Clinical Laboratory

List of clinical test reference values

Laboratory test department

In laboratory tests, biochemical and immunological tests (blood drugs, endocrine, tumor markers), hematological tests (blood count, coagulation, morphology), general tests (qualitative, sediment, cerebrospinal fluid tests), and emergency tests are performed. increase. We perform tests using a variety of methods, including automatic analyzers and microscopes, and promptly report highly accurate test results to assist in the diagnosis, treatment, and follow-up of diseases.

Biochemical/immunological test

In biochemical and immunological tests, the components contained in the blood (mainly serum), urine, pleural effusion, ascites, and cerebrospinal fluid collected from the patient are examined. Components such as sugars, lipids, electrolytes, and proteins contained in blood and urine fluctuate due to organ damage. Depending on the measurement method, it is divided into biochemical tests such as enzymes, proteins, lipids, and electrolytes, and immunological tests such as hormones and tumor markers. We report the results within about an hour after the arrival of the specimen, and strive to make the test results available before the examination.

List of biochemical and immunological test items

biochemical test

• total protein
• albumin
• total bilirubin
• indirect bilirubin
• AST (GOT)
• ALT (GPT)
• LDH
• ALP
• Y GPT
• LAP
• Ch-E
• CK
• CK MB
• AMY
• LIP
• BUN
• CRE
• UA
• Na
• K.
• Cl
• Ca
• IP
• Fe
• UIBC
• Mg
• TG
• T-CHO
• HDL
• LDL
• Glu
• glycoalbumin
• HbA1c
• NAG
• UTP
• No haptoglobin typing
• blood gas
• ethanol
• ammonia
• unbound bilirubin
• ICG
• Osmotic pressure
• Blood drug concentration
• Phenytoin
• Phenobarbital
• carbamazepine
• sodium valproate
• Theophylline
• Digoxin
• Acetaminophen
• lithium carbonate
• salicylic acid
• methotrexate

immunological test

• CRP
• IgG
• IgA
• IgM
• IgE
• C3
• C4
• pre ALB
• RF
• β2MG
• KL 6
• SP-D
• sIL 2R
• NGAL
• AFP
• CEA
• CA19-9
• CA15-3
• Cifra
• CA125
• insulin
• CPR
• ferritin
• prolactin
• cortisol
• TSH
• T3
• T4
• FT3
• FT4
• thyroglobulin
• TGAb
• TRAb
• TPOAb
• HCG
• GH
• procalcitonin
• NT Pro BNP
• PIVKA Ⅱ
• High-sensitivity PSA
• SCC
• LH
• FSH
• Troponin I
• ACTH
• iPTH

Blood test

In the hematology laboratory, general blood tests to check the number and size of red blood cells, white blood cells and platelets, hemoglobin concentration, etc., blood imaging tests to check the classification and morphology of white blood cells, and the morphology of red blood cells and platelets, as well as diseases that bleed easily We perform coagulation and fibrinolysis tests to check diseases that are prone to thrombus formation. In addition, we perform tests such as platelet aggregation ability and erythrocyte sedimentation rate, which are one of the tests for platelet function.

List of items such as general blood and coagulation

List of items such as general blood and coagulation

• WBC
• RBC
• HGB
• HCT
• PLT
• RET
• Leukocyte classification
• visual inspection

Coagulation test

• PT
• APTT
• fibrinogen
• D-dimer
• ATⅢ
• cross mixing

others

• erythrocyte sedimentation rate
• βD-glucan
• malaria
• red blood cell resistance test
• Agglutination test
• eosinophil
• Special dyeing

General inspection department

In the general examination room, we carry out necessary examinations such as urinalysis (qualitative, sediment), stool examination (fecal occult blood), auxiliary diagnosis of diseases of kidneys and other organs, and follow-up of treatment. Urine and stool, which are human excreta, do not cause pain to the patient and can be collected most easily, so they are used as basic examinations. Urinalysis is useful for diagnosing not only kidney and urinary tract diseases but also various other diseases such as diabetes, based on quantitative changes in normal urine components and appearance of abnormal components.

List of urine and stool test items

Urinalysis

• urine qualitative
• urine sediment
• Urinary BTA

stool test

• fecal hemoglobin
• stool fat staining

others

• Cerebrospinal fluid examination
• Puncture fluid Ph, specific gravity
• joint fluid crystals
• urea breath test

Pathological examination

Nine clinical laboratory technicians (including six cytotechnologists and three certified pathologists) are engaged in histopathological and cytological examinations to accurately diagnose whether a disease is benign or malignant, under the guidance of a pathologist in Clinical Pathology (Acting Director, Dr. Shigeo Hara).

Histopathological examination is an examination in which a tissue piece collected by surgery or biopsy is subjected to HE staining or immunostaining after certain manipulations, and a pathologist examines the tissue morphology under a microscope. As special tests, we also support fluorescent antibody tests for kidney diseases, tests related to drug therapy for breast cancer, and tests related to compatibility with molecular-targeted drugs.

Cytological examination involves collecting cells from the cervix, uterine body, sputum, urine, pleural effusion, ascites, and various other organs, staining them after a certain procedure, and having a cytologist examine cancer cells under a microscope. This is a test to check for the presence or absence of Since 2017, our hospital has also introduced a sample processing method using the liquefaction cytology (LBC) method to improve diagnostic accuracy.

In addition, we actively support intraoperative rapid diagnostic tests, assistance with pathological autopsies, clinical pathology conferences (CPC), support for presentations by clinicians at academic conferences, and clinical trials. In addition, it also serves as a pathology laboratory as a cancer genomic medicine collaboration hospital.

Department of Cell Genetics

In the detection of measurable residual disease (MRD), which is important for diagnosing hematopoietic malignancies, judging therapeutic effects, and prognostic classification, flow cytometry (FCM) and genetic Testing is becoming more and more important.

Our department has a testing system that is rare in Japan, where bone marrow imaging, FCM-based cell testing, and PCR-based genetic testing are conducted in the same department. In addition to being able to report test results quickly, it is possible to enhance the ability to interpret test results comprehensively and to have close discussions with clinicians and other laboratory departments.

For FCM testing, we have introduced a next-generation flow cytometer capable of 10-color analysis, and we use KobeFlow, which we developed based on the analysis method proposed by EuroFlow, to provide highly accurate testing. For genetic testing, we have also introduced the latest equipment such as digital PCR to detect a wide variety of genetic abnormalities. Recently, we have introduced opportunistic infection-related virus PCR testing, utilizing the know-how we have accumulated over many years not only in the field of hematopoietic tumors but also in the field of infectious diseases.

Inspection item

bone marrow imaging

1. Bone marrow interpretation

Cytometry (FCM)

1. Peripheral blood lymphocyte subset test
   • T cell/B cell/NK cell percentage test
   • T cell subset percentage test
2. Hematopoietic tumor cell antigen test
3. CCR4 protein
4. CD34-positive hematopoietic stem cell count measurement
5. CD3 positive T cell count measurement
6. reticulated platelet ratio
7. Highly sensitive PNH blood cell test

Genetic testing (PCR)

1. Hematopoietic tumor gene test
   • Major BCR::ABL1 定量検査
   • minor BCR-::BL1定量検査
   • RUNX1::RUNX1T1定量検査
   • PML::RARA定量検査
   • CBFB::MYH11定量検査
   • TCF3::PBX1定量検査
   • FUS::ERG定量検査
   • DEK::NUP214定量検査
   • KMT2A::MLLT3定量検査
   • KMT2A::ELL定量検査
   • NPM1 mutation quantification test
   • WT1 mRNA quantitative test
   • MYD88 L265P quantitative inspection
   • RHOA G17V quantitative inspection
   • BRAF V600E quantitative inspection
   • JAK2 V617F quantitative inspection
   • MPL mutation test
   • CALR mutation test
   • JAK2 exon12 mutation test
   • CD79B mutation test
   • EZH2 mutation test
   • SF3B1 mutation test
   • KIT mutation test
   • IGH::BCL2検査
   • Comprehensive AML gene mutation test
     (FLT3-ITD, FLT3-TKD, NPM1, KRAS, NRAS, IDH1, IDH2, TP53, DNMT3A, CEBPA, ASXL1, RUNX1)
   • Patient-specific FLT3-ITD quantitative test
2. Immune-related gene rearrangement
   • IGH reconstruction test
   • IGL reconstruction examination
   • TCRB reconstruction test
   • TCRG reconstruction test
   • TCRD reconstruction test

chimerism analysis

1. Pre-transplant screening analysis
2. Post-transplant chimerism analysis

virus check

1. Quantitative testing of viruses associated with opportunistic infections
   (HSV1,HSV2,VZV,CMV,EBV,HHV6,HHV7,HHV8,ParvoB19,BKV,JCV,ADV)

Microbiology Department

We carry out bacterial culture, drug susceptibility testing, and immunological/genetic infectious disease testing for various clinical specimens. We have a system that allows us to perform rapid diagnostic tests for various bacteria and viruses at any time. In addition, we actively participate in ICT and AST activities as team medical care and contribute to preventive measures against nosocomial infections.

Inspection item

General bacteriological examination

1. smear test
2. culture
3. Identification test (mass spectrometry, etc.)
4. Drug susceptibility test
5. genetic test
   • Detection of mycoplasma by LAMP method
   • Detection of Bordetella pertussis by LAMP method
   • 16S rRNA gene PCR and sequence analysis
   • ITS region gene PCR and sequence analysis
   • D1/D2 region gene PCR and sequence analysis
   • Various drug resistance gene PCR
   • Species-specific gene PCR
   • Typing using the POT method

Mycobacterial test

1. smear test
2. Culture/identification test
3. Drug susceptibility test
4. genetic test
   • Detection of Mycobacterium tuberculosis complex, Mycobacterium avium, and Mycobacterium in tracellulare by PCR-Quenching Probe (QProbe) method

rapid test

1. Antigen, antibody and toxin detection tests (each test material is different)
   • influenza virus
   • adenovirus
   • respiratory syncytial virus
   • rotavirus
   • norovirus
   • human metapneumovirus
   • dengue virus
   • Meningococcal bacteria
   • pneumococcus
   • legionella
   • CD toxin, etc.
2. HBV-DNA quantitative test
3. HCV-RNA quantitative test

Infectious disease marker test

1. Hepatitis B-related markers
2. Hepatitis C-related markers
3. syphilis test
4. HIV-associated markers
5. HTLV-1 associated markers

Immunosuppressant

1. Tacrolimus blood concentration measurement
2. Cyclosporine blood concentration measurement

Anti-MRSA drugs

1. Vancomycin blood concentration measurement

Blood transfusion control room

This department conducts blood group tests, irregular antibody tests, cross-matching tests, centrally manages blood products and albumin products, and supervises and manages operations related to blood transfusion. The emergency outpatient department is always equipped with transfusion preparations for extreme emergencies, and a system is in place to handle highly urgent blood transfusions 24 hours a day, 365 days a year.

Furthermore, in cooperation with doctor, pharmacists, and clinical engineers, we provide comprehensive services related to hematopoietic stem cells, including CAR-T cell therapy, peripheral blood stem cell preparation, cord blood/bone marrow transplantation, granulocyte transfusion, and donor lymphocyte transfusion. We also manage.

Inspection item

blood typing

1. ABO blood group test
2. Rh(D) blood group test
3. ABO subtyping
4. Transplantation blood type test

Irregular antibody test

1. Antibody screening test
2. Irregular antibody identification test

cross-matching

Other inspections

1. direct coombs test
2. Indirect Coombs test
3. D-L antibody
4. Antibody titer measurement

Special inspection department

Today, with the spread of the Internet, etc., it has become possible to easily obtain information on poisoning and various drugs and poisons. We have to deal with it. Our department searches for poisoning-causing substances using simple measurement reagents and precision analysis measurement equipment. In addition, we also carry out detailed examinations such as separation analysis in response to clinical requests.

Inspection item

1. Inspection using simple measurement reagents
   • urinary methanol
   • Organophosphorus pesticides in urine
   • Carbamate pesticides in urine
   • Paraquat in urine
   • Arsenic compounds in urine
   • blood cyanide
2. Inspection using precision analysis and measurement equipment (gas chromatograph mass spectrometer: GC/MS)

Inspection information management department

We manage outsourced work and coordinate the operation of laboratory test work for PFI projects. In order to maintain and manage the testing system and improve the quality of medical care, we participate in various team medical care (NST, diabetes classroom, kidney disease classroom, etc.). In addition, we have an examination consultation room as a service business for patients and clinics, providing information related to all examinations to the medical side, consultation response, complaint handling, updating the website, issuing examination information for patients, and medical care support using the database. We also provide support for clinical research and clinical trial operations.

Department of Neurophysiology

We perform neurophysiological examinations of the peripheral and central nervous systems and ultrasonography of the head and neck vasculature. Functional tests include electroencephalography, nerve conduction tests, evoked potential tests (auditory brainstem response, somatosensory evoked potentials, visual evoked potentials), and needle electromyography. Neurophysiological testing is a testing method that evaluates nerve function by stimulating the peripheral and central nerves and applying the electrical activity of the nerves. In recent years, intraoperative neuromonitoring using this method has become popular, and in our laboratory, we monitor brain and spinal cord functions in real time under intraoperative anesthesia, and there is a demand for surgeries aimed at preserving neurological function. is responding to We also perform E-ABR to confirm the auditory nerve pathway after cochlear implant surgery.

Inspection item

Nerve conduction studies (NCS)

1. Motor nerve conduction test (MCS, F wave)
2. Sensory nerve conduction studies (SCS)
3. repeated stimulation test
4. Magnetic stimulation test

Cerebral/brain stem evoked potential

1. Auditory Brainstem Response (ABR)
2. Somatosensory evoked potential (SEP)
3. Visual evoked potential (VEP)

Other evoked potentials

1. blink reflex
2. Magnetic stimulus motor evoked potential

Intraoperative neuromonitoring (IOM)

Electroencephalography (EEG)

Overnight sleep polysomnography (PSG)

carotid ultrasound

Transcranial cerebrovascular ultrasound

Outpatient blood collection department

We collect blood from over 10,000 outpatients per month. An automatic reception system issues a blood collection numbered ticket just by swiping the patient's examination card, and the number is used to guide the patient to the blood collection booth. I'm here.

There are 8 blood collection booths, and in addition to outpatient general blood collection, sterile blood collection for blood culture, clinical trial cases, and blood collection for cancer genome medical treatment are also performed.

Department of Abdominal Ultrasonography

Screening examinations, examinations to investigate the causes of symptoms, and follow-up examinations for general abdominal organs, mammary glands, thyroid glands, otolaryngological systems (parotid glands, submandibular glands), and vascular systems (aorta, peripheral blood vessels, etc.)・Evaluation before and after surgery ・Emergency measures such as acute abdomen and contrast-enhanced echo using ultrasound contrast media are available. In addition, we perform hemodynamic evaluation of organs and lesions using color Doppler and pulsed Doppler methods, and perform qualitative diagnosis such as benign/malignant differentiation and inflammation stage classification.

Abdominal surface ultrasonography

Ultrasound examination is a test that uses ultrasonic waves from outside the body to create images from the signals bounced back from organs, etc., and diagnoses the pathology from the distance and shape. Special examinations such as abdominal ultrasonography, mammary gland ultrasonography, thyroid ultrasonography, vascular ultrasonography of upper and lower extremities, and contrast-enhanced ultrasonography using contrast agents are also performed in our laboratory. Ultrasound is a safe and painless examination. Pregnant women can also take it safely.

In addition, we perform detailed examinations including skin perfusion pressure measurement and arterial ultrasonography related to revascularization treatment (clinical trial) for severe lower extremity ischemia.

Inspection item

1. abdominal ultrasound
2. breast ultrasound
3. thyroid ultrasound
4. body surface ultrasound
5. Vascular ultrasonography (lower limb arteries and veins, upper limb arteries and veins)
6. Abdominal contrast-enhanced ultrasonography (examination, screening)
7. mammography ultrasound

Lower extremity artery workup

We are examining clinical trials of revascularization treatment using CD34-positive cell transplantation for arteriosclerosis obliterans and Buerger's disease. This is a detailed examination to evaluate the arterial hemodynamics of the affected limb by measuring perfusion pressure at the capillary level, percutaneous partial pressure of oxygen, and fingertip arterial pressure. We conduct specialized examinations and evaluate patients before and after regenerative treatment of lower extremity arterial blood vessels.

Inspection item

1. lower extremity arterial ultrasonography
2. Skin perfusion pressure measurement
3. Transcutaneous partial pressure measurement
4. Digital artery pressure measurement

Cardiopulmonary function test department

It examines the functions of the circulatory system (mainly heart) and respiratory system (mainly lungs and bronchi). Cardiovascular examinations include electrocardiography and cardiac ultrasound (echocardiography) to check the condition of the heart. On the other hand, respiratory tests include pulmonary function tests and airway reversibility tests, which examine the ventilatory function (ventilation state of air into the lungs) and the gas exchange function of oxygen and carbon dioxide.

Inspection item

electrocardiogram

1. resting electrocardiogram
2. Exercise stress electrocardiography (treadmill stress electrocardiography)
3. Ambulatory ictal ECG
4. 24-hour, 7-day, and 21-day electrocardiogram testing (Holter ECG testing)
5. Autonomic function test (CVRR)

Blood pressure plethysmography (PWV/ABI)

pulmonary function test

1. vital capacity (VC)
2. % vital capacity (%VC)
3. Forced vital capacity (FVC)
4. Volume in 1 second (FEV1)
5. 1 second rate (%FEV1)
6. Residual air content (FRC)
7. Lung spreading capacity (DLCO)
8. Airway reversibility test
9. respiratory resistance test

echocardiography

1. Transthoracic echocardiography (TTE)
2. Transesophageal echocardiography (TEE)
3. Stress echocardiography (exercise/drug)
4. Microbubble test

team medical

Team medical care is a patient-centered approach in which doctor, nurses, clinical laboratory technologists, pharmacists, registered Registered Dietitian, physical therapists, and other medical staff make use of each other's expertise and bring out their maximum capabilities. This is an initiative at a medical site that provides treatment. The most effective treatment methods and policies for patients are considered through close communication with staff members in each specialized field.

In-hospital team medical care involving clinical laboratory technologists

1.Nutrition support team

This is a specialized team nutrition support team that is involved in in-hospital nutrition therapy and considers the nutrition of individual patients. We measure the test items for nutritional evaluation, provide information such as nutritional status and general condition that can be understood from the test data, and are involved in nutritional management of patients in cooperation with other medical staff.

2. In-hospital patient classroom

Classes held in hospital for patients and their families. We participate in diabetes classrooms and kidney and kidney disease classrooms, where we explain test data and perform simple tests together using simple equipment. We aim to raise awareness of the importance of testing in the early detection of diseases and the determination of therapeutic effects.

3. Infection control team

A dedicated team responsible for infection control within the hospital. MRSA and multi-gram staining conference We provide data on the detection of drug-resistant Pseudomonas aeruginosa as well as chemical and blood test data. We are striving to prevent At our hospital, which provides highly advanced medical care, there are many patients with weakened immune systems who are prone to in-hospital infections. In order to provide advanced medical care based on medical safety, infection control in medical care is very important and plays a role.

4.Foot care team

This is a team that works with the goal of "protecting the feet" for patients with blood flow disorders and ulcers in the lower extremities. We hold case review meetings with Dermatology, Cardiology, and nurses specializing in chronic disease nursing. Clinical laboratory technologists perform various tests and provide data related to detailed blood flow evaluations that are necessary for deciding treatment strategies.

5.Medical Safety Management Team

Incident reports reported at hospitals are statistically said to be "the number of hospital beds x 5" (in the case of our hospital, there are approximately 3,500 incidents per year). The Chief Technologist joins the Medical Safety Management Team as the Deputy Director of the Medical Safety Management Risk Management, and works jointly with a multidisciplinary team to clarify the causes of incidents reported from all departments within the hospital, and to implement responses and improvement measures in each department. We verify the status of PDCA for planning and recurrence prevention. In addition, in order to promote a culture of medical safety in the Clinical Laboratory, we verify case studies of the testing department, monitor the progress of improvement measures, and control medical safety in the testing department.

6. Clinical path

A clinical path is a medical treatment schedule table that contains information such as treatment, care, and examinations necessary to cure an inpatient's illness, and was created for the purpose of standardizing and improving the efficiency of medical care. We have created a pamphlet that describes the content, necessity, and precautions of the examination so that patients can be relieved of their anxieties about the examination and receive the examination with peace of mind.

7. Inspection consultation room

The Laboratory Consultation Office aims to centralize the consultations, inquiries, complaints, and requests received from medical professionals in the hospital to ensure the smooth functioning of hospital operations. We issue “test information” that describes test items for patients and distribute it at the blood sampling room and general reception.

◆◆Special Feature No. 27◆◆

Our hospital's joint ultrasound approach, focusing on evaluation of rheumatoid arthritis activity

Abdominal Ultrasound Examination Room Yukiko Yano

What is rheumatoid arthritis (RA)?

What is rheumatoid arthritis (RA)?
Synovial joints ^*): Highly mobile joints mainly found in the limbs, including the wrists, finger and toe joints, elbows, shoulders, knees and ankles.

How to evaluate RA

Conventionally, the diagnostic criteria for RA proposed by the 2010 ACR/EULAR have been used to diagnose RA (Figure 1). In these criteria, the evaluation of tenderness and swelling is important for diagnosing RA, but these are largely subjective to the patient and examiner, and an accurate diagnosis can sometimes be difficult.

Therefore, ultrasound has attracted attention as an imaging test that is simple, safe, and highly sensitive and can objectively evaluate tenderness and swelling, and Japan College of Rheumatology formulated the "Guidelines for Joint Ultrasound Imaging" in February 2011. This standardization presented semi-quantitative scores for synovial proliferation and inflammatory findings (Figures 2 and 3), making it possible to visually evaluate RA activity in joints and to provide highly objective follow-up.

RA cases experienced at our hospital

Patient: 73-year-old female
Chief Complaint: Pain in the hands
History of current illness: Five months ago, pain appeared in both hands and in the joints of the fingers. It improved and worsened repeatedly. Blood tests showed CRP levels were
0.18mg/dL, 1-hour erythrocyte sedimentation rate 20mm. MRI showed no obvious abnormalities. Swelling was mild in both hands and fingers.
There was no tenderness. RA was suspected, but a definite diagnosis was not made. Ultrasound was performed on the wrists, MCP joints, PIP joints, and IP joints of both hands.
was carried out.

Synovial proliferation was observed in both joints (radial and ulnar sides) and the MCP joints of both hands (areas indicated by red circles on the left in the image above). The right side of the image above shows an ultrasound image of the MCP joint of the fifth finger on the right hand (GS grade 2, PD grade 2).
Although anti-CCP antibodies and RF were negative, the ultrasound findings indicated that the patient had seronegative RA, and treatment was initiated.

Ten months later, synovial proliferation in both fingers had improved, including in the MCP joint of the fifth finger of the right hand (GS grade 0, PD grade 0).

Cases experienced at our hospital

Patient: 36-year-old male
Chief Complaint: Pain in both Achilles tendons
History of current illness: 15 years ago, the patient experienced pain in the left Achilles tendon during exercise (about once a month). Symptoms lasted for several days to two weeks.
The condition persisted. Although the patient had been treated at another hospital, such as Orthopedic Surgery, there was no improvement, so the patient visited our hospital 3 months ago.

Blood tests showed CRP 0.54 mg/dL and antinuclear antibodies 40x (Homogeneous/Speckled). No peripheral nerve or muscle disorders. No abnormal findings were found in either the pelvic/lumbar spine X-ray or the sacroiliac joint MRI. A young man with Achilles tendon pain. Spondyloarthritis was suspected, so an ultrasound was performed mainly on the foot.

Screening for tendonitis did not reveal any tendonitis, but thickening of both Achilles tendons and increased internal blood flow were noted, predominantly on the left side. X-rays also revealed thickening of the Achilles tendons, predominantly on the left side, at 18mm on the left and 13mm on the right (normal value for Achilles tendons in men is 4-5mm). A blood test revealed high LDL cholesterol of 265mg/dL, so familial hypercholesterolemia was suspected, and genetic testing detected a heterozygous mutation in LDLR, one of the four causative genes, resulting in a definitive diagnosis. This is a case in which joint ultrasound was useful in examining lesions around the tendons.

At the end

Although it has been standardized by guidelines, since it is an ultrasound examination, the results of the joint ultrasound test depend on the skill of the surgeon, and it has the disadvantage of being less reproducible and objective than MRI or CT. However, the great strength of joint ultrasound is that it can evaluate multiple joints easily, in detail, in a short time, and at low cost without exposure to radiation, and it plays an important role, especially in evaluating the activity of RA, which tends to require long-term treatment.

References
1) Japan College of Rheumatology. “Rheumatoid Arthritis Supporter Guide for Medical Staff According to Life Stage”. https://www.ryumachi-jp.com/medical-staff/life-stage-guide/, accessed July 2024
2) Japan College of Rheumatology Rheumatoid Arthritis Ultrasound Standardization Committee. Guidelines for Joint Ultrasound Imaging in Rheumatoid Arthritis. Yodosha. 2011
3) Kazuhide Tanimura. Advances in joint ultrasound imaging diagnosis. Clinical Rheumatology. 2016, vol. 28, p. 7-15

About genetic testing: FLT3 and NPM1 mutations

About genetic testing: FLT3 and NPM1 mutations

In the cytogenetic laboratory, we conduct cell-level tests using flow cytometry ^*1 and gene-level tests using PCR*2, mainly for blood tumors such as leukemia and malignant lymphoma. Responsible for relevant inspections. Research in the field of hematologic malignancies has been impressive in the last decade, and significant advances have been made in diagnosis and treatment. Genetic testing is now indispensable in the definitive diagnosis of leukemia, and is used for detailed classification of disease types. The test results obtained are used to determine the optimal treatment strategy for each disease type.

"FLT3 mutation and NPM1 mutation" ^*3 in the title are genetic abnormalities that are attracting attention in relation to acute myeloid leukemia. Using the PCR method, it is possible to predict the therapeutic effect of chemotherapy by examining the presence or absence of "FLT3 mutation and NPM1 mutation" at the time of diagnosis of acute myeloid leukemia. can provide important information to the attending physician. In addition, if a genetic abnormality is discovered, detailed genetic ^pattern analysis will be performed, and an optimal test method for each individual patient will be developed. effect can be determined accurately.

Currently, there are only a limited number of medical institutions that can test for "FLT3 mutations and NPM1 mutations." Our laboratory started testing in 2008 ahead of the rest of the country, and has a track record of more than 100 cases. In addition to the tests introduced this time, we would like to actively work on the introduction and development of the latest and best test methods while maintaining close cooperation with clinicians, and disseminate the results obtained both domestically and internationally. thinking about.

