Multiplex TaqMan qPCR Assay for Detection, Identification, and Quantification of Three Sclerotinia Species

White mold (orSclerotinia stem rot), caused bySclerotinia species, is a major air, soil, or seed-transmitted disease affecting numerous crops and wild plants. Microscopic or culturebased methods currently available for their detection and identification are time-consuming, laborious, and often erroneous. Therefore, we developed a multiplex quantitative PCR (qPCR) assay for the discrimination, detection, and quantification of DNA collected from each of the three economically relevant Sclerotinia species, namely, S. sclerotiorum, S. minor, and S. nivalis. TaqMan primer/probe combinations specific for each Sclerotiniaspecies were designed based on the gene sequences encoding aspartyl protease. High specificity and sensitivity of each probe were confirmed for sclerotium and soil samples, as well as pure cultures, using simplex and multiplex qPCRs. This multiplex assay could be helpful in detecting and quantifying specific species of Sclerotinia, and therefore, may be valuable for disease diagnosis, forecasting, and management.

Co-Occurrence of Two Phylogenetic Clades of Pseudoperonospora cubensis, the Causal Agent of Downy Mildew Disease, on Oriental Pickling Melon

The genus Pseudoperonospora, an obligate biotrophic group of Oomycota, causes the most destructive foliar downy mildew disease on many economically important crops and wild plants. A previously unreported disease by Pseudoperonospora was found on oriental pickling melon (Cucumis melo var. conomon) in Korea, which is a minor crop cultivated in the temperate climate zone of East Asia, including China, Korea, and Japan. Based on molecular phylogenetic and morphological analyses, the causal agent was identified as Pseudoperonospora cubensis, and its pathogenicity has been proven. Importantly, two phylogenetic clades of P. cubensis, harboring probably two distinct species, were detected within the same plots, suggesting simultaneous coexistence of the two clades. This is the first report of P. cubensis causing downy mildew on oriental pickling melon in Korea, and the confirmation of presence of two phylogenetic clades of this pathogen in Korea. Given the high incidence of P. cubensis and high susceptibility of oriental pickling melon to this disease, phytosanitary measures, including rapid diagnosis and effective control management, are urgently required.

High-Temperature-Tolerant Fungus and Oomycetes in Korea, Including Saksenaea longicolla sp. nov

Global temperatures are steadily increasing, leading to significant changes in microbial diversity and ecology. In the present study, we isolated high-temperature-growing fungi and fungi-like group (Oomycota) strains from freshwater environments of Korea and identified them based on cultural, morphological, and multilocus phylogenetic analyses. As a result, we introduce Saksenaea (Fungi) isolates as a new species, Saksenaea longicolla sp. nov. and record Phytophthora chlamydospora and P. lagoariana (Oomycota) new to Korea. In the growth experiments, they exhibited high-temperature tolerance, which can grow at 35–40°C but become inactive at 4 °C and below. This study confirms the presence of high-temperature-tolerant fungi and oomycetes in Korea and suggests that the Korean climate conditions are changing in favor of these species. This indicates that climate warming is altering microbial distributions in freshwater environments.

Co-Occurrence of Two Phylogenetic Clades of Pseudoperonospora cubensis, the Causal Agent of Downy Mildew Disease, on Oriental Pickling Melon

The genus Pseudoperonospora, an obligate biotrophic group of Oomycota, causes the most destructive foliar downy mildew disease on many economically important crops and wild plants. A previously unreported disease by Pseudoperonospora was found on oriental pickling melon (Cucumis melo var. conomon) in Korea, which is a minor crop cultivated in the temperate climate zone of East Asia, including China, Korea, and Japan. Based on molecular phylogenetic and morphological analyses, the causal agent was identified as Pseudoperonospora cubensis, and its pathogenicity has been proven. Importantly, two phylogenetic clades of P. cubensis, harboring probably two distinct species, were detected within the same plots, suggesting simultaneous coexistence of the two clades. This is the first report of P. cubensis causing downy mildew on oriental pickling melon in Korea, and the confirmation of presence of two phylogenetic clades of this pathogen in Korea. Given the high incidence of P. cubensis and high susceptibility of oriental pickling melon to this disease, phytosanitary measures, including rapid diagnosis and effective control management, are urgently required.

