Comparison of Shoulder Ultrasonographic Assessments between Polymyalgia Rheumatica and Frozen Shoulder in Patients with Bilateral Shoulder Pain: A Comparative Retrospective Study.

This study aimed to assess and compare the ultrasonographic (US) pathologic findings in patients with polymyalgia rheumatica (PMR) and bilateral frozen shoulder (FS). We included 19 patients with clinically diagnosed PMR and 19 patients with stage II bilateral FS. The US evaluation included the assessment of subacromial-subdeltoid (SASD) bursitis, long head of biceps (LHB) tenosynovitis, and posterior and inferior glenohumeral (GH) synovitis. Unilateral SASD bursitis was noted significantly more frequently in PMR patients than in bilateral FS patients (p = 0.001). There were no significant differences in the incidence of unilateral LHB tenosynovitis and posterior GH synovitis between PMR and bilateral FS patients (p = 0.108 and p = 0.304, respectively). Unilateral inferior GH synovitis was more common among bilateral FS patients than among PMR patients (p < 0.001). Bilateral SASD bursitis and LHB tenosynovitis were noted significantly more frequently in PMR patients than in bilateral FS patients (p < 0.001 and 0.049, respectively). Significant differences were not observed in the incidence of bilateral posterior GH synovitis between PMR and bilateral FS patients (p = 0.426). Bilateral inferior GH synovitis was more common among bilateral FS patients than among PMR patients (p = 0.044). The US evidence for bilateral inferior GH synovitis without bilateral SASD showed high specificity (94.7%) with sensitivity (78.9%) for the diagnosis of bilateral FS. SASD bursitis, representing periarticular synovial inflammation, was more common among the patients with PMR than among the patients with bilateral FS. Inferior GH synovitis without SASD bursitis suggests FS rather than PMR in patients with bilateral shoulder pain.

Diagnosis of Duchenne Muscular Dystrophy in a Presymptomatic Infant Using Next-Generation Sequencing and Chromosomal Microarray Analysis: A Case Report.

Duchenne muscular dystrophy is a progressive and lethal X-linked recessive neuromuscular disease caused by mutations in the dystrophin gene. It has a high rate of diagnostic delay; early diagnosis and treatment are often not possible due to delayed recognition of muscle weakness and lack of effective treatments. Current treatments based on genetic therapy can improve clinical results, but treatment must begin as early as possible before significant muscle damage. Therefore, early diagnosis and rehabilitation of Duchenne muscular dystrophy are needed before symptom aggravation. Creatine kinase is a diagnostic marker of neuromuscular disorders. Herein, the authors report a case of an infant patient with Duchenne muscular dystrophy with a highly elevated creatine kinase level but no obvious symptoms of muscle weakness. The patient was diagnosed with Duchenne muscular dystrophy via next-generation sequencing and chromosomal microarray analysis to identify possible inherited metabolic and neuromuscular diseases related to profound hyperCKemia. The patient is enrolled in a rehabilitation program and awaits the approval of the genetic treatment in Korea. This is the first report of an infantile presymptomatic Duchenne muscular dystrophy diagnosis using next-generation sequencing and chromosomal microarray analysis.

Application of Numerical Weather Prediction Data to Estimate Infection Risk of Bacterial Grain Rot of Rice in Korea.

This study was conducted to evaluate usefulness of numerical weather prediction data generated by the Unified Model (UM) for plant disease forecast. Using the UM06- and UM18-predicted weather data, which were released at 0600 and 1800 Universal Time Coordinated (UTC), respectively, by the Korea Meteorological Administration (KMA), disease forecast on bacterial grain rot (BGR) of rice was examined as compared with the model output based on the automated weather stations (AWS)-observed weather data. We analyzed performance of BGRcast based on the UM-predicted and the AWS-observed daily minimum temperature and average relative humidity in 2014 and 2015 from 29 locations representing major rice growing areas in Korea using regression analysis and two-way contingency table analysis. Temporal changes in weather conduciveness at two locations in 2014 were also analyzed with regard to daily weather conduciveness (C i ) and the 20-day and 7-day moving averages of C i for the inoculum build-up phase (C inc ) prior to the panicle emergence of rice plants and the infection phase (C inf ) during the heading stage of rice plants, respectively. Based on C inc and C inf , we were able to obtain the same disease warnings at all locations regardless of the sources of weather data. In conclusion, the numerical weather prediction data from KMA could be reliable to apply as input data for plant disease forecast models. Weather prediction data would facilitate applications of weather-driven disease models for better disease management. Crop growers would have better options for disease control including both protective and curative measures when weather prediction data are used for disease warning.

