Rapid and correct diagnosis is essential for national tuberculosis (TB) control. A greater national concern for quality control (QC) of Mycobacterium tuberculosis (MTB) testing is required to improve the proficiency of domestic clinical laboratories using diverse testing protocols in private and public sectors. External quality assessment (EQA) is an important program accompanying internal QC in clinical TB laboratories. In Korea, the EQA program initiated in 2005 by the Korean Association of External Quality Assessment Service (KEQAS) has made remarkable progress in the harmonization of private and public sectors with governmental support since 2011. An integrative TB EQA program led by the KEQAS with financial support from the Korea Centers for Disease Control and Prevention provides optimized EQA materials for both public and private sectors. In 2017, the KEQAS implemented ‘The Next-Generation Proficiency Testing Program’ equipped with a centralized control system of QC material production and electronic data management, which increased the scale of operating programs from 46 to 54 and recruited 1,700 participants. The TB program was also expanded to provide three times EQA for private laboratories from 2 times a year. For TB EQA programs implemented via the Clinical Microbiology Subcommittee of the KEQAS, survey materials were distributed by sectional orders for tests such as acid-fast bacilli (AFB) smears, AFB culturing and identification, antituberculous drug susceptibility screening, AFB molecular diagnosis, and rapid detection of rifampin and isoniazid resistance. All survey materials were produced by sophisticated manufacturing processes and thoroughly analyzed by various commercial kits, targeted DNA sequencing, and whole-genome sequencing in pre- and post-manufacturing phases for advancement in the EQA program.
Centers for Disease Control and Prevention (U.S.) ; Clinical Laboratory Techniques ; Diagnosis ; Financial Support ; Isoniazid ; Korea ; Mass Screening ; Mycobacterium tuberculosis ; Private Sector ; Public Sector ; Quality Control ; Rifampin ; Sequence Analysis, DNA ; Tuberculosis

BACKGROUND: As stated in ‘The Action Strategy for Tuberculosis-Free Korea,’ last March, high-throughput, large-scale analytical instruments for interferon gamma release assays (IGRA) are demanded by many clinical laboratories using the QuantiFERON-TB Gold In-Tube assay (Cellestis/Qiagen, Australia). Agility (Dynex Technologies, USA) is an automated high-throughput enzyme linked immunosorbent assay analyser. The present study aimed to evaluate its accuracy and speed. METHODS: Pooled plasma was prepared using samples obtained after IGRA testing. Analyses of precision, linearity, cut-off evaluation, and comparison with conventional methods were performed for multiple Agility instruments according to the Clinical and Laboratory Standards Institute EP5-A3, EP6-A, EP9-A3 and EP12-A2 guidelines. The turnaround time and throughput were also analysed. RESULTS: The coefficient of variation range was 2.48%–4.0%, 7.01%–11.17%, and 9.69%–14.84% for the repeatability, between-run precision, and between-day precision analyses, respectively. The linearity ranged from 0 to 10.541. Comparison analysis presented a high concordance of Agility with the conventional instrument, DS2 (Dynex Technologies), and manual method for IGRA. The cut-off value of 0.35 IU/mL was well compatible with the C50. It was identified that the C50±20% contained the C5–C95 interval. The average turnaround time was 3.84 hours, from the submission of pre-treated samples to the reporting of results. The throughput was determined to be 290 tests during a routine working time of 8 hours. CONCLUSIONS: Agility showed high precision, linearity, concordance, and had a 2.5 times faster throughput than with the conventional and manual method. It could be useful for large-scale IGRA testing in latent tuberculosis infection screening project. Samples within C50±20% are suspected to show relatively low reporducible results of high inversion between postivie and negative.
Enzyme-Linked Immunosorbent Assay ; Interferon-gamma Release Tests ; Interferons ; Latent Tuberculosis ; Mass Screening ; Methods ; Plasma

Purpose: The purpose of this study was to explore the experience of case management for early psychosis and identify factors influencing care management. Methods: We conducted in-depth interviews with 10 mental health professionals who implemented the Social Treatment for Early Psychosis (STEP) program. The collected data were analyzed using qualitative content analysis. Results: The findings consisted of 4 categories and 15 subcategories. Case management should develop expertise considering the desires of young adults, and grew as experts by promoting family cooperation and coping with mental crises. Administrator's support and peer support programs had a positive impact, while the absence of collaborative systems with psychiatric institution were identified as limitations in the operating system of the basic center. Consulting and monitoring of the metropolitan center provided a foundation for case management at the basic center, while the government's support policy is needed to improve of working environment and set up the youth-friendly early intervention system. Conclusion The results suggest that case management for early psychosis requires multilateral and cooperative efforts by strengthening the capabilities of case managers, establishing an integrated case management network of basic and metropolitan centers, and expanding the government's human and physical infrastructure.

Purpose: The purpose of this study was to explore the experience of case management for early psychosis and identify factors influencing care management. Methods: We conducted in-depth interviews with 10 mental health professionals who implemented the Social Treatment for Early Psychosis (STEP) program. The collected data were analyzed using qualitative content analysis. Results: The findings consisted of 4 categories and 15 subcategories. Case management should develop expertise considering the desires of young adults, and grew as experts by promoting family cooperation and coping with mental crises. Administrator's support and peer support programs had a positive impact, while the absence of collaborative systems with psychiatric institution were identified as limitations in the operating system of the basic center. Consulting and monitoring of the metropolitan center provided a foundation for case management at the basic center, while the government's support policy is needed to improve of working environment and set up the youth-friendly early intervention system. Conclusion The results suggest that case management for early psychosis requires multilateral and cooperative efforts by strengthening the capabilities of case managers, establishing an integrated case management network of basic and metropolitan centers, and expanding the government's human and physical infrastructure.

