The novel coronavirus infection (COVID-19: coronavirus disease 2019), which has caused a global pandemic since 2019, has been reported to have a significant impact on the respiratory system, particularly resulting in restricted ventilation impairment and decreased pulmonary diffusion capacity. However, there are no reports on lung function tests (LFTs) in Japan. In this study, we investigated changes in LFT results over time and normal factors after COVID-19 infection. LFTs were performed at 3, 6, and 9–12 months in 50 patients (33 in the normal group: forced vital capacity % predicted (%FVC) ≥ 80% and diffusing capacity of the lung for carbon monoxide % predicted (%DL_CO) ≥ 80% and 17 in the decreased group: %FVC < 80% or %DL_CO <80%) after discharge from the hospital. The results showed that the decreased group had higher severity, longer hospital stays, and more residual symptoms. Although the total lung capacity (TLC) was improved in the decreased group 9–12 months after treatment, the measured %TLC was lower than that in the normal group, indicating potential residual fibrosis or inflammation, which was caused by interstitial pneumonia. The factor most strongly associated with the decreased group was %DL_CO, but its longitudinal changes were limited. Diffusion impairment was speculated to persist for a long time and could be observed at 3 months after discharge, indicating its involvement in long-term lung dysfunction. The decreased group in this study demonstrated restrictive ventilation impairment and decreased lung diffusion capacity, indicative of long-term lung dysfunction. Furthermore, %DL_CO at 3 months after discharge was identified as a factor associated with normal or decreased LFT parameters following COVID-19 infection.

Deep vein thrombosis (DVT), which is no longer rare, is a disease in which a thrombus forms in veins. However, the risk factors for residual thrombus have not been fully investigated nor reported. In this study, we analyzed the risk factors for residual thrombus in patients with DVT and investigated whether the prognosis of thrombus can be predicted. The subjects were 114 patients in whom thrombosis was found by ultrasonography, and the thrombus was monitored by a second ultrasonography. We retrospectively collected patient characteristics, ultrasonography-related information, and thrombosis risk factors and scores. The patients were classified into two groups, namely, those with residual thrombus and those with thrombus disappearance, and then compared. Among all the patients, gender, age, treatment, and examination interval were found significant by multivariate analysis. Regarding patients who received treatment, there was a significant difference in examination interval and thrombosis risk score as determined by multivariate analysis. For those with no treatment, there was a significant difference in age as determined by multivariate analyses. Thrombus remained significant in patients with a high thrombosis risk score, showing that the thrombosis risk score is also useful for predicting residual thrombus. Of the thrombosis risk score items, there was a significant difference in bedridden state. Patients with thrombus retraction are reported to have significantly less severe sarcopenia and significantly thicker gastrocnemius muscles. Thus, a bedridden state should lead to muscle weakness due to sarcopenia and may be a risk factor for residual thrombus. In addition, it is presumed that the significant residual thrombus in the elderly is also related to the thickness of the gastrocnemius muscles. The present study indicated the possibility of predicting the prognosis of residual thrombus.

Many contaminants other than components derived from the urinary tract are present when performing urinary sediment examination. Skin barriers attached to the urostomy pouch after urinary diversion surgery also contaminate urinary sediments, but reports on its components are few. We investigated the effects of four types of skin barrier (CPGFb, CPGbs, CPbh, and CPGHbs) used in our hospital on urinary sediment examination. The components commonly observed in urinary sediments from patients using these skin barriers were unstructured cast-like and near-circular components. Fibrous components were observed in patients using CPGFb-based skin barriers, and capsule-like components were observed in patients using CPGHbs-based skin barriers. Cast-like components were similar to hyaline casts and waxy casts in urinary sediments, and capsule-like components were similar to food residues in feces. When feces are observed in urinary sediments, contamination during urine collection or an intestinal fistula is suspected. However, feces in urine after urinary diversion surgery is an unlikely contaminant during urine collection. It is conceivable that capsule-like components from skin barriers may be misidentified as feces and lead to the clinical suspicion of an intestinal fistula. Morphologically distinguishing between feces and capsule-like components derived from skin barriers is difficult. The following points were useful in distinguishing between capsule-like components from skin barriers and feces: capsule-like components derived from skin protective agents are unstained and colorless, various fecal components other than the capsule-like components are not observed, and the patient is known to use CPGHbs skin barriers. Contamination by skin barriers should be considered when performing urinary sediment examinations.

