Japanese Journal of Medical Technology
Online ISSN : 2188-5346
Print ISSN : 0915-8669
ISSN-L : 0915-8669
Volume 65, Issue 1
Displaying 1-18 of 18 articles from this issue
Review Article
  • Tomoko YAGI
    Article type: Review Article
    2016 Volume 65 Issue 1 Pages 1-11
    Published: January 25, 2016
    Released on J-STAGE: March 10, 2016
    JOURNAL FREE ACCESS
    Polysomnography (PSG) records simultaneously many physiological signals throughout a given night, including electroencephalograms, electro-oculograms, electromyograms, nasal-oral flow, chest and abdominal movements, electrocardiograms and arterial oxygen saturation. PSG evaluates sleep state and wakefulness, and both quality and quantity of sleep. It is also useful for diagnosing sleep breathing disorders, periodic limb movement disorders, sleep-related epilepsy, narcolepsy, and rapid eye movement sleep behavior disorders and their severities. To maximize the advantages of PSG, it should be performed by a trained technologist in a sleep laboratory equipped with a monitoring camera and a microphone to record both images and sound. Unfortunately, the number of such sleep laboratories is limited in Japan because of the high equipment and labor costs and difficulties in the education and training of technologists. Since a PSG report directly contributes to the diagnosis of various sleep disorders, technologists have a heavy responsibility. It is necessary for the technologists to perform PSG appropriately and safely in order to obtain an accurate score. In this report, I will describe the standard procedure and scoring method from a technical viewpoint and the current position and status of PSG in Japan.
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Original Articles
  • Takanori KURATA, Satomi SHIBAHARA, Etsuko MIYAJIMA, Noriko TANAKA, Tak ...
    Article type: Original Article
    2016 Volume 65 Issue 1 Pages 12-17
    Published: January 25, 2016
    Released on J-STAGE: March 10, 2016
    JOURNAL FREE ACCESS
    Red blood cell distribution width (RDW) has recently been reported to be related to the prognosis of patients with myocardial infarction, heart failure, and old age. However, there have been few reports on the relationship between RDW and peripheral arterial disease (PAD). This study was performed to clarify the significance of RDW in the diagnosis of PAD and the prognosis of PAD patients. Two thousand forty-six patients over 40 years of age who underwent measurements of ankle/brachial pressure index (ABI) and RDW, hemoglobin (Hb) concentration, and mean corpuscular volume (MCV) from January 2009 to December 2013 were included in this study. The lower right or left ABI was recorded, and PAD was defined as ABI ≤ 0.90. The mean ABI was 1.05 ± 0.17, and the number of patients with ABI ≤ 0.90 (PAD patients) was 288 (14.1%). The mean RDW was 14.4 ± 1.7. There was a significant correlation between ABI and RDW (y = –0.012x + 1.227, x: RDW, y: ABI, R = 0.125, p < 0.0001). The age and RDW of PAD patients were significantly higher than those of non-PAD patients, and the Hb concentration of PAD patients was significantly lower than that of non-PAD patients. The age, RDW, and Hb concentration were significant independent factors related to ABI ≤ 0.90 in multivariate analysis. The overall survival (OS) of PAD patients was significantly lower than that of non-PAD patients; in addition, the OS of PAD patients with RDW ≥ 15.1 was significantly lower than that with RDW ≤ 15.0. This difference was remarkable in non-anemic patients. In conclusion, RDW is useful for the diagnosis and prognosis of PAD.
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  • Takeshi HASHIMOTO, Katsuyuki UMEBASHI, Masatomo TOMIZONO, Megumi TAKAN ...
