The usefulness of the 3-parameter estimated glomerular filtration rate (eGFR) and 5-parameter eGFR was examined based on the correlation and discrepancy ratio between 24-hour creatinine clearance (24CCr)and the GFR conversion formula for 24CCr (24CCrGFR conversion). The 3-parameter eGFR deviated from the comparator in a number of cases; in particular, 15.4% of patients had a discrepancy ratio of 2.01 or higher than that of 24CCrGFR conversion, suggesting overestimation of the renal function. In contrast, the 5-parameter eGFR tended to deviate below the 24CCr. However, 66.5% of deviations from the 24CCrGFR conversion converged within 0.7–1.3, and the ratio of ≥ 2.01 was 6.3%, indicating a high degree of accuracy. In the present validation, the 5-parameter eGFR was considered more useful than the 3-parameter eGFR because it showed a good correlation with the 24CCrGFR conversion, had a smaller discrepancy ratio, and was more accurate.

In recent years, transcatheter aortic valve implantation (TAVI) has gained attention as a treatment for aortic stenosis (AS). While the efficacy of TAVI has been demonstrated, the American College of Cardiology dataset reports that 14.3% of patients were readmitted for heart failure and 23.7% died within one year after TAVI. Atherosclerosis are predictors of cardiovascular (CV) morbidity and mortality, and the ankle-brachial index (ABI) and pulse wave velocity (PWV) are widely used to assess these conditions. However, the relationship between brachial-ankle pulse wave velocity (baPWV) and mid-term CV outcomes after TAVI remains unclear. In this study, we investigated the association between pre-TAVI ABI/baPWV measurements and post-TAVI CV events. The study included 128 consecutive patients who underwent ABI/baPWV measurements prior to TAVI. The mean follow-up period was 2 years and 10 months, during which 36 patients (28%) experienced CV events. The group with events was significantly older, higher STS scores and baPWV values. Multivariate Cox proportional hazards regression analysis identified baPWV as an independent prognostic factor. Furthermore, Kaplan-Meier curve analysis showed that the group with baPWV ≥ 1,683 cm/s had a significantly higher incidence of CV events (log-rank p < 0.001, chi-square: 20.3). Pre-TAVI baPWV measurement was significantly associated with post-TAVI CV events and is considered a clinically useful indicator.

The performance of five SARS-CoV-2 genetic analysers cobas^® z480, Smart Gene^®, ID NOW^TM instrument, cobas^® Liat^® system and GeneXpert^® system was evaluated respectively. The minimum detection sensitivity of each method was 1.0 copies/μL, 2.27 copies/μL, 5.75 copies/μL, 0.125 copies/μL and 2.0 copies/μL, respectively. 313 patients with SARS-CoV-2 infection or suspected infection were included in the study. The sensitivity, specificity and concordance rate were compared between the SG and z480 methods: sensitivity 93.2%, specificity 96.6% and concordance rate 94.7%; between the SG and ID NOW methods: sensitivity 91.7%, specificity 98.4% and concordance rate 95.1%; between the Liat and z480 methods: sensitivity 100.0%, specificity 82.4% and concordance rate 95.1%. The comparison between the GX and Liat methods showed a high correlation with a sensitivity of 100.0%, specificity of 93.8% and concordance rate of 96.7%. In the discordant cases, 14 of the 17 cases tended to have a high mean Ct value of 37.7, 9–59 days after onset of illness, and it was considered that a decrease in the amount of virus in the upper respiratory tract, differences in the detection sensitivity of the instruments and uneven distribution of virus during sampling affected the discrepancy in the results. The operation of tests including post-corona should be established after understanding the characteristics of the instruments and discussing the results with the clinical staff.