Afatinib-Induced Acute Fatal Pneumonitis in Metastatic Lung Adenocarcinoma / 가정의학회지

Afatinib is an oral tyrosine kinase inhibitor (TKI) that inhibit Endothelial Growth Factor Receptor (EGFR), Human Epidermal Growth Factor Receptor 2 (HER2), and HER4. The common side effects of EGFR TKI are rash, acne, diarrhea, stomatitis, pruritus, nausea, and loss of appetite. Drug induced pneumonitis is the less common adverse effects of EGFR TKI. Afatinib, 2nd generation EGFR TKI is anticipated to overcome drug resistance from 1st generation EGFR TKI according to preclinical study, and several studies are being conducted to compare clinical efficacy between 1st and 2nd EGFR TKI. Several cases of rug induced acute fatal pneumonitis were reported after use of erlotinib or gefitinib. However, a case of acute fatal pneumonitis associated with afatinib was note reported except drug induced pneumonitis in other clinical study. Here, we present a cases of acute severe pneumonitis related with afatinib in metastatic lung adenocarcinoma with literature review.

Afatinib-Induced Acute Fatal Pneumonitis in Metastatic Lung Adenocarcinoma / 가정의학회지

Afatinib is an oral tyrosine kinase inhibitor (TKI) that inhibit Endothelial Growth Factor Receptor (EGFR), Human Epidermal Growth Factor Receptor 2 (HER2), and HER4. The common side effects of EGFR TKI are rash, acne, diarrhea, stomatitis, pruritus, nausea, and loss of appetite. Drug induced pneumonitis is the less common adverse effects of EGFR TKI. Afatinib, 2nd generation EGFR TKI is anticipated to overcome drug resistance from 1st generation EGFR TKI according to preclinical study, and several studies are being conducted to compare clinical efficacy between 1st and 2nd EGFR TKI. Several cases of rug induced acute fatal pneumonitis were reported after use of erlotinib or gefitinib. However, a case of acute fatal pneumonitis associated with afatinib was note reported except drug induced pneumonitis in other clinical study. Here, we present a cases of acute severe pneumonitis related with afatinib in metastatic lung adenocarcinoma with literature review.

Relapsed Esophageal Web in a Patient with Plummer-Vinson Syndrome

Plummer-Vinson syndrome is characterized by dysphagia, iron deficiency anemia, and upper esophageal web. The associated symptoms can be resolved by administering iron supplements as well as by endoscopic intervention. Relapse in patients with Plummer-Vinson syndrome is very rare. We describe a case of a 42-year-old woman with Plummer-Vinson syndrome whose symptoms were successfully treated with endoscopic dilatation and iron supplementation at first admission; however, 1 year later, she revisited our hospital because of dysphagia. On second admission, investigations revealed esophageal web relapse in Plummer-Vinson syndrome. She was again successfully treated with endoscopic dilatation and iron supplementation. After first admission, her anemia was not normalized due to poor compliance and loss of follow-up. We experienced a case of esophageal web relapse due to uncorrected iron deficiency anemia in a patient with Plummer-Vinson syndrome. This experience indicates that continuous iron supplementation and long-term follow-up is important in patients with Plummer-Vinson syndrome.

Relapsed Esophageal Web in a Patient with Plummer-Vinson Syndrome

Plummer-Vinson syndrome is characterized by dysphagia, iron deficiency anemia, and upper esophageal web. The associated symptoms can be resolved by administering iron supplements as well as by endoscopic intervention. Relapse in patients with Plummer-Vinson syndrome is very rare. We describe a case of a 42-year-old woman with Plummer-Vinson syndrome whose symptoms were successfully treated with endoscopic dilatation and iron supplementation at first admission; however, 1 year later, she revisited our hospital because of dysphagia. On second admission, investigations revealed esophageal web relapse in Plummer-Vinson syndrome. She was again successfully treated with endoscopic dilatation and iron supplementation. After first admission, her anemia was not normalized due to poor compliance and loss of follow-up. We experienced a case of esophageal web relapse due to uncorrected iron deficiency anemia in a patient with Plummer-Vinson syndrome. This experience indicates that continuous iron supplementation and long-term follow-up is important in patients with Plummer-Vinson syndrome.