*1: Flow cytometry
A method to comprehensively measure the presence or absence of proteins in specific cells using a flow cytometer and special reagents to analyze the characteristics of the cells.
*2: PCR
A technique that uses a device called a thermal cycler and special reagents to amplify a very small amount of genes and analyze the presence or absence of genetic abnormalities.
*3: FLT3 mutation and NPM1 mutation
FLT3 and NPM1 mutations are attracting attention as prognostic factors for acute myeloid leukemia. In the 4th edition of the WHO classification, acute myeloid leukemia with genetic mutations is established as an independent disease type, one of which includes NPM1 mutations. On the other hand, FLT3 mutations are not defined as a subtype, but mutation analysis is recommended at the time of diagnosis.
*4: Minimal residual disease
Remaining state of very few leukemia cells that cannot be detected with a microscope

Inspection department news

New inspection item

*November 2011 Inspection items implemented in-hospital

1. glycoalbumin
2. magnesium

Academic report

Paper presentation

• Keiji Takekawa:
  Facts of fungal identification II.
  Clinical and Microbiology 38; 551-557.2011. paper

Presentations, Lectures, etc. July to December 2011

• July 9, 2011
  Kyoto Prefectural Medical Technologists Association Physiological Examination Workshop Abdominal Ultrasound Hands-on & Lecture Course
  Lecturer: Nobuhiro Iwasaki "Gastrointestinal tract - neoplastic lesions"
• July 23, 2011
  Japanese Gastrointestinal Cancer Screening Society Kinki Branch Ultrasound Subcommittee 12th Annual General Meeting/Academic Meeting
  Educational Lecture: Nobuhiro Iwasaki "US and Blood Flow"
• June 25, 2011
  The 111th Regional Meeting of the The Japanese Circulation Society Education Session for Residents
  Hands-on lecturer: Toshiko Konda
• August 20, 2011
  Wakayama Association of Clinical Technologists Physiological Testing Workshop
  Educational Lecture: Nobuhiro Iwasaki "Step-up Gastrointestinal Ultrasound"
• September 20, 2011
  The 111th Hyogo Prefecture Association of Clinical Laboratory Technicians Microbiological Testing Workshop
  Lecturer: Keishi Takegawa "Series: Fungal Testing ② -Let's Master Fungal Testing Methods-"
• September 17, 2011
  Gastrointestinal Echo Live Seminar
  Lecturer: Nobuhiro Iwasaki "Step-up gastrointestinal ultrasonography - A guidepost for diagnosis learned from cases -"
• September 25, 2011
  Hyogo Prefecture Medical Technologists Association Abdominal Ultrasound Practical Training Course
  Lecturer: Nobuhiro Iwasaki "Precautions in device settings and examinations, liver anatomy and physiology"
• October 9, 2011
  Hyogo Prefecture Medical Technologists Association Abdominal Ultrasound Practical Training Course
  Lecturer: Nobuhiro Iwasaki "Anatomy and physiology of the biliary system"
• October 16, 2011
  Hyogo Prefecture Medical Technologists Association Abdominal Ultrasound Practical Training Course
  Lecturer: Nobuhiro Iwasaki "Anatomy and Physiology of the Pancreas"
• October 23, 2011
  Hyogo Prefecture Medical Technologists Association Abdominal Ultrasound Practical Training Course
  Lecturer: Nobuhiro Iwasaki "Kidney anatomy and physiology"
• October 15, 2011
  Advanced Medical Foundation CAS-CARE Ultrasound Examination Seminar
  Lecturer: Ichiro Sasaki
• October 29, 2011
  Echo Heart Izumo 2011
  Lecture and practical instruction: Toshiko Konda "Fever of unknown origin"
• October 29, 2011
  Echo Heart Izumo 2011
  Lecture and practical instruction: Junichi Kawai "Examination of chest pain"
• November 6, 2011
  Hyogo Prefecture Medical Technologists Association Tantan Area Academic Research Group
  Lecturer: Nobuhiro Iwasaki "Ultrasound diagnosis of gastrointestinal neoplastic lesions"
• November 13, 2011
  The 38th Kansai Regional Conference of the The Japan Society of Ultrasonics in Medicine
  Presentation: Nobuhiro Iwasaki "A case of colon angioectasia for which Doppler examination was useful"
• November 13, 2011
  The 38th Kansai Regional Conference of the The Japan Society of Ultrasonics in Medicine
  Presentation: Nobuhiro Iwasaki "A case of intralymphangioma hemorrhage"
• November 17, 2011
  The 170th Osaka Abdominal Ultrasound Study Group
  Presentation: Nobuhiro Iwasaki "Contrast-enhanced ultrasonography for gastrointestinal diseases: Current situation at our hospital"
• November 27, 2011
  Gastrointestinal Echo Hands-on Seminar
  Lecturer: Nobuhiro Iwasaki
• November 13, 2011
  The 38th Kansai Regional Conference of the The Japan Society of Ultrasonics in Medicine
  Presentation: Mamiko Takebayashi "A case of pancreatic tumor detected by screening test"
• November 17, 2011
  The 170th Osaka Abdominal Ultrasound Study Group
  Presentation: Mamiko Takebayashi "A case of pancreatic tumor detected by screening test"
• November 5, 2011
  17th Kobe Clinical Forum
  Educational Lecture: Hayato Maruoka "Flow cytometry and genetic testing in hematological tumor diagnosis"
• November 19, 2011
  The 58th Annual Meeting of the Japanese Society for Laboratory Medicine
  Presentation: Hayato Maruoka "Immunophenotyping of mature lymphoid tumors using 6-color flow cytometry"
• December 7, 2011
  First Aid Open Seminar
  Lecturer: Nobuhiro Iwasaki "Ultrasonography in acute abdomen"
• December 21, 2011
  First Aid Open Seminar
  Lecturer: Ichiro Sasaki "Seminar for dealing with brain death in emergency medicine"
• December 18, 2011
  The 111th Lecture Seminar on Medical Ultrasound, Japanese Society of Ultrasonography
  Lecturer: Nobuhiro Iwasaki "How to proceed with ultrasonography in acute abdomen"

Advances in contrast-enhanced ultrasound

Physiological Function Testing Room Nobuhiro Iwasaki

contrast-enhanced ultrasonography

Hemodynamic evaluation of mass lesions is extremely important for diagnosis and decision of treatment strategy. Color Doppler examination has been conventionally used as a method for evaluating hemodynamics using ultrasound, but since it uses only the reflected sound waves from blood cells, the sensitivity decreases if the reflected sound waves are weak. However, in contrast-enhanced ultrasonography, the contrast agent serves as a strong reflection source, so it is possible to evaluate hemodynamics with higher sensitivity.

Contrast agent for ultrasound: SonazoidⓇ

SonazoidⓇ is an ultrasound contrast agent for the diagnosis of hepatic mass disease. This contrast agent is a formulation containing perflubutane (PFB; Fig. 1), which is a chemically stable gas, and is excreted in the breath after administration. Five years have passed since the start of sales in January 2007, but there have been almost no reports of serious side effects. Imaging diagnostic methods using other contrast agents such as CT and MRI have a certain percentage of serious side effects, and cannot be performed in patients with hypersensitivity to contrast agents. It can also be performed in multiple ways, and may be the only hemodynamic diagnostic method for hepatic mass disease.

Current status of contrast-enhanced ultrasonography at our hospital

Contrast-enhanced ultrasonography requires dedicated equipment with a contrast-enhanced mode. The abdominal ultrasound examination room is equipped with six high-end ultrasound diagnostic equipment ^*1, and we have been actively working on this since the beginning of sales of contrast agents. In addition, although advanced technology and knowledge are required for examinations, multiple technicians who are well-versed are permanently stationed to respond to various requests from clinical practice. At our hospital, contrast-enhanced ultrasonography is divided into screening contrast-enhanced examination and detailed contrast-enhanced examination. The main purpose of screening contrast-enhanced examination is to diagnose the presence of a mass. Contrast media is administered in the outpatient central treatment room, and then moved to the ultrasonography room to observe the presence or absence of defects in the Kupffer phase ^*2 (post vascular phase). On the other hand, detailed angiography is mainly aimed at qualitative or differential diagnosis of masses. In order to observe the vascular phase ^*3 (vascular phase) and Kupffer phase immediately after contrast agent administration, everything from contrast agent administration to the end of the examination is performed in the abdominal ultrasonography room. In addition, in cases where multiple masses are observed or new defect images are observed in other sites, the contrast agent is re-administered to evaluate the vascular phase of the lesion, and the ``Defect Reperfusion Ultrasound'' proposed by Kudo et al. Imaging ^*4” (Fig. 2). Therefore, compared to screening angiography, it may take about 1 hour, so we have a reservation frame of 1 person / 1 hour from the afternoon. In addition, in the treatment of hepatocellular carcinoma, when it is difficult to recognize the lesion during radiofrequency ablation ^*5 (RFA), we use "Defect Reperfusion Ultrasound Imaging" to support treatment so that RFA can be performed safely and accurately. are actively implemented as

*1 High-end ultrasonic diagnostic equipment: Ultrasonic diagnostic equipment that employs the latest technology and pursues high functionality and performance.
*2 Kupffer phase: Part of the contrast agent (microbubbles) is taken up by the reticuloendothelial system (Kupffer cells in the liver). Tumors without Kupffer cells are not contrasted, the difference in contrast between the tumor and normal liver tissue becomes clear, and the time phase after 5 to 10 minutes after administration of the contrast medium, when the presence of the tumor can be diagnosed.
*3 Vascular phase: The time phase from immediately after administration of a contrast medium to 3 minutes in which blood vessels within, at the periphery of, and surrounding hepatic tumor lesions can be imaged.
*4 After a nodule that cannot be detected by normal ultrasonography is detected as a defective image (defect) in the Kupffer phase, the contrast medium is re-administered to determine whether the defective nodule has arterial blood flow or not. ).
*5 Radiofrequency ablation treatment: A treatment method in which an electrode needle is inserted from outside the body into the affected area under ultrasound guidance, and high heat generated by applying radio waves causes coagulation necrosis of the affected area.

Applications of contrast-enhanced ultrasonography

At present, contrast-enhanced ultrasonography is not only used for the diagnosis of hepatic mass disease, but is also being applied to guide puncture for local treatment of liver cancer and to evaluate treatment as treatment support. Intense focused ultrasound therapy (HIFU) using microbubbles as agents is also being investigated). In addition, intraoperative contrast-enhanced ultrasonography is also spreading in liver resection. Intraoperative angiography can probe the liver directly, enabling more detailed observations and detecting small lesions that cannot be detected from outside the body. Therefore, it is a useful index for determining or changing the surgical method such as the extent of resection.

case

1. Hepatocellular carcinoma: early vascular phase (Figure 3)

A 1-cm-sized, internally heterogeneous hyperechoic mass (arrow) is observed in liver S6. Ten seconds after administration of the contrast agent, the entire mass is darkened.

2. Portal vein tumor embolism: reperfusion image (MFI) (Fig. 4)

A faint solid echo is observed in the portal vein (P6) (arrow). Intratumor blood vessels running inside are clearly visualized by MFI.

3. Small Bowel Malignant Lymphoma: Vascular Phase (Figure 5)

Focal wall thickening was observed in the ileum, and the layered structure was obscured (arrows). Early enhancement and dendritic vascular architecture within the tumor are captured.

4. Metastatic liver cancer: Kupffer phase (Figure 6)

A clear image of a 1.5 cm-sized defect was captured in S6 of the liver (arrow).

Conclusion

At our hospital, the introduction of contrast-enhanced ultrasonography has dramatically improved the ability to diagnose hepatic mass disease. In addition, it plays a major role in supporting the treatment of liver cancer, and we would like to further enhance the examination and treatment system, including the training of operators.

1) Kudo M, Hatanaka K, Maekawa K: Newly developed novel ultrasound technique, defect reperfusion ultrasound imaging, using sonazoid in the management of hepatocellular carcinoma.Oncology, 2010 Jul;78 Suppl 1:40-5. Epub 2010 Jul 8.

Inspection department news

New inspection item

*April 2012 Inspection items implemented in-hospital

1. Anti-thyroglobulin antibody (Tg-Ab)
2. Anti-thyroid peroxidase antibody (TPO-Ab)

Academic report

Presentations, Lectures, etc. January to March 2012

• Hitoshi Kazuo and others:
  Appropriate disinfection time for intravenous blood sampling with chlorhexidine gluconate in alcohol-free patients: a bacteriological study with blood sampling simulation
  Medical Examination Vol.61:374-379, 2012

Presentations, Lectures, etc. July to December 2011

• February 24, 2012
  21st Abdominal Ultrasound Practical Training Course "Lower Limb Vein Ultrasound"
  Lecture: Kazushi Minowa Practice: Kuroda, Hajime Hamada, Araki, Miwa
  18 participating doctor
• February 25, 2012
  Hyogo Prefecture Technician Association Abdominal Ultrasound Practical Training Course "Gastrointestinal Echo"
  Practical: Kazushi Minowa, Nobuhiro Iwasaki
• March 3, 2012 Place Kyoto Terrsa
  Lecturer, 5th EEG/EMG Seminar
  Ichiro Sasaki : "Legal judgment of brain death"
• March 15, 2012 Venue Kobe City Medical Center Auditorium
  Presented at the 109th Abdominal Ultrasound Conference
  "Consider a flowchart for diagnosing gastrointestinal diseases"
  Nobuhiro Iwasaki: "About the flow chart of gastrointestinal disease diagnosis at our hospital"
  Mamiko Takebayashi: "US Diagnosis Flowchart for Typical Gastrointestinal Disorders"
  Eriko Miwa: "Problems in the gastrointestinal disease diagnosis flow chart"
• March 24, 2012 Location: Tajima Area Local Industry Promotion Center
  Presentation at the 10th North Kinki Heart Imaging Study Group
  Junichi Kawai: "Evaluation of mitral regurgitation by transesophageal echocardiography and three-dimensional echocardiography"

Introduction of microbiology laboratory

Microbiology Laboratory Marie Niki

Microorganisms are organisms that cannot be observed with the naked eye, such as bacteria, yeast, and viruses, and are essential to human life. When we hear the word microbes, we tend to get a vague image of them, but there are more than 100 trillion of them in the human body, and these are called indigenous bacteria. For example, intestinal bacteria such as Escherichia coli that live in the intestine protect our bodies by helping the digestion of food and eliminating newly invading bacteria. However, for people with weakened immune systems, these indigenous bacteria may become the causative bacteria (pathogenic microorganisms) of infectious diseases. In addition, there are microorganisms (pathogenic microorganisms) that enter the body and harm people, such as pathogenic Escherichia coli O-157 and Campylobacter. The microbiology laboratory provides information on such pathogenic microorganisms to the attending physician.

The role of the microbiology laboratory can be broadly divided into four

① General bacteria test

Patient specimens such as sputum, urine, pus, and blood are used to test for the presence of pathogenic microorganisms. First, the submitted sample is applied to a slide glass and Gram staining ^*1 is performed. The Gram stain distinguishes between Gram-positive bacteria, which stain dark purple, and Gram-negative bacteria, which stain pink. These are observed under a microscope, and the type of bacteria is estimated from the stained color and morphology of the bacteria. Gram staining is the most important step in classifying and identifying bacteria.

Next, the sample is applied to several types of media and incubated in an incubator. When cultured overnight, bacteria that could not be seen with the naked eye grow on the medium, multiply, form colonies, and grow to a visible size. By applying it to several types of media, the name of the fungus can be guessed to some extent from the presence or absence of growth on the media, and the color and shape of the colonies.

Once colonies are formed, the bacteria are identified and tested for drug susceptibility. In the identification test, the type of bacteria is determined by examining the properties of the bacteria, such as whether they can decompose glucose or lactose. On the other hand, drug susceptibility testing examines drugs that are effective against pathogenic microorganisms detected in patient specimens. Identification and drug susceptibility testing are performed by a fully automatic bacteria analyzer using an identification panel like the photograph, except for some bacteria.

②Rapid antigen test

By examining the antigens*2 of pathogenic bacteria excreted in feces and urine, it is possible to quickly report the presence or absence of pathogenic bacteria. A rapid antigen test can report results within 15 to 30 minutes, whereas normal culture tests can take more than two days to detect bacteria. In our hospital, we perform influenza virus antigen test, fecal rotavirus antigen test, pharyngeal mucus adenovirus test, urinary pneumococcal antigen test, urinary Legionella antigen test, etc.

Urinary pneumococcal antigen test: antigen positive on the left, antigen negative on the right

③ Acid-fast bacteria test

Our hospital also conducts testing for acid-fast bacilli such as tuberculosis. In the smear examination, fluorescence staining and Ziehl-Nensen staining are performed. These stains do not stain bacteria other than acid-fast bacteria, so they can be distinguished from other general bacteria.

Many mycobacteria grow slowly and it takes a long time to culture them, so it may take 1-2 months to get culture results. However, by performing the PCR method ^*3 at the same time, it is possible to report the results within half a day.

④ Nosocomial infection control

As a member of the infection control team (ICT), bacteria that cause nosocomial infections such as MRSA (methicillin-resistant Staphylococcus aureus), MDRP (multidrug-resistant Pseudomonas aeruginosa), and ESBL (extended specificity beta-lactamase)-producing bacteria We are investigating the detection status of this and are working to prevent nosocomial infections. In addition, we are working to prevent outbreaks*4 by conducting environmental surveys to check for drug-resistant bacteria that cause nosocomial infections around the water in the ward.

However, when an outbreak does occur, we conduct an epidemiological investigation using genetic analysis. Pulsed-field gel electrophoresis (PFGE) is widely used for this genetic analysis, but it lacks simplicity and speed. I'm here.

Numbers 1 and 4 are from different patients. 2 and 3 are bacteria found around the water in patient number 1's room. 5 is a fungus that was around the water in the room of patient number 4. In other words, in the right figure, 1 and 2 have 98.3% homology ^*5, which proves that they are almost the same strain, but 1 and 4 have 65.5% homology, so they are derived from different strains.

Requests to Patients

Since the microbiology laboratory handles living organisms, it is sometimes difficult to report the results immediately, but we make every effort to find pathogens as quickly as possible and provide information on appropriate antibiotics to the attending physician.

しかし、せっかく検体を提出していただいたのにも関わらず、検査に不適切な検体もあります。例えば、喀痰の場合は唾液の含まれる粘液状のものだと口腔内には常在菌がたくさんいるため、病原微生物以外の菌のみが発育してしまい、検査結果の意味がなくなってしまいます。正確な検査結果を報告するために、喀痰を提出していただく際には、まずはうがいをし、口腔内の常在菌をできるだけ減らしてから、膿性な喀痰を提出していただくようにお願いします。

*1 Gram staining: Due to differences in the structure of bacteria's cell walls, bacteria are classified as gram-positive bacteria, which stain deep purple, and gram-negative bacteria, which stain pink.
*2 Antigen: A general term for a substance (such as a structural protein of a microorganism) that triggers an immune response to defend the body when it enters the body. The principle of this immune response is used in clinical testing.
*3 PCR method: A method that uses a machine called a thermal cycler and special reagents to amplify the DNA contained in bacteria, making it easy to confirm the presence or absence of even a small amount of bacteria.
*4 Outbreak: An outbreak of an infectious disease caused by the same bacterial species in a specific location within a certain period of time.
*5 Homology: A specific part of a gene has a common evolutionary ancestor. Those with a high degree of homology can be determined to be derived from the same strain.

Postscript

From this June, the waiting hallway of the physiological examination room on the second floor has been decorated with cute flowers. Are these flowers used by the staff of the physiological examination room and the blood collection room in your home garden, rental farm, roadside? I bring flowers that are blooming and growing in the garden and decorate them. It's not the gorgeous flower you see in stores, but because it's a wild flower, I feel like I'm calming down and calming down.

In addition, when the flowers are displayed, patients and other staff say, "The flowers are pretty, aren't they?"

Wildflowers are not gorgeous and gorgeous flowers that shine brightly, but bloom quietly and unnoticeably, but soften the heart in the scenery of people who pass by.

doctor and nurses, we do not interact with patients all the time. I want to do my best to make sure that you feel comfortable and have a good examination.

The relationship between HPV and actual cervical cancer screening

Pathology Laboratory Masahito Omatsu

Cervical cancer is mostly caused by HPV (human papillomavirus) infection. HPV is a virus that infects the skin and mucous membranes. Currently, more than 100 types of HPV have been discovered, and they are numbered in order of discovery. HPV that infects the genital mucosa is divided into high-risk and low-risk types according to the degree of carcinogenesis risk. Among the high-risk types, types 16 and 18 are said to be particularly involved in carcinogenesis. It has been.

Cervical cancer occurs frequently in people in their 40s and 50s, but in recent years the prevalence of cervical cancer among women under the age of 40 is increasing. However, since dysplasia (lesion before cervical cancer develops) can be detected, it is possible to prevent the onset of cancer by detecting and treating dysplasia at the stage of cervical cancer through regular cervical cancer screening. . In addition, bivalent HPV vaccines (types 16 and 18) and quadrivalent vaccines (types 6, 11, 16, and 18) against the HPV virus, which is said to account for the majority of cervical cancers, are now available. It is said that this vaccine is highly effective in preventing cancer.

In the pathology laboratory, cytological examinations of the cervix and cervix are performed to check for cervical cancer and precancerous lesions, as well as for HPV and other infectious diseases. Therefore, this time, we will introduce the actual cytological examination of cervical cancer performed in the pathology laboratory.

A. Cell collection and sample preparation method for cytological examination

The cervix is composed of squamous epithelium continuously from the outside to the skin, vulva, and vagina. And there is a place where it collides with the lineal cells that make up the epithelium just after entering the entrance of the uterus. Cervical cancer frequently occurs at the junction between the squamous epithelium and the glandular epithelium (S-C junction), so this area is scraped with instruments such as cotton swabs, spatulas, and brushes.

Next, the collected smear is smeared on a preparation and quickly placed in a 95% alcohol solution before it dries to fix the cells. After that, Papanicolaou staining is performed, and the stained specimen is examined under a microscope for abnormal findings by a clinical laboratory technologist with specialized qualifications called a cytotechnologist.

B Various cell images and their characteristics

① Coilosite

It is a change seen in HPV-infected cells, and distinct vacuoles are observed around the nucleus, which is called a nuclear perimeter.

② Mild dysplasia (mild dysplasia, low-grade squamous intraepithelial lesion [LSIL])
Classification: Class Ⅲa

Cells with nuclear atypia of superficial to middle-layer squamous epithelial cells are seen. The nuclei are larger than normal cells and stain dark purple. An increase in the N/C ratio (nuclear/cytoplasmic ratio) is seen. Further investigation may be required and colposcopy and tissue biopsy may be performed.

③ Severe dysplasia, high-grade squamous intraepithelial lesion [HSIL]
Class classification: Class Ⅲb

Cells with nuclear atypia of parabasal squamous epithelial cells are mainly seen. The size of the nucleus relative to the cytoplasm becomes larger, irregular shapes and notches are often observed, and the nucleus is stained darker. As with mild dysplasia, close examination is required.

④ Squamous cell carcinoma Invasive cancer
Classification: Class V

The background has a lot of necrosis and looks dirty, and the cells are distorted, and small to large malignant cells are seen in flat clumps. The size of the nucleus is large and small, and the variation is conspicuous. The cytoplasm shows spindle-shaped, snake-shaped, and tadpole-shaped morphologies, and malignant cells that stain dark orange may also be seen. We will conduct detailed examinations such as histological examinations and decide on a treatment policy.

C Summary

Most cervical cancers are caused by HPV infection. However, as explained this time, it is a cancer that can be detected and treated at an early stage by confirming cell dysplasia by cytological examination. It is thought to be preventable through regular cervical cancer screening and vaccination.

* Vaccines are quite expensive (at our hospital, the total cost for three doses is around 52,000 yen), but some local governments subsidize vaccination costs. Kobe City subsidizes the full amount for girls from the first year of junior high school to the first year of high school. For details, please check the website of Kobe City.

Contact information

Kobe City Public Health Center Preventive Health Division Tuberculosis and Infectious Disease Section
TEL 078-322-6788
Our hospital
TEL 078-302-4321 (representative)

《Postscript June 20》
On June 14, 2013, the Ministry of Health, Labor and ministry of Health, Labor and Welfare notation issued a statement about routine vaccination of human papillomavirus infections (recommendation), which states that "the occurrence frequency of side reactions will be clarified, and appropriate measures will be taken." It should not be actively recommended until information can be provided." For details, please contact the above contact information or each medical institution.

Inspection department news

Academic report

Paper presentation

• Inoue D, Matsushita A, Kiuchi M, Takiuchi Y, Nagano S, Arima H, Mori M, Tabata S, Yamashiro A, Maruoka H, Oita T, Imai Y, Takahashi T.：Successful Treatment of γ-Heavy-Chain Disease with Rituximab and Fludarabine.　Acta Haematol. 128: 139-143, 2012

Conference presentation

• September 19, 2012
  Osaka Ultrasonic Society Osaka International Conference Center
  Presented by Masafumi Sugawara, Hitoshi Kazuo, Hokaku Jeong, et al.: "A case of pediatric acute appendicitis that appears like a cystic mass"
• September 19, 2012
  Japanese Society for Clinical Medical Examinations Kansai Branch General Meeting Shirahama, Wakayama Prefecture
  Presentation: Natsumi Nomoto, Hayato Maruoka, Koji Nasu, Tatsuo Oita: "Immunophenotyping of plasma cell tumors using 6-color flow cytometry"
  Presentation: Akiko Yamashiro, Yoko Shibata, Akiyo Tamura, Kanji Miki, Tatsuo Oita: "Report on five years after the opening of the examination consultation room"
  Presented by: Hitoshi Kazuo, Kenji Sakizono, Keishi Takekawa, Masaaki Eto:
  "Appropriate disinfection time for intravenous blood collection with chlorhexidine gluconate in alcohol-free patients"
• October 6, 2012
  The 39th Kansai Regional Conference of the The Japan Society of Ultrasonics in Medicine, Osaka
  Presentation: Mamiko Takebayashi, Nobuhiro Iwasaki, Yoshiki Suginoshita, et al.: “Study of Abdominal Tumors in the Past Five Years at Our Hospital”
  Presentation: Nobuhiro Iwasaki, Mamiko Takebayashi, Yoshiki Suginoshita, et al.: "A case of pancreatic pseudoarteriovenous malformation (AVM) associated with acute pancreatitis"
  Presentations: Nobuhiro Iwasaki, Mamiko Takebayashi, Yoshiki Suginoshita, et al.: "A case of diverticulum perforation caused by amoeba infection"
  Presentation: Kazumi Hamada, Takako Tosaka, Sho Sasaki, et al.: "A case of diffuse sclerosing papillary carcinoma in the residual lobe of follicular cancer"
  Presentation: Eriko Miwa, Naoko Araki, Nobuhiro Iwasaki, et al.: "A case of hepatic malignant lymphoma treated with contrast-enhanced ultrasound"
  Presentation: Masafumi Sugawara, Hitoshi Kanoo, Kazumi Hamada, et al.: "A case of pediatric perforated appendicitis with hydronephrosis: On the mechanism that appears like a cystic mass"
  Presentation: Namiko Nomura, Tomoko Tani, Toshiko Konda, et al.: "Two cases in which left ventricular hypertrophy was suspected on electrocardiogram, but left ventricular wall thickening was not confirmed by transthoracic echocardiography"
• October 11, 2012
  Japanese Audiological Society Kyoto International Conference Center Kyoto
  Presentation: Mitsuo Hamada: "A case of unilateral auditory neuropathy with mild laterality in hearing tests"
• November 5, 2012
  The The Japanese Association for Infectious Diseases Central Japan Regional Society ACROS Fukuoka
  Presentation: Marie Niki, Kanji Miki, Keishi Takekawa: "Epidemiological survey of Pseudomonas aeruginosa by rep-PCR analysis"
• November 30, 2012
  General Assembly of the Japanese Society for Laboratory Medicine, Kyoto
  Presentation: Hayato Maruoka, Tatsuo Oita, Takayuki Ishikawa: "Immunophenotyping of B-ALL by 6-color flow cytometry"

Lecture

• June 28, 2012
  Abdominal Ultrasound Conference Kobe
  Lecture: Nobuhiro Iwasaki: "Ultrasound Diagnosis of Abdominal Tumors"
• July 21, 2012
  Physiology Department System Forum Osaka
  Lecture: Junichi Kawai: "Efforts to introduce a departmental system"
• July 26, 2012
  The 13th Kobe Glam Dyeing Conference Kobe ANA Crowne Plaza Hotel
  Lecture: Hiroshi Takegawa: "A Case of Cellulitis in a Patient with Castleman's Disease"
• September 21, 2012
  emergency conference
  Lecture: Yoko Shibata: "For safe blood transfusion"
• September 30, 2012
  General Meeting of the Kansai Branch of the Society of Clinical Medical Examinations (Shirahama, Wakayama)
  Lecture: Keiji Takekawa: "Minimum reporting for Gram staining"
  Lecture: Hitoshi Kazuo: "Tips for evaluating hepatocellular carcinoma (HCC)"
• September 15, 2012
  2012 Infection Control Certified Nurse Education Course Kobe Training Center
  Lecture: Hiroshi Takegawa: "Fungi and hard-to-cultivate microorganisms"
• September 21, 2012
  2012 Infection Control Certified Nurse Curriculum Kobe University Graduate School of Health Sciences
  Lecture: Keishi Takegawa: "Introduction to Microbial Testing/Basic Operation of Testing"
• September 22, 2012
  2012 Infection Control Certified Nurse Curriculum Kobe University Graduate School of Health Sciences
  Lecture: Keishi Takegawa: "Observation and Judgment of Culture Medium"
• September 23, 2012
  2012 Infection Control Certified Nurse Curriculum Kobe University Graduate School of Health Sciences
  Lecture: Hiroshi Takegawa: "Mycobacterial test, observation of fungi, determination of drug susceptibility, etc."

