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Background: Percutaneous nephrolithotomy (PNL) is a widely used surgical method for renal stone management. However, it can be associated with several complications. Case: We report an acute hemothorax during PNL in 57-year-old male patient with a stone. After observing air bubbles at the diaphragm on the laparoscopic screen, we considered pulmonary complications. A chest radiograph demonstrated a shade that measured 130 mm wide and 70 mm long and fluid retention on the right side of the chest. During drainage of 200 ml of blood through a chest tube, the patient’s vital signs became unstable. After the patient received hydration and intravenous injection of vasopressor, his vital signs stabilized. Conclusions: Pulmonary complications due to pleural injury during PNL can result in death, but the complications can be managed by early diagnosis and treatment. Close cooperation between surgeon and anesthesiologist and routine chest radiographs after PNL can reduce the pulmonary complications.

Purpose: To report a case of acute stromal keratitis after vitrectomy for the treatment of myopic tractional maculopathy in a lupus patient.Case summary: A lupus patient who were treated with low dose steroid complained of decreased visual acuity due to myopic tractional maculopathy with fovea detachment. No evidence of intraocular inflammation was observed. The best-corrected visual acuity (BCVA) was 20/40. We performed the vitrectomy and removal of epiretinal membrane and internal limiting membrane. BCVA of 20/80 at day 1 decreased to hand motion at day 5. Severe corneal edema and superficial punctate keratitis that were observed did not improve three days after the anti-herpetic treatment. Based on this, we diagnosed her as immune-mediated acute stromal keratitis in lupus, and treated with oral methylprednisolone of 20 mg. The corneal edema improved rapidly following high dose systemic steroid. Myopic fovea detachment also improved. Improvement of BCVA was limited to 20/80 at six months, compared to the baseline one.Conclusions: We observed the development of acute stromal keratitis after vitrectomy for the myopic tractional maculopathy in the patient with lupus. High dose systemic steroid improved this corneal complication. Increased dose of systemic steroid should be considered before and after vitrectomy in lupus patients.

Fracture of prosthetic valve leaflets in the absence of traumatic injury is very rare. Leaflet fracture can cause acute pulmonary edema and cardiogenic shock and is potentially life-threatening, requiring emergency surgery. Thus, a leaflet fracture must be diagnosed quickly and accurately. We present the case of a 46-year-old man with CarboMedics prosthetic aortic and mitral valve replacements implanted 24 years previously. The patient presented at our emergency department with abrupt dyspnea and fever. We diagnosed severe mitral valve regurgitation with anterior leaflet fracture. The patient underwent venoarterial extracorporeal membrane oxygenation and delayed mitral valve replacement. The foreign body was removed step by step because the diagnosis was missed. Two pieces of broken leaflets were found in the left common iliac artery and left external iliac artery. The patient was treated successfully and remains asymptomatic 1 year following surgery.

Purpose To evaluate the differences in individual segmental retinal layer thickness in adult patients with high myopia. Methods This study compared the retinal layers of patients with high myopia (axial length of ≥26.0 mm) with those of normal controls using spectral-domain optical coherence tomography. The thicknesses of the retinal layers were compared using nine Early Treatment Diabetic Retinopathy Study subfields. Choroidal thickness was also measured in the subfoveal area. Results We included 37 eyes with high myopia and 37 eyes of healthy subjects. The mean age was 42.95 and 47.73 years (p = 0.114), and the mean axial length was 27.28 and 24.47 mm (p l 0.001), respectively. The parafoveal areas (outer ring segment) of the ganglion cell layer and inner plexiform layer, all segmental areas except the subfoveal region of the inner nuclear layer, most segmental areas (inner superior, inner inferior, outer superior, outer temporal, and outer nasal) of outer plexiform layer, and most segmental areas (subfovea, inner temporal, inner inferior, inner nasal, outer temporal, and outer inferior) of outer nuclear layer were thinner in eyes with high myopia than in normal eyes (all p l 0.05). There were no statistically significant differences between the levels of photoreceptor layer, retinal pigment epithelium, and nerve fiber layer. The mean choroidal thickness was 153.81 ± 64.80 and 239.54 ± 44.28 μm in the high myopia and control groups, respectively, which were significantly different (p l 0.001). Conclusions In high myopia without pathologic changes, there was a meaningful thinning of the retina and choroid, especially in most Early Treatment Diabetic Retinopathy Study subfield areas of the deep vascular complex, perifoveal area of the superficial vascular complex, and most areas of the outer nuclear layer in the outer retinal layer, which are associated with myopic axial elongation.

