External Quality Assessment of MERS-CoV Molecular Diagnostics During the 2015 Korean Outbreak
Identifieur interne : 000079 ( Pmc/Curation ); précédent : 000078; suivant : 000080External Quality Assessment of MERS-CoV Molecular Diagnostics During the 2015 Korean Outbreak
Auteurs : Moon-Woo Seong [Corée du Sud] ; Seung Jun Lee [Corée du Sud] ; Sung Im Cho [Corée du Sud] ; Kyungphil Ko [Corée du Sud] ; Mi-Na Kim [Corée du Sud] ; Heungsub Sung [Corée du Sud] ; Jae-Seok Kim [Corée du Sud] ; Ji Soo Ahn [Corée du Sud] ; Byung Su Yu [Corée du Sud] ; Taek Soo Kim [Corée du Sud] ; Eui Chong Kim [Corée du Sud] ; Sung Sup Park [Corée du Sud]Source :
- Annals of Laboratory Medicine [ 2234-3806 ] ; 2015.
Abstract
The largest outbreak of Middle East respiratory syndrome coronavirus (MERS-CoV) infection outside Middle East Asia in 2015 has necessitated the rapid expansion of laboratories that conduct MERS-CoV molecular testing in Korea, together with external quality assessment (EQA) to evaluate the assays used.
The EQA program consisted of two phases; self-validation and blind assessment. For the first EQA phase,
The first EQA phase results for 46 participants showed a linear relationship between the threshold cycle (CT) values of RNA materials and the logarithmic concentrations for both upE and ORF1a gene targets (R2=0.73 and 0.75, respectively). The mean CT value for each concentration was different depending on which commercial kit was used for the assay. Among the three commonly used kits, PowerChek MERS Real-Time PCR kit (KogeneBiotech, Korea) showed the lowest CT values at all concentrations of upE and most concentrations of ORF1a. The second EQA phase results for 47 participants were 100% correct for all tested samples.
This EQA survey demonstrates that the MERS-CoV molecular testing performed in Korea during the 2015 outbreak is of robust capability. However, careful establishment and validation of a cut-off value are recommended to ensure good analytical sensitivity.
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DOI: 10.3343/alm.2016.36.3.230
PubMed: 26915611
PubMed Central: 4773263
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">External Quality Assessment of MERS-CoV Molecular Diagnostics During the 2015 Korean Outbreak</title><author><name sortKey="Seong, Moon Woo" sort="Seong, Moon Woo" uniqKey="Seong M" first="Moon-Woo" last="Seong">Moon-Woo Seong</name><affiliation wicri:level="1"><nlm:aff id="A1">Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea.</nlm:aff><country xml:lang="fr" wicri:curation="lc">Corée du Sud</country><wicri:regionArea>Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul</wicri:regionArea></affiliation></author><author><name sortKey="Lee, Seung Jun" sort="Lee, Seung Jun" uniqKey="Lee S" first="Seung Jun" last="Lee">Seung Jun Lee</name><affiliation wicri:level="1"><nlm:aff id="A1">Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea.</nlm:aff><country xml:lang="fr" wicri:curation="lc">Corée du Sud</country><wicri:regionArea>Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul</wicri:regionArea></affiliation></author><author><name sortKey="Cho, Sung Im" sort="Cho, Sung Im" uniqKey="Cho S" first="Sung Im" last="Cho">Sung Im Cho</name><affiliation wicri:level="1"><nlm:aff id="A1">Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea.</nlm:aff><country xml:lang="fr" wicri:curation="lc">Corée du Sud</country><wicri:regionArea>Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul</wicri:regionArea></affiliation></author><author><name sortKey="Ko, Kyungphil" sort="Ko, Kyungphil" uniqKey="Ko K" first="Kyungphil" last="Ko">Kyungphil Ko</name><affiliation wicri:level="1"><nlm:aff id="A1">Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea.</nlm:aff><country xml:lang="fr" wicri:curation="lc">Corée du Sud</country><wicri:regionArea>Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul</wicri:regionArea></affiliation></author><author><name sortKey="Kim, Mi Na" sort="Kim, Mi Na" uniqKey="Kim M" first="Mi-Na" last="Kim">Mi-Na Kim</name><affiliation wicri:level="1"><nlm:aff id="A2">Department of Laboratory Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.</nlm:aff><country xml:lang="fr" wicri:curation="lc">Corée du Sud</country><wicri:regionArea>Department of Laboratory Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul</wicri:regionArea></affiliation></author><author><name sortKey="Sung, Heungsub" sort="Sung, Heungsub" uniqKey="Sung H" first="Heungsub" last="Sung">Heungsub Sung</name><affiliation wicri:level="1"><nlm:aff id="A2">Department of Laboratory Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.</nlm:aff><country xml:lang="fr" wicri:curation="lc">Corée du Sud</country><wicri:regionArea>Department of Laboratory Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul</wicri:regionArea></affiliation></author><author><name sortKey="Kim, Jae Seok" sort="Kim, Jae Seok" uniqKey="Kim J" first="Jae-Seok" last="Kim">Jae-Seok Kim</name><affiliation wicri:level="1"><nlm:aff id="A3">Department of Laboratory Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea.</nlm:aff><country xml:lang="fr" wicri:curation="lc">Corée du Sud</country><wicri:regionArea>Department of Laboratory Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul</wicri:regionArea></affiliation></author><author><name sortKey="Ahn, Ji Soo" sort="Ahn, Ji Soo" uniqKey="Ahn J" first="Ji Soo" last="Ahn">Ji Soo Ahn</name><affiliation wicri:level="1"><nlm:aff id="A1">Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea.</nlm:aff><country xml:lang="fr" wicri:curation="lc">Corée du Sud</country><wicri:regionArea>Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul</wicri:regionArea></affiliation></author><author><name sortKey="Yu, Byung Su" sort="Yu, Byung Su" uniqKey="Yu B" first="Byung Su" last="Yu">Byung Su Yu</name><affiliation wicri:level="1"><nlm:aff id="A1">Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea.</nlm:aff><country xml:lang="fr" wicri:curation="lc">Corée du Sud</country><wicri:regionArea>Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul</wicri:regionArea></affiliation></author><author><name sortKey="Kim, Taek Soo" sort="Kim, Taek Soo" uniqKey="Kim T" first="Taek Soo" last="Kim">Taek Soo Kim</name><affiliation wicri:level="1"><nlm:aff id="A1">Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea.</nlm:aff><country xml:lang="fr" wicri:curation="lc">Corée du Sud</country><wicri:regionArea>Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul</wicri:regionArea></affiliation></author><author><name sortKey="Kim, Eui Chong" sort="Kim, Eui Chong" uniqKey="Kim E" first="Eui Chong" last="Kim">Eui Chong Kim</name><affiliation wicri:level="1"><nlm:aff id="A1">Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea.</nlm:aff><country xml:lang="fr" wicri:curation="lc">Corée du Sud</country><wicri:regionArea>Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul</wicri:regionArea></affiliation></author><author><name sortKey="Park, Sung Sup" sort="Park, Sung Sup" uniqKey="Park S" first="Sung Sup" last="Park">Sung Sup Park</name><affiliation wicri:level="1"><nlm:aff id="A1">Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea.</nlm:aff><country xml:lang="fr" wicri:curation="lc">Corée du Sud</country><wicri:regionArea>Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul</wicri:regionArea></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">26915611</idno><idno type="pmc">4773263</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4773263</idno><idno type="RBID">PMC:4773263</idno><idno type="doi">10.3343/alm.2016.36.3.230</idno><date when="2015">2015</date><idno type="wicri:Area/Pmc/Corpus">000079</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000079</idno><idno type="wicri:Area/Pmc/Curation">000079</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Curation">000079</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">External Quality Assessment of MERS-CoV Molecular Diagnostics During the 2015 Korean Outbreak</title><author><name sortKey="Seong, Moon Woo" sort="Seong, Moon Woo" uniqKey="Seong M" first="Moon-Woo" last="Seong">Moon-Woo Seong</name><affiliation wicri:level="1"><nlm:aff id="A1">Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea.</nlm:aff><country xml:lang="fr" wicri:curation="lc">Corée du Sud</country><wicri:regionArea>Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul</wicri:regionArea></affiliation></author><author><name sortKey="Lee, Seung Jun" sort="Lee, Seung Jun" uniqKey="Lee S" first="Seung Jun" last="Lee">Seung Jun Lee</name><affiliation wicri:level="1"><nlm:aff id="A1">Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea.</nlm:aff><country xml:lang="fr" wicri:curation="lc">Corée du Sud</country><wicri:regionArea>Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul</wicri:regionArea></affiliation></author><author><name sortKey="Cho, Sung Im" sort="Cho, Sung Im" uniqKey="Cho S" first="Sung Im" last="Cho">Sung Im Cho</name><affiliation wicri:level="1"><nlm:aff id="A1">Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea.</nlm:aff><country xml:lang="fr" wicri:curation="lc">Corée du Sud</country><wicri:regionArea>Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul</wicri:regionArea></affiliation></author><author><name sortKey="Ko, Kyungphil" sort="Ko, Kyungphil" uniqKey="Ko K" first="Kyungphil" last="Ko">Kyungphil Ko</name><affiliation wicri:level="1"><nlm:aff id="A1">Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea.</nlm:aff><country xml:lang="fr" wicri:curation="lc">Corée du Sud</country><wicri:regionArea>Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul</wicri:regionArea></affiliation></author><author><name sortKey="Kim, Mi Na" sort="Kim, Mi Na" uniqKey="Kim M" first="Mi-Na" last="Kim">Mi-Na Kim</name><affiliation wicri:level="1"><nlm:aff id="A2">Department of Laboratory Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.</nlm:aff><country xml:lang="fr" wicri:curation="lc">Corée du Sud</country><wicri:regionArea>Department of Laboratory Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul</wicri:regionArea></affiliation></author><author><name sortKey="Sung, Heungsub" sort="Sung, Heungsub" uniqKey="Sung H" first="Heungsub" last="Sung">Heungsub Sung</name><affiliation wicri:level="1"><nlm:aff id="A2">Department of Laboratory Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.</nlm:aff><country xml:lang="fr" wicri:curation="lc">Corée du Sud</country><wicri:regionArea>Department of Laboratory Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul</wicri:regionArea></affiliation></author><author><name sortKey="Kim, Jae Seok" sort="Kim, Jae Seok" uniqKey="Kim J" first="Jae-Seok" last="Kim">Jae-Seok Kim</name><affiliation wicri:level="1"><nlm:aff id="A3">Department of Laboratory Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea.</nlm:aff><country xml:lang="fr" wicri:curation="lc">Corée du Sud</country><wicri:regionArea>Department of Laboratory Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul</wicri:regionArea></affiliation></author><author><name sortKey="Ahn, Ji Soo" sort="Ahn, Ji Soo" uniqKey="Ahn J" first="Ji Soo" last="Ahn">Ji Soo Ahn</name><affiliation wicri:level="1"><nlm:aff id="A1">Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea.</nlm:aff><country xml:lang="fr" wicri:curation="lc">Corée du Sud</country><wicri:regionArea>Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul</wicri:regionArea></affiliation></author><author><name sortKey="Yu, Byung Su" sort="Yu, Byung Su" uniqKey="Yu B" first="Byung Su" last="Yu">Byung Su Yu</name><affiliation wicri:level="1"><nlm:aff id="A1">Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea.</nlm:aff><country xml:lang="fr" wicri:curation="lc">Corée du Sud</country><wicri:regionArea>Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul</wicri:regionArea></affiliation></author><author><name sortKey="Kim, Taek Soo" sort="Kim, Taek Soo" uniqKey="Kim T" first="Taek Soo" last="Kim">Taek Soo Kim</name><affiliation wicri:level="1"><nlm:aff id="A1">Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea.</nlm:aff><country xml:lang="fr" wicri:curation="lc">Corée du Sud</country><wicri:regionArea>Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul</wicri:regionArea></affiliation></author><author><name sortKey="Kim, Eui Chong" sort="Kim, Eui Chong" uniqKey="Kim E" first="Eui Chong" last="Kim">Eui Chong Kim</name><affiliation wicri:level="1"><nlm:aff id="A1">Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea.</nlm:aff><country xml:lang="fr" wicri:curation="lc">Corée du Sud</country><wicri:regionArea>Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul</wicri:regionArea></affiliation></author><author><name sortKey="Park, Sung Sup" sort="Park, Sung Sup" uniqKey="Park S" first="Sung Sup" last="Park">Sung Sup Park</name><affiliation wicri:level="1"><nlm:aff id="A1">Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea.</nlm:aff><country xml:lang="fr" wicri:curation="lc">Corée du Sud</country><wicri:regionArea>Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul</wicri:regionArea></affiliation></author></analytic><series><title level="j">Annals of Laboratory Medicine</title><idno type="ISSN">2234-3806</idno><idno type="eISSN">2234-3814</idno><imprint><date when="2015">2015</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Background</title><p>The largest outbreak of Middle East respiratory syndrome coronavirus (MERS-CoV) infection outside Middle East Asia in 2015 has necessitated the rapid expansion of laboratories that conduct MERS-CoV molecular testing in Korea, together with external quality assessment (EQA) to evaluate the assays used.</p></sec><sec><title>Methods</title><p>The EQA program consisted of two phases; self-validation and blind assessment. For the first EQA phase, <italic>in vitro</italic> transcribed upstream region of the envelope gene (upE) and the open reading frame (ORF)1a RNAs were used at a concentration of 1,000 copies/µL. The test panel for the second EQA phase consisted of RNA extracts from three samples, which were obtained from two MERS-CoV positive patients and one MERS-CoV negative patient.</p></sec><sec><title>Results</title><p>The first EQA phase results for 46 participants showed a linear relationship between the threshold cycle (C<sub>T</sub>) values of RNA materials and the logarithmic concentrations for both upE and ORF1a gene targets (R<sup>2</sup>=0.73 and 0.75, respectively). The mean C<sub>T</sub> value for each concentration was different depending on which commercial kit was used for the assay. Among the three commonly used kits, PowerChek MERS Real-Time PCR kit (KogeneBiotech, Korea) showed the lowest C<sub>T</sub> values at all concentrations of upE and most concentrations of ORF1a. The second EQA phase results for 47 participants were 100% correct for all tested samples.</p></sec><sec><title>Conclusions</title><p>This EQA survey demonstrates that the MERS-CoV molecular testing performed in Korea during the 2015 outbreak is of robust capability. However, careful establishment and validation of a cut-off value are recommended to ensure good analytical sensitivity.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Van Boheemen, S" uniqKey="Van Boheemen S">S van Boheemen</name></author><author><name sortKey="De Graaf, M" uniqKey="De Graaf M">M de Graaf</name></author><author><name sortKey="Lauber, C" uniqKey="Lauber C">C Lauber</name></author><author><name sortKey="Bestebroer, Tm" uniqKey="Bestebroer T">TM Bestebroer</name></author><author><name sortKey="Raj, Vs" uniqKey="Raj V">VS Raj</name></author><author><name sortKey="Zaki, Am" uniqKey="Zaki A">AM Zaki</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Zaki, Am" uniqKey="Zaki A">AM Zaki</name></author><author><name sortKey="Van Boheemen, S" uniqKey="Van Boheemen S">S van Boheemen</name></author><author><name sortKey="Bestebroer, Tm" uniqKey="Bestebroer T">TM Bestebroer</name></author><author><name sortKey="Osterhaus, Ad" uniqKey="Osterhaus A">AD Osterhaus</name></author><author><name sortKey="Fouchier, Ra" uniqKey="Fouchier R">RA Fouchier</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Corman, Vm" uniqKey="Corman V">VM Corman</name></author><author><name sortKey="Eckerle, I" uniqKey="Eckerle I">I Eckerle</name></author><author><name sortKey="Bleicker, T" uniqKey="Bleicker T">T