Flow cytometric immunophenotyping of fresh healthy human peripheral blood shows granulocyte (Gr), monocyte, and lymphocyte (Ly) populations in a constant pattern on the CD45/side scatter dot plots. The aim of this study was to evaluate the factors affecting CD45 fluorescence intensity (CD45FI) in Gr and Ly regions shifted from the normal pattern. The subjects were 390 samples from 169 patients for which leukocyte surface antigen analysis was performed during routine testing. First, we examined the correlation between CD45FI in the Gr or Ly region and laboratory data related to inflammation (C-reactive protein, lactate dehydrogenase (LD), neutrophil, lymphocyte, and white blood cell counts). The patients were then divided into groups by diagnosis, and CD45FI was compared between each group and a healthy group. CD45FI was also compared between immunosuppressants-treated, non-treated and healthy groups. The results showed that CD45FI in Gr region correlated with LD and white blood cell counts very weakly, and in Ly region correlated with LD very weakly. Compared to the healthy group, CD45FI in the Gr region was significantly lower in autoimmune disease group (p < 0.001) and congenital immunodeficiency group (p < 0.05), and that in Ly region was significantly lower in the autoimmune disease group (p < 0.01) and fever of unknown origin group (p < 0.01). CD45FI in both regions was significantly lower in the immunosuppressant-treated group than in the non-treated group (p < 0.0001) and the healthy group (p < 0.01). This study suggests that one of the factors affecting CD45FI in both regions is the involvement of immunosuppressive conditions, including with immunosuppressant therapy.

95% confidence intervals for the coefficient of variation (95%CI_CV) were estimated by the boot-strap (BS) method. The BS method was independently implemented using Excel VBA. The sample size for BS method was set to 50, and the number of iterations was set to 100. The 95% CI_CV was estimated from the mean and 2.5 and 97.5 percentile values of the distribution of CV% calculated by the BS method. The 95% CI_CVs were compared for 12 clinical laboratory tests of healthy reference individuals across eight Asian cities, including Osaka, Hong Kong, and Hanoi. The results showed significant intercity differences in γGT, triglycerides and IgA. Conversely, a significant correlation was found only in ALP between the latitude of each city and the range of the 95% confidence intervals (r = −0.727, p = 0.041). However, this relationship was a pseudo-correlation, with small intestinal ALP, whose activity in serum is increased in blood types B and O, being a confounding factor. Estimation of 95% CI_CV by the BS method is practical in that it does not require complex calculations and is extremely useful for measurement method evaluation and assessment of interindividual differences.

Deep learning in artificial intelligence is a method of algorithmically detecting hidden features in data by training on a large amount of data. This method can generate an accurate decision model in the form of a multi-layered neural network inspired by the neural circuits of the brain. Although automated morphology classification requires high accuracy in differentiating various cell types, it has been reported that some conventional systems using machine learning cannot achieve high accuracy for reactive or neoplastic cells. In this study, we developed models for normal–reactive–abnormal lymphocyte differentiation to demonstrate the usefulness of artificial intelligence-assisted technology in blood morphology testing. Five models using residual neural networks were applied to deep learning, and their performance in automated morphological differentiation was evaluated. The original image set for training consisted of 6,402 typical nucleated blood cell images. A data augmentation process was applied to the original images, and transfer learning and fine-tuning were performed on each model. The subjects for clinical assessment were 25 healthy persons, 25 cases of reactive lymphocytosis, and 15 cases of acute lymphoblastic leukemia. The results of clinical assessments showed that the total accuracy ranges were 0.9433–0.9791 for healthy subjects, 0.8108–0.8425 for reactive lymphocytosis, 0.8248–0.8545 for acute lymphoblastic leukemia, and 0.8645–0.8875 overall. Our proposed artificial intelligence model of lymphocyte morphology differentiation using deep learning achieved a high recognition accuracy. We expect that this approach will be beneficial in developing morphological differentiation assistance technology for blood smear screening.