Severe coronavirus infection (COVID-19) requires treatment with extracorporeal membrane oxygenation (ECMO). COVID-19 patients have high transfusion requirements, but there are few reports on how to manage and administer them. From 2019 to 2021, 37 patients with COVID-19 and ischemic heart disease (IHD) were enrolled. We obtained information about the patients’ background features, blood product requirements, duration of ECMO, laboratory data, and outcomes. During ECMO, transfusion was administered in both groups at the time of laboratory data reduction and ECMO weaning. IHD patients were administered each blood product in the early phase of ECMO. In contrast, COVID-19 patients were administered blood products every day during ECMO and used significantly more FFP than IHD patients. Laboratory data are generally used as a guideline for transfusion therapy, but transfusions are also administered during weaning from ECMO, it is necessary to pay attention to the status of the treatment. We need to monitor laboratory data and treatment status to manage blood products and to quickly respond to transfusion requests.

Recently, hematology analyzers have been used for puncture fluid tests because they are easy to use and generate results quickly and consistently. In this study, we evaluated the basic performance, atypical cell detectability, and the relationship between three-dimensional scattergrams which is new function of the XR-Series and cell morphology confirmed visually in the body fluid mode of the XR-Series, an automated hematology analyzer newly developed by Sysmex. Performance sensitivity, dilution linearity, and correlation with visual microscopy and the Sysmex XN-Series showed good results, suggesting that the XR-Series has sufficient capability to perform body fluid tests. In the evaluation of atypical cell detectability using the measured values, HF-BF# (a research parameter) was the most significant in the monomeric category. Significant items were obtained for the detection of atypical cells in the items defining the features of two-dimensional scattergrams, and higher detectability was confirmed by combining them with the measured values (HF-BF# and LY-BF%: research parameters). In the study of three-dimensional scattergrams, as a feature of WDF (EXT) scattergrams of atypical cell samples, the presumed atypical cell population was plotted in the medium to high FSC (forward scattered light intensity), SSC (side scattered light intensity), and SFL (side fluorescence intensity) regions. In terms of SFL, which reflects the amount of nucleic acid, atypical cells with increased nuclear chromatin showed medium to high levels, whereas mesothelial cells and histiocytes showed low levels, showing significant differences. In the future, we expect to investigate the atypical cell detection function by accumulating research findings on scattergram features and three-dimensional scattergram findings.

Serum cystatin C-based estimated glomerular filtration rate (eGFRcys) is recommended for cases considering the influence of muscle mass, but it faces limitations in costs. We aimed to develop a renal function evaluation method that is less influenced by muscle mass using commonly available clinical test values. We collected data from 11,921 cases with measurements of eGFRcys, along with gender, age, and values of 17 general clinical test items. The dataset was divided into training and validation sets with an 8:2 ratio. Using Lasso regression analysis, we performed feature selection and created eight models by discarding four variables and keeping 15 selected features. After parameter tuning, the models underwent 10-fold cross-validation, and we calculated their average mean squared error. The extreme-gradient-boosting regression model with the lowest mean squared error was selected as the machine learning-based glomerular filtration rate (GFR) prediction model, referred to as eGFRml. We computed eGFRml for the validation data and compared it with eGFRcys, resulting in a correlation coefficient of r = 0.939 and an error range of −19.0 to 4.4 mL/min/1.73 m². Furthermore, the agreement rates for classifying GFR categories in chronic kidney disease severity ranged from 69.6% to 82.5%, with an overall agreement rate of 77.3%. These results indicate a significant improvement compared to eGFRcre, which utilizes serum creatinine. Our study successfully developed a method to efficiently evaluate renal function by predicting eGFRcys-approximated values using commonly available clinical test values, providing a more effective alternative to eGFRcre, which is influenced by factors such as muscle mass.