Postscript

Autumn is the season for academic conferences. Members of our Clinical Laboratory also energetically made presentations at academic conferences such as the Medical Examination Society, the Ultrasonic Society, and the Society for Infectious Diseases. There were 5 presentations by the newcomers hired in 2011 and 2012, and I think it is a showcase of their efforts as well as the skills of their instructors. This year, previews were held throughout the examination room. Since clinical testing is divided into a wide range of fields, such as blood testing, bacteriological testing, pathological testing, and ultrasonography, the presenter first gives a brief lecture on technical terms and measurement principles in order to give the audience a background knowledge of the content of the presentation. The announcement was made after deepening the understanding of the audience. The newcomer calmly made a solid presentation, and responded well to the questions and answers after the presentation. There were also comments from outside the field, and a great deal of discussion took place, making the meeting very meaningful.

About the sample test flow - from sample collection to result reporting -

General examination room: Asami Yorioka, Biochemical examination room: Chihiro Miyazaki

Our laboratory is located on the 2nd and 3rd floors. In the back of the urine collection room on the 2nd floor, there is a general examination room, which mainly analyzes the urine submitted from the urine collection room. In addition, the blood collected in the blood collection room is transported to the 3rd floor on a transport tray, where it is analyzed in the biochemical test, immunological test, and blood test departments.

In our laboratory, we are making various efforts to report accurate test results quickly. For outpatient pre-examination testing, we implement immediate reporting, which means that results are reported within one hour of the specimen's arrival at the laboratory, so that test results can be provided before the examination. Nearly 100 items including hormones and tumor markers, as well as general test items for liver function and anemia, are subject to immediate test items. In addition, we have established a system in which clinical laboratory technologists urgently contact the attending physician if, judging from the test results, a test value (panic value) indicating a pathological condition requiring immediate treatment is detected. In addition, we have established a system that enables emergency examinations 24 hours a day, 365 days a year to support emergency medical care at our hospital.

This time, I will briefly introduce the flow from the examination of the specimen after blood and urine collection from the patient until the results are obtained.

Did you understand the blood test items that are affected by diet and exercise?

Exercising, eating, drinking alcohol, smoking, etc. on the previous day or the day of the test may affect the test results and cause them to fluctuate. In order to provide more accurate test results, the patient's cooperation is essential.

In addition, all the staff are working hard to provide each clinical department with quick and accurate test results, but depending on the test content, it may take time. We ask that you complete blood and urine collection in advance.

Inspection department news

Academic report

Paper presentation

• Inoue D, Matsushita A, Kiuchi M, Takiuchi Y, Nagano S, Arima H, Mori M, Tabata S, Yamashiro A, Maruoka H, Oita T, Imai Y, Takahashi T.：Successful Treatment of γ-Heavy-Chain Disease with Rituximab and Fludarabine.　Acta Haematol. 128: 139-143, 2012

Conference presentation

• ○September 19, 2012
  Osaka Ultrasonic Society Osaka International Conference Center
  Presented by Masafumi Sugawara, Hitoshi Kazuo, Hokaku Jeong, et al.: "A case of pediatric acute appendicitis that appears like a cystic mass"
• September 19, 2012
  Japanese Society for Clinical Medical Examinations Kansai Branch General Meeting Shirahama, Wakayama Prefecture
  Presentation: Natsumi Nomoto, Hayato Maruoka, Koji Nasu, Tatsuo Oita: "Immunophenotyping of Plasma Cell Tumors Using 6-Color Flow Cytometry"
  Presentation: Akiko Yamashiro, Yoko Shibata, Akiyo Tamura, Kanji Miki, Tatsuo Oita: "Report on five years after the opening of the examination consultation room"
  Presented by: Hitoshi Kazuo, Kenji Sakizono, Keishi Takekawa, Masaaki Eto:
  "Appropriate disinfection time for intravenous blood collection with chlorhexidine gluconate in alcohol-free patients"
  Presentation: Toyokazu Akita, Hiromi Takano: "A Trial to Introduce a Training Program for Newcomers to Blood Transfusion Testing Facilities"
  Presentation: Hisae Suzuki, Fumie Inoue, Yukiko Shishido, Toshiyuki Ueno: "Search for D-dimer quantitative values and disease relevance in our hospital"
  Presentation: Miyuki Hasegawa, Yayoko Kaizuma, Mineyo Kiuchi, Toyokazu Akita: "Fundamental study of reagents for TgAb and TPOAb measurement by automatic electrochemiluminescence immunoanalyzer cobas e411"
• October 6, 2012
  The 39th Kansai Regional Conference of the The Japan Society of Ultrasonics in Medicine, Osaka
  Presentation: Mamiko Takebayashi, Nobuhiro Iwasaki, Yoshiki Suginoshita, et al.: “Study of Abdominal Tumors in the Past Five Years at Our Hospital”
  Presentation: Nobuhiro Iwasaki, Mamiko Takebayashi, Yoshiki Suginoshita, et al.: "A case of pancreatic pseudoarteriovenous malformation (AVM) associated with acute pancreatitis"
  Presentations: Nobuhiro Iwasaki, Mamiko Takebayashi, Yoshiki Suginoshita, et al.: "A case of diverticulum perforation caused by amoeba infection"
  Presentation: Kazumi Hamada, Takako Tosaka, Sho Sasaki, et al.: "A case of diffuse sclerosing papillary carcinoma in the residual lobe of follicular cancer"
  Presentation: Eriko Miwa, Naoko Araki, Nobuhiro Iwasaki, et al.: "A case of hepatic malignant lymphoma treated with contrast-enhanced ultrasound"
  Presentation: Masafumi Sugawara, Hitoshi Kanoo, Kazumi Hamada, et al.: "A case of pediatric perforated appendicitis with hydronephrosis: On the mechanism that appears like a cystic mass"
  Presentation: Namiko Nomura, Tomoko Tani, Toshiko Konda, et al.: "Two cases in which left ventricular hypertrophy was suspected on electrocardiogram, but left ventricular wall thickening was not confirmed by transthoracic echocardiography"
• October 11, 2012
  Japanese Audiological Society Kyoto International Conference Center Kyoto
  Presentation: Mitsuo Hamada: "A case of unilateral auditory neuropathy with mild laterality in hearing tests"
• November 5, 2012
  The The Japanese Association for Infectious Diseases Central Japan Regional Society ACROS Fukuoka
  Presentation: Marie Niki, Kanji Miki, Keishi Takekawa: "Epidemiological survey of Pseudomonas aeruginosa by rep-PCR analysis"
• November 30, 2012
  General Assembly of the Japanese Society for Laboratory Medicine, Kyoto
  Presentation: Hayato Maruoka, Tatsuo Oita, Takayuki Ishikawa: "Immunophenotyping of B-ALL by 6-color flow cytometry"

Lecture

• June 28, 2012
  Abdominal Ultrasound Conference Kobe
  Lecture: Nobuhiro Iwasaki: "Ultrasound Diagnosis of Abdominal Tumors"
• July 21, 2012
  Physiology Department System Forum Osaka
  Lecture: Junichi Kawai: "Efforts to introduce a departmental system"
• July 26, 2012
  The 13th Kobe Glam Dyeing Conference Kobe ANA Crowne Plaza Hotel
  Lecture: Hiroshi Takegawa: "A Case of Cellulitis in a Patient with Castleman's Disease"
• September 21, 2012
  emergency conference
  Lecture: Yoko Shibata: "For safe blood transfusion"
• September 30, 2012
  General Meeting of the Kansai Branch of the Society of Clinical Medical Examinations (Shirahama, Wakayama)
  Lecture: Keiji Takekawa: "Minimum reporting for Gram staining"
  Lecture: Hitoshi Kazuo: "Tips for evaluating hepatocellular carcinoma (HCC)"
• September 15, 2012
  2012 Infection Control Certified Nurse Education Course Kobe Training Center
  Lecture: Hiroshi Takegawa: "Fungi and hard-to-cultivate microorganisms"
• September 21, 2012
  2012 Infection Control Certified Nurse Curriculum Kobe University Graduate School of Health Sciences
  Lecture: Keishi Takegawa: "Introduction to Microbial Testing/Basic Operation of Testing"
• September 22, 2012
  2012 Infection Control Certified Nurse Curriculum Kobe University Graduate School of Health Sciences
  Lecture: Keishi Takegawa: "Observation and Judgment of Culture Medium"
• September 23, 2012
  2012 Infection Control Certified Nurse Curriculum Kobe University Graduate School of Health Sciences
  Lecture: Hiroshi Takegawa: "Mycobacterial test, observation of fungi, determination of drug susceptibility, etc."

Postscript

said. ran away. And I'm about to leave
Monthly events in 2013.
The deadline for updating the website has passed. Time flies fast. too fast.
Thankfully.
I have a lot to do. Too many. But I am grateful to be able to do it.
I am happy.
However, it has not been done. That's why "time" passes quickly.

It's been a year since the birth of "TEKARI" by The Inspection Department Times.
Although it is updated only 4 times once every 3 months, it continues.
It is growing steadily.
has become respectable.
Good content anyway. Thanks to contributors.
Aiming for my 2nd birthday, let's do our best again for another year.
"Transmission from Kobe to the world, Kobe Kobe City Medical Center Clinical Laboratory"

H.T

Regarding blood transfusion services after relocation to the new hospital

Transfusion Testing Management Office Toshiko Kusumoto

Inspection department news

Academic report

ain Disease with Rituximab and Fludarabine. Acta Haematol. 128: 139-143, 2012

Conference presentation

• March 2, 2013
  6th Electroencephalogram and Electromyogram Seminar, Kyoto, Kyoto Terrsa
  Presentation: Ichiro Sasaki: "About legal brain death determination according to Course C"
• March 10, 2013
  ACC2013 Moscone center in San Francisco
  Presentation: Toshiko Konda, Tomoko Tani, and Yutaka Furukawa: "Mitral Annular Disjunction in Consecytive Cases: Echocardiographic Detection"
• May 18-19, 2013
  The 62nd Japanese Society of Medical Technology
  Presentation: Toshiyuki Ueno, Satoru Miyano, Makiko Tanaka, Kaori Sakurai, Fumie Inoue, Hisae Suzuki, Toyokazu Akita, Yoshimasa Niwa: "Evaluation of blood gram training using the JAMT recommended method and the JSLH standard bill"
• May 18-19, 2013
  The 62nd Japanese Society of Medical Technology
  Presentation: Hirokazu Mori, Chihiro Miyazaki, Koji Takeichi, Saioko Umitsuma, Toyokazu Akita, Hiromi Takano, Kyoichiro Aikawa: "An Attempt to Implement a Training Program for New Employees and Educational Instructors (Mentor System)"
• May 18-19, 2013
  The 62nd Japanese Society of Medical Technology
  Presentation: Asami Yooka, Chiaki Suzuki, Hiroshi Hisae, Toyokazu Akita, Hiromi Takano, Kyoichiro Aikawa: "Introduction of a new employee training system (mentor system) and its effectiveness"

Postscript

When I read the feature articles in "TEKARI", I am shocked at the narrowness of my own insight. It is exactly like "a frog in a well does not know the ocean". This proverb originates from "A frog in a well cannot speak of the ocean, it is stuck in lies" in the "Qiushui" chapter of "Zhuangzi", and is a phrase used to mock those with narrow knowledge, meaning that "for a frog living in a well, the inside of the well is everything, and he does not know that there is a big ocean". We who perform tests also tend to become proud of the well of our own "specialty field" and do not think about anything else. Looking out at the clear blue sky from the well, I hope that "TEKARI" will continue to provide information without interruption in order to know our own "well" and further "know the ocean, at least its depths", and that it will be an opportunity to reexamine "ourselves in the well".

Arteriosclerosis and plethysmography (PWV/ABI)

Physiological Function Testing Cardiopulmonary Department Natsumi Nomoto

According to the Japan Atherosclerosis Society, the number one cause of death among Japanese people is cancer, but if you combine the second-ranking heart disease and the third-ranking cerebrovascular disease, it is reported that the number of people who die from these diseases is the same as that from cancer. The majority of these heart diseases and cerebrovascular diseases are caused by arteriosclerosis.

Arteriosclerosis is a condition in which arteries change with age, blood vessels lose elasticity and harden, and lipids such as cholesterol are deposited on the walls of blood vessels, narrowing the lumen. People with lifestyle-related diseases such as diabetes, high blood pressure, and hyperlipidemia are more likely to develop arteriosclerosis. Arteriosclerosis can cause diseases such as ischemic heart disease, such as angina pectoris and myocardial infarction, cerebrovascular disorders such as cerebral infarction, and arteriosclerosis obliterans.

Arteriosclerosis obliterans (ASO) is a disease in which arteriosclerosis in the blood vessels of the hands and feet causes the blood vessels to narrow (stenosis) or become clogged (occlusion), resulting in poor blood flow to the extremities, causing various disorders in the hands and feet. The main symptoms include cold sensation in the lower limbs and intermittent lameness (inability to walk due to pain after walking several tens to several hundred meters, but symptoms subside when resting), and in severe cases, pain at rest, necrosis of the lower limbs, and skin ulcers may occur.

For these reasons, evaluating the stiffness of the arterial walls and the clogging of the arteries is very important in understanding the state of arteriosclerosis, which is the cause of various diseases. These can be evaluated using a pulse wave test called ABI (ankle/brachial index) and PWV (pulse wave velocity).

This time, we will explain pulse wave imaging (ABI/PWV), which can easily and non-invasively evaluate the stiffness of arterial walls and arterial blockage.

What is ABI (Ankle/Brachial Index)?

ABI (Ankle/Brachial Index) is the ratio of ankle systolic blood pressure to brachial systolic blood pressure. The formula is as follows:

• In healthy individuals, blood pressure in the legs is the same as or slightly higher than that in the arms, so the ABI falls in the range of 1.00 to 1.29.
• When there is stenosis of the lower limb blood vessels, the blood pressure in the lower limbs decreases, causing the ABI to be 0.9 or less.
• A difference in blood pressure between the left and right sides is also a sign of suspected stenosis.

However, even if the ABI is 0.9 or more, stenosis may occur. This is because blood pressure does not drop suddenly unless the blood vessels are narrowed by 75% or more, and because arterial calcification in diabetes and other conditions requires higher pressure to constrict the blood vessels, which can result in the measured value being expressed as higher.

Therefore, it is important to evaluate the ABI comprehensively, including not only the numerical value but also the waveform, etc.

What is PWV (Pulse Wave Velocity)?

PWV (Pulse Wave Velocity) is the speed at which the pulsation of blood pushed out from the heart travels through the arteries. In our laboratory, we measure ba PWV (Brachial-Ankle pulse Wave Velocity). The calculation formula is as follows:

• In healthy people, the blood vessels are flexible and elastic, and the pulse waves are absorbed by the blood vessel walls, slowing down the speed.
• The harder and thicker the blood vessel walls are, the less the pulse waves are absorbed by them and the faster they travel.

There are age-specific standard values for ba PWV, and it increases with age. Until the mid-50s, women tend to have lower values than men due to the influence of female hormones, but the difference disappears after the age of 60. ba PWV can also be used to estimate vascular age.

Citation) Early diagnosis of arteriosclerosis using PWV, Supervised by Yoshiki Nishizawa et al., Published by Kyowa Kikaku

The actual inspection

Let me introduce the actual inspection process. The diagram below shows the machine and the measurement in progress.

1. The patient will be asked to rest in a supine position for about 5 minutes before the examination.
2. Since blood pressure monitors will be attached to your upper arms (near the upper arms) and ankles, you will be asked to remove any thick clothing. You will also be asked to remove your socks or pull them down so that your heels are visible.
3. A blood pressure monitor will be attached to the upper arms and ankles, electrodes for an electrocardiogram will be attached to both wrists, and a microphone for a phonocardiogram will be attached to the chest (intercostal spaces).
4. Your blood pressure will be measured twice at four locations at the same time. Please inform the examiner if you are undergoing dialysis or have suffered any major injuries to your hands or feet.
5. During the test, your heart sounds will be recorded, so please refrain from moving or talking.
6. The test takes approximately 10 minutes from the time you enter the room.

At the end

Arteriosclerosis progresses asymptomatically (no symptoms are felt) with age, but arteriosclerosis has already been observed in young people. Therefore, arteriosclerosis is not a disease that only affects middle-aged and elderly people, and it is important to diagnose it earlier and take measures earlier. Pulse wave chart (PWV/ABI) is one of the tests to detect early arteriosclerosis, and it is easy to perform with little burden on the patient. If you have symptoms in your lower limbs or are at high risk of lifestyle-related diseases, please consult your doctor.

References

Early diagnosis of arteriosclerosis using PWV, Supervised by Yoshiki Nishizawa et al., Published by Kyowa Kikaku

Blood Collection Q&A

Outpatient Blood Collection Room Akiyo Tamura

Q1. Is there an appropriate outfit to wear when having your blood drawn?

A. Please remove your jacket when taking your blood. We will also roll up your sleeves, so please wear clothes that are not too tight when you roll up your sleeves. If your sleeves are too tight, it will be difficult to stop the bleeding when the needle is removed.

Q2. I've had a meal, is it okay?

A. Unless the patient has been instructed by doctor to take a blood test fasting, it is okay to eat. However, if you can take it on the same day as another fasting test, please follow the instructions for that test. (If you have a check in the 'Please take the test by fasting' at the top of the test guide, you are fasting) Even if you are instructed to fast for blood collection, you can take fluids except in special cases. Unless you are instructed not to drink water, please take water (water, hot water, tea, etc.) in the morning normally. Please check with your doctor about medications.

Q3. What is the best way to collect blood smoothly?

A. It's inevitable to feel nervous when having your blood drawn, but when you're nervous, your blood vessels shrink. Please relax as you receive the blood. Also, if you stand up straight and hold your hand with your thumb inside, it seems to make it easier to see your veins. If you haven't had a drop of water since the morning, your veins will be harder to see. Unless you have been advised by doctor to restrict your fluid intake, please drink fluids as usual in the morning (water, hot water, tea, etc.).

Q4. Why do we take multiple blood samples?

A. The test involves:

1. Blood is coagulated and the supernatant (serum) is measured
2. Measurement of the supernatant (plasma) without clotting the blood
3. Measurement without separation

Since different drugs are contained in the blood collection tubes for each of these various tests, several blood samples will be required.

Q5. Why do you swirl the blood collection tube?

A. As mentioned above, there are many types of blood collection tubes, and some contain various medications for tests. These blood collection tubes need to be thoroughly mixed with the medication and blood, so they are mixed by rotating them mechanically to save the blood collector the trouble of having to mix by hand.

Q6. Is it okay to take so many blood samples?

A. Although it varies depending on body weight, about 4 to 6 liters (about 1/13 of body weight) of blood circulates through the body in adults. In the blood collection room, most patients have 3 to 5 blood samples taken, with the amount of blood taken being less than 20 ml (about 1 tablespoon), so this is about 1/250 of the blood circulating through the body. Please rest assured.

Q7. Can I take a bath on the day my blood is drawn?

A. You may take a bath if the bleeding has stopped. However, please be careful not to rub the area too hard and keep it clean on the day of collection.

Q8. After blood collection, the area disinfected becomes red and causes a rash.

A. When taking blood samples, we use cotton soaked in alcohol for disinfection. If you are sensitive to alcohol, using alcohol cotton can cause redness, itching, and swelling. If you let us know in advance, we will use a different type of disinfectant cotton. If the itching or swelling does not go away after a few days, please consult us. Also, if you have an allergic reaction to tape, we can accommodate you if you let us know.

Q9. Why do they hold my hand down for 5 minutes after taking my blood?

A. The bleeding will not stop immediately. If you simply apply tape over the cotton, it will only close the holes in the skin, so the blood from the blood vessels will pool under the skin and turn blue (internal bleeding). By pressing firmly from above, the holes in the blood vessels will also be closed. Also, please be aware that if you lift something heavy with the hand that collected the blood or measure your blood pressure immediately after the blood is drawn, blood may leak from the closed holes, causing internal bleeding and staining your clothes. If you are taking medications that make it difficult to stop the bleeding (such as warfarin or aspirin), please press firmly for a longer period (about 10 minutes).

Q10. My blood turned blue after being drawn.

A. As mentioned above, if the blood is not held firmly after collection, blood will leak under the skin, causing internal bleeding and turning blue. Also, for people with thin blood vessels, the blood collection technique is difficult and may result in some damage to the blood vessels. If there is no pain or fever, leave it as it is and the blood will be gradually absorbed into the cells and the color will disappear. At that time, the blue bruise may turn yellow, but please rest assured that this is just a change in the pigment of the red blood cells during the absorption process. Please allow 1 to 4 weeks for it to clear up.

Q11. Was it very painful when your blood was taken?

A. I'm sorry for the pain. Since blood is drawn by inserting a needle, some pain will occur. If you feel severe pain during the blood draw, please inform the blood drawer. The blood draw will be stopped. Most pain will go away once the blood draw is completed, but if you experience severe pain or numbness that extends to your fingers, your nerves may have been damaged. We blood drawers always take great care when drawing blood, but the course of the nerves varies greatly from person to person, and it is not possible to check the course from the outside, so it is not possible to avoid nerve damage 100%. Nerve damage is said to occur once in about 10,000 to 100,000 times, and in normal blood draws, the damage is mild and the symptoms are mild and temporary. Even if pain or numbness continues, it usually subsides within a few days to a month, but in rare cases, the pain may continue for more than a few months. If you have any of these symptoms, please inform the blood drawer. Our staff will take the utmost care when collecting blood, but please let us know if you have any symptoms that concern you. Also, if you have any questions or concerns about blood collection, please feel free to ask our staff.

Inspection department news

Academic report

Paper presentation

• September 11, 2013
  2013 Japan-China-Hong Kong-Macau Hospital Infection Control Academic Research Conference, The First Affiliated Hospital of Guangzhou Medical University, China
  Lecturer: Hirofumi Takekawa: The role and function of clinical laboratory technicians in infectious disease diagnosis and treatment
• September 14, 2013
  KMI 47th Regular Meeting Osaka Knowledge Capital
  Lecturer: Hirofumi Takekawa: Infection control systems
• September 15, 2013
  FY2013 Infection Control Certified Nurse Training Course Japanese Nursing Association Kobe Training Center
  Lecturer: Hirofumi Takekawa: About difficult-to-culture microorganisms and fungi
• September 18, 2013
  Cytotechnologist Training Course Hyogo Prefecture Association of Clinical Laboratory Technologists Training Center
  Microscope training: Narikazu Haratome
• September 22, 2013
  FY2013 Infection Control Certified Nurse Training Course Kobe University School of Medicine, School of Health Sciences
  Lecturer: Hirofumi Takekawa: About fungi
• September 28, 2013
  Public Lectures at Kobe City Nishi Ward Community Center
  Lecturer: Shigekazu Haratome: Pathological examination and breast tumors
  Lecturer: Kazushi Minowa: Ultrasound examination of the mammary glands - Let's examine the mammary glands -
• October 19-20, 2013
  The 53rd Japan Society of Clinical Laboratory Technologists Kinki Branch Medical Testing Conference, Fukui
  Academic Encouragement Award Winner: Natsumi Nomoto: Immunophenotyping of plasma cell neoplasms using six-color flow cytometry
  Presentation by: Namiko Nomura: A case of infective endocarditis showing characteristic physical findings
  Presentation by: Mitsuo Hamada: Nine cases of unilateral hearing loss shown by ASSR and cochlear nerve canal stenosis or cochlear nerve hypoplasia shown by CT and MR
  Presentation by Takuya Naito: A case of Scedospolium prolificans detected in blood culture
  Presentation: Masashi Sugawara: Characteristic pancreatic duct findings on US in localized autoimmune pancreatitis: A comparative study with pancreatic cancer
  Presentation by Junko Miyamoto: Gram staining training for emergency department residents at our hospital
• November 9, 2013
  The 40th Kansai Regional Academic Meeting The Japan Society of Ultrasonics in Medicine Osaka
  Lecturer: Nobuhiro Iwasaki: Systematic Procedures for Digestive Tract Screening Ultrasound - How to Avoid Pitfalls?
  Presentation by Yumi Narita: Retrospective study of hypoechoic areas around hepatic hemangiomas observed on US, especially in association with fatty liver
  Presentation: Eriko Miwa: A case of suspected intragastric abscess caused by a foreign body
  Presentation by Nobuhiro Iwasaki: Ultrasound images of small intestinal tumor lesions
  Presentation by Natsumi Nomoto: A case in which three-dimensional transesophageal echocardiography was useful in diagnosing left atrial myxoma

Postscript

Being a lazy person, I started growing a small bonsai called Kochougi. I was worried that it would die, but before I knew it, I started to love it as it continued to grow even though it got colder. I took good care of it and am happy every day when I find new leaves coming out. I heard that this tree will bloom with pale purple flowers in the spring. I'd like to wait for spring with it during the winter. (MN)

Testing Consultation Room - Aiming to improve patient services -

Test Information Management Office Akiko Yamashiro

The Laboratory Consultation Room is located within the Laboratory Information Management Office, which is responsible for statistical processing of Clinical Laboratory 's work, maintenance and management of the testing system, support for clinical research and clinical trial work, and management and operational coordination of outsourced work.

This time we will introduce the work of the Inspection Consultation Room.

This office was established with the aim of ensuring the smooth functioning of all clinical testing operations within the hospital by providing a centralized point of contact for inquiries from hospital staff regarding clinical testing. The graph below shows the number of inquiries to the Test Consultation Office over the six years from its opening in 2007 to 2013, categorized by content into questions, consultations, requests, and complaints. In the fifth year, the number of inquiries increased significantly due to changes in systems and operations, such as the introduction of electronic medical records following the move to a new hospital. The content of requests and complaints has been discussed within the department, and improvements have been made where possible. Although small, this number also includes inquiries from patients.

This time, we will introduce some examples of improvements made in response to requests and complaints from patients.

1. Reduction in the number of blood samples taken In general hospitals like ours, there are patients who visit multiple medical departments at the same time. Before moving to the new hospital, when patients visited multiple departments to have blood samples taken on the same day, even if the same blood collection tube was used, several blood samples were taken using the same blood collection tube if different test items were requested. There were also complaints from patients that "too many blood samples were taken" when blood was taken. Therefore, with the move to the new hospital, we installed a blood collection tube aggregation function in the testing department system, and by consolidating blood collection tubes during outpatient blood collection, we were able to minimize the number of blood samples taken, thereby reducing the burden on patients.
2. 2) Publication of Test Information In recent years, as patients have become more interested in their own medical care, there have been more occasions when patients ask for explanations of test items in the outpatient blood collection room, etc. In response to this, we have published test information that lists the test items, abbreviations, explanations of the items, reference ranges, etc., and we place it in the blood collection room, consultation reception, etc. to distribute to patients who need it.

