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

MicroRNAs (miRNA) are non-coding small RNAs. Exosomes carry extracellular miRNAs in plasma and other body fluids. Levels of plasma miRNAs show disease-specific changes. Thus, miRNAs are expected to be new biomarkers in many diseases. However, the method of analysis of plasma miRNAs is not well established. In this study, we tested the influences of high speed centrifugation and membrane filtration on results from plasma miRNA analysis using reverse transcriptase-based quantitative polymerase chain reac- tion (RT-qPCR). We studied plasma from 12 normal subjects. The level of plasma miR-451 did not change significantly after high speed centrifugation and filtration, rather showed slight increment, 1.543 ± 0.263 fold (mean±SD, N=3). The levels of plasma miR-126 and miR-223 decreased with high speed centrifugation and filtration, (0.038 ± 0.008 fold and 0.041 ± 0.003 fold, respectively). Our data suggested that removing platelets and cellular debris from plasma with high speed centrifugation and/or filtration is essential for stand- ardization of plasma miRNA analysis. [Original].

As natural disasters have been occurring more frequently in recent years, the need to prepare for a future disaster is growing. Based on the experience of the Great Hanshin earthquake occurred in 1995, we pre- dicted that laboratory test demand will be increased one week post-disaster. Also, the provision of medical and health care services is indispensable in areas affected by disasters for not only acute-phase patients, but also for those with diabetes, hypertension, and chronic diseases. This study summarized how laboratory medicine supplies were provided to the region affected by the Great East Japan earthquake occurred in 2011. In order to provide laboratory medicine supplies in the affected region, the Japanese Society of Laboratory Medicine set up a committee to respond to the Great East Japan earthquake as a temporary measure. Since electric power and water supplies are cut after a disaster, we decided to provide support using Point-Of-Care Testing (POCT) devices and disposable In-Vitro Diagnostic (IVD) reagents. A total of 40 companies agreed to provide support, and more than 100 IVD reagents were prepared. We posted the above information on our website, and updated it immediately when additional support requests were made. In addition, volunteer clinical technologists were sent to the affected region for 8 weeks, in order to support laboratory tests per- formed in temporary clinics or first aid stations. This experience was immediately applied to medical sup- port activities performed after the 2016 Kumamoto earthquake. This study identified the usefulness of la- boratory tests and clinical technologists in disaster-affected regions. [Review].

Inflammatory biomarkers have been considered as a promising option to help diagnose infections, where uncertainty exists in the clinical or microbiological diagnostic approach. However, there is an inherent weakness in biomarkers, given the fact that infection is one, but not all, of the causes of inflammation. Clas- sical markers such as white blood cells or c-reactive proteins confer a low diagnostic accuracy. Procalcitonin or presepsin, relatively new markers, show better, but still imperfect overall sensitivity/specificity of -75- 80%, indicating that it is difficult to use any biomarkers as a sole diagnostic test of infection. Serial meas- urements of procalcitonin provide information regarding stopping antibiotics earlier, and could be utilized in the context of an antimicrobial stewardship program. Further research is necessary to investigate the pos- sibility of utilizing biomarkers in combination with other genetic diagnostic methods as rapid, point-of-care, tests. [Review].

In this report, we reviewed the results of RCPC held at the 63rd national congress of the Japanese Society of Laboratory Medicine. The case was a 9th decade female with dementia, who had anemia pointed out on a routine laboratory check. The type of anemia was macrocytic(MCV>130 fL). The serum Vit.B12 and folate levels were markedly decreased. However, her anemia was not improved despite supplementation with Vit.B12 and folate (data on MCV were improved). The WBC increased gradually, but she subsequently died. Laboratory data were assessed by three doctors (DN, NM, and TT: blood cell counts, smear morpholo- gy of peripheral blood cells, and clinical chemistry, respectively). They diagnosed the patient with a hema- tological disorder, probably neoplastic hematological diseases; however, it was very difficult to make a further clinical diagnosis because of the necessary data not presented at this meeting. The final diagnosis was acute myeloid leukemia (AML-M4). The direct cause of death was rupture of her spleen due to the massive infil- tration of neonlastic cells. rReviewl.

Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is a curative therapy for hematologic ma- lignancies. However, there are some potentially fatal complications, including graft-versus-host disease or infections, and transplant-related mortality is still high. One of the life-threatening complications related to allo-HSCT is cardiotoxicity. There are several causes of cardiotoxicity, such as pre-transplant chemothera- py, conditioning chemotherapy, cytokine storms due to sepsis or allogeneic immune reactions, rapid altera- tion of body fluid, and ischemic heart disease caused by transplant-associated thrombotic microangiopathy or calcineurin inhibitors. Echocardiography is a very useful and convenient method when assessing the cardiac function in daily clin- ics. The ejection fraction is a useful surrogate marker of the cardiac systolic function, and the trans-mitral valve inflow pattern is a useful surrogate marker of the cardiac diastolic function. There are several causes of cardiotoxicity during the course of allo-HSCT. In the pre-phase of allo-HSCT, the cumulative dose of anthracycline before transplantation is correlated with the rate of cardiac complications. In the acute phase of allo-HSCT, we should bear in mind cyclophosphamide-induced cardiotoxicity. Since these cardiotoxicities sometimes cannot be detected in the cardiac systolic function but can in the diastolic one, we should evaluate the cardiac diastolic function such as trans-mitral valve inflow pattern with echocar- diograms. In addition, some types of conditioning chemotherapies could have significant impacts on cardiac functions even in the chronic phase of allo-HSCT. In conclusion, it is very important to assess cardiac systolic and diastolic functions using echocardiograms for the improved management of cardiotoxicity in allo-HSCT recipients. [Review].

