Rinsho Byori. The Japanese Journal Of Clinical Pathology[JOURNAL]
Sun
200 papers
[Research Ethics on Handling of Clinical Samples].
Tohyama K
Rinsho Byori · 2016 Nov · PMID 30695311
Medical research that has utilized the residual parts of clinical samples after routine laboratory examination has yielded numerous findings and contributed to the progress in clinical medicine as well as the detailed el...
Medical research that has utilized the residual parts of clinical samples after routine laboratory examination has yielded numerous findings and contributed to the progress in clinical medicine as well as the detailed elucidation of pathological states of various diseases. However, ethics guidelines on human medical research have recently been established by the Japanese Government, and the Personal Information Protection Law has now imposed stricter rules. Therefore, the enactment of a new guideline became necessary for the secondary utilization of the residual parts of clinical samples. Basic concepts are proposed as follows: (1) research utilizing the residual parts of clinical samples can be performed using an opt-out form that guarantees the right to refuse'8eing enrolled in a study; and (2) the importance and significance of such studies using residual samples should be disseminated in society. To support the promotion of laboratory medical research and avoid the unnecessary or excessive suppres- sion of research, the Japanese Society of Laboratory Medicine is aiming to devise and disseminate appropriate ethics guidelines. [Review].
[Biorisk Management for Clinical Diagnostic Laboratories].
Shigematsu M
Rinsho Byori · 2016 Nov · PMID 30695310
The mission of the clinical diagnostic laboratory is to continuously provide high-quality diagnostic services. For this purpose, quality management, continuous technical improvement, work place safety assurance, and bios...
The mission of the clinical diagnostic laboratory is to continuously provide high-quality diagnostic services. For this purpose, quality management, continuous technical improvement, work place safety assurance, and biosecurity are their objectives. Biorisks arise from handling clinical samples categorized at the highest risk level due to their unknown nature. The "undetermined risk" was not able to risk assess by predetermined risk management approach explained in many existing biosafety references, such as the Biosafety in Microbi- ological and Biomedical Laboratories. By reviewing books, documents, article, and standard guidelines on biorisk management or biosafety, this report provides a comprehensive summary of how biorisk is defined, the existing approach to biorisk assessment, how human factors play roles in biorisk assessment, how vital communication and incident reporting are in biorisk management, and how the biorisk management system support the clinical diagnostic laboratories to fulfil their mission. Given that laboratories are already imple- menting the Quality Management System from the International Standard Organization and starting to report its positive impact on daily activity, it is logical to consider how to integrate the biorisk management system together. A biorisk management system will allow a laboratory to continue business at a high standard not just by preventing laboratory accidents, but proactively reducing near misses and incidents and improving diagnostic process efficiency through risk-assessment-based biosafety and biosecurity. [Review].
[Notes on the Features of an Outbreak Caused by MDRA in Our Hospital].
Kinoshita T, Ishikawa K
Rinsho Byori · 2016 Nov · PMID 30695309
In Japan, the criteria for multi-drug-resistant Acinetobacter baumannii (MDRA) have been developed in response to two large-scale MDRA outbreaks reported in 2010. A. baumannii can survive for a long period in a dry envir...
In Japan, the criteria for multi-drug-resistant Acinetobacter baumannii (MDRA) have been developed in response to two large-scale MDRA outbreaks reported in 2010. A. baumannii can survive for a long period in a dry environment, and it is also detected frequently from carriers over a long period. For mixed infection with some other bacteria, it cannot be accurately detected due to masking by other bacteria. For these reasons, the detection of MDRP infection is delayed. Furthermore, the infection control of MDRA must require the determination of the quarantine period, release criteria, and a clean environment, without sufficient levels of evidence. It is not rare for this to take more than a year to resolve an MDRA outbreak. Therefore, it is important to monitor daily occurrence in any hospital. [Review].
[Importance of Clinical Laboratory and Molecular Epidemiology for Investigation of MRSA Outbreak].
Kanemitsu K, Nakamura K
Rinsho Byori · 2016 Nov · PMID 30695308
MRSA has been a major pathogen associated with nosocomial outbreaks. Moreover, the isolation of community-acquired MRSA(CA-MRSA) is increasing even in Japanese hospitals. It is necessary to carry out outbreak investigati...