In this way, we have been able to improve our operations and systems by taking into account feedback from patients, which has led to improved patient services. Although we are not currently officially responding to inquiries from patients, we hope to be able to provide explanations about tests in the future.

Inspection department news

Academic report

Conference presentation

• Takekawa, K., Onanuki, K., Naito, T., Niki, M., and Sakizono, K.: A case of Helicobactoer trogontum infection rapidly identified by 16S rRNA gene analysis of blood culture fluid. The 25th General Meeting of the Japanese Society for Clinical Microbiology. Nagoya. February 1, 2014.
• Marie Niki, Hayato Maruoka, Hiroshi Takekawa, Takuya Naito, Kenji Sakizono: Detection of Mycobacterium kansasii using hybridization probe and melting curve method. 25th General Meeting of the Japanese Society for Clinical Microbiology. Nagoya. February 1, 2014.

Paper presentation

• Maruoka H, Inoue D, Takiuchi Y, Nagano S, Arima H, Tabata S, Matsushita A, Ishikawa T, Oita T, Takahashi T. IP-10/CXCL10 and MIG/CXCL9 as novel markers for the diagnosis of lymphoma-associated hemophagocytic syndrome. Ann Hematol. 2014 Mar; 93(3): 393-401.

Postscript

It's getting warmer with each rain, and it seems that spring is definitely on its way. As it gets closer, there are fewer people working with us who are retiring, and the days are getting lonely. I would like to work hard so that the "shine" of our seniors will not fade. It's the season for cold flowers, so please stay warm and rest. (HT)

About Chimerism Testing

Masahiro Yoshida, Cell and Genetic Testing Laboratory

What is chimerism testing?

First of all, what comes to mind when you hear the word chimerism? A trendy exercise!?

The chimerism test introduced here is a test used primarily as an indicator of post-transplant survival to determine the extent to which the donor's blood cells have taken hold ^*1 in the recipient's body during hematopoietic stem cell transplantation, one of the treatments for patients with diseases (leukemia, aplastic anemia, etc.) that make it difficult to produce normal blood cells.

The word chimerism originates from the chimera in Greek mythology. A chimera is a sacred beast with a lion's head, a goat's body, and a snake's tail, made up of multiple organisms. It is said that the name chimerism comes from the fact that the donor's and recipient's blood cells combine after transplantation.

How can we be sure that the donor's blood cells have truly taken hold after a transplant?

Pre-transplant testing

Human DNA contains many sequences in which several to several dozen bases are repeated, and among these, relatively short repeats of base sequences are called STRs (Short Tandem Repeats). These differ from person to person, so by examining the length of multiple STR loci, it is possible to identify an individual. Before transplantation, it is necessary to carry out testing to determine the STRs, which are markers for identifying individuals. This STR analysis is also used in DNA testing and parent-child testing in criminal investigations.

Before transplantation, blood samples are taken from the donor and recipient, and the DNA is amplified using Multiplex STR-PCR, which targets multiple STR loci, to search for STR loci. This is shown in the left figure below. From these, unique STR loci that can clearly identify the donor and recipient are selected. This is shown in the right figure below.

In this example, the STR locus "D12S1064" can be used as a marker because the donor and recipient have different lengths of 195bp and 179bp, respectively. After transplantation, the donor peak of 195bp and the recipient peak of 179bp of this locus will be monitored.

Post-transplant chimerism testing

When a hematopoietic stem cell transplant is performed, blood cells derived from the recipient and the donor are mixed in the body after the transplant. This state is called mixed chimerism. If the donor's blood cells are then successfully engrafted, the recipient's blood cells will disappear from the recipient's body, and only the donor's blood cells will remain. This state in which the donor's blood cells are engrafted in the recipient is called complete chimerism.

After transplantation, tests are performed to confirm the stage of engraftment. Tests separate the blood into T lymphocytes (T cells) and non-T lymphocyte cells (non-T cells), and analyze each separately. This is because dissociation between the two can be observed, and this can provide useful information on early engraftment after transplantation, GVHD (graft-versus-host disease) ^*2 sup>, anti-tumor effects, etc.

DNA collected from both T cells and non-T cells is amplified using STR-PCR and analyzed.

By examining the 195bp donor peak and 179bp recipient peak of the STR locus "D12S1064" that was used as a marker before transplantation, the area ratio of each peak can be used to determine what percentage of donor-derived blood cells have survived in the recipient's body.

The left figure above shows the results of a chimerism test conducted 46 days after transplantation. For non-T cells, only the donor's 195bp peak is present, so the donor is 100% when calculated from the area ratio. On the other hand, for T cells, the donor's 195bp peak is the majority, but there is also a small amount of the recipient's 179bp peak. When calculated from the area ratio, the donor is 86%.

The test results 210 days after transplantation are shown in the right figure above. For both T cells and non-T cells, only the 195bp peak of the donor was detected, and no recipient peak was detected. The donor calculated from the area ratio was also 100%, which means that the donor's blood cells were completely engrafted.

Benefits of performing chimerism testing in-house

There are only a few facilities nationwide that perform chimerism testing in-house. Outsourced testing often takes 1-2 weeks to produce a report, but by performing the testing in-house at our hospital, we are able to produce the report the next day.

By conducting chimerism testing early after transplantation, we can determine in real time whether the donor's blood cells have engrafted. We can also take prompt action in cases where patients show signs of rejection, which can help us select the next treatment method.

Our hospital's cytogenetic testing lab has a close relationship with doctor in Hematology, and by having the lab next door to Hematology, we can share information and respond immediately by reporting results and changing or adding test items according to the patient's condition. We also hold conferences on test results from time to time.

In this environment, we will continue to proactively introduce new tests and strengthen our collaboration with doctor in an effort to provide patients with high-quality medical care that they can trust.

Terminology

*1 Engraftment: The process by which the donor's hematopoietic stem cells take root in the recipient's bone marrow.
*2GVHD (Graft-versus-host disease): An immune reaction in which the graft provided by the donor attacks the recipient's body and organs themselves, viewing them as enemies.

Inspection department news

Academic report

Conference presentation

• 1. Nomoto Natsumi, Tani Tomoko, Konda Toshiko, Tsunoda Toshiaki, Kawai Junichi, Kim Moo-tae, Kitai Tsuyoshi, Furukawa Yutaka, Kita Toru: Study of echocardiogram examinations in cardiac tumor cases in our hospital over the past 14 years. 78th Annual Meeting The Japanese Circulation Society, Tokyo, March 22, 2014.
• 2.Masahito Omatsu, Narukazu Haratome, Hideshi Imoto, Noriko Sakamoto, Akiko Morita, Keiichiro Uehara, Yukihiro Imai. Cytological findings of seven cases of Pneumocystis jirovecii infection. The 30th General Meeting Hyogo Prefecture Society of Clinical Cytology. Kobe. March 15, 2014.
• 3. Konda, R., Tani, S., Fujii, Y., Kawai, J., Kim, K., Kitai, T., Furukawa, Y., Kita, T.: Study on Mitral Annular Disjunction in Patients with Severe Mitral Regurgitation Due to Mitral Valve Prolapse. 78th Annual Meeting The Japanese Circulation Society, Tokyo, March 21, 2014.

Postscript

The other day, I went to a temple in Kyoto where it is said that wishes come true. Apparently, if you recite your address, name, and a wish, Jizo wearing straw sandals will come to your house and grant your wish. Before making my wish, I listened to a heartwarming sermon from the head priest, which said, "From the time we are born until the time we die, we live our lives interacting with others, so we must always keep a humble heart and never forget the words 'thanks to you, thank you for taking care of us, we are all in this together.'" I suddenly looked back at myself and realized that in my busy days, I don't use these words very often. I believe that if I can look back at myself and work hard every day with a humble heart, Jizo will surely come to my house and grant my wish. (NM)

Let's go beyond the examination room! -Current status of bedside testing-

Neurological Function Testing Laboratory Mamiko Nakamura

Introduction

In the physiological testing room, tests are usually performed by having patients come to the testing room.

However, there are cases where patients are unable to come to the examination room for various reasons, and in those cases, clinical laboratory technicians visit the patient to perform the tests. In such cases, the environment is different from that of the examination room, and various ingenuity is required to carry out the tests.

This time, we will focus on bedside testing and show how clinical laboratory technicians in the abdominal and neurological function testing lab go beyond the testing room to perform tests.

Where you travel and what types of tests you perform

The most common place to leave the examination room for testing is in critical care units such as the ICU (intensive care unit). Patients in the ICU are often in an unstable condition and require many medical devices such as IV drips and artificial ventilators, making it extremely difficult and dangerous to move them to the examination room. For this reason, laboratory technicians visit the patient's room with testing equipment, which is called bedside testing or portable testing. In the abdominal and neurological function testing room, we perform bedside tests such as electroencephalography, abdominal ultrasound, vascular ultrasound, and neurological function tests.

[Graph] shows the ratio of bedside tests by type in fiscal year 2013. The total number of tests in fiscal year 2013 was 14,991, of which 338 were bedside tests. At our hospital, the number of EEG tests is overwhelmingly higher, which is thought to be because patients hospitalized in the intensive care unit often suffer from impaired consciousness, and EEG tests are requested as a detailed examination of impaired consciousness.

Similarly, neurological function tests are often requested as brain function tests and require travel.

Abdominal ultrasound examinations are mainly requested to evaluate the liver, gallbladder, bile ducts, etc., while vascular ultrasound examinations are often requested to search for deep vein thrombosis of the lower extremities (blood clots that form in the veins of the legs due to prolonged bed rest, etc.).

Differences from laboratory tests

What is the difference between testing in a testing room and testing outside of the testing room? Let's take the example of EEG testing, which is the most common bedside test.

(1) Inspection equipment

To conduct bedside testing, the testing equipment must first be transported. Because the EEG machines used in the testing room are large and difficult to transport, a compact EEG machine that can be easily moved by one person is used for bedside testing (Figure 1).

The small size of the machine makes it convenient for testing in the limited space of a hospital room without interfering with other medical equipment. However, the bedside EEG machine at our hospital is not equipped with a video camera to record the patient's condition, so the technician must take notes on the condition during the test to record it in detail, and it is therefore inferior in functionality to the EEG machines in the testing room.

(2) Environment

EEG testing is usually performed in a room called a shielded room (Figure 2).

This room blocks electromagnetic waves, which are one of the causes of artifacts (waveforms that originate from brain activity other than what should be recorded) in EEG testing, making it the ideal environment for recording EEG. On the other hand, in the ICU, where bedside testing is often performed, there are many sources of artifacts, including medical equipment, and it is not necessarily a good environment for EEG testing. For this reason, we ask ward staff to unplug equipment that can be turned off, and for equipment that cannot be turned off, we keep it as far away from the patient as possible, in order to create as good an environment as possible for testing.

Figure 3A shows an EEG recorded at the bedside with significant artifacts. The thick lines (arrows) are areas with significant artifacts, and all of these were recorded with electrodes attached to the left side of the head. This makes it impossible to interpret the patient's actual EEG, making the test pointless.

This is where the technician's skills come into play. From the waveform, we predicted that the main cause of the artifacts was AC interference, and took the measures mentioned above. However, we were unable to remove the artifacts to the extent that we could read the EEG, so we thought that it was probably due to the influence of the environment outside the room, such as the next room or the nurse's station, and decided to retest at a later time.

Figure 3B shows the EEG recorded after a re-examination about 4 hours after A. Compared to A, the artifacts have been reduced and the EEG is readable. It is believed that the artifacts have been reduced due to a change in the electrical environment outside the hospital room.

As such, bedside testing can require the knowledge and experience of a technician, and can be thought of as an "advanced" version of laboratory testing.

Clinical laboratory technicians rushing out of the examination room

When working in an examination room, you rarely have contact with staff from other professions, but when performing bedside examinations, you almost always have contact with ward staff to help support the patient and deal with artifacts.

They also ask us questions about tests, and we exchange knowledge by asking about things we don't understand, so there is an advantage in that learning about things outside of one's specialty broadens one's horizons. When you're in the examination room, you can only actually see the testing part of the medical treatment, but going outside the examination room broadens your horizons and allows you to see that testing is one part of the larger flow of medical treatment, including doctor 's examination and the nurse's care.

This will give them an opportunity to think about what kind of tests will be useful in treating patients, and will motivate them to report clinically useful test results. In addition, by showing the ward staff the work of a medical technician, which they don't usually see, this is also a good opportunity for them to learn about the profession of a medical technician.

If there is even a little mutual understanding between these professions, cooperation between staff will be smoother and patient treatment will proceed more smoothly.

Conclusion

We introduced work outside the examination room, focusing on bedside testing. Bedside testing is not limited to the electroencephalography test introduced this time, but can be more difficult than testing in the examination room because the equipment and environment are different from those in the examination room and various ingenuity is required. However, interacting with ward staff broadens your perspective and is also an opportunity to deepen mutual understanding. In addition to bedside testing, there are many tasks that are performed outside the examination room, such as infection control teams (ICT), nutrition support teams (NST), and intraoperative neuromonitoring.

In each case, they have found areas where they can utilize their expertise as medical technicians among the various staff members in various professions. We would like to proactively find other places in the hospital where medical technicians' skills are needed and can be utilized.

Inspection department news

Academic report

Paper presentation

• Akiko Yamashiro, Naoko Suganuma, Yoko Shibata, Akiyo Tamura, Tatsuo Oita: Report on the six years since the establishment of the examination consultation room. Medical Examination 63: 366-373, 2014

Conference presentation

1. Akiko Morita, Hideshi Imoto, Hayato Maruoka, Tatsuo Oita, Toshiyuki Ueno, Yoshimasa Niwa: A case of chronic myelomonocytic leukemia (CMML) with small intestinal invasion observed in our hospital. 63rd Annual Meeting of the Japanese Society of Medical Technology, Niigata, May 17-18, 2014.
2. Tamura, A., Nasu, K., Tsunoda, T., Morita, A., Niki, M., Naito, T., Nomoto, N., Nakamura, M., Narita, Y., Oita, T.: Activities of the medical safety team in the Clinical Laboratory of our hospital. 63rd Japan Society of Medical Technology, Niigata, May 17-18, 2014.
3. Nobuhiro Iwasaki: Symposium: Advances in gastrointestinal ultrasound examinations - Ultrasound diagnosis of neoplastic diseases - The diagnostic level to aim for. The 87th academic meeting The Japan Society of Ultrasonics in Medicine, Yokohama, May 11, 2014.
4. Narita, Y., Tsujio, H., Suginoshita, Y., Chung, H., Imai, Y., Tamura, A., Iwasaki, N., Hamada, K., Minowa, K., and Inokuma, T.: Study on the hypoechoic area around hepatic hemangioma by ultrasound. 87th Annual Meeting The Japan Society of Ultrasonics in Medicine, Yokohama, May 11, 2014.
5. Takekawa, Keiji: Fungi: from basics to clinical practice. Fukui Prefectural Association of Clinical Laboratory Technologists. Fukui. July 12, 2014.
6. Takekawa, Hiroshi: Importance of fungal identification - Experience with a case of Exophiala dermatidis - Kinki Region Joint Microbiology Workshop 2014. Osaka. August 30, 2014
7. Nobuhiro Iwasaki: You'll want to try it! Gastrointestinal echo - focusing on small intestinal diseases. The 5th Pediatric Small Intestinal Endoscopy Study Group, Osaka, July 6, 2014
8. Nobuhiro Iwasaki: Ultrasound examination of the digestive tract –TURUGI-. GE Ultrasound seminar Osaka, July 13, 2014
9. Nobuhiro Iwasaki: Ultrasound examination of the digestive tract –TURUGI-. GE Ultrasound seminar Tokyo, August 3, 2014
10. Junichi Kawai: Experience with EPIQ and the Use of 3D Echocardiography. Kansai Structural Heart Disease Seminar, Osaka, August 9, 2014
11. Junichi Kawai: Seminar on prevention of asthma and COPD, etc. Lung age measurement practice using a spirometer. Kobe City, Independent Administrative Institution Environmental Restoration and Conservation Agency (Preventive Business Division), Kobe, August 25, 2014

Postscript

It has been about two and a half years since Clinical Laboratory 's website was newly launched. This is finally the 10th update. We update it once every three months, but with each update we hope to improve ourselves and provide better information so that "TEKARI" shines brighter and more. (OM)

Mold and Laboratory Testing

Microbiology Laboratory Takuya Naito

Food poisoning (O-157, etc.) is more likely to occur in the summer, while infectious diseases such as influenza are prevalent in the winter. Most infectious diseases are caused by general bacteria and viruses, but there are also infectious diseases caused by "fungi" bacteria. Fungi can be broadly classified into filamentous fungi and yeast, and many are found in the environment such as water, soil, air, and animals, so infections can occur through the lungs or skin such as wounds where the fungi are inhaled.

What are filamentous fungi?

A general term for fungi that are composed of tubular cells called hyphae.

I think it will be easier to understand if you imagine it as something like mold or mushrooms.

Although mold may conjure up some kind of dirty image, it has been used since ancient times in sake, miso, and soy sauce, which are indispensable on the Japanese dining table, and is still used as medicine today, showing that humans have coexisted with mold. (For example, Awamori ⇒ Aspergillus oryzae, antibiotic ⇒ penicillin, etc.)

Athlete's foot, which develops on the toes, soles of the feet, and nails, is an infection caused by a fungus called Trichophyton rubrum.

Depending on the site of infection, they are classified as deep (visceral) mycoses, deep (deep) cutaneous mycoses, and superficial (superficial) mycoses. Representative diseases include 1) aspergillosis, 2) candidiasis, and 3) cryptococcosis, and are particularly likely to cause serious mycoses in immunocompromised people.

This time, we will introduce the testing methods for filamentous fungi, a type of fungus.

Mold testing

1. Macroscopic observation

1) Creation of giant colonies

Patient samples (sputum, skin, blood, etc.) are cultured, and giant colonies (huge, single masses of bacteria) are grown on the medium, and the growth rate, color (front and back), condition of the colony surface, and state of hyphae are observed. Most general bacteria grow in about 24 hours, but filamentous fungi may take several weeks. Growth conditions (growth temperature, culture time) are determined according to the type of bacteria.

<Features>
Cotton-like
- Initially white, then grey or light grey to black
-Growth rate is fast

<Features>
- Young colonies are cottony or wet, light gray to black in color.
Dark brown to black when mature
As it ages, white mycelium appears.

<Features>
・White flocculent, then changes to dark gray to black
-Growth rate is fast

<Features>
- Velvety or powdery surface
- The border is a narrow white band
・The underside is white to yellowish brown

2. Microscopic observation

Observation under a microscope confirms the state of the mycelium, and the size, shape, and structure of the conidia (spores formed by fungi). For example, the fungus in the image below that resembles flying dandelion fluff is of the genus Aspergillus, but if it is an Aspergillus fungus, there are several points to check and identify the fungus.

1) Whether the conidial head is cylindrical or radial

2) Whether Aspergilla is single-row or double-row

3) Whether the cell wall is smooth or rough

④Is the color of the conidia colorless or brown?

In this way, in order to observe under a microscope how conidia are formed, the following method is used.

1) Direct smear method (cellophane tape method, imprint method)

The spores of colonies that have grown on the medium are attached to cellophane tape and stained with lactophenol-cotton blue solution (staining solution) on a glass slide. This direct smear method is very simple and allows for quick observation of morphology.

2) Preparation of slide cultures

The bacteria is inoculated onto an agar medium of about 5 mm square on a glass slide, and after culturing, the cover glass with the bacteria attached is observed under a microscope. Although creating a slide culture takes time, it allows the morphological characteristics of the mycelium and conidia to be observed more clearly. Furthermore, the specimen can be preserved for a long time by sealing the periphery of the cover glass with nail polish or the like (sealing it to block out air).

3. Drug susceptibility

In areas where fungal growth is observed, the indicator changes color from blue to red (bacteria grow: concentration at which antibacterial drugs are ineffective) due to the oxidoreductase enzymes produced by the bacteria, and this is used to determine which drug is effective at what concentration. A bacterial solution adjusted to a specified concentration is dispensed onto a panel that has already been coated with a fungal infection treatment drug, and then cultured. Normally, an intermediate judgment is made 24 hours after culture, and a final judgment is made after 48 hours.

4. Summary

In the case of fungi, some species grow slowly, and observation under a microscope requires experience, so identification is not always possible immediately. However, there are only a limited number of drugs that are effective against some fungi, and some drugs that were effective may no longer be effective (resistance). Rapid identification is particularly important in cases of deep-seated mycoses and bloodstream infections, and our hospital also uses molecular biology methods to identify fungi from gene sequences.

There is a growing trend to isolate and identify fungi from clinical specimens, and in general, fungi are often bewildering because of their unfamiliar names and morphology. However, it is quite possible that we will continue to encounter rare fungi. We will continue to make further efforts to improve our technology and knowledge so that we can contribute to treatment as quickly as possible.

reference

1. Guidelines for identifying pathogenic fungi Masahiko Okuhira Bunkodo 1986
2. Medical Mycology Identification Guide (5th Edition) DH LaRone et al. Eiken Chemical Co., Ltd.
3. http://www.bdj.co.jp/safety/articles/ignazzo/hkdqj2000005r4ix.html

Inspection department news

Academic report

Conference presentation

1. Hayato Maruoka: Hematology Symposium: Immunophenotyping by flow cytometry. 54th Japan Society of Clinical Laboratory Technologists Kinki Branch Medical Laboratory Science Conference Kobe International Conference Center 2014.9.20
2. Masahiro Yoshida, Hayato Maruoka, Yoko Fujiwara, Koji Nasu, Tatsuo Oita: Establishment of a detection system for immunoglobulin light chain rearrangement in malignant lymphoma. 54th Japan Society of Clinical Laboratory Science Kinki Branch Medical Laboratory Science Conference Kobe International Conference Center 2014.9.21
3. Akiko Morita, Kana Hori, Masashi Sugawara, Noriko Sakamoto, Ryoichiro Matsuura, Hideshi Imoto, Akiyo Tamura, Tatsuo Oita: Cytological examination of pulmonary pleomorphic carcinoma at our hospital. 54th Japan Society of Clinical Laboratory Technology Kinki Branch Medical Laboratory Science Conference Kobe International Conference Center 2014.9.21
4. Kana Hori, Akiko Morita, Hideshi Imoto, Ryoichiro Matsuura, Akiyo Tamura, Tatsuo Oita: Study on the usefulness of post-fixation in EBER-ISH, 54th Japan Society of Clinical Laboratory Technologists Kinki Branch, Kobe International Conference Center, September 20, 2014
5. Narita, Y., Tochio, J., Hamada, M., Minowa, K., Oita, T.: A case of lower lumbar hernia detected by ultrasound examination. 54th Japan Society of Clinical Laboratory Technologists Kinki Branch Medical Laboratory Science Society Kobe International Conference Center 2014.9.21
6. Junichi Kawai: [Utilization] System updates from other manufacturers and current operations (thoughts on the next department update). 1st Kansai Vita Seminar (Physiological Test Department System Forum) Grand Front Osaka Knowledge Capital 2014.9.13
7. Misaki Morimoto, Keiji Takekawa, Miyuki Nogami, Takuya Naito, Namiko Nomura, Kenji Sakizono, Yuka Tanaka: A case of infection of an artificial knee joint caused by Syncephalastrum racemosum. 54th Japan Society of Clinical Laboratory Technologists Kinki Branch Medical Laboratory Science Conference Kobe International Conference Center 2014.9.21
8. Takashi Matsushita: A case of abdominal malignant lymphoma forming a mass in the pancreas or around the pancreas. 114th Abdominal Ultrasound Conference 2014.10.30
9. Tamaki Eriko: A case of pancreatic NET. 114th Abdominal Ultrasound Conference 2014.10.30
10. Takako Tosaka: A case of pancreatic trauma. 114th Abdominal Ultrasound Conference 2014.10.30
11. Nobuhiro Iwasaki: Ultrasound diagnosis of the digestive tract. 114th Abdominal Ultrasound Conference 2014.10.30
12. Nobuhiro Iwasaki: The Light and Shadow of Digestive Tract Echo. Digestive Tract Echo Seminar, Osaka, November 1, 2014
13. Hayato Maruoka, Masahiro Yoshida, Tatsuo Oita, Takayuki Ishikawa: Quantitative analysis of NPM1 mutations using the Pfaffl method. 61st Annual Meeting of the Japanese Society of Clinical Laboratory Medicine, Fukuoka, 2014.11.23
14. Masahiro Yoshida, Hayato Maruoka, Tatsuo Oita: Usefulness of immunoglobulin light chain rearrangement test in B-cell malignant lymphoma. 61st Annual Meeting of the Japanese Society of Clinical Laboratory Medicine, Fukuoka, 2014.11.23
15. Akiko Morita, Hayato Maruoka, Tatsuo Oita, Yotaro Ochi, Yukihiro Imai: A case of CD61-positive and MPO-positive AML with infiltration of the breast. 61st Annual Meeting of the Japanese Society of Clinical Laboratory Medicine, Fukuoka, 2014.11.24
16. Aya Nakano, Tomoko Tani, Toshiko Konda, Yoko Fujii, Hitomi Nakamura, Eriko Miwa, Junichi Kawai, Naoko Suganuma, Natsumi Nomoto, Yutaka Furukawa: Two cases of pradoxical low-flow low-gragient aortic stenosis with different severity. The 41st Kansai Regional Meeting of The Japan Society of Ultrasonics in Medicine, Kyoto, November 22, 2014.
17. Miyamoto, Junko, Tani, Tomoko, Konda, Toshiko, Fujii, Yoko, Nakamura, Hitomi, Tsunoda, Toshiaki, Kawai, Junichi, Suganuma, Naoko, Nomoto, Natsumi, Furukawa, Yutaka: Two cases in which echocardiography was useful for diagnosing structural valvular deteriotation (SVD). The 41st Kansai Regional Meeting The Japan Society of Ultrasonics in Medicine, Kyoto, 2014.11.22
18. Hitoshi Tochio, Masashi Sugawara, Yukihiro Imai, et al.: Hyper enhance rim (HER) around metastatic liver cancer in the postvascular phase of contrast-enhanced ultrasound: Histopathological study of resected specimens. The 41st Kansai Regional Meeting The Japan Society of Ultrasonics in Medicine, Kyoto, November 22, 2014.
19. Nobuhiro Iwasaki: (Lecture) The Light and Shadow of Digestive Tract Echo. Digestive Tract Echo Seminar 2014 in Osaka, November 1, 2014
20. Nobuhiro Iwasaki: (lecture) The role of US in diagnostic imaging - necessary knowledge and thinking - 179th Osaka Abdominal Ultrasound Study Group, 2014.11.14
21. Takashi Matsushita, Hitoshi Tochio, Yoshiki Suginoshita, et al.: Gallbladder cancer discovered by abdominal US following acute cholecystitis - A case of mixed adeno neuroendcrine carcinomas (MANECs) - The 41st Kansai Regional Meeting of the Japanese Society of Ultrasound in Medicine, Kyoto, November 22, 2014
22. Tamaki Eriko, Tochio Hitoshi, Imai Yukihiro, Kikawa Yuichiro, et al.: "A case of myeloid sarcoma treated with contrast-enhanced ultrasound examination" The 41st Kansai Regional Meeting The Japan Society of Ultrasonics in Medicine, Kyoto, November 22, 2014

Postscript

It's gotten noticeably colder recently. The much talked about bomb cyclone has arrived, and it's getting pretty tough to get up in the morning. How is everyone doing? They say you should eat hot food when it's hot, but hot food is also great when it's cold. Eating something that warms the body will keep you warm even if it's cold outside. Especially in winter, hot pots with a large group of people are the best! 3D hot pots made with grated daikon radish to make your favorite character seem to be popular these days, but for us, the classic Yosenabe is still the best. It's even better to finish off with a rice porridge to fill your stomach. Let's get through the cold winter with this!! PS I'd like to try sukiyaki with Kobe beef someday☆ (MK & KH)

Pathology Laboratory

Pathology Laboratory: Misaki Morimoto

The purpose of a pathology test is to observe tissues and cells taken from the affected area with the naked eye and under a microscope to diagnose the disease (cause, benign/malignant determination, progression, etc.). So what kind of tests are actually performed in a pathology laboratory? Pathology tests are broadly divided into two types: "tissue diagnosis" and "cytology." We will briefly introduce the flow of each test.

tissue diagnosis

A tissue biopsy is a procedure in which organs or tissues taken from the affected area are made into specimens and examined under a microscope to diagnose a disease.