Bleicker</name></author><author><name sortKey="Zaki, A" uniqKey="Zaki A">A Zaki</name></author><author><name sortKey="Landt, O" uniqKey="Landt O">O Landt</name></author><author><name sortKey="Eschbach Bludau, M" uniqKey="Eschbach Bludau M">M Eschbach-Bludau</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Corman, Vm" uniqKey="Corman V">VM Corman</name></author><author><name sortKey="Muller, Ma" uniqKey="Muller M">MA Muller</name></author><author><name sortKey="Costabel, U" uniqKey="Costabel U">U Costabel</name></author><author><name sortKey="Timm, J" uniqKey="Timm J">J Timm</name></author><author><name sortKey="Binger, T" uniqKey="Binger T">T Binger</name></author><author><name sortKey="Meyer, B" uniqKey="Meyer B">B Meyer</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Pas, Sd" uniqKey="Pas S">SD Pas</name></author><author><name sortKey="Patel, P" uniqKey="Patel P">P Patel</name></author><author><name sortKey="Reusken, C" uniqKey="Reusken C">C Reusken</name></author><author><name sortKey="Domingo, C" uniqKey="Domingo C">C Domingo</name></author><author><name sortKey="Corman, Vm" uniqKey="Corman V">VM Corman</name></author><author><name sortKey="Drosten, C" uniqKey="Drosten C">C Drosten</name></author></analytic></biblStruct></listBibl></div1></back></TEI><pmc article-type="research-article"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">Ann Lab Med</journal-id><journal-id journal-id-type="iso-abbrev">Ann Lab Med</journal-id><journal-id journal-id-type="publisher-id">ALM</journal-id><journal-title-group><journal-title>Annals of Laboratory Medicine</journal-title></journal-title-group><issn pub-type="ppub">2234-3806</issn><issn pub-type="epub">2234-3814</issn><publisher><publisher-name>The Korean Society for Laboratory Medicine</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">26915611</article-id><article-id pub-id-type="pmc">4773263</article-id><article-id pub-id-type="doi">10.3343/alm.2016.36.3.230</article-id><article-categories><subj-group subj-group-type="heading"><subject>Original Article</subject><subj-group subj-group-type="subheading"><subject>Clinical Microbiology</subject></subj-group></subj-group></article-categories><title-group><article-title>External Quality Assessment of MERS-CoV Molecular Diagnostics During the 2015 Korean Outbreak</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Seong</surname><given-names>Moon-Woo</given-names></name><degrees>M.D.</degrees><xref ref-type="aff" rid="A1">1</xref></contrib><contrib contrib-type="author"><name><surname>Lee</surname><given-names>Seung Jun</given-names></name><degrees>M.D.</degrees><xref ref-type="aff" rid="A1">1</xref></contrib><contrib contrib-type="author"><name><surname>Cho</surname><given-names>Sung Im</given-names></name><degrees>M.S.</degrees><xref ref-type="aff" rid="A1">1</xref></contrib><contrib contrib-type="author"><name><surname>Ko</surname><given-names>Kyungphil</given-names></name><degrees>M.T.</degrees><xref ref-type="aff" rid="A1">1</xref></contrib><contrib contrib-type="author"><name><surname>Kim</surname><given-names>Mi-Na</given-names></name><degrees>M.D.</degrees><xref ref-type="aff" rid="A2">2</xref></contrib><contrib contrib-type="author"><name><surname>Sung</surname><given-names>Heungsub</given-names></name><degrees>M.D.</degrees><xref ref-type="aff" rid="A2">2</xref></contrib><contrib contrib-type="author"><name><surname>Kim</surname><given-names>Jae-Seok</given-names></name><degrees>M.D.</degrees><xref ref-type="aff" rid="A3">3</xref></contrib><contrib contrib-type="author"><name><surname>Ahn</surname><given-names>Ji Soo</given-names></name><degrees>M.T.</degrees><xref ref-type="aff" rid="A1">1</xref></contrib><contrib contrib-type="author"><name><surname>Yu</surname><given-names>Byung Su</given-names></name><degrees>M.T.</degrees><xref ref-type="aff" rid="A1">1</xref></contrib><contrib contrib-type="author"><name><surname>Kim</surname><given-names>Taek Soo</given-names></name><degrees>M.D.</degrees><xref ref-type="aff" rid="A1">1</xref></contrib><contrib contrib-type="author"><name><surname>Kim</surname><given-names>Eui Chong</given-names></name><degrees>M.D.</degrees><xref ref-type="aff" rid="A1">1</xref></contrib><contrib contrib-type="author" corresp="yes"><name><surname>Park</surname><given-names>Sung Sup</given-names></name><degrees>M.D.</degrees><xref ref-type="aff" rid="A1">1</xref></contrib></contrib-group><aff id="A1"><label>1</label>Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea.</aff><aff id="A2"><label>2</label>Department of Laboratory Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.</aff><aff id="A3"><label>3</label>Department of Laboratory Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea.</aff><author-notes><corresp>Corresponding author: Sung Sup Park. Department of Laboratory Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea. Tel: +82-2-2072-3206, Fax: +82-2-747-0359, <email>sparkle@snu.ac.kr</email></corresp></author-notes><pub-date pub-type="ppub"><month>5</month><year>2016</year></pub-date><pub-date pub-type="epub"><day>23</day><month>2</month><year>2015</year></pub-date><volume>36</volume><issue>3</issue><fpage>230</fpage><lpage>234</lpage><history><date date-type="received"><day>04</day><month>9</month><year>2015</year></date><date date-type="rev-recd"><day>11</day><month>11</month><year>2015</year></date><date date-type="accepted"><day>29</day><month>1</month><year>2016</year></date></history><permissions><copyright-statement>© The Korean Society for Laboratory Medicine.