COVID-19 had continued to threaten the world as a category 2 infectious disease from the end of 2019 to May 8, 2023. Our hospital has introduced real-time PCR and NGS, actively conducting tests for SARS-CoV-2. In this report, we have compiled the results of SARS-CoV-2 testing over the past two years and summarized the infection situation in Matsusaka City. The results of 9,007 specimens that tested positive by real-time PCR at our hospital from January 2021 to April 2023 were analyzed. We compared the number of positive cases, the onset until the peak of each epidemic wave, and the emergence period of the main variants with Tokyo and Osaka prefectures. Additionally, we conducted a full genome analysis using NGS on 64 of those samples. Comparing the graphs of the respective positive counts, it was thought that the data from our hospital reflected the number of positive cases in Matsusaka City. While it showed a similar curve to Mie Prefecture, when compared to Tokyo and Osaka, it took longer to reach the peak of each infection wave. The occurrence of mutant strains was also detected earlier in Tokyo and Osaka. Furthermore, there were no variants that could have mutated uniquely in Matsusaka City. By understanding the infection situation in urban areas, it is believed that more time can be secured for implementing infection control measures. Our testing laboratory, equipped with both real-time PCR and NGS, is expected to contribute to Matsusaka City, infection control efforts in the future.

Deep learning is a machine learning technique using a multilayered neural network that mimics the neural circuits in the human brain. Deep learning models are capable of automatic identification of hidden features in data sets following numerous training iterations, ranging from dozens to hundreds, that result in the generation of an accurate and efficient decision model. The immature granulocyte or blast cell population in peripheral blood is a critical indicator for differentiating hematopoietic diseases. Thus, a highly accurate automated screening technology needs to be established. This study examined the training conditions in generating immature granulocyte recognition artificial intelligence models using convolutional neural networks. We examined the clinical potential of the generated artificial intelligence models. This study used five types of ResNet models with a layer count ranging from 18 to 152 layers. Transfer learning and fine-tuning were performed using 6727 labeled blood cell images and eight types of optimizers to generate immature granulocyte recognition artificial intelligence models with optimal weighting. Clinical assessments were performed on 25 healthy and 25 cases with the appearance of immature granulocytes using the trained artificial intelligence models. The minimum–maximum total accuracy ranges were 0.9131–0.9788 for the healthy cases and 0.8177–0.8812 for the immature granulocyte cases. Our convolutional neural network-based immature granulocyte recognition artificial intelligence model had an accuracy rate of 97% for healthy cases and a rate higher than 88% for cases with the appearance of immature granulocytes. These findings indicate that our artificial intelligence model is a useful morphological differentiation support technology for peripheral blood smear screening.

As an approach to resistant bacteria in urinary tract infections, we investigated whether it is possible to estimate the drug susceptibility of such bacteria from changes bacterial count in which a susceptibility disc is directly placed in urine using the UF-5000’s bacterial count measurement function. The drugs used were levofloxacin (LVFX), which is often prescribed for urinary tract infections, and cefotaxime (CTX), which is also used for extended-spectrum β-lactamase (ESBL) judgement. Changes bacterial count after 30, 60, 90, and 120 min were compared. Drug administration/blank value was calculated to determine the cut-off value at which antimicrobial agents can be judged to be effective. For LVFX, if the drug administration/blank value was less than 0.8 within 90 min, the bacteria were assumed to be sensitive, and if it was 0.8 or higher within 90 to 120 min, the bacteria were assumed to be 70 to 80% resistant. For CTX, if the drug administration/blank value was less than 0.8 within 60 min, the bacteria were estimated to be sensitive, and if it was 0.8 or higher, the bacteria were estimated to be 70% resistant. Since CTX alone yielded only 70% accuracy, cefotaxime clavulanate (CTX/C) was added and compared with CTX, focusing on the inhibition of ESBL by clavulanic acid. When the difference in bacterial count between CTX and CTX/C was compared, ESBL could be determined if the difference bacterial count was 800 or larger at each time point, and ESBL could be determined if the difference is a positive integer in CTX and CTX/C at 120 min.

