Heavy Element Effects in the Diagonal Born-Oppenheimer Correction within a Relativistic Spin-Free Hamiltonian.

Methodologies beyond the Born-Oppenheimer (BO) approximation are nowadays important to explain high precision spectroscopic measurements. Most previous evaluations of the BO correction are, however, focused on light-element molecules and based on a nonrelativistic Hamiltonian, so no information about the BO approximation (BOA) breakdown in heavy-element molecules is available. The present work is the first to investigate the BOA breakdown for the entire periodic table, by considering scalar relativistic effects in the Diagonal BO correction (DBOC). In closed shell atoms, the relativistic EDBOC scales as Z(1.25) and the nonrelativistic EDBOC scales as Z(1.17), where Z is the atomic number. Hence, we found that EDBOC becomes larger in heavy element atoms and molecules, and the relativistic EDBOC increases faster than nonrelativistic EDBOC. We have further investigated the DBOC effects on properties such as potential energy curves, spectroscopic parameters, and various energetic properties. The DBOC effects for these properties are mostly affected by the lightest atom in the molecule. Hence, in X2 or XAt molecule (X = H, Li, Na, K, Rb, and Cs) the effect of DBOC systematically decreases when X becomes heavier but in HX molecules, the effect of DBOC seems relatively similar among all the molecules.

Efficacy of 1.0% chlorhexidine-gluconate ethanol compared with 10% povidone-iodine for long-term central venous catheter care in hematology departments: a prospective study.

The efficacy of 1% chlorhexidine-gluconate ethanol and 10% povidone-iodine for skin antisepsis of central venous catheter (CVC) sites were compared among hematology patients. The CVC site colonization rates of those groups were 11.9% and 29.2%, respectively, and the catheter-associated blood stream infections were 0.75 and 3.62 per 1,000 catheter-days, respectively. One percent chlorhexidine-gluconate ethanol was superior to povidone-iodine to reduce skin colonizers at CVC sites even when catheters were used for long duration.

[Nationwide surveillance of parenteral antibiotics containing meropenem activities against clinically isolated strains in 2009].

The antibacterial activity of meropenem (MEPM) and other parenteral antibiotics against clinical isolates of 2655 strains including 810 strains of Gram-positive bacteria, 1635 strains of Gram-negative bacteria, and 210 strains of anaerobic bacteria obtained from 30 medical institutions during 2009 was examined. The results were as follows; (1) MEPM was more active than the other carbapenem antibiotics tested against Gram-negative bacteria, especially against enterobacteriaceae and Haemophilus influenzae. MEPM was also active against most of the species tested in Gram-positive and anaerobic bacteria, except for multidrug resistant strains including methicillin-resistant Staphylococcus aureus (MRSA). (2) MEPM maintained potent and stable antibacterial activity against Pseudomonas aeruginosa. The proportion of MEPM-resistant strains to ciprofloxacin-resistant strains or imipenem-resistant strains were 53.1% and 58.0% respectively. (3) The proportion of extended-spectrum beta-lactamase (ESBL) strains was 3.1% (26 strains) in enterobacteriaceae. And the proportion of metallo-beta-lactamase strains was 2.0% (6 strains) in P. aeruginosa. (4) Of all species tested, there were no species except for Bacteroides fragilis group, which MIC90 of MEPM was more than 4-fold higher than those in our previous study. Therefore, there is almost no significant decrease in susceptibility of clinical isolates to meropenem. In conclusion, the results from this surveillance study suggest that MEPM retains its potent and broad antibacterial activity and therefore is a clinically useful carbapenem for serious infections treatment at present, 14 years passed after available for commercial use in Japan.

[Evaluation of serum iron in hemodialysis patients and its variation due to the difference of blood sampling time].

Diurnal variations in serum iron concentration were examined to investigate the influence of sampling time in hemodialysis (HD) patients and healthy subjects. The serum iron concentration and TIBC of HD patients decreased significantly (p<0.01, p<0.01 respectively) compared to those of healthy subjects. Inversely, the serum ferritin concentration of HD patients increased significantly (p<0.01) compared to that of healthy subjects. These findings show the disturbance of iron transport system: under such condition intracellural iron transition out into peripheral blood stream is low in HD patients. Serum iron concentration in samples collected in the evening decreased significantly both in HD patients (p<0.05) and in healthy subjects (p<0.01). Diurnal variations in serum iron concentration reveal almost similar decrement in both groups. In HD patients, serum iron concentration of the blood samples collected on the third day morning after HD and second day morning after HD was examined to see the influence from changes of circulating plasma volume. The serum iron concentration and Hct value in the second day sampling increased significantly compared to the third day sampling (p<0.01, p<0.01 respectively). In addition, the serum iron concentration corrected by Hct in the second day sampling increased significantly (p<0.01) compared to the third day sampling. We conclude from our results that diurnal variations of serum iron concentration vary in sampling time in HD patients as well as in healthy subjects. We also deduct that there may be other factors concerning changes in circulating plasma volume.