Purpose: The purpose of this study was to systematically review peer support services related to mental health services utilization by people with severe mental illness and to identify core strategies essential for effective peer support services. Methods: A systematic search was conducted using keywords in English, 4 electronic databases, including CINAHL, EMBASE, MEDLINE, and PubMed. Of the 1,305 publications identified, 14 studies were finally included in this systematic review. The Scottish Intercollegiate Guidelines Network (SIGN) was used for the quality assessment. Results: The 14 studies consisted of 8 randomized controlled trials (RCTs), 4 cohort studies, and 2 quasi-experimental studies. Overall, peer support services were found to be effective in reducing hospitalization rates, hospitalization days, number of emergency room visits, and total medical costs. There was inconsistent evidence that the services were associated with positive effects on measures of psychiatric symptoms, quality of life, and social support. Conclusion Peer support services for people with severe mental illness can be a cost-effective way to increase crisis stabilization and continuity of treatment. The core strategies of the services is the development of structured programs to cultivate professional peer providers and the establishment of a cooperative system between mental health professionals and peer providers.

The epithelial barrier in the gastrointestinal (GI) tract is a protective interface that endures constant exposure to the external environment while maintaining its close contact with the local immune system. Growing evidence has suggested that the intercellular crosstalk in the GI tract contributes to maintaining the homeostasis in coordination with the intestinal microbiome as well as the tissue-specific local immune elements. Thus, it is critical to map the complex crosstalks in the intestinal epithelial-microbiome-immune (EMI) axis to identify a pathological trigger in the development of intestinal inflammation, including inflammatory bowel disease. However, deciphering a specific contributor to the onset of pathophysiological cascades has been considerably hindered by the challenges in current in vivo and in vitro models. Here, we introduce various microphysiological engineering models of human immune responses in the EMI axis under the healthy conditions and gut inflammation. As a prospective model, we highlight how the human “gut inflammation-on-a-chip” can reconstitute the pathophysiological immune responses and contribute to understanding the independent role of inflammatory factors in the EMI axis on the initiation of immune responses under barrier dysfunction. We envision that the microengineered immune models can be useful to build a customizable patient's chip for the advance in precision medicine.

Hematopoietic stem cell transplantation (HSCT) causes many complications such as anorexia, nausea, vomiting, diarrhea, and mucositis. Most patients undergoing HSCT have risk for malnutrition in the process of transplantation so artificial nutrition support is required. The purpose of this case report is to share our experience of applying nutrition intervention during the transplantation period. According to HSCT process, the change of the patient's gastrointestinal symptoms, oral intake and nutritional status was recorded. By encouraging oral intake and providing parenteral nutrition, the patient had only 0.3%, losing weight during the transplantation period. In conclusion, it emphasized that the nutritional status changes during the HSCT period should be closely monitored and nutritional management through appropriate nutritional support and interventions in hospital and after discharge.
Anorexia ; Diarrhea ; Hematopoietic Stem Cell Transplantation ; Humans ; Malnutrition ; Mucositis ; Nausea ; Nutritional Status ; Nutritional Support ; Parenteral Nutrition ; Peripheral Blood Stem Cell Transplantation* ; Precursor Cell Lymphoblastic Leukemia-Lymphoma* ; Vomiting

Background: Whole genome sequencing (WGS) is an increasingly useful tool for tuberculosis (TB) diagnosis and disease management. In this study, we evaluated the utility of userfriendly WGS tools in reporting resistance profiles and identifying lineages of clinical TB isolates from South Korea. Methods: Forty clinical samples from TB patients showing discrepancies between their rapid molecular and conventional drug susceptibility tests were used in this study. Among these clinical isolates, 37 strains were successfully evaluated via WGS software, using the GenTB, TB Profiler, PhyResSE, CASTB, and Mykrobe. Results: More accurate and faster susceptibility results could be obtained with isoniazid than with rifampin. Using the phenotypic test as the gold standard, the isoniazid concordance rate between phenotypic drug susceptibility test (DST) and WGS (GenTB: 45.9%, TB profiler: 40.5%, PhyResSE: 40.5%, CASTB: 48.6%, and Mykrobe: 43.2%) was much higher than between phenotypic DST and rapid molecular genotypic DST (18.9%) among the 37 strains.In contrast, the rifampin concordance rate between phenotypic DST and WGS and that between phenotypic DST and rapid molecular genotypic DST was similar (81.1–89.2%). We also found novel mutations associated with INH in katG and ahpC gene region, not covered by the line probe assay. In addition, lineage analysis identified 81.1% of these samples as L2 East Asian lineage strains, and 18.9% as L4 Euro-American lineage strains. Conclusion WGS may play a pivotal role in TB diagnosis and the detection of drug resistance, genetic diversity, and transmission dynamics in the near future because of its accuracy, speed, and extensibility.