MRSA has been a major pathogen associated with nosocomial outbreaks. Moreover, the isolation of community-acquired MRSA(CA-MRSA) is increasing even in Japanese hospitals. It is necessary to carry out outbreak investigations in cooperation with the clinical laboratory as it is the site where MRSA is identi- fied. "Timing of information on MRSA from the clinical laboratory" is crucial for the ICT. To detect signs of an outbreak, information on the number of MRSA isolates is essential in every ward per week or month. It is desirable to perform active surveillance routinely. However, there are problems to be solved such as the cost of active surveillance, workload of laboratory technicians, and shortage of private rooms for isolation. It is necessary that the infection control department confirms clonal spread on analysis of the molecular epi- demiology, including the PCR-based open reading frame typing (POT) method. When the number of MRSA isolates increased and some strains had the same POT number on a ward, we suspected MRSA outbreak and strengthened infection control measures. We describe herein the importance of the relationship with the clinical laboratory for infection control and how to control an MRSA outbreak rapidly. [Review].
[Multidrug-Resistant Acinetobacter baumannii].
Asahara M, Matsunaga N, Furukawa T
Rinsho Byori · 2016 Nov · PMID 30695307
Teikyo University Hospital reported an outbreak of multidrug-resistant Acinetobacter baumannii (MDRAB) to the local public health department in 2010. The number of inpatients with MDRAB including asympto- matic carriers...
Teikyo University Hospital reported an outbreak of multidrug-resistant Acinetobacter baumannii (MDRAB) to the local public health department in 2010. The number of inpatients with MDRAB including asympto- matic carriers was 58 between August 2009 and September 2010. The way to tackle infection control issues has been comprehensively revised since this event in our hospital. The change could not have been achieved by a single department, such as the Department of Infection Control and Prevention or the Central Laboratory alone. Rather, collaboration among every department in the hospital was necessary. Although the impact of the outbreak on our hospital was enormous, it elucidated various clues to improve hospital man- agement regarding not only infection control but also safety management. [Review].
[Multi-Drug-Resistant Pseudomonas Aeruginosa].
Nagao M
Rinsho Byori · 2016 Nov · PMID 30695306
Infection control is one of the most important measures for the safety of medical treatment. The microbiology unit of the clinical laboratory is the first defense against nosocomial infection. Our infection control team...
Infection control is one of the most important measures for the safety of medical treatment. The microbiology unit of the clinical laboratory is the first defense against nosocomial infection. Our infection control team belongs to the clinical laboratory and our infection control practices are based on the accessibility of microbiology data. We have learned lessons from 2 outbreaks of multi-drug-resistant Pseudomonas aeru- ginosa in the past and have established the current surveillance system for multi-drug-resistant organisms in our hospital. In this article, I describe how we can utilize laboratory data for an effective infection control strategy and how the laboratory department can contribute to infection control practice. [Review].
[Vancomycin-Resistant Enterococci].
Takakura S
Rinsho Byori · 2016 Nov · PMID 30695305
Vancomycin-resistant enterococci (VRE) have been detected from all over Japan since 1996. However, the incidence has been relatively low. In 2006, we organized Kyoto VRE surveillance group, established a VRE control prog...
Vancomycin-resistant enterococci (VRE) have been detected from all over Japan since 1996. However, the incidence has been relatively low. In 2006, we organized Kyoto VRE surveillance group, established a VRE control program, and conducted an investigation which was to control the post-outbreak prevalence of VRE in the affected Kyoto region. The study period was from 2005 to 2010. Faecal samples were subjected to VRE screening, and vancomycin resistance genes were detected by polymerase chain reaction (PCR). A VRE control program consists of a laboratory-based faecal VRE screening system, annual surveillance of hospital inpatients and the promotion of adequate infection control measures. Number of VRE-detected patients was significantly smaller in hospitals with routine laboratory-based faecal VRE screening. From an- nual surveillance, the rate of faecal VRE carriage among the patients enrolled in the annual surveillance in- creased until 2007, when it reached 24(1.2%) of the 2,035 enrolled patients. The rate began to decrease in 2008 and, by 2010, reached a low of 4(0.17%) of the 2,408 enrolled patients. While VRE did spread within the Kyoto region, our program succeeded in controlling the overall VRE spread. [Review].
[IgM-Lambda Type Paraproteinemia Interferes with Haptoglobin Measurements].
