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Introduction: Numerous AI‐based systems are being developed to evaluate peripheral blood (PB) smears, but the feasibility of these systems on different smear preparation methods has not been fully understood. In this study, we assessed the impact of different smear preparation methods on the robustness of the deep learning system (DLS). Methods: We collected 193 PB samples from patients, preparing a pair of smears for each sample using two systems: (1) SP50 smears, prepared by the DLS recommended fully automated slide preparation with double fan drying and staining (May–Grunwald Giemsa, M–G) system using SP50 (Sysmex) and (2) SP1000i smears, prepared by automated smear preparation with single fan drying by SP1000i (Sysmex) and manually stained with M–G. Digital images of PB cells were captured using DI‐60 (Sysmex), and the DLS performed cell classification. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were used to evaluate the performance of the DLS. Results: The specificity and NPV for all cell types were 97.4%–100% in both smear sets. The average sensitivity and PPV were 88.9% and 90.1% on SP50 smears, and 87.0% and 83.2% on SP1000i smears, respectively. The lower performance on SP1000i smears was attributed to the intra‐lineage misclassification of neutrophil precursors and inter‐lineage misclassification of lymphocytes. Conclusion: The DLS demonstrated consistent performance in specificity and NPV for smears prepared by a system different from the recommended method. Our results suggest that applying an automated smear preparation system optimized for the DLS system may be important. [ABSTRACT FROM AUTHOR]

Introduction: This study evaluated the feasibility of the Sysmex XN‐3000 automated hematology analyzer for the assessment of total nucleated cells (TNC) and bone marrow (BM) cell density in routine bone marrow aspiration (BMA) samples. Methods: A total of 54 BMA samples from 39 hematological patients were evaluated. The number of megakaryocytes was calculated by a specific gating algorithm using the body fluid mode of the WBC differential (WDF) channel. Lipid contents were calculated through a newly developed algorithm utilizing the WDF channel. The ratio of lipid particles over TNCs by the WNR channel was compared with the BM cellularity assessed by the BM biopsy. The myeloid/erythroid (M/E) ratio was calculated by measuring the number of myeloid cells in the WDF channel and the number of nucleated red blood cells (NRBCs) in the WNR channel. Results: XN‐3000 counts and microscopic results showed a linear correlation in TNC (R2 =.98, p <.001), megakaryocytes (R2 =.59, p =.002), NRBC (R2 =.84, p <.001), and M/E ratio (R2 =.59, p <.001). There were significant differences in the lipid/TNC ratios of hypercellular, normocellular, and hypocellular BMs measured by XN‐3000 (p <.001). Receiver‐operating characteristic analysis detected cut‐off values of the lipid/TNC ratio of >0.4054 for hypoplasia and <0.157 for hyperplasia. The sensitivity and specificity for hypoplasia were 100% and 88%, and for hyperplasia were 89% and 86%, respectively. Conclusion: XN‐3000 provides a quantitative assessment of BM cellularity, supporting the qualitative assessment by myelogram and BM biopsy. [ABSTRACT FROM AUTHOR]

Cutibacterium acnes, a resident bacterium of the skin, is a target for antimicrobial treatment of acne vulgaris, because it exacerbates inflammation. Recently, antimicrobial‐resistant C. acnes strains have been isolated worldwide, and their prevalence has led to failure of antimicrobial treatment. This study aimed to analyze the antimicrobial resistance of C. acnes strains isolated from Japanese patients with acne vulgaris who visited the hospital and dermatological clinics between 2019 and 2020. Resistance rates to roxithromycin and clindamycin increased during 2019 to 2020 compared with those during 2013 to 2018. Additionally, the proportion of doxycycline‐resistant and low‐susceptibility strains (minimum inhibitory concentration [MIC] ≥8 μg/mL) increased. No difference in clindamycin resistance rates between patients with and without a history of antimicrobial use was observed during 2019 to 2020, which were significantly higher for patients with a history than for patients without a history during 2016 to 2018. The proportion of high‐level clindamycin‐resistant strains (MIC ≥256 μg/mL) gradually increased; particularly, the resistance rate was 2.5 times higher in 2020 than that in 2013. The proportion of strains showing high‐level clindamycin resistance that also have the exogenous resistance genes erm(X) or erm(50), which confer high resistance, showed a strong positive correlation (r = 0.82). Strains with the multidrug resistance plasmid pTZC1 encoding erm(50) and tet(W) genes were frequent in clinic patients. Notably, most strains with erm(X) or erm(50) were classified as single‐locus sequence types A and F (traditional types IA1 and IA2). Our data show that the prevalence of antimicrobial‐resistant C. acnes is increasing in patients with acne vulgaris attributable to acquisition of exogenous genes in specific strains. To control the increasing prevalence of antimicrobial‐resistant strains, it is important to select the appropriate antimicrobials while taking into consideration the latest information on resistant strains. [ABSTRACT FROM AUTHOR]

