Rinsho byori. The Japanese journal of clinical pathology
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Although both asthma and chronic obstructive pulmonary disease (COPD) are characterized as obstructive lung disease, their pathophysiologies are quite different. Characteristics of asthma include chronic airway inflammation, airway narrowing with reversibility, and responsiveness of airways. Cough, wheezing, and dyspnea and variability in these symptoms are also characteristic features of asthma. ⋯ Recently, overlap syndrome, with features of both asthma and COPD, is drawing attention. When treating elderly patients with asthma who have persistent airway limitation or patients with COPD who show variability in symptoms and reversibility of lung function, the possibility of overlap syndrome should be considered. The prevalence of overlap syndrome seems to be high in general practice, so the introduction of practical criteria for the diagnosis and a proper guide for therapies is expected.
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On July 1st, 2013, about two years after the FDA's drafting of the guidance for companion diagnostics (CoDx), the Ministry of Health, Labour, and Welfare in Japan issued an official notification regarding the co-development of CoDx with a drug which requires dedicated diagnostic tests or medical devices to predict the efficacy of or adverse reactions to the drug. Both recommend to co-develop CoDx and drugs as well as indicate the approved tests and devices on the package insert of the drug. ⋯ This strategically new regulatory framework may allow clinical laboratories certified under the CLIA Act to more easily perform LDT for genetic markers. Unfortunately, no act like the CLIA exits in Japan to promote LDT well validated for clinical practice, and it may be necessary to reform the regulatory classification and requirements and also quality management system for in-vitro diagnostics tests and devices for reimbursement in the future.
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Midgut volvulus accompanied by intestinal malrotation is classified as a surgical emergency disease of the newborn, which emerges with the bilious vomiting or melena. This report presents four patients of this disease in our hospital, evaluated by color Doppler ultrasonography before surgical operation. All four patients were presented by bilious vomiting at the onset. ⋯ The clinical courses of four cases were good, and all patients were discharged within 17 days. Early diagnosis and timely surgical operation are essential for decreasing the possibility of occurring intestinal ischemic changes and improving clinical outcome after surgical operation. We propose that color Doppler ultrasonography is the powerful tool for the diagnosis of this disease, especially for the newborn, for whom the available diagnostic tests are limited.
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Liver-type fatty acid binding protein (L-FABP) is expressed in the cytoplasm of human renal proximal tubules. Renal L-FABP expression is up-regulated and urinary excretion of renal L-FABP is increased by various stressors, such as urinary protein, hyperglycemia, tubular ischemia, toxins, and salt-sensitive hypertension, which lead to the progression of kidney disease. Urinary L-FABP levels accurately reflect the degree of tubulointerstitial damage and are strongly correlated with the prognosis of chronic kidney disease (CKD) patients in clinical studies. ⋯ Furthermore, in a longitudinal study, a higher level of urinary L-FABP was found to be a risk factor for the progression of diabetic nephropathy. With respect to acute kidney disease (AKI), urinary L-FABP facilitates the early detection of AKI before an increase in serum creatinine. Therefore, urinary L-FABP was approved as a new tubular biomarker by the Ministry of Health, Labour and Welfare of Japan.
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In case of a disaster, the clinical laboratory's departmental staff is not only responsible for recovery efforts of routine work and the continuation of emergency tests, but also for protecting patients against both dangers and possible risks in the blood collecting room and physiology laboratory. For this reason, we decided to participate in an emergency drill, which focuses on the initial response to a disaster, specifically evacuation procedures and the cessation of phlebotomy operations. Since there were no existing manuals regarding disasters in our blood collection room, we first made a draft disaster plan. ⋯ Although this was the first practice for the blood collection room, we were able to achieve our first goal by raising awareness of disaster prevention activities. The precautions against disaster that eliminate accidents require an immense amount of time and effort. Thus, it is necessary to continue training in order to increase the staffs awareness of disaster defense and to continue to improve our skills in the future.