Nojiri T, Masuda A, Ohkawa R … +4 more , Okubo S, Kurano M, Ikeda H, Yatomi Y
Rinsho Byori · 2016 Nov · PMID 30695304
Paraproteinemia is a condition induced by an increase in paraprotein. Paraprotein is a monoclonal immu- noglobulin produced by plasma cells as a result of aging or malignancy. Paraprotein often induces a variety of labor...
Paraproteinemia is a condition induced by an increase in paraprotein. Paraprotein is a monoclonal immu- noglobulin produced by plasma cells as a result of aging or malignancy. Paraprotein often induces a variety of laboratory test abnormalities by interfering with laboratory test reagents. The haptoglobin (Hp) measurement in a 55-year-old woman with IgM-lambda type paraproteinemia associated with lymphoplasmacytic lymphoma was found to be falsely low because of white-turbidity caused by an abnormal reaction. An in- creased absorbance was observed at 596 nm after the addition of the buffer reagent and was reduced by dilution with saline. This result indicates the existence of interfering substances in the patient's sample. To identify the inhibitors, we obtained the white-turbidity pellet by centrifugation of a mixture of the patient's serum and the Hp buffer reagent. A high IgM concentration was observed in the white-turbidity pellet. Moreover, a correlation was observed in a time series between the IgM concentration in sera and the extent of the turbidity during the Hp measurement. These results indicated that IgM was the main component of the white-turbidity. Next, we showed that the addition of the white-turbidity pellet to normal serum caused an increase in absorbance and a false low Hp value. A correlation was also observed in a time series be- tween the IgM concentration in sera and the rate of the Hp reduction. These results suggest that the false low Hp measurements were due to IgM present in the white-turbidity. In conclusion, false low values of Hp may occur in patients with IgM-lambda type paraproteinemia. Therefore, the presence or absence of an increase in absorbance after the addition of the buffer reagent in a time-course reaction may be required.
[Benign Subcutaneous Nodules for the Diagnosis of Which Ultrasonography Is Useful].
Yaaaoka M, Kuramochi A, Kutani K … +3 more , Katoh K, Saitoh T, Ikebuchi K
Rinsho Byori · 2016 Nov · PMID 30695303
OBJECTIVE: We analyzed sonographic appearance of dermatofibroma, schwannoma, small-sized venous mal- formation, glomus tumor, nodular fasciitis, and thrombus for effective use in the diagnosis. METHODS: We evaluated with...
OBJECTIVE: We analyzed sonographic appearance of dermatofibroma, schwannoma, small-sized venous mal- formation, glomus tumor, nodular fasciitis, and thrombus for effective use in the diagnosis. METHODS: We evaluated with sonography 44 subcutaneous nodules in histopathologically proven cases. RESULTS AND DISCUSSION: 1) Sonography was the most useful for diagnosing schwannoma. Six of 8 lesions were diagnosed correctly from sonographic appearance. They had increased posterior echo and Doppler flow signals. 2) Sonography was helpful in diagnosis of subungual glomus tumor, though malignant melano- ma should be excluded. One of 6 glomus tumors was not detected but all of the other had well-defined mar- gins and showed internal vascularity. Three subungual glomus tumors were diagnosed from sonographic appearance although 2 nonsubungual tumors were not. 3) It was difficult to diagnose nodular fasciitis with sonography. Two of 5 cases were not detected. The other 3 lesions were ill-defined, and 2 were hy- perechoic and 2 showed internal vascularity. Interval between emergence of the lesion and sonography ex- amination was important. This duration was more than 50 days in lesions not detected with sonography, about 20 days in 2 hyperechoic lesions, and 6 days in a hypoechoic lesion. 4) Dermatofibromas (n =14) were also difficult to be diagnosed. The region was very characteristic, that is, in the upper dermis. Other find- ings, such as hypoechoic appearance and well-defined margin, were nonspecific. CONCLUSION: Sonography was more useful for diagnosing schwannoma and glomus tumor. We have to know their characteristic appearance on sonography to use sonography effectively. [Original].
[Evaluation of Immature Platelet Fraction Measurements Using an Automated Hematology Analyzer, Sysmex XN].
Yoshikawa N, Masuda A, Jona M … +5 more , Okubo S, Nannya Y, Yokota H, Kurokawa M, Yatomi Y
Rinsho Byori · 2016 Nov · PMID 30695302
The immature platelet fraction (IPF%) is a parameter for the automatic quantification of reticulated plate- lets and is considered to reflect platelet production. We evaluated IPF% measurements using an automated analyze...
