Clock genes efficiently regulate circadian rhythms and also the biological environment rhythm and determine an efficient morning and night routine, acting as risk factors for psychosis. In this study, after obtaining informed consent, blood samples were obtained from male (n = 34) and female (n = 107) subjects. We performed NEO-FFI personality and STAI tests to determine whether or not clock gene polymorphisms are associated with reward personality-related traits, as assessed using the five-factor model. We used the unpaired T-test for statistical analysis, and the statistical significance level was defined as p < 0.025. As a result of the statistical analysis, significant differences were found in the allele frequencies of the rs3805151 polymorphism in terms of openness in the NEO-FFI personality test (p = 0.003 in all subjects; p = 0.0004 in female subjects). We conclude that the CLOCK polymorphic may affect openness, as measured by NEO-FFI. Further investigations involving personality questionnaires with more subjects are necessary to confirm the relationship between the clock gene and personality.

The administration of rituximab to an organ transplantation recipient has the effects of depleting a part of B cells and temporarily suppressing their differentiation into antibody-producing cells. Therefore, rituximab has been used as a therapeutic drug to suppress the production of nascent antibodies that could develop into donor-specific alloantibodies (DSA) and treat antibody-mediated rejection. However, rituximab is known to cause a false positive result in the complement-dependent cytotoxicity crossmatch (CDC-XM) test using B cells, which is performed to detect DSA. In this study, to avoid the interference of rituximab, we investigated the protective effects against rituximab of a serum treatment method using magnetic beads and anti-idiotypic antibodies and a CD20 antigen treatment method using proteolytic enzymes on B cells. The serum treatment method enabled the prevention of false positives in patients administered with rituximab up to 600 mg/kg body weight. However, stable results could not be obtained with the B cell treatment method using proteolytic enzymes. The CDC-XM test is still the gold standard method for detecting only the complement-dependent antibodies that show reactivity with the rabbit complement. It is speculated that this serum treatment method will be a useful preconditioning method in the CDC-XM test for rituximab-administered cases.

Streptococcus pneumoniae causes severe infections in immunocompromised children and elderly patients. To examine the effects of pneumococcal vaccines, serotypes and drug susceptibility of S. pneumoniae in respiratory specimens were compared before and after the introduction of vaccines. Analyses included 375 strains collected between 2007 and 2009 (prevaccination) and 150 strains collected between 2016 and 2018 (postvaccination). Because serotypes 19, 14, and 9 being covered by the pneumococcal conjugate vaccine (PCV13), they were seldom found postvaccination. However, regarding the pneumococcal polysaccharide vaccine (PPV23), the serotypes included were similarly observed during pre- and postvaccinations. In contrast, serotypes 35 and 34, and non-type (NT), which were not covered by the vaccines, increased after vaccination. Furthermore, the drug susceptibility rates of PCG, CTX, and CFPM were significantly increased after vaccination. The frequencies of mutations in pbp1a, pbp2x, and pbp2b were comparable between pre- and postvaccinations (approximately 32.4%). This was due to the appearance of penicillin-resistant S. pneumoniae (PRSP) whose serotypes 23, 35, and NT did not decrease. The respiratory strains of S. pneumoniae postvaccination were found to include a higher percentage of NT strains and a higher frequency of PRSPs than those before the vaccine introduction. Since NTs often form atypical colonies, careful examination is necessary. Furthermore, because PRSPs continue to occur at a high rate, it is important to conduct appropriate drug susceptibility testing.