A high sensitivity quantitative assay for hepatitis B virus (HBV) surface antigen (HBsAg-HQ assay) was recently developed and is useful for earlier detection of HBV reactivation. We created HBsAg-HQ assay operational proce- dures by the sample transport system and laboratory information system. In this study, we evaluated the perfor- mance and utility of the HBsAg-HQ assay based on our operational procedures using internal quality control (IQC) data and 13,762 samples routinely measured for 8 months. The IQC data of the HBsAg-HQ assay demonstrated good accuracy (CV: 1.6-2.7%). The difference in IQC data between two of the same analyzers or several reagent lots had no clinical significance. Of 13,762 samples, HBsAg titer was negative in 12,592(91.5%) and positive in 1,169(8.5%), and HBsAg negative samples were remarkably lower(<0.001 IU/mL) than the cut-off value(0.005 IU/mL). Among 114 HBsAg weakly positive samples ranging from 0.005 to 1.000 IU/mL, false positive results occurred in 12 samples, which were converted into negative results after re-measurement. We could effectively perform carry-over prevention and dilution of high titer samples using our operational procedures. Furthermore, we performed inhibition test in 52 HBsAg weakly positive samples, and 20 samples, most of which were taken from patients with connective tissue disease or malignancy, were judged as non-specific reactivity. Taken together, our operational HBsAg-HQ assay procedures may contribute to efficient workflow for routine testing. Moreover, the HBsAg-HQ assay may be clinically useful for not only highly sensitive assays, but also for reducing false positives.

During disasters, medical services are occasionally provided by temporary medical offices organized within emergency shelters. The types of disease dealt with by these offices change with time after the event, and their conditions also change depending on the time needed for normal activities to resume. As usable devic- es and test methods are limited due to various causes, such as interrupted life lines, it is necessary for medi- cal service providers to flexibly manage the situation, and for supporters to provide them with resourceful support. [Review].

The clinical laboratory is essential to medicine in general. Clinical laboratory staff with a core of medical technologists are asked to take part in disaster medicine, and their education and training are urgently neces- sary to markedly contribute to disaster medicine. Clinical laboratory staff who participate in disaster medicine should have the following: 1) understanding of disaster medicine and the skills to implement it, 2)warm spirits of togetherness with disaster victims and enthusiasm to help them, 3) physical strength and self-control, 4) the ability to communicate and connect with other staff, 5) the ability to devise clinical laboratory systems according to the situation. It is desirable for associations of clinical laboratory and those of disaster medicine to work together to de- velop education programs and certification systems, and for education programs to be developed into medical technologist-training schools. [Review].

Despite the marked progress in the procedure of allogeneic hematopoietic stem cell transplantation (allo- HCT) as a curative therapy for hematological malignancy, we still need to resolve issues in clinical laboratory testing for the assessment of transplant patients. For example, minimal residual disease (MRD) negativity before transplantation is known to be associated with good survival, but the widespread use of the multi-color flow cytometry system is needed for the routine assessment of MRD. In addition, we should apply an appropriate testing system for counting harvested bone marrow cells with careful consideration of the meas- urement principle of testing equipment because bone marrow is different from peripheral blood in its compo- sition of cells and components. It is also a problem that the short tandem repeat-polymerase chain reaction (PCR) for the evaluation of donor chimerism is not covered by Japanese national health insurance. Tissue biopsy is useful for the diagnosis of graft-versus-host disease, transplantation-associated microangi- opathy, and sinusoidal obstruction syndrome. It is, however, potentially dangerous for patients who have thrombocytopenia after allo-HCT to undergo a biopsy. Non-invasive tests including surrogate makers for the diagnosis of those complications are highly desirable, but they have been not established. Moreover, limitations in the diagnosis of infection after allo-HCT by laboratory tests include the poor clinical utility of the viral antibody test after allo-HCT and the fact that quantitative virus PCR tests after allo-HCT are not covered by Japanesehational health insurance. The number of long-term transplant survivors has increased in recent years. We therefore need to focus on treatment strategies against long-term complications after allo-HCT and the improvement of the quality of life. Further progress in laboratory medicine in the allo-HCT field may contribute to the prevention of late complications and/or improvement of the quality of life. I.

The metabolism and nutrition section of JSLM2015 was constructed following the previous version JSLM2012. The examinations of dyslipidemia and glucose metabolism and weight loss and obesity were described in the first chapter Laboratory data approach and the second chapter Symptoms, respectively. Dyslipidemia, diabetes, gout and hyperuricemia, and osteoporosis were described in the third chapter Diseas- es. This paper provides an outline with a focus on dyslipidemia examination and dyslipidemia in the first and third chapters, respectively. [Review].