Comparison of the Diagnostic Performance of Elecsys Anti-HCV II and Elecsys and Vitros Anti-HCV Assays / 임상검사와정도관리

BACKGROUND: We evaluated the diagnostic performance of a newly developed Elecsys Anti-HCV II assay in Korean patients. METHODS: A total of 500 serum samples (400 antibody to hepatitis C virus [anti-HCV]-negative and 100 anti-HCV-positive samples) were collected after testing with Elecsys Anti-HCV assay (Roche Diagnostics, Germany). All the samples were tested for anti-HCV by using Vitros Anti-HCV (Ortho-Clinical Diagnostics, UK) and Elecsys Anti-HCV II (Elecsys II) (Roche Diagnostics, Germany) assays. Specimens that were found to be positive or negative in all the 3 assays were considered positive or negative for anti-HCV, respectively, and medical records of the patients, including results of previous HCV tests, were reviewed to determine the final results for anti-HCV when there were discrepancies among the results of the anti-HCV assays. RESULTS: Discrepancies between the results of the 3 anti-HCV assays were found for 4 of the 500 samples (0.8%). Sensitivity/specificity values for Elecsys II were 98.0%/100.0%, and the corresponding values for Elecsys and Vitros assays were 100.0%/100.0% and 100.0%/99.5%. Concordance rates between the results of any 2 of the 3 assays were equal or greater than 99.2%, with a kappa coefficient of 0.98 or greater (P < 0.0001). CONCLUSIONS: Sensitivities and specificities of the anti-HCV assays evaluated in this study were high enough for being used in clinical laboratories, and the results of the 3 assays showed good agreement. However, samples for which weak-positive results were obtained would need to be retested, considering the discrepancies between the anti-HCV assays.

Selective addition of CXCR3+CCR4-CD4+ Th1 cells enhances generation of cytotoxic T cells by dendritic cells in vitro

Increasing importance is being given to the stimulation of Th1 response in cancer immunotherapy because its presence can shift the direction of adaptive immune responses toward protective immunity. Based on chemokine receptor expression, CXCR3+CCR4-CD4+ T cells as Th1-type cells were investigated its capacity in monocyte-derived dendritic cell (DC) maturation and polarization, and induction of antigen specific cytotoxic T lymphocytes (CTL) in vitro. The levels of IL-4, IL-5 and IL-10 were decreased to the basal level compared with high production of IFN-gamma, TNF-alpha, and IL-2 in CXCR3+CCR4-CD4+ T cells stimulated with anti-CD3 and anti-CD28 antibodies. Co-incubation of activated CD4+ or CXCR3+CCR4-CD4+ T cells with DC (CD4+/DC or CXCR3+CD4+/DC, respectively) particularly up-regulated IL-12 and CD80 expression compared with DC matured with TNF-alpha and LPS (mDC). Although there was no significant difference between the effects of the CXCR3+CCR4-CD4+ and CD4+ T cells on DC phenotype expression, CXCR3+CD4+/DC in CTL culture were able to expand number of CD8+ T cells and increased frequencies of IFN-gamma secreting cells and overall cytolytic activity against tumor antigen WT-1. These results demonstrated that the selective addition of CXCR3+CCR4-CD4+ T cells to CTL cultures could enhance the induction of CTLs by DC in vitro, and implicated on a novel strategy for adoptive T cell therapy.

Differential Parental Transmission of Markers in BCL3 among Korean Cleft Case-parent Trios / 예방의학회지

OBJECTIVES: Isolated cleft lip with or without cleft palate (CL/P) is among the most common human birth defects, with a prevalence of approximately 1 in 700 live births. The B-Cell Leukemia/lymphoma 3 (BCL3) gene has been suggested as a candidate gene for CL/P based on association and linkage studies in some populations. This study tests for an association between markers in BCL3 and isolated, non-syndromic CL/P using a case-parent trio design, while considering parent-of-origin effects. METHODS: Forty case-parent trios were genotyped for two single nucleotide polymorphisms (SNPs) in the BCL3 gene. We performed a transmission disequilibrium test (TDT) on individual SNPs, and the FAMHAP package was used to estimate haplotype frequencies and to test for excess transmission of multi-SNP haplotypes. RESULTS: The odds ratio for transmission of the minor allele, OR (transmission), was significant for SNP rs8100239 (OR=3.50, p=0.004) and rs2965169 (OR=2.08, p=0.027) when parent-of-origin was not considered. Parent-specific TDT revealed that SNP rs8100239 showed excess maternal transmission. Analysis of haplotypes of rs2965169 and rs8100239 also suggested excess maternal transmission. CONCLUSIONS: BCL3 appears to influence risk of CL/P through a parent-of-origin effect with excess maternal transmission.

