Rinsho byori. The Japanese journal of clinical pathology最新文献

Severe fever with thrombocytopenia syndrome (SFTS) caused by the SFTS virus (SFTSV), a novel phlebovirus belonging to the family Bunyaviridae, is an emerging infectious disease recently described in China, and a serious disease with a 7.8-46% case fatality rate. SFTSV is believed to be mainly transmitted by ticks (arthropod-borne infection). However, direct contact with infected blood or bloody secretions can cause infection, and a few clusters of cases have been reported, which suggests human-to-human transmission of the disease. The major clinical signs and symptoms of SFTS are fever, abdominal symptoms, thrombocytopenia, leuko- penia, and elevated serum hepatic enzyme levels. The typical course of infection has four distinct periods: incubation (4-14 days), fever (7 days), multiple organ failure (7-14 days), and convalescence. Immune activation and exaggerated cytokine production in the form of cytokine storm can potentially drive the SFTS disease process. As a result of cytokine storm, patients develop hemophagocytic lymphohistiocytosis, but the possibility of latent infection has also been reported, and not all cases are diagnosed. Further research is warranted for an improved understanding of SFTS. [Review].

Chronic liver diseases consist of several etiologies, including hepatitis C virus (HCV), hepatitis B virus (HBV), and non-alcoholic steatohepatitis (NASH). All these diseases can progress to liver cirrhosis and finally hepatocellular carcinoma (HCC). Recently therapies against HCV have markedly improved. Several direct anti-viral agents (DAAs) have been developed that show significant viral eradication efficiency. How- ever, viral eradication does not mean the complete cure of hepatitis C. Several reports have shown that, even after HCV eradication, HCC can occur in some patients, especially in those with advanced liver fibrosis. As well as HCV, patients with HBV have also shown that advanced liver fibrosis is associated with a high rate of HCC development. Accordingly, anti-fibrosis therapy would be one promising approach to improve the prognosis .of chronic liver disease patients. However, to date, no anti-fibrotic agent has been approved in clinical practice. We focused on angiogenesis. Angiogenesis has now been recognized to play an important role in many physiological and pathological events. We found that several clinically available agents exerted a marked anti-fibrotic effect both in basic and clinical studies at least partly mediated by anti-angiogenic activ- ity. Until newly developed agents become available, these clinical agents may offer alternative strategies against chronic liver diseases. [Review].

It has become easier to acquire patients' clinical information from clinical laboratories using the electronic medical record system. However, it is possible that clinical laboratories do not consider abnormal laboratory data when elucidating the pathological mechanism of diseases in patients when their clinical information is obtained from the electronic medical records. In this reversed clinicopathological conference, we analyzed the laboratory data of a patient with elevated lactate dehydrogenase (LD) levels and anemia. Although the presence of hemolysis was clear from the elevated LD levels, anemia, and decreased haptoglobin levels, the ,excessive increase in the LD level suggested a particular mechanism of hemolysis. Drug intake was sus- pected on the basis of a prolonged prothrombin time with a normal activated partial thromboplastin time. At the conference, these findings led to in-depth discussions. We elucidated the pathological mechanism in this patient based only on the laboratory data, with intentionally restricted clinical information, and again recog- nized the importance of analyzing laboratory data thoroughly. Training modules for medical technologists and doctors in clinical laboratories that provide information regarding elucidating pathological mechanisms using laboratory data may prove useful for improving the nature of comments in laboratory data reports. In addition, clinicians should also receive training to elucidate the pathological mechanism of a disease on the basis of only laboratory data, as well as training for diagnosing patients on the basis of clinical information and physical examination findings. [Review].

In a borderless era, infectious diseases that are prevalent in other countries may also spread to Japan at any time. Among such diseases, attention should particularly be paid to emerging, re-emerging, and zoonosis, arthropod-borne infectious diseases, as well as those occurring after major disasters. Important emerging infectious diseases include SARS, swine influenza, MERS, and infection by antimicrobial-resistant bacteria, while zoonosis is represented by rabies. Rabies is a vaccine-preventable, but vaccination is insufficient due to high costs in some areas. Arthropod-borne infectious diseases, such as malaria, dengue fever, Chikungu- nya fever, Zika fever, and yellow fever, are also important. Learning various lessens from the management of these diseases in other countries, human resource development is currently being promoted in Japan. [Review].

Dengue fever is a painful, debilitating, arthropod-borne disease. In recent years, dengue endemic regions have markedly expanded in the tropics, South-east Asia, and the Americas. Epidemics have also been re- ported in subtropical regions of East Asia and Europe. Factors including an increase in the frequency of international travel and period of stay, increase in population density, and global warming, are hypothesized to be associated with the rapid spread of dengue. Approximately 4 billion people are estimated to be infected with the virus each year'). However, there are no effective therapeutics nor clinically approved vaccine for dengue in the region. In 2014, a local dengue outbreak involving 162 cases occurred in Japan2). With the increasing annual numbers of imported dengue cases, there is a need to strengthen and improve the capacity for disease control and prevention. [Review].

Objective: Our recent study for the first time reported genotyping method of the diazepam binding inhibitor (DBI) rs2276596 polymorphism using a Polymerase Chain Reaction-Restriction Fragment Length Polymor- phism (PCR-RFLP), and revealed a significant relationships between this polymorphism and alcohol depend- ence. In this study, to facilitate elucidation of the pathogeneses of psychoses including schizophrenia and mood (affective) disorders, we investigated the relationship between the DBI rs2276596 polymorphism (C/A) and psychoses.

