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

Translational research is leading to new technology and generating in practical diagnostic tests with clinical utility. This paper introduces three cutting-edge technologies: liquid biopsy, amino acid profiling, and con- tinuous glucose monitoring (CGM). Liquid biopsy was reviewed as one of the "10 Breakthrough Technologies in 2015" by MIT. This technol- ogy is based on fast DNA-sequencing machines or high-sensitivity PCR and non-invasive tests that detect fragments of DNA or cells in blood or other bodily fluids. Cell-free DNA refers to segments of DNA that are mainly derived from apoptotic and necrotic cells, and it is used for the detection and monitoring of cancer. Profiling of plasma-free amino acid is a promising approach because amino acid profiling links all organ sys- tems and amino acids have important roles in metabolism. Furthermore, amino acid profiles are known to be influenced by specific diseases, including cancers. CGM systems use a tiny sensor inserted under the skin to continuously check glucose levels in tissue fluid and convert blood glucose levels. CGM can provide valuable information at any points during the day and facilitate better treatment decisions and glucose control. [Review].

In the helium gas dilution method, functional residual capacity (FRC) is calculated from a helium concentra- tion equilibrium curve. In this study, we analyzed the helium concentration equilibrium curves of healthy patients, clarified the determinants of the equilibrium concentration, and studied the effects of an uneven lung distribution. We collected data from 200 patients (92 males and 108 females) whose FRC values had been measured at our institution over the past 6 years. Their FRC values ranged from 80% to 120%, and theit other pulmo- nary function values were within the normal range. In the compartmental model analysis, we discovered that the helium concentration equilibrium curve was composed of one compartment, and that it did not have a polyphasic structure. Each 0.25-minute (15-second) segment of the helium concentration equilibrium curve obtained from the patients was evaluated using univariate and multivariate regression analyses. The helium concentration equilibrium curve decreased exponentially over the time course of the analysis, and the multiple correlation coefficient for the relationship between the 0.25-minute to 0.75-minute segments and the 1.00-minute to 1.50-minute segments in the final model was 0.949. Finally, we examined the influence of an uneven peripheral lung distribution. A model based on the con- centration change seen between the initial and middle periods during at rest ventilation indicated that the latter parameter was not affected by the ventilation volume of the peripheral lung. [Original].

Diagnosing sepsis can be very difficult and without prompt treatment, sepsis frequently results in death. No definitive biomarker for diagnosing sepsis currently exists, although the use of various biomarkers, includ- ing procalcitonin (PCT), as diagnostic indicators has been considered valuable. The biomarker presepsin (P- SEP) has gained attention as a diagnostic tool for sepsis since health insurance coverage approval in Japan in 2014. In this study, we categorized 156 children into five groups based on the presence or absence of sys- temic inflammatory response syndrome and infection, and compared the levels of P-SEP and PCT among these groups. Furthermore, they were categorized into five groups based on the diagnosed disease, and the P-SEP and PCT levels were compared among these groups. The P-SEP levels exceeded the cut-off value in all patients with sepsis, and patients of other groups hardly exceeded the cut-off value. In contrast, the PCT levels increased in patients with sepsis, but those in other groups, particularly in local infection, also exceed- ed the cut-off value. Similarly, during the diagnosed disease classification, PCT levels also increased in Ka- wasaki disease. In conclusion, P-SEP could be a useful biomarker for the diagnosis of sepsis in children and should be studied further. [Short Communication].

Conventional reversed clinicopathological conference (RCPC) is an educational method to interpret labora- tory data. In this RCPC, physicians and several specialists in laboratory medicine discussed laboratory data of a patient with tuberculous spondylitis who complained of back pain and general fatigue. Then, they and the moderators held a question-and-answer session with an audience in a hall, and they tried to understand the detailed state of the patient. This discussion revealed the usefulness of RCPC to elucidate the clinical state of patient. At the same time, we can understand the limits of laboratory data analysis. [Review].

The maintenance of the QOL by preventing the onset and progression of arteriosclerosis-related complica- tions such as a stroke and myocardial infarction is very important in the treatment of diabetes. However, recent large clinical trials reported that aggressively reducing the HbAlc level by the use of insulin or oral antidiabetic agents increased severe hypoglycemia, resulting in cardiovascular events and deaths. A "good quality of glycemic control" that improves postprandial hyperglycemia without hypoglycemia is required for the treatment of diabetes, and confirmation of the fluctuations in blood glucose for 24 hours using CGM (continuous glucose-monitoring) is now attracting marked attention. The introduction of CGM is use- ful for the patient to understand the effect of drugs and get more motivated for the treatment. Furthermore, real-time CGM provides a value of blood glucose on the spot, resulting in strict glycemic control. A sensor- augmented pump (SAP) was released last year in Japan, and patients have been able to confirm their blood glucose level in real time and adjust the amount of insulin timely. Such a new glucose-monitoring system is emerging. It does not need the drawing of blood from the finger- tip by a puncture needle, requiring only the attachment of a sensor to the outside of the upper arm, and linking a hand-held reader to the sensor could provide cumulative data with a frequency of every 15 min for up to 8 h. We expect such new devices to provide the level of blood glucose in real time to improve therapy. [Review].