MBCAST: A Forecast Model for Marssonina Blotch of Apple in Korea.

A disease forecast model for Marssonina blotch of apple was developed based on field observations on airborne spore catches, weather conditions, and disease incidence in 2013 and 2015. The model consisted of the airborne spore model (ASM) and the daily infection rate model (IRM). It was found that more than 80% of airborne spore catches for the experiment period was made during the spore liberation period (SLP), which is the period of days of a rain event plus the following 2 days. Of 13 rain-related weather variables, number of rainy days with rainfall ≥ 0.5 mm per day (L day ), maximum hourly rainfall (P max ) and average daily maximum wind speed (W avg ) during a rain event were most appropriate in describing variations in air-borne spore catches during SLP (S i ) in 2013. The ASM, S i = 30.280+5.860×L day ×P max -2.123×L day ×P max ×W avg was statistically significant and capable of predicting the amount of airborne spore catches during SLP in 2015. Assuming that airborne conidia liberated during SLP cause leaf infections resulting in symptom appearance after 21 days of incubation period, there was highly significant correlation between the estimated amount of airborne spore catches (S i ) and the daily infection rate (R i ). The IRM, R̂ i = 0.039+0.041×S i , was statistically significant but was not able to predict the daily infection rate in 2015. No weather variables showed statistical significance in explaining variations of the daily infection rate in 2013.

Development and Evaluation of a Quick Response Code-Based Nursing Education Program for Operating and Recovery Room Nurses.

The purpose of this study was to develop and evaluate the effectiveness of a quick response code-based nursing education program to improve the competence of operation and recovery room nurses. An experimental methodological design was used to develop a quick response code-based nursing educational program and analyze its effects and nurses' satisfaction with its use. The quick response code-based nursing education program was developed in five steps based on the ADDIE model: analysis, design, development, implementation, and evaluation. The program was built on smartphones, and a Web site was linked to it. After testing the program for 40 days, nurses' attitudes toward various medical devices were significantly less negative. Nurses were able to use a large number of medical devices and were highly satisfied and willing to engage with the quick response code-based nursing educational program. In the context of nursing education, introducing educational content using quick response codes helps to improve nurses' knowledge and competence in providing high-quality nursing care and medical services.

Alveolar Molding Effect in Infants With Unilateral Cleft Lip and Palate: Comparison of Two- and Three-Dimensional Measurements.

The purpose of this study was to compare the results of two- (2D) and three-dimensional (3D) measurements for the alveolar molding effect in patients with unilateral cleft lip and palate. The sample consisted of 23 unilateral cleft lip and palate infants treated with nasoalveolar molding (NAM) appliance. Dental models were fabricated at initial visit (T0; mean age, 23.5 days after birth) and after alveolar molding therapy (T1; mean duration, 83 days). For 3D measurement, virtual models were constructed using a laser scanner and 3D software. For 2D measurement, 1:1 ratio photograph images of dental models were scanned by a scanner. After setting of common reference points and lines for 2D and 3D measurements, 7 linear and 5 angular variables were measured at the T0 and T1 stages, respectively. Wilcoxon signed rank test and Bland-Altman analysis were performed for statistical analysis. The alveolar molding effect of the maxilla following NAM treatment was inward bending of the anterior part of greater segment, forward growth of the lesser segment, and decrease in the cleft gap in the greater segment and lesser segment. Two angular variables showed difference in statistical interpretation of the change by NAM treatment between 2D and 3D measurements (ΔACG-BG-PG and ΔACL-BL-PL). However, Bland-Altman analysis did not exhibit significant difference in the amounts of change in these variables between the 2 measurements. These results suggest that the data from 2D measurement could be reliably used in conjunction with that from 3D measurement.

Effects of Interrupted Wetness Periods on Conidial Germination, Germ Tube Elongation and Infection Periods of Botryosphaeria dothidea Causing Apple White Rot.