Gait Analysis of Patients with Unilateral Total Hip Arthroplasty

OBJECTIVE: The purpose of this study is to evaluate objectively and quantitatively gait improvement after total hip arthroplasty (THA) using a 3-dimensional computerized Vicon motion analyzer. METHOD: A preoperative gait evaluation was performed within one month before surgery and two postoperative gait evaluations at 6 months intervals after surgery. Pre- and postoperative gait parameters of 176 patients with unilateral total hip arthroplasty were evaluated and data were compared with those of 56 healthy persons. RESULTS: 1) Single limb support of affected limb increased significantly at postoperative 6 and 12 months compared with preoperative data. 2) The improvements of hip flexion and abduction of affected limb were in almost normal range at postoperative 12 months. 3) Maximal hip flexor moment in terminal stance of affected limb reached to nearly normal level at postoperative 12 months. CONCLUSION: A quantitative gait analyzer is a very useful tool to assess objectively the success of THA as substantiated by the results of this study with a significant improvement in all the parameters of gait.

Anemia in the Acute Phase of Traumatic Spinal Cord Injury

OBJECTIVE: Anemia had been reported to be one of the common complications in the spinal cord injured patients. The purposes of this study were to investigate the incidence of anemia, its relating factors and efficacy of rehabilitation therapy in the acute spinal cord injured patients. METHOD: A retrospective study was performed in the 103 acute spinal cord injured patients. We monitored serum hemoglobin, serum hematocrit, serum albumin and protein and change of the weight in the acute spinal cord injured patients at our rehabilitation department. RESULTS: The incidence of anemia was 62.1% (64/103). According to the level of injury, the incidence of anemia was 65.2% in cervical cord injury, 62.5% in thoracic cord injury and 46.2% in lumbar cord injury. The incidence of anemia was not different significantly by the severity of injury. The relating factors of anemia were urinary tract infection, pressure sore, acute bleeding, pneumonia, hypoalbuminemia, hypoproteinemia. Among these, hypoproteinemia was statistically related to anemia. The efficacy of functional independence measure (FIM) was significantly lower in the anemic group. CONCLUSION: Therefore we should concern about the prevention and treatment of anemia in the spinal cord injured patients.

The Effects of Tracheostomy for the Functional Outcomes of Severe Traumatic Brain Injury Patients

OBJECTIVE: The purposes of this study were to estimate the incidence and complications of the tracheostomy and after decannulation, and to compare the functional outcomes between tracheostomy and non-tracheostomy groups in the severe traumatic brain injury (TBI) patients. METHOD: One hundred and fifteen severe TBI patients were included in this study and the functional outcomes were measured by the Functional Independence Measure (FIM) scores retrospectively. RESULTS: The incidence of tracheostomy was 45.2% and the average duration of tracheostmy was 69.7 days. Twenty seven complications associated with the tracheostomy (51.9%) were reported and a pneumonia was the most common complication. Fourteen complications (26.9%) were reported after the decannulation and a tracheal granuloma was the most common complication. Complications mostly occurred during the first two weeks of tracheostomy. The duration of rehabilitation treatment for the patients with tracheostomy was longer than the patients without tracheostomy. TBI patients with tracheostomy had significantly lower initial and discharge FIM scores, FIM gain, and FIM efficiency than the patients without tracheostomy. CONCLUSION: The complications of tracheostomy were mostly occurred early in the acute stage. Functional outcomes were lower in severe TBI patients with tracheostomy, thus early comprehensive and aggressive rehabilitation treatments would be necessary.

Interval between Initial Hospital Arrival and Start of Rehabilitation Therapy in Sroke Patients of Tertiary Medical Center

The rehabilitation therapy as well as the initial medical management for stroke patients should be started early to be effective. However, a little attention has been paid to the interval between the onset of stroke and rehabilitation therapy. We studied the delay from the onset of stroke to the start of rehabilitatioin therapy and its impact on outcomes. This study was performed retrospectively on 807 acute stroke patients who were admitted to Asan Medical Center to evaluate the interval between ictus of stroke and hospital arrival or rehabilitation therapy and to compare in the ischemic and hemorrhagic groups. Forty seven percents of the stroke patients arrived after 24 hours of the onset of stroke and 70% of stroke patients started their rehabilitation therapy 1 week later. Hemorrhagic patients started their rehabilitation therapy significantly earlier than the ischemic patients. This delay in hospital arrival may be attributed to the lack of awareness about the symptoms and early signs of stroke by the patients, general public, and even medical personnels. The delay in rehabilitation therapy from the onset of stroke can be prevented by the public compaigns emphasizing the better outcome with earlier rehabilitation treatment.