[Introduction] α-Amylase (AMY) is essential for diagnosing salivary gland and pancreatic diseases. During our correlation test using Gal-G₂-CNP and Et-G₇-pNP methods, we found significant discrepancies in AMY values for a specific sample. Therefore, we investigated substrate characteristics in the AMY measurement reagents and the reasons for discrepancy in the specific sample. [Method] We evaluated AMY and P-AMY measurement reagents, assessing reactivity differences due to isozyme variations and α-Glucosidase inhibitor effects between substrates. Moreover, the sample with significant discrepancies underwent PEG treatment. [Results] The correlations were strong for AMY. When the divergence rate was categorized into three groups, decreasing P-AMY proportion significantly increased the deviation rate between Gal-G₂-CNP and Et-G₇-pNP (p < 0.001). The α-Glucosidase inhibitors had no observed effect on the substrates (p = 0.703). The significant discrepancies sample had undergone PEG treatment, and suggesting macro-AMY as a possible cause. [Discussion] The AMY and the P-AMY reagents for Gal-G₂-CNP and Et-G₇-pNP showed strong correlations and yielded good results. However, AMY reactivity between substrates varied with P-AMY proportion. PEG treatment suggested macro-AMY as a possible cause for the divergence, but did not clarify the underlying reason for such significant deviation. In the future in Japan, as standardized methods for AMY become more prevalent, the likelihood of clinical discrepancies like this one is expected to decrease.

Introduction: Blood products for transfusion need to be stored in dedicated refrigerators equipped with self-recording temperature gauges and alarms. Centralized management within the transfusion department is essential, as this is a mandatory requirement for transfusion service accreditation and a common area of scrutiny during audits. In this study, we aimed to assess the utility of Bluetooth-enabled temperature and humidity sensors for red blood cell product temperature management. Methods: We utilized the BLE temperature sensor BST-01A (manufactured by LIMNO) and the obniz BLE/Wi-Fi Gateway (provided by Encored Japan). These sensors were installed in operating rooms, patient wards, and the transfusion department to evaluate their suitability for remote monitoring. Additionally, we placed BLE temperature sensors in transport bags to verify their effectiveness in temperature management during blood product transportation. Results: By connecting the gateway to the hospital’s Wi-Fi network, we successfully monitored the temperature of refrigerators in patient wards. Real-time observations included abnormal temperature readings, detection status, and remaining battery levels. Furthermore, placing BLE temperature sensors inside transport bags allowed us to track temperature fluctuations during transportation. Discussion: The use of BLE temperature sensors for red blood cell product temperature management is valuable, enabling more robust control. Recent research has explored electronic cooling-based blood transport systems (such as blood rotation) for effective blood product utilization, especially in remote or island regions. BLE sensors offer cost-effectiveness and compactness, making them a promising option for recording temperatures during transportation.

This study aimed to examine the basic performance of reagents for alkaline phosphatase (ALP) measurement using serum samples from patients undergoing hemodialysis using the IFCC standardization method (IFCC method) and former JSCC standardization method (JSCC method) and characteristics of activity values according to blood type and presence or absence of diabetes mellitus. Methods: Residual serum was obtained from patients undergoing hemodialysis in August 2023 using L-type Wako ALP/IFCC and ALP/J2 by the IFCC and JSCC method, respectively. The reagents were tested for concomitant accuracy, reproducibility in the laboratory, accuracy, dilution linearity, limit of quantification, influence of coexisting substances, correlation test as reagent performance tests, and ALP isozyme test to determine the difference in activity values between the blood type A/AB and B/O groups and in the presence of diabetes mellitus. In the basic performance test, the IFCC method showed good results in all tests; however, the JSCC method showed a negative error at high hemoglobin concentrations only in the hemolytic hemoglobin of the influence of the coexisting substances test. As a characteristic of blood groups, there was no difference in activity between the A/AB and B/O groups in the IFCC method; however, in the JSCC method, the activity was higher in the B/O group than in the A/AB group (p = 0.022). Among the isozymes, the B/O group had a higher percentage of the small intestinal type than the A/AB group (p < 0.001). Regarding the characteristics of patients with or without diabetes mellitus, there was no difference in activity values between the DM and non-DM groups using either the IFCC or JSCC methods, and isozymes. Conclusion: L-type Wako ALP/IFCC showed good reagent performance in serum from patients undergoing hemodialysis, suggesting that the difference in ALP values between the A/AB and B/O types was smaller than that of the JSCC method.