    Article type: Original Article
    2016 Volume 65 Issue 1 Pages 18-24
    Published: January 25, 2016
    Released on J-STAGE: March 10, 2016
    JOURNAL FREE ACCESS
    Aortic regurgitation (AR) is a disease characterized by the regurgitation of blood into the left ventricle from the aorta, and it is important to assess the severity of AR because surgery is needed if the condition becomes serious. Ankle brachial pressure index (ABI) is frequently used for the screening of atherosclerosis obliterans, and it is reported to reach a pseudohigh level in patients with AR. The aim of this study was to compare between the ABI test and transthoracic echocardiography (TTE) in terms of usefulness in the evaluation of the severity of AR. The study population consisted of 85 patients (mean age of 70.2 ± 10.8 years; 60 males and 25 females) who were tested for ABI and whose severity of AR was assessed by TTE at around the same time. Ankle pulse pressure (p < 0.01) and ABI (p < 0.01) showed significant differences in relation to the severity of AR among the items measured using ABI. Ankle pulse pressure (r = 0.43, p < 0.01) and ABI (r = 0.45, p < 0.01) exhibited a positive correlation with %AR. Receiver operating characteristic (ROC) curve analysis showed that the cut-off value of ankle pulse pressure in a patient diagnosed with severe AR was 104 mmHg (AUC, 0.707; sensitivity, 73.7%; specificity, 78.8%), and ABI was 1.32 (AUC, 0.806; sensitivity, 68.4%; specificity, 80.3%). In this study, ankle pulse pressure and ABI are suggested to be associated with the severity of AR, and are considered to be useful for the evaluation of the severity of AR.
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  • Fumie MAEDA, Osamu YAMAMURA, Shinsaku UEDA, Tasuku SAITO, Muneichi SHI ...
    Article type: Original Article
    2016 Volume 65 Issue 1 Pages 25-31
    Published: January 25, 2016
    Released on J-STAGE: March 10, 2016
    JOURNAL FREE ACCESS
    After the Niigata Chuetsu earthquake and later in 2004, the incidence of deep vein thrombosis (DVT) in shelters has increased, and various studies have been conducted to investigate its occurrence and risk factors. Soleal vein dilatation is considered as a risk factor for DVT, but the risk factors for soleal vein dilatation are unknown. Here, we present the results of our DVT screening in individuals living in temporary housing after the Great East Japan Earthquake. During successive several days of September 2012 and 2013, we examined the risk factors for soleal vein dilatation in a total of 339 people who had moved to temporary housing in Watari-cho and Yamamoto-cho, Watari-gun, Miyagi Prefecture. After a background interview, each resident underwent ultrasonography in a sitting position using a portable device. Exploration for venous thrombosis of the popliteal vein and its distal veins was performed on both sides, and the maximum soleal vein diameter was measured. Vein dilatation (≥ 9.0 mm) was detected in 41 individuals. The prevalence of cardiac disease was significantly higher in the dilatation-positive group (18 patients, 44%) than in the dilatation-negative group (78 patients, 26%; p < 0.05). In the multiple logistic regression analysis, history of heart disease was an independent risk factor for soleal vein dilatation. Six patients (30%) in the DVT-positive group had soleal vein dilatation; the Prevalence rate of dilatation was significantly higher than that in the DVT-negative group (35 patients, 11%; p < 0.05). Thus, soleal vein dilatation was a significant risk factor for DVT. Collectively, the measurement of soleal vein diameter may be useful for generally evaluating risk status for DVT incidence and possible prevalence of heart disease in individuals living in disaster-affected areas.
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  • Tsukasa NOZAKI, Hiroyasu MASE, Yumiko TANAKA, Shinichi YAMAZAKI, Takay ...
    Article type: Original Article
    2016 Volume 65 Issue 1 Pages 32-37
    Published: January 25, 2016
    Released on J-STAGE: March 10, 2016
    JOURNAL FREE ACCESS
    We have developed a novel method for quality control of monitoring technical errors in examiners in the microscopic examination of red blood cells in urine sediment. This method is based on the relative ratio of the results determined by medical technologists to those of corresponding urine occult blood analysis in any patient population examined, allowing us to evaluate inter- and intra-examiner variabilities. When it was implemented in laboratory practice on a monthly basis, the coefficients of variation among technologists decreased from 12.4–14.1% to 7.4–10.0% after one year, proving its effectiveness. The novel method for quality control requires neither special equipment nor applications and thus can be easily implemented in daily laboratory practice.
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  • Shunsuke SUZUKI, Maki NAITOU, Naoki HIRAMATSU, Shinichi NISHIKAWA, Aki ...