In April 2020, our hospital introduced AUTION EYE AI-4510 (AI-4510), a urine sediment analyzer using image analysis method by ARKRAY company, with the aim of improving operational efficiency. In AI-4510, components that could not be determined as various cell components are quantified and classified as unclassified. We examined the relationship between this unclassified measured value (unclassified value) and the ratio of other cellular components. Measured 5,616 requested urine sediment samples with AI-4510 and microscopy. Based on the unclassified value of AI-4510, group A: 0.0–9.9 cells/μL (1,676 cases), group B: 10.0–19.9 cells/μL (1,294 cases), group C: 20.0–49.9 cells/μL (1,308 cases), Group D: Classified into 4 groups of 50.0 cells/μL or more (1,338 cases), and compared the concordance rates of both measurement methods for 5 components (red blood cells, white blood cells, squamous epithelial cells, hyaline casts, and bacteria) using a multiple comparison test. As a result of calculating the concordance rate with the microscopic method for various sediment components by unclassified value, it became clear that the lower the unclassified value in the above five items, the higher the concordance rate between AI-4510 and the microscopic method. Therefore, AI-4510 can be used to determine the necessity of microscopic examination, which is generally performed by cross-checking qualitative results and mechanical methods, using unclassified values as an index.

Although over three years have passed since the outbreak of the coronavirus disease (COVID-19) pandemic, few studies have been conducted to examine the severe acute respiratory syndrome coronavirus 2 RNA copy number and Cq values in specimens from different collection sites in COVID-19 patients. In this study, we aimed to address this knowledge gap. One hundred and forty specimens were collected from nine patients on ventilators with severe COVID-19 symptoms. Cq values were obtained by polymerase chain reaction-capillary electrophoresis, and copy numbers were obtained by conversion based on Ct values measured by reverse transcription quantitative polymerase chain reaction. Strong correlations between the Cq value and the copy number were observed, suggesting that the Cq value can serve as an indicator of the copy number. Copy numbers in oral secretion and sputum samples were higher than those in the nasal cavity and nasopharynx samples, and the sputum viral load was never below the detection sensitivity. The viral load decreased at a lower rate in oral secretions than in other secretions, suggesting that in patients with tracheal intubation, the virus remains in the oral cavity. No significant differences between surviving and deceased cases were observed in copy number or transition, suggesting that factors other than viral load may correlate with the prognosis. These results suggest that, in patients with severe COVID-19, the virus may persist in oral secretions and sputum for a long time, regardless of drug administration or number of days since onset.

ID NOW (Abbott) is a nucleic acid detection test with an extremely short turnaround time (15 min), and retests can be performed with a single sample sampling. We evaluated ID NOW Screening Tests for SARS-CoV-2 in asymptomatic people who need urgent care or surgery. Eighty out of 4,507 positive cases identified on an initial ID NOW test were retested using ID NOW and other genetic testing methods. The results of six out of the 80 (7.5%) cases differed from those of the initial ID NOW retests. The results of ID NOW and standard genetic testing methods matched perfectly. The turnaround time for ID NOW was about 30 min, including retests, which is significantly shorter than that for other testing methods. The false-positive rate of ID NOW can be reduced by retesting, suggesting that ID NOW can contribute to rapid and simplified SARS-CoV-2 genetic tests. On the basis of this study, we can introduce the following operational flow with retesting as a potentially effective method: (1) ID NOW testing is to be used for the urgent screening of patients. (2) If negative, the result is to be reported as “negative”. (3) If positive, the patient is to be retested using ID NOW. (4) If the second result is positive and the same as the initial result, we report “positive”. (5) If the retest is negative whereas the initial result is positive, we report “negative”. With this test flow, all test results were reported within 30 min. In the screening tests for SARS-CoV-2, ID NOW is introduced, and the first positive sample is retested using the remaining extracted liquid. This system is useful in saving time and simplifying flow.

From August 2019, most microbiological tests in our hospital were changed from outsourced to in-house implementation. Microbiology-testing-related items at one year of outsourcing and one year of in-house implementation were compared. The income/expense ratio increased from 101% to 125%. The total number of specimens identified slightly increased from 6,813 to 6,821. The number of sputum cultures positive for methicillin-resistant Staphylococcus aureus (MRSA) increased from 147 to 293. The number of urine cultures found to be positive for Aerococcus spp. increased from 1 to 33. In the case of drug-resistant bacteria detected, the number of MRSA increased from 230 to 405. For one organism, the number of bacteria tested for drug susceptibility decreased from 1,674 to 1,387. In comparing blood culture tests between the two periods, the positivity rate increased from 11.9% to 12.1%, and the contamination rate decreased from 2.8% to 2.4%. The in-hospital mortality rate of patients with positive blood cultures decreased from 37.3% to 32.6%. Meropenem antimicrobial use density decreased from 0.77 to 0.76, and the number of days of therapy decreased from 1.14 to 1.09. The interval from the arrival of the sample at the laboratory to the final report increased from 4.00 to 4.16 days, except for blood cultures, and decreased from 8.00 to 4.97 days for positive blood cultures. The shift to in-house microbiology testing may contribute to not only the prompt report of the test results and increased accuracies, but also laboratory profitability, patient survival rates, and cost savings in other departments.