Mycoplasma pneumoniae is one of the major causative pathogens of atypical pneumonia and can cause severe pneumonia in certain instances. The number of antibiotics that can be used is limited, and early differential diagnosis to rule out typical bacterial pneumonia is recommended for initiating appropriate antibiotic treatment as soon as possible; however, conventional rapid antigen tests are not very sensitive, and a more sensitive rapid kit is therefore required. In this study, we evaluated the performance of a mycoplasma detection kit that uses a silver amplification-based high-sensitivity immunochromatography method and found it to be up to 64 times more sensitive than a conventional rapid antigen kit using the ATCC bacterial strain solution dilution series. With regard to M. pneumoniae DNA copy number and the number of colony-forming units a difference of 101.9 and 160.6 times, respectively, was observed, further indicating extremely high detection sensitivity. Additionally, this method is more useful because the use of a dedicated automated device provides more objective results and also helps avoid inaccurate reporting of results due to manual input.

The U.S. Food and Drug Administration (FDA) has approved Paige Prostate (Paige.US), an artificial intelligence (AI) technology that uses images to identify the area most likely to contain occult cancer in prostate biopsies. We evaluated the diagnostic accuracy of this system for detecting prostate cancer. The subjects were 108 biopsies from 10 patients with cancers, and the results of Paige Prostate analysis and HE staining diagnosis by humans were evaluated to determine: 1) Prostate’s biopsy diagnostic accuracy, 2) number of detected cancer areas, 3) Gleason pattern, and 4) reproducibility of the analysis. Prostate’s biopsy by Paige Prostate diagnostic accuracy is 100% sensitive and 82.3% specific. The concordance rate between Paige Prostate and human microscopic observation on Gleason pattern was 64.7% (44/68 areas: Patterns 3 and 4), whereas the concordance rate was 35.3% (24/68 areas: Pattern 4 glomerular-like structure, Pattern 5 signet ring cell subtype), indicating a tendency to misrecognize rare histological subtypes. Paige Prostate is a useful system that does not overlook cancer areas, In the future, further learning in non-cancerous areas and rare histological subtype areas will lead to practically useful pathological diagnosis AI with higher diagnostic accuracy.

Latex agglutination immunoturbidimetry is an immunological assay for pulmonary surfactant protein D (SP-D), but assay devices and reagents are limited. In this study, we conducted a basic performance evaluation of the reagent “Nanopia SP-D”, which can now be measured by a general-purpose automated analyzer. We evaluated the accuracy, analytical range, specificity, sample storage stability, and comparison with a control method, and obtained good results for all items. In terms of specimen storage stability, an increase in measured values was observed in specimens stored at room temperature from the 1st day to the 10th day, but the detailed cause of this increase was not clear. In comparison with the control method, some high value samples showed a bias in measured values, and some samples showed deviations in measured values from the control method, suggesting the possibility of storage conditions of samples or accidental errors. The high sensitivity of the test reagent is expected to contribute to early detection and prompt therapeutic intervention in lung-related disorders such as alveolar proteinosis and interstitial pneumonia.

Currently, reagents that can simultaneously detect HTLV-I and HTLV-II antibodies are widely used in screening tests for infection with human T-cell leukemia virus types I and II. In the present study, we compared HTLV-I/II antibody reagents based on chemiluminescence (Elecsys Reagent Anti-HTLV I/II, HTLV-Abbott and Lumipulse HTLV I/II). In the sensitivity comparison, in HTLV-I, Lumipulse HTLV-I/II was twice as sensitive as the others. In HTLV-II, Lumipulse HTLV-I/II was equivalent to HTLV/Abbott, and was twice as sensitive as Elecsys HTLV-I/II. The agreement rate for the correlation between each reagent, including SERODIA HTLV-I, the reagent used at our hospital, was 94.8% to 100%. Comparing the measured values of SERODIA HTLV-I and each reagent, the correlation was best in HTLV-Abbott. The measured value of the discrepancy in the sample that occurred between each reagent was near the cut off value, and the cause was thought to be a difference in reagent reactivity due to differences in each reagent composition and principle. Regarding the reactivity in each reagents positive specimen to various specific antigens of the confirmation reagent INNOLIA HTLV, the concordance rate was best with the Elecsys HTLV-I/II. Therefore, the present comparative study of the three HTLV-I/II antibody reagents based on the chemiluminescence method, all of them can be used as screening reagents with good sensitivity and specificity, but it is necessary to pay attention to positive cases near the cut off value and understand the characteristics of the measured values before using them.