This study describes an autopsy case of pancreatic/peripancreatic myeloid sarcoma in a 70-year-old man, initially presenting with obstructive jaundice. Pathologically, diffuse infiltration of round cells containing atypical nuclei with marked cleavage was observed mainly in the pancreas head, peripancreatic lymph nodes, spleen, bilateral lung, and bone marrow. Immunohistochemically, the tumor cells were negative for CD20, CD79a, CD3, CD5, c-kit, CD34, and TdT and positive for myeloperoxidase, CD33, CD68, and CD163. Flow cytometry of the peripheral blood showed underexpression of CD11c and aberrant expression of CD56 in the monocyte subset. The peripheral blood smear showed an increase in monocytes and atypia in neutrophils and monocytes, as well as enlarged platelets and polychromatic erythroblasts. Hence, it was suggested that the myeloid sarcoma was derived from the acute transformation of chronic myelomonocytic leukemia. Myeloid sarcoma is an extramedullary-mass-forming hematologic malignancy that is difficult to diagnose, especially when the initial presentation is a pancreatic mass. However, early diagnosis is important for appropriate therapy. Although bone marrow examination could not be performed because of the patients' severe condition, the pathological specimen obtained with autopsy helped subtype the patient's leukemia. The immunohistochemical features of this case merit attention. [ABSTRACT FROM AUTHOR]

Introduction: Developing prognostic markers can be useful for clinical decision‐making. Peripheral blood (PB) examination is simple and basic that can be performed in any facility. We aimed to investigate whether PB examination can predict prognosis in coronavirus disease (COVID‐19). Methods: Complete blood count (CBC) and PB cell morphology were examined in 38 healthy controls (HCs) and 40 patients with COVID‐19. Patients with COVID‐19, including 26 mild and 14 severe cases, were hospitalized in Juntendo University Hospital (Tokyo, Japan) between April 1 and August 6, 2020. PB examinations were performed using Sysmex XN‐3000 automated hematology analyzer and Sysmex DI‐60 employing the convolutional neural network‐based automatic image‐recognition system. Results: Compared with mild cases, severe cases showed a significantly higher incidence of anemia, lymphopenia, and leukocytosis (P <.001). Granular lymphocyte counts were normal or higher in mild cases and persistently decreased in fatal cases. Temporary increase in granular lymphocytes was associated with survival of patients with severe infection. Red cell distribution width was significantly higher in severe cases than in mild cases (P <.001). Neutrophil dysplasia was consistently observed in COVID‐19 cases, but not in HCs. Levels of giant neutrophils and toxic granulation/Döhle bodies were increased in severe cases. Conclusion: Basic PB examination can be useful to predict the prognosis of COVID‐19, by detecting SARS‐CoV‐2 infection‐induced multi‐lineage changes in blood cell counts and morphological anomalies. These changes were dynamically correlated with disease severity and may be associated with disruption of hematopoiesis and the immunological system due to bone marrow stress in severe infection. [ABSTRACT FROM AUTHOR]

A long‐term study was conducted in Japanese patients with primary axillary hyperhidrosis who completed the preceding 6‐week phase III, confirmatory study of 5% sofpironium bromide gel (hereinafter referred to as sofpironium) to evaluate the safety and efficacy of 52‐week treatment with sofpironium. In the long‐term study, 185 patients who completed the confirmatory study (94 and 91 patients in the vehicle and sofpironium groups, respectively) started to receive sofpironium (switching and extension groups, respectively), and all these patients were included in both the full analysis set (FAS) and the safety analysis set (SAF). In the FAS, there were more females than males (73.0% vs. 27.0%), and median age was 38.0 years. A total of 161 patients (86 and 75 patients in the switching and extension groups, respectively) completed the study at week 52. The proportions of patients with hyperhidrosis disease severity score of 1 or 2 and a 50% or more reduction in total gravimetric weight of sweat were 57.4% in the switching group and 58.2% in the extension group at week 52. The proportions of patients who achieved this efficacy end‐point in the long‐term study were similar to that (53.9%) in the sofpironium group in the confirmatory study. In the SAF, the incidences of adverse events (AEs) were 80.9% in the switching group and 83.5% in the extension group, and the incidences of adverse drug reactions were 39.4% and 45.1%, respectively. AEs that occurred in at least 20% of patients in both treatment groups were application site dermatitis (25.5% and 33.0%, respectively) and nasopharyngitis (31.9% and 23.1%, respectively). Reported AEs were generally mild, and there were no deaths. Serious AEs occurred in three patients, but none were considered related to the study drug. In this study, the efficacy of sofpironium was maintained during 52‐week treatment, and no new safety risk was observed. [ABSTRACT FROM AUTHOR]