The immature platelet fraction (IPF%) is a parameter for the automatic quantification of reticulated plate- lets and is considered to reflect platelet production. We evaluated IPF% measurements using an automated analyzer, the Sysmex XN. We measured the platelet counts and the IPF% values in 35 healthy subjects and 275 patients with various diseases using both the XN analyzer and a conventional analyzer, the Sysmex XE. Significant correlations in the platelet count and the IPF% were observed between the XN results and the XE results. In the same samples, significant inverse correlations were observed between the platelet count and the IPF% in both the XN and XE results. The coefficient of variation values for the platelet count and the IPF% measurements obtained using the XN analyzer were lower than those obtained using the XE ana- lyzer. In patients who had undergone hematopoietic stem cell transplantation, the IPF% measurements obtained using the XN analyzer increased several days before platelet recovery. IPF% measurements performed using the XN analyzer are adequate for clinical use. This parameter may be a useful marker for the prediction of platelet recovery. [Original].
[How Long Are Unstained Sections Available for Immunostaining? -A Study of Antigenicity Preservation Time-].
Inoue S, Matsuki Y, Mori M
Rinsho Byori · 2016 Nov · PMID 30695301
It is well known that the antigenicity of unstained sections put on a slide glass decreases when the slides are stored at room temperature. Several methods have been reported to prevent reduced antigenicity, such as stor...
It is well known that the antigenicity of unstained sections put on a slide glass decreases when the slides are stored at room temperature. Several methods have been reported to prevent reduced antigenicity, such as storing in a dark place at 4°C, covering sections with paraffin or a sheet, and storing in a deep freezer at -80°C. The aim of the present study is to determine how long unstained sections can be stored in a refriger- ator (ie, 1 week, 2 weeks, 1 month and 2 months). Each section was well stained and equal to the day 0 section for CD3, CD20, bcl-2, bcl-6, ER, PgR, HER2, Ki-67, chromogranin-A, synaptophysin, CK5, CK7, CK20, and TTF-1. In conclusion, unstained sections can be used for immunostaining after at least 2 months of storage, and preparing several control sections and storing them in a refrigerator is useful for minimizing control block loss. [Original].
Reversed Clinicopathological Conference.
Sugano M, Honda T
Rinsho Byori · 2016 Oct · PMID 30609479
Routine laboratory tests are the most frequently performed among clinical laboratory tests, and they can provide important information for the diagnosis and treatment of patients. They are more useful when sev- eral data...
Routine laboratory tests are the most frequently performed among clinical laboratory tests, and they can provide important information for the diagnosis and treatment of patients. They are more useful when sev- eral data are combined to interpret the pathophysiological state of a patient. Changes of routine laboratory data are important even when they are within their reference ranges, and they sometimes show a more de- tailed condition of the patient. In this RCPC, we-focused on changes of albumin and electrolytes, bacterial infections, and anemia. [Review].
[Production of an Anti-PIVKA-II Recombinant Single-Chain-Antibody in Escherichia Coli].
Satoh H, Furukawa E
Rinsho Byori · 2016 Oct · PMID 30609478
Protein induced by vitamin K absence or antagonist-II (PIVKA-II) is an abnormal prothrombin lacking gamma-carboxylation of the 10 glutamic-acid residues in the N-terminal region. PIVKA-II has been used as an effective bi...
Protein induced by vitamin K absence or antagonist-II (PIVKA-II) is an abnormal prothrombin lacking gamma-carboxylation of the 10 glutamic-acid residues in the N-terminal region. PIVKA-II has been used as an effective biomarker of hepatocellular carcinoma (HCC) since the PIVKA-II level is not correlated with that of alpha-fetoprotein (AFP), which is another effective biomarker for HCC. Monoclonal antibodies for the clinical biomarker test are usually expensive because of their high production costs. Recently, many studies involving the expression of the recombinant globulin molecules in bacterial cells and plants have been con- ducted. These studies have enabled us to produce recombinant monoclonal antibodies at much lower costs. In this study, we first produced a hybridoma expressing a monoclonal antibody against PIVKA-II, and then we constructed and produced a single-chain fragment-variable antibody (scFv), created by the linking of variable regions of light- and heavy-chains of the PIVKA-II monoclonal antibody with a peptide linker of triplicated GGGGS. The scFv was expressed in E. coli and exhibited high specificity for PIVYKA-II binding, while its binding titer was low. [Review].