① Fixation and cutting

Tissues collected during endoscopic examinations or outpatient visits, or organs removed during surgery, are fixed in a chemical called formalin to prevent damage to the tissue (fixation).Then, they are submitted to the pathology laboratory and cut into pieces of appropriate size for preparation of specimens (sectioning).

② Embedding and slicing

Since it is not possible to slice the excised tissue as is, the tissue is embedded in a type of wax called paraffin to create a block (embedding). The block is then sliced into thin slices of approximately 2-3 μm (1 μm is 1/1000 of a mm) using a device called a microtome, and the sliced slices are attached to glass (thin sections).

③ Dyeing

To make it easier to observe the structure of tissues and cells, the sliced tissues are stained with various dyes. Usually, hematoxylin and eosin staining (HE staining) is used, but if necessary, staining to observe the characteristics of the tissue (special staining, about 40 types) or staining to stain components contained in the tissue or cells (immunostaining, about 100 types) may be used.

④Microscopic examination and diagnosis

A pathologist will examine the resulting specimen under a microscope and make a diagnosis.

In addition, tissue biopsies also include "rapid intraoperative testing" in which a sample of tissue is taken and examined during surgery to determine whether the lesion is benign or malignant and to decide the extent of removal.

When a specimen is sent from the operating room, a pathologist first cuts it out, embeds it in a special liquid, and flash freezes it at -80℃. The resulting block is then sliced thinly with special equipment to prepare specimens, stained, and then diagnosed by a pathologist. Preparation time is short, about 10 minutes per tissue, allowing for a rapid diagnosis.

Cytology

Cytology is the process of diagnosing disease by examining individual cells or small groups of cells under a microscope to determine whether or not they are malignant.

1) Smearing and fixing

The test materials are urine, sputum, pleural fluid, ascites, cervical cells, and cells from mammary glands that have been punctured with a syringe to extract the cells. The submitted specimen is applied to glass and fixed with alcohol and dried.

② Dyeing

As with a biopsy, staining is done to make the cells easier to observe. Usually, Papanicolaou staining is used, and other staining methods are also used if necessary.

③Microscopic examination and diagnosis

The completed specimens are then examined under a microscope by a cytotechnologist (a clinical laboratory technician with certification to perform cytological diagnosis) and diagnosed in consultation with a pathologist. In addition, just like with histological diagnosis, rapid intraoperative testing is also performed for cases where cytological diagnosis is necessary.

In addition to histological and cytological examinations, our hospital's pathology laboratory also performs pathological autopsies.

autopsy

With the consent of the bereaved family, autopsies are performed on the bodies of those who have died of illness to examine their organs, and the results are used to determine the cause of death, the degree of progression of the disease, the effectiveness of treatment, whether the diagnosis made during the patient's life was correct, whether appropriate treatment was administered, etc., in order to improve future medical care. Autopsies are performed by pathologists, and clinical laboratory technicians assist.

Inspection department news

Academic report

Conference presentation

1. Toshiko Konda (presenter): 19th Winter Seminar Japanese Society of Echocardiography, January 24-25, 2015
2. Akiko Morita: A case of CD61-positive and MPO-positive AML with infiltration into breast cancer. 2nd in-hospital forum, our hospital, March 7, 2015
3. Masahito Omatsu: A case of intraepithelial carcinoma of the fallopian tube discovered through uterine corpus cytology in our hospital. The 31st Annual Meeting of Hyogo Prefecture Society of Clinical Cytology, Kobe City, March 7, 2015.
4. Tamaki, Eriko: A case of hepatic hypervascular tumor that was difficult to diagnose. 180th Osaka Abdominal Ultrasound Study Group, Osaka, March 12, 2015.
5. Nobuhiro Iwasaki: A case of mesenteric liposarcoma. The 129th Osaka Ultrasound Study Group, Osaka, March 18, 2015.
6. Toshiko Konda: Study on the difference in severity of aortic stenosis depending on the measurement site of energy loss coefficient ELCo. 26th Annual Meeting Japanese Society of Echocardiography, Kitakyushu, March 26, 2015
7. Junichi Kawai: Anatomical characteristics of the aortic root in patients with severe aortic stenosis -Study using 3D transesophageal cine-chondroscopic imaging-. The 26th Annual Meeting of Japanese Society of Echocardiography, Kitakyushu, March 26, 2015
8. Junichi Kawai: Measurement of the aortic root in patients with severe aortic stenosis - A comparative study of transesophageal 3D echocardiography and MDCT. The 26th Annual Meeting Japanese Society of Echocardiography, Kitakyushu, March 27, 2015

Postscript

The cold has eased a little, but you still shouldn't let your guard down. Have you caught a cold due to the temperature difference? We are now in the middle of cherry blossom season. How about starting preparations for cherry blossom viewing and a picnic? We recommend the cherry blossoms along the Ashiya River. Eating delicious food while admiring the cherry blossoms in full bloom along the river will help relieve your daily fatigue. Prepare your health and cooking skills for a fun cherry blossom viewing! PS The cherry blossoms in front of the hospital are beautiful, too! (M.K & K.H)

Uncovering the mysteries of blood collection tubes!

Sample Testing Room: Kosaka, Hirano, and Kano

Do you like having your blood drawn? I'm sure there are many people who don't like it. Have you ever wondered why blood collection tubes are replaced one after another during a blood draw? This time, I would like to introduce you to those blood collection tubes.

About procoagulants and anticoagulants

If you look closely at a brand new blood collection tube before blood is put into it, you will see that there is something inside (liquid, powder, etc.). These are chemicals that are necessary to produce accurate test results.

Let's take a closer look at the blood collection tubes you often see in blood collection rooms! Pay attention to the color of the caps!

These blood collection tubes can measure serum proteins, enzymes, electrolytes, etc., to determine the patient's health condition and the degree of illness, including liver function, cardiac function, kidney function, and pancreatic function. The caps of the blood collection tubes vary in color depending on their capacity, and they are used according to the number of items being tested.

In addition, in outpatient clinics, blood is drawn on the day of the appointment and the results are often available before the appointment, so we mainly use containers that contain a coagulation promoter (thrombin). The white material at the bottom is a serum separator (which separates blood into serum and blood cells when centrifuged ^*1), and the round paper is a coagulation promoter film.

*1 Centrifugation: By spinning the blood at 3,000 revolutions per minute, the blood cell portion sinks to the bottom and the blood is separated into serum (liquid) and blood cells (solid components).

There are over 50 different types of blood collection tubes, and each one is chosen depending on the purpose of the test. This means that multiple blood samples are required. Most people have 3-5 blood samples taken, but the maximum amount of blood taken is about one tablespoon (20ml or less).

There are many different types of blood collection tubes like this, but many of them are very colorful, bright, and cute. When drawing blood, please pay attention to these things. It might help you to be distracted and make it less painful.

Inspection department news

Academic report

Conference presentation

1. Konda, Toshiko: Study of mitral annular disjuncton using transthoracic echocardiography.
   The 79th Annual Meeting The Japanese Circulation Society, Osaka, April 25, 2015
2. [Lecture] Hayato Maruoka: The usefulness of immunophenotyping in malignant lymphoma.
   Kinki Region BD Bioscience Seminar 2015. Kyoto. 2015.04.11
3. Akiko Morita: Two cases of enteropathic T-cell lymphoma (EATL) found in cerebrospinal fluid cytology.
   64th Japanese Society of Medical Technology, Fukuoka, May 17, 2015
4. Hayato Maruoka: Establishment of a detection system for FLT3-ITD and NPM1 mutant genes using the HRM method.
   64th Japanese Society of Medical Technology, Fukuoka, May 17, 2015
5. Nobuhiro Iwasaki: Workshop; Is contrast-enhanced ultrasound necessary for gastrointestinal diseases other than liver tumors?
   The usefulness of contrast-enhanced ultrasound examination for gastrointestinal tumor lesions
   The 88th Annual Meeting The Japan Society of Ultrasonics in Medicine, Tokyo, May 23, 2015
6. Nobuhiro Iwasaki: Workshop; Gastrointestinal diagnosis: How much can be diagnosed by ultrasound? How much should be diagnosed?
   Usefulness of Ultrasonography in Small Intestinal Tumor Lesions
   The 88th Annual Meeting The Japan Society of Ultrasonics in Medicine, Tokyo, May 23, 2015
7. Nakamura Mamiko: A case of malignant lymphoma of the gallbladder. The 88th Annual Meeting The Japan Society of Ultrasonics in Medicine, Tokyo, May 24, 2015.
8. Junichi Kawai: Luncheon Seminar: New Technology Changes Routine Echo Examination
   xMATRIX Technology Transforms Echocardiography Routine
   The 40th Annual Meeting of the Japanese Society of Ultrasound Technology, Yokohama, May 17, 2015
9. Namiko Nomura, Keiji Takekawa, Miyuki Nogami, Takuya Naito, Marie Niki, Yuka Tanaka, Kenji Sakizono, and Tatsuo Oita:
   A case of pyogenic spondylitis caused by Helicobactor cinaedi. 64th Annual Meeting of the Japanese Society of Medical Technology, Fukuoka, May 17, 2015.
10. Marie Niki, Akiyo Tamura, Toshiaki Tsunoda, Natsumi Nomoto, Takuya Naito, Akiko Morita, Mamiko Nakamura, and Tatsuo Oita:
    Report on the activities of the medical safety team in Clinical Laboratory of our hospital. 64th Japanese Society of Medical Technology, Fukuoka, May 16, 2015

Postscript

The end of May is finally here, and the rainy season is fast approaching. Recently, there have been many days with summer-like sunshine, and it's already time to wear short sleeves and sandals, making the cherry blossom season seem like a distant memory. The best thing to see in this coming season is hydrangeas. By the way, the Chinese character for "hydrangea" was probably given to lilac by the Tang Dynasty poet Bai Kobe City Botanical Garden and Kobe Animal Kingdom, so why not take a little trip to see them? (YS)

Important information: Post-transfusion complications

Transfusion Testing Management Office Masahiro Yoshida

What are transfusion-transmitted infections?

Currently, it is said that the number of patients receiving blood transfusions in Japan is approximately 1.2 million per year. As such, blood transfusions are a common medical treatment that anyone can receive, and it is important for patients themselves to correctly understand the safety of blood transfusions. Blood transfusions are a treatment that uses blood from other people when the body's blood-producing ability is reduced or when the body is anemic due to bleeding.

One of the problems that cannot be avoided in blood transfusions is the risk of viral infections through blood transfusions. As a measure against viral infections through blood transfusions, the Red Cross Blood Center introduced a nucleic acid amplification test (NAT) that can detect viruses with high sensitivity, and the accuracy of the test has improved dramatically compared to before, making it safer.

Since the introduction of NAT at the Red Cross Blood Center, testing has become more rigorous, from the initial 500-sample pooling method ^*1 (1999-2000) to the 50-sample pooling method (2000-2004), the 20-sample pooling method (2004-2014), and finally to NAT being performed on each sample individually (since August 2014).

However, when a blood donor is in the "very early stage of infection" just after infection, it is difficult to detect the virus even with NAT, and there is a period (window period) when the virus cannot be detected by testing. Currently, the incidence of post-transfusion viral infection is approaching zero, but it is still not possible to completely eliminate it.

*1 Sample pooling method: A method in which samples are tested together to a certain extent. Since they are tested together, it is less time-consuming, but the more samples there are, the lower the detection sensitivity becomes.

Against this background, the Biological Product Infection Relief System was established on April 1, 2004. This system is designed to provide prompt relief to those who contract an infectious disease caused by a transfusion product despite its proper use. In the unlikely event that a person becomes infected with a pathogenic virus through a blood transfusion, relief is available under the above system, and they can receive benefits such as medical expenses, medical allowances, and disability pensions. In order to receive this relief, it is necessary to undergo an infectious disease test before and after the transfusion.

Beginning with the April 2014 blood transfusions at our hospital, we have been sending out "Recommendations for Post-Transfusion Infectious Diseases" direct mail to patients' homes in order to encourage them to undergo infectious disease testing 3 to 4 months after their transfusion.

Here we will answer various questions regarding post-transfusion infectious disease testing in the form of questions.

What are post-transfusion infections? How common are they?

This is the contraction of viral infections such as hepatitis B virus (HBV), hepatitis C virus (HCV), and AIDS virus (HIV) through blood transfusion. Since August 2014, testing has been tightened to perform NAT on each sample individually, further increasing the detection sensitivity, and it is estimated that the number of post-transfusion infections is less than one case per year for hepatitis B virus, and less than one case every few to ten years for hepatitis C virus and AIDS virus.

What are the test items?

In accordance with ministry of Health, Labor and Welfare notation 's "Guidelines for the Implementation of Blood Transfusion Therapy," our hospital performs three post-transfusion infection tests: HBV nucleic acid amplification tests, HCV core antigen tests, and HIV antibody tests.

Why is post-transfusion infection testing necessary?

Although safety has increased with the introduction of NAT, it is impossible to reduce the risk of viral infection to zero. It is necessary to receive compensation under the "Biological Product Infection Relief System" established for that purpose. In addition, if a transfusion-related viral infection is suspected, early detection and early treatment can prevent the condition from becoming severe.

In order to qualify for the relief system, it is necessary to undergo infectious disease testing before and after a transfusion, but does everyone undergo testing before transfusion?

In some cases, infectious disease testing is not performed before transfusion. However, at our hospital, we store the patient's blood for a certain period of time before transfusion. In the unlikely event that a patient is found to be infected, we can use that blood for detailed testing to prove that the virus was transmitted through a transfusion.

Does everyone get tested for post-transfusion infections? Is it absolutely necessary to get tested?

At our hospital, 60-70% of patients who receive direct mailings have undergone the test. We encourage patients to undergo the test, but it is not compulsory.

How much does it cost?

The cost of the test is approximately 3,000 yen, with health insurance covering 30% of the cost (an additional 810 yen will be charged for first visits and 210 yen for follow-up visits).

When will the test results be available?

It takes about two weeks for the test results to become available. Your doctor will explain the results to you, so please come in for an outpatient visit.

I would like to get tested. How do I make an appointment?

Please call our hospital's post-transfusion infection testing desk at the number listed below.
TEL: 078-302-7173 (Weekdays 9:00-17:00)

The direct mailing said that testing should be done three months after the last transfusion, but would it be okay to test five months later?

It is possible to undergo testing, but for early detection, we recommend that you do so 3 to 4 months after your last transfusion. When the estimated date approaches (approximately 2 months after your transfusion), we will send you a direct mail message from our hospital to encourage you to undergo testing at an appropriate time.

What if I get an infection from a blood transfusion?

If you contract an infectious disease as a result of a blood transfusion, there is a Biological Product Infection Relief System to provide relief to those who have suffered health damage. This system provides benefits such as medical expenses, medical allowances, and disability pensions.

What blood products are eligible for direct mail?

This applies to "blood for transfusion" such as red blood cell preparations, plasma preparations, and platelet preparations.

Aren't albumin preparations and immunoglobulin preparations not eligible for direct mail?

We do not send direct mail regarding "plasma fraction products" such as albumin preparations, immunoglobulin preparations, coagulation factor preparations, and fibrin preparations. These products are not subject to post-transfusion infection testing, but if you are concerned, please call our post-transfusion infection testing desk to make an appointment for testing.

However, this is not covered by insurance.

What is the approximate window period during which NAT cannot determine infection?

The infection lasts for about 34 days for Hepatitis B virus, 23 days for Hepatitis C virus, and 11 days for AIDS virus. Blood donated during this period immediately after infection cannot be detected by testing, so the blood may be transfused. For this reason, we recommend that you undergo testing 3 to 4 months after transfusion.

Can I get tested at another hospital?

Yes, that's OK. If you receive any direct mail or contact from our hospital, just let them know that you will be having the test at another hospital. There is no need to inform us of the test results.

At our hospital's Blood Transfusion Testing Management Office, we hope that as many patients as possible will have a correct understanding of the safety of blood transfusions and be able to receive them with peace of mind.

We will work hard to raise awareness among doctor and other medical professionals, as well as patients, that blood transfusions and post-transfusion infection testing go hand in hand, and to increase the rate of post-transfusion infection testing to closer to 100%.

Inspection department news

Academic report

Paper presentation

1. Natsumi Nomoto, Tomoko Tani: Cardiac tumors. MDCT transforms cardiovascular clinical practice – making the most of its potential – 218-221, 2015
2. Hitoshi Tono: Oblique holding of a winged needle, Examination and Technology 43: 305, 2015
3. Hitoshi Toshio: Tips for blood collection that are not written in textbooks: Baton relay style method, Examination and Technology 43: 487, 2015
4. Hitoshi Tono: Tips for blood sampling that are not written in textbooks: How to hold a tourniquet down, Examination and Technique 43: 487, 2015

Conference reports and lectures

1. Junichi Kawai: Practical application of echocardiography using xMATRIX probes. The 2nd Kansai PHILIPS Ultrasound Seminar
   Kobe, July 4, 2015
2. Nobuhiro Iwasaki: Ultrasound Diagnosis of the Digestive Tract -Lights and Shadows-GE Ultrasound Summer Forum 2015
   Nagoya, July 26, 2015
3. Junichi Kawai: xMATRIX technology changes the routine of echocardiography. The 3rd Kansai PHILIPS Ultrasound Seminar
   Osaka (Osaka Martandise Mart), July 12, 2015
4. Akiko Morita: Two cases of aggressive NK cell leulemia/lymphoma that were difficult to distinguish from anaplastic large cell lymphoma. 16th Annual Meeting of the Japanese Society of Laboratory Hematology,
   Nagoya (Nagoya International Congress Center) 2015.7.12

Postscript

The rainy season is over, and the hot summer has arrived. I love the vivid colors of summer. However, I don't like the heat or the cold... It's also the season for delicious fruits like peaches and watermelon. Also, some summer vegetables seem to have a cooling effect on the body. My way of dealing with the heat is watermelon and ingenious bedding. Let's get through the heatwave with our own ingenuity. Drink plenty of water and be careful of heatstroke.
Please enjoy some cool photos.

Pulmonary function tests

Physiological Function Testing Cardiopulmonary Department Junko Miyamoto

Pulmonary function tests are a type of physiological function test that can objectively and quantitatively evaluate lung function.

• Assessment of the degree of ventilation disorders and treatment effectiveness for respiratory diseases
• before surgery
• Disability Certification

It is used in a variety of situations, and is a basic test for considering the overall picture of lung function. By measuring the volume and speed of air entering and leaving the mouth, it is possible to evaluate how easily the lungs expand and how easily air flows through the airways. The measured values are evaluated by comparing them with predicted values based on age, height, and gender.

A Pulmonary function test performed at our hospital

There are vital capacity (VC/SVC), forced vital capacity (FVC), functional residual capacity (FRC), pulmonary diffusion capacity (DLCO), airway reversibility test, airway resistance, etc. This time, we will introduce vital capacity (VC/SVC) and forced vital capacity (FVC).

a. Vital capacity: VC (vital capacity)/SVC (slow vital capacity)

• This is the most basic test for lung volume fractionation and shows the amount of change in lung volume.
• The measurement is performed by having the patient breathe slowly and maximally, and each indicator is measured from the lung volume fraction, including vital capacity.

b. Forced vital capacity: FVC (forced vital capacity)

• Each index is measured from the flow-volume curve obtained by exhaling as strongly and quickly as possible from maximum inspiration to maximum expiration.
• The lung capacity obtained here is called the forced vital capacity (FVC) and reflects respiratory muscle strength and airway narrowing, including airway resistance.

B. Actual inspection procedure

a. Measurement preparation

• The test is performed in a sitting position.
• Sit deep in your chair and make sure you sit with good posture and your back is straight.
• Place the mouthpiece in your mouth and attach the nose clip to your nose.

Important points to note
*Hold the mouthpiece firmly so that it presses against your lips.
* Be careful not to cover the hole with your tongue.

b. Vital capacity (VC/SVC)

1. Breathe naturally (shallow, easy breathing) as you normally would.
2. The technician will give you a signal, and you will then inhale as deeply as you can when the signal comes.
3. Inhale as much as you can and then exhale slowly.
4. Vomit until you can't vomit anymore.
5. Repeat steps 2 to 4 two or three times to complete the measurement.

C. Forced vital capacity (FVC)

1. Start by breathing naturally (easy).
2. The technician will give you a signal, so please inhale as deeply as you can.
3. Exhale as hard, fast and as quickly as you can.
4. Continue vomiting until it is completely gone.

C. Actual test results

D. Classification of ventilation disorders based on pulmonary function tests

*1-second rate: The rate of the volume of air exhaled in the first second using forced vital capacity (1-second forced volume)

A. Obstructive ventilation disorder

This is a blockage that narrows the air passages, causing symptoms such as shortness of breath and difficulty breathing.

b. Restrictive ventilatory disorder

This is a disorder in which the lungs are unable to hold air. It is caused by a decrease in lung elasticity, a decrease in lung capacity, or a decrease in respiratory muscle strength.

E Pulmonary function tests are useful for the following:

Pulmonary function tests are the best way to detect COPD early and allow classification of severity.

*What is chronic obstructive pulmonary disease (COPD)?
COPD is an inflammatory lung disease caused by long-term inhalation and exposure to harmful substances, mainly tobacco smoke, and is a lifestyle-related disease that develops as a result of smoking habits. 15-20% of smokers develop COPD, and it is the ninth leading cause of death in Japanese people (seventh in men). It is believed that the majority of cases are undiagnosed and untreated, so early detection is important.

At the end

Pulmonary function tests require maximum effort from the patient. Unless you breathe to the maximum, you will not be able to obtain the best data to evaluate your respiratory function. We, the clinical laboratory technicians, will encourage you to make the maximum effort possible while taking into consideration your condition, so let's work hard together♪ Please cooperate with the test.

References

Hyatt R, A Practical Guide to the Selection and Use of Office Spirometry, by Osaki R, Irie T.
"Respiratory Function Test Training", Chugai Medical Publishing, by Takashi Hajiro and Masayoshi Shibata
"The Basics and Secrets of Spirometry", Katsuseido Publishing

Inspection department news

Academic report

Paper presentation

1. Hitoshi Toshio: Tips for blood collection that aren't written in textbooks: "Face the subject and stand up straight"
   Inspection and Technology 43: 673, 2015
2. Hitoshi Toshio: Blood collection tips not found in textbooks: Collecting blood from the back of the hand using a "boxer's fist"
   Inspection and Technology 43: 765, 2015
3. Hitoshi Toshio: Tips for blood collection that are not written in textbooks: Effective training methods for blood collection from the back of the hand:
   "Stretchable Rubber Band Piercing Training" Examination and Technology 43: 1149, 2015
4. Hitoshi Tono: Tips for blood collection that are not written in textbooks: Patient identification methods that lead to success:
   "Mr. XX, what is your name?" Inspection and Technology 43: 1221, 2015
5. Hitoshi Tochio, Masafumi Sugahara, Yukihiro Imai, Hiroshi Tei, Yoshiyuki Suginoshita, Nobuhiro Iwasaki, Ichhiro Sasaki, Michio Hamada, Kazushi Minowa, Tetsurou Inokuma, Masatoshi Kudo: Hyperenhanced Rim Surrounding Liver Metastatic Tumors in the Postvascular Phase of Sonazoid-Enhanced Ultrasonography: A Histological Indication of the Presence of Kupffer Cells. Oncology 89:33-41, 2015

Co-authored papers

1. Mayuko Izumi.,Hiroko Tsunemine, Yasuhiro Suzuki, Akihiro Tomita, Toshiko Kusumoto,Taiichi Kodaka, Kiminari Itoh, Takayuki Takahashi: Successful treatment of refractory cold hemagglutinemia in MYD88 L265P mutation-negative Waldenstrom`s macroglobulinemia with bortezomib. Int J Hematol 102: 238 -243, 2015.