</copyright-statement><copyright-year>2016</copyright-year><license license-type="open-access" xlink:href="http://creativecommons.org/licenses/by-nc/3.0/"><license-p>This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (<ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by-nc/3.0/">http://creativecommons.org/licenses/by-nc/3.0/</ext-link>) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.</license-p></license></permissions><abstract><sec><title>Background</title><p>The largest outbreak of Middle East respiratory syndrome coronavirus (MERS-CoV) infection outside Middle East Asia in 2015 has necessitated the rapid expansion of laboratories that conduct MERS-CoV molecular testing in Korea, together with external quality assessment (EQA) to evaluate the assays used.</p></sec><sec><title>Methods</title><p>The EQA program consisted of two phases; self-validation and blind assessment. For the first EQA phase, <italic>in vitro</italic> transcribed upstream region of the envelope gene (upE) and the open reading frame (ORF)1a RNAs were used at a concentration of 1,000 copies/µL. The test panel for the second EQA phase consisted of RNA extracts from three samples, which were obtained from two MERS-CoV positive patients and one MERS-CoV negative patient.</p></sec><sec><title>Results</title><p>The first EQA phase results for 46 participants showed a linear relationship between the threshold cycle (C<sub>T</sub>) values of RNA materials and the logarithmic concentrations for both upE and ORF1a gene targets (R<sup>2</sup>=0.73 and 0.75, respectively). The mean C<sub>T</sub> value for each concentration was different depending on which commercial kit was used for the assay. Among the three commonly used kits, PowerChek MERS Real-Time PCR kit (KogeneBiotech, Korea) showed the lowest C<sub>T</sub> values at all concentrations of upE and most concentrations of ORF1a. The second EQA phase results for 47 participants were 100% correct for all tested samples.</p></sec><sec><title>Conclusions</title><p>This EQA survey demonstrates that the MERS-CoV molecular testing performed in Korea during the 2015 outbreak is of robust capability. However, careful establishment and validation of a cut-off value are recommended to ensure good analytical sensitivity.</p></sec></abstract><kwd-group><kwd>External quality assessment</kwd><kwd>MERS-CoV</kwd><kwd>Molecular diagnostics</kwd><kwd>upE</kwd><kwd>ORF1a</kwd><kwd>Real-time PCR</kwd></kwd-group><funding-group><award-group><funding-source country="KR"><institution-wrap><institution>Korea Centers of Disease Control and Prevention</institution></institution-wrap></funding-source><award-id>2015-P48001-00</award-id></award-group></funding-group></article-meta></front><floats-group><fig id="F1" orientation="portrait" position="float"><label>Fig. 1</label><caption><title>Boxplot of threshold cycle (C<sub>T</sub>) values of external quality assessment (EQA) materials by target genes. The central line shows the median and the box covers the interquartile range. The four clusters for the upE gene and ORF1a gene represent 1,000, 100, 10, and 1 copies/µL, respectively. Each cluster denotes results from all methods, PowerChek kit (KogeneBiotech), and DiaPlexQ kit (Solgent), respectively, from left to right.</title></caption><graphic xlink:href="alm-36-230-g001"></graphic></fig><table-wrap id="T1" orientation="portrait" position="float"><label>Table 1</label><caption><title>Summary of results from the first phase of EQA</title></caption><alternatives><graphic xlink:href="alm-36-230-i001"></graphic><table frame="hsides" rules="rows"><thead><tr><th valign="middle" align="left" rowspan="2" colspan="1">Sample (copies/µL)</th><th valign="middle" align="center" rowspan="2" colspan="1">Kit</th><th valign="middle" align="center" rowspan="1" colspan="2">C<sub>T</sub> (Mean±SD)</th><th valign="middle" align="center" rowspan="2" colspan="1">N of participants<sup>*</sup></th></tr><tr><th valign="middle" align="center" rowspan="1" colspan="1">upE</th><th valign="middle" align="center" rowspan="1" colspan="1">ORF1a</th></tr></thead><tbody><tr><td valign="top" align="left" rowspan="5" colspan="1">1,000</td><td valign="top" align="left" rowspan="1" colspan="1">AccuPower</td><td valign="top" align="center" rowspan="1" colspan="1">31.7 ± 1.5</td><td valign="top" align="center" rowspan="1" colspan="1">32.3 ± 0.6</td><td valign="top" align="right" rowspan="1" colspan="1">4</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">PowerChek</td><td valign="top" align="center" rowspan="1" colspan="1">28.6 ± 1.1</td><td valign="top" align="center" rowspan="1" colspan="1">28.6 ± 1.1</td><td valign="top" align="right" rowspan="1" colspan="1">24</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">DiaPlexQ</td><td valign="top" align="center" rowspan="1" colspan="1">29.6 ± 0.5</td><td valign="top" align="center" rowspan="1" colspan="1">30.0 ± 1.2</td><td valign="top" align="right" rowspan="1" colspan="1">5</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Others<sup>†</sup></td><td valign="top" align="center" rowspan="1" colspan="1">30.1 ± 1.0</td><td valign="top" align="center" rowspan="1" colspan="1">29.5 ± 0.9</td><td valign="top" align="right" rowspan="1" colspan="1">4</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Total</td><td valign="top" align="center" rowspan="1" colspan="1">29.3 ± 1.5</td><td