We evaluated the performance of the densitometer “QuickNavi Reader^TM2”. The concordance rate between reader judgment and visual judgment was 100% for SARS-CoV-2 antigen-positive specimens, influenza virus antigen-positive specimens, and negative control specimens. Using automatic read mode, the time from sample addition to positive line detection in SARS-CoV-2 antigen-positive specimens was investigated and averaged 1.28 minutes. Individual differences in visual positivity were observed in the comparison of the determination thresholds of the SARS-CoV-2 recombinant antigen dilution series samples, SARS-CoV-2 antigen-positive pool samples, and influenza virus A antigen-positive pool samples and Negative decision threshold. On the other hand, the reader’s judgment threshold and the visual judgment threshold were almost the same in all three series. QuickNavi Reader^TM2 guarantees judgment accuracy and reproducibility equivalent to visual observation, saves labor in time management, and shortens the time to report results, contributing to the provision of higher quality immunochromatographic methods.

We have encountered a rare case of Anaerobiospirillum succiniciproducens infection. The patient was an 89-year-old woman who was taking prednisolone and had diabetes and a dog. She was admitted to our hospital because of a fever and inability to eat. She was diagnosed as having pneumonia on the basis of CT findings. Antibiotics were started after blood cultures were taken. Gram-negative spiral bacteria grew from her blood culture the next day. Although it was impossible to determine the bacterial species with a commercially available kit, A. succiniciproducens was identified by mass spectrometry. In addition, a 100% concordance was obtained in the 16S RNA gene search. Although A. succiniciproducens infection is difficult to determine in hospitals without a mass spectrometer, it can be estimated from Gram staining findings, colony findings, biochemical properties, and the presence of a dog. It is important to accumulate knowledge on methods to identify A. succiniciproducens.

We report a case in which cytological diagnosis, cell block immunohistochemistry, and transmission electron microscopy (TEM) were used on a cell block to differentiate between adenocarcinoma and malignant mesothelioma (MM) in ascites. A woman in her 70s came to our hospital with abdominal distention, and a large number of ascites were found in an imaging examination. Ascites cytology showed atypical cells with irregular nuclear shapes, nuclear inclusion bodies, and intracytoplasmic vacuoles on a hematogenous background, suggesting high-grade serous carcinoma (HGSC) of the female genital tract. However, MM could not be ruled out owing to the presence of squamoid orangeophilic cells and atypical cells with marginal obscuration and abundant cytoplasm. The immunohistochemistry of the ascites cell block showed that the atypical cells were positive for cytokeratin 7, PAX8, WT-1, and ER, and overexpressed p53. Ep-CAM, CEA, and claudin 4 were negative. Mesothelial markers were partially positive for calretinin and D2-40 and positive for HEG1. We performed a TEM observation of the ascites cell block after obtaining the immunohistochemical results. A tumor cell with a retained microvillus shape was identified, and the length-to-diameter ratio (LDR) was measured for each of the 10 microvilli from the longest to the shortest parts. The mean LDR of the 10 microvilli was 6.58, which was characteristic of adenocarcinoma with fewer than 10 microvilli, and malignancy in ascites due to HGSC was diagnosed. The LDR measurement of microvilli with TEM was considered useful for differentiating HGSC from MM in ascites.

A 64-year-old woman with anorexia since February 2022, followed by abdominal distention despite reduced food intake, visited a hospital in September. She underwent abdominal CT, which revealed liver cirrhosis and a large amount of ascites effusion. After performing an abdominocentesis and histopathological examination, a diagnosis of HHV8-negative primary effusion lymphoma (PEL)-like lymphoma was made. The patient was transferred to our hospital for further treatment. The blood test performed upon admission showed an abnormally high level of KL-6 (24,141 U/mL). Since KL-6 levels decreased gradually after chemotherapy for HHV8-negative PEL-like lymphoma, we hypothesized that KL-6 might be derived from HHV8-negative PEL-like lymphoma.