To identify the features of bacteremia in patients on dialysis, we retrospectively examined the blood culture results taken over 6 years and 1 month at our specialized dialysis hospital. The most commonly isolated bacteria were Staphylococcus aureus including methicillin-resistant S. aureus (MRSA) (41.9%), with Staphylococcus spp. accounting for 50% or over. Importantly, vascular access, in particular, the dialysis catheter, was the focus of infection for more than 50% of patients. The isolation rate of Enterobacteriaceae bacteria was low (25.1%), and the suspected infection focus was the liver or kidney cyst. The 30-day mortality rate (10.3%) for patients with positive blood culture at our facility was lower than previous reports; however, the number of MRSA deaths (n = 7) accounted for 41.2% of the total deaths due to bacteremia (n = 17), which was significant. Patients on dialysis characteristically had a low isolation rate of Enterobacteriaceae bacteria and small number of deaths due to these bacteria. Therefore, the number of MRSA deaths was significantly high. Our results suggest that MRSA is a significant cause of bacteremia among patients on dialysis, and the dialysis catheter is a significant infection focus. In the future, studies that involved multiple facilities are needed to further clarify the etiology of bacteremia in patients on dialysis.

The aim of this study was to investigate the current status and effectiveness of patient identification for undiagnosed hepatitis C in medical institutions through a multicenter questionnaire survey. The questionnaire survey was performed at nine institutions approved by the Kyushu Immuno-Serum Study group. A total of 10,194 hepatitis C virus (HCV) antibody tests were performed. Of these, 248 (2.4%) were HCV antibody positive, and 9,946 (97.6%) were HCV antibody negative. After HCV antibody positivity, HCV-RNA was measured in 77 cases (31.0%). Of these, 16 (6.5%) were HCV-RNA positive, while 61 (24.6%) did not have HCV-RNA measured. In 171 cases (69.0%), HCV-RNA was not measured. Among those not measured, 109 (44.0%) had a history of HCV infection, and 56 (22.5%) were undiagnosed. The methods for undiagnosed hepatitis C pick-up included: two hospitals creating a list of HCV antibody-positive patients only, one hospital notifying the attending physician of a positive result by email only, two hospitals using an alert system in the electronic medical record only, and two hospitals implementing a combination of all three methods. The proportion of undiagnosed hepatitis C patients was significantly lower in hospitals using a combination of all three methods than in hospitals using only one method. The pick-up of undiagnosed hepatitis C in healthcare institutions is crucial, and we hope that the efficiency of pick-up will guide hepatitis C patients toward appropriate treatment.

Streptococcus agalactiae (Group B Streptococci; GBS) is known as a causative agent of infections in susceptible hosts such as the elderly and diabetic patients, and also causes severe invasive infections such as neonatal meningitis and sepsis. Because GBS has been sensitive to β-lactams, β-lactams, especially penicillins, have been used as first-line antimicrobial for GBS infection. Recently, however, the existence of GBS with reduced penicillin susceptibility (PRGBS) has been reported. Therefore, we investigated the antimicrobial susceptibility of 2,987 GBS strains isolated in our hospital from 2012 to 2022 and isolation rate of PRGBS. The PCG non-sensitivity rate for GBS declined after 2019 and remained around 2%. Respiratory specimens had the highest isolation rate of PRGBS at 22.1%. By age, the majority of isolates of PRGBS were from older persons in the 70s and above, regardless of specimen type. PRGBS was not isolated from genital specimens in the 10–40 age range or from newborns. PRGBS was isolated more frequently from hospitalized patients than from outpatients, especially from older hospitalized patients aged 70 years or older, who accounted for about 20% of isolates. In addition, PRGBS were nonsusceptible to penicillins, as well as to cephalosporins, macrolides, and fluoroquinolones, indicating that they tended to be multidrug-resistant. We consider it necessary to continue to monitor trends in GBS antimicrobial susceptibility for appropriate selection of antimicrobial agents for GBS infections.