    Article type: Original Article
    2016 Volume 65 Issue 1 Pages 38-44
    Published: January 25, 2016
    Released on J-STAGE: March 10, 2016
    JOURNAL FREE ACCESS
    BNP concentration is highly reliable for assessing objectively the severity of heart failure (HF) and has been widely used as a biomarker to assess and monitor the severity of HF both at rest and during exercise. In contrast, transthoracic echocardiography (TTE) has been widely used for noninvasive assessment of the hemodynamical severity of HF. In this study, we demonstrate whether BNP concentration measured on the same day as TTE is useful for assessing the severity of HF in comparison with echo parameters, including the estimated pulmonary artery systolic pressure (PASP). Four hundred seventy-six consecutive patients with chronic HF who underwent TTE and blood sampling at the same time were recruited. Significant independent echo variables such as PASP were extracted using a multivariate logistic regression model with a dependent variable, namely, BNP concentration divided by the median. One-way analysis of variance (ANOVA) was performed on the extracted significant variables for the BNP category. Significant factors such as PASP and E/A were extracted. As the severity of each significant factor increased, BNP concentrations concomitantly increased, and the result of ANOVA showed that the BNP concentrations were higher in the other groups than in control group (1st quartile group). As the severity of HF in relation to BMI increased, BNP concentration decreased significantly in comparison with the control group. BNP concentrations are closely related to the estimated PASP, which objectively reflects the severity of HF. Therefore, we conclude that BNP concentration is an excellent biomarker for assessing and monitoring the severity of HF.
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  • Hitomi HASEGAWA, Akiyoshi SAKAI, Sayori NAKASHIMA
    Article type: Original Article
    2016 Volume 65 Issue 1 Pages 45-50
    Published: January 25, 2016
    Released on J-STAGE: March 10, 2016
    JOURNAL FREE ACCESS
    We have analyzed chronic hepatitis C virus (HCV) genotype, amino acid substitutions at positions 70 and 91 of the HCV core region (core aa 70 and core aa 91), the number of interferon-sensitivity-determining region (ISDR) mutations since December 2009, and drug resistance mutations in nonstructural (NS) 3 and NS5A since September 2014. In this study, we gathered the analysis results. Genotyping was as follows (n = 315): 1a: 3 (1.0%), 1b: 192 (61.0%), 2a: 80 (25.4%), 2b: 33 (10.5%), 3a: 1 (0.3%), 3b: 1 (0.3%), and mixed type: 5 (1.6%). Of 192 HCV-1b samples, 156 were analyzed in terms of core aa 70, core aa 91, and ISDR mutations. There were mutations in 60 samples at core aa 70 (38.5%) and in 48 samples at core aa 91 (30.8%). The samples with ISDR mutations of the wild (no mutation), intermediate (1–3 mutations), and mutant (≥ 4 mutations) types were 66 (42.3%), 77 (49.4%), and 13 (8.3%), respectively. Thirty-six of 94 samples at NS3 and 23 of 94 samples at NS5A showed drug resistance mutations (38.3% and 24.5%, respectively). A more detailed effect prediction of HCV treatment was enabled by these genomic analyses.
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Case Reports
  • Tomotaka CHIKAOKA, Hitoshi SOMA, Hiroshi KAWAHIRA, Hiroshi TANAKA, Shu ...
    Article type: Case Report
    2016 Volume 65 Issue 1 Pages 51-54
    Published: January 25, 2016
    Released on J-STAGE: March 10, 2016
    JOURNAL FREE ACCESS
    A 67-year-old male was admitted to our hospital in November 2011 for treatment of hepatocellular carcinoma (HCC). He was repeatedly hospitalized owing to HCC recurrence. During this time, early gastric carcinoma and esophageal varix were also found and he had Helicobacter pylori eradication therapy. Ten months after the eradication therapy, in May 2013, severe anemia (Hb level, 6.9 g/dL) due to upper gastrointestinal hemorrhage was observed; thus, blood transfusion was carried out. Detailed examination was carried out after the screening for antibodies revealed this time positive results. He had warm-reactive irregular antibodies, and a direct antiglobulin test revealed the existence of anti-erythrocyte antibodies. Furthermore, the haptoglobin level was < 10 mg/dL. Given all these symptoms, his condition was considered to be autoimmune hemolytic anemia in addition to upper gastrointestinal hemorrhage. We studied the critical causes of all the symptoms. We found that in the past, he had allergic reactions to Takepron, such as rubefaction; thus, he stopped taking it. During the Helicobacter pylori eradication therapy, he took Lansap, which contains Takepron; after which, his hemoglobin level decreased. Later on, Takepron was not administered and his anemia gradually improved. Twenty months after taking Lansap, both direct and indirect antiglobulin tests showed negative results. On the basis of the above findings, this case was considered to be Takepron-induced autoimmune hemolytic anemia.
