Rinsho byori. The Japanese journal of clinical pathology
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Tumor necrosis factor (TNF) is critically involved in biological responses against various insults. TNF excessively produced by monocytes or macrophages activates endothelial cells and neutrophils, thereby inducing endothelial cell injury. Endothelial cells are capable of inhibiting TNF production by producing prostaglandins that inhibit TNF production. ⋯ E-selectin, an endothelial leukocyte adhesion molecule, is released from the endothelial cell membrane by the action of TNF and exists as soluble E-selectin in plasma. The detection of increases in plasma levels of soluble E-selectin in patients with systemic inflammatory response syndrome predicts the imminent onset of acute respiratory syndrome. Early detection of increases in plasma levels of soluble E selectin by a rapid assay system, developed by the authors, enables early effective treatment of patients with sepsis.
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The pain remaining after a needle stick is categorized as neuropathic pain. CRPS (Complex Regional Pain Syndrome) is a typical disease in this category. Neuropathic pain is extremely intractable when it becomes chronic pain, inducing psychological and physical pain in patients over a long period of time. ⋯ In the stage of chronic pain, it is very important to improve patients' ADL (activity of daily living) and QOL (quality of life). If neuropathic pain is suspected, it is crucial to treat at an early stage. Therefore, it should be emphasized that when pain persists after a needle stick, the patient should immediately consult a pain clinician or an orthopedist.
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The diagnosis of disseminate intravascular coagulation (DIC) was first based on the detection of microthrombi, but it currently involves analysis of hemostatic abnormalities by various laboratory tests and further studies are needed to simplify diagnosis of DIC. There are three diagnostic criteria for DIC developed by the International Society of Thrombosis Haemostasis (ISTH), the Japanese Association for Acute Medicine (JAAM) and the Japanese Ministry Health and Welfare. These diagnostic criteria consist of the scoring system by the same global coagulation tests. ⋯ ISTH diagnostic criteria has high specificity and low sensitivity, but JAAM criteria has low specificity and high sensitivity. Several molecular hemostatic markers such as thrombin antithrombin complex, D-dimer, soluble fibrine (SF) and plasmin-plasmin inhibitor complex have to be adopted for further improvement of diagnostic criteria for DIC. Finally, prospective study for new diagnostic criteria for DIC should be carried out in infectious diseases by molecular hemostatic markers.
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A non-invasive hemoglobin measurement instrument (Sysmex Co. Ltd., Kobe, Japan) was used for the evaluation of hemoglobin levels just before blood drawing for repeat autologous blood donation. There was a statistically significant correlation (r = 0.598) between the hemoglobin levels determined with the non-invasive instrument (NINV-Hb) and true Hb levels (T-Hb) evaluated by direct analysis with automatic hematology analyzer, KX-21 (Sysmex). ⋯ There was a closer relationship between NINV-Hb and T-Hb for the 76 measurements for the second or third blood donation obtained from 56 patients (r = 0.704) than for the entire data (r = 0.598). When 12 g/dl was used as the cut off value for NINV-Hb, sensitivity and specificity for the detection of 1l g/dl of T-Hb, which is considered the critical level for drawing autologous blood for donation, were 83.6% and 77.8%, respectively. We conclude, therefore, that NINV-Hb evaluation can be expected to be useful for repeated autologous blood donation of limited patients, however, it is strongly expected to develop a new system having more sensitive and accurately detectable ability.