Identification of Candida Species by Multiplex Polymerase Chain Reaction / 대한임상미생물학회지

BACKGROUND: Polymerase chain reacation (PCR)-based methods have been described for rapid detection and identification of Candida spp. Multiplex PCR assay was developed using internal transcribed spacers and topoisomerase II gene for the accurate identification of Candida species. METHODS: We designed Dual Specificity Oligo (DSO) primers for multiplex PCR. Multiplex PCR was followed by agarose gel electrophoresis to test 8 type strains (C. albicans, C. parapsilosis, C. glabrata, C. tropicalis, C. krusei, C. guilliermondii, C. lusitaniae, C. dubliniensis) and 96 clinical isolates (C. albicans 51 isolates, C. parapsilosis 10 isolates, C. glabrata 10 isolates, C. tropicalis 9 isolates, C. krusei 6 isolates, C. guilliermondii 5 isolates, C. lusitaniae 5 isolates) of Candida spp. RESULTS: With multiplex PCR using DSO primers, the eight Candida type strains each could be easily differentiated and all 96 clinical isolates were identified as the same species as were identified by the conventional method. CONCLUSION: Multiplex PCR followed by electrophoresis can be useful for the simple and rapid identification of Candida species in routine laboratories.

Long-term Prognostic Value of Dipyridamole Stress Myocardial SPECT / 대한핵의학회잡지

PURPOSE: Dipyridamole stress myocardial perfusion SPECT could predict prognosis, however, long-term follow-up showed change of hazard ratio in patients with suspected coronary artery disease. We investigated how long normal SPECT could predict the benign prognosis on the long-term follow-up. MATERIALS AND METHODS: We followed up 1169 patients and divided these patients into groups in whom coronary angiography were performed and were not. Total cardiac event rate and hard event rate were predicted using clinical, angiographic and SPECT findings. Predictive values of normal and abnormal SPECT were examined using survival analysis with Mantel-Haenszel method, multivariate Cox proportional hazard model analysis and newly developed statistical method to test time-invariance of hazard rate and changing point of this rate. RESULTS: Reversible perfusion decrease on myocardial perfusion SPECT predicted higher total cardiac event rate independently and further to angiographic findings. However, myocardial SPECT showed independent but not incremental prognostic values for hard event rate. Hazard ratio of normal perfusion SPECT was changed significantly (p<0.001) and the changing point of hazard rate was 4.4 years of follow up. However, the ratio of abnormal SPECT was not. CONCLUSION: Dipyridamole stress myocardial perfusion SPECT provided independent prognostic information in patients with known and suspected coronary artery disease. Normal perfusion SPECT predicted least event rate for 4.4 years.

Present status and Problems of Liver transplantation in Korea / 대한법의학회지

No abstract available.

Reliability for Multiple Reviewers by using Loglinear Models / 예방의학회지

To guarantee the inter-reviewer reliability is very important in evaluating the quality of large number of clinical research papers by multiple reviewers. We cannot find reports on statistical methods for evaluating reliability for multiple raters in clinical research field. The purpose of this paper is to introduce the statistical methods focused on kappa statistic and five kinds of loglinear models for, which can be applied when evaluating the reliability of multiple raters. We have applied these methods to the result of a project, in which seven reviewers have evaluated the quality of 33 papers with regard to four aspects of paper contents including study hypothesis, study design, study population, study method, data analysis and interpretation. Among the five loglinear models including Symmetry model, Conditional symmetry model, Quasi-symmetry model, Independence model, and Quasi-independence model, Quasi-symmetry model shows the best model of fitting. And the level of reliability among seven reviewers revealed to be acceptable as meaningful.

Methodologic Considerations on the Cohort Study of Risk Factors of Stomach Cancer: On the Incompleteness of Case Ascertainment / 한국역학회지

BACKGROUND AND PURPOSE: The authors conducted the study to evaluate the incompleteness of follow-up as well as the validity of the diagnostic code in the medical insurance databases in a cohort study. They also suggested several useful regression models for the analysis of such incomplete data. METHODS: The subjects of Seoul Cohort(n=14,533) were followed up for three and a half years. Based on the chart reviews of the subjects who had the diagnostic code of gastric cancer in the medical insurance databases, forty-four cases of gastric cancer were idenfified, using cancer registry databases and death certificates as the secondary source. Regression coefficients and the associated p-values were estimated using the following six methods and the results were compared with each other. Method 1: The subjects with the diagnostic code in the medical insurance databases were considered as the cases of gastric cancer. Method 2: The confirmed cases were considered as the cases of gastric cancer. Method 3: The cases were the subjects with the diagnositc code whose diagnosis was confirmed by medical chart reriew. Method 4: Ordinal logistic regression. Method 5: Weighted logistic regression. Method 6: Polytomous logistic regression RESULTS: A total of 12,541 subjects were followed up excluding censored cases. One hundred and nine subjects were diagnosed with gastric cancer in the medical utilization databases: forty-three were probable cases whose dianosis was not confrimed by chart review, twenty-six were ruled out and 26 were confirmed cases. Another 14 cases were confirmed using the cancer registry and death certificates. Using the secondary sources, four another cases were confirmed and 44 cases were confirmed during follow-up. In method 1, past history of gastritis and gastric ulcer was significant risk factor whereas intake frequency of fresh vegetable, ice cream and coffee was associated with significantly decreased risk. In the second and the sixth method, green tea was a significant protective factor, whereas in methods 3-5, no significant variables were found. CONCLUSIONS: Polytomous logistic regression was the preferred method in the cohort study using secondary sources of information for the follow-up, and it provided additional information for the risk factor identification, especially for the specificity of the risk factors.

Professional Socialization of Medical Students / 예방의학회지

This paper concerns professional socialization of medical students. Professional socialization, in the context of this paper, means the process through which a layperson becomes a doctor equipped with professional identity and values. While medical education does not include such process in the curriculum, medical students obtain certain values and identity informally. The dependent variables were professional values and professionalism. The former means the desirable attributes required to conducting professional works such as humane attitudes, science-oriented mind, capability for organizational management. The latter means socio-political reasoning with which doctors can rationalize their privileges such as autonomy. A specially designed questionnaire was developed. The data were collected from five medical schools for 1,318 students in 1994. A total of 1,070 cases were finally included in the statistical analysis. The students emphasized the human factor in the professional values. Their attitude did not change with the grade. Other independent variables such as motives for entering a medical school, socioeconomic status, satisfaction with medical education, etc. also did not influence professional values. It implies that professional values were not consolidated among the students. However, the factors of professionalism change significantly with the grade. It implies that the students paid more attention to socio-political issues related to doctor`s interests as the grade went up. And the factor scores for professionalism were higher for those students who had more positive attitude towards doing medical practice for profit, expected higher income, and were more conservative about social reform. Other independent variables did not influence professionalism. It seems that the students also give emphasis on professionalism, like current medical doctors, mainly because of their concern with recent unfavorable changes in economic conditions of medical care providers.

Effect of Halothane , Enflurane and Nitrous Oxide-Thalamonal Aneathesia on Bleeding Time / 대한마취과학회지

30 patients were randomly divided into three groups : halothane in oxygen(N=10) ; enflurane in oxygen(N= 10) ; Thalamonal plus nitrous oxide in oxygen(N= 10). Standardized bleeding time was measured using Ivy method before and at leaat 40 min after the induction of anesthesia. Arterial pressure was maintained at+/- 200 of control values and tem-perature was kept at 35~37 degrees C. The bleeding time was prolonged by 58% in the halothane group (P<0.001). There was essentially no change in bleeding time in the groups receiving enflurane and nitrous oxide-Thalamonal group, although there was considerable variability within each group, which did not seem to be related to differences in sex, age, type of surgery, concentration of agent used or surgical procedure. In conclusion, our resultg suggest that halothane may be contraindicated in situations where optimal hemostasis is critical.

Epidural Pentazocine for Postoperative Pain Relief / 대한마취과학회지

A number of recent reports haTe described the usefulness of the epidural injection of narcotics for the relief of postpoerative pain. But the epidural or intrathecal uke of a narcotic agonist-antagonist, especially one with a high lipid solubility such as penta97cine, has not been reported. The present studr was undertaken to evaluate the feasibility of pentagocine as an agent for postoperative pain relief when injected epidurally. 80 patients involved in this study were divided raadomlr into four groups: 10 ml saline (group 1, n=20); 0.2 mg/kg pentazocine in 10m1 saline(group 2, n=20): 0.3mg/kg penta- zocine in 10 ml saline(group 3, R= 20) ; 0.4 mg/kg pentazocine in 10 ml(group 4, n=20). she results were as follows : 1) 20(100%) patients from the 0.2 mg pentazocine group, 18(90%) form the 0.3mg/kg pentazocine group and 20(100%) from the 0.4 mg/kg pentazocine group obtained analgesic effects following the epidural injection of pentagzocine. 2) The peak analgesic effect following epidural pentafocine ocurred at 15 min(mean val-ue). 3) The duration of analgesia following epidural pentazocine ranged from 6 to 13 hours. 4) No patient had respiratory depression, itching or vomiting but some patients had urinary retention and nausea. In conclusion, the present study suggests that pentazocine is a useful agent for postope-ratilve pain relief when injected epidurally.