[Various troubles in the Central Clinical Laboratory (violence, others) and actions to be taken].

We need to attend to a patient face to face in the physiological function testing room and the central blood-drawing room of the central clinical laboratory in a hospital. Recently, there have been some problems and troubles experienced by medical staff because patients may have had some over-expectations regarding our medical service and their sense of entitlement may have been unrealistic. We report some problems experienced in our Central Clinical Laboratory and hospital, and describe some solutions. If a medical staff member gets into trouble with a patient because of some difference in awareness between him/her and the patient, we should take prompt action regarding these claims and be considerate to the patient. However, we have to take a tough stance against some severe cases, for example violence and intemperate language directed toward medical staff. One of the most important things is to investigate complaints against us, and, through this, keep on improving. Another important thing is to disseminate information among central clinical laboratory teams liaising with nursing and other departments. Therefore, we can establish a good trusting relationship between patients and staff, and consequently our patient service will improve.

[Utility of Hybrisep in the diagnosis of blood stream infection].

Hybrisep is an in situ hybridization (ISH) method to detect phagocytosed bacteria in peripheral blood neutrophils and macrophages. We report 10 actual clinical cases tested using Hybrisep with new DNA probes, and the data were compared to the actual blood culture results. A normal Hybrisep strategy employs 5 DNA probes to detect the following bacterial DNA: "SA" probe for S. aureus, "SE" for S. epidermidis, "PA" for P. aeruginosa, "EF" for E. faecalis, and "EK" for E. coli, E. cloacae, and K. pneumoniae. Six newly designed DNA probes were used in this study: "GB" probe for 49 common bacteria, "SP" for S. pneumoniae, "BF" for B. fragilis, "HI" for H. influenzae, "GC" for Candida species, and "CA" for C. albicans. Three cases were positive on ISH, but all their blood cultures were negative. One case showed a positive blood culture, but was negative on ISH. In another 6 cases, both were negative. We postulated that empirical therapy of antibiotics resulted in only positive ISH. Cases only showing a positive outcome on blood culture might be due to a diminished phagocytic function during patients' severe disease conditions. In conclusion, ISH with Hybrisep has clinical advantages such as being able to defect causative pathogens even after the use of antibiotics, and facilitates more rapid identification than routinely performed bacterial cultures only.

[Adaptations to the incidental cases encountered at the division of clinical laboratory].

We analyzed 4 cases that were not determined as incidents and another 7 cases determined as incidents, found at the department of clinical laboratory of us from April 2009 to March 2010. The former cases were, excess values of LD, and Cl, and glucose leveled as 0 mg/dl incorrectly, and misdirected blood samples at the ER. Our routine equipment and sample flow did not detect these false values. Resetting for auto dilution system and secondary check by every worker were reconsidered for these measurements. Antiseptic drug usage was notified by clinicians, and actually affected to the excessive Cl value. Real incidents were, two unprocessed samples, leakage of a sample, missing processes that caused delay of clinical practice, mixed up sample labels, a lost narcotic patch during cardiac ultrasonography. A lack of checking, carelessness, and accidental mistakes were reevaluated and reminded for workers on the duties. Also inadequate pharmaceutical knowledge and responsibilities of this section might severely affect on these lessons. Efforts were taken so that all workers shared the accurate information. Code blue cases are defined here as those of life-threatening events and sudden vital changes occurred in highest emergency, involve all health care workers, patients, and families. It is very important here to keep regular trainings for workers to cope with such events as well as preemptive assessments on environment and underlying risks in our laboratory. In line with the continuous advances in clinical medicine, medical safety managements are growing issues. To achieve safer environment and minimize various type of risks in the hospital, these incidents are to be assessed and reported regularly.

[Nationwide survey for autoantibodies and proposal of a new method for standardization of rheumatoid factors].

There exist inter-laboratory differences in measurements of rheumatoid factor (RF) and antinuclear antibodies (ANA), leading to a misdiagnosis of rheumatoid arthritis (RA) and other collagen diseases. This study was carried out to bring the positivity of RF and ANA of different reagents into accord by standardizing their data. The titer and cutoff value was inconsistent among the 17 different kits. We found a possibility in standardization of RF by a new concept in cooperation with Japanese Committee for Clinical Laboratory Standards (JCCLS). Sera from 1300 healthy subjects and 79 RA patients were measured for RF by 17 different RF kits, and sera with a little deviation among the kits were selected. Panels for detection of RF positive rate in healthy subjects were made from the pooled sera. The cutoff value in 5% positive in the panel was defined tentatively as 15 IU/ml. The 100 IU/ml was also able to become in general accord by adjusting the individual data using pooled RF-positive reference sera. The nationwide survey of immunofluorescence ANA (IF-ANA) was performed in 41 laboratories using 6 pooled sera. The reported titer was fairly different among laboratories, and a striking discrepancy was found for low-titer samples. When the titer was corrected by simultaneously measured reference serum, inconsistency of ANA titer among different laboratories was mostly compensated. Here, we propose a new method for standardization of RF and also try to standardize the positivity of RF and IF-ANA by providing pooled reference sera.