Enhancement of Proliferation and Antigen Presentation of Human B Cells in Vitro by K562 Cells Expressing CD40L

BACKGROUND: CD40-activated B (CD40-B) cells might be an attractive source of autologous antigen-presenting cells (APCs) for immunotherapy due to the convenience to obtain from peripheral blood and expand in vitro. Moreover, CD40-B cells were found to be comparable with DCs in their capacity to raise antigen-specific CD8+ T cells. Here, we have established K562 cells expressing CD40L to expand CD40-activated B cells used for APCs. METHODS: After activation of B cell by K562/CD40L, CD40-B cells were examined by counting B cell numbers. Surface expression of CD54, CD80, CD86 and HLA class II was measured by flow cytometry. The CD40-B cells were tested for its function as APC by mixed lymphocyte reactions (MLR) and by induction of T cell responses specific for pp65 peptide in vitro. RESULTS: The expansion of B cells by K562/CD40L increased about 6-folds compared with anti-CD40 or K562. Furthermore, the expression of CD54, CD80, CD86 and HLA class II was up-regulated by K562/CD40L. B cells by K562/CD40L showed comparable antigen presentation activity with mature DCs as shown in MLR, INF-gamma ELISPOT assay. CONCLUSION: These results suggest that K562/CD40L could be used to generate activated B cells as potent APCs which could be useful for cellular vaccination and adoptive immunotherapy.

Ras association domain family 1A (RASSF1A) Ala133Ser polymorphism is associated with cervical cancer in Korean women / 부인종양

OBJECTIVE: The ras association domain family 1A (RASSF1A) gene plays an important part in carcinogenesis by inactivation via promoter hypermethylation in several cancers. We aimed to examine the effect of the RASSF1A Ala133Ser polymorphism on cervical carcinogenesis in reference to environmental factors, such as smoking and age at first sexual intercourse. METHODS: Seven hundred five patients who were diagnosed with cervical neoplasia and who had a positive results for human papillomavirus were enrolled to experimental group, and 641 of normal healthy women were enrolled as controls. All of the subjects were genotyped using the SNaPshot single base primer extension assay. RESULTS: Compared with RASSF1A TT/GT, the odds ratio (95% confidence interval) for RASSF1A GG was 1.4 (0.9-2.1) for invasive cervical cancer and 1.1 (0.7-1.7) for cervical intraepithelial neoplasia (CIN) II or III. The risks for cervical cancer were higher in patients under 40 years old at diagnosis (1.6, 1.0-2.6), than in patients over 40 years old at diagnosis (1.0, 0.7-1.5). Women with RASSF1A GG who currently smoke had a 2.7 (1.3-5.9) times higher risk of cervical cancer. Women with RASSF1A GG who had an early age of first intercourse, as compared with RASSF1A TT/GT, were also at increased risk. CONCLUSION: The RASSF1A Ala133Ser polymorphism is associated with a higher risk of cervical cancer and particularly with an early onset of cervical carcinogenesis.

Smoking and cause of death in Korea: 11 years follow-up prospective study / 한국역학회지

OBJECTIVE: In Korea, male smoking prevalence is among the world's highest and mortality rates from smoking-caused cancers, particularly lung cancer, are escalating. This cohort study examined the effects of cigarette smoking on the risk of mortality from all causes, cancers and cardiovascular diseases(CVD), and characterized the relationship of the risk with the amount and duration of cigarette smoking. METHOD: A eleven-year prospective cohort study was carried out of on 1,207,592 Koreans, 30 to 95 years of age. The study population includes participants in a national insurance program, who completed a questionnaire on smoking and other risk factors. The main outcome measures were death from all causes, cancer and CVD, obtained through record linkage. At baseline, 482,997 men(60.0%) and 19,755(5.3%) women were current cigarette smokers. RESULTS: In multivariate Cox proportional hazards models, controlling for age, alcohol drinking, exercise, and obesity, current smoking among men increased the risks of mortality from all cause death (relative risk[RR], 1.56; 95% confidence interval[CI], 1.52~1.59), all cancer (1.75, 1.68~1.82), and CVD(1.46, 1.38~1.55). Similar results were found for mortality among women. Smoking also increased the risks of mortality for cancer of the lung(4.60, 4.09~5.33) and other cancers, including larynx, bile duct, esophagus, liver, stomach, pancreas, bladder, and also leukemia. Current smoking among women increased the risk of lung cancer mortality(RR=2.83, 95% CI 2.38~3.36). CONCLUSION: In Korea, smoking is an independent risk factor for death from all causes, CVD and a number of major cancers. The findings affirm the need for aggressive tobacco control in Korea in order to minimize the epidemic of smoking-caused disease.