We compared the trends of the levels of IL-6 and other biomarkers in patients admitted to our ICU and investigated the usefulness of IL-6 as an early marker of inflammation. The results showed that IL-6 appeared earlier than PCT, CRP, and SAA after admission to the ICU and its level tended to decrease gradually thereafter. The IL-6 level tended to peak on the first day regardless of the presence or absence of infection, surgical urgency, or surgical site. Furthermore, the possibility of predicting the length of stay using IL-6 levels at ICU admission was examined, and IL-6 (p < 0.05) and PCT (p < 0.01) levels at admission were significantly higher in the group that stayed in the ICU for more than 4 days than in the group that left within 3 days, suggesting that the levels at ICU admission may contribute to predicting the length of stay. The results suggest that the levels at ICU admission may contribute to the prediction of the length of stay. Since this study also suggests that the degree of invasion and the presence or absence of infection may cause fluctuations in IL-6 levels, the evaluation of IL-6 levels based on a comprehensive judgment of other findings is expected to contribute to an early decision on a treatment strategy.

Background: Oxytocin is known to have anxiolytic, antistress, and analgesic effects, and it supports social connection. We examined the utility of salivary biomarkers as indicators for the early detection of developmental disorders and understanding stress responses. Methods: We recruited 56 university-aged males and females (age range: 21–23). They donated saliva samples from 12:00 to 13:10, then completed three questionnaires on the same day. Salivary oxytocin, cortisol, and α-amylase activity levels were measured using an enzyme immunoassay kit. Traits of developmental disorders and stress responses were assessed using three questionnaires: the Autism-Spectrum Quotient Japanese version (AQ), Public Health Research Foundation scale (PHRF-SCL-SF), and Connors Adult attention-deficit hyperactivity disorder (ADHD) Rating Scale (CAARS) Japanese version. We analyzed the relationship between questionnaire scores and biomarker measurements. Results: In the group with autistic tendencies (who scored highly on the AQ), we found that interpersonal problems were significantly associated with elevated salivary cortisol levels, and imagination problems were significantly associated with decreased salivary α-amylase activity. We also found a significant association between communication difficulties and reduced salivary oxytocin levels in the group with autistic tendencies. Conclusions: Measurement of salivary biomarkers may lead to the detection of developmental or stress disorders in university students who have not yet been diagnosed.

Japan’s total population has begun to decline, and in 2007, we entered a super-aging society. The environment around us is constantly and drastically changing, and reforms in the way doctors work will begin in fiscal year 2024. In this turbulent environment, it is important to understand the supply and demand for clinical laboratory jobs to look to the future. Demand was determined on the basis of the estimated population in October 2019, and the number of clinical laboratories in the future was calculated by multiplying the number of tests performed per capita by gender and age group and the estimated future population using NDB open data. Other data, such as the patient uptake rate from the patient survey, were also used as references. For supply, the number of clinical laboratories in medical institutions and the number of clinical laboratories that passed the national examination from the Survey of Medical Institutions and the Functional Report on Hospital Beds were used as references. The number of clinical laboratories will peak around 2030 and begin to decline thereafter, indicating that the total number of clinical laboratories itself will decline after 2045 from 2019. The number of hospitals where medical technologists work is declining, and the most recent survey of medical facilities showed that the number of medical technologists working there is not increasing. In addition, with the increase in the number of training schools, both the number of candidates and the number of successful candidates increased around 2011. This suggests that there is a strong possibility that supply and demand will not match in the future and that it will be necessary to actively and proactively expand opportunities for medical technologists, such as by actively participating in task shifting/sharing work and becoming a much-needed human resource in this era, while demonstrating expertise and strengths.

Objective: In this study, we aimed to investigate how the evaluation of fatty liver changed when the B-mode semiquantitative and attenuation methods were used in combination. Subjects and Methods: The study subjects were 1,169 subjects who underwent abdominal ultrasonography. Fatty liver was defined as mild or severe by the B-mode semiquantitative method or as an attenuation coefficient of 0.62 dB/cm/MHz or greater. Results and Discussion: Among the 1,169 subjects, the attenuation coefficients could be measured in 1,039 subjects. Of the 541 patients who were determined to have fatty liver either on the basis of the B-mode finding or by the attenuation method, 53.8% were determined by both methods, 28.8% on the basis of the B-mode finding alone, and 17.4% by the attenuation method alone. These results suggest that the attenuation method can detect fatty liver in some cases that could not be determined on the basis of the B-mode finding alone, whereas many cases of fatty liver were missed by the attenuation method alone. In 11.1% of 130 subjects in which the attenuation coefficient could not be measured, the more advanced the fatty liver, the higher the percentage of cases in which the attenuation coefficient could not be measured. This suggests that the attenuation method is effective in cases where the B-mode cannot be determined as a fatty liver. Conclusion: In this study, we showed that the combined use of the B-mode semiquantitative and attenuation methods effectively detects fatty liver that could not be determined on the basis of the B-mode finding alone.

