A Rare Case of Primary Myelofibrosis With a Solitary 1q Triplication

No abstract available.

The Comparison between Serologic Tests and Magicplex HepaTrio Real-time PCR in the Diagnosis of Viral Hepatitis

BACKGROUND: Magicplex HepaTrio Real-time PCR (Magicplex, Seegene, Korea) simultaneously detects and distinguishes each type of hepatitis A, hepatitis B, and hepatitis C viruses. We investigated the diagnostic performance of Magicplex in comparison with that of serologic test. METHODS: We tested and analyzed 184 serum samples for hepatitis A IgM antibody (IgM antiHAV), hepatitis B virus surface antigen (HBsAg), and anti-hepatitis C virus antibody (antiHCV). Serologic markers including IgM antiHAV, HBsAg, and antiHCV were tested with electrochemiluminescence immunoassay method. We calculated positive rates of the test results and concordance rates between serologic tests and Magicplex. RESULTS: The positive rates of IgM antiHAV, HBsAg, and antiHCV using serologic methods were 15.2% (28/184), 13.6% (25/184), and 8.2% (15/184), respectively. The positive rates of the corresponding viral nucleic acid detection by Magicplex were 18.5% (34/184), 16.3% (30/184), and 4.3% (8/184), respectively. The concordance rates between serologic test and Magicplex were 95.7% (176/184) in hepatitis A, 97.3% (179/ 184) in hepatitis B, and 96.2% (177/184) in hepatitis C. CONCLUSIONS: In our study, the concordance rates between Magicplex and traditional serologic tests are over 95%. Magicplex could not yet totally replace traditional serologic tests because there are some possibilities of cross reaction among the hepatitis viruses and false negative results in hepatitis C. If Magicplex resolves these problems, it would be a useful tool for screening test for the diagnosis of viral hepatitis as it provides an automated, easy, and simultaneous detection of the 3 major hepatitis viruses.

A Survey of the Self-contribution Rate of Manuscripts Published in the Korean Journal of Blood Transfusion using Internal Impact Score / 대한수혈학회지

BACKGROUND: The authors produced a new citation index of the Korean Journal of Blood Transfusion (KJBT). The index, which was developed to determine the internal impact score (IIS), could examine contributions to the KJBT according to the manuscript, author and institute. METHODS: For manuscripts published in the KJBT from Volume 1 No. 1 in 1990 to Volume 17 No. 1 in 2006, a database of the journals and their references was constructed, and an index was created. The citation index was analyzed using three indicators, the internal impact score for the manuscript (IIS-M), internal impact score for the author (IIS-A) and the internal impact score for the institute (IIS-I). RESULTS: The total number of references cited in the manuscripts was 5,392. Of these references, 498 (9.2%) were published in the KJBT. The mean IIS-M of all manuscripts cited was 0.97. The total number of authors who participated in the cited manuscripts was 351. The highest IIS-A score, which was calculated in consideration of each author's participation and the weight of the manuscript, was 203.26. The number of institutes that had produced the cited manuscripts was 35. The highest IIS-I score, which was calculated in consideration of each organization's participation and the weight of manuscripts, was 187.45. CONCLUSION: If the indicators developed by the authors are used as tools to analyze the citation indices of the journals, they can quantify the contribution of the manuscripts, authors and institutes to each journal, and promote the development of academic journals based on the quantified contribution.

A Survey of the Self-contribution Rate of Manuscripts Published in JKRA using Internal Impact Score / 대한류마티스학회지