The long-term video-electroencephalogram (vEEG) monitoring test simultaneously records brainwaves and video over several days. To evaluate the usefulness of vEEG, we retrospectively examined the capture of epileptic seizures on vEEG. As a result, seizures were captured in 56 of 117 cases (47.9%) in which vEEG was performed, and the capture rate was higher in cases with a high seizure frequency, cases with a high number of antiseizure medications, and cases with intellectual disability. Seizure types diagnosed after vEEG included generalized onset seizures (23.4%), focal onset seizures (62.6%), generalized onset + focal onset seizures (4.7%), unknown onset seizures (3.7%), psychogenic non-epileptic seizures (4.7%), and generalized onset + psychogenic non-epileptic seizures (0.9%). After vEEG, antiseizure medication was adjusted in 31 cases (26.5%), of which 12 cases showed a decrease in seizure frequency, 9 cases showed no change, 8 cases were unknown, 2 cases were continuing to be adjusted, and no cases showed an increase. Surgical treatment was performed in 28 cases (23.9%), including corpus callosotomy in 5 cases, epilepsy focus resection in 12 cases, vagus nerve stimulation in 10 cases, and deep brain stimulation planned in 1 case. 25 cases (21.4%) were followed-up, 18 cases (15.4%) were unknown, and 15 cases (12.8%) were judged to require further examination by stereotacticelectroencephalography. After detailed examination, epilepsy focus resection was performed in 7 cases, 1 case was judged to be unresectable, and 7 cases were unknown. In conclusion, vEEG is considered to be useful for the diagnosis and treatment of difficult cases.

In recent years, an increasing number of facilities have introduced urinary particle analyzers to improve the efficiency of urinary sediment testing and reduce the visual detection rate. The main measurement principles of urinary particle analyzers are flow cytometry and image analysis, and analysis methods that utilize the characteristics of each device are used. Detection of mulberry bodies is important as a screening test for Fabry disease, but detection of mulberry bodies is difficult even by visual inspection, and there have been no reports of detection of mulberry bodies using urinary particle analyzers. In April 2020, our hospital introduced AUTION EYE AI-4510 (ARKRAY, 2019), a urinary particle analyzer that uses image analysis. In this article, we report on image verification of mulberry bodies, which show various morphologies, using the AI-4510.

Spirometer calibration is verified by confirming whether the measured volume meets the accuracy requirement of ±3% using a 3-L syringe. We demonstrate the effectiveness of observing the waveform on a volume–time spirogram during calibration verification to identify equipment defects. We pushed and pulled the 3-L syringe five times and checked the plateau and repeatability of the positions at full expiration and full inspiration, in addition to the measured volume. For Case 1, the measured volume was within the calibration limit, but the positions at full expiration and full inspiration gradually changed. The abnormality disappeared after the breathing tubes were replaced. For Case 2, the measured volume was also within the calibration limit, but the positions at full expiration and full inspiration gradually changed. The abnormality disappeared after replacing the adapter connecting the breathing tube to the syringe. Pushing and pulling the 3-L syringe for some time and observing the waveform during calibration verification enabled the identification of mild defects in the equipment. These are useful indicators for quality control of pulmonary function tests.

Critical values are set by each healthcare organization according to the specific characteristics of its facilities. Reporting critical values is a key component of JCI certification and ISO 15189 accreditation. To enhance the rate of medical record entries within one hour of critical value reporting by medical technologist, so we show findings with tabulations before and after the review. The new critical values were approved by the Clinical Laboratory Appropriateness Committee in July 2020 and started to operate in the same month. We compared reports from April 2019 to March 2020 (“FY 2019”) and April 2021 to March 2022 (“FY 2021”). In FY 2019, the total number of reports was 3,131 (about 261 reports/month) and in FY 2021, the total number of reports was 1,631 (about 136 reports/month). An increase in critical value reporting can strain on laboratory personnel, and interferes with the work of the physicians receiving the reports and may reduce the tension over critical value reporting. In addition to reviewing critical values, we regularly report the results to each department head and keep trying to request cooperation from departments with low reporting rates, but the JCI goal has not been achieved. In the future, we would like to evaluate each item and implement effective measures to further improve the rate of medical record entries.