Mass spectrometry is an effective and widely used method for identifying mycobacteria, but there is no clear recommendation for the type of preculture medium or preculture period. Therefore, in this study, we investigated the culture medium and culture period for the slow-growing nontuberculous mycobacteria (SGM)/Mycobacterium tuberculosis (MTB) group and the rapid-growing mycobacterium (RGM) group. We used the Kyokuto 2% Ogawa medium (Ogawa medium) and Vital Media 7H11-C agar medium (7H11C plate), and cultured the samples for about 1 to 2 weeks. As a result of the investigation, both SGM and RGM showed the highest species-level identification rate and score value (SCV) for mass spectrometry identification performed after 1 week of culture using the Ogawa medium. The SCV for identifying RGM was low after two weeks of culture, and the SCV was significantly lower on the 7H11C plate. The reason for the low identification rate at the species level on the 7H11C plate cultured for 1 week was considered to be the insufficient amount of growing bacteria. The reason why the SCV of RGM was low after two weeks of culture is considered to be that the culture period was too long and a good spectrum could not be obtained. In conclusion, when a solid medium is used for preculture, the Ogawa medium gives better results than the 7H11C plates, and the preculture periods for mass spectrometry identification are about 1–2 weeks for SGM and 1 week for RGM. It is inferred that this leads to good identification results.

The loop-mediated isothermal amplification (LAMP) method is used for detecting novel coronaviruses (e.g., severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)). However, the effect of reaction inhibitors in specimens has not been evaluated. We evaluated external controls developed for the LAMP assay targeting SARS-CoV-2. The specimens included nasopharyngeal specimens (20 were SARS-CoV-2-positive and 80 were SARS-CoV-2 negative). Threshold time (Tt) was determined by the LAMP method using standard kits and external controls. For the external control, distilled water (SARS-CoV-2-negative sample) was measured, and the Dt ([Tt of specimen] − [Tt of distilled water]) was calculated. We evaluated Tt and Dt of the external control. All the specimens (n = 100) showed amplification of the external control. No specimen was suspected of having an obvious inhibitory reaction. The median Dt values were 1.4 for SARS-CoV-2-positive specimens and 1.3 for SARS-CoV-2-negative specimens, with a maximum value of 4.0. The median Tt of the external control was not significantly different between the SARS-CoV-2-positive (15.9) and -negative (15.8) specimens (p = 0.75). In conclusion, external controls showed normal amplification reactions in all the specimens. The result of the specimen that showed the maximum Dt value of 4.0 min could be determined without the influence of reaction inhibition. Further evaluation of external controls is needed using specimens and sputum that show response inhibition.

