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

Antimicrobial dosing can be targeted to achieve pharmacokinetic (PK) -pharmacodynamic parameters at the minimal inhibitory concentration of bacteria. Therapeutic drug monitoring (TDM) of glycopetides [vanco- mycin (VCM) and teicoplanin] and aminoglycosides (gentamicin, tobramycin, and amikacin) makes it possible to optimize dosing in individual patients. TDM of these antimicrobials can improve clinical outcomes, de- crease adverse events, and reduce costs. Therefore, PK-monitoring for VCM and aminoglycosides is rec- ommended in the Antimicrobial Stewardship Program implementing guidelines developed by the Infectious Disease Society of America and the Society for Healthcare Epidemiology of America in 2016. In addition, Clinical practice guidelines for TDM have been developed by the Japanese Society of Chemotherapy and the Japanese Society of TDM since 2012, and they were updated in 2016. The aim of this study was to review TDM of antimicrobial agents. [Review].

In Japan, the number of living renal transplant donors with medical complications has been increasing in recent years due to the.aging of donors. It is important to assess donor renal function properly before donation to ensure donor safety. This study aimed to assess different renal function measures of donors, includ- ing serum creatinine (Cr), creatinine clearance (Ccr), estimated glomerular filtration rate (eGFR), and inulin clearance (Cin). The mean Cr and eGFR values of 64 donors before surgery and at 1 month, 1 year, and 3 years after surgery were 0.74, 1.15, 1.13, and 1.05 mg/dL, respectively, and 71.7, 42.4, 44.9, and 49.5 mL/min/1.73m2, respectively. Values of eGFR 3 years after surgery in 20 out of 36 donors (55.6%) were less than 50 mL/min/1.73m2, showing that moderately decreased levels of GFR persist for a long time after donation. The preoperative renal function of 20 candidate donors was evaluated based on Cr, Ccr, eGFR, and Cin. The mean preoperative values were Cr 0.74 mg/dL, eGFR 71.9 mL/min/1.73m2, Ccr 137.3 mL/min, and Cin 92.9 mL/min. Ccr overestimated Cin in 18 out of 20 donors (90%) and eGFR underestimated Cin in 16 donors (80%). Cin measurements are complicated, which can lead to human errors in measurement. Conversely, eGFR measurements are simple but are inferior to Cin in terms of accuracy; therefore, the pre- operative renal function of donors should be evaluated by Cin, combined with other tests as much as possible to ensure a safe living renal transplant. [Original].

Calcineurin inhibitors, cyclosporine and tacrolimus, and everolimus are used to prevent reactions following organ transplantation. However, these immunosuppressive drugs have narrow therapeutic ranges, and their inter- and intra-individual pharmacokinetics differ greatly. Therefore, daily doses must be adjusted accord- ing to blood trough concentrations. Although mycophenolate mofetil is generally used in a fixed dosing strategy, the need for more accurate drug dosing has become evident. A number of clinical factors, such as the time from transplantation, patient age and ethnicity, food consump- tion, albumin and hematocrit values, liver function, gastrointestinal motility, concomitant medication, and genetics, may affect the pharmacokinetics of immunosuppressive agents. The Japanese Society of Therapeutic Drug Monitoring (JSTDM) and the Japanese Society of Transplantation (JST) have developed and launched the first TDM guidelines to standardize routine TDM practice for immu- nosuppressive drugs used in kidney, liver and heart transplantation. These guidelines describe a consensus document among transplantation experts of the JST and TDM experts of the JSTDM. In the main part of this document, the TDM guidelines for immunosuppressive drugs are summarized and described. [Review].

A case conference of hematological malignancies based on the morphology of blood cells was held as a Joint Symposium of the Japanese Society of Laboratory Medicine and Japanese Society of Laboratory Hematology. This style of joint symposium was held four times from 2012 to 2016, whereas child cases were presented for the first time this year. The 4 cases presented in this symposium were as follows: an infant with Down syn- drome showing an atypical clinical course of transient abnormal myelopoiesis (TAM) and myeloid leukemia, a relatively older girl with juvenile myelomonocytic leukemia (JMML), one adult with acute myeloid leukemia (AML) with inv (16) (p13.1q22); CBFB-MYH11 morphologically resembling AML with t (8;21) (q22;q22.1); RUNX1-RUNX1T1, and one adult with high-grade B-cell lymphoma showing t (14;18) (q32;q21); IGH/BCL2. Each case included pathological and interesting morphological findings that were carefully examined and in- tensively discussed by two experienced commentators and participants, including pediatric hemato- pathologists. The importance of the morphological evaluation of characteristic cells such as immature leukemic blasts or lymphomatous ones was reconfirmed at this conference. In addition, immunological, cytogenetic, and molecular examinations were also essential for the final diagnosis of these cases. [Review].

Objective: We analyzed sonographic appearance of dermatofibroma, schwannoma, small-sized venous mal- formation, glomus tumor, nodular fasciitis, and thrombus for effective use in the diagnosis.

Methods: We evaluated with sonography 44 subcutaneous nodules in histopathologically proven cases.