[Induction of PBP2' by antibiotics and disinfectants in MRSE].

OBJECTIVE: Methicilllin-resitant Staphylococcus aureus (MRSA) is still the most important bacterium for hospital infection control, and is known to exhibit beta-lactam resistance. Moreover, the increase in PBP2'-producing methicillin-resistant coagulase-negaive Staphylococcus (MR-CNS), especially methicillin-resistant S. epidermidis (MRSE) has been problematic. In this study, we investigated the induction of PBP2' by MPIPC, other antibiotics and disinfectants in MRSE. MATERIALS AND METHODS: The bacterial strains used were MRSE isolated in our clinical laboratory. MRSA-LA 'Seiken' was used for the detection of PBP2'. To investigate induction of PBP2' by MPIPC in MRSE, MRSE was cultured on the medium containing MPIPC at 11 different concentrations from 0.0001 to 6 microg/ml, and PBP2' induction was investigated. Strains in which no induction was noted at a low MPIPC concentration were cultured with other antibiotic discs and discs impregnated with various disinfectants, and PBP2' was detected in colonies that grew around the disc and PBP2' induction was investigated. RESULTS: In the culture on MPIPC-supplemented medium, PBP2' was detected in all strains at 0.01-6 microg/ml. At 0.001 and 0.0001 microg/ml, 8/10 and 4/10 were positive, respectively. Addition of another beta-lactam, particularly cephem antibiotics, induced PBP2' in some strains that were negative at 0.0001 microg/ml. In cultures with disinfectants, inhibition zones were noted, but no PBP2' was induced. CONCLUSION: PBP2' was induced by a low beta-lactam and was not by disinfectants in MRSE.

[Preanalytical issues].

Preanalytical issues in laboratory medicine have been recognized to be important but not so much effort have been focused to them. Urinalysis is one of the most susceptible examinations to preanalytical issues because urine samples are collected by patients themselves and so is stool examination too. Midstream urine catch is well-known appropriate procedure for many urinalysis. Surface scratching is an appropriate method of stool occult blood testing for colorectal cancer and also strategies to avoid the contact of stool with toilet water is another important technique. We also report a case of abnormal results of creatinine clearance (Ccr) caused by the urine collection apparatus as an example of preanalytical issue.

[Sampling variables in examinees--skin site differences in the measurements of bleeding time and self-monitoring of blood glucose].

Differences in bleeding time and self-monitoring blood glucose (SMBG) level at various skin sites have been scarcely examined in humans. The within-run variation (n=6) of bleeding time in earlobes (Duke's method) ranged from 1 min to 3 min and 30 sec (mean = 1 min and 40 sec), and in day-to-day variation (n= 8), it ranged from 1 min to 3 min (mean = 1 min and 36 sec). Site difference in bleeding time was speculated. In SMBG, firstly, sequential measurement of blood collected from 10 sites in the left forearm was performed, and secondly, comparative measurements of venous blood and blood from finger tips (1-5th), palm (3 sites), forearm (4 sites) and earlobe (1 site) were sequentially performed within 30 min before and after glucose (Trelan-G, 75g) intake. Glucose levels in blood from the fingertips, palm and forearm were generally higher than that of venous blood, and site differences were observed among fingertips, palm and forearm. It was speculated that bleeding time and capillary blood glucose or SMBG level differ among skin sites.

[Nationwide surveillance of parenteral antibiotics containing meropenem activities against clinically isolated strains in 2006].