The aim of this study was to report the long-term outcomes after sacrocolpopexy (SCP) with or without transobturator tape (TOT). We conducted a planned secondary analysis of a prospective, observational study comparing urinary outcomes in women who underwent SCP with or without TOT based on the results of a prolapse-reduction stress test. Patients were enrolled between November 2008 and December 2011 and were followed up 5 years after surgery. The primary outcomes were 5-year success rates for stress urinary incontinence (SUI) and pelvic organ prolapse (POP) estimated using the Kaplan–Meier method. SUI success was defined as a negative cough stress test, no bothersome SUI symptoms, and no additional anti-incontinence surgery. POP success was defined as no vaginal bulge symptoms, no apical descent greater than one-third of the total vaginal length or anterior or posterior vaginal wall prolapse beyond the hymen, and no retreatment for prolapse. Of 240 women enrolled, 175 (73%) completed 5 years of follow-up. The estimated SUI success rate was 91.1% in the TOT group and 56.5% in the no TOT group (difference, 34.6%; 95% confidence interval, 24.1 to 45.1). The estimated POP success rate was 90.0% in the TOT group and 92.9% in the no TOT group (difference, −2.9%; 95% confidence interval, −10.7 to 4.9). The advantage of concomitant TOT for SUI after SCP that was seen at 2 years remained at 5 years. Long-term POP failure rates after SCP are low and not affected by concomitant TOT.

This study analyzed factors influencing clinical symptoms and treatment of patients with traffic accident injuries. It used a retrospective chart review and questionnaire survey obtained from 560 patients (266 men and 294 women). It also conducted follow-up observations of progress after car insurance settlements and investigated the usefulness of and patient satisfaction with integrative Korean medicine treatment for traffic accident injuries. Retrospective data of patients admitted for traffic accident injury were obtained. A questionnaire survey was conducted to collect data regarding the degree of traffic accident damage, severity of pain at settlement, any treatment after settlement and duration and cost of such treatment, and patient satisfaction with car insurance services and Korean medicine treatment for traffic accident injury. The results showed no significant association between pain and the degree of damage to the car at the time of traffic accident (P = 0.662), although the degree of damage to the car was more significantly associated with time to reach a car insurance settlement than severity of pain in the patient (P = 0.003). There was no significant association between the degree of damage to the car in a traffic accident and pain after a traffic accident. Greater severity of pain at the time of the car insurance settlement was associated with greater cost and longer time spent in treatment after the car insurance settlement.

OBJECTIVE: Asthma self-management depends partly on access to inhalers; for children, this includes independent inhaler carry and use at school (“self-carry”). Although laws and policies support self-carry, little is known about practices within schools. This study aimed to identify factors associated with inhaler self-carry among children and examine barriers and facilitators to self-carry. METHODS: This mixed-methods observational study included child-parent dyads and nurses from four Chicago schools. Children and parents answered questions about asthma care and morbidity, confidence in self-carry skills, and facilitators and barriers to self-carry. Nurses reported asthma documentation on file and their confidence in children’s self-carry skills. Analysis utilized logistic regression. Thematic analysis was performed for open-ended questions. RESULTS: Of 65 children enrolled (mean=10.66 years), 45 (69.2%) reported having quick-relief medication at school, primarily inhalers, and 35 (53.8%) reported self-carry. Inhaler self-carry was associated with controller medication use and parent confidence in child’s self-carry skills. Children and parents identified several facilitators to self-carry: child’s asthma knowledge, inhaler characteristics, and need for easy inhaler access. Barriers included child’s limited understanding of asthma and inhalers, perception that inhaler is not needed, and limited inhaler access. Children also emphasized social relationships as facilitators and barriers, while parents described children’s responsibility as a facilitator and inconsistent policy implementation as a barrier. CONCLUSIONS: Efforts to improve inhaler self-carry at school should focus on educating children about asthma and inhaler use, creating supportive environments for self-carry among peers and teachers, and fostering consistent implementation and communication about asthma policy among schools and families.

To analyze the changes in each retinal layer and the recovery of the ellipsoid zone (EZ) after full-thickness macular hole (FTMH) surgery. Patients who underwent surgery for FTMH were included. Spectral-domain optical coherence tomography (SD-OCT) was performed preoperatively and postoperatively at 1, 3, 6, 9, and 12 months. A total of 32 eyes were enrolled. Ganglion cell layer, inner plexiform layer, and inner nuclear layer showed significant reductions over time after surgery (P = 0.020, P = 0.001, and P = 0.001, respectively), but were significantly thicker than those of fellow eyes at 12 months postoperatively. The average recovery duration of the external limiting membrane (ELM), outer nuclear layer (ONL), and EZ was 1.5, 2.1, and 6.1 months, respectively. Baseline best-corrected visual acuity (BCVA) (P = 0.003), minimum linear diameter (MLD) (P = 0.025), recovery of EZ (P = 0.008), and IRL thickness (P