Results and discussion: 1) Sonography was the most useful for diagnosing schwannoma. Six of 8 lesions were diagnosed correctly from sonographic appearance. They had increased posterior echo and Doppler flow signals. 2) Sonography was helpful in diagnosis of subungual glomus tumor, though malignant melano- ma should be excluded. One of 6 glomus tumors was not detected but all of the other had well-defined mar- gins and showed internal vascularity. Three subungual glomus tumors were diagnosed from sonographic appearance although 2 nonsubungual tumors were not. 3) It was difficult to diagnose nodular fasciitis with sonography. Two of 5 cases were not detected. The other 3 lesions were ill-defined, and 2 were hy- perechoic and 2 showed internal vascularity. Interval between emergence of the lesion and sonography ex- amination was important. This duration was more than 50 days in lesions not detected with sonography, about 20 days in 2 hyperechoic lesions, and 6 days in a hypoechoic lesion. 4) Dermatofibromas (n =14) were also difficult to be diagnosed. The region was very characteristic, that is, in the upper dermis. Other find- ings, such as hypoechoic appearance and well-defined margin, were nonspecific.

Conclusion: Sonography was more useful for diagnosing schwannoma and glomus tumor. We have to know their characteristic appearance on sonography to use sonography effectively. [Original].

Biological therapy with companion diagnostic such as the combination of anti-Her-2 therapy (Herceptin™) and measurement of Her-2 expression in breast tumors (HercepTest™) has proven successful in Oncology. Screening targets that have both diagnostic and therapeutic applications (theranostic targets) at the discovery stage should provide the best strategy for the development of novel targeted therapies with companion diag- nostics in Oncology. This strategy is at the basis of the product pipeline developed by A&G Pharmaceutical. To identify theranostic targets, A&G has developed a biological screen for functional drivers of tumorigenesis abnormally expressed in cancer tissues when compared to normal tissue counterparts. The advantage of this strategy is that identified targets will combine from the start, diagnostic and therapeutic applications. A&G has identified a secreted 88 kDa autocrine growth and survival factor, GP88 (progranulin) overex- pressed in cancer tissue and has demonstrated its critical role in the biological process of breast cancer devel- opment, invasiveness, survival and drug resistance. A protein/antibody-based pipeline consisting of prod- ucts able to detect GP88 in tissues, in circulation and to block GP88 was developed at A&G. This pipeline combines a neutralizing anti-GP88 monoclonal antibody therapeutic with two companion diagnostic tissue (IHC) and serum (EIA) tests. Diagnostic kits for measurement of GP88 in tissue and serum of cancer pa- tients have been validated in clinical studies. Preclinical and pathological studies support the importance of diagnostic and therapeutic products and the potential of GP88 targeted therapy with companion diagnostic in the clinical settings for several cancer indications such as anti-estrogen resistant breast cancer. [Review].

The immature platelet fraction (IPF%) is a parameter for the automatic quantification of reticulated plate- lets and is considered to reflect platelet production. We evaluated IPF% measurements using an automated analyzer, the Sysmex XN. We measured the platelet counts and the IPF% values in 35 healthy subjects and 275 patients with various diseases using both the XN analyzer and a conventional analyzer, the Sysmex XE. Significant correlations in the platelet count and the IPF% were observed between the XN results and the XE results. In the same samples, significant inverse correlations were observed between the platelet count and the IPF% in both the XN and XE results. The coefficient of variation values for the platelet count and the IPF% measurements obtained using the XN analyzer were lower than those obtained using the XE ana- lyzer. In patients who had undergone hematopoietic stem cell transplantation, the IPF% measurements obtained using the XN analyzer increased several days before platelet recovery. IPF% measurements performed using the XN analyzer are adequate for clinical use. This parameter may be a useful marker for the prediction of platelet recovery. [Original].

Infection control is one of the most important measures for the safety of medical treatment. The microbiology unit of the clinical laboratory is the first defense against nosocomial infection. Our infection control team belongs to the clinical laboratory and our infection control practices are based on the accessibility of microbiology data. We have learned lessons from 2 outbreaks of multi-drug-resistant Pseudomonas aeru- ginosa in the past and have established the current surveillance system for multi-drug-resistant organisms in our hospital. In this article, I describe how we can utilize laboratory data for an effective infection control strategy and how the laboratory department can contribute to infection control practice. [Review].

The mission of the clinical diagnostic laboratory is to continuously provide high-quality diagnostic services. For this purpose, quality management, continuous technical improvement, work place safety assurance, and biosecurity are their objectives. Biorisks arise from handling clinical samples categorized at the highest risk level due to their unknown nature. The "undetermined risk" was not able to risk assess by predetermined risk management approach explained in many existing biosafety references, such as the Biosafety in Microbi- ological and Biomedical Laboratories. By reviewing books, documents, article, and standard guidelines on biorisk management or biosafety, this report provides a comprehensive summary of how biorisk is defined, the existing approach to biorisk assessment, how human factors play roles in biorisk assessment, how vital communication and incident reporting are in biorisk management, and how the biorisk management system support the clinical diagnostic laboratories to fulfil their mission. Given that laboratories are already imple- menting the Quality Management System from the International Standard Organization and starting to report its positive impact on daily activity, it is logical to consider how to integrate the biorisk management system together. A biorisk management system will allow a laboratory to continue business at a high standard not just by preventing laboratory accidents, but proactively reducing near misses and incidents and improving diagnostic process efficiency through risk-assessment-based biosafety and biosecurity. [Review].

Teikyo University Hospital reported an outbreak of multidrug-resistant Acinetobacter baumannii (MDRAB) to the local public health department in 2010. The number of inpatients with MDRAB including asympto- matic carriers was 58 between August 2009 and September 2010. The way to tackle infection control issues has been comprehensively revised since this event in our hospital. The change could not have been achieved by a single department, such as the Department of Infection Control and Prevention or the Central Laboratory alone. Rather, collaboration among every department in the hospital was necessary. Although the impact of the outbreak on our hospital was enormous, it elucidated various clues to improve hospital man- agement regarding not only infection control but also safety management. [Review].