Epicardial adipose tissue (EAT) is metabolically bioactive, and accumulation of this tissue is related to early impairment of left ventricular (LV) systolic function as well as diastolic function. However, pericardial adi- pose tissue (PAT), located outside the EAT, has recently been demonstrated to be more closely associated with metabolic risk factors than EAT. The present study aimed to clarify whether PAT thickness is related to early impairment of LV function in a similar manner to EAT thickness, with both evaluated echocardio- graphically. Subjects were 49 women (mean age, 68ill years) composed of both patients with metabolic diseases and those with other diseases, and ejection fraction (EF) >55%. Systolic function was assessed by measuring EF, systolic mitral annular velocity (S'), and tissue mitral annular displacement percentage (TMAD%). Diastolic function was assessed by measuring early rapid filling wave velocity (E)/late filling wave velocity due to atrial contraction (A) ratio (E/A), peak early diastolic mitral annular velocity (e'), and E/e' ratio. Correlations between EAT or PAT thickness and LV systolic or diastolic function were assessed. EAT thickness correlated with S' and TMAD%(r=-0.399, p=0.005 and r=-0.570, p<0.001, respective- ly), but not with EF. However, PAT thickness was not correlated with any of these. EAT thickness corre- lated with E/A, e' and E/e'(r=-0.382, p=0.007; r=-0.493, p<0.001; and r=0.331, p=0.020, respective- ly). Again, PAT thickness was not correlated with any of these. PAT thickness appears unrelated to early impairment of LV function.

Objective: The aim of this study was to evaluate the relationship between nerve conduction and sonographic measurements of the median nerve, and to investigate the effects of aging and sex on nerve structure.

Methods: Measurements from both hands of 82 healthy volunteers were included in this study (45 men and 37 women, 38.9 ?17.7 years). The cross-sectional area(CSA) of the median nerve was evaluated at the carpal tunnel inlet (MA) and at the midpoint of the forearm (MB).

Results: The CSA of the median nerve at the MA was significantly correlated with age (r=0.501, P< 0.001), and distal motor latency (r=0.269, P<0.001). Although this study demonstrated the effects of the sex dif- ferences and aging on the CSA of the median nerve at MA, there was no significant effect at the MB.

Conclusions: Our study suggests that aging could affect median nerve structure, especially at the anatomical entrapment point. [Original].

"Liquid biopsy" is one of the hottest topics in the cancer molecular diagnostics field because of its potential to replace conventional tissue biopsy. "BEAMing" is one of the digital PCR platform technologies for liquid biopsy samples, and it features a high enough sensitivity to detect a very low concentration of mutation frag- ments in circulating tumor DNA from the plasma of cancer patients. In this article, some of the promising clinical applications of BEAMing technology and its future possibilities as an advanced cancer diagnostic will be briefly summarized. [Review].

Amino acids are present in the blood. In healthy people, the concentrations of these amino acids in the blood are maintained at stable levels. However, different diseases disturb the balance of amino acids in the blood in different ways. AminoIndex® is a service that uses the latest medical technology to measure the concentration of amino acids in the blood to check a person's health and detect various diseases. It is now possible to conduct an AminoIndex® Cancer Screening (AICS®) test that can detect cancer from early stages. The AICS® measures the concentrations of amino acids in the blood and statistically analyzes the differ- ences in the balance of amino acid concentrations between healthy people and those with cancer. As a result, we can simultaneously screen for certain types of cancer. Currently, the test can screen for gastric cancer, lung cancer, colorectal cancer, prostate cancer (in males), breast cancer (in females), and uterine/ovarian cancer* (in females). The application of AminoIndex® technology will spread through the fields of medicine, such as in the treat- ment of metabolic syndrome. (*The uterine/ovarian cancer test determines the overall risk of having any of the three cancers: cervical cancer, endometrial cancer, and ovarian cancer, and can not determine the individual risk of having each cancer.) [Review].

The recent development of innovative therapeutic drugs has changed the relationship between diagnostics and therapeutic drugs. One of the major changes is personalized healthcare and companion diagnostics; many of innovative drugs such as Herceptin, Alectinib, and Atezolizumab have been developed and launched together with their corresponding companion diagnostics. Another aspect of the recent innovative drugs is the utilization of high-level biotechnology and develop- ment of antibody-based therapeutic drugs. Antibody-based drugs often induce heterophilic antibodies such as human anti-mouse antibody (HAMA). Taking this into account, the interference of HAMA is investigated intensively during the development of in-vitro diagnostics, and it is eliminated by employing countermeasures such as the addition of quench proteins, and utilization of fragmented antibodies as well as chimera-antibodies. With those measures, the incidence of interference can be reduced to acceptable levels and the assays can generate reliable results, which contribute to beneficial therapy. On the other hand, the recent development of innovative unique therapeutic drugs sometimes leads to interference in diagnostic assays, which were not expected during development. One example is interference observed in the BNP assay induced by a new drug for heart failure: angiotensin receptor-neprilysin inhibitor (ARNI). When patients take ARNI, BNP values increase instead of the improved condition of heart failure. Due to this observation, NT-proBNP, which is unaffected by ARNI, is usually used for monitoring the effect of the drug. The issue of drug-resistant bacteria is also discussed in conjunction with the potential contribution of diag- nostics for the effective use of antimicrobial agents. [Review].