Responses of Botryosphaeria dothidea to interrupted wetness periods were investigated under in vivo and in vitro conditions. Conidia of B. dothidea were allowed to germinate on apple fruits under wetting condition at 25ºC for 5 hr. They were air-dried for 0, 1, 2 or 4 hr, and then rewetted at 25ºC for 5 hr. Following an initial wetness period of 5 hr, 83% of the conidia germinated. The percent conidial germination increased to 96% when wetting was extended continuously another 5 hr. However, no further conidial germination was observed when wetting was interrupted by dry periods of 1, 2 and 4 hr, resulting in 83, 81 and 82%, respectively. The mean length of the germ tubes was 37 µm after 5 hr of wetting and elongated to 157 µm after 10 hr of continuous wetting. On the other hand, interruption of wetting by a dry period of 1 hr or longer after the 5 hr of initial wetting arrested the germ tube elongation at approximately 42 µm long. Prolonged rewetting up to 40 hr did not restore germ tube elongation on slide glasses under substrate treatments. Model simulation using weather data sets revealed that ending infection periods by a dry period of at least 1 hr decreased the daily infection periods, avoiding the overestimation of infection warning. This information can be incorpo- rated into infection models for scheduling fungicide sprays to control apple white rot with fewer fungicide applications.

BGRcast: A Disease Forecast Model to Support Decision-making for Chemical Sprays to Control Bacterial Grain Rot of Rice.

A disease forecast model for bacterial grain rot (BGR) of rice, which is caused by Burkholderia glumae, was developed in this study. The model, which was named 'BGRcast', determined daily conduciveness of weather conditions to epidemic development of BGR and forecasted risk of BGR development. All data that were used to develop and validate the BGRcast model were collected from field observations on disease incidence at Naju, Korea during 1998-2004 and 2010. In this study, we have proposed the environmental conduciveness as a measure of conduciveness of weather conditions for population growth of B. glumae and panicle infection in the field. The BGRcast calculated daily environmental conduciveness, Ci , based on daily minimum temperature and daily average relative humidity. With regard to the developmental stages of rice plants, the epidemic development of BGR was divided into three phases, i.e., lag, inoculum build-up and infection phases. Daily average of Ci was calculated for the inoculum build-up phase (Cinf ) and the infection phase (Cinc ). The Cinc and Cinf were considered environmental conduciveness for the periods of inoculum build-up in association with rice plants and panicle infection during the heading stage, respectively. The BGRcast model was able to forecast actual occurrence of BGR at the probability of 71.4% and its false alarm ratio was 47.6%. With the thresholds of Cinc = 0.3 and Cinf = 0.5, the model was able to provide advisories that could be used to make decisions on whether to spray bactericide at the pre- and post-heading stage.

Micromorphology of epicuticular waxes and epistomatal chambers of pine species by electron microscopy and white light scanning interferometry.

High-resolution imaging and quantitative surface analysis of epicuticular waxes and epistomatal chambers of pine species were performed by field emission scanning electron microscopy and white light scanning interferometry. Both juvenile and adult needles were collected from the two-year-old seedlings of Pinus rigida and Pinus densiflora and subjected to surface observations. Epicuticular wax structures developed on the cuticle layer as well as in the epistomatal chambers and appeared to occlude the cavities in the two pine species. The stomata of P. densiflora were characterized by more distinctly raised rings around openings than P. rigida. The most common epicuticular wax structures of the two pine species included tubules with terminal openings and coiled rodlets. Wax platelets were deposited on epistomatal chambers. Either rodlets or tubules seemed to be longer and thicker in P. rigida than those in P. densiflora. White light scanning interferometry revealed quantitative surface profiles, demonstrating more ridged (ca. 4 µm high) stomatal apertures and nearly twofold deeper (ca. 20 µm deep) epistomatal chambers of P. densiflora than those of P. rigida. These results suggest that white light scanning interferometry can be applied to unravel the quantitative surface features of epicuticular sculptures on plant leaves.

Visualization of wound periderm and hyphal profiles in pine stems inoculated with the pitch canker fungus Fusarium circinatum.