The antibacterial activity of meropenem (MEPM) and other parenteral antibiotics against clinical isolates of 876 strains of Gram-positive bacteria, 1764 strains of Gram-negative bacteria, and 198 strains of anaerobic bacteria obtained from 30 medical institutions during 2006 was measured. The results were as follows; 1. MEPM was more active than the other carbapenem antibiotics tested against Gram-negative bacteria, especially against enterobacteriaceae and Haemophilus influenzae. MEPM was also active against most of the species tested in Gram-positive and anaerobic bacteria, except for multi-drug resistant strains including methicillin-resistant Staphylococcus aureus. 2. As for Pseudomonas aeruginosa, all of the MEPM-resistant strains were resistant to imipenem (IPM). MEPM showed low cross-resistant rate both againt IPM-resistant P. aeruginosa (41.8%) and ciprofloxacin-resistant P. aeruginosa (33.3%). 3. The proportion of extended-spectrum beta-lactamase (ESBL) strains was 4.3% (6 strains) in Escherichia coli, 1.1% (1 strain) in Citrobacter freundii, 21.7% (5 strains) in Citrobacter koseri, 3.1% (4 strains) in Klebsiella pneumoniae, 3.3% (3 strains) in Enterobacter cloacae, 0.8% (1 strain) in Serratia marcescens, and 4.9% (2 strains) in Providencia spp. The proportion of metallo-beta-lactamase strains was 3.1% (10 strains) in P. aeruginosa. 4. Of all species tested, there were no species, which MIC90 of MEPM was more than 4-fold higher than those in our previous study. Therefore, there is almost no significant decrease in susceptibility of clinical isolates to meropenem. In conclusion, the results from this surveillance study suggest that MEPM retains its potent and broad antibacterial activity and therefore is a clinically useful carbapenem at present, 11 years after available for commercial use.

[Evaluation of the measurement of waist circumference].

OBJECTIVES: A series of basic analyses was performed to disclose the problems in the measurement of waist circumference (WC) at umbilical level, which will provide quite important parameters in the national annual health check for metabolic syndrome coming in April, 2008 in Japan. MATERIALS AND METHODS: WC and body fat ratio was measured in 53 healthy volunteer, especially in 10 subjects (male 10, female 10), measurements were done by 5 examiners identically to disclose inter-examiner variances, changes due to respiration maximal depression of abdomen (or maximal intentional depression of WC), and eating and after lunch. RESULTS AND DISCUSSION: WC tended to be higher in aged male, than aged and young female, and was positively correlated with body fat ratio. Minimal and maximal inter examiner variances of WC were 0.3 and 4.7cm, respectively. We need to pay attention to it. The effect of respiration and eating lunch were relatively low and may not cause serious problems. Intentional depression of abdomen caused from 2 to 8.1cm decrease of WC, which could provide false negative results. CONCLUSION: WC measurement seems to be easy but actually it is difficult. We need to remind some difficulties or preanalytical or analytical problems in this easy looking examination, especially used in large scale screening test.

[Standardization and issues of rheumatoid factor measurement].

OBJECTIVES: To disclose the current situation of rheumatoid factor (RF) measurement in Japan. METHOD: A small-scale survey was performed among members of the committee for the improvement of RF measurement in 2003 using manufacturers' RF reference materials valued based on WHO RF reference and pooled sera. A nationwide questionnaire survey was also performed. Questionnaires were sent to 356 educational institutes certified by the Japan College of Rheumatology in December 2004. RESULTS: The small-scale survey showed inter-laboratory differences of measured RF values, especially using RF references, and less in pooled sera. In the questionnaire survey (187 responses, recovery, 53%), qualitative or semi-quantitative RF measurement methods were used in a small number of institutes and quantitative methods were used in large numbers of institutes, the latex immunoassay (turbidimetric or nepherometric) was predominantly employed. The measuring instruments were various. The upper limit of the reference interval was distributed widely from 5 IU/ml to 40 IU/ml, indicating obvious inter-laboratory differences in RF measurement. Many institutes used the reference intervals recommended by the manufacturers. CONCLUSION: There are remarkable inter-laboratory differences in RF measurement. Clearly, one of the major issues is the lack of reference materials. We therefore need to establish a reference material of RF, even if it is a temporary one. Scientific societies (Japan College of Rheumatology and Japanese Society of Laboratory Medicine) and manufacturers providing RF measurement reagents should work together for the improvement of RF measurement.

Serum amyloid A (SAA) concentration varies among rheumatoid arthritis patients estimated by SAA/CRP ratio.

BACKGROUND: C reactive protein (CRP) and serum amyloid A (SAA) are similarly sensitive indicators of inflammation, but discrepancies are recognized in several disease conditions. SAA levels are generally higher and vary more among individuals. The significance of the SAA/CRP ratio was evaluated in the estimation of SAA. METHODS: Sera of out-patients with rheumatoid arthritis (RA) and healthy subjects were measured for CRP and SAA cross-sectionally and longitudinally by a highly sensitive latex agglutination turbidimetric immunoassay. The results were classified into four groups according to the CRP concentration, and the SAA/CRP ratios were calculated and evaluated. RESULTS: In the cross-sectional study, CRP and SAA were shown to correlate significantly in sera of patients with RA, but not in healthy subjects. The SAA/CRP ratios were wide RA patients and tended to decrease in the range and mean values were observed depending on the concentration of CRP. In the longitudinal study, variations of the ratio among individuals were wide, but smaller and similar within individuals. The difference in magnitude of the ratios is due to the difference in SAA concentration. CONCLUSION: Variations of SAA/CRP ratios were affected by SAA concentrations. The ratio should be checked in the evaluation of SAA.