valign="top" align="center" rowspan="1" colspan="1">29.3 ± 1.6</td><td valign="top" align="right" rowspan="1" colspan="1">37</td></tr><tr><td valign="top" align="left" rowspan="5" colspan="1">100</td><td valign="top" align="left" rowspan="1" colspan="1">AccuPower</td><td valign="top" align="center" rowspan="1" colspan="1">35.9 ± 1.0</td><td valign="top" align="center" rowspan="1" colspan="1">35.9 ± 1.0</td><td valign="top" align="right" rowspan="1" colspan="1">3</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">PowerChek</td><td valign="top" align="center" rowspan="1" colspan="1">31.8 ± 1.0</td><td valign="top" align="center" rowspan="1" colspan="1">32.2 ± 1.2</td><td valign="top" align="right" rowspan="1" colspan="1">24</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">DiaPlexQ</td><td valign="top" align="center" rowspan="1" colspan="1">33.1 ± 0.9</td><td valign="top" align="center" rowspan="1" colspan="1">32.5 ± 1.1</td><td valign="top" align="right" rowspan="1" colspan="1">5</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Others<sup>‡</sup></td><td valign="top" align="center" rowspan="1" colspan="1">33.9 ± 1.4</td><td valign="top" align="center" rowspan="1" colspan="1">33.5 ± 1.9</td><td valign="top" align="right" rowspan="1" colspan="1">2</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Total</td><td valign="top" align="center" rowspan="1" colspan="1">32.5 ± 1.6</td><td valign="top" align="center" rowspan="1" colspan="1">32.7 ± 1.6</td><td valign="top" align="right" rowspan="1" colspan="1">34</td></tr><tr><td valign="top" align="left" rowspan="5" colspan="1">10</td><td valign="top" align="left" rowspan="1" colspan="1">AccuPower</td><td valign="top" align="center" rowspan="1" colspan="1">NA</td><td valign="top" align="center" rowspan="1" colspan="1">NA</td><td valign="top" align="right" rowspan="1" colspan="1">0</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">PowerChek</td><td valign="top" align="center" rowspan="1" colspan="1">35.3 ± 1.7</td><td valign="top" align="center" rowspan="1" colspan="1">35.9 ± 1.9</td><td valign="top" align="right" rowspan="1" colspan="1">13</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">DiaPlexQ</td><td valign="top" align="center" rowspan="1" colspan="1">38.0 ± 0.0</td><td valign="top" align="center" rowspan="1" colspan="1">35.0 ± 0.0</td><td valign="top" align="right" rowspan="1" colspan="1">1</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Others<sup>‡</sup></td><td valign="top" align="center" rowspan="1" colspan="1">NA</td><td valign="top" align="center" rowspan="1" colspan="1">36.5 ± 2.0</td><td valign="top" align="right" rowspan="1" colspan="1">2</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Total</td><td valign="top" align="center" rowspan="1" colspan="1">35.7 ± 1.8</td><td valign="top" align="center" rowspan="1" colspan="1">36.0 ± 1.8</td><td valign="top" align="right" rowspan="1" colspan="1">16</td></tr><tr><td valign="top" align="left" rowspan="5" colspan="1">1</td><td valign="top" align="left" rowspan="1" colspan="1">AccuPower</td><td valign="top" align="center" rowspan="1" colspan="1">NA</td><td valign="top" align="center" rowspan="1" colspan="1">NA</td><td valign="top" align="right" rowspan="1" colspan="1">0</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">PowerChek</td><td valign="top" align="center" rowspan="1" colspan="1">37.0 ± 1.5</td><td valign="top" align="center" rowspan="1" colspan="1">38.1 ± 0.9</td><td valign="top" align="right" rowspan="1" colspan="1">6</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">DiaPlexQ</td><td valign="top" align="center" rowspan="1" colspan="1">NA</td><td valign="top" align="center" rowspan="1" colspan="1">NA</td><td valign="top" align="right" rowspan="1" colspan="1">0</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Others<sup>‡</sup></td><td valign="top" align="center" rowspan="1" colspan="1">37.8 ± 1.5</td><td valign="top" align="center" rowspan="1" colspan="1">37.5 ± 2.4</td><td valign="top" align="right" rowspan="1" colspan="1">2</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Total</td><td valign="top" align="center" rowspan="1" colspan="1">37.3 ± 1.4</td><td valign="top" align="center" rowspan="1" colspan="1">37.9 ± 1.3</td><td valign="top" align="right" rowspan="1" colspan="1">8</td></tr></tbody></table></alternatives><table-wrap-foot><fn><p><sup>*</sup>The number of participants was different for each concentration because the first EQA phase was based on self-validation; <sup>†</sup>This includes two laboratory-developed tests, MERS-CoV Detection kit (Nanobiosys, Seoul, Korea) and ModularDx kit MERS-CoV (TIB MOLBIOL, Berlin, Germany); <sup>‡</sup>This includes two laboratory-developed tests.</p><p>Abbreviations: EQA, external quality assessment; C<sub>T</sub>, threshold cycle; NA, not applicable.