Postpenetration behavior of Fusarium circinatum in stems of pine species was investigated with light and transmission electron microscopy. Two-year-old stems of Pinus rigida and P. densiflora were wound-inoculated with the fungal conidial suspension and subjected to 25 degrees C for up to 30 days. It was common to observe the formation of wound periderm on each pine species, recovering wounded sites with newly formed tissues. The outermost thick layer of wound periderm was pink to red colored with the phloroglucinol-EtOH staining, indicating heavy deposition of lignin in wound periderm. The cork layers in the wound periderm of the two pine species consisted of cells that were mostly devoid of cellular contents in cytoplasm. The cork cells showed convoluted cell walls with different electron density (lamellations), which was seemingly more prevalent in P. densiflora than P. rigida. Hyphae of F. circinatum appeared normal with typical eucaryotic cytoplasm in P. rigida on ultrathin sections. Meanwhile, hyphae in P. densiflora were found to possess highly vacuolated cytoplasm, implying hyphal weakening and disintegration. Hyphal cytoplasm appeared to be a thin layer between the vacuole and the plasma membrane surrounded by cell wall. In addition, intrahyphal hyphae and concentric bodies were observed in hyphal cytoplasm. These results suggest that the architecture of wound periderm may be responsible for different responses of pine species to the invasion of F. circinatum.

Comparative ultrastructure of nonwounded Mexican lime and Yuzu leaves infected with the citrus canker bacterium Xanthomonas citri pv. citri.

Ultrastructural aspects of citrus canker development were investigated in nonwounded leaves of citrus species by transmission electron microscopy (TEM). A susceptible species Mexican lime and a resistant species Yuzu were spray-inoculated with a virulent strain of Xanthomonas citri pv. citri. Initial symptoms occurred on Mexican lime approximately 9 days after inoculation, whereas they appeared on Yuzu mostly 11 days after inoculation. In Mexican lime leaves, the bacterial invasion was usually accompanied by host cell wall dissolution and cellular disruption. Fibrillar materials from degenerated cell walls were usually found in intercellular spaces. Damaged host cells with necrotic cytoplasm showed the localized separation of plasma membrane from the cell wall. Bacterial multiplication and electron-transparent capsule-like structures around bacteria were commonly observed. Meanwhile, cell wall protuberances were prominent outside host cell walls in response to bacterial invasion in Yuzu leaves. Occlusion of intercellular spaces was also formed by the fusion of two or more individual cell wall protuberances originated from two adjacent host cells. Papillae-like materials accumulated locally within host cells in close proximity to bacteria. Some bacteria were found to be undergoing degeneration in xylem vessels. Also, the shrunken, inactive bacteria were surrounded by electron-translucent fibrillar materials in intercellular spaces, implying bacterial immobilization. These cellular responses are thought to be the consequences of defense responses of Yuzu leaves to invading bacteria. In both citrus species, X. citri pv. citri contained polyphosphate bodies showing electron-dense and elliptical structures in cytoplasm.

Ultrastructure of spined conidia and hyphae of the rice false smut fungus Ustilaginoidea virens.

Spined conidia and hyphae of Ustilaginoidea virens were examined by light and electron microscopy. Bright-field light microscopy showed that conidia were round to elliptical and warty on the surface with diameters approximately ranging from 3 to 5 microm. Scanning electron microscopy revealed the globose to irregularly rounded and ornamented conidia with prominent spines. The spines were pointed at the apex or irregularly curved, and approximately 200-500 nm long. Ultrastructure of spined conidia and hyphae revealed by transmission electron microscopy showed lipid globules and vacuoles in the cytoplasm enclosed by an electron-transparent cell wall. Conspicuous electron-dense spines were evident on the surface of conidia, and had obclavate or irregularly protruding shapes with varying heights along the conidial cell wall. Microfibrillar structures with stretching or branching patterns were evident in the spine matrix. Some conidia were interconnected by spines from the neighboring conidia by their extended outgrowth. Hyphae had concentric bodies that showed an electron-transparent core surrounded by an electron-dense layer. One or more intrahyphal hyphae were found in hyphal cytoplasm. The fungus is thought to form concentric bodies and intrahyphal hyphae as survival mechanisms against the water- and nutrient-deficient environments that may occur in the necrotic regions of host plants.

Solid-state NMR spectroscopy of silicon-treated rice with enhanced host resistance against blast.

Silicon is the second-most abundant element on the surface of the earth, and has been considered important for plant growth and development. As for its role in enhanced plant disease resistance, silicon has been reported to reinforce the physical barrier against the penetration and colonization of pathogens. Rice leaves of silicon-treated plants and control plants at the eight- and twelve-leaf growth stages were analyzed by 29Si solid-state nuclear magnetic resonance spectroscopy to characterize the silicon-induced, cell wall fortification of rice leaves, which demonstrated an ability to counter a pathogen attack.