Correlation between Body Temperature and Infarct Size and Recovery in the Stroke

Cerebral ischemia in experimental animals was worsened by hyperthermia, whereas was improved by hypothermia. Whether these observations apply to human beings with stroke is unknown. The objective of this study is to determine the relation between body temperature of stroke patient on admission and infarct size and functional recovery. In a retrospective study, 101 charts of stroke patients who had been admitted to the hospital were reviewed. Initial body temperature on admission, infarct size, and functional recovery were checked and analyzed. Based on body temperature differences, cases were divided into three groups, hypothermia, normothermia, and hyperthermia group. Infarct size was measured by computed tomography. Functional recovery was evaluated with functional independence measure(FIM) on admission and discharge. Multiple regression of ANOVA and Student's T-test were used for statistical analysis. Results disclosed that body temperature had no correlation with functional recovery but cases with initial high body temperature trended to increase in infarct size.

A Case of Orbital Neuroblastoma

Orbital neuroblastoma is the most common childhood metastatic malignant tumor almost always originating from the adrenal medulla; orbital primary origin is very rare. The authors experenced a case of orbital neuroblastoma. The patient was 3 year old Korean female child who was in apparently good health and no abnormalities noted of physical examminations when she developed ecchymosis of right lower lid. About two week later, she quickly developed a growing mass in the right lower orbital soft tissue. The mass was removed and his topathologically diagnosed as neuroblastoma. Radiotherapy was recommended. About 4 months bter, the patient was readmitted because of recurrence of orbital mass 3t the same site. At surgery, tumor was found invading inner and flooe wall of the orbital bone. The patient died of poor course of the disease, about one year after the onset of symptoms. It was suggested that this case was represented metastatic orbital neuroblastoma on histopathological base, but authors were unable to determine the primary site. A brief review of the related literatures is present.

A Case of Sympathetic Ophthalmia

Sympathetic ophthalmia is a bilateral of the entire uveal tissue almost caused by a traumatic perforating wound that involves uveal tract. It is recently rare and unknown etiology. Authors have experienced with a rare case of sympathetic ophthalmia. Patient was a 36 years old Korean female who injured her left eye with limbal laceration and prolapse iris, and developed sympathetic ophthalmia on posterior segment is involved first after 36 days. The exciting eye is not to enucleated because of relatively good visual acuity and won't operation. Both eyes was improved fairly after corticosteroid theraphy per os. A brief review of the related literatures is present.

A Case of Chronic Gonorrheal Orbital Cellulitis

Authors have experienced a case of long standing chronic gonorrheal orbital cellulitis in a 50 years old Korean male. Surgical evacuation of pus discharges and microscopcially confirmed the gram negative intncellular and extracellular gonococcus. A brief review of the related literatures is present.

A Modified Berke Operation for Ptosis

The surgical correction of blepharoptosis is accomplished by operations utilizing the levator frontalis or superior rectus muscle. To obtain the best results in ptosis surgery, it is necessayr to select the appropriate operation for each case. When the levator action is relatively good, resection of the levator muscle is the operation of choice. The treatment of choice when the levator function is minimal or absent is suspending the ptotic upper lid from the brow. For this purpose sutures of cat gut, silk and gold chain or wire (gold, platinum, tantalum, stainless steel), or sling technique of Kangaroo tendon, silicone, fascia lata, skin, orbicularis muscle and sclera have been used. According to Berke, of the above, fascia lata is the best because it does not pull out of the tissues or become infected as often as do other materials. Allogeneic fascia lata seems to be a desirable material, but it is not readily available. The authors attached the ptotic upper lid to the brow by means of using the levator muscle. Instead of resecting the levator muscle as in the Berke ptosis operation through the skiu route, we did not resect the muscle but utilized it. In the course of Berke operation, after the levator muscle has been completely freed, it is divided into three equal parts by longitudinal severing with scissors. The levator muscle is sutured to the upper tarsal edge in correct position with 6-0 cat gut. Next, three stab skin incisions are made at the eyebrow, one near the center, one in the nasal third, one in the temporal third. Three tunnels are made under the skin from the eyebrow incisions to the lid incis:ons. A small forceps is passed through this tunnel and a tongue of the levator muscle drown up and sutured to the frontalis muscle. The other two tongues of the levator muscle are sutured in the same way. The skin incisions are closed with 6-0 black silk, then Frost suture and pressure dressing are applied. The advantages of this method are remarkable, that is, increment of the post operative motility of the upper lid and utilzation of living autogeheic levater muscle VS. heterotopic graft of fascia lata or other materials in all six cases of our report, good results were obtained and infections or complications did not occur.