Method: We analyzed the DBI genotypes using the PCR-RFLP method in healthy controls, and psychotics including schizophrenia and mood (affective) disorders (including recurrent depressive disorder and bipolar affective disorder) (ICD-10: F31, F33).

Result: There was no significant difference in the rs2276596 genotype and allele frequencies of the DBI gene between these psychoses and healthy controls.

Conclusion: The present data suggested that a mutated allele of the DBI was not one of the risk factors for schizophrenia and mood (affective) disorders, as for the rs2276596 polymorphism. [Original].

More than 700,000,000 prescriptions are issued every year for the approximately 18,000 pharmaceutical products in Japan. Consequently, numerous measures have been implemented to ensure the safety and efficacy with which these large quantities of drugs are managed. One of these approaches is the PreAVOID report, which focuses on the prevention and avoidance of adverse reactions and drug interactions by collect- ing and analyzing pharmaceutical care reports compiled by hospital pharmacists. According to the Japanese Society of Hospital Pharmacists, more than 20,000 such reports are issued annually. These reports are screened for abnormal clinical test values to identify which adverse reactions occur at the highest frequencies. While many hospital pharmacists scrutinize these laboratory test sheets, the awareness of clinical laboratory specialists regarding prescribed medicines is not known. We therefore invited specialists who are well versed in matters related to pharmaceutical risk management to this symposium to present the latest topics related to the influence of prescribed medicines on laboratory test values, and to discuss current issues asso- ciated with monitoring adverse events and adverse reactions. In addition, we examined potential strategies for avoiding severe adverse effects by establishing specialist teams and the role of laboratory specialists on such teams. [Review].

Macroprolactin is mostly a complex of monomeric prolactin (PRL) with IgG and considered to be biological inactive. Its presence commonly leads to diagnostic confusion and misdiagnosis. Polyethylene-glycol (PEG) precipitation method is widely used for a screening of macroprolactinemia. We applied PEG precipi- tation method for 200 samples which was ordered test of PRL. The PRL recovery was 65.0±11.2% (mean ±SD). In our data, PRL recovery less than 42.5% (mean-2SD) indicates the presence of macroprolactin. The prevalence of macroprolactinemia was 4.5%(9/197) in total samples and 9.5%(2/21) in hyperprolac- tinemia. Our result indicates the need for PEG screening for macroprolactinemia to avoid misdiagnosis. [Short Communication].

Middle East respiratory syndrome (MERS) is an emerging infectious disease of growing global importance, which has caused severe acute respiratory disease in more than 1,700 people, resulting in almost 600 deaths. MERS is caused by a novel betacoronavirus (MERS-CoV). All cases of MERS have been linked through travel to or residence in countries in or near the Arabian Peninsula. Dromedary camels are considered natu- ral reservoirs for MERS-CoV. MERS-CoV is mainly transmitted from infected dromedary camels to human beings, and it is transmitted among human beings by droplets, contact, and perhaps airborne spread. Both community-acquired and hospital-acquired cases have been reported with little human-to-human transmis- sion reported in the community. The largest known outbreak of MERS outside the Arabian Peninsula oc- curred in the Republic of Korea in 2015, with 186 cases. The outbreak was associated with a traveler re- turning from the Arabian Peninsula. Clinical features of MERS range from asymptomatic or mild disease to acute respiratory distress syndrome and multi-organ failure resulting in death, especially in individuals with underlying comorbidities. MERS is suspected in the presence of febrile acute respiratory illness and close contact with MERS-CoV, and can be confirmed by the detection of viral nucleic acid through RT-PCR or se- rology. No specific drug treatment exists for MERS; however, the neutralizing antibodies, ribavirin and interferon have been shown to be potentially useful anti-MERS-CoV drugs. Rigorous infection prevention and control measures with droplet and contact precautions are crucial to prevent the spread in health-care facilities. [Review].

Recently, hepatitis B virus (HBV) reactivation has attracted attention as a complication of cancer chemo- therapy or immunosuppressive therapy. To prevent hepatitis B due to HBV reactivation, practical guide- lines were issued in 2009. The guidelines include the relevant diagnostic algorithms for HBV markers (HBsAg, anti-HBc, anti-HBs, and HBV-DNA). Nonetheless, cases of acute liver failure due to HBV reacti- vation have occurred in Japan since 2009, likely because many of the physicians prescribing anti-cancer or immunosuppressive agents have not acted in conformity with the guidelines. The reasons for this non- conformance are considered to be as follows: First, the incidence of HBV reactivation varies markedly be- tween anti-cancer or immunosuppressive agents, and many physicians are simply not aware of this risk. Second, establishing a system for assessing compliance to the guidelines is complicated because it requires integrating both prescription data and HBV marker data, and then feeding back this information to physicians. Several medical faculties have established a survey system by establishing specialist teams comprising a hepatologist, pharmacist, laboratory technician, medical information manager, and other specialists. The multidisciplinary nature of these teams means that the actions of individuals are complemented and supported by the team as a whole and problems are resolved through teamwork. The role of clinical laboratory special- ists is likely to become more important, as their commitment to teamwork means that they are highly capable of supporting the development of clinical risk management initiatives. [Review].