Glyoxysomal Nature of Microbodies Complexed with Lipid Globules in Botryosphaeria dothidea.

ABSTRACT The glyoxysomal nature of microbodies was determined in Botryosphaeria dothidea hyphae based on morphology and in situ enzyme characteristics by transmission electron microscopy and cytochemistry. Bound by a single membrane, microbodies had a homogeneous matrix and varied in size ranging from 200 to 400 nm in diameter. Microbodies often had crystalline inclusions that consisted of parallel arrays of fine tubules in their matrices. Microbodies and lipid globules were placed in close association with each other, forming microbody-lipid globule complexes in hyphae. The cytochemical activities of catalase and malate synthase were localized in microbodies, showing intense electron density of the organelle. In addition, immunogold labeling detected the presence of catalase in a multivesicular body-like organelle and the cell wall as well as in the matrix and crystalline inclusion of microbodies, supporting the enzyme secretion outward. Meanwhile, isocitrate lyase was localized only in matrices of microbodies. These results suggest that the microbodies complexed with lipid globules in B. dothidea hyphae are functionally defined as glyoxysomes which may enable the fungus to survive latent periods using lipids via the glyoxylate cycle and catalase secretion.

Structural Modifications and Programmed Cell Death of Chili Pepper Fruit Related to Resistance Responses to Colletotrichum gloeosporioides Infection.

ABSTRACT Postharvest (detached) and in planta (attached) fruits of pepper plants, Capsicum annuum cv. Jejujaerae (susceptible) and Capsicum baccatum cv. PBC80 (resistant), inoculated with the anthracnose pathogen Colletotrichum gloeosporioides were examined using light, confocal laser scanning, and electron microscopy to compare the cytological differences between the compatible and incompatible interactions. In nonwound inoculation of postharvest pepper fruit, resistant pepper tissues showed a significant increase in the thickness of the cuticle layer compared with that of the susceptible and noninoculated fruit. Cytological features of programmed cell death (PCD) were observed in the resistant pepper fruit with postharvest inoculation, and these were characterized by positive responses to terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling. The oligonucleosomal fragments of DNA were confirmed electrophoretically as DNA laddering. The PCD-positive responses occurred around the inoculation sites early in in planta wound inoculation in the resistant pepper. Nuclear modifications and structural changes of hypersensitivity were also observed in the resistant fruit, including separation of the plasma membrane from the cell wall, dilation of the endoplasmic reticulum, accumulation of electron-dense inclusions in vacuoles, and cytoplasmic vacuolization accompanying fragmentation of the cytoplasm. These structural changes may also implicate PCD-like host responses. In addition, in planta wound inoculation resulted in cell enlargement and cell division during the later stages of infection to form a periderm-like boundary layer around the inoculation site.

Silicon-induced cell wall fortification of rice leaves: a possible cellular mechanism of enhanced host resistance to blast.

ABSTRACT Locations of silicon accumulation in rice leaves and its possible association with resistance to rice blast were investigated by electron microscopy and X-ray microanalysis. A blast-susceptible cultivar, Jinmi, and a partially resistant cultivar, Hwaseong, were grown under a hydroponic culture system with modified Yoshida's nutrient solution containing 0, 50, 100, and 200 ppm of silicon. Electron-dense silicon layers were frequently found beneath the cuticle in epidermal cell walls of silicon-treated plants. Increasing levels of silicon were detected in the outer regions of epidermal cell walls. Silicon was present mainly in epidermal cell walls, middle lamellae, and intercellular spaces within subepidermal tissues. Furthermore, silicon was prevalent throughout the leaf surface, with relatively small deposition on stomatal guard cells in silicon-treated plants. Silicon accumulation and epidermal cell wall thickness in leaves were greater in cv. Jinmi than in cv. Hwaseong. However, the thickness ratios of the silicon layers to epidermal cell walls were greater in cv. Hwaseong (53.25 to 93.28%) than in cv. Jinmi (36.58 to 66.54%). Leaf blast severity was lower in cv. Hwaseong than in cv. Jinmi and was significantly reduced in silicon-treated plants of both cultivars. These results suggest that silicon-induced cell wall fortification of rice leaves may be closely associated with enhanced host resistance to blast.