Conference reports and lectures

1. Hayato Maruoka: Genetic Testing Basics and Practice. Arklay Gene Academy Osaka 2015. Kyoto. 2015.08.08
2. Nobuhiro Iwasaki: "Attack on Digestive Tract Echo -step after step goes far-"
   44th Japanese Society of Digestive Cancer Screening Kinki Regional Meeting Lunch Seminar Lecture, Osaka (International Conference Center) 2015.8.29
3. Nobuhiro Iwasaki: "Ultrasound diagnosis of the digestive tract -lights and shadows-" GE ultrasound clinical seminar 2015
   Seminar lecture by ultrasound instructor, Saitama (Lafre Saitama) 2015.8.30
4. Keiji Takekawa: "Fungal testing methods: from basics to clinical practice". 3rd Clinical Microbiology Department Workshop
   Gifu Prefectural Medical Technologists Association. Gifu. September 12, 2015.
5. Seiko Nasu: "Basic knowledge of urinary tract infections useful for urinary sediment examinations". General examination training seminar
   Hyogo Prefecture Prefectural Association of Clinical Laboratory Technologists, Kobe, September 30, 2015
6. Nobuhiro Iwasaki: Special feature "Ultrasound Lessons for Tomorrow - Abdominal Pain - Examining LQQTSFA with US"
   The 42nd Kansai Regional Meeting The Japan Society of Ultrasonics in Medicine. Osaka. September 26, 2015.
7. Minami, K., Iwasaki, N., Araki, N., Tochio, J., Minowa, K., Jeong, H., Suginoshita, Y., Hashida, Y., Inokuma, T.,
   Yukihiro Imai: General presentation: "A case of appendix mucinous carcinoma in which contrast-enhanced US was useful for diagnosis"
   The 42nd Kansai Regional Meeting The Japan Society of Ultrasonics in Medicine. Osaka. September 26, 2015.
8. Junichi Kawai: COPD seminar for health professionals: "How to interpret spirometer test results and lectures and practical training on lung age measurement."
   Sponsored by Kobe City Health and Welfare Bureau Health Promotion Support Division. Kobe (Kinro Kaikan). 2015.09.03
9. Eri Tamaki, Hitoshi Tochio, Nobuhiro Iwasaki, Kazushi Minowa, Ho-eun Jeong, Yoshiki Suginoshita, Tetsuro Inokuma, and Yukihiro Imai:
   "A study of five cases of hepatic angiomyolipoma treated with Sonazoid contrast-enhanced ultrasound"
   The 42nd Kansai Regional Meeting The Japan Society of Ultrasonics in Medicine. Osaka. September 26, 2015.
10. Natsumi Nomoto, Tomoko Tani, Toshiko Konda, Yoko Fujii, Hitomi Nakamura, Eriko Miwa, Naoko Suganuma, Junko Miyamoto, Aya Nakano,
    Toshiaki Tsunoda, Junichi Kawai, Ki-Tae Kim, Mitsuhiko Ohta, Tsuyoshi Kitai, and Yutaka Furukawa
    "A study of cardiac tumors detected by echocardiography at our hospital over the past 15 years"
    The 63rd Annual Meeting Japanese College of Cardiology. Yokohama 2015.9.20
11. Kana Hori, Tomoko Tani, Toshiko Konda, Yoko Fujii, Junichi Kawai, Naoko Suganuma, Natsumi Nomoto, Go Kitai, Mitsuhiko Ohta,
    Yutaka Furukawa "A case of coronary artery fistula where the opening was difficult to diagnose"
    The 42nd Kansai Regional Meeting The Japan Society of Ultrasonics in Medicine. Osaka. September 26, 2015.
12. Shun Yamamoto, Hayato Maruoka, Yumi Shiraishi, Natsumi Nomoto, Masahiro Yoshida, Nakako Yamauchi, and Tatsuo Oita:
    Improving the sensitivity of mutant gene detection by COLD-PCR: detection of JAK2V617F as an example.
    The 55th Japanese Society of Medical Technologists Kinki Branch Medical Laboratory Society, Osaka, October 18, 2015
13. Chihiro Shiromoto, Masahito Omatsu, Ryoichiro Matsuura, Hideshi Imoto, Akiko Morita, Masashi Sugawara, Misaki Morimoto, Kaoru Sueoka, Akito Tashiro, Akiyo Tamura,
    Oita Tatsuo, Imai Yukihiro: Study of discoloration in cytological specimens using a xylene-free preparation.
    The 55th Japanese Society of Medical Technologists Kinki Branch Medical Laboratory Society, Osaka, October 17, 2015
14. Sueoka, K., Sugawara, M., Matsuura, R., Omatsu, M., Imoto, H., Morita, A., Morimoto, M., Shiromoto, C., Tashiro, A.,
    Tamura, A., Oita, T., Imai, Y.: Investigation of artifacts occurring during frozen sectioning of lymph nodes.
    The 55th Japanese Society of Medical Technologists Kinki Branch Medical Laboratory Society, Osaka, October 17, 2015
15. Takashi Matsushita, Ichiro Sasaki, Kaori Minami, Mamiko Nakamura, Kazumi Hamada, Mamami Kuroda, Nobuo Yukihara
    A case of polyneuropathy where interpretation of test results was difficult. 55th Meeting of the Kinki Branch of the Japanese Society of Medical Technologists, Medical Laboratory Society.
    Osaka, October 18, 2015
16. Kaori Minami, Ichiro Sasaki, Takashi Matsushita, Mamiko Nakamura, Kazumi Hamada, Mamami Kuroda:
    Technical note on repetitive stimulation testing in the trapezius muscle.
    The 55th Japanese Society of Medical Technologists Kinki Branch Medical Laboratory Society, Osaka, October 18, 2015
17. Maruoka Hayato: The usefulness of FCM and genetic testing in hematopoietic tumors.
    Fukui Prefecture Medical Technologists Association Genetics and Hematology Joint Training Session. Fukui. October 31, 2015.
18. Nobuhiro Iwasaki: Let's use ultrasound examinations (abdominal pain). Open seminar at our emergency department. Kobe. October 28, 2015.
19. Takekawa, H.: Fungi and microorganisms that are difficult to culture. Japanese Nursing Association.
    FY2015 Infection Control Certified Nurse Education Course. Kobe. October 12, 2015
20. Yuka Tanaka, Keiji Takekawa, Takuya Naito, Kenji Sakizono, Tatsuo Oita:
    A Case of Mastitis Caused by Corynebacterium kroppenstedtii
21. Ichiro Sasaki, Takashi Matsushita, Mamiko Nakamura, Kaori Minami, Takako Tosaka, Hitoshi Tono, Kazushi Minowa, Tatsuo Oita,
    The usefulness of dynamic recording in intraoperative neurophysiological monitoring (IOM).
    The 55th Japanese Society of Medical Technologists Kinki Branch Medical Laboratory Society, Osaka, October 18, 2015
22. Takashi Matsushita, Ichiro Sasaki, Kaori Minami, Mamiko Nakamura, Kazumi Hamada, Mamomi Kuroda, and Nobuo Kohara:
    Amplitude and duration of compound muscle action potential (CMAP) - correlation between different measurement methods, 54th Annual Meeting of the Japanese Society of Neurophysiology
    Academic Conference, Osaka, November 6, 2015
23. Akiko Morita, Hideshi Imoto, Masahito Omatsu, Akihito Tashiro, Keiichiro Uehara, and Yukihiro Imai:
    The efforts of cytotechnologists in our hospital's Clinical Laboratory.
    The 54th Autumn Meeting The Japanese Society of Clinical Cytology, Nagoya, November 22, 2015
24. Masahito Omatsu, Hideshi Imoto, Akiko Morita, Akito Tashiro, Keiichiro Uehara, and Yukihiro Imai:
    A case of intraepithelial carcinoma of the fallopian tube discovered through uterine corpus cytology.
    The 54th Autumn Meeting The Japanese Society of Clinical Cytology, Nagoya, November 22, 2015
25. Mamiko Nakamura, Ichiro Sasaki, Takashi Matsushita, Kaori Minami, Kazumi Hamada, Mamomi Kuroda, and Nobuo Kohara:
    A study of the incidence of accessory deep peroneal nerve in our hospital, 54th Annual Meeting of the Japanese Society of Neurophysiology, Osaka, November 6, 2015
26. Takekawa, H.: Fungal identification and drug susceptibility. 18th Microbiology Research Meeting. Kobe. November 17, 2015.
27. Kenji Sakizono: The ABCs of Gram Staining. Emergency Open Seminar. Our Hospital. November 4, 2015
28. Yamamoto Shun, Maruoka Hayato, Oita Tatsuo: Establishment of a highly sensitive method for quantifying JAK2 V617F allele burden.
    The 62nd Annual Meeting of the Japanese Society of Clinical Laboratory Medicine, Gifu, November 20, 2015
29. Nobuhiro Iwasaki: Desmoid Tumors, Gastrointestinal Echo Seminar 2015, Osaka, November 14, 2015

Postscript

It's getting colder, and the winter feeling is growing day by day. Kobe held the Kobe Luminarie from December 4th to 13th. The Kobe Luminarie is held every year to commemorate the victims of the Great Hanshin-Awaji Earthquake, and to express dreams and hopes for the city's recovery and revitalization. When you visit, you can reflect on the disaster and pray for the souls of the victims and for the city's recovery. This year, LED light bulbs have been used, giving it a different feel from previous years, so why not come and visit next year? It is also the influenza and norovirus season, so please take care of your health. (MM)

Introduction of the blood collection room

Blood Collection Room Junichi Kawai

Introduction

Although drawing blood is painful, the information obtained from the blood drawn from patients is very useful for diagnosing illnesses and understanding their condition. In this issue of "TEKARI," we will introduce our outpatient blood drawing room.

Overview of our outpatient blood collection room

• Our hospital's outpatient blood collection room has seven booths, and blood collection is carried out by seven staff members and one administrative staff member.
• The staff consists of nationally qualified clinical laboratory technicians and nurses.
• We collect 500 to 700 blood samples per day, and on busy days we can collect more than 800 samples.

Requests to patients receiving blood draws

To prevent complications and medical accidents, we will check the following items, so if any of these apply to you, please let us know before your blood is drawn.

• I have felt sick during blood draw.
• I am prone to rashes from alcohol, paper tape (surgical tape), and gloves (latex).
• Bleeding is difficult to clot (I am taking blood-thinning medication).
• I am undergoing dialysis (blood is taken from the arm with the shunt avoided).
• There are plans for chemotherapy drips and CT scans, in which contrast agents will be injected.
• Ports have been implanted for clinical trial purposes, etc.

Please feel free to consult us about any concerns you may have regarding blood collection.

Outpatient blood sampling at our hospital

We will introduce the actual process in our outpatient blood collection room.

1. Test reception

1. Check-in can be done at the automated reception machine or at Reception Counter C (C Block Reception).
   • The automated reception machines will begin accepting applications from 7:30am.
   • Reception at Reception Counter C begins at 8:15 a.m. and ends at 5:30 p.m.
   • Blood collection will begin at 8:30am.
2. Please insert your patient card into the automated reception machine and follow the instructions.
3. Please take your reception number slip and a urine collection cup (these will be provided automatically if requested by doctor).
4. Finally, please take your medical card.
   • If the message "Please go to Reception Counter C" (Figure 1) is printed on your reception number slip, please go to Reception Counter C as there is something we need to check.

2. Entering the waiting area in the blood collection room

1. When the number on your reception number ticket is displayed on the electronic display board, please enter the waiting area in the blood collection room.
   • To ensure smooth blood collection, please roll up your sleeves up to your elbows beforehand.
2. Once you enter the inner waiting area, please sit in a chair and wait until the number on your reception number ticket appears on the electronic display board above the blood collection booth.
3. When it is your turn, an electronic beep will sound from the blood collection booth and an electronic voice will play a message guiding the patient.
   (Note) We may prioritize blood collection for those who are feeling unwell or depending on the type of test. In such cases, the order of people may change, so we ask for your understanding and cooperation.
4. Please place your belongings and sit where the number on the electronic display board above the blood collection booth matches the number on your reception number slip (Figure 2).

3. Identity verification before blood collection

In the blood collection room, we will verify your identity to ensure that blood collection is carried out safely and correctly.

1. Once you sit down in the chair in the blood collection booth, please hand your reception number ticket to a staff member.
2. The patient should introduce themselves to the person taking the blood sample. We appreciate your cooperation (Figure 3).

4. Blood Collection

1. Preparation before blood collection

a. The patient should sit in a chair with their back straight (Figure 4).
(Reason) Stretching your posture causes your blood vessels to expand, making them easier to see.
Hitoshi Toshio. From "facing the patient with your back straight". Inspection and Technology vol 43, p.673, 2015

b. When taking your blood, you will be asked to hold the needle with your thumb inside (Figure 5).
(Reason) As blood flow in the veins increases, the blood vessels expand, making them easier to see.

*We may also ask you to warm your hands and fingers, hold your hands down for a while, etc. Also, please drink plenty of fluids and relax when your blood is taken to make it easier to see your veins.

• Patients who wish to have blood drawn
  If you are feeling unwell or have a history of fainting or dizziness, please let us know so that we can take your blood sample while you are in bed.
• Patient in wheelchair
  Patients in wheelchairs will be treated while remaining seated in their wheelchairs, so please remain in the appropriate booth and wait.

② Puncture

a. As a general rule, butterfly needles (Figure 6) are used in all blood collection rooms at our hospital.

b. We take measures to prevent infection by replacing the gloves used when drawing blood with new ones for each patient.

c. Alcohol swabs are usually used for skin disinfection. If you have a rash from alcohol, please inform the staff. We use an alcohol-free disinfectant (Hexidine) (Figure 7). However, to enhance the disinfecting effect of the Hexidine, disinfect for 30 to 60 seconds.

d. Blood is usually collected from the superficial veins at the elbow. However, if it is not possible to collect blood from both elbows, it will be collected from other veins, such as the back of the hand (Figure 8).

e. The amount of blood drawn for testing does not usually cause anemia.

f. In rare cases, if there is insufficient blood after collection or if the blood is unsuitable for testing (hemolysis or coagulation), we may ask you to collect blood again. We appreciate your understanding and cooperation.

③ After blood collection

After the blood collection, the puncture site will be compressed with dry cotton to stop the bleeding and paper tape will be applied. If you have a history of allergic reactions to paper tape, please inform us in advance.

b. After blood collection, the patient should apply pressure to the collection site without massaging it for approximately 5 minutes (Figure 9).

c. Rub the area where the blood is drawn, which may inhibit hemostasis and result in internal (subcutaneous) bleeding and a blue discoloration of the blood draw site.

d. Patients taking blood-thinning medications such as warfarin should apply pressure to stop the bleeding for at least 10 minutes.

Complications of blood sampling

a. Internal (subcutaneous) bleeding If pressure is not applied to the blood collection site to stop bleeding or if the blood collection site is massaged, the blood collection site may turn blue or become swollen. Internal bleeding is usually absorbed into the body within a few days to a few weeks. If the area with internal bleeding spreads, becomes swollen, or is painful, please inform the staff in the blood collection room.

b. Nerve damage After blood collection, pain or numbness may spread to the fingers, and may persist even after a certain period of time has passed. If pain or numbness persists in the fingers, please inform the staff in the blood collection room.

c. Fainting, dizziness, etc. Fainting and dizziness during blood collection are believed to be caused by the vagal reflex. It is thought to be caused by tension or anxiety regarding blood collection. Symptoms include facial pallor, discomfort, and palpitations. If you have a history of feeling unwell, fainting, or dizziness during blood collection, please let us know so that we can collect your blood in bed.

At the end

All blood collection staff are keenly aware that blood collection is painful for patients. There are also cases where blood collection does not go well and causes inconvenience to patients. As the blood collection staff, we do our best to minimize pain for patients and collect blood as quickly as possible. We ask for your understanding and cooperation.

Inspection department news

Academic report

Paper presentation

1. Hitoshi Tono: Blood collection tips not found in textbooks 9: How to minimize pain with a needle
   Inspection and Technology 43: 1305, 2015
2. Hitoshi Toshio: 10 tips for blood collection that are not written in textbooks: "Oh, there is no backflow",,,Causes and countermeasures when puncture fails,
   Inspection and Technology 44: 47, 2016
3. Hitoshi Toyo: Tips for drawing blood that aren't written in textbooks 11: "Ah, the bleeding has stopped." What do you do then?
   Inspection and Technology 44: 217, 2016
4. Hitoshi Toshio: Blood collection tips that aren't written in textbooks 12: How to avoid vasovagal reflex (VVR) "Make the patient smile"
   Inspection and Technology 44: 427, 2016

Conference reports and lectures

1. Misaki Kohara: Two cases of pancreatic cancer suspected to be mass-forming pancreatitis by US.
   The 106th Abdominal Open Conference, Kobe, 2015.12.03
2. Hayato Maruoka: Fundamentals of gene mutation analysis. Workshop on the genetics department of the Japan Clinical Laboratory Association Kinki Branch. Kyoto. January 23, 2016.
3. Natsumi Nomoto, Mitsuhiko Ohta, Toshiko Konda, Junichi Kawai, Toshiaki Tsunoda, Naoko Suganuma, Masataka Nakajima, Takashi Yamane, Tomoko Tani, and Yutaka Furukawa:
   A case of transcatheter aortic valve implantation for severe aortic stenosis suspected to be bicuspid valve by intraoperative transesophageal echocardiography. 82nd Kobe Clinical Echocardiography Study Group, Kobe, January 30, 2016
4. Ichiro Sasaki: Legal Brain Death Determination. 9th Electroencephalogram-Electromyogram Seminar, Kansai Electroencephalogram-Electromyogram Research Society. Kyoto. 2016.01.29
5. Ichiro Sasaki: Evoked Potential Hands-on. 9th Electroencephalography and Electromyography Seminar, Kansai Electroencephalography and Electromyography Research Society. Kyoto. 2016.01.29
6. Seiko Nasu, Keishi Takekawa, Takuya Naito, Kenji Sakizono: Analysis of blood culture tests at our hospital over the past 10 years.
   The 27th Annual General Meeting of the Japanese Society for Clinical Microbiology. Sendai, Miyagi, January 30, 2016
7. Hirofumi Takekawa: Workshop on the Eight Strategies of the Inchu Institute - Aiming for Better Reporting of Microbiological Tests - Fungal Tests,
   The 27th General Meeting and Academic Conference of the Japanese Society for Clinical Microbiology, Miyagi, Sendai, January 30, 2016
8. Akito Tashiro, Hideshi Imoto, Akiko Morita, Masahito Omatsu, Keiichiro Uehara, Yukihiro Imai: A case of metastatic tumor in which toxic granules were observed in neutrophils and G-CSF production was suggested. The 32nd Annual Meeting of Hyogo Prefecture Society of Clinical Cytology, Kobe, March 5, 2016
9. Hayato Maruoka: Questions and answers about testing using flow cytometers.
   BD FACSTM Clinical Solutions Seminar in Kyoto 2016, Kyoto, March 19, 2016
10. Nobuhiro Iwasaki et al., Ultrasound Imaging of Meckel's Diverticulum. 131st Osaka Ultrasound Research Meeting, Osaka, March 9, 2016
11. Junko Miyamoto, Tomoko Tani, Toshiko Konda, Yoko Fujii, Junichi Kawai, Toshiaki Tsunoda, Naoko Suganuma, Natsumi Nomoto, Mitsuhiko Ohta, Motoyasu Kane, Yutaka Furukawa: "Left atrial function in various pathological conditions of severe aortic stenosis - A transthoracic echocardiographic study" The 80th Annual Meeting The Japanese Circulation Society, Sendai, March 18-20, 2016

Postscript

At this time of year, when the cherry blossoms are starting to bloom, there are farewells and new encounters as usual this year. In our laboratory, we have three people who have retired after working for the laboratory for many years. My senior was always easygoing and cheerful, and when I was feeling down, he would cheer me up by saying, "It'll be fine!" He also showed me a willingness to study hard to improve my work skills. My senior never easily compromised with the results, and if he thought something was wrong, he would thoroughly investigate the cause. He showed me the way to continue working hard while raising children, and was a role model not only as a laboratory technician but also as a woman. My mentor was my first assignment when I was a new employee, and taught me everything from the letter "ke" in "kensa". It's hard to say goodbye to any of them, and I feel uneasy and anxious when I think that they will be gone. My three seniors taught me so many things, not just with words, but also with their backs. I think that my mentor in particular shaped the origin of my current career as a laboratory technician. Of course, I learned how to consider things, read data, and present them, but I also learned more than just tangible things like that. I was also taught how to be myself, such as "always look around," "read the situation," and "think one or even two steps ahead and act accordingly." I'm still a long way from reaching my master's level, and every day I feel remorse and regret, but I always keep his words in my heart and hope to get a little closer to him. In April, I will be meeting new people. I hope that they will meet wonderful seniors like me, and that they will grow greatly as medical technicians and as people. (AT)

Minimal Residual Disease (MRD) Assessment for Hematopoietic Malignancies

Cell and Genetic Testing Laboratory Yumi Shiraishi

Introduction

There are various methods for diagnosing hematopoietic tumors such as leukemia and malignant lymphoma, and for evaluating minimal residual disease (MRD) after treatment, such as observing specimens under an optical microscope, chromosome analysis, flow cytometry, and PCR. However, the detection sensitivity of each method differs (for more information on flow cytometry, PCR, and minimal residual disease, please see "Special Feature No. 1 Genetic Testing: FLT3 Mutations and NPM1 Mutations"). In our laboratory, we are able to perform multifaceted testing by combining flow cytometry and PCR. In this issue of TEKARI, we will introduce the actual use of these two methods with case studies.

Case 1: Malignant lymphoma

This is a case in which lymph node swelling was incidentally detected during a CT scan at another hospital, and the patient was subsequently diagnosed with malignant lymphoma through a lymph node biopsy.

Left: Impression specimen image of lymph node. The N/C ratio (nucleus/cytoplasm ratio) is high, and many small tumor cells can be seen.
Right: Electrophoresis (PAGE) results of the IgH rearrangement test (※1). A positive band (arrow) is observed. (The rightmost band is the positive control.)

*1 IgH rearrangement test: Normally, B cells produce a wide variety of clones through rearrangement of immunoglobulin genes during differentiation and maturation to produce a variety of antibodies. However, in tumors, a single clone proliferates, so the gene sequence produced by the rearrangement is identical. Taking advantage of this property, this test is detected by PCR.

The figure above shows the results of flow cytometry, which revealed that the tumor cells were small and had the following characteristics: CD19+, CD20+, CD10+, CD43-, CD45+, Lambda+.

In addition, a bone marrow fluid test was performed to check for lymphoma cell infiltration in the bone marrow.

Left: A smear of bone marrow fluid. Various types of cells are observed in the bone marrow fluid, but infiltration of lymphoma cells is not clear.
Right: Results of a highly sensitive IgH rearrangement test (※2). The top row shows the results from a lymph node biopsy, and the bottom row shows the results from this test using bone marrow fluid. The values are almost identical, and it has become clear that the same tumor cells found in the lymph nodes are also present in the bone marrow fluid.

*2 High-sensitivity IgH rearrangement test: For cases that test positive in the IgH rearrangement test, case-specific primers are selected based on that information, and a more sensitive PCR method is performed using the semi-nested PCR method. The results are determined as positive or negative by measuring the length of the PCR product using fragment analysis.

This is the result of flow cytometry of bone marrow fluid. By using a case-specific antibody panel based on past positive patterns, it is possible to detect lymphoma cell infiltration with higher sensitivity. In this case, the test was performed based on the information obtained from the lymph node biopsy: CD10+, CD20+, CD43-, CD45+, Lambda+. This test also showed infiltration in 0.1% of the bone marrow fluid cells.

Case 2: Acute myeloid leukemia

This is one example of a patient who visited a local doctor after developing a fever and was diagnosed with acute myeloid leukemia after undergoing detailed examinations at our hospital.

This is the result of flow cytometry using bone marrow aspirate at the time of initial onset. Tumor cells with the characteristics of CD4+CD7+CD16－CD34+CD45dim+CD123+ were found in 54% of the bone marrow aspirate. Using this result, we will periodically test the bone marrow aspirate and use flow cytometry to monitor the effectiveness of treatment.

In addition, because the tumor cells were found to have a mutation in the NPM1 gene, it was possible to monitor the disease progression from the perspective of PCR by measuring the expression level of this mutated gene in bone marrow fluid. The graph below shows the change after the initial expression level, which is set to 1. Similar to the flow cytometry results, the expression level gradually increased, and then rose sharply at the time of relapse (MRD4), but fell to an extremely low level after bone marrow transplantation.

Conclusion

As we have introduced here, by performing tests from two aspects, flow cytometry and PCR, it is sometimes possible to find the presence of tumor cells that were not revealed by specimen observation alone, and these tests are considered to be useful for evaluating MRD. In our laboratory, we are actively adding new test items and improving current methods, and we are striving every day to provide highly sensitive and accurate results quickly to clinical practice.

Inspection department news

Academic report

Paper presentation

1. Hitoshi Tono: Blood collection tips not found in textbooks 9: How to minimize pain with a needle
   Inspection and Technology 43: 1305, 2015
2. Hitoshi Toshio: 10 tips for blood collection that are not written in textbooks: "Oh, there is no backflow",,,Causes and countermeasures when puncture fails,
   Inspection and Technology 44: 47, 2016
3. Hitoshi Toyo: Tips for drawing blood that aren't written in textbooks 11: "Ah, the bleeding has stopped." What do you do then?
   Inspection and Technology 44: 217, 2016
4. Hitoshi Toshio: Blood collection tips that aren't written in textbooks 12: How to avoid vasovagal reflex (VVR) "Make the patient smile"
   Inspection and Technology 44: 427, 2016

Conference reports and lectures

1. Misaki Kohara: Two cases of pancreatic cancer suspected to be mass-forming pancreatitis by US.
   The 106th Abdominal Open Conference, Kobe, 2015.12.03
2. Hayato Maruoka: Fundamentals of gene mutation analysis. Workshop on the genetics department of the Japan Clinical Laboratory Association Kinki Branch. Kyoto. January 23, 2016.
3. Natsumi Nomoto, Mitsuhiko Ohta, Toshiko Konda, Junichi Kawai, Toshiaki Tsunoda, Naoko Suganuma, Masataka Nakajima, Takashi Yamane, Tomoko Tani, and Yutaka Furukawa:
   A case of transcatheter aortic valve implantation for severe aortic stenosis suspected to be bicuspid valve by intraoperative transesophageal echocardiography. 82nd Kobe Clinical Echocardiography Study Group, Kobe, January 30, 2016
4. Ichiro Sasaki: Legal Brain Death Determination. 9th Electroencephalogram-Electromyogram Seminar, Kansai Electroencephalogram-Electromyogram Research Society. Kyoto. 2016.01.29
5. Ichiro Sasaki: Evoked Potential Hands-on. 9th Electroencephalography and Electromyography Seminar, Kansai Electroencephalography and Electromyography Research Society. Kyoto. 2016.01.29
6. Seiko Nasu, Keishi Takekawa, Takuya Naito, Kenji Sakizono: Analysis of blood culture tests at our hospital over the past 10 years.
   The 27th Annual General Meeting of the Japanese Society for Clinical Microbiology. Sendai, Miyagi, January 30, 2016
7. Hirofumi Takekawa: Workshop on the Eight Strategies of the Inchu Institute - Aiming for Better Reporting of Microbiological Tests - Fungal Tests,
   The 27th General Meeting and Academic Conference of the Japanese Society for Clinical Microbiology, Miyagi, Sendai, January 30, 2016
8. Akito Tashiro, Hideshi Imoto, Akiko Morita, Masahito Omatsu, Keiichiro Uehara, Yukihiro Imai: A case of metastatic tumor in which toxic granules were observed in neutrophils and G-CSF production was suggested. The 32nd Annual Meeting of Hyogo Prefecture Society of Clinical Cytology, Kobe, March 5, 2016
9. Hayato Maruoka: Questions and answers about testing using flow cytometers.
   BD FACSTM Clinical Solutions Seminar in Kyoto 2016, Kyoto, March 19, 2016
10. Nobuhiro Iwasaki et al., Ultrasound Imaging of Meckel's Diverticulum. 131st Osaka Ultrasound Research Meeting, Osaka, March 9, 2016
11. Junko Miyamoto, Tomoko Tani, Toshiko Konda, Yoko Fujii, Junichi Kawai, Toshiaki Tsunoda, Naoko Suganuma, Natsumi Nomoto, Mitsuhiko Ohta, Motoyasu Kane, Yutaka Furukawa: "Left atrial function in various pathological conditions of severe aortic stenosis - A transthoracic echocardiographic study" The 80th Annual Meeting The Japanese Circulation Society, Sendai, March 18-20, 2016

Postscript

The rainy season is over, the cicadas have started chirping, and it's starting to feel like summer. How are you all doing? Fireworks, festivals, the beach, the pool... There are so many exciting events in the summer! In order to enjoy the summer to the fullest, we would like to introduce some ways to prevent summer fatigue. Please try them out☆

• Set the cooler temperature to 27℃!
• Even if you don't have an appetite because of the heat, make sure to eat a good meal!
• Don't just drink cold things, drink hot things too!
• Although it's the season when showers are common, why not take a soak in the bathtub?
• ・Eat sweet things to boost your metabolism! (Be careful not to eat too much)

Use these tips to enjoy the hot summer! Be sure to stay hydrated and take care to avoid heatstroke!

About Nerve Conduction Tests

Physiological Function Testing Neurology Department Yuka Tanaka

Introduction

As humans, we take walking and talking for granted in our daily lives. If nerve damage occurs, even these simple daily actions become difficult. This time, we will explain nerve function tests to diagnose such nervous system disorders. Nerve function tests are mainly conducted to find out which nerves are abnormal and where they are damaged. At our hospital, we perform various tests such as nerve conduction tests, somatosensory evoked potentials (SEP), repetitive stimulation tests, and auditory brainstem response (ABR), but this time we will introduce the most representative nerve conduction tests.

Nerves are classified into "central nerves" located in the brain and spinal cord, and "peripheral nerves" that are distributed throughout the body. The peripheral nerves are further classified into "motor nerves" that move the limbs when the brain issues commands, and "sensory nerves" that transmit sensations felt by the limbs to the brain. In nerve conduction tests, electrical stimulation is given to the motor and sensory nerves to excite them, and the reaction is recorded from the muscles and nerves to evaluate the speed and conduction of the nerves.

Inspection flow

1. You will be asked to lie on your back.
2. Electrodes are placed on the hands and feet.
3. Next, a weak current is sent through the skin using a stimulation electrode and measurements are taken. Although it is electricity, it is similar to the low-frequency devices used to treat stiff shoulders. Although it varies from person to person, it may be accompanied by a tingling pain. Several points are stimulated for each nerve. (For the upper limbs, the wrist, elbow, and upper arm, and for the lower limbs, the ankle and back of the knee, etc.)
4. Finally, measure the distance between the stimuli using an appropriate instrument.