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  • Eri MARUYAMA, Minoru SATO, Hiroshi KOMATSU, Hitoshi SHIBUYA, Chikara S ...
    Article type: Case Report
    2016 Volume 65 Issue 1 Pages 55-63
    Published: January 25, 2016
    Released on J-STAGE: March 10, 2016
    JOURNAL FREE ACCESS
    A 65-year-old man underwent surgery for implantable cardioverter defibrillator (ICD) placement for idiopathic ventricular fibrillation (VF) in May 2011. In September 2012, he suddenly lost consciousness at rest but recovered spontaneously by himself. This was his first episode of unconsciousness after ICD placement. After admission, VF, which was terminated by ICD shocks, was recorded by a 12-lead Holter electrocardiogram (ECG). The QRS complexes of premature ventricular contraction (PVC) that triggered VF showed a left bundle branch block pattern with a superior axis; thus, the origin of PVC was suspected to be in the inferior wall of the right ventricle. Catheter ablation (ABL) targeting to trigger PVC was performed immediately. After ABL, VF was cured. For the evaluation of the efficacy of ABL, plot analyses of coupling interval (CI) and RR interval preceding PVC were performed before and after ABL. In comparison with the regression line before and after ABL, the gradient after ABL apparently became steeper than before ABL. In addition, by analyzing the ratio of CI to RR interval preceding PVC in temporal axes, many PVCs with small ratios and a long RR interval preceding PVC were observed just before the onset of VF, suggesting that such repeated stimulations led to the onset of VF. In conclusion, 12-lead Holter ECG is helpful for determining the origin of PVC that triggers VF. Plot analyses of CI and RR interval preceding PVC seemed to be useful for estimating the efficacy of ABL treatment and the mechanism of VF onset.
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  • Kana JOO, Yuya ARAKAWA, Yoriko NOGUCHI, Yoko OKAZAKI, Itsuko SATO, Yuj ...
    Article type: Case Report
    2016 Volume 65 Issue 1 Pages 64-69
    Published: January 25, 2016
    Released on J-STAGE: March 10, 2016
    JOURNAL FREE ACCESS
    Cholinesterases (ChEs) are enzymes that catalyze the hydrolysis of acetylcholine to choline and acetic acid. There are two types of cholinesterase, acetylcholinesterase (intrinsic AChE) and butyrylcholinesterase (pseudo-ChE or BChE). AChE hydrolyzes only acetylcholine. However, BChE, also known as pseudocholinesterase, is a nonspecific cholinesterase that hydrolyzes many different choline esters. BChE is generally used in reference to a clinical test that reflects the levels of ChE in the blood. An assay of BChE activity in the plasma can be used as a liver function test. Hereditary BChE deficiencies have been reported. Hydrolysis of succinylcholine, a muscle relaxant drug, is slow in patients with BChE deficiency. Therefore, BChE deficiency poses a risk of long-term apnea. We performed a genetic analysis in a patient with BChE deficiency. In the genetic analysis, we found an insert of homozygous A at codon 315 of Exon 2 of the BChE gene. Therefore, it was found that the stop codon is generated at codon 322 (p.Thr315Asnfsx7).
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Technical Articles
  • Yuri KOBAYASHI, Tsutomu ISHIZUKA, Mineko YASUO, Hitomi MIURA, Kazuhiro ...
    Article type: Technical Article
    2016 Volume 65 Issue 1 Pages 70-77
    Published: January 25, 2016
    Released on J-STAGE: March 10, 2016
    JOURNAL FREE ACCESS
    In renal transplantation, it is immunologically critical to detect donor-specific HLA antibodies (DSA) at a highly sensitive level before transplantation to avoid antibody-mediated acute rejection. We conducted basic research on refining the conventional flow cytometry lymphocyte crossmatch-IgG (FCXM-IgG) test to detect HLA antibodies at a highly sensitive level and on standardizing this novel procedure. We measured the levels of FCXM-IgG and LABScreen single-IgG using human donor lymphocytes in serum samples of 78 renal transplant recipients who visited the outpatient clinic of the Department of Surgery III at Tokyo Women’s Medical University. The correlation coefficients between FCXM-IgG MFI level and LABScreen single-IgG nMFI level were as good as about 0.8 for both B and T cells. These coefficients measured in linear values were almost equal to those measured in channel values. Even if we consider that the LABScreen single-IgG level could be affected by the coexistence of natural antibodies to some extent, we demonstrated in this study that the measured levels of FCXM-IgG and LABScreen single-IgG with fluorescence intensity correlated well with each other.