A phase 3 study was conducted to verify the efficacy and safety of 5% sofpironium bromide (BBI‐4000) gel (hereinafter referred to as sofpironium) administrated for 6 weeks in Japanese patients with primary axillary hyperhidrosis. The primary efficacy end‐point was the proportion of patients who satisfied both criteria of a Hyperhidrosis Disease Severity Score (HDSS) of 1 or 2 at the end of 6‐week treatment and a 50% or more reduction in total gravimetric weight of sweat at the end of treatment relative to baseline. A total of 281 patients were randomized to receive 5% sofpironium (141 patients) or vehicle (140 patients), and all patients were included in the full analysis set (FAS). In the FAS, 70.1% of patients were female, and the median age was 35.0 years. The proportion of patients who achieved the primary efficacy end‐point was 53.9% in the sofpironium group and 36.4% in the vehicle group, with a statistically significant difference of 17.5% (95% confidence interval, 6.02–28.93) between these two groups (P = 0.003). The incidence of adverse events was 44.0% in the sofpironium group and 30.7% in the vehicle group, and the incidence of adverse drug reactions was 16.3% in the sofpironium group and 5.0% in the vehicle group. Reported adverse events were generally mild or moderate in severity. In the sofpironium group, common events (incidence, ≥5%) were nasopharyngitis (14.2%) and dermatitis/erythema at the application site (8.5%/5.7%), with no serious adverse events reported. This study demonstrated the efficacy and safety of 5% sofpironium. [ABSTRACT FROM AUTHOR]

Use of antimicrobials for acne treatment is correlated with an increased occurrence of antimicrobial‐resistant Cutibacterium acnes. To clarify the role of antimicrobial use on the resistance and to investigate the characteristics of resistant strains, we conducted a multicenter study in dermatological clinics frequently visited by new patients with acne vulgaris. We collected specimens in 264 acne patients and tested 164 C. acnes strains isolated from 164 patients visiting 13 dermatological clinics. Antimicrobial susceptibility testing showed that the rates of resistance for tetracyclines, macrolides and clindamycin were significantly higher in C. acnes strains isolated from patients using antimicrobials for acne treatment than patients not using them. In particular, clindamycin‐resistant strains were frequently isolated from patients with older median age (≥24 years) and severe/moderate acne. After investigating the resistance mechanism of 15 high‐level clindamycin‐resistant strains, the transposable clindamycin resistance genes, erm(X) or erm(50), were detected in 14 strains. Using single‐locus sequence typing for C. acnes, the strains with erm(X) or multidrug resistance plasmid pTZC1 coding erm(50) and tetracycline resistance gene tet(W) were classified into clade F, which were specifically isolated from Japanese patients with acne, except for one strain. Our data showed that patients' information, such as antimicrobial use, age and acne severity, are valuable in estimating whether a patient carries antimicrobial‐resistant C. acnes. Additionally, our results suggest that the clade F strains have a high risk of acquiring multidrug resistance. [ABSTRACT FROM AUTHOR]

The induction of flowering under long-day conditions is an important adaptation by short-day plants, such as adzuki beans ( Vigna angularis), to high-latitude environments. This study clarified the genetic control underlying the long-day insensitivity of adzuki bean cultivar 'Shumari'. 'Shumari' was found to be insensitive to a 16-h day, whereas landrace Acc2265 was highly sensitive. When grown under natural long-day conditions at Obihiro (42°9′N), Acc2265 initiated flowering at least 80 days after 'Shumari'. When 86 recombinant inbred lines ( RILs) derived from crosses between 'Shumari' and Acc2265 were grown under these conditions, their flowering dates ranged from the middle of July to the end of October. The distinct bimodal distribution in the RIL population was due to a single major gene, designated Flowering Date1 ( FD1). Molecular mapping showed that FD1 was located between the SSR markers Az02-37M3 and Az02-40M9, at distances of 6 and 10.4 cM, respectively, on linkage group 2. RILs carrying FD1 S lacked long-day sensitivity, whereas RILs carrying FD1 A were sensitive to long-day conditions, confirming that FD1 controls long-day sensitivity. [ABSTRACT FROM AUTHOR]