Thrombophilia has recently become a more frequently reported disorder. Hereditary protein S deficiency is one of the anticoagulant deficiencies that eventually results in thrombophilia. A 49-year-old female patient was suffering from unexplained thrombosis for the second time with pulmonary thromboembolism. Screening tests for anticoagulant proteins found that the activity of protein S markedly decreased (10.0%). Molecular genetic analysis revealed a nonsense mutation, c.1009_1013delGTGA, in exon9 of PROS1. The mutation discovered here is a rare one affecting codon 337 of PROS1, which results in the replacement of valine at codon 337 of protein S with threonine, leading to a reduction in protein S function.

Cardiobacterium hominis is a resident of the oropharynx and rarely causes infectious endocarditis. We experienced treating a case of C. hominis-infected endocarditis in which Bact/ALERT 3D did not show positive results. The patient was a 57-year-old male. He consulted the emergency department presenting with fever and dyspnea on exertion, and a blood culture test was conducted. Later, transesophageal echocardiography revealed bacterial vegetations at two mitral valve cusps. He was diagnosed with infectious endocarditis and received ceftriaxone at home. He was hospitalized two days later and received ceftriaxone and sulbactam/ampicillin. A mitral valve replacement was performed on the 6th day of hospitalization. A large number of Gram-negative bacilli were detected by Gram staining of mitral valve tissue samples. However, a tissue culture test showed negative results. We confirmed these negative test results using the blood samples collected for culture at the time of his outpatient visit using Bact/ALERT 3D, whose automatic judgment was also negative. However, a slight increase was observed in one of the four bottle graphs. Gram staining was performed on this bottle graph, and Gram-negative bacilli were found. After culturing, colonies grew and were identified as C. hominis. Mitral valve tissue culture could not confirm the growth of bacteria, probably because the test was conducted after the administration of antibiotics. Although the automatic blood culture device did not give a positive result, we could identify C. hominis by searching blood culture bottles.

Cases of ceftriaxone-related urinary crystals or urolithiasis in children have been reported; however, there is little information about urolithiasis in adult patients. We herein report an adult case of crystalluria that was observed during the administration of ceftriaxone. The patient was a woman in her 90s. During the administration of ceftriaxone at 2 g/day for the treatment of cellulitis in the left lower extremity, reduction in urine output and floating matter (sludge) in urine were recognized. Urinary sediment examination revealed numerous yellow-brown needle-shaped, agglomerated, and irregular plate-like crystals. Acute renal injury due to ceftriaxone-related crystals was suspected on the basis of her clinical course. Sharing of information and cooperation with the pharmacist led to the early discontinuation of the drug and the rapid recovery of renal function.

A 95-year-old female patient suffering from hypertension and chronic renal failure has been visiting the Internal Medicine Department of our hospital since 20XX - 2. She demonstrated hypoxemia, as shown by her percutaneous oxygen saturation of the peripheral artery (SpO₂) of 86% on a vital sign check in August 20XX. She had no significant cardiac or pulmonary symptoms. Further arterial blood gas analysis using ABL800 FLEX (Radiometer Co., Ltd., Tokyo) did not yield data on the partial pressure of arterial oxygen (PaO₂). Thus, the arterial saturation (SaO₂) and PaO₂ values were considered to be inappropriately correlated, and hemoglobinopathy was suspected because no significant respiratory or circulatory abnormality leading to hypoxemia was observed. Finally, genetic testing disclosed a low-affinity abnormal variant or Hb Yuda: codon 130 GCT(Ala)→GAT(Asp) at the α2-globin gene. As in this case, when we encounter a low SpO₂ value that does not match clinical symptoms, SaO₂ should be confirmed by arterial blood gas analysis. If PaO₂ is higher than that expected from the SaO₂ level, hemoglobinopathy of the low-affinity variant should be suspected.