*The examination usually takes about 30 minutes, but if there are many nerves being examined, it may take up to an hour.

Test results

When stimulated, a waveform like this appears.

The waveform obtained by stimulating a motor nerve is called the compound muscle action potential (CMAP), and the waveform obtained by stimulating a sensory nerve is called the sensory nerve action potential (SNAP). These waveforms are analyzed mainly by looking at the following four items:

*Normal nerve conduction velocity is 50-60 cm/s for the upper limbs and 40-50 cm/s for the lower limbs.

Interpretation of test results

As shown in the diagram below, a nerve cell has an axon extending from the nerve cell body, which is surrounded by a myelin sheath. The axon transmits neural information, and the myelin sheath speeds up the transmission.

Peripheral nerve abnormalities can be broadly divided into axonal damage, myelin sheath damage, and a mixture of both.

Nerve conduction test precautions

The results of nerve conduction testing vary depending on factors such as skin temperature, height, age, etc. Also, since a weak electric current is applied, you may feel a tingling pain, but this test has no adverse effects on the body, so you can take the test with peace of mind.

At the end

Among physiological function tests, neurological function tests are relatively less frequently performed than electrocardiograms and ultrasound tests. I think it's hard to imagine what a neurological test is, so if you have any questions or concerns, please feel free to ask. In particular, if you strain yourself during this test, the correct waveform will not be obtained, and the test will not proceed. In order to get the best results, the patient's cooperation is necessary. Let's do our best together.

References

Pocket Manual of Nerve Conduction Tests, Ishiyaku Publishing Co., Ltd. Clinical Laboratory Science Course 3rd Edition Physiological Function Tests, Ishiyaku Publishing Co., Ltd.

Inspection department news

Academic report

Paper presentation

1. Hitoshi Tono: Blood collection tips not found in textbooks 12: How to avoid vasovagal response (VVR) "Make the patient smile" Kensa to Gijutsu 44: 293, 2016
2. Tamaki, E., Toshio, H., Kikawa, Y., Imai, Y., Kuroda, M., Araki, N., Tosaka, T., Hashimoto, I., Minowa, K., and Kato, D.: A case of myeloid sarcoma of the breast evaluated by contrast-enhanced ultrasound before and after chemotherapy, The Japan Society of Ultrasonics in Medicine 2016- Vol.43 (No.3):509-514
3. Hitoshi Tono, Eriko Tamaki, Yukihiro Imai, Nobuhiro Iwasaki, Ho-eun Jung, Yoshiki Suginoshita, Kazushi Minowa, Tetsuro Inokuma: Intratumoral localization of CD68-positive cells in angiomyolipoma with residual tumors detected by Sonazoid contrast-enhanced ultrasound, Liver 2016,57:302-304

Conference reports and lectures

1. Akiko Morita: Significance of FLT3-ITD expression in acute myeloid leukemia. 17th Annual Meeting of the Japanese Society of Laboratory Hematology, Fukuoka, August 6, 2016.
2. Hayato Maruoka: AML gene mutation screening method using HRM analysis. 17th Annual Meeting of the Japanese Society of Laboratory Hematology, Fukuoka, August 6, 2016.
3. Yumi Shiraishi, Hayato Maruoka, Shun Yamamoto, Yukiko Yano, Kaoru Sueoka, Tatsuo Oita: Establishment of RAS gene testing method for AML using HRM analysis. 65th Japanese Society of Medical Technology, Kobe, 2016.09.03
4. Kohara, M.; Matsushita, T.; Nakamura, M.; Minami, K.; Sugawara, M.; Sasaki, I.; Toshio, H.; Minowa, K.: Carpal tunnel syndrome reduces proximal conduction velocity: A study using MCV and F waves. 65th Annual Meeting of the Japanese Society of Medical Technology, Kobe, 2016.09.03
5. Natsumi Nomoto, Akiyo Tamura, Takuya Naito, Mamiko Nakamura, Marie Niki, Akiko Morita, Toshiaki Tsunoda, Tatsuo Oita: Initiatives to introduce Team STEPPS in Clinical Laboratory of our hospital. 65th Japanese Society of Medical Technology, Kobe, 2016.09.04
6. Seiko Nasu, Keiji Takekawa, Miyuki Nogami, Marie Niki, Takuya Naito, Namiko Nomura, Aya Kanda, Kenji Sakizono: Analysis of blood culture tests in our hospital over the past 10 years. 65th Japanese Society of Medical Technology, Kobe, 2016.09.04
7. Morita, A., Maruoka, S., Tashiro, A., Omatsu, M., Imoto, H., Uehara, K., and Imai, Y.: A case of T-lymphoblastic lymphoma (T-LBL) diagnosed early by pleural effusion cytology. 65th Annual Meeting of the Japanese Society of Medical Technology, Kobe, 2016.09.03.
8. Masashi Sugawara, Hideshi Imoto, Ryoichiro Matsuura, Hideshi Imoto, Tatsuo Oita: Study on EBER-ISH non-specific reaction in cecal samples. 65th Japanese Society of Medical Technology, Kobe, 2016.09.03.
9. Hitoshi Tono, Eriko Mori, Naoko Araki, Nobuhiro Iwasaki, Kazushi Minowa, Naoto Uranino, Ho-eung Jeong, Yoshiki Suginoshita: A case of esophageal diverticulum filled with food residue (Zenkar diverticulum) where ultrasound examination was useful. The 43rd Kansai Regional Meeting of The Japan Society of Ultrasonics in Medicine, Osaka, October 29, 2016.
10. Takashi Matsushita, Nobuhiro Iwasaki, Ichiro Sasaki, Hitoshi Tono, Masaaki Eto, Ho-eun Jung, Yoshiki Suginoshita, Tetsuro Inokuma, Eijiro Onishi, Yukihiro Imai: A case of femoral nerve primary retroperitoneal schwannoma. The 43rd Kansai Regional Meeting The Japan Society of Ultrasonics in Medicine, Osaka, October 29, 2016.
11. Takashi Matsushita, Misaki Kohara, Mamiko Nakamura, Kazumi Hamada, Ichiro Sasaki, Nobuo Kohara: Correlation between tibial nerve F-wave minimum latency and tibial nerve somatosensory evoked potential (SEP) P40 - Prediction of P40 from F-wave minimum latency -. 46th Annual Meeting JAPANESE SOCIETY OF CLINICAL NEUROPHYSIOLOGY, Fukushima, October 27, 2016.
12. Yuka Tanaka, Takako Tosaka, Nobuhiro Iwasaki, Ichiro Sasaki, Hitoshi Takeo, Kazushi Minowa, Ho-eun Jung, Yoshiki Suginoshita, Tetsuro Inokuma, Seiichi Shimada: A case of ovarian sliding hernia in which ultrasound examination was useful. The 43rd Kansai Regional Meeting The Japan Society of Ultrasonics in Medicine, Osaka, 2016.10.29.
13. Nobuhiro Iwasaki, Symposium "Advances and new developments in abdominal ultrasound examination" The raw diamond of gastrointestinal ultrasound examination - "initial 5 minutes" Ultrasonography in the gastrointestinal disease - The 43rd Kansai Regional Meeting The Japan Society of Ultrasonics in Medicine, Osaka, October 29, 2016
14. Misaki Kohara, Nobuhiro Iwasaki, Ichiro Sasaki, Hitoshi Toshio, Yoshiki Suginoshita, Ho-eun Jung, Tetsuro Inokuma: Two cases of GVHD colitis with different clinical courses. The 43rd Kansai Regional Meeting The Japan Society of Ultrasonics in Medicine, Osaka, October 29, 2016.
15. Shun Yamamoto, Mitsuhiko Ohta, Tomoko Konda, Toshiaki Tsunoda, Naoko Suganuma, Natsumi Nomoto, Atsuko Ohata, Tomoko Tani, Shuichiro Kaji, Yutaka Furukawa: A case in which echocardiography was useful for anatomical position abnormality of the digestive tract. The 43rd Kansai Regional Meeting The Japan Society of Ultrasonics in Medicine, Osaka, October 29, 2016.

Postscript

It's getting colder day by day, how are you all doing? It's almost time for the kotatsu and mandarin oranges. Apparently, two or three mandarins provide a day's worth of vitamin C. The vitamin C in mandarins is packed with the power to get through the cold winter, so eat some mandarins and get through the winter in good health! This is also the season when influenza and other diseases are prevalent, so please take care of your health.

Blood culture testing

Microbiology Laboratory: Miyuki Nogami

A blood culture test is a test to check the presence and type of bacteria in the blood. Blood is usually sterile, but if bacteria are detected, it may lead to a serious infection, so caution is required.

1. Purpose of blood culture tests

When bacteria are detected from blood, which is normally sterile, appropriate antibiotics can be selected by conducting drug sensitivity tests on the detected bacteria. There are many types and properties of bacteria, and the antibiotics that should be used for treatment vary depending on these differences. The causative bacteria are various, including gram-positive cocci (staphylococci, streptococci, etc.), gram-negative bacilli (Escherichia coli, Pseudomonas aeruginosa, etc.), and fungi.

2. Bacteremia and sepsis

When bacteria are found in the blood, it is called bacteremia, and the systemic inflammatory response syndrome caused by these bacteria is called sepsis.

Systemic inflammatory response syndrome (SIRS) is a condition characterized by signs of inflammation throughout the body, such as fever and increased white blood cells (conditions that meet the diagnostic criteria for SIRS).

3. Blood Collection

There are aerobic bacteria that love oxygen and anaerobic bacteria that hate oxygen, so blood is collected in an aerobic bottle and an anaerobic bottle. To increase the detection rate of bacteria and to make it easier to distinguish between pathogenic bacteria and contamination, blood is usually collected in two sets, one for aerobic and one for anaerobic bottles. The detection rate of bacteria varies depending on the number of sets, as follows:

The more sets you have, the higher the detection rate of bacteria.

4. Culture

Once the culture is positive, microscopic examination, identification of the bacteria, and drug susceptibility testing will be performed.

5. Identification and drug susceptibility testing

1. Blood culture. If the blood culture is positive, it is first gram stained and examined under a microscope. Depending on the bacteria seen, the results of the microscopic examination will be reported to the attending physician as "suspected staphylococcus" or "suspected enterobacteria". Depending on the bacteria seen in the microscopic examination, a rapid drug susceptibility test will be performed. The bacteria will be cultured on blood agar, chocolate agar, MacConkey agar, etc.

2. The name of the bacteria will be identified using a rapid method, drug susceptibility testing will be performed, and an interim report will be submitted to the attending physician.
The diagnosis is made based on the appearance of the bacteria, simple tests, and susceptibility.
If the drug is effective, an inhibition zone (a circle where bacteria cannot grow) will appear, and its size will be measured to determine the effectiveness.

3. The name of the bacteria is identified using analytical equipment and identification kits, drug susceptibility tests are performed, and a final report is submitted to the attending physician.

6. Summary

If the blood culture is positive, the patient may become very ill. When the blood culture is positive and bacteria are found in the microscopic examination, the first report is sent to the patient's doctor. Once the results of the rapid identification and drug susceptibility tests are available, an interim report is sent, and once the detailed identification and drug susceptibility test results are confirmed, a final report is sent. We strive to provide the patient with the information known at that time as quickly as possible. Causes of bacteria being detected in blood include infective endocarditis and urinary tract infections. In addition to conducting rapid and accurate tests, we also strive to provide as much information as possible about the test results related to identifying the site or source of infection.

Inspection department news

Academic report

Conference reports and lectures

1. Takashi Matsushita, Misaki Kohara, Mamiko Nakamura, Kazumi Hamada, Ichiro Sasaki, Nobuo Kohara: Correlation between tibial nerve F-wave minimum latency and tibial nerve somatosensory evoked potential (SEP) P40 - Prediction of P40 from F-wave minimum latency -. 46th Annual Meeting JAPANESE SOCIETY OF CLINICAL NEUROPHYSIOLOGY, Fukushima, October 27, 2016.
2. Hitoshi Tono, Eriko Mori, Naoko Araki, Nobuhiro Iwasaki, Kazushi Minowa, Naoto Uranino, Ho-eung Jeong, Yoshiki Suginoshita: A case of esophageal diverticulum filled with food residue (Zenkar diverticulum) where ultrasound examination was useful. The 43rd Kansai Regional Meeting of The Japan Society of Ultrasonics in Medicine, Osaka, October 29, 2016.
3. Takashi Matsushita, Nobuhiro Iwasaki, Ichiro Sasaki, Hitoshi Tono, Masaaki Eto, Ho-eun Jung, Yoshiki Suginoshita, Tetsuro Inokuma, Eijiro Onishi, Yukihiro Imai: A case of femoral nerve primary retroperitoneal schwannoma. The 43rd Kansai Regional Meeting The Japan Society of Ultrasonics in Medicine, Osaka, October 29, 2016.
4. Yuka Tanaka, Takako Tosaka, Nobuhiro Iwasaki, Ichiro Sasaki, Hitoshi Takeo, Kazushi Minowa, Ho-eun Jung, Yoshiki Suginoshita, Tetsuro Inokuma, Seiichi Shimada: A case of ovarian sliding hernia in which ultrasound examination was useful. The 43rd Kansai Regional Meeting The Japan Society of Ultrasonics in Medicine, Osaka, 2016.10.29.
5. Nobuhiro Iwasaki, Symposium "Advances and new developments in abdominal ultrasound examination"; The gemstone of gastrointestinal ultrasound examination - "initial 5 minutes" Ultrasonography in the gastrointestinal disease - The 43rd Kansai Regional Meeting The Japan Society of Ultrasonics in Medicine, Osaka, October 29, 2016
6. Misaki Kohara, Nobuhiro Iwasaki, Ichiro Sasaki, Hitoshi Toshio, Yoshiki Suginoshita, Ho-eun Jung, Tetsuro Inokuma: Two cases of GVHD colitis with different clinical courses. The 43rd Kansai Regional Meeting The Japan Society of Ultrasonics in Medicine, Osaka, October 29, 2016.
7. Shun Yamamoto, Mitsuhiko Ohta, Tomoko Konda, Toshiaki Tsunoda, Naoko Suganuma, Natsumi Nomoto, Atsuko Ohata, Tomoko Tani, Shuichiro Kaji, Yutaka Furukawa: A case in which echocardiography was useful for anatomical position abnormality of the digestive tract. The 43rd Kansai Regional Meeting The Japan Society of Ultrasonics in Medicine, Osaka, October 29, 2016.
8. Akito Tashiro, Hideshi Imoto, Akiko Morita, Masahito Omatsu, Keiichiro Uehara, Yukihiro Imai: A case of metastatic tumor in which toxic granules were observed in neutrophils and G-CSF production was suggested. 55th Autumn Meeting The Japanese Society of Clinical Cytology, Oita, November 18, 2016.
9. Hayato Maruoka: Genetic testing for hematopoietic tumors - Principles and clinical usefulness of the testing. Joint training session of the Nara Prefecture Association of Clinical Laboratory Technologists and the Japanese Society of Chromosome Genetic Testing, Nara Prefecture, 2016.12.10

Postscript

The cold weather is easing up and it's getting warmer, but how are you all doing? At this time of year, many people are battling invisible bacteria and pollen, including viruses. Here are some ways to boost your immunity.

• smile
• Do some light exercise
• Get a good night's sleep
• Take lactic acid bacteria
• Eat foods that boost your immunity (broccoli, garlic, natto, mushrooms, radish, etc.)

Please use these tips to boost your immunity. March is the season of partings, and April is the season of new encounters, so there will be big changes in your life and work from now on. Everyone, take care of your health and do your best in your new life starting in April!

Breast Cancer and Pathological Tests

Pathology Laboratory: Misaki Morimoto

Breast cancer, which has been a hot topic recently, is the most common cancer among women and is said to be increasing year by year. Common screening tests for breast cancer include interviews, palpation, mammography, and ultrasound examinations. If there is clinical suspicion, MRI and pathology tests are performed to determine whether there are any malignant findings.

This time, we will briefly introduce what kind of pathology tests (pathology diagnoses) are performed when breast cancer is suspected or when breast cancer is actually confirmed.

For more information on pathology testing, please see "Special Feature No. 13: Introduction to the Pathology Laboratory."

Breast cancer pathology testing has two major roles.

The first method is to take a part of the lesion when there is a lump in the breast and examine it under a microscope to see if it is cancerous. Local anesthesia is administered to relieve pain, and the diseased tissue is taken with a needle thicker than an injection needle. The taken tissue is then made into a specimen and observed under a microscope to determine whether it is benign or malignant.

The second is to examine the type, characteristics, size, progression, and metastasis of breast cancer when it is diagnosed. For example, the photos below are both breast cancers, but they are different types of breast cancer. The appearance of the tissue differs depending on the type of breast cancer, and the clinical prognosis differs.

Furthermore, pathology tests are also deeply involved in the treatment of breast cancer. In principle, breast cancer is treated by surgical resection (surgery), in combination with chemotherapy such as anticancer drugs (hormonal therapy, chemotherapy, molecular targeted therapy) and radiation therapy. Many people know that the stage of breast cancer and the presence or absence of metastasis are related to the treatment plan, but the plan for drug therapy may also be determined by pathology tests.

Some breast cancer cells have estrogen receptors (ER) and progesterone receptors (PgR), which are strongly bound by the female hormones estrogen and progesterone. For example, in cancer cells that have estrogen receptors, estrogen binds to the receptor and stimulates the cancer cells to grow. For such breast cancers, hormone therapy that blocks estrogen from binding is effective. The presence or absence of hormone receptors can be examined by immunohistochemistry*1 in pathological examinations.

In addition, molecular targeted drugs ^*2 have come to be used actively in treatment. In breast cancer, drugs that suppress the action of a protein (HER2) that exists on the surface of cells and is thought to be related to the proliferation of breast cancer have been attracting attention. Since molecular targeted drugs are applicable to breast cancer that has HER2 protein, our pathology laboratory also uses immunohistochemistry to check for the presence or absence of HER2 protein.

I have briefly talked about breast cancer and pathology tests. Although I was not able to introduce them this time, we also perform "intraoperative rapid tests" to determine the extent of removal of the affected area during surgery, and "cytological examinations" to examine cells and secretions collected from the breast. As such, pathology tests are deeply involved in diagnosing breast cancer and determining treatment plans, and are very important and essential tests. All of our staff work hard to provide quick and accurate results, not just for breast cancer.

Terminology

*1 Immunostaining: Staining that detects protein components contained in tissues and cells.
*2 Molecularly targeted therapy: A drug that suppresses the proliferation of cancer cells by targeting specific proteins or genes related to the development and proliferation of cancer.

Inspection department news

Academic report

Conference reports and lectures

1. Takekawa, Keiji: Current status and issues of "fungal identification" in clinical testing. The 28th General Meeting of the Japanese Society for Clinical Microbiology, Nagasaki, January 21, 2017.
2. Ichiro Sasaki: Evoked potential measurement. 10th Kansai EEG and EMG Seminar, Kyoto, January 21, 2017
3. Hayato Maruoka: Principles of measurement in FCM and how to interpret and interpret data. The 27th Kinki Branch Hematology Training Workshop of the Japan Clinical Laboratory Association. Osaka Prefecture. February 4, 2017.
4. Masahito Omatsu: Changes in the incidence of Bacillus cereus bacteremia before and after the implementation of restrictions on administration of amino acid-containing electrolyte preparations, 32nd Annual Meeting of the Japanese Society for Parenteral and Enteral Nutrition, Okayama, February 23, 2017.
5. Ayano Naka: A case of malignant melanoma treated with immunohistochemistry, 33rd General Meeting of the Hyogo Society of Clinical Cytology, Kobe, March 4, 2017.

Postscript

The season of dazzling new greenery is upon us. How is everyone doing? The light coming in through the window is so sparkling that it makes you want to go out without even thinking. Well, this comfortable season will be over in the blink of an eye, and we will soon enter the gloomy rainy season. "Baiu" is a word that was originally introduced from China, and it is said that the original character for "韴雨" (mold grows well in this season) was changed to the character for plum, whose fruit ripens in June, and became "rainy season". It is said that these plum fruits have a good effect on mental and physical discomfort during the humid rainy season. Let's get through the rainy season with one pickled plum a day and a nice umbrella!

Introduction to the specimen testing room

Sample Testing Room: Reika Irie

After you come to the hospital and have your blood drawn, the blood tubes are transported to the specimen testing room. Not only blood, but also urine and other specimens are transported. The samples are then classified into biochemical tests, blood tests, general tests, etc., and various test items are measured.

Blood collection

Even as adults, many people feel a little scared of having blood drawn. It can be a bit scary when a lot of blood collection tubes are presented. The total amount of blood is about 8% of body weight, so a person weighing 50 kg has about 4,000 mL of blood. It depends on the tests the doctor orders, but the average amount is 10-20 mL, and even the most common person has about 50 mL of blood collection tubes, so there's no need to worry. It's a bit reassuring to know that it's not that much.

The type and number of blood collection tubes vary depending on the purpose of the test, such as tests that use whole blood (untreated blood), tests that use the supernatant (serum) separated by clotting blood, and tests that use the supernatant (plasma) separated by mixing an anticoagulant to prevent blood from clotting. There are also several types of anticoagulants that prevent blood from clotting, depending on the test item. Commonly used anticoagulants include EDTA (salt), which is suitable for observing blood cells, and heparin, which is used to measure blood gases.

Blood cells (red blood cells, white blood cells, and platelets) are all produced by differentiation from hematopoietic stem cells. In adults, the process of hematopoietic stem cells becoming mature blood cells (hematopoiesis) takes place in the bone marrow of the skull, sternum, ribs, femur, etc. However, during the fetal period, when bone marrow development is immature, hematopoiesis takes place mainly in the liver and spleen, and after birth, the site of hematopoiesis gradually shifts to the bone marrow.

Approximately 45% of blood is made up of cellular components such as red blood cells, white blood cells, and platelets. These are collectively called blood cells. The remaining 55% is called plasma. 90% of plasma is water, with electrolytes (Na, K, Cl, etc.), proteins, sugars, amino acids, lipids, vitamins, hormones, waste products, etc. dissolved in it. Depending on the disease or pathology, the balance of components in the blood may change, and components that are not seen in healthy people may appear.

The main role of red blood cells is to transport oxygen. This is made possible by hemoglobin's ability to bind with oxygen. Red blood cells are made up of proteins and electrolyte solutions, with over 95% of the protein being hemoglobin. Red blood cells also have a lifespan. Red blood cells that have been active in the body for 120 days are eaten by macrophages and disappear.

Test results

All of our staff are working hard to shorten patient waiting times as much as possible and to provide accurate and reliable test data.

Even so, after the samples arrive at the laboratory, they are sorted for each test item, and after the necessary processing (such as centrifugation) is carried out, it takes about an hour for the measurements to be carried out and the results to be obtained. If there is a significant change from the previous measurement result or if the result exceeds the standard value, we will retest in order to report the correct test result.

Inspection department news

Academic report

Conference reports and lectures

1. Kana Hori, Mitsuhiko Ohta, Atsuko Ohata, Namiko Nomura, Natsumi Nomoto, Naoko Suganuma, Toshiko Konda, Yoko Fujii, Toshiaki Tsunoda, Tomoko Tani, Yutaka Furukawa, Tadaaki Koyama: Morphological changes in the left ventricular outflow tract before and after aortic valve replacement: A study using three-dimensional transesophageal echocardiography. The 28th Annual Meeting Japanese Society of Echocardiography, Nagoya, April 23, 2017.
2. Hayato Maruoka: Basic knowledge of antibody panel creation and antibody panel creation workshop. BD FACS Clinical Solutions Seminar IN Kyoto 2017, Kyoto, May 20, 2017
3. Akiko Morita: A case of embryonal rhabdomyosarcoma with tumor cells in pleural effusion. 58th Annual Meeting of The Japanese Society of Clinical Cytology, Spring Meeting, Osaka, May 27, 2017.
4. Sugawara, M., Tashiro, A., Minami, K., Morimoto, M., Omatsu, M., Morita, A., Matsuura, R., and Imoto, H.: Study on staining of anti-PD-L1 antibodies of two types of clones in lung cancer. 66th Japanese Society of Medical Technology, Chiba, 2017.6.17.
5. Minami, K., Sugawara, M., Tashiro, A., Morimoto, M., Omatsu, M., Morita, A., Matsuura, R., and Imoto, H.: A case of abnormal staining of CK-MNF116. 66th Annual Meeting of the Japanese Society of Medical Technology, Chiba, 2017.6.17.
6. Misaki Morimoto, Masashi Sugawara, Akito Tashiro, Kaori Minami, Masahito Omatsu, Akiko Morita, Ryoichiro Matsuura, Hideshi Imoto: Expression of E-cadherin in renal angiomyolipoma: 66th Annual Meeting of the Japanese Society of Medical Technology, Chiba, June 18, 2017.
7. Akiko Morita: Three cases of mixed phenotype acute leukemia (MPAL). 66th Japanese Society of Medical Technology, Chiba, June 18, 2017.
8. Hayato Maruoka: Usefulness of immunoglobulin gene rearrangement tests in the diagnosis of B-cell malignant lymphoma - using small amounts of biopsy material. 66th Japanese Society of Medical Technology, Chiba, June 18, 2017.
9. Yukiko Yano: Detection of BRAFV600E mutations in five patients with hairy cell leukemia. 66th Japanese Society of Medical Technology, Chiba, June 18, 2017.
10. Ichiro Sasaki: Fundamentals and Applications of Cerebral Evoked Potentials (Examination Room and Operating Room). 66th Japanese Society of Medical Technology Skills Improvement Seminar, Chiba, June 16, 2017.
11. Ichiro Sasaki: Introduction and effectiveness of an educational model using a highly sensitive electroencephalogram recording environment simulator. 66th Japanese Society of Medical Technology Skills Improvement Seminar, Chiba, June 17, 2017.
12. Naoko Suganuma, Toshiko Konda, Yoko Fujii, Natsumi Nomoto, Namiko Nomura, Atsuko Ohata, Kana Hori, Shun Yamamoto, Chihiro Shiromoto, Maya Nagano, Toshiaki Tsunoda: A case of diagnosis by accidentally detecting the rapidly expanding apical echo free space after open heart surgery. 85th Kobe Clinical Echocardiography Study Group, Kobe, 2017.06.10
13. Akiko Morita, Hayato Maruoka: Relationship between FLT3-ITD, NPM1 mutations and antigen expression in acute myeloid leukemia. 18th Japanese Society of Laboratory Hematology, Sapporo, July 22, 2017.
14. Maruoka, H., Ono, Y., Kato, D., Hiramoto, N., Sueoka, K., Yano, Y., Yoshida, M., Morita, A., Minowa, K., Ishikawa, T.: MYD88L265P mutation analysis method in primary macroglobulinemia using B cell isolation and HRM analysis. 18th Annual Meeting of the Japanese Society of Laboratory Hematology, Sapporo, July 23, 2017.
15. Oka, K., Maruoka, S., Yoshida, M., Shiraishi, Y., Yano, Y., Minowa, K., Ishikawa, T.: Establishment of a multiplex PCR method for detecting gene mutations in myeloproliferative neoplasms. 18th Annual Meeting of the Japanese Society of Laboratory Hematology, Sapporo, July 23, 2017.
16. Ichiro Sasaki: Legal Brain Death Determination: A to Z. FY2017 Training Seminar for Five Types of Target Facilities, Ibaraki, July 1, 2017.

Postscript

It seems like every year it takes longer to think "the summer heat will be over soon". I almost caught a cold, probably because of summer fatigue. It seems that in summer, the temperature difference between the outside temperature and the air-conditioned room makes it easy to get sick. Be careful to avoid heat stroke and take care of your health. When I went shopping, the colors of the store had completely changed to autumn colors. I could even hear the occasional insect chirp from the hedges. Autumn is just around the corner. I'm looking forward to going out and attending events once it cools down, and I'd like to get through the summer by spoiling myself a little by eating my favorite ice creams and sweets. I hope you don't work too hard and get fatigued from the summer.