Methods based on immunology are used to detect many hormones in sera. In these immunological methods, however, we occasionally find a discrepancy in the detection values between different reagents. The causes of such discrepancy include the influences of biotin or heterophil antibodies in patient serum on streptavidin, a common component of reagents. To determine the cause of the discrepancy, we examined differences of the FT3 levels by comparing three different reagents, namely, “former Elecsys FT3 III reagent” (former reagent) based on the electrochemiluminescence immunoassay (ECLIA), “improved Elecsys FT3 III reagent” (improved reagent) based on ECLIA, which is improved to prevent the negative effect on streptavidin, and “Accuraseed reagent” based on the chemiluminescent enzyme immunoassay (CLEIA). We observed a significant correlation between the FT3 levels of the former reagent and the improved reagent in 1,005 random serum samples. In contrast to the detection values of the former reagent, no unexpected elevation of the FT3 levels of the improved reagent with the addition of biotin into the serum was observed. We found a significant decrease in the FT3 level of the improved reagent in 13 out of 28 serum samples, which was observed with the dissociation between the FT3 levels of the former reagent and the improved reagent, and the existence of immunoglobulin was suspected in those 13 serum samples, as shown by the results of PEG, HBT, and Protein A analyses. Further studies are needed because it is still unclear why the FT3 levels of the improved reagent are different from those of the CLEIA in 15 out of 28 serum samples.

In this study, we evaluated the clinical usefulness of an automated antimicrobial susceptibility testing system (DPS192iX, Eiken Chemical Co. Ltd.) for Aerococcus urinae. MICs for nine antimicrobial agents, whose breakpoints were defined in CLSI M45 3rd Edition, were measured using DPS192iX for 38 A. urinae strains isolated and stored in the University of the Ryukyus Hospital between 2014 and 2020 and two ATCC strains, Streptococcus pneumoniae ATCC49619 and A. urinae ATCC51268. Results were compared with MICs determined by a reference method using frozen plates (Eiken Chemical Co., Ltd.). Overall, the ±1 essential agreement (±1 EA) and category agreement (CA) were 94.3% and 97.1%, respectively, whereas the ±1 EA or CA for several agents was less than 90% (±1 EA for ceftriaxone was 85.7%, that for linezolid was 88.6%, and CA for levofloxacin was 85.7%). The minor errors for ciprofloxacin and levofloxacin were 8.6% and 14.3%, respectively, but we did not observe a major error or a very major error. From these observations, the antimicrobial susceptibility testing system DPS192iX is considered useful for A. urinae, although further evaluation is required for several antimicrobial agents such as fluoroquinolones, ceftriaxone, and linezolid.

The coronavirus disease 2019 pandemic has led to the widespread use of the nucleic acid amplification test (NAAT), along with an increase in demand for SARS-CoV-2 tests. NAAT has been used to detect drug resistance (AMR) genes since before the pandemic, but the test has been performed in a limited number of facilities. We investigated the current status and background of Japanese clinical laboratories by surveying the implementation of genotypic AST in NAAT, which has become widespread owing to the pandemic. This means that 59% of the respondents possessed NAAT and were using it for genotypic AST. GeneXpert and FilmArray were introduced in the majority of cases (62.5% and 82.6%, respectively), with the pandemic as the trigger. More than half of the respondents cited “rapid detection” (56.0%) and “ICT requests” (52.4%) as the reasons for introducing the system. Regarding usefulness, “contribution to infectious disease treatment” (74.1%) showed the highest percentage. Among the respondents who cited “not implemented”, the most frequent responses were “I have no plans, but I want to do it.” (38.1%) and “would do so if requested by a physician” (33.3%). The most common reason for not implementing the system was concern about increased workload (52.9%). We believe that this is due to changes in the working environment caused by the pandemic and the characteristics of Japanese society. In the future, to promote the adoption of genotypic AST, it will be necessary to approach it through reports on its usefulness from domestic facilities, and simultaneously, improving and enhancing efficiency in work processes will also be essential.

To evaluate cell diameter values in the literature, smears of peripheral blood from eight (21 to 23 years old) subjects were prepared by the wedge method. May-Grünwald-Giemsa staining was then performed and cell diameters were measured from digital images. Measurement results were then compared with literature values for red blood cells, platelets, and the five white blood cell fractions of the subjects. In addition, the effects of two drying methods, forced drying and natural drying, on cell diameters were compared. The diameters measured from digital images of various peripheral blood cells in this study differed depending on red blood cells, platelets, and the five white blood cells described in the literature. No significant differences in cell diameters were observed between forced drying and natural drying.

