the Fujita Health University Okazaki Medical Center, 12 clinical laboratory technicians had completed the designated training and participated in vaccination against COVID-19 at a large-scale vaccination center. We obtained permission to inject the vaccine from the Okazaki City Medical Association, made it known to the hospital, and shared the schedule with the Nursing Department. There are many COVID-19-infection-related tasks in the hospital, and many departments handle them. At each medical institution, the response to COVID-19 patients has been prolonged, and the burden on each department has accumulated. This time, we will report on the vaccination efforts at a large-scale vaccination center.

Background: Adenoid cystic carcinoma (AdCC) is characterized by slow growth and a long clinical course, but dedifferentiated AdCC grows rapidly and has a poor prognosis compared with low- or high-grade AdCCs. We report four cases of dedifferentiated AdCC of the head and neck treated at our hospital. Cases: The patients were men and women aged 38 to 78 years and had both low-grade AdCC and high-grade AdCC coexisting in one tumor with extensive necrosis. The tumors were wholly or partially replaced with poorly differentiated or undifferentiated components. Highly malignant components were observed also in the cytological materials, and the characteristic findings of AdCC were hardly observed. Although it was difficult to estimate the original tissue type, it is important to carefully search for features such as cribriform structures and tubular structures. In addition, it was reported that cytological materials are useful for distinguishing between highly malignant and dedifferentiated cases. In these four cases, the cellular findings such as the degree of atypia and polymorphism, swelling of the nucleus and nucleolus, and small to medium cytoplasm were consistent with the literature. However, it should be noted that the cytological material reflects only part of the tumor. Conclusion: Cytodiagnosis is important in clinically determining the presence of dedifferentiated components and providing useful information to support histological diagnosis.

Cardiovascular complications such as myocardial damage and thromboembolism have been problems encountered in COVID-19. However, there have been no reports on the evaluation of cardiac function in the acute and recovery phases in Japan. In this study, we evaluated the cardiac function of four patients admitted to our hospital with moderate COVID-19 in the acute and recovery phases. In addition, we compared the levels of D-dimer, hsTnT, hsTnI, and IL-6 in their blood samples. All four patients had no history of cardiovascular or respiratory disease, and LVEF was within the normal range in all four patients. However, in the comparison of cardiac function between the acute and recovery phases, all four patients showed a decrease in LVGLS, RVFAC, and TAPSE. The D-dimer level was slightly elevated in two patients and one patient remained positive for the D-dimer. The hsTnT level was within the reference level in all four patients, but trace amounts were detected in three patients, and the IL-6 level was abnormally high in two patients. In conclusion, there was no lung inflammation or respiratory distress, and LVEF was maintained within the normal range in the recovery phase, although both left and right ventricular functions were decreased. Those results suggest that regular follow-up of left and right ventricular functions may be necessary even after the COVID-19 recovery phase.

Daptomycin (DAP) is an antimicrobial agent for methicillin-resistant Staphylococcus aureus (MRSA) infection. MRSA, which is not susceptible to DAP, is rarely observed. We experienced a case of MRSA infection that became nonsusceptible during DAP treatment. A man in his 60s had a central venous catheter infection caused by MRSA after surgery for hilum cholangiocarcinoma on the 61st day of admission. Since vancomycin treatment was unsuccessful, DAP was administered on day 66. On day 83, the MRSA isolated from the blood culture was found to be nonsusceptible to DAP. Magnetic resonance imaging and computed tomography were performed to evaluate back pain, and the results suggested pyogenic spondylitis. On day 91, DAP was changed to linezolid with rifampicin, and the blood cultures became negative for MRSA. The patient was discharged on day 110. The DAP-nonsusceptible MRSA isolates from blood culture had mprF mutations, which were reported to be the underlying mechanism of DAP nonsusceptibility. During long-term DAP treatment, microbiological studies with antimicrobial susceptibility testing and comprehensive clinical evaluation, including imaging studies, are recommended.

Blood glucose level control in pregnant women with diabetes mellitus is important to prevent maternal and infant complications. However, severe hypoglycemia is often a problem for pregnant women with type 1 diabetes. A sensor-augmented pump (SAP) is a device that combines CSII and CGM and can strictly manage blood glucose level. In this study, we experienced a case of blood glucose level management using SAP from before pregnancy. The patient was 30 years old and developed type 1 diabetes mellitus. Her HbA1c level was poorly controlled at around 9% on MDI. At the age of 34, she wanted to have a baby and SAP was introduced. Her HbA1c level at her first outpatient visit was 8.8%. The HbA1c level decreased after the introduction of SAP and was 6.3% at the time of pregnancy. At 37 weeks and 3 days, she delivered a 3,292 g baby with no maternal or infant complications. In this patient, SAP was used effectively, and strict control of blood glucose level was achieved. The use of SAP is expected to reduce the risk of maternal and infant complications, and it is important to use it under appropriate guidance.

The ease or difficulty of blood collection varies from patient to patient. According to the standard blood collection guidelines, it is recommended for patients to tightly clench their fist after tying the tourniquet around the arm. However, in the actual blood collection, the conditions often vary. We examined whether it would be possible to improve the efficiency of blood collection by increasing the rate of compliance with the recommended method and unifying blood collection conditions. Blood samples were collected from 1,353 patients (591 males, 762 females, average age of 60.0 years). In this study, seven conditions were set, which were considered from the blood collection procedure in accordance with the standard blood collection guidelines. The person collecting blood did not give any instructions to the patient and observed the patient’s arm and tied it with a tourniquet. When the recommended method was used, 54% of the patients did all the blood collection conditions, 27% of the patients did the conditions for blood collection with clenching the fist, and 19% of the patients did not clench their fist. In addition, in 5% of patients, swelling of blood vessels was observed when they clenched and unclenched their fist. Results of this study showed that 36% of the patients had their blood collected by methods different from the recommended methods. It was also found that adherence to the recommended method prevented difficult blood collection events caused by the patient’s natural behavior. Further improvement of compliance with the recommended guidelines will enable a smooth blood collection.