About hematopoietic stem cell transplantation

Transfusion Inspection Management Office Jang Yun-hee

What is hematopoietic stem cell transplantation?

Hematopoietic stem cell transplantation is a treatment that replaces diseased blood cells with healthy cells. After tumor cells and immune cells are destroyed by chemotherapy and/or total body radiation therapy, a process called "conditioning," healthy hematopoietic stem cells are transplanted via infusion.

Hematopoietic stem cell transplants are indicated for diseases such as leukemia, lymphoma, multiple myeloma, and aplastic anemia. Hematopoietic stem cell transplants are divided into two types: "autologous transplants," in which the patient's own hematopoietic stem cells are collected in advance, frozen and stored, and then transplanted after conditioning, and "allogeneic transplants," in which hematopoietic stem cells from a donor*1 are collected and transplanted into the patient after conditioning.

"HLA" determines the success of transplants

Donors for hematopoietic stem cell transplants must have a compatible white blood cell type (HLA) with the patient. Just as the so-called blood types (ABO types) are types of red blood cells, there are also various types of white blood cells. Among them, the three types of HLA-A, -B, and -DR are important for hematopoietic stem cell transplants, and a donor with a matching HLA is searched for. If a donor cannot be found among blood relatives, a bone marrow bank is used to find a donor. The Japan Marrow Bank acts as an intermediary between patients and "donor candidates" registered nationwide.

What happens if the HLA is different?

When donor-derived hematopoietic stem cells are recognized as non-self and rejected by the patient's immune cells, this complication is called "engraftment failure." Engraftment failure increases the risk of infection and may require re-transplantation, placing a heavy burden on the patient. In contrast, a complication in which the transplanted hematopoietic stem cells attack the recipient after engraftment is called "GVHD (graft-versus-host disease)." When GVHD occurs, the skin, liver, and digestive tract are particularly damaged, and in severe cases it can be fatal. If the HLA type is different, the risk of developing such serious complications increases. Thus, choosing a donor with a matching HLA is an important point that greatly affects the prognosis of the transplanted patient.

Types of hematopoietic stem cell transplantation

Hematopoietic stem cell transplants can be divided into three types depending on the origin of the cells and the location where they are collected. We will introduce the characteristics, advantages, and disadvantages of each type.

1) Bone marrow transplantation

This is a method to extract and transplant hematopoietic stem cells from the donor's bone marrow. The stem cells are extracted by puncturing various areas of the ilium at the back of the pelvis several times.

2) Umbilical cord blood transplantation

This is a method of transplanting hematopoietic stem cells contained in fetal blood (umbilical cord blood) that remains in the placenta and umbilical cord after delivery. Umbilical cord blood transplants can only be performed at facilities registered with the Japan Cord Blood Bank Network.

3) Peripheral blood stem cell transplantation

Normally, hematopoietic stem cells are found in the bone marrow and rarely in the peripheral blood, but this method allows hematopoietic stem cells to be collected in the peripheral blood by administering G-CSF.

Hematopoietic stem cell transplantation at our hospital

Our hospital performs bone marrow transplants, umbilical cord blood transplants, and peripheral blood stem cell transplants. In 2016, 8 bone marrow transplants, 24 umbilical cord blood transplants, and 41 peripheral blood stem cell transplants (10 were allogeneic transplants and 31 were autologous transplants) were performed. *Including transplants at the Advanced Medical Center.
Additionally, during peripheral blood stem cell autotransplantation, doctor Hematology pharmacists to adjust the cells.

summary

• This is a brief overview of hematopoietic stem cell transplantation.
• Hematopoietic stem cell transplantation involves medical professionals from a variety of professions, including not only clinical laboratory technologists, but also doctor, nurses, pharmacists, clinical engineers, and radiologists.
• In the Transfusion Testing Management Office, we work hard every day as part of the medical team, coordinating with other professions, to contribute to the success of transplants for as many patients as possible.

Terminology

*1 Donor: The person who provides the transplant cells.

References

・Illness Visible Blood vol.5, edited by Medical Information Chemistry Institute, published by Medic Media
・Visual counseling book for hematopoietic stem cell transplantation, published by NOVARTIS ONCOLOGY

Inspection department news

Academic report

Conference reports and lectures

1. Hayato Maruoka: The usefulness of FCM and genetic testing in hematopoietic tumors. Joint training session of the Chromosome and Genetics Department/Clinical Hematology Department of the Fukui Prefectural Association of Clinical Laboratory Technologists, Fukui, September 30, 2017.
2. A. Ohata, M. Ohta, R. Konda, T. Tsunoda, K. Kim, T. Kitai, T. Kaji, S. Tani, T. Koyama, T. Furukawa, Y.: A case of acute prosthetic valve dysfunction 14 years after aortic valve replacement. 44th Kansai Regional Meeting The Japan Society of Ultrasonics in Medicine, Osaka, 2017.09.23.
3. Nobuhiro Iwasaki: "An example of hypervascular liver tumor (answer edition)", "An example of ascending colon perivascular epithelioid cell tumor", 134th Osaka Ultrasound Research Meeting, Osaka International Convention Center, September 20, 2017
4. Nobuhiro Iwasaki: Workshop "Abdominal Diseases Considered with Ultrasound" "Gastrointestinal Tract". 44th Kansai Regional Meeting The Japan Society of Ultrasonics in Medicine, Osaka, September 23, 2017.
5. Nobuhiro Iwasaki: "The Beginnings of Abdominal Echocardiogram" 3rd Hyogo Prefecture Regional doctor Ultrasound Hands-on Seminar, Kobe, September 18, 2017
6. Nobuhiro Iwasaki: "Pancreas and Kidneys" 3rd Hyogo Prefecture Regional doctor Ultrasound Hands-on Seminar, Kobe, September 10, 2017
7. Masashi Sugawara: "Ultrasound Examination of Pancreas and Kidneys" "Pancreas and Kidneys" 3rd Hyogo Prefecture Regional doctor Ultrasound Hands-on Seminar, Kobe, September 18, 2017
8. Yuka Tanaka: "Pancreas and Kidneys" 3rd Hyogo Prefecture Regional doctor Ultrasound Hands-on Seminar, Kobe, September 18, 2017
9. Yuka Tanaka, Hitoshi Takeo, Ho-eung Jeong, Nobuhiro Iwasaki, Ichiro Sasaki, Kazushi Minowa, Yoshiki Suginoshita, Yukihiro Imai, Tetsuro Inokuma: A case of liver metastasis from mucinous carcinoma with characteristic US findings. The 44th Kansai Regional Meeting The Japan Society of Ultrasonics in Medicine, Osaka, September 23, 2017.
10. Sugawara, M.; Toshio, J.; Iwasaki, N.; Sasaki, I.; Minowa, K.; Suginoshita, Y.; Suzuki, I.; Fujikura, K.; Imai, Y.: A case of hydrocele associated with cryptorchidism diagnosed by US due to hernia. The 44th Kansai Regional Meeting The Japan Society of Ultrasonics in Medicine, Osaka, 2017.09.23
11. Yamamoto Shun, Ohta Mitsuhiko, Konda Toshiko, Tsunoda Toshiaki, Nomoto Natsumi, Nomura Namiko, Tani Tomoko, Kaji Shuichiro, Koyama Tadaaki, Furukawa Yutaka: Two cases of early structural valve deterioration after aortic valve replacement using externally wound bioprosthetic valves. The 44th Kansai Regional Meeting The Japan Society of Ultrasonics in Medicine, Osaka, 2017.09.23
12. Takashi Matsushita, Nobuhiro Iwasaki, Hitoshi Toshio, Yoshiki Suginoshita, Ho-eun Jung, Tetsuro Inokuma, Yukihiro Imai: A case of sclerosing hemangioendothelioma showing a specific image on contrast-enhanced US. The 44th Kansai Regional Meeting The Japan Society of Ultrasonics in Medicine, Osaka, September 23, 2017.
13. Akiko Tamaki: What to consider when erythroblasts in bone marrow exceed 50%. 57th Japan Society of Clinical Laboratory Technologists Kinki Branch Medical Laboratory Science Conference, Kyoto, October 29, 2017.
14. Hideshi Imoto: Incidents in the pathology laboratory and their countermeasures: What can we learn from our hospital's work procedures? 57th Japan Society of Clinical Laboratory Technologists Kinki Branch Medical Laboratory, Kyoto, October 29, 2017.

Postscript

The change of seasons can easily affect our physical condition, and this year, especially since October, there has been a large difference in temperature, and I am confused as to how to change my body and mind to suit the temperature change, as if winter had come without skipping over summer and autumn. British naturalist Charles Robert Darwin left behind the famous quote, "It is not the strongest of the species that survives, nor the most intelligent that survives. It is the one that is most adaptable to change." You may think that it is strange to quote such a quote for a mere change in temperature, but we are greatly affected by even changes in temperature, which are only a part of natural phenomena. In modern society, there are many changes that we cannot resist, and there are many cases where we cannot adapt. However, in order to live with ease in both body and mind, we need to make an effort to become someone who can adapt to as many things as possible. Why not take a step forward so that you don't get confused?

About Electrocardiograms

Maya Nagano and Fumiko Norimasa, Cardiopulmonary Department, Physiological Function Testing Laboratory

A) What is an electrocardiogram?

Introduction

Have you ever had an electrocardiogram at a medical checkup or hospital? There are many different types of tests available, but electrocardiograms are probably one that you are relatively familiar with. As the name suggests, it is a test that examines the function of the heart. The heart is an organ that periodically generates a small amount of electricity, and as this electricity is transmitted to the heart muscle (myocardium), it contracts and expands, using that force to send large amounts of blood throughout the body. An electrocardiogram checks the state of that electricity to determine whether the heart is beating regularly and whether there is any damage to the myocardium.

How electricity is transmitted through the heart (conduction system)

The heart's excitation stimuli are generated at regular intervals by the sinus node in the right atrium. This interval determines the speed of the heart's beat, or "heart rate." The excitation stimuli generated by the sinus node cause the atria to contract, and are transmitted to the atrioventricular node through the myocardium inside the atria. The excitation stimuli are then transmitted from the atrioventricular node to the bundle of His → left bundle branch → right bundle branch → Purkinje fibers, in that order, causing the ventricles to contract. Simply put, an electrocardiogram is a waveform that represents the flow of electricity in this excitation conduction system.

The diagram below provides an easy-to-understand explanation of how the nerve conduction system works.

What kind of waveform is an electrocardiogram?

A normal electrocardiogram waveform will appear in the following order: P waves, QRS waves, T waves, and U waves. As mentioned earlier, an electrocardiogram shows the flow of electricity in the heart, and we clinical laboratory technicians conduct the examination by closely observing each waveform component.

B) How do you test it?

1. First, you lie on your back on the bed with your chest, wrists, and legs exposed. At this time, your legs should be slightly apart and your arms should be slightly away from your body.
2. The clothespin-like limb electrodes are attached to the hands and feet, and the octopus-like chest electrodes are attached to the chest. They may feel a little cold, but are not painful.
3. After attaching the electrodes, relax your body and try not to move your arms, legs, etc. The recording itself takes about one minute, or at most two minutes, but it may take longer if you move or tense your body and are unable to record smoothly.
4. Once recording is complete, the electrodes are removed and the test is complete. If everything goes smoothly, the test will take about 5 minutes from preparation to completion (this may vary depending on the patient's condition and the test circumstances).

C) Examination tips (to get a clear electrocardiogram)

At our hospital, there is something that we clinical laboratory technicians keep in mind when taking electrocardiograms. That is, to leave an electrocardiogram waveform that "does not interfere with reading the waveform." When performing routine work, we encounter various cases like the ones below. In such cases, rather than simply giving up and saying, "It's a bit of a rough waveform, but oh well!", we make an effort to somehow make the waveform look nice.

-example-

I. No ECG waveform on the monitor
Response) Check that the limb lead electrodes are not dry or broken.

II. Contamination of electromyograms

Response) Tell the person that they are tensing their whole body too much and to relax. Try changing the position of the pillow.

III. Fluctuations in the baseline of limb leads

Response) Check that there is no body movement, that there is contact with the skin, that the electrodes are not dry, and that the electrode metal fittings are not loose.

IV. Overall sway of chest leads
Response) Eliminate the effects of breathing (don't allow the person to take large breaths, have them hold their breath).

V. The fluctuation of each baseline
Response) Check for contact with the skin and for electrode removal. Use cream if you have chest hair, dry skin, cannot lie on your back, or are thin.

Ⅵ. What if an infant comes for testing?
Solution) Use sticker-type electrodes for children (as it is difficult to keep the child still and regular electrodes tend to come off).

VII. What if I have had an amputation or cannot stop shaking?
Response) Use the limb electrodes on the shoulders or waist instead (measurements on the central side have less of an effect than measurements on the peripheral side).

D) A request from the examination room! (To ensure a smooth examination...)

1. You do not need to take off your clothes, but the examination will go more smoothly if you wear clothing that easily exposes your wrists, ankles, and chest (please refrain from wearing dresses or bodysuits on the day of the examination).
2. It is especially helpful for women to avoid wearing tights or stockings if possible (you will need to remove tights etc. as electrodes will be attached to your ankles).
3. A wristwatch is fine, but if you are wearing a lot of jewelry (necklaces, etc.), you may be asked to remove it during the examination.

E) Actual waveforms (Various types of arrhythmias revealed by electrocardiograms!)

<Explanation> Normal waveform.
- The shape of the QRS wave is the same, it appears neither too early nor too late, and has a regular rhythm.

<Explanation> Premature ventricular contraction.
On the 4th and 5th beats, two consecutive QRS waves with a different shape than the previous ones appear at an earlier timing. This is the type of arrhythmia known as "skipped beats/missed beats."
- "Premature ventricular contractions" occur when electricity is generated quickly from a place other than the normal place where electricity is normally generated.

<Explanation> Atrial fibrillation (tachycardial).
-A typical example of tachycardia-type arrhythmia that causes the symptom "chest pounding."
This occurs when electricity to make the heart beat is produced abnormally quickly, or when an electrical pathway is created in an abnormal place, causing electricity to pass through it.

<Explanation> High-grade atrioventricular block.
-A type of bradycardia arrhythmia in which the pulse is slow.
Bradycardia occurs when the electricity needed to make the heart beat is no longer produced or when electricity stops passing through the heart midway.
-If you experience symptoms such as dizziness even when you are not doing anything, you should be careful as there may be an abnormality in the way the electricity that makes the heart beat is produced, causing the heart to stop temporarily.

F) Conclusion

Here is a brief summary of electrocardiograms. This is an important test that can provide clues for discovering dangerous diseases such as arrhythmia, angina, and myocardial infarction. Although it may seem like a simple test at first glance, we clinical laboratory technicians strive every day to provide clinicians with the best possible test data by using various ingenuity. It is a safe test that takes only a short time and is painless, so if you have the opportunity to have an electrocardiogram in the future, please feel free to come to our clinic.

References

・Supervision of the Circulatory Function Testing Technique Textbook: Japan Association of Medical Technologists
・Diseases in Perspective vol.2 Circulatory System 4th Edition
・Dr. Hart's Electrocardiogram Classroom Part 1, Revised Second Edition

Inspection department news

Academic report

Ojinshi: Blood collection tips that aren't written in textbooks 12: How to avoid vasovagal reflex (VVR) "Make the patient smile"
Inspection and Technology 44: 427, 2016

Conference reports and lectures

1. Tashiro, A., Imoto, H., Morita, A., Omatsu, M., Naka, A., Yamashita, D., and Imai, Y.: Cytological features of atypical polypoid adenomyoma (APAM) of the uterus. 56th Autumn Meeting The Japanese Society of Clinical Cytology, Fukuoka, 2017.11.19.
2. Ayano Naka, Hideshi Imoto, Akiko Morita, Masahito Omatsu, Akito Tashiro, Masashi Sugawara, Daisuke Yamashita, Keiichiro Uehara, Yukihiro Imai: A case of malignant melanoma treated with immunohistochemistry. 56th Autumn Meeting The Japanese Society of Clinical Cytology, Fukuoka, 2017.11.19.
3. Yamamoto S, Ohta M, Konda T, Tsunoda T, Suganuma N, Nomoto N, Nomura N, Ohata A, Hori K, Sasaki Y, Kim K, Kitai T, Yamane T, Ehara N, Kobori A, Kinoshita S, Kaji S, Furukawa Y, Koyama T.: Two cases of early structural deterioration after aortic valve replacement using the Trifecta valve. 8th Annual Meeting of the Japan Valve Society, Tokyo, 2017.11.24.
4. Takashi Matsushita: Correlation between neuromotor testing and skin temperature measured at three points on the upper limbs. 47th Annual Meeting JAPANESE SOCIETY OF CLINICAL NEUROPHYSIOLOGY, Yokohama, November 30, 2017
5. Ichiro Sasaki: What lies ahead for intraoperative neuromonitoring. 54th JAPANESE SOCIETY OF CLINICAL NEUROPHYSIOLOGY Technical Training Workshop, Yokohama, December 1, 2017
6. Masahiro Yoshida: Let's learn about genetic testing for hematopoietic tumors! 9th Sysmex User Training Session, Hyogo, 2017.12.02
7. Yukiko Yano: Why is flow cytometry so great? 9th Sysmex User Training Session. Hyogo. 2017.12.02
8. Takemoto Y, Nasu S, Nogami M, Niki M, Kanda A, Udo H, Makita M, Takekawa K: A case of obturator muscle abscess and osteomyelitis due to Salmonella O4 bacteremia. 23rd Hyogo Prefecture Medical Laboratory Society. Kobe. 2017.12.10.
9. Udo H, Nasu S, Nogami M, Niki M, Kanda A, Takemoto M, Makita M, Takekawa K: Two cases of strongyloidiasis detected at our hospital. 23rd Hyogo Prefecture Medical Laboratory Society. Kobe. 2017.12.10.
10. Nakayama, Y., Matsuura, R., Imoto, H., Morita, A., Omatsu, M., Tashiro, A., Naka, A., Morimoto, M., Minami, K., Imai, Y.: Examination of acid-philic bacillus staining method in paraffin sections. 23rd Hyogo Prefecture Society of Medical Laboratory Science. Kobe. 2017.12.10.

Postscript

Every year, at the beginning of the year, I feel like starting something new, but before I know it, it's already mid-February. In the end, I don't get to start anything, and time just passes by every year. It's almost March, also known as Yayoi. There are various theories, but one is that it's a contraction of "Kikusa Yai Ya Ohi Moru Tsuki," which means "the month when the plants and trees begin to grow more and more." Hoping to feel the spring coming as soon as possible, I planted plum trees in my garden, and they have started to bloom here and there. Little by little, spring is approaching. Now, I'm thinking about what to start anew in the new fiscal year.

PCR testing for the new coronavirus

Cell and Genetic Testing Laboratory Mayuko Himeno

PCR (polymerase chain reaction) is a technique that uses special reagents and equipment to amplify a target gene. This technique is used to detect human pathological genes and viruses.
Our hospital uses this technology to examine genetic abnormalities seen mainly in blood diseases such as leukemia and malignant lymphoma, but with the recent outbreak of the novel coronavirus (SARS-CoV-2), we have begun to use our existing know-how to conduct PCR tests for the novel coronavirus in-house. In this article, we will introduce the PCR test for the novel coronavirus.

Overview of the new coronavirus testing process

1. A swab is used to take a sample from the patient's nasopharynx
2. RNA is extracted from the virus in the laboratory
3. Prepare PCR reagents
4. The results are judged using the CFX96 (a special machine).

RNA extraction

Since the virus itself cannot be subjected to PCR as is, RNA is extracted using a special machine called Maxwell RSC.

The virus on the swab is dropped into a solution, mixed with reagents, and then placed into the machine, and RNA extraction is completed in about 40 minutes.
Although RNA extraction may seem simple at first glance, there is a risk of exposure, so we work inside a safety cabinet. We also wear double gloves, an apron, a mask, and goggles, and frequently disinfect our hands with alcohol swabs.

About the testing method

Among the novel coronavirus pathogen detection methods proposed by the National Institute of Infectious Diseases, our hospital uses the real-time One-step RT-PCR method. This method combines reverse transcription (RT), which converts RNA extracted from the virus into cDNA, with real-time PCR. Since RT and real-time PCR are performed consecutively in a single tube, there is no risk of contamination and the operation is simple.

*Reverse transcription reaction (RT): The process of converting RNA to cDNA using reverse transcriptase. RNA cannot be used directly in PCR, so it must be converted to cDNA when performing PCR using RNA.

What is PCR?

PCR is a technology that amplifies the target gene by mixing the sample with a special reagent and running it through a machine called a thermal cycler.
PCR involves a cycle of denaturation, annealing, and extension reactions, and this process is repeated many times to amplify genes.

What is Real-Time PCR?

This method performs PCR using DNA as a template, and quantifies the amount of template DNA by measuring the amplification of the template DNA in real time using a fluorescent dye.

There are various real-time PCR techniques, but the method used to detect the new coronavirus is to use a probe labeled with a fluorescent dye.

A probe is a short gene sequence labeled with a reporter (a fluorescent dye) and a quencher that inhibits this, and is attached to the template DNA during annealing. At this time, the reporter is inhibited by the quencher, so it cannot emit fluorescence even when exposed to excitation light.

As the extension reaction proceeds, the probe is decomposed and the reporter emits fluorescence in response to excitation light. Quantitation is achieved by reading this fluorescence.

Interpreting the results

Once real-time PCR is complete, a curve like the one below will be generated.

This curve is called an amplification curve. The vertical axis represents the amount of fluorescence, and the horizontal axis represents the number of cycles (reaction time).
As real-time PCR progresses and reaches a certain level of fluorescence, the curve will rise as shown in the figure. In this case, it is judged as positive. If the amount of fluorescence does not increase within the PCR reaction time, the curve will remain flat and it will be judged as negative.

In this case, 1 and 2 are positive because the curves are rising, and 3 is negative because it remains flat.

summary

PCR may seem simple at first glance, but it is a test that requires careful attention to avoid putting the wrong reagent in and contamination. Also, PCR has a small possibility of false negatives depending on the quality of the sample, so although it is an important test, it cannot be said to be an absolute test.

Therefore,
"PCR negative = not infected with coronavirus"
This does not mean that.

It is important to consider not only PCR but also other information such as lung X-rays, clinical symptoms, and patient interviews comprehensively.

Introduction of outpatient blood collection room

Outpatient blood collection room Tsuyoshi Yamamoto

Blood sampling is a medical practice necessary to "diagnose disease" and "understand the condition" by examining the blood components flowing through the body. Blood collection is a highly safe procedure because blood is collected from a vein, but in rare cases, "blood collection complications" may occur. If it is determined that the biological information to be confirmed by blood sampling is higher than the risk of blood sampling complications, blood sampling will be ordered by the doctor in charge. "Blood sampling complications" will be described later, but please understand the necessity and risks of blood sampling before receiving blood sampling.

2. Request to patients who can receive blood collection

From the viewpoint of medical safety, the following items are checked at the time of blood collection (Fig. 1). If applicable, please inform the blood collection staff at the time of blood collection.

1) Confirmation of the arm for blood sampling

Blood collection is performed by damming up the blood in the vein with a tourniquet, but there are cases where the tourniquet cannot be wrapped. Please let us know in advance if you have any of the following conditions.

① Those who have a shunt for artificial dialysis
②Those who are in port for chemotherapy
(3) Those who wear Libre for self-monitoring of blood sugar
④Those who have implanted parathyroid glands

Also, if you have a history of allergies, please let us know at the time of blood collection.

⑤ If you have a history of allergies to alcohol: use antiseptics other than alcohol.
6.Have a history of allergies to tapes: use adhesive plaster or paper bandages.

2) Guidance on blood sampling complications

In rare cases, the following health hazards (blood sampling complications) may occur during blood sampling (Figure 2).

(1) Nerve damage: Pain at the puncture site and numbness in the fingertips.
(2) Subcutaneous hematoma (bruise): This occurs when bleeding is not sufficiently stopped after blood collection.
(3) Allergies: Rubbing alcohol or tape causes a rash, redness, or itching.
④ Vasovagal reflex (feeling bad): Woke up by nerve reflex when stabbing. Blood pressure drops or tachycardia.

3. Flow up to blood collection

1) Reception

① Reception will be done at the automatic reception machine or reception C (manned). Please have your medical card ready.
② Please issue a "reception number" at the reception. If you do not receive a number, please issue a ticket at reception C (manned).
③ The start time of the reception time is as follows.
a) Automatic reception machine: Starts at 7:30 AM.
b) Reception C (manned): Starts at 8:15 AM.
In addition, if you need to check the contents even with the automatic reception machine, it will be displayed as "Please come to the reception C counter." In that case, you may be asked to go to Reception C (manned). note that.
④Please wait in the outside waiting area until the "reception number" is displayed on the bulletin board. Please enter the blood collection room when it is displayed.
⑤ If you are wearing a long-sleeved shirt, please wait with your arm out.

2) Preparation for blood collection

①When the "reception number" is displayed on the bulletin board of the blood collection table, please proceed to the blood collection table.
② Hand the “reception number slip” to the person in charge of blood collection. Required for name verification.
③ We will ask for your name and date of birth to verify your identity.
④ Depending on the item (such as renin blood sampling), blood sampling may be performed after resting for 30 minutes. Follow your doctor's instructions.
⑤ For the glucose tolerance test, blood is collected 30, 60, and 120 minutes after drinking the glucose solution.

3) Blood sampling

(1) Blood will be collected mainly from the elbow, so please place your elbow on the blood collection pillow.
(2) Hold it lightly with your thumb inside.
(3) Extend your elbow to collect blood.
④ If blood cannot be collected from the elbow, we may collect blood from the forearm or the back of the hand.
⑤ If you are using a wheelchair, blood will be drawn while you are sitting. In that case, the order may change. note that.
⑥ If you feel unwell or have felt unwell in the past, please let us know so that we can collect blood on your bed.
⑦ After removing the needle, firmly press the place where blood was collected for 5 minutes (pressure hemostasis). If you are taking blood-thinning medication, press firmly for 10 minutes.

Four. Crowded blood collection room

It is very crowded in the morning, so it is recommended for those who come only for blood collection after 14:00 as it is relatively free (Fig. 3). Please help us to eliminate the waiting time in the blood collection room.

Our Clinical Laboratory has acquired ISO15189 certification. In the outpatient blood collection room, we are striving to improve patient waiting time by managing TAT (turn around time: response time for examination). From fiscal 2019 to fiscal 2020, we were able to significantly shorten the waiting time by improving staff allocation and work content in order to shorten the waiting time (Fig. 4). We will continue to investigate waiting times and strive to further shorten waiting times.

Five. Overview of outpatient blood collection room

(1) The outpatient blood collection room has 9 booths, and clinical laboratory technologists and nurses are in charge of blood collection.
(2) Blood collection work by clinical laboratory technologists is handled by all staff, regardless of specimen testing or physiological testing.
③ The number of patients for blood sampling is about 500 to 700 every day.
(4) The blood collection system is built with Sysmex CNA, and two BC-ROBO 8001 RFID blood collection tube supply devices are installed.
⑤ We conduct various training throughout the year for new employee education.

6. others

①Please come to the hospital wearing clothes that are easy to draw blood on the day of the procedure.
(2) In the case of clothes with tight sleeves, it may not be possible to collect blood from the elbow, or the bleeding may not be sufficiently stopped.

Certificate of Participation in Clinical Laboratory Accuracy Control Survey Japan Medical Association

Certificate of Participation in Nichiringi Clinical Laboratory Accuracy Control Survey

Military skill accuracy control survey participation certificate

Inspection results Fiscal 2021

Number of people with various certifications

Affiliated academic society