</p></fn></table-wrap-foot></table-wrap><table-wrap id="T2" orientation="portrait" position="float"><label>Table 2</label><caption><title>Summary of results from the second phase of EQA</title></caption><alternatives><graphic xlink:href="alm-36-230-i002"></graphic><table frame="hsides" rules="rows"><thead><tr><th valign="middle" align="left" rowspan="2" colspan="1">Sample</th><th valign="middle" align="center" rowspan="2" colspan="1">Correct results</th><th valign="middle" align="center" rowspan="2" colspan="1">Kit</th><th valign="middle" align="center" rowspan="1" colspan="2">C<sub>T</sub> (Mean±SD)</th><th valign="middle" align="center" rowspan="2" colspan="1">N of participants<sup>*</sup></th></tr><tr><th valign="middle" align="center" rowspan="1" colspan="1">upE</th><th valign="middle" align="center" rowspan="1" colspan="1">ORF1a</th></tr></thead><tbody><tr><td valign="top" align="left" rowspan="5" colspan="1">A</td><td valign="bottom" align="center" rowspan="5" colspan="1">100%</td><td valign="top" align="left" rowspan="1" colspan="1">AccuPower</td><td valign="top" align="center" rowspan="1" colspan="1">28.1 ± 0.6</td><td valign="top" align="center" rowspan="1" colspan="1">29.8 ± 0.2</td><td valign="top" align="right" rowspan="1" colspan="1">4</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">PowerChek</td><td valign="top" align="center" rowspan="1" colspan="1">25.8 ± 0.9</td><td valign="top" align="center" rowspan="1" colspan="1">26.5 ± 0.7</td><td valign="top" align="right" rowspan="1" colspan="1">31</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">DiaPlexQ</td><td valign="top" align="center" rowspan="1" colspan="1">28.0 ± 1.9</td><td valign="top" align="center" rowspan="1" colspan="1">26.8 ± 2.2</td><td valign="top" align="right" rowspan="1" colspan="1">9</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Others<sup>*</sup></td><td valign="top" align="center" rowspan="1" colspan="1">26.5 ± 1.3</td><td valign="top" align="center" rowspan="1" colspan="1">27.1 ± 1.4</td><td valign="top" align="right" rowspan="1" colspan="1">3</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Total</td><td valign="top" align="center" rowspan="1" colspan="1">26.6 ± 1.6</td><td valign="top" align="center" rowspan="1" colspan="1">27.0 ± 1.6</td><td valign="top" align="right" rowspan="1" colspan="1">47</td></tr><tr><td valign="top" align="left" rowspan="5" colspan="1">B</td><td valign="bottom" align="center" rowspan="5" colspan="1">100%</td><td valign="top" align="left" rowspan="1" colspan="1">AccuPower</td><td valign="top" align="center" rowspan="1" colspan="1">31.6 ± 0.7</td><td valign="top" align="center" rowspan="1" colspan="1">33.3 ± 0.2</td><td valign="top" align="right" rowspan="1" colspan="1">4</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">PowerChek</td><td valign="top" align="center" rowspan="1" colspan="1">29.5 ± 1.0</td><td valign="top" align="center" rowspan="1" colspan="1">30.2 ± 0.9</td><td valign="top" align="right" rowspan="1" colspan="1">31</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">DiaPlexQ</td><td valign="top" align="center" rowspan="1" colspan="1">30.5 ± 1.8</td><td valign="top" align="center" rowspan="1" colspan="1">30.6 ± 2.4</td><td valign="top" align="right" rowspan="1" colspan="1">9</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Others<sup>*</sup></td><td valign="top" align="center" rowspan="1" colspan="1">30.1 ± 1.3</td><td valign="top" align="center" rowspan="1" colspan="1">30.7 ± 1.4</td><td valign="top" align="right" rowspan="1" colspan="1">3</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Total</td><td valign="top" align="center" rowspan="1" colspan="1">30.2 ± 1.5</td><td valign="top" align="center" rowspan="1" colspan="1">30.7 ± 1.6</td><td valign="top" align="right" rowspan="1" colspan="1">47</td></tr><tr><td valign="top" align="left" rowspan="5" colspan="1">C</td><td valign="bottom" align="center" rowspan="5" colspan="1">100%</td><td valign="top" align="left" rowspan="1" colspan="1">AccuPower</td><td valign="top" align="center" rowspan="1" colspan="1">Negative</td><td valign="top" align="center" rowspan="1" colspan="1">Negative</td><td valign="top" align="right" rowspan="1" colspan="1">4</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">PowerChek</td><td valign="top" align="center" rowspan="1" colspan="1">Negative</td><td valign="top" align="center" rowspan="1" colspan="1">Negative</td><td valign="top" align="right" rowspan="1" colspan="1">31</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">DiaPlexQ</td><td valign="top" align="center" rowspan="1" colspan="1">Negative</td><td valign="top" align="center" rowspan="1" colspan="1">Negative</td><td valign="top" align="right" rowspan="1" colspan="1">9</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Others<sup>*</sup></td><td valign="top" align="center" rowspan="1" colspan="1">Negative</td><td valign="top" align="center" rowspan="1" colspan="1">Negative</td><td valign="top" align="right" rowspan="1" colspan="1">3</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Total</td><td valign="top" align="center" rowspan="1" colspan="1">Negative</td><td valign="top" align="center" rowspan="1" colspan="1">Negative</td><td valign="top" align="right" rowspan="1" colspan="1">47</td></tr></tbody></table></alternatives><table-wrap-foot><fn><p><sup>*</sup>This includes laboratory-developed test, MERS-CoV Detection kit (Nanobiosys, Seoul, Korea) and ModularDx kit MERS-CoV (TIB MOLBIOL, Berlin, Germany).</p><p>Abbreviations: EQA, external quality assessment; C<sub>T</sub>, threshold cycle.