[Objective] Genetic testing using formalin-fixed paraffin-embedded (FFPE) sections is hardly carried out in clinical laboratories because the nucleic acid extraction process is very complicated and time-consuming. We have found that nucleic acid extraction using zirconia beads (beads method) is useful for the detection and identification of Mycobacterium spp. from FFPE sections by polymerase chain reaction (PCR) analysis. [Methods] Eleven samples that were found to be positive for Mycobacterium tuberculosis (MTB), Mycobacterium avium (MAV), and Mycobacterium intracellulare (MIN) by the culture and Z-N stain methods and 35 samples that were found to be negative by the culture and Z-N stain methods were extracted by the column method for the detection of MTB, MAV, and MIN by PCR analysis. The same samples pretreated by the beads method were also detected by the same PCR analysis. [Results] In the column method, MTB was detected in 5 of 7 MTB-positive samples, MAV in 2 of 2 MAV-positive samples, and MIN in 1 of 2 MIN-positive samples. MTB and MAV were not detected in 34 of 35 MTB- and MAV-negative samples, and MIN was not detected in all MIN-negative samples. In the beads method, MTB was detected in 6 of 7 MTB-positive samples, and other results were similar to those of the column method. Measurement times were 160 min for the column method and 70 min for the beads method. [Conclusion] This study shows that PCR analysis using the beads and column methods is useful for detecting and identifying Mycobacterium spp. from FFPE sections.

Apheresis is a blood collection method used in Japan in which blood from a patient or healthy donor is drawn into a blood collection device, separated into its components, and then only the necessary blood components are collected. Until now, medical technologists (MTs) have rarely been involved in the apheresis collection process but have focused on the subsequent cell preparation and storage of cells. Task shifting/sharing has enabled biomedical laboratory scientists to perform various tasks. At our hospital, MTs have been operating the apheresis collection device since January 2007, and on the basis of this experience, we considered how MTs should be involved in apheresis collection duties in the future. However, apheresis also involves many invasive procedures on patients; therefore, sufficient training is required and it is necessary to be extremely careful when performing these procedures.

Inventory control is important for medical care and cost control. However, there are only a few reports on inventory management in clinical laboratories. In this study, we evaluated the effect of the introduction of inventory management software in the clinical laboratory supporting system on laboratory management and operations. The numbers of incomplete records were 1,465 by handwriting, 551 by FileMaker, and 383 by clinical laboratory supporting system, all of which decreased with the use of the management software (p < 0.05). Group A in the ABC analysis had the highest reduction rate of cost in the immunological test at 35%. The purchase amounts were 2.77 ± 2.04 million yen in 2019, 2.36 ± 430 thousand yen in 2020, and 2.97 ± 430 thousand yen in 2021. The sales ratios were 13.4% in 2019, 17.8% in 2020, and 20.7% in 2021. The inventory values were 6.29 ± 1.24 million yen in 2019, 4.91 ± 960 thousand yen in 2020, and 4.61 ± 500 thousand yen in 2021. The inventory turnover rates for reagents were 6.2 ± 8.9 in 2019, 5.3 ± 4.7 in 2020, and 9.1 ± 10.2 in 2021, and those for consumables were 4.2 ± 2.7 in 2019, 3.3 ± 2.4 in 2020, and 6.1 ± 4.7 in 2021. The purchase value and sales ratio increased, but the inventory value and inventory turnover improved (p < 0.05). The inventory management software in the laboratory system is useful in clinical laboratory work and is considered to contribute to efficient hospital management.