[Mitochondrial Dysfunction and Oligomer Formation in Neurodegenerative Diseases].
Okado-Matsumoto A
Rinsho Byori · 2016 Oct · PMID 30609477
Mitochondrial respiratory chain complexes are responsible for the oxidative phosphorylation system, and the association of these complexes is called a supercomplex. Since the formation of supercomplexes en- hances energy...
Mitochondrial respiratory chain complexes are responsible for the oxidative phosphorylation system, and the association of these complexes is called a supercomplex. Since the formation of supercomplexes en- hances energy production and reduces electron leakage, the destabilization of supercomplexes may increase oxidative stress and mitochondrial dysfunction in the presence of aging and neurodegenerative disease. Both blue native polyacrylamide gel electrophoresis (BN-PAGE) and high-resolution clear native (hrCN) - PAGE are effective to examine supercomplex formation. Since the sensitivity of the in-gel enzyme activity assay of hrCN-PAGE is higher than that of BN-PAGE, we used hrCN-PAGE and two-dimensional hrCN/ SDS-PAGE to examine supercomplex formation in human mononuclear leukocytes, and compared them in relation to the sex and age group. We also applied the results to the analysis of soluble oligomer formation in neurodegenerative disease. Herein, we introduce the possibility of applying a clinical laboratory test for neurodegenerative diseases. [Review].
[Usefulness of Glycemic Control Utilizing CGM and Future Prospects].
Tsuriya D, Maekawa M
Rinsho Byori · 2016 Oct · PMID 30609476
The maintenance of the QOL by preventing the onset and progression of arteriosclerosis-related complica- tions such as a stroke and myocardial infarction is very important in the treatment of diabetes. However, recent la...
The maintenance of the QOL by preventing the onset and progression of arteriosclerosis-related complica- tions such as a stroke and myocardial infarction is very important in the treatment of diabetes. However, recent large clinical trials reported that aggressively reducing the HbAlc level by the use of insulin or oral antidiabetic agents increased severe hypoglycemia, resulting in cardiovascular events and deaths. A "good quality of glycemic control" that improves postprandial hyperglycemia without hypoglycemia is required for the treatment of diabetes, and confirmation of the fluctuations in blood glucose for 24 hours using CGM (continuous glucose-monitoring) is now attracting marked attention. The introduction of CGM is use- ful for the patient to understand the effect of drugs and get more motivated for the treatment. Furthermore, real-time CGM provides a value of blood glucose on the spot, resulting in strict glycemic control. A sensor- augmented pump (SAP) was released last year in Japan, and patients have been able to confirm their blood glucose level in real time and adjust the amount of insulin timely. Such a new glucose-monitoring system is emerging. It does not need the drawing of blood from the finger- tip by a puncture needle, requiring only the attachment of a sensor to the outside of the upper arm, and linking a hand-held reader to the sensor could provide cumulative data with a frequency of every 15 min for up to 8 h. We expect such new devices to provide the level of blood glucose in real time to improve therapy. [Review].
[Can Plasma Free Amino Acid Profiling Be Used to Assess Cancer Risk?].
Ando T
Rinsho Byori · 2016 Oct · PMID 30609475
Amino acids are present in the blood. In healthy people, the concentrations of these amino acids in the blood are maintained at stable levels. However, different diseases disturb the balance of amino acids in the blood i...
Amino acids are present in the blood. In healthy people, the concentrations of these amino acids in the blood are maintained at stable levels. However, different diseases disturb the balance of amino acids in the blood in different ways. AminoIndex® is a service that uses the latest medical technology to measure the concentration of amino acids in the blood to check a person's health and detect various diseases. It is now possible to conduct an AminoIndex® Cancer Screening (AICS®) test that can detect cancer from early stages. The AICS® measures the concentrations of amino acids in the blood and statistically analyzes the differ- ences in the balance of amino acid concentrations between healthy people and those with cancer. As a result, we can simultaneously screen for certain types of cancer. Currently, the test can screen for gastric cancer, lung cancer, colorectal cancer, prostate cancer (in males), breast cancer (in females), and uterine/ovarian cancer* (in females). The application of AminoIndex® technology will spread through the fields of medicine, such as in the treat- ment of metabolic syndrome. (*The uterine/ovarian cancer test determines the overall risk of having any of the three cancers: cervical cancer, endometrial cancer, and ovarian cancer, and can not determine the individual risk of having each cancer.) [Review].