This study aimed to measure the validity and reliability of the Korean version of the Dysphagia Handicap Index (K-DHI) and evaluate its diagnostic efficacy for predicting aspiration. We enrolled 104 patients with dysphagia symptoms (D group) and 88 controls (ND group). Among controls, there were 43 patients without dysphagia symptoms (ND patient group). All subjects completed the K-DHI survey. The D and ND group patients underwent the Gugging Swallowing Screen (GUSS) and videofluoroscopic swallowing study (VFSS). Two weeks later, the D group completed the second session of the K-DHI survey. The internal consistency of the K-DHI was good to excellent (Cronbach’s α: 0.79–0.95). The test–retest reliability of the K-DHI survey was also high (interclass correlation coefficient = 0.88). There were moderate correlations between the K-DHI and GUSS (r = − 0.65, p

BackgroundFor chronic kidney disease (CKD) patients, management of nutritional status is critical for delaying progression to end-stage renal disease. The purpose of this study is to provide the basis for personalized nutritional intervention in pre-dialysis patients by comparing the foods contributing to nutrients intake, nutritional status and potential dietary inflammation of CKD patients according to the diabetes mellitus (DM) comorbidity and CKD stage.MethodsTwo hundred fifty-six outpatients referred to the Department of Nephrology at SNUH from Feb 2016 to Jan 2017 were included. Subjects on dialysis and those who had undergone kidney transplantation were excluded. Bioelectrical impedance analysis (BIA), subjective global assessment (SGA), dietary intake, and biochemical parameters were collected. Subjects were classified into 4 groups according to DM comorbidity (DM or Non-DM) and CKD stage (Early or Late) by kidney function. Two-way analysis of variance and multinomial logistic regression analysis were performed for statistical analysis.ResultsTotal number of malnourished patients was 31 (12.1%), and all of them were moderately malnourished according to SGA. The body mass index (BMI) of the DM-CKD group was significantly higher than the Non-DM-CKD group. The contribution of whole grains and legumes to protein intake in the DM-CKD group was greater than that in the Non-DM-CKD group. The DM- Early-CKD group consumed more whole grains and legumes compared with the Non-DM-Early-CKD group. The subjects in the lowest tertile for protein intake had lower phase angle, SGA score and serum albumin levels than those in the highest tertile. The potential for diet-induced inflammation did not differ among the groups.ConclusionsSignificant differences in intakes of whole grains and legumes between CKD patients with or without DM were observed. Since contribution of whole grains and legumes to phosphorus and potassium intake were significant, advice regarding whole grains and legumes may be needed in DM-CKD patients if phosphorus and potassium intake levels should be controlled. The nutritional status determined by BIA, SGA and serum albumin was found to be different depending on the protein intake. Understanding the characteristics of food sources can provide a basis for individualized nutritional intervention for CKD patients depending on the presence of diabetes.

Purpose: To identify the effects of prolonged type 2 diabetes (T2DM) on macular microcirculation and the inner retinal layer in diabetic eyes without clinical diabetic retinopathy (DR). Methods: 97, 92, and 57 eyes in the control, patients with T2DM &lt, 10 years (DM group one), and patients with T2DM &ge, 10 years (DM group two) were enrolled. The ganglion cell-inner plexiform layer (GC-IPL) thickness and superficial vessel density (VD) were compared. Linear regression analyses were performed to identify factors associated with VD in T2DM patients. Results: GC-IPL thicknesses in the control, DM group one, and DM group two were 84.58 &plusmn, 0.89, 83.49 &plusmn, 0.70, and 79.04 &plusmn, 0.96 &mu, m, respectively (p &lt, 0.001). The VDs of the full area were 20.32 &plusmn, 0.15, 19.46 &plusmn, 0.17, and 18.46 &plusmn, 0.23 mm&minus, 1 (p &lt, 0.001). Post-hoc analyses revealed that the VDs of the full area was significantly different in the control vs. DM group one (p = 0.001), control vs. DM group two (p &lt, 0.001), and DM group one vs. DM group two (p = 0.001). Multivariate linear regression analyses revealed that DM duration (p = 0.037), visual acuity (p = 0.013), and GC-IPL thickness (p &lt, 0.001) were significantly associated with the VD of T2DM patients. Conclusions: We confirmed GC-IPL thinning and decreased superficial VD in the macular areas using OCTA in T2DM patients. Patients with T2DM &ge, 10 years exhibited significantly more severe macular microcirculation impairment compared to patients with T2DM &lt, 10 years and normal controls.