Background: Trophoblastic differentiation, when observed, indicates a pathological condition that holds clinical significance as it predicts a poor prognosis. It is difficult to differentiate trophoblastic differentiation from other similar cytomorphological changes, and sensitivity and specificity of β-hCG, conventional trophoblastic differentiation marker, are limited. Case: A male patient in his late 70s presented with a bladder tumor measuring 11 cm in diameter as detected by CT scan. Urine cytology indicated high-grade urothelial carcinoma, so he underwent chemotherapy. After tumor reduction, radical cystectomy was performed. Histological examination of resected tumor revealed, in addition to conventional high-grade urothelial carcinoma, pale cells with distinct cell borders and mononucleated or multinucleated giant cells suggesting trophoblastic differentiation in the tumor. Immunohistochemical staining showed approximately 1% positivity for β-hCG in giant cells, while HSD3B1, a marker with excellent sensitivity and specificity for intermediate trophoblasts and syncytiotrophoblasts, was positive in most giant cells. Urine cytology before chemotherapy showed few giant cells, while post-chemotherapy urine cytology revealed numerous mononucleated and multinucleated giant cells. Immunocytochemical staining showed approximately 1% positivity for β-hCG, but approximately one-quarter of the giant cells were positive for HSD3B1. Final diagnosis of urothelial carcinoma with trophoblastic differentiation was made. Conclusion: The experience of the present case recommends immunostaining of HSD3B1 when giant cells are observed in pathological specimens of the patients undergoing chemotherapy for urothelial carcinoma to rule out cellular damage due to chemotherapy.

Streptobacillus notomytis is a pathogen that causes rat-bite fever, similar to Streptobacillus moniliformis, and has been identified as a new species in 2015. These two bacteria are difficult to differentiate using biochemical properties and mass spectrometry; therefore, genetic analysis is required. We encountered a case in which ingestion of food contaminated with rat excrement was suspected to cause arthritis and bacteremia, which were identified as S. notomytis by genetic analyses. A woman in her 70s was admitted to our hospital with pain in the knee joints and fever. Blood tests showed elevated inflammatory markers and computed tomography revealed fluid retention in the knee joints. On hospitalization day 4, a cloudy articular fluid culture was detected with filamentous gram-negative rods, which we suspected to belong to the genus Streptobacillus. We asked the clinical side to confirm contact history with rats and received information that her home was infested with rats. Blood culture was extended to 14 days, and gram-negative rods were detected on hospitalization day 9. Mass spectrometry identified S. moniliformis, but the score was low. It was identified as S. notomytis by 16S rRNA gene analysis. For mass spectrometry, the database for the genus Streptobacillus contains only S. moniliformis. Therefore, if the identification score is low, S. notomytis infection should be considered. Additionally, on suspecting S. notomytis based on morphology, it is important to extend the incubation period and confirm the animal contact history. In this case, these measures led to a successful diagnosis and treatment.

A woman in her 80s undergoing peritoneal dialysis presented to our hospital with diarrhea and vomiting. She exhibited systemic symptoms such as decreased appetite and leg edema, leading to an emergency admission with suspected infectious enteritis and peritonitis. Blood cultures and samples of continuous ambulatory peritoneal dialysis (CAPD) effluent were submitted, but no pathogens were detected. Because the inflammatory response persisted and antimicrobial therapy did not improve symptoms, blood cultures and CAPD effluent were again submitted, but were negative for culture. However, fully automated analyzer of formed elements in urine (UF-5000) detected bacteria in the same CAPD effluent, raising suspicion of mycobacterial infection. Acid-fast staining was performed and was positive. Additionally, Mycobacterium tuberculosis gene testing using loop-mediated isothermal amplification was positive, confirming the presence of M. tuberculosis. Further testing of submitted gastric juice also detected M. tuberculosis, leading to a diagnosis of tuberculous peritonitis and pulmonary tuberculosis. Mycobacteria are difficult to stain with Gram staining and require a lengthy culture process. Without noticing the discrepancy between the UF-5000 results and bacterial culture results, it is highly likely that M. tuberculosis would not have been detected. This case highlights the importance of interdepartmental collaboration in contributing to pathogen detection and diagnosis.