Legal brain death determination is performed when the patient had consented to organ donation under brain death conditions, and in many cases, a biomedical laboratory scientist is involved in electroencephalography (EEG) and blood gas measurements. Recently, we have performed legal brain death determination at our hospital for the first time in about 11 years. We were in charge of EEG and blood gas measurement during the apnea test, and we report our experience in this case because the preparations involved in legal brain death determination are extremely important for medical staff members. The patient was an adult female with subarachnoid hemorrhage. The preparations for EEG included checking the condition of the EEG equipment, checking the necessary supplies, and assigning roles to the medical staff members during the examination. Preparations for blood gas measurement included moving the blood gas equipment to the patient room and changing the calibration start time. Legal brain death determination began at 6:00 p.m. on the day of the tests. We entered the hospital room three hours before the tests to prepare for the EEG and apnea tests. The tests were completed without delay, owing in part to the preliminary preparations. Preparations for the EEG test and examination of its results were also completed without delay for the legal brain death determination in the second case. Legal brain death determination is often requested at short notice. Therefore, it is important to routinely check the condition of the equipment and involve the medical staff in preparations in advance.

Streptococcus agalactiae is increasingly reported as a causative agent of invasive infections [namely, group B streptococcal (GBS) bacteremia] in the elderly and adults with underlying diseases, with mortality rates ranging from 8.47 to 11.58%. In particular, bacteremic patients have a higher mortality rate than nonbacteremic patients, but because there are few reports focusing exclusively on GBS bacteremia, we examined GBS bacteremia retrospectively. We studied GBS bacteremia in 15 years and older from January 2015 to December 2021. Sixty-nine patients were found to have GBS bacteremia during this period, and the disease occurred more frequently in patients aged 60 years or older (88.4%), particularly in relation to the presence of diabetes mellitus (33.3%), liver cirrhosis (23.1%), and solid tumor (18.8%). GBS bacteremia was frequently caused by urinary tract infections (27.5%), skin and soft tissue infections (27.5%), and bloodstream infections of unknown focus (24.6%). The mortality rate of GBS bacteremia was 8.7%. The results of drug susceptibility testing of GBS strains showed that many of them were resistant to macrolide and new quinolone antibacterial agents, and two cases of GBS clinical isolates with reduced penicillin susceptibility (PRGBS) were also observed. PCG can be fully effective as a first-line drug for GBS bacteremia, but on the other hand, the presence of PRGBS must also be taken into account, albeit slightly.

In recent years, learning methods have become more diverse, with an increasing number of universities moving away from microscopic sketches to digital imaging methods, including smartphone images and virtual slides. We took photos of hematoxylin–eosin-stained specimens using a smartphone camera placed over the ocular lens of an optical microscope at different distances under different conditions to investigate whether organs could be identified from these photos. At an optical microscope magnification of 100× (low-power magnification), in-focus images were obtained without camera shake at smartphone camera magnifications of ×1.0 to ×5.0. Images of similar quality to optical micrographs were obtained, allowing organs to be identified by revealing tissue structures and intranuclear and cytoplasmic features. The distance from the smartphone camera to the ocular lens increased as the smartphone camera magnification increased. The best fixation of the smartphone camera was achieved at up to ×5.0. The present results suggest that improvements in the imaging capability of smartphone cameras fitted with a microscopic adapter could lead to more precise imaging.

A group called “a gathering place of medical technologists interested in dementia” was set up by BAND, a group communication application, as a place to exchange opinions and share information on dementia, which began its operation in March 2021. Since the start of the operation, the number of registrants increased; therefore, we conducted a questionnaire survey to verify whether the registrants found the operation useful. The participants were those aged ≥ 20 years who were registered with the group up to January 31, 2023, excluding the principal investigator or those who were involved in the creation of the questionnaire or setting up of the group. The participants were asked to complete a self-administered anonymous questionnaire via Google Forms. Of the 108 group members registered up to January 31, 2023, 33 responded. Regarding their impressions of participating in the group, 66.7% felt that it was “very good” and 33.3% felt that it was “good.” Regarding what they were glad to participate in, 97.0% of the respondents answered that “I can obtain information about workshops” or “I can obtain dementia-related information,” and 75.8% answered that “I can connect with others.” Possible bias in the results was a concern because of the small number of respondents relative to the number of registrants, although all the respondents gave favorable evaluations of the operation method. This finding indicated that a certain level of demand exists. Since it is beneficial to have a place for exchanging information in fields other than dementia, this article should serve as a reference when conducting similar initiatives.