[Clinical Application of Cancer Molecular Diagnostics with Liquid Biopsy].
Kubota M
Rinsho Byori · 2016 Oct · PMID 30609474
"Liquid biopsy" is one of the hottest topics in the cancer molecular diagnostics field because of its potential to replace conventional tissue biopsy. "BEAMing" is one of the digital PCR platform technologies for liquid...
"Liquid biopsy" is one of the hottest topics in the cancer molecular diagnostics field because of its potential to replace conventional tissue biopsy. "BEAMing" is one of the digital PCR platform technologies for liquid biopsy samples, and it features a high enough sensitivity to detect a very low concentration of mutation frag- ments in circulating tumor DNA from the plasma of cancer patients. In this article, some of the promising clinical applications of BEAMing technology and its future possibilities as an advanced cancer diagnostic will be briefly summarized. [Review].
[New Horizon in Clinical Examination -Chairmen's Introductory Remarks -].
Nakatani K, Ishikawa T
Rinsho Byori · 2016 Oct · PMID 30609473
Translational research is leading to new technology and generating in practical diagnostic tests with clinical utility. This paper introduces three cutting-edge technologies: liquid biopsy, amino acid profiling, and con-...
Translational research is leading to new technology and generating in practical diagnostic tests with clinical utility. This paper introduces three cutting-edge technologies: liquid biopsy, amino acid profiling, and con- tinuous glucose monitoring (CGM). Liquid biopsy was reviewed as one of the "10 Breakthrough Technologies in 2015" by MIT. This technol- ogy is based on fast DNA-sequencing machines or high-sensitivity PCR and non-invasive tests that detect fragments of DNA or cells in blood or other bodily fluids. Cell-free DNA refers to segments of DNA that are mainly derived from apoptotic and necrotic cells, and it is used for the detection and monitoring of cancer. Profiling of plasma-free amino acid is a promising approach because amino acid profiling links all organ sys- tems and amino acids have important roles in metabolism. Furthermore, amino acid profiles are known to be influenced by specific diseases, including cancers. CGM systems use a tiny sensor inserted under the skin to continuously check glucose levels in tissue fluid and convert blood glucose levels. CGM can provide valuable information at any points during the day and facilitate better treatment decisions and glucose control. [Review].
[How to Interpret Data from Routine Laboratory Tests].
Matsumoto G, Honda T
Rinsho Byori · 2016 Oct · PMID 30609472
Routine laboratory tests are performed in almost all hospitals in the world. If you can fully interpret such routine laboratory tests, you can evaluate the general condition of patients in detail. In the reversed clinico...
Routine laboratory tests are performed in almost all hospitals in the world. If you can fully interpret such routine laboratory tests, you can evaluate the general condition of patients in detail. In the reversed clinico- pathological conference (RCPC), we analyzed a patient's condition using only data from routine laboratory tests, as one of the most effective training methods to acquire the ability to interpret routine laboratory tests. In this RCPC, we discussed routine laboratory data from a patient who was transported by ambulance due to systemic weakness, and conducted interpretation of the data using the method of Shinshu University Hospital. At Shinshu University Hospital, we consider the time series results of the routine laboratory tests according to 13 steps, because our aim is to understand the patient's condition without oversight rather than to make a diagnosis. [Review].
[Discussion of Routine Laboratory Data of a Patient Complaining of Back Pain and General Fatigue].
Satoh N, Yanai M, Ebashi M … +4 more , Hayashi Y, Masuda A, Murakami J, Hosokawa N
Rinsho Byori · 2016 Oct · PMID 30609471
Conventional reversed clinicopathological conference (RCPC) is an educational method to interpret labora- tory data. In this RCPC, physicians and several specialists in laboratory medicine discussed laboratory data of a...
Conventional reversed clinicopathological conference (RCPC) is an educational method to interpret labora- tory data. In this RCPC, physicians and several specialists in laboratory medicine discussed laboratory data of a patient with tuberculous spondylitis who complained of back pain and general fatigue. Then, they and the moderators held a question-and-answer session with an audience in a hall, and they tried to understand the detailed state of the patient. This discussion revealed the usefulness of RCPC to elucidate the clinical state of patient. At the same time, we can understand the limits of laboratory data analysis. [Review].
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