Vibrio mimicus resides in marine water, sea mud and fisheries, and causes gastroenteritis and diarrhea as food poisoning after taking seafoods, which usually produce mild symptoms. We recently experienced a case with blood infection of V. mimicus which is a very rare condition with this species; this is the fifth case to the best of our knowledge. Case presentation: An 84-year-old male patient felt an abdominal fulness from the morning and visited his family doctor. He did not receive any special treatment at the time because he did not show a fever or serious signs. On the same day in the evening, he was taken to the emergency room of our hospital because of a high fever and recurrent vomiting with confusion. Infective enteritis was suspected from the findings of abdominal CT. The administration of ceftriaxone (CTRX) was started after taking two sets of blood culture samples, which revealed to be positive for Vibrio mimicus on the next day. The symptoms became better after the beginning of the antibiotic treatment for 10 days. Finally, he was discharged on the hospital day 13. Bacterial species belonging to the genus Vibrio commonly exhibit Gram-negative curved bacilli-like morphology. It would be valuable to report probable Vibrio infections upon this characteristic microscopic finding to improve clinical management through the early diagnosis and the appropriate antibiotic treatments.

We report a case of pseudohigh thyroid stimulating hormone (TSH) due to a nonspecific IgG response. The patient was an 88-year-old woman. At the time of initial examination, her blood sample showed TSH 19.66 μIU/mL, free triiodothyronine (FT3) 2.61 ng/dL, and free thyroxine (FT4) 1.76 pg/mL, indicating elevated levels of TSH only. Since no abnormality was found after a loading test and other tests, and only TSH remained elevated, a nonspecific reaction was considered. There was no significant difference in the measurement results of the three different reagents. No significant differences were observed between the three reagents and the human anti-mouse antibody absorption test. On the other hand, in the additive recovery test and polyethylene glycol treatment test, a decrease in recovery was observed for all three reagents, suggesting the influence of some interfering substance. Therefore, HPLC gel filtration analysis was performed, and it was confirmed that the interfering substance was IgG. In addition, the recovery rate of IgG and TSH standard purified from the fractionated aliquot of the case was decreased in the additive recovery test, suggesting that the false high value in this case was caused by measuring the TSH-IgG complex.

A 50-year-old woman presented with a dimple in C area of the right breast since 1 year ago, also redness and pain in AC area of the left breast since three months ago. Breast ultrasonography detected the hypoechoic mass measuring 18 × 15 × 14 mm and 41 × 39 × 31 mm, respectively. Histopathological examination by US-guided core needle biopsy diagnosed invasive ductal carcinoma (IDC) (luminal A) and IDC (triple negative), respectively. Contrast-enhanced computed tomography (CT) revealed metastasis of the lung. Chemotherapy was started based on the diagnosis of bilateral breast cancer with metastasis of lung. Seventeen months after the diagnosis of breast cancer, the patient was taken to the hospital due to unconsciousness. Then craniotomy lumpectomy was performed for metastasis of the brain. Two years later, contrast-enhanced CT detected an enlarged low density nodule in the right lobe of the thyroid gland. Thyroid ultrasonography detected the internal hypoechoic mixed nodule in the right lobe of the thyroid gland, that was 19 × 19 × 23 mm in size and irregularly shaped. Compared with the thyroid ultrasonographic image of 12 years ago, the present ultrasonography showed the nodule in the right lobe, protruding slightly outward. Histopathological examination by US-guided fine needle aspiration cytology revealed metastasis of breast cancer. Breast cancer can metastasize to multiple organs in the terminal stage, but metastasis to the thyroid gland is relatively rare and has been reported in a few cases. We have reported this case with a review of the literature.

Background: We report very rare subtype of prostate cancer, prostate ductal adenocarcinoma, found in the urinary sediment. Case: The patient was a man in his 80s. He had a history of low-grade urothelial carcinoma (LGUC) 5 years ago and is continuing follow-up. Urinalysis showed atypical cells. Subsequent examination revealed that the atypical cells were prostate ductal adenocarcinoma cells. Conclusion: Urinary sediment examination revealed a rare case of adenocarcinoma. In this case, LGUC could not be ruled out, and it was difficult to distinguish prostate ductal adenocarcinoma and LGUC. However, we were able to report it as an unusual finding and proceeded to a closer examination. It is important to improve the accuracy of testing by carefully reviewing the test results.