The Nara Association of Medical Technologists has introduced online Off-Job Training (Off-JT) starting from FY2020 in response to the COVID-19 pandemic. In this study, we aim to evaluate the online Off-JT, which differs from the traditional face-to-face format. First, we compared the online Off-JT and face-to-face Off-JT formats in terms of their ability to attract participants. Despite having fewer training sessions (40.8% less), the online format had an average attendance of 105.4% higher (39.7 vs. 19.3) than that of the face-to-face format. To enhance participant convenience, we offered a limited number of live and video-on-demand (VOD) sessions on YouTube and evaluated their usefulness through an online survey focusing on work–life balance (WLB). The survey results showed that 81.9% (458/559) of the respondents reported an improvement in WLB. The effect on WLB improvement varied depending on the viewing method, with VOD sessions showing an 84.1% (376/447) improvement and live sessions showing a 73.2% (82/112) improvement. We believe that the increased capability of the online Off-JT to attract participants is mainly due to the elimination of travel burdens through internet-connected devices. The combination of live and VOD sessions on YouTube allowed participants to adjust their viewing time, leading to a better allocation of free time and improved WLB. The online Off-JT and VOD delivery have been shown to enhance convenience for participants by eliminating geographical and time constraints, resulting in positive effects.

In typical acute promyelocytic leukemia (APL), the fusion gene PML::RARA is formed by a chromosomal translocation of t(15;17)(q24.1:q21.2). However, in rare cases, cryptic t(15;17)(q24.1:q21.2) exists when a fine region of RARA is inserted into PML, forming the fusion gene PML::RARA, but no t(15;17)(q24.1:q21.2) is detected. We report a case of therapy-related cryptic APL diagnosed on the basis of a bone marrow specimen obtained during treatment for follicular lymphoma. The patient was a female in her 60s. During the treatment of follicular lymphoma, leukopenia was observed and bone marrow puncture was performed. Bone marrow examination did not reveal any histopathological or chromosomal abnormalities. On the basis of a small number of faggot cells in the bone marrow image, the hematology technologist suspected APL and reported this to the physician in charge, who asked for additional genetic tests, which revealed the fusion gene PML::RARA. When checking bone marrow images, it is important that hematology technologists keep therapy-related myeloid neoplasms in mind and do not miss even a few abnormal cells when checking bone marrow images for an early diagnosis and treatment. I reaffirmed this importance in this study.

Aerococcus spp. are facultative anaerobic gram-positive cocci that often cause urinary tract infections in older men with a history of urological diseases. These species have been reported to rarely cause bacteremia or endocarditis. In our hospital, we encountered three cases of bacteremia in older men with urological diseases; one of these cases was infective endocarditis. Aerococcus spp. have the same characteristics as Staphylococcus spp. on Gram staining of blood culture media. However, on blood agar medium, they show alpha-hemolytic colonies and resemble alpha-hemolytic Streptococcus and Enterococcus spp. Therefore, Aerococcus spp. may be misidentified as α-Streptococcus. In addition, during the use of identification test kits and automatic analyzers, some strains are difficult to identify owing to insufficient databases of these instruments. In fact, in all three cases in our hospital, the results of the urine culture performed by an outsourced laboratory identified the causative organisms as Streptococcus spp. However, they were all re-identified as Aerococcus spp. using an automatic analyzer, an identification kit such as API20Strep, and a mass spectrometer. For the identification of Aerococcus spp., a thorough understanding of their characteristics is important. Furthermore, identification should be confirmed by MALDI-TOF-MS or genetic testing for future accumulation of information.