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  • Shigenobu TATSUMI, Takeshi NISHIKAWA, Hisae SUZUKI, Mao TAKEUCHI, Kaor ...
    Article type: Technical Article
    2016 Volume 65 Issue 1 Pages 78-83
    Published: January 25, 2016
    Released on J-STAGE: March 10, 2016
    JOURNAL FREE ACCESS
    It is difficult to distinguish clearly the color contrast between the cytoplasm and collagen fibers by collagen fiber staining methods such as AZAN staining if tissues are treated only with formalin. To settle this, a mordant with a mixture of equal amounts of 10% potassium dichromate and 10% trichloroacetic acid was considered, and it is generally utilized at present. However, it is necessary to develop a substitute mordant because potassium dichromate is a hazardous reagent. Thus, we examined the usefulness of other mordants in AZAN staining. As a result, we were able to clearly distinguish between the cytoplasm and collagen fibers when we used Bouin’s fluid or only a picric acid-saturated aqueous solution as the mordant. Bouin’s fluid includes formalin, which is regulated by the Ordinance on Prevention of Hazards due to Specified Chemical Substances, and has the problem of being a chemical hazard. Therefore, in AZAN staining, the use of picric acid at 60°C for 30 min may replace the traditional use of a mixture of equal amounts of 10% potassium dichromate and 10% trichloroacetic acid. Moreover, the widespread use of this method is desired because it is safer and shows better stainability.
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  • Maiko SHIBATA, Hiroyasu MASE, Takayuki SASOU, Tsukasa NOZAKI, Yutaka S ...
    Article type: Technical Article
    2016 Volume 65 Issue 1 Pages 84-90
    Published: January 25, 2016
    Released on J-STAGE: March 10, 2016
    JOURNAL FREE ACCESS
    Blood hemoglobin A1c (HbA1c) level is widely used as an important parameter for the medical care of diabetes patients. We evaluated the measurement performance of a new HbA1c analyzer based on high-performance liquid chromatography (HPLC: HLC-723 G11, Toso Co., Ltd.). Within-run and day-to-day-run reproducibilities were 0.00 to 0.01% and 0.70 to 0.84%, respectively, in coefficient of variation. Correlation with DM-JACK II was y = 1.043x − 0.23, r ‍= 0.990. There was no interference when adding substances such as bilirubin C and F and chyle. Extremely high concentrations of modified hemoglobin caused interference. In conclusion, the HbA1c measurement performance of HLC-723 G11 has been proven satisfactory as it rapidly provides reliable results for the daily care of diabetes patients.
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  • Naomi YOSHINO, Eri YAMADA, Kenzo ENDA, Hisashi BABA, Yoshitsugu IINUMA
    Article type: Technical Article
    2016 Volume 65 Issue 1 Pages 91-97
    Published: January 25, 2016
    Released on J-STAGE: March 10, 2016
    JOURNAL FREE ACCESS
    The hepatitis B virus (HBV) surface antigen (HBsAg) is a secreted envelope glycoprotein of HBV. Although a qualitative test of HBsAg is important in the diagnosis of HBV infection, a quantitative assay of HBsAg has recently been used for monitoring during the treatment of chronic HBV infection as well as for the prediction of clinical responses. In this study, we evaluated the new quantitative reagent Lumipulse HBsAg-HQ in terms of its fundamental performance in the testing of HBsAg. Lumipulse HBsAg-HQ showed good performance in terms of within-run and between-day reproducibility and stability against coexistent substances. Compared with the conventional reagent Lumipulse II HBsAg, concordant results were obtained in 98.6% (205/208) of tested samples. The results of an inhibition assay using three samples with discrepant results between the two reagents suggested that Lumipulse HBsAg-HQ showed improved sensitivity. Thus, our data suggest that Lumipulse HBsAg-HQ could provide more accurate and useful information on the HBsAg status for clinicians than Lumipulse II HBsAg.
