Young Ae Lim

Reduction in Glycopeptide Resistance in Vancomycin-Resistant Enterococci as a Result of vanA Cluster Rearrangements

ABSTRACT The molecular characterization of five clinical isolates of vanA-containing vancomycin-resistant enterococci with altered resistance to glycopeptides was examined. One strain represented an IS1216V insertion accompanied by partial deletion of the reading frame of vanX following a transposition event. The other four strains represented IS1216V within the vanX-vanY intergenic region associated with deletion of vanY or vanZ.

Comparison of multiplex reverse transcription polymerase chain reaction and conventional cytogenetics as a diagnostic strategy for acute leukemia

To clarify the usefulness of multiplex reverse transcription polymerase chain reaction (mRT‐PCR) in diagnosing acute leukemia, mRT‐PCR detecting 28 different translocations was performed on bone marrow aspirates of 156 patients with acute leukemia, and the results were compared with conventional chromosomal karyotypes. About 113 of 156 patients had acute myeloid leukemia (AML), and 36 had acute lymphoid leukemia (ALL) with patients’ ages ranging from 1 to 84 (median: 34.5). Concordance rate between karyotyping and mRT‐PCR was 50% (51% in AML and 44% in ALL). Karyotype revealed chromosomal abnormalities in 70 patients (45%) while mRT‐PCR showed some aberrations in 59 patients (38%). mRT‐PCR detected t(1;19), t(4;11), t(9;11), t(10;11), t(11;19), t(12;21), and TAL1d, which were not detected by G‐banding. In addition, 10 patients with t(15;17), one patient with t(8;21), and four patients with t(9;22) detected by mRT‐PCR revealed normal karyotypes. However, mRT‐PCR did not detect numerical abnormalities, deletions, and translocations other than the 28 translocations included in the assay as expected. In conclusion, although it cannot be a substitute of the conventional chromosome analysis, mRT‐PCR could be a complementary diagnostic strategy of acute leukemia.

A study of blood usage by diagnoses in a Korean university hospital

Background and Objectives   There is paucity of comprehensive data on the blood usage with regard to diagnostic categories of Asian recipients. The purpose of this study is to analyse data for blood usage in a korean university hospital in order to obtain additional information on transfusion practices in relation to diagnoses.

Comparison of ABO antibody titers on the basis of the antibody detection method used.

Background Detection methods for ABO antibody (Ab) titers vary across laboratories, and the results are different depending on the method used. We aimed to compare titer values using different detection methods for the measurement of ABO Ab titers. Methods For ABO Ab detection, pooled group A or B red blood cells (RBCs) were reacted with each of 20 sera from blood groups A, B, or O without dithiothreitol treatment. The room-temperature (RT) incubation technique and the indirect antiglobulin test (IAT) were used in the tube test and gel card test. Flow cytometry (FCM) was performed by using anti-IgM and anti-IgG Abs. Results Regardless of the blood groups tested, the FCM assay with anti-IgM showed the highest titer compared to the tube test and gel card test with RT incubation in both. The tube test with IAT showed a higher titer than the gel card test with IAT (Gel-IAT) or FCM with anti-IgG in blood group A and B, while Gel-IAT showed the highest titer relative to the other tests, only for the anti-A Ab in blood group O. Conclusions There were significant differences in the titers depending on the detection method used, and each method showed a different detection capacity for each ABO Ab depending on the ABO blood group tested. Therefore, caution should be exercised in interpreting ABO Ab titer results, taking into consideration the detection method used and the blood group.

Establishment of a national on-line registry for apheresis in Korea.

National apheresis registries can be used to evaluate changes in technology, clinical indications, and applications over the years. Since the establishment of the Korean Society of Apheresis (KSFA) in 1999, basic data on the status of apheresis have been collected using letters and e-mails on a biennial basis. In February 2006, a KSFA homepage and an on-line apheresis registry were constructed (http://www.apheresis.or.kr/). The registry consists of two sub-registries, one addressing overall aspects, e.g., the numbers and types of apheresis machines, total numbers of apheresis procedures, and the other addressing therapeutic plasmapheresis, e.g., diagnoses, modes of treatment, instrument used, replacement fluids, volumes processed, vascular access, anticoagulants, complications, and clinical responses. Data registered on-line is presumed to represent about 95% of total apheresis procedures performed in Korea. In this report, we introduce our on-line registry system and compared the data obtained by on-line registry with the previous ones.