</p></fn></table-wrap-foot></table-wrap><table-wrap id="T3" orientation="portrait" position="float"><label>Table 3</label><caption><title>Comparison of C<sub>T</sub> values between two real-time PCR platforms using PowerChek kit</title></caption><alternatives><graphic xlink:href="alm-36-230-i003"></graphic><table frame="hsides" rules="rows"><thead><tr><th valign="middle" align="left" rowspan="2" colspan="1">EQA phase</th><th valign="middle" align="center" rowspan="2" colspan="1">Materials</th><th valign="middle" align="center" rowspan="2" colspan="1">Target</th><th valign="middle" align="center" rowspan="1" colspan="4">C<sub>T</sub> (Mean±SD)</th><th valign="middle" align="center" rowspan="2" colspan="1"><italic>P</italic> value<sup>*</sup></th></tr><tr><th valign="middle" align="center" rowspan="1" colspan="1">ABI</th><th valign="middle" align="center" rowspan="1" colspan="1">N</th><th valign="middle" align="center" rowspan="1" colspan="1">BioRad</th><th valign="middle" align="center" rowspan="1" colspan="1">N</th></tr></thead><tbody><tr><td valign="top" align="left" rowspan="6" colspan="1">1st</td><td valign="top" align="center" rowspan="2" colspan="1">1,000</td><td valign="top" align="left" rowspan="1" colspan="1">upE</td><td valign="top" align="center" rowspan="1" colspan="1">28.2 ± 1.3</td><td valign="top" align="right" rowspan="1" colspan="1">10</td><td valign="top" align="center" rowspan="1" colspan="1">29.0±0.8</td><td valign="top" align="right" rowspan="1" colspan="1">13</td><td valign="top" align="center" rowspan="1" colspan="1">NS</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">ORF1a</td><td valign="top" align="center" rowspan="1" colspan="1">28.3 ± 1.1</td><td valign="top" align="right" rowspan="1" colspan="1">8</td><td valign="top" align="center" rowspan="1" colspan="1">28.8±1.1</td><td valign="top" align="right" rowspan="1" colspan="1">11</td><td valign="top" align="center" rowspan="1" colspan="1">NS</td></tr><tr><td valign="top" align="center" rowspan="2" colspan="1">100</td><td valign="top" align="left" rowspan="1" colspan="1">upE</td><td valign="top" align="center" rowspan="1" colspan="1">31.5 ± 1.2</td><td valign="top" align="right" rowspan="1" colspan="1">10</td><td valign="top" align="center" rowspan="1" colspan="1">32.0±1.0</td><td valign="top" align="right" rowspan="1" colspan="1">13</td><td valign="top" align="center" rowspan="1" colspan="1">NS</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">ORF1a</td><td valign="top" align="center" rowspan="1" colspan="1">31.7 ± 0.7</td><td valign="top" align="right" rowspan="1" colspan="1">10</td><td valign="top" align="center" rowspan="1" colspan="1">32.4 ±1.4</td><td valign="top" align="right" rowspan="1" colspan="1">12</td><td valign="top" align="center" rowspan="1" colspan="1">NS</td></tr><tr><td valign="top" align="center" rowspan="2" colspan="1">10</td><td valign="top" align="left" rowspan="1" colspan="1">upE</td><td valign="top" align="center" rowspan="1" colspan="1">34.5 ± 1.2</td><td valign="top" align="right" rowspan="1" colspan="1">5</td><td valign="top" align="center" rowspan="1" colspan="1">36.1±1.2</td><td valign="top" align="right" rowspan="1" colspan="1">7</td><td valign="top" align="center" rowspan="1" colspan="1">NS</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">ORF1a</td><td valign="top" align="center" rowspan="1" colspan="1">35.4 ± 1.2</td><td valign="top" align="right" rowspan="1" colspan="1">5</td><td valign="top" align="center" rowspan="1" colspan="1">36.9±2.2</td><td valign="top" align="right" rowspan="1" colspan="1">6</td><td valign="top" align="center" rowspan="1" colspan="1">NS</td></tr><tr><td valign="top" align="left" rowspan="4" colspan="1">2nd</td><td valign="top" align="center" rowspan="2" colspan="1">A</td><td valign="top" align="left" rowspan="1" colspan="1">upE</td><td valign="top" align="center" rowspan="1" colspan="1">25.5 ± 0.7</td><td valign="top" align="right" rowspan="1" colspan="1">14</td><td valign="top" align="center" rowspan="1" colspan="1">26.3±0.6</td><td valign="top" align="right" rowspan="1" colspan="1">15</td><td valign="top" align="center" rowspan="1" colspan="1">0.0011</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">ORF1a</td><td valign="top" align="center" rowspan="1" colspan="1">26.4 ± 0.7</td><td valign="top" align="right" rowspan="1" colspan="1">14</td><td valign="top" align="center" rowspan="1" colspan="1">26.8±0.7</td><td valign="top" align="right" rowspan="1" colspan="1">15</td><td valign="top" align="center" rowspan="1" colspan="1">0.0447</td></tr><tr><td valign="top" align="center" rowspan="2" colspan="1">B</td><td valign="top" align="left" rowspan="1" colspan="1">upE</td><td valign="top" align="center" rowspan="1" colspan="1">29.2 ± 0.7</td><td valign="top" align="right" rowspan="1" colspan="1">14</td><td valign="top" align="center" rowspan="1" colspan="1">30.0±0.7</td><td valign="top" align="right" rowspan="1" colspan="1">15</td><td valign="top" align="center" rowspan="1" colspan="1">0.0035</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">ORF1a</td><td valign="top" align="center" rowspan="1" colspan="1">30.0 ± 0.9</td><td valign="top" align="right" rowspan="1" colspan="1">14</td><td valign="top" align="center" rowspan="1" colspan="1">30.5±0.8</td><td valign="top" align="right" rowspan="1" colspan="1">15</td><td valign="top" align="center" rowspan="1" colspan="1">NS</td></tr></tbody></table></alternatives><table-wrap-foot><fn><p><sup>*</sup>The comparison of C<sub>T</sub> values between the two groups was performed by using the Mann-Whitney test because sample sizes of some groups were small.</p><p>Abbrviations: EQA, external quality assessment; C<sub>T</sub>, threshold cycle; NS, not significant.</p></fn></table-wrap-foot></table-wrap></floats-group></pmc></record>Pour manipuler ce document sous Unix (Dilib)
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