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  • Miyuki YAMADA, Tomoyo ABE, Naohito SATO, Tomoaki SATO, Keita MORIKANE
    Article type: Technical Article
    2016 Volume 65 Issue 1 Pages 98-102
    Published: January 25, 2016
    Released on J-STAGE: March 10, 2016
    JOURNAL FREE ACCESS
    We compared the hepatitis B virus surface antigen (HBsAg) assay using HISCL-2000i (HISCL) with those using Architect (Arc) and Lumipulse Prest II (Lum). Good results were obtained using the HISCL assay in terms of simultaneous repeatability, daily precision and minimum detection level. Microfibrin contained in the specimen affected the accuracy of the value obtained using the Lum assay, but not those obtained using the HISCL and Arc assays. The correlation of the values obtained using the HISCL and Arc assays was generally consistent. However, the values obtained using the HISCL assay tend to be higher than those obtained using the Lum assay for the specimens with low HBsAg concentrations, whereas those obtained using the HISCL assay tend to be lower for the specimen with high HBsAg concentrations, suggesting the effect of dilution. In the HBsAg mutant detection test, the detection rate was 100% with the HISCL assay, and the Arc assay could detect all 22 HBsAg mutants tested, but the Lum assay could detect all except the mutant of D144-G145R. These results suggest that the HISCL assay is both sensitive and specific, with the capability to detect various types of HBsAg mutant.
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Materials
  • Kazuhito SHIRAISHI, Yayoi ONISHI, Yoshimasa KONDOU, Namie NAKATA, Naom ...
    Article type: Material
    2016 Volume 65 Issue 1 Pages 103-109
    Published: January 25, 2016
    Released on J-STAGE: March 10, 2016
    JOURNAL FREE ACCESS
    Abdominal ultrasonography is conducted as a medical examination procedure in numerous institutes. However, only a few institutes compile abdominal ultrasonography results and make a detailed report about them. Therefore, we collected such results for a year at Imabari Saiseikai Hospital to obtain the trends and frequencies of various diseases and determine the current status of abdominal ultrasonography in medical examination. As a result, abnormalities or normal variations were found with a high frequency (86.7%). Examination of internal organs, such as the liver, kidney and gallbladder, accounted for about 80% of all medical examinations. By gender, more males have fatty liver, gallbladder polyps and renal cysts than females. In particular, fatty liver was found in about 50% of all male medical examinees. The result also showed that gallbladder stones are significantly more frequently detected in females over the age of 60. Moreover, in both men and women, the number of cystic lesions (liver cysts and renal cysts) increases with age. Only two patients (0.11%) were found to have a malignant disease, which is a low frequency. From the collected results, most of the medical examinees did not have subjective symptoms, although they showed a high frequency of some abnormal findings or normal variations, which were mostly caused by an unhealthy lifestyle. The results are useful as a guide and ultrasonography will continue to be used in medical examination as it is noninvasive.
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  • Junko ANDOU, Takuo KANAHARA, Masanori OGOU, Kuniki TAKAMATSU
    Article type: Material
    2016 Volume 65 Issue 1 Pages 110-114
    Published: January 25, 2016
    Released on J-STAGE: March 10, 2016
    JOURNAL FREE ACCESS
    Multifocus virtual slides show images that are generated by digitalizing specimens on glass slides. Since the sample components can be observed in three dimensions by changing the depth of focus, it is possible to perform an evaluation similarly to actual microscopy observation. In this study, we examined students who completed a two-week general laboratory practice in our hospital. Both photographs and multifocus virtual slides of the same components of urine sediments were presented to the students. We tried to confirm the utility of the multifocus virtual slides by comparing the accuracy rate between both methods. The accuracy rate was higher for the multifocus virtual slides than for the photographs because the students can easily discriminate the thickness of the components, the material contained in the casts, and the brightness of fat globules by changing the focus. The multifocus virtual slides were proven to be efficacious. However, it is also important to observe the urine sediments under direct visual examination using a microscope, since there are some problems such as the difficulty of determining the cell size in a single application of this method. It is concluded that providing good tips on cell observation through combinational learning from the early years of education may increase the educational effectiveness.
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