Background Dietary intervention at the early stage of chronic kidney disease (CKD) is important for preventing progression to the end-stage renal disease (ESRD). However, few studies have investigated dietary intake of CKD patients in non-dialysis stage. Therefore, we investigated the dietary intake of Korean non-dialysis CKD patients and aimed to establish baseline data for the development of dietary education and intervention strategies for CKD patients. Methods Three hundred fifty CKD patients who visited Seoul National University Hospital outpatient clinic from February 2016 to January 2017 were recruited for this cross-sectional study. Subjects on dialysis and those who had undergone kidney transplantation were excluded. Dietary intake, demographic information, and biochemical characteristics of 256 subjects who completed three-day dietary records were analyzed. Subjects were divided into four groups based on diabetes mellitus (DM) (DM-CKD and Non-DM-CKD groups) and kidney function (Early-CKD and Late-CKD groups). Results Total energy intake was lower in the Late-CKD group compared with the Early-CKD group. In men, carbohydrate intake was higher and protein and fat intakes tended to be lower in the Late-CKD group compared with the Early-CKD group. In women, carbohydrate intake tended to be lower in the DM-CKD group than the Non-DM-CKD group. Protein intake tended to be higher in the DM-CKD groups. Phosphorus and sodium intakes were higher in the DM-CKD groups compared with the Non-DM-CKD groups in women, and tended to be higher in the DM-CKD groups in men. Conclusion DM and kidney function affected energy and nutrient intakes. Subjects in the Late-CKD group consumed less energy than those in the Early-CKD group. Non-DM subjects seemed to restrict protein intake starting from the Early-CKD stage than subjects with DM. Subjects in this study had low energy and high sodium intakes compared with recommended levels. Protein intake was lower in advanced CKD patients, but their intake level was still higher than the recommendation. Dietary intervention strategies for non-dialysis CKD patients need to be customized depending on the presence of DM and kidney function., Graphical Abstract

Background Online haemodiafiltration (OL-HDF) may improve middle molecular clearance in contrast to conventional haemodialysis (HD). However, OL-HDF requires higher convective flows and cannot sufficiently remove large middle molecules. This study evaluated the efficacy of a medium cut-off (MCO) dialyser in removing large middle molecular uraemic toxins and compared it with that of conventional high-flux (HF) dialysers in HD and predilution OL-HDF. Methods Six clinically stable HD patients without residual renal function were investigated. Dialyser and treatment efficacies were examined during a single midweek treatment in three consecutive periods: 1) conventional HD using an HF dialyser, 2) OL-HDF using the same HF dialyser, and 3) conventional HD using an MCO dialyser. Treatment efficacy was assessed by calculating the reduction ratio (RR) for β2-microglobulin (β2M), myoglobin, κ and λ free light chains (FLCs), and fibroblast growth factor (FGF)-23 and measuring clearance for FLCs. Results All three treatments showed comparable RRs for urea, phosphate, creatinine, and uric acid. MCO HD showed greater RRs for myoglobin and λFLC than did HF HD and predilution OL-HDF (myoglobin: 63.1 ± 5.3% vs. 43.5 ± 8.9% and 49.8 ± 7.3%; λFLC: 43.2 ± 5.6% vs. 26.8 ± 4.4% and 33.0 ± 9.2%, respectively; P P = 0.01). There was no significant difference among MCO HD, HF HD, and predilution OL-HDF in the RRs for κFLC (63.2 ± 6.0%, 53.6 ± 15.5%, and 61.5 ± 7.0%, respectively; P = 0.37), and FGF-23 (55.5 ± 20.3%, 34.6 ± 13.1%, and 35.8 ± 23.2%, respectively; P = 0.13). Notably, MCO HD showed improved clearances for FLCs when compared to HF HD or OL-HDF. Conclusions MCO HD showed significantly greater RR of large middle molecules and achieved improved clearance for FLCs than conventional HD and OL-HDF, without the need for large convection volumes or high blood flow rates. This would pose as an advantage for elderly HD patients with poor vascular access and HD patients without access to OL-HDF. Trial registration Clinical Research Information Service (CRIS): KCT 0003009. The trial was prospectively registered on the 21 Jul 2018.

Vitamin D status has been implicated in obesity and adipose tissue inflammation. In the present study, we explored the effects of dietary vitamin D supplementation on adipose tissue inflammation and immune cell population, and the effects of in vitro 1,25-dihydroxyvitamin D3 (1,25-(OH)2D3) treatment on pro-inflammatory cytokine production by stromal vascular cells (SVCs) and adipocytes in lean and high-fat diet-induced obese mice. The results show that epididymal fat Mcp-1 and Rantes mRNA levels, which were higher in obese mice compared with lean mice, were significantly down-regulated by vitamin D supplementation. While obese mice had higher numbers of macrophages and natural killer (NK) cells within adipose tissue, these remained unaltered by vitamin D supplementation. In accordance with these in vivo findings, the in vitro 1,25(OH)2D3 treatment decreased IL-6, MCP-1, and IL-1&beta, production by SVCs from obese mice, but not by adipocytes. In addition, 1,25(OH)2D3 treatment significantly decreased Tlr2 expression and increased mRNA levels of I&kappa, ba and Dusp1 in SVCs. These findings suggest that vitamin D supplementation attenuates inflammatory response in adipose tissue, especially in SVCs, possibly through inhibiting NF-&kappa, B and MAPK signaling pathways in SVCs but not by the inhibition of macrophage infiltration.