Platelet products also contain small amounts of red blood cells, but considerations such as the selection of antigen-negative blood for irregular antibody-positive patients are not currently made. In the present case, we experienced a case detected anti-E by secondary immune response. A man in his 70s was started on AZA therapy for MDS in March 20XX − 2. In January 20XX, an irregular antibody test was positive and the identification test was identified anti-E. All of Recent erythrocyte products contained DCCee, but the donor antigen of the platelet product was DCcEe. Irregular antibody tests were only positive for the ficin method. DTT treatment revealed anti-E of IgG type. Differential tests for mimicking antibodies were performed and mimicking antibodies were excluded. After the detection of anti-E, E-antigen-positive platelet products were transfused, but no haemolytic findings were observed. The results suggest that multiple rounds of immunosensitisation may be required to reactivate antibodies by platelet products. On the basis of this case, we will seek to investigate the possibility that platelet transfusion induces a secondary immune response and the production of irregular antibodies.

We report three cases of left ventricular stenosis in patients with other than hypertrophic obstructive cardiomyopathy or hypertrophic cardiomyopathy with midventricular obstruction. Case 1 was a patient diagnosed with takotsubo cardiomyopathy, and transthoracic echocardiography (TTE) revealed left ventricular outflow tract stenosis due to sigmoid septum and hypercontraction of the left ventricular base. The mitral valve anterior apex was long in morphology and the left ventricular outflow tract stenosis also appeared, indicating systolic anterior motion (SAM) and associated moderate mitral regurgitation (MR). Case 2 had breathlessness on exertion, and coronary angiography (CAG) showed no significant stenosis. TTE revealed a form of concentric remodeling and sigmoid septum, with no left ventricular outflow tract stenosis, but a long mitral apex, SAM-like, and mild MR. A master two-step test was performed until the onset of symptoms, and symptoms appeared after 5 minutes of loading. TTE at that time showed left ventricular stenosis at mid level. Case 3 was under observation for exertional angina pectoris and complained of breathlessness, although CAG showed no significant stenosis. TTE showed concentric remodeling, narrowing of the lumen, and a tendency for the lumen to disappear during systole, but no accelerated blood flow, but when Valsalva loading was performed, left ventricular stenosis was observed at mid level. Characteristic morphology led to the appearance of left ventricular accelerated blood flow, and TTE was useful in one case to detect the cause of MR due to left ventricular outflow tract stenosis, and in two cases to detect subclinical left ventricular stenosis.

We report a case of acute myeloid leukemia with Major-BCR::ABL1, which could not be detected by RT-qPCR method. The patient was a male in his 70s. He was diagnosed as acute myeloid leukemia because of the finding of leukocytosis and 37% blast-like cells in the peripheral blood and 26.6% in the bone marrow. In the bone marrow, we conducted RT-qPCR as a screening method for chimeric gene, including Major-BCR::ABL1 which commonly found in leukemia patients. Although no chimeric gene was detected by RT-qPCR, cytogenetics and FISH indicated the existence of BCR::ABL1. Later, detail investigation revealed that the fusion gene in this case was the Major-BCR::ABL1 [e14 (b3) a3 type], in which the ABL1 has a rare cleavage point. In addition, we built a new method based on RT-qPCR for measuring Major-BCR::ABL1 [e14 (b3) a3 type]. New method enables us to detect not only a2 type Major-BCR::ABL1 but also a3 type Major-BCR::ABL1. We will adapt the new method as a screening for patients suspected with leukemia, especially at the first onset.