Estimation of heritability attributable to single-locus effects with a regression of offspring on mid-parent (ROMP) method for cardiovascular risk factors / 한국역학회지

PURPOSE: The objective of this study was to estimate the heritability attributable to single-locus effects with a regression of offspring on mid-parent (ROMP) method for cardiovascular risk factors. METHODS: The regression of offspring on mid-parent is determined with and without the inclusion of a single-locus effect, and the difference between the slopes of these two regression is an estimate of the heritability attributable to the single-locus effect. The study population included 1,550 family members of 295 patients, derived from cardiovascular genome center. The risk factors considered were total serum cholesterol, triglyceride, LDL cholesterol, apoAI and apoB. Heritability was estimated from the slope of the linear regression of offspring on mid-parents. RESULTS: Estimated heritability was 35 to 46% for total cholesterol with 6.2% attributable to polymorphism S128R. For triglyceride, the estimated heritability was 47.6% with 2% attributable to polymorphism G-217A. The heritability was 36-46% for LDL-cholesterol. For LDL cholesterol, S128R specific effect was 8.7%. Estimated heritability was 62.2% for apoAI with 3.2% attributable to polymorphism G-217A and 58 to 75% for apoB with 5.4% attributable to polymorphism S128R. CONCLUSIONS: These traits were significantly associated with polymorphism S128R. These results highlight the importance of considering genetic factors in studies of cardiovascular risk factors. Unlike traditional population-based tests of association, ROMP appears to be robust with respect to population stratification.

Telemedicine in Long-Term Care: An Example of a Nursing Home System

No abstract available.

Long-Term Care Facilities in the United States

No abstract available.

Comparison of the reverse transcription-PCR with the branched DNA assay for measurement of human immunodeficiency virus type 1 RNA levels in plasma of Korean patients

Viral load testing of human immunodeficiency virus (HIV) is an essential tool for initiating and monitoring the antiretroviral therapy for HIV patients. To this end, several methods including polymerase chain reaction (PCR), branched DNA (bDNA), nucleic acid sequence based amplification assay (NASBA) and internally controlled virion PCR (ICV PCR) have become available. Of these methods, the standard reverse transcription-PCR (RT-PCR) assay has been widely used in Korea. However, no comparison study has been performed among the various detection methods currently used in Korean patients. We evaluated the correlation and agreement between the PCR and the branched DNA (bDNA) assay for measurement of HIV RNA in Korean patients. Eighty randomly selected samples from HIV-1-seropositive patients visiting Yonsei Medical Center Severance Hospital were studied. We found that these assays show good agreement, have a reliable correlation (r = 0.92, mean difference in log10 copies/ mL +/- 2 standard deviation = 0.098 +/- 0.805) and produce values whose relationship is given by the following equation: log10v3 bDNA = -0.3405 + 1.0601 x log10RT-PCR. Thus, we conclude that these two methods may allow direct comparison of the results obtained from different assay systems.

Segregation Analysis of Serum LDL-cholesterol in Korean Families of Coronary Heart Disease Patients / 한국역학회지

PURPOSES: The aim of this study was to investigate the familial correlation of lipid profile and the mode of inheritance of LDL-cholesterol through segregation analysis. The study population included 414 family members of 67 Probands who had a coronary heart disease. METHODS: Gene frequency(qH) of the allele for high LDL-cholesterol levels, means of each genotypes, and other putative gene related parameters were estimated. Maximum likelihood methods were used to fit several genetic and nongenetic modes of inheritance to these data to determine if an unobserved Mendelian major gene could explain the familial distribution of LDL-cholesterol. LDL-cholesterol levels were adjusted for age, gender, body mass index, smoking and alcohol consumption. RESULTS: LDL-cholesterol levels revealed familial correlation among spouses, parent-offsprings and siblings with correlations of 0.10, 0.22, and 0.32, respectively. The heritability of LDL-cholesterol was 53%. Two models of inheritance in LDL-cholesterol distribution, the Mendelian codominant model and the polygenic equal transmission model were found. Comparison of these two models in each family among 67 families showed that thiry-six families favored the major gene model with Mendelian codominant and thirty-one families favored the polygenic model of equal transmission. In families favoring Mendelian codominant inheritance, means of each genotypes; LL, HL, HH were 102.1, 143.3, 248.4 mg/dl and gene frequency of H allele was 0.08. In families favoring equal transmission inheritance, means of each genotypes were 101.6, 122.7, 185.5 mg/dl and gene frequency of H allele was 0.14. CONCLUSIONS: In conclusion, families of coronary heart disease patients of this study showed substantial familial correlation and results suggested that variation in LDL-cholesterol may be influenced by major gene effect.

A Study of Major Gene Dominant Family for Factor VII Concentration: Segregation Analysis / 한국역학회지

Elevated plasma level of factor VII is a risk factor for coronary artery disease. We investigated environmental, familial, and genetic influences on factor VII levels. We used maximum likelihood segregation analysis to fit several genetic and nongenetic modes of inheritance to the data to determine whether Mendelian inheritance of a major gene could best explain the familial distribution of factor VII. The study population included 414 family members of 67 subjects who had undergone elective coronary arteriography. The factor VII level was adjusted for age, gender, body mass index, smoking and alcohol drinking (R2=20.6%). Factor VII levels revealed strong familial aggregation with estimated correlation spouse of 0.12, parent-offspring of 0.31, and siblings of 0.40. Regressive models were used to examine inter-individual variation in adjusted factor VII levels in these 67 families. This analysis strongly favored a major gene model with codominant transmission. Genotypic means were 111.6, 123.2, and 184.3% with relative frequencies of 59.4%, 35.4%, and 5.2%. This putative major gene explains 39.9% of the total variance of factor VII. Likelihood was used to search for etiologic heterogeneity by sorting pedigrees into groups that favor one model over another. Compared to pedigrees less favoring Mendelian models, pedigrees favoring Mendelian codominant models have almost 8 times earlier onset of coronary heart disease. These family data suggest that there are strong familial and genetic effects on the factor VII activity in these high risk families. Therefore, linkage studies in these families may be worthwhile to clarify the molecular basis of factor VII levels.

Korean family's crisis analysis and function evaluation

BACKGROUND: Since the winter of 1997, Korea has been in an economic crisis. During this period family-the most important and basic social unit- faoed many problems. The purpose of this survey was to assess Korean family's functional status and emphasize family as a social support unit. METHODS: During April- May 1998 Nationwide Telephone survey was done. Sampling was done by Multi State Stratified Random Sampling technique. We questioned subjects on 5 categories of present family problems and used Modified Faces -III Questionnaire for the evaluation of family function. RESULTS: By 5 point scale, the impact of present ecanomic problems to the family showed the highest score(3.7). Other causes had a score range of 1.7-2.1. Economic impact was greater in 4th and 5th life cycle step, those with low income, and those in bereavement. Family type was divided in to 3 groups; extreme type 20%, mid-range 50%, and balanced 30%. Among extreme groups chaotic adoption and enmeshed cohesion type were the most common(10.8%). CONCLUSIONS: In the Korean family 1998, economic problem seems to be the most important impact factor and the proportion of extreme type family is high.

Degree of stress and stress-related factors by the Korean version of the BEPSI

BACKGROUND: The BEPSI(Brief Encounter Psychosocial Instrument) was developed as an instrument for quick assessment of stress in a busy office setting, and well correlated with other stress scales. Bae et al. developed the BEPSI(Korean version)[BEPSI-K] in Korea, which was used broadly in health examination. In this study, we attempted to assess degree of stress and to find stress-related factors among Koreans by the BEPSI-K. METHODS: A household telephone survey of 1,060 responders was carried out using multistage stratifed random sampling technique from April to May, 1997. The data were collected from 947 subjects who answered all the items of the BEPSI-K. RESULTS: The reliability of the BEPSI-K was demonstrated (Cronbachs alpha 0.71). The BEPSI-K score showed left-shifted distribution, and its mean was 1.72. It also was significantly high in the unmarried, those with a low educational level, those with a low income, non-economic group, hypertensive patients, smokers, non-exercisers and drinkers. Among 947 subjects, 7.7 percent was high stress according to tercile of the original BEPSI score. CONCLUSIONS: Stress-related factors were marital status, educational level, income level, occupation, exercise, smoking, drinking, and hypertension in Korea.