Obesity is associated with the risk of developing several severe diseases, such as metabolic disorder, diabetes, and heart diseases. Despite wide investigation and trials, a noninvasive obesity therapy is still an important medical unmet need, targeting the abnormal adipose tissue. Here, we developed hyaluronate-hollow gold nanosphere-adipocyte-targeting peptide (HA-HAuNS-ATP) conjugates for the photothermal ablation of adipose tissues. The HA-HAuNS-ATP conjugate could be noninvasively delivered into the skin and effectively target to adipocytes in the subcutaneous. With near-infrared laser illumination, HA-HAuNS-ATP conjugate enabled highly effective photothermal ablation of adipose tissues in C57BL/6 obesity mice. The photoacoustic imaging confirmed the successful transdermal delivery and the photothermal lipolysis of HA-HAuNS-ATP conjugate. Taken together, the transdermal HA-HAuNS-ATP conjugate might have a great potential for noninvasive photothermal lipolysis.

Knowledge of the long-term outcomes of survivors of pediatric critical illness is sparse but important. The aim of this study was to evaluate morbidity and mortality 6 months and 3 years after hospital discharge.Prospective cohort study.Urban, inner city, academic PICU.Consecutive patients admitted to the PICU from June 2012 to August 2012.None.We collected descriptive and demographic information and functional status assessments at baseline, admission, hospital discharge, 6 months and 3 years following discharge. Functional status was measured with the Functional Status Scale. New morbidity was defined as a change in Functional Status Scale score of greater than or equal to 3. Postdischarge assessments utilized scripted telephone surveys. Of 303 consecutive PICU patients, 253 were eligible and 129 parents consented. Follow-up outcomes were obtained for 77 patients (59.7%) at 6 months and 70 of these patients (54.2%) at 3 years. Both mortality and morbidity increased after discharge. Cumulative mortality increased from 3.9% (n = 3) at discharge to 7.8% (n = 6) at 6 months (p = 0.08) and 10.4% (n = 8) at 3 years (p = 0.03). New morbidity increased cumulatively from 5.2% (n = 4) at discharge to 6.5% (n = 5) at 6 months (p = 0.65) and 10.4% (n = 8) at 3 years (p = 0.16). Almost as many children demonstrated worsening of their functional status or died (38%) as children who survived without a change in functional status (44%). Less than 10% of children exhibited functional gains over time. Long-term functional outcome was associated with PICU variables including the need for invasive therapies and indicators of severity of illness such as use of mechanical ventilation, ventilator days, use of vasoactive medications, and PICU length of stay. The combined poor outcomes of new morbidity and mortality increased cumulatively from 9.1% (n = 7) at discharge to 14.3% (n = 11) at 6 months (p = 0.16) and 20.8% (n = 16) by 3 years (p = 0.01).Mortality and new morbidity appear to substantially increase after discharge. Critical illness is associated with a sustained impact on survival and functional status.

We previously reported that rolling Nagoya mice carrying a mutation in the α1 subunit of the Cav2.1 channel protective from ischemia- and kainate-induced neuronal damage. However, the protective effect of this mutation and its relationship to brain injury recovery have not been examined. To examine the relationship between Cav2.1 channel function and brain injury, we induced cryogenic brain damage in homozygous rolling Nagoya (rol/rol), control wild-type (+/+), ω-agatoxin IVA-pretreated +/+ (ω-aga +/+), and ω-agatoxin IVA-post-treated +/+ (ω-aga-post-treated +/+) mice. We measured the lesion area, blood brain-barrier permeability and performed immunohistochemistry and western blot analysis. The lesions of rol/rol and ω-aga +/+ mice were significantly smaller than those observed in +/+ mice at both day 1 and day 7 after injury. Similar results were shown in blood-brain barrier permeability. We observed more reactive astrogliosis in +/+ mice than in rol/rol or ω-aga +/+ mice. rol/rol and ω-aga +/+ mice had fewer degenerating cells due to cryogenic injury than did +/+ mice at both day 1 and day 7. ω-Aga-post-treated +/+ mice 24h after injury were sacrificed on day 7. The lesions were smaller in ω-aga-post-treated +/+ mice than those in vehicle-treated +/+ mice. We also examined phosphorylated p38 (pp38) at the injured site. ω-Aga-post-treated +/+ mouse brain slices showed weak pp38 signal; vehicle-treated +/+ mouse brain slices were pp38-positive. These findings demonstrate that the mutant Cav2.1 channel exerts a protective effect against cryogenic brain injury in rolling Nagoya mice. Our results indicate that inhibitors of the Cav2.1-dependent p38 signaling cascade would be useful as therapeutic agents in the treatment of brain injury.