OBJECTIVE: The authors created a new citation index of the Journal of the Korean Rheumatism Association (JKRA) and, based on the index, developed internal impact score, which can measure contribution to the development of the journal by manuscript, by author and by institute. Thus, we report the results in this paper. METHODS: For manuscripts published in the JKRA from Volume 1 No. 1 in 1994 to Volume 13 No. 4 in 2006, we built a database of the journals and their references, and created an index using the database. The citation index were analyzed using three indicators internal impact score for manuscript (IIS-M), internal impact score for author (IIS-A) and internal impact score for institute (IIS-I). RESULTS: The total number of references cited in the manuscripts was 7,341, and of the references, 80 (1.1%) had been published in the JKRA. The mean IIS-M of all the cited manuscripts was 0.46. The total number of authors participated in the cited manuscripts was 226. In IIS-A calculated in consideration of each author's participation and the weight of manuscripts, the highest score was 19.253. The number of institutes that had produced the cited manuscripts was 29. In IIS-I calculated in consideration of each organization's participation and the weight of manuscripts, the highest score was 92. CONCLUSION: If the indicators developed by the authors are used as tools for analyzing the citation indexes of journals, they can quantify the contribution of manuscripts, authors and institutes to each journal, and compensation based on the quantified contribution will promote the development of academic journals considerably.

Irradiated Blood Usage in a Tertiary-care Hospital / 대한진단검사의학회지

BACKGROUND: Irradiated blood is used to prevent transfusion-associated graft-versus host disease in high risk patients. The guidelines for usage of irradiated blood components vary from one country to other according to their needs. But in Korea, little information is available on the current usage of and the guidelines for irradiated blood. Therefore, we analyzed the usage of irradiated blood components in Hanyang University Medical Center. METHODS: Medical records were reviewed for 187 patients who had been transfused with irradiated blood products during the period from January 2004 to June 2005. And we investigated the proportion of irradiated blood products among the total number of blood products that were transfused during a one-year period. RESULTS: Hematologic diseases and solid cancer patients comprised 63.7% and 24.6% respectively. The proportion of irradiated blood products among the total blood components were 25.7% of platelet concentrates, 61.4% of apheresis platelets, and 5.1% of packed red cells. Total transfused amount by disease categories and the average transfused units per patient of irradiated blood components were high in a group of patients with several hematologic diseases such as acute leukemia. CONCLUSIONS: The use of irradiated blood components takes a great proportion in total blood product transfusions and the majority of blood components were transfused to a group of patients with a few hematologic diseases. The proper use of blood should be guided by the promotion and education of a modified usage protocol for irradiated blood products and by a continuous data analysis.

Guideline for the Order of Anticipated Red Cell Uses Incorporating Preoperative Patient's Variables for Elective Surgery / 대한진단검사의학회지

BACKGROUND: Most red blood cells that are crossmatched in a hospital blood bank are for surgical patients, and the majority of them is not transfused in spite of the use of MSBOS (maximum surgical blood order schedule). Because preoperative patients variables are omitted in MSBOS, an alternative system for ordering red cell units, which incorporates the patients variables for surgical patients, has been developed. METHODS: We studied the average amount of transfused red blood cell units per each elective surgery and also calculated the average red blood cell volume reduction and average hemoglobin reduction for each elective surgery incorporating patients variables, such as preoperative hemoglobin, postoperative hemoglobin, weight during the period from January to December, 2001 in Hanyang university hospital. We compared transfused units with the anticipated units using MSBOS and the average red blood cell volume reduction and the average hemoglobin reduction. We evaluated factors associated with the risk of transfusion during surgery. RESULTS: Total units transfused in elective surgeries were 2099 units. The anticipated units were 1925 in MSBOS, 1508 in average hemoglobin reduction, 1559 in average red blood cell volume reduction. With the exception of over-transfusion, the total transfused units were 953 units and the anticipated units were 1173 in the MSBOS, 1054 in the average hemoglobin reduction, and 1038 in the average red blood cell volume reduction. Factors associated with the risk of transfusion in multivariate regression analysis were preoperative hemoglobin (OR: 0.7431), sex (male=1, female=2, OR: 1.3166), weight (OR: 0.9890), age (OR: 1.0541), operating time (OR:1.0090). CONCLUSIONS: Preoperative hemoglobin and weight are major factors associated with transfusions. Therefore, preoperative ordering for red cell incorporating these factors may be effective in reducing the unnecessary excessive cross matching and the workload in blood banks.