Genetic Rearrangements of Tn1546-Like Elements in Vancomycin-Resistant Enterococcus faecium Isolates Collected from Hospitalized Patients over a Seven-Year Period

ABSTRACT The heterogeneity of Tn1546 results from point mutations, deletions, and the integration of insertion sequence (IS) elements. Among these variations, the presence of IS elements accounts for much of the heterogeneity. Such a rearrangement could play a key role in the evolution of the vanA gene cluster, and hence, it may modify its transferability. In this study, we characterized the consequence of Tn1546 in vanA-containing Enterococcus faecium isolates collected from patients over time. From 1998 to 2004, 57 vanA-containing E. faecium isolates were collected from hospitalized patients at Ajou University Hospital in Korea. PCR amplification of internal regions of Tn1546 was performed, and both DNA strands were directly sequenced by the dideoxy termination method. All isolates were divided into three main types, including the prototype, according to the distribution of IS elements integrated into Tn1546 elements. Type I was characterized by an IS1542 insertion in the orf2-vanR intergenic region and an IS1216V insertion in the vanX-vanY intergenic region. Type II was represented by the presence of two copies of IS1216V at the 3′ end of IS1542 and in the vanX-vanY intergenic region, as well as IS1542 in the orf2-vanR intergenic region. Seventeen strains isolated from 1998 to 2000 represented type I, and 38 strains isolated from 2000 to 2004 represented type II. The remaining two isolates were the prototype. The tendency for the rearrangement of Tn1546 was that the sequences were shortened as time passed, especially at the left or the right end, and hence, this could gradually modulate their transferability.

Unusually high alkaline phosphatase due to intestinal isoenzyme in a healthy adult.

Abstract Intestinal alkaline phosphatase (ALP) is more prevalent in individuals of blood group O or B, and increases after a meal, especially on a high-fat diet. We did not realize that clinicians could underestimate the importance of fasting for ALP measurement until one healthy adult showed a huge difference in ALP levels before and after a meal. We report a case of transient hyperphosphatasemia resulting in unnecessary workup due to intestinal ALP in a healthy adult of blood group O.

A case of chronic myelogenous leukemia with e8a2 fusion transcript

The Philadelphia chromosome and its corresponding fusion gene, BCR-ABL, is one of the best-known genetic abnormalities in hematological malignancies. Major BCR-ABL translocation is much more common in chronic myelogenous leukemia (CML) and minor BCR-ABL in acute lymphoblastic leukemia. We experienced an extraordinarily rare case of CML with an e8a2 variant. An unusual band, other than the common transcripts, was observed in reverse transcription-polymerase chain reaction (RT-PCR) for the BCR-ABL gene rearrangement. Sequence analysis of the PCR product revealed an 1172-bp e8a2 fusion with a 14-bp insertion of ABL intron Ia. The patient achieved a complete hematological response 3 months after imatinib treatment. It is necessary to keep in mind that an unexpected band revealed with RT-PCR may mean the presence of unusual fusion gene.

Effect of transfusion of fresh‐frozen plasma on recipients’ antibodies to hepatitis B surface antigen and hepatitis B surface antigen status in countries where hepatitis B virus is endemic

Background and Objectives Antibodies to hepatitis B virus (HBV) that are passively acquired through transfusions may lead to confusion and inappropriate clinical decisions. We evaluated the effects of transfusing fresh‐frozen plasma (FFP) on serological tests for HBV antibodies in patients without such antibodies.

The Effects of Helicobacter pylori on the prognosis of patients with curatively resected gastric cancers in a population with high infection rate

Purpose The goal of this study was to assess the correlation between the Helicobacter pylori status of patients who underwent curative resection for gastric adenocarcinoma and their prognosis in Eastern societies where H. pylori infection is prevalent. Methods Between 2006 and 2007, 192 patients who had a curative resection for the treatment of gastric adenocarcinoma were enrolled in the study. Of these patients, 18 were excluded due to an inexact evaluation of the H. pylori status, thereby leaving 174 patients in the final analysis. Serologic testing for H. pylori was assessed using an enzyme-linked immunosorbent assay kit for immunoglobulin G, and the histological presence of H. pylori was identified using the Giemsa stain. Results Of the 174 patients, 111 patients (63.8%) were confirmed for H. pylori infection. H. pylori status did not correlate with the overall or disease-free survival. For patients with stage III or IV gastric cancer, a positive H. pylori status was a significant predictive factor for recurrence over that of a negative H. pylori status (P = 0.019). Negative H. pylori status was a predictive factor for recurrence in multivariable analysis (relative risk, 2.724; 95 confidence interval, 1.192 to 6.228). Conclusion Helicobacter pylori status did not correlate with the clinicopathologic factors of gastric adenocarcinoma. However, a negative Helicobacter pylori status may be a predictive factor for recurrence in patients diagnosed with advanced gastric adenocarcinoma.