Vitamin D has been reported to regulate the maturation and function of dendritic cells (DCs). Obesity was shown to be associated with the dysregulation of vitamin D metabolism and malfunction of DCs. We investigated the effects of in vitro 1,25(OH)2D3 treatment (0, 1, or 10 nM) on phenotype and expression of genes related to function of bone marrow-derived DCs (BMDCs) from control and obese mice. C57BL/6 N mice were fed a control or high-fat (10% or 45% kcal fat: CON or HFD) diets for 15 weeks. Differentiation toward DCs was induced with GM-CSF (20 ng/ml) and maturation was induced by LPS (50 ng/ml); 10 nM 1,25(OH)2D3 treatment inhibited BMDC differentiation (CD11c+) and decreased the percentage of mature DCs (MHCIIhighCD11c+ and CD86highCD11c+) in both CON and HFD groups. The Il10 expression in stimulated BMDCs from the CON group increased with the 10 nM 1,25(OH)2D3 treatment, but not in those from the HFD group. The Il12b mRNA levels in stimulated BMDCs were lower in the HFD group than in the CON group. In conclusion, lower levels of Cd 40, Cd83 and Il12 mRNA in LPS-stimulated BMDCs from obese mice suggest malfunction of DCs as antigen presenting cells. 1,25(OH)2D3 treatment inhibited the differentiation and maturation of BMDCs in both control and obese mice. Differential effects of 1,25(OH)2D3 on the expression of Il10 between control and obese mice suggest that regulation of immune response by vitamin D could be influenced by obesity.

Objective Although sacrocolpopexy (SCP) can provide durable apical support, the use of mesh may give rise to various complications, including vaginal mesh erosion. The aim of this study was to identify the risk factors for vaginal mesh erosion after SCP in Korean women. Methods This retrospective cohort study included 363 women who underwent SCP with type 1 polypropylene mesh. They were evaluated at 1, 4, and 12 months after surgery and then annually thereafter with respect to anatomy and complications. Univariate and multivariate analyses using the Cox proportional hazard model were performed to identify the risk factors for mesh erosion. Results During the median 2-year follow-up period, vaginal mesh erosion was found in 29 women (8.0%). Among them, 19 (65.5%) required surgical correction. Estrogenic status was the only independent risk factor for mesh erosion. The risk for mesh erosion was 4.5 times higher in premenopausal women than in menopausal women not on estrogen replacement therapy (ERT) (95% confidence intervals [CI] 1.9–10.9, p

Background The survival rate of grafted fat is difficult to predict, and repeated procedures are frequently required. In this study, the effects of the freezing period of harvested adipose tissue and the addition of human adipose tissue-derived stem cells (ASCs) on the process of fat absorption were studied. Methods Adipose tissue was obtained from patients who underwent a lipoaspirated fat graft. The fat tissue was cryopreserved at -20℃ in a domestic refrigerator. A total of 40 nude mice were used. The mice in the experimental group received three different subcutaneous injections in the back: an injection of fresh fat and ASCs, an injection of fat that had been frozen for one month and ASCs, and an injection of fat that had been frozen for two months and ASCs. The control mice received fat grafts without ASCs. The mice were sacrificed at four or eight weeks after the procedure, and the grafted fat tissues were harvested. The extracted fat was evaluated using photographic analysis, volume measurements, and histological examination. Results In the control group, the fat resorption rates four weeks after transplantation in the grafts of fresh fat, fat that had been frozen for one month, and fat that had been frozen for two months were 21.14%, 22.46%, and 42.56%, respectively. In the experimental group, the corresponding resorption rates were 6.68%, 13.0%, and 33.9%, respectively. Conclusions ASCs can increase the fat graft survival rate. The use of ASCs in fat grafting can reduce the need for repeated fat grafts and provide good long term results.

Background Pincer nail deformity is a transverse overcurvature of the nail. This study aimed to define the anatomical characteristics of pincer nail deformity and to evaluate the surgical outcomes. Methods A retrospective review was conducted on 20 cases of pincer nail deformity of the great toe. Thirty subjects without pincer nail deformity or history of trauma of the feet were selected as the control group. Width and height indices were calculated, and interphalangeal angles and base widths of the distal phalanx were measured with radiography. We chose the surgical treatment methods considering perfusion-related factors such as age, diabetes mellitus, kidney disease, and peripheral vascular disease. The zigzag nail bed flap method (n=9) and the inverted T incision method (n=11) were used to repair deformities. The outcomes were evaluated 6 months after surgery. Results The interphalangeal angle was significantly greater in the preoperative patient group (14.0°±3.6°) than in the control group (7.9°±3.0°) (P Conclusions We believe that the width and height indices are useful for evaluating the deformity and outcomes of surgical treatments. We used two different surgical methods for the two patient groups with respect to the perfusion-related factors and found that the outcomes were all satisfactory. Consequently, we recommend taking into consideration the circulatory condition of the foot when deciding upon the surgical method for pincer nail deformity.

Among various types of supernumerary nipples, intra-areolar polythelia (IAP) is an extremely rare congenital malformation. The authors report a case of a young woman with unilateral IAP on her right breast. The patient was 24 years old; she had had it since she was 5 or 6 years old, and it had enlarged 3 to 4 years before presentation to our clinic. Surgical excision was performed under local anesthesia as a prophylaxis against breast cancer and cosmetic problems.