Latex Agglutination Test for Differentiating Neonatal Blood from the Maternal Blood in the Meconium / 대한진단검사의학회지

BACKGROUND: The Apt test is used for differentiating neonatal blood from the maternal blood in the meconium. The test requires a sufficient amount of blood to be detectable to the naked eyes. But many of the specimens in the hospital laboratory contain only a small amount of blood and is not detectable to the naked eyes and usually the results are reported 'impossible to determine' due to the small amount of blood. We developed a latex agglutination test to solve this problem and to differentiate the neonatal blood from the maternal blood in a small amount that was not detectable with the naked eyes. METHODS: Latex reagents for hemoglobin A (Hb A) and hemoglobin F (Hb F) were made. Ten milligrams of meconium were dissolved in 1mL of deionized water (DW). Ten milligrams of meconium that had shown negative results for both of the above reagents were mixed, each with 10microL of whole blood (WB) from 10 pregnant women and 10 neonates who had various hemoglobin concentrations (10-17 g/dL). Each of the 20 mixtures was dissolved in 1 mL of DW (WB 10microL/mL). Then, serial dilutions were made at a ratio of 1:10 until the final concentration of 10 pL/mL. Each of the six dilutes were tested with the two latex reagents. RESULTS: The dilutes of WB 10microL/mL looked red, WB 1microL/mL looked pink and all other dilutes showed no colors to the naked eyes. The reagent for Hb A showed agglutination in dilutes from WB 1microL to 1 nL/mL DW from all of the 20 persons. The reagent for Hb F reacted with dilutes from WB 1microL to 1 nL/mL DW from the ten neonates but did not react with those from any pregnant women. CONCLUSIONS: The latex agglutination test can be applied to the specimen with no color detectable to the naked eyes after dilution. The specimen reacted with both the Hb A and Hb F reagents could be determined as fetal blood and the one that reacted with the reagent only for Hb A could be determined as maternal blood.

Distribution of HBV Genotypes in Patients With Chronic HBV Infection in Korea / 대한간학회지

BACKGROUND/AIMS: Chronic HBV infection is associated with a wide spectrum of clinical manifestations, including asymptomatic carrier state, chronic hepatitis, liver cirrhosis, and hepatocellular carcinoma. Genotypically, HBV genomes have been classified into seven groups, designated A to G. Several studies have suggested recently that HBV genotypic differences influence the severity of liver disease and clinical outcomes. The distribution of HBV genotypes in Korea and its clinical relevance are poorly understood. We investigated the prevalence of HBV genotypes in Korea and the association between the distinct genotypes and the severity of liver disease. METHODS: A total of 214 HBV-DNA positive serum samples, were used for the genotyping. All patients were HBV-bDNA positive chronic HBsAg carriers. 199 patients were histologically verified with liver cirrhosis (6), chronic hepatitis (192) and fatty liver (1). The other patients were clinically diagnosed with liver cirrhosis (13) or hepatocellular carcinoma (2). HBV genotype was determined by PCR using type-specific primers. RESULTS: Genotyping was possible in all patients. Out of 214 patients, 213 (99.5%) were HBV genotype C. Only one (0.5%) was genotype A. The patient with genotype A had minimal hepatitis as diagnosed by liver biopsy. CONCLUSIONS: These results indicate that almost all chronic HBV infections are genotype C in Korea. HBV genotypic difference therefore does not influence the clinical outcome of HBV infection in Korea. Because genotype C may be associated with more severe liver disease, the predominance of genotype C in Korea may result in more severe outcomes than in other countries where other genotypes are predominant.

Evaluation of serotyping using monoclonal antibodies and PCR-RFLP for Chlamydia trachomatis serotype identification

We compared genotyping by restriction fragment length polymorphism (RFLP) analysis of the amplified omp1 gene with serotyping by dot enzyme-linked immunosorbent assay (dot-ELISA) to determine the suitability of RFLP analysis for epidemiologic study. Fifteen prototypes of Chlamydia trachomatis and 30 clinical isolates were used in this study. To serotype with dot-ELISA, chlamydia antigen was spotted onto a series of replicate nitrocellulose membrane patches and reacted with 11 mAbs that distinguish the 15 known serovars of C. trachomatis. For RFLP analysis, the amplified chlamydia omp1 gene was digested with AluI to differentiate serovars A to K and L1 to L3. Serovars of C, H, I, J, and L3 were further typed by RFLP analysis after digestion with HinfI, and a combination of EcoRI and DdeI. PCR-based RFLP could identify serotype of 28 among 30 clinical isolates tested. The remaining two untypical isolates were probably due to double infections or mechanical transferring error. Serotyping of C. trachomatis isolates shows that serovars E, D, F, and H are the most prevalent types found in urogenital samples in Korea. In this study, we show that RFLP analysis of amplified omp1 gene may be useful in genotyping C. trachomatis isolates.

Contamination rate of white blood cells in fresh frozen plasma and evaluation of a commercial WBC-reduction filter / 대한임상병리학회지

BACKGROUND: Recently, sufficient numbers of lymphocytes that may cause alloimmunization have been detected in fresh frozen plasma (FFP) and the need for filtration and/or irradiation of FFP for certain patients has been proposed. We examined the numbers of white blood cells (WBCs) in FFP and evaluated a new WBC-reduction filter designed for FFP. METHODS: A total of 118 units of FFP were analyzed. We counted WBCs by using the crystal violet-staining method. Forty-four units of FFP were tested for WBC numbers before and after filtration by using the Nageotte chamber. The viable WBC count was performed using the 0.4% trypan blue-staining method. The biologic activity of the coagulation factor viii was measured in 34 units of FFP before and after filtration with the ACL 3000 (Instrumentation Laboratory, Milano, Italy). RESULTS: In the 118 units of FFP, 39 units (33.1%) and 1 unit (0.9%) had counts greater than 1X10(6)/unit and 5X10(6)/unit, respectively. The filter reduced the WBC numbers to less than 1X106/unit in all units. The average percentage of viable WBCs before and after filtration was 34.9% and 4.7%, respectively. The average leukocyte removal rate of the WBC-reduction filter was 81.0%. The average factor viii activity before and after filtration was 72.2 U/dL and 75.1 U/dL, respectively. CONCLUSIONS: Some FFP prepared by the Korean Red Cross blood center may contain enough to require WBC-reduction filtration. Therefore, WBC-reduction filtration of FFP should be considered in order to prevent adverse effects, particularly in those patients expected to receive repeated transfusions.

A Case of Partial-D Category Va / 대한수혈학회지

The patient, a 65-year-old woman, was admitted for chronic subdural hematoma. ABO and Rh blood typing were performed as a pre-operation test. Her red blood cells were not agglutinated with anti-D reagent (Ortho Diagnostic System, USA). But they were positive in subsequently performed weak-D test and also agglutinated with three other anti-D reagents (Baxter Dade, USA; Biotest Diagnostics, Korea; Bioscot Ltd., UK). The patient s Rh phenotype was CcDe. Antibody screening test, direct and indirect antiglobulin tests showed negative results. Different reactivity to various anti-D reagents as shown in this case suggested that her cells have partial-D antigen which lack one or more components of the Rh D antigen. We considered that this case was category Va according to the reactivity patterns of monoclonal anti-D antibodies with various partial- D cells.

Economic Profile of Biochemical Tests in Rheumatic Disease / 대한류마티스학회지

Developments in science have brought about progress in automated chemistry analyzers, which have increased the capability of testing various items in short time period. This has resulted in grouping several test items into a profile. However, the profiles generally used can include some unnecessary tests for a specific patient group. Therefore, selecting the right tests for a profile of a particular patient group is a prerequisite for cost-effective medical care. The present study set out to develop an economic chemistry profile in patients suspected of having a rheumatic disease. The study included 60,302 patients who attended the Hospital for Rheumatic Diseases between June 1995 and May 2000. A total 21 different chemistry tests were performed by the automated chemistry analyzer (Hitachi-747, Hitachi Inc., Tokyo, Japan). RESULTS: A total of 758,305 chemistry tests were performed, an average of 12.6 tests per patient. The tests relatively less commonly ordered were direct bilirubin, gamma glutamyl transpeptidase, iron, TIBC. The percentage of abnormal results of total protein, albumin, total calcium, creatinine and total bilirubin were less than 5%. Therefore, these tests should be eliminated from routine testing. CONCLUSION: An economic chemistry profile for rheumatology outpatients would include alkaline phosphatase, alanine aminotransferase, aspartate aminotransferase, blood urea nitrogen, total cholesterol, creatine kinase, glucose, HDL-cholesterol, lactate dehydrogenase, triglyceride, uric acid. This would result in a 46.4% decrease in cost of biochemical test.

Serotyping of Chlamydia trachomatis by Polymerase Chain Reaction: Restriction Fragment Length Polymorphism Analysis / 대한임상병리학회지

BACKGROUND: Chlamydia trachomatis is currently classified into 15 serovars (A, B, Ba, C, D, E, F, G, H, I, J, K, L1, L2, L3) and a large number of serovariants. Typing of C. trachomatis serovars has generally been performed by the MOMP (major outer membrane protein) serotyping method, which requires a large panel of polyclonal and monoclonal antibodies. Recently the PCR was successfully applied to the genotyping of different C. trachomatis serovars by means of restriction fragment length polymorphism (RFLP) analysis and direct sequencing of amplified omp1 DNA. The objective of this study was to evaluate the serotyping of C. trachomatis by PCR-FLP and to determine the serovars of C. trachomatis urogenital isolates. METHODS: The 15 reference strains of C. trachomatis and 27 clinical isolates were analyzed by PCR-FLP. The C. trachomatis omp1 gene was amplified by PCR. For serotyping by RFLP analysis, the omp1 PCR products were digested with AluI and were electrophoresed through a 7% polyacrylamide gel with ethidium bromide staining. If necessary, the PCR products were analyzed with HinfI, a combination of EcoRI and DdeI, or CfoI. RESULTS: In serotyping of 15 reference strains of C. trachomatis, serovars A, B, Ba, E, F, G, K, and L2 were clearly identified after AluI digestion. However serovars C, H, I, J, L3 and serovars D, L1 were respectively identical patterns after AluI digestion. Serovars C and J and serovars D and L1 were further discriminated by a second step of enzyme digestion with HinfI. Serovar H, I, and L3 were distinguished by enzyme digestion with EcoRI and DdeI. In serotyping of C. trachomatis from 27 urogenital isolates, 25 isolates were clearly typed. Nine were typed as serovar E, 8 were typed as serovar D, 6 were typed as F, 2 were typed as serovar H. Two isloates showed unidentifiable RFLP pattern which was not in accordance with any of the existing C. trachomatis prototypes. CONCLUSIONS: PCR-FLP analysis is a rapid, simple, and powerful tool for differentiating serovars of C. trachomatis. Therefore, this approach is recommended for future epidemiological studies of C. trachomatis. And the serovar E, D, and F are the most prevalent types found in urogenital specimens, representing 92% of those investigated.

Serotyping of Chlamydia trachomatis by Polymerase Chain Reaction: Restriction Fragment Length Polymorphism Analysis / 대한임상병리학회지

BACKGROUND: Chlamydia trachomatis is currently classified into 15 serovars (A, B, Ba, C, D, E, F, G, H, I, J, K, L1, L2, L3) and a large number of serovariants. Typing of C. trachomatis serovars has generally been performed by the MOMP (major outer membrane protein) serotyping method, which requires a large panel of polyclonal and monoclonal antibodies. Recently the PCR was successfully applied to the genotyping of different C. trachomatis serovars by means of restriction fragment length polymorphism (RFLP) analysis and direct sequencing of amplified omp1 DNA. The objective of this study was to evaluate the serotyping of C. trachomatis by PCR-FLP and to determine the serovars of C. trachomatis urogenital isolates. METHODS: The 15 reference strains of C. trachomatis and 27 clinical isolates were analyzed by PCR-FLP. The C. trachomatis omp1 gene was amplified by PCR. For serotyping by RFLP analysis, the omp1 PCR products were digested with AluI and were electrophoresed through a 7% polyacrylamide gel with ethidium bromide staining. If necessary, the PCR products were analyzed with HinfI, a combination of EcoRI and DdeI, or CfoI. RESULTS: In serotyping of 15 reference strains of C. trachomatis, serovars A, B, Ba, E, F, G, K, and L2 were clearly identified after AluI digestion. However serovars C, H, I, J, L3 and serovars D, L1 were respectively identical patterns after AluI digestion. Serovars C and J and serovars D and L1 were further discriminated by a second step of enzyme digestion with HinfI. Serovar H, I, and L3 were distinguished by enzyme digestion with EcoRI and DdeI. In serotyping of C. trachomatis from 27 urogenital isolates, 25 isolates were clearly typed. Nine were typed as serovar E, 8 were typed as serovar D, 6 were typed as F, 2 were typed as serovar H. Two isloates showed unidentifiable RFLP pattern which was not in accordance with any of the existing C. trachomatis prototypes. CONCLUSIONS: PCR-FLP analysis is a rapid, simple, and powerful tool for differentiating serovars of C. trachomatis. Therefore, this approach is recommended for future epidemiological studies of C. trachomatis. And the serovar E, D, and F are the most prevalent types found in urogenital specimens, representing 92% of those investigated.

Sequence Analysis of the omp1 gene in Chlamydia pneumoniae / 대한임상병리학회지

BACKGROUND: Chlamydia pneumoniae has recently been established as an important cause of acute respiratory tract infections such as pneumonia and bronchitis in humans. The purpose of our study was to define the sequence of the C. pneumoniae omp1 gene. METHODS: The omp1 gene of C. pneumoniae was amplified by touchdown polymerase chain reaction (PCR) on sputum samples. The PCR product was cloned into pT7Blue T-Vector using the TA cloning technique. The nucleotide sequence of the cloned omp1 gene was determined with the Cy5TM AutoReaderTM Sequencing Kit. RESULTS: We designated the cloned PCR product as CpT-207. The sequence of CpT-207 DNA was 96%-100% identical to the omp1 gene of C. pneumoniae isolated from other countries. CONCLUSIONS: The sequence analysis of CpT-207 DNA was almost identical to the sequences of the omp1 gene of C. pneumoniae isolated from other countries. The CpT-207 can be used as a control or a probe for the molecular diagnosis of C. pneumoniae.

An Isolated AST Elevation due to Macroenzyme Formation / 대한간학회지

Serum aspartate aminotransferase (AST) is a common enzyme for the evaluation of the hepatic, muscular and cardiac diseases and is produced also at kidney, brain, pancreas, lung, leukocytes, erythrocytes, etc. The elevation of its activity is usually caused by the necrosis of hepatocytes when there are not muscular injuries or myopathies. Recently, it is found that AST can exist as a macroenzyme by forming a complex with an immunoglobulin and this complex is erroneously considered to indicate the presence of liver disease as a result of elevation of AST activity on routine blood chemistry analysis. We experienced the patient with isolated AST elevation due to the formation of AST-mmunoglobulin complex confirmed by AST isoenzyme electrophoresis (EP).

A Case of Hemolytic Disease of the Newborm due to Anti - Dib Antibody

The Diego blood group system consists of two pairs of antigens, Dia and Dib The incidence of Dia is low among pure Caucasian, Blacks, Polynesian and Eskimo, however, the rnongolians and American indians have both Dia and Dib. We report a case of two days old male who was admitted on first day of life for jaundice and subsquently exchange transfusion was performed on second day of life for bilirubin of 20 mg/dl. The blood groups of patient and his mother were both Rh D positive 0 type. Direct and indirect Coombstest were strong positive in the patient and indirect Coombstest was positive in his mother. We found anti-Dib antibody in his rnother's serum. The phenotype of Diego blood group system of the patient and his mother were Di (a+b+) and Di (a+b- ), respectively and hemolytic anemia in this case was due to anti-Dib antibody.

Genotyping of Diego Blood Group System by Use of Polymerase Chain Reaction and Nae I Restriction Enzyme / 대한임상병리학회지

BACKGROUND: The Diego blood group system consists of two independent pairs of antigens, Dia and Dib. Immunization to Dia or Dib is clinically significant, because anti-Dia and anti-Dib may cause hemolytic transfusion reactions of transfused incompatible red cells or hemolytic disease of the newborn. At the nucleotide level, the difference between the Di a and Di b alleles is a single-base change of exon 19 that results in the substitution of leucine (CTG) for proline (CCG) at position 854. METHODS: Peripheral blood was collected from 116 patients. DNA was isolated from 50 L of blood. PCR was performed with previously described primers by Bruce et al (S22: 5'-GTC ACGTCGCTCAGCGG, AS13: 5'-GACCTTCCTCCTCATCAA). The 5 L of PCR products were digested by Nae I. We analyzed 10ul of each digested PCR product by electrophoresis on 1.5 % agarose gel with ethidium bromide staining. RESULTS: A concordance rate of 100 percent was observed between genotyping and phenotyping (105 Di (a-b+), 11 Di (a+b+)). CONCLUSIONS: This method can be effectively used for the Diego typing and is particularly useful in cases where the serological typing method is difficult as in autoimmune hemolytic anemia.

Detection of Chlamydia pneumoniae by 'Touchdown' PCR / 대한임상병리학회지

BACKGROUND: Chlamydia pneumoniae has recently been established as an important cause of acute respiratory tract infections such as pneumonia and bronchitis in humans. We introduced a 'touchdown' PCR method for detection of C. pneumoniae from sputum. METHODS: A total of 474 patients with respiratory infection were enrolled in the study. The sputum samples were tested for C. pneumoniae by the 'touchdown' PCR and cultured for Chlamydia. The sputum samples were pretreated with 5% NaOH for mucolysis. In 'touchdown' PCR, the first round PCR amplified DNA from both C. pneumoniae and Chlamydia psittaci, while the second round specifically targeted C. pneumoniae, allowing the two species to be differentiated. RESULTS: The 'touchdown' PCR could detect 10-2 inclusion forming unit (IFU) in the 1st round and 10-3 IFU in the second round PCR. None of the C. trachomatis serovars, C. psittaci and other organisms tested was amplified. 'Touchdown' PCR detected C. pneumoniae DNA in 24 (5%) of the 474 sputum samples. Nine patients with C. pneumoniae had community acquired pneumonia. Another nine patients had pulmonary tuberculosis of which three had coexisting pneumonia. Two patients had lung cancer, another two had chronic bronchitis, one had pharyngitis, and one person was a normal healthy individual. CONCLUSIONS: The sputum preparation with 5% NaOH and the 'touchdown' PCR method are effective in the detection of C. pneumoniae. C. pneumoniae is one of the most common causative agents for pulmonary infection.

An OSCE Assessment of Fourth-year Medical Students as A Comprehensive Evaluation of Medical Skills Before Graduation / 한국의학교육

BACKGROUND: Experiences on Objective Structured Clinical Examination(OSCE) for student assessment are limited in medical colleges in Korea. The purposes of this study were to develop an OSCE to fourth-year medical students after completion of all clerkships at Hanyang University Medical College. METHODS: The OSCE was a 8-station examination, with each station taking five minutes. We conducted two parallel OSCEs simultaneously by duplication. We checked each stage of the process in the development of OSCEs with recording of diary. We analysed validity and costs of the OSCE. We got feedback from all participants by questionnaires. RESULTS: Of the total 102 fourth-year students, only 74 persons(72.5%) were evaluated. The rate of pass was 63.5%. Cronbach alpha of the OSCE was 0.14. The scores were different between sites according to stations, especially in items related to attitude and physical. The total OSCE score was not significantly different either between duplication sites or among groups. OSCE scores didn't relate to those of both multiple choice tests and entrance exam for internship. Our use of only a few SP's contributed to relatively low cost of $85 per examinee. Both students and faculty were satisfied with the examination, and felt that the material tested was relevant and appropriate for primary care. The OSCE process served to identify weakness in the curriculum and/or teaching methods, and thus could serve as a mechanism to improve educational effectiveness. CONCLUSIONS: Problems of validity and reliability were detected in the developing process of the OSCE. It appeared financially feasible. Setting appropriate goal, optimum number of station, training of evaluators, development of good checklist, and enthusiastic support of the school's administartion were all needed more to success of such a program.