Cav2.1α1 is involved in glutamate release. The kainate-induced intensive firing of neurons via glutamate receptors causes seizure and neuronal damage, especially in the hippocampus. Cav2.1α1 mutation in homozygous rolling Nagoya (rol/rol) mice caused reduced Ca(2+) permeability compared to wild-type mice. The rol/rol mice exhibited ataxia approximately after 2 weeks of age. Although we have reported that heterozygous rolling Nagoya (rol/+) mice show age-dependent behavioral changes, sensitivity to kainate has not been examined. To examine the relationship between Cav2.1 function and neurological disease, we investigated how Cav2.1 is related to kainate-induced seizure and neuronal damage using 2- and 18-month-old rol/+ mice. The seizure scores of 18-month-old rol/+ mice that received 20mg/kg kainate intraperitoneally were significantly lower than those of wild-type mice. As a consequence of seizure, kainate induced delayed neuronal damage along with astrocytic growth in the hippocampus in wild-type mice, with a moderate effect observed in rol/+ mice. In the hippocampus of 18-month-old rol/+ mice, the levels of mutant-type Cav2.1α1 were increased compared to +/+ mice. The phosphorylation of p38, a mitogen-activated protein kinase (MAPK) activated by kainate, was not increased after kainate injection compared to +/+ mice. No difference was observed between 2-month-old rol/+ and wild-type mice intraperitoneally injected with 20mg/kg kainate in these analyses. These findings suggest that rol/+ mice experience age-related changes in sensitivity to kainate due to changes in the p38 MAPK signaling pathway via a mutant Cav2.1 channel. Hence, rol/+ mice may represent a novel model to delineate the association between Cav2.1 function, synaptic transmission, and the postsynaptic signaling cascade.

Post-tonsillectomy hemorrhage (PTH) is the most frequent complication of tonsillectomy, and occasionally results in a lethal outcome. A 21-year-old man (height 180 cm, weight 95 kg) was scheduled for a bilateral tonsillectomy and uvulopalatopharyngoplasty for treatment of obstructive sleep apnea. He required 5 rounds of general anesthesia due to recurrent PTH. The anesthesiologist used sugammadex a total of 3 times to achieve the successful reversal of the deep neuromuscular blockade (NMB) induced by rocuronium. After sugammadex 2 mg/kg was administered, the NMB was reversed in 2 minutes each time. Re-administration of rocuronium within a short time interval after sugammadex may result in unpredictable effects of neuromuscular blocking agents. Sugammadex made it possible to perform a rapid, complete reverse when the residual block was maintained by an incomplete reversal of anticholinesterase.

Background The septal cartilage is the most useful donor site for autologous cartilage graft material in rhinoplasty. For successful nasal surgery, it is necessary to understand the developmental process of the nasal septum and to predict the amount of harvestable septal cartilage before surgery. Methods One hundred twenty-three Korean patients who underwent three-dimensional (3D) facial bone computed tomography (CT) were selected for evaluation of the midsagittal view of the nasal septum. Multiple parameters such as the area of each component of the nasal septum and the amount of harvestable septal cartilage were measured using Digimizer software. Results The area of the total nasal septum showed rapid growth until the teenage years, but thereafter no significant change throughout the lifetime. However, the development of the septal cartilage showed a gradual decline due to ossification changes with aging after puberty in spite of a lack of change in the total septal area. The area of harvestable septal cartilage in young adults was 549.84±151.26 mm2 and decreased thereafter with age. Conclusions A 3D facial bone CT scan can provide valuable information on the septal cartilage graft before rhinoplasty. Considering the developmental process of the septal cartilage identified in this study, septal surgery should not be performed until puberty due to the risk of nasal growth impairment. Furthermore, in elderly patients who show a decreased cartilage area due to ossification changes, septal cartilage harvesting should be performed carefully due to the risk of saddle nose deformity.

OBJECTIVES: Several in vitro studies showed that 1,25-dihydroxyvitamin D3 (1,25(OH)2D3) treatment could inhibit chronic inflammation in mouse or human adipocytes; however there have been a few in vivo studies. We investigated whether vitamin D supplementation affects subpopulation of immune cells in adipose tissue and the effects of in vitro 1,25(OH)2D3 treatment on pro-inflammatory cytokine secretion by stromal vascular cells (SVC) and adipocytes. METHODS: Five-wk old C57BL/6 N mice were divided into 4 groups and fed diets differ in fat amount (10 or 45% kcal fat: CON or HFD) and vitamin D content (1000 or 10,000 IU/kg of diet: DC, or DS) for 13 wks. Subpopulation of immune cells (macrophage, NK cell, CD 4 T cell, CD 8 T cell, B cell) from adipose tissue-derived SVC was determined by FACS analysis. Five-wk old C57BL/6 mice were fed control or HFD diets (10 or 60% kcal fat, CON or HFD) for 12 wks. Adipocytes and SVC, isolated from visceral adipose tissue, were cultured with or without 10 nM of 1,25(OH)2D3 for 48 h and stimulated with LPS during the last 24 h. Pro-inflammatory cytokines produced by SVC and adipocytes were measured by ELISA. The mRNA levels of Tlr2, Tlr4, Dusp1, and Dusp10 were determined in SVC by real-time PCR. RESULTS: The number of macrophages and NK cells within adipose tissue were higher in the HFD groups than CON groups. Dietary vitamin D did not alter the number of immune cells in adipose tissue. The production of IL-6 and MCP-1 from SVC and adipocytes were higher in the HFD groups compared with CON groups. In vitro 1,25(OH)2D3 treatment decreased IL-6, MCP-1, IL-1β production by SVC from HFD group and decreased IL-6 production by SVC from CON group. SVC Tlr2 mRNA levels, which were higher in the HFD group, decreased significantly by in vitro 1,25(OH)2D3 treatment. mRNA levels of Dusp1, which inhibits MAPK signaling, were increased by in vitro 1,25(OH)2D3 treatment. However, pro-inflammatory cytokine secretion from adipocytes was not affected by in vitro 1,25(OH)2D3 treatment. CONCLUSIONS: Although vitamin D supplementation did not reduce macrophage and NK cell numbers in adipose tissue, 1,25(OH)2D3 seemed to decrease pro-inflammatory cytokine production from SVCs by regulating Tlr2 and Dusp1. FUNDING SOURCES: Supported by the grant from the National Research Foundation (NRF) of Korea (NRF-2018R1D1A1B070491).

Objective : This study reports the effect of korean medicine on ptosis patient 1 case diagnosed as idiopathic oculomoter nerve palsy. Methods : We experienced one case of ptosis diagnosed as idiopathic ocu lomoter nerve palsy treated with herbal medicine and acupuncture. Ptosis and associated symptoms had be en estimated with difference of both eye’s interpalpebral fissure and VAS(Visual Analogue Scale). Result : After the treatment, symptoms were decreased and almost disap peared. In this case, difference of both eye’s interpalpebral fissure decreased from 6mm to 1mm in a month. Conclusion : This study suggests that korean medicine is effective on ptos is diagnosed as idiopathic oculomoter nerve palsy. Key words : Ptosis; Idiopathic oculomoter nerve palsy; Korean medicine; Difference of both eye’s interpalpebral fissure; Visual Analogue Scale ⓒ 2013 the Society of Korean Medical Ophthalmology & Otolaryngo logy & DermatologyThis is an Open Access journal distributed under the terms of t he Creative Commons Attribution Non-Commercial License (http://creativecommons.org/license/by-nc/3.0/) which permits u nrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Senescence-accelerated mouse prone (SAMP) strains of mice show early onset of senescence, whereas senescence-accelerated mouse resistant (SAMR) strains are resistant to early senescence and serve as controls. Although SAMP6 and SAMP8 are established models of central nervous system alterations, it is unclear whether SAMP1/Sku (SAMP1) is characterized by brain alterations and dysfunction related to behavioral functioning. In the present study, behavioral tests (i.e., locomotor activity, Y-maze, rotating rod, hind-limb extension, and traction), histochemistry, and Western blot analyses were employed to study this mouse model using 2- and 4-month-old SAMP1 and age-matched control SAMR1. Although 2-month-old SAMP1 and SAMR1 showed similar activity, 4-month-old SAMP1 exhibited less activity than age-matched SAMR1 in locomotor activity and Y-maze tests. In rotating rod test, 2- and 4-month-old SAMP1 showed motor-coordination dysfunction. An abnormal extension reflex in the hind-limb test was observed in 2- and 4-month-old SAMP1. There were no significant differences between SAMP1 and SAMR1 with respect to grip strength in the traction test or alternation behavior in the Y-maze test. Histochemistry and Western blot analyses exhibited that cerebellar Purkinje cells in 4-month-old SAMP1 mice persistently expressed tyrosine hydroxylase. These results suggest that SAMP1 is a useful model for examining mechanisms underlying motor dysfunction.

Autochthonous human gnathostomiasis had never been reported in the Republic of Korea. We report here a case of Gnathostoma spinigerum infection in a 32-year-old Korean woman, presumed to have been infected via an indigenous route. The patient had experienced a painful migratory swelling near the left nasolabial fold area of the face for a year, with movement of the swelling to the mucosal area of the upper lip 2 weeks before surgical removal of the lesion. Histopathological examinations of the extracted tissue revealed inflammation with heavy eosinophilic infiltrations and sections of a nematode suggestive of a Gnathostoma sp. larva. The larva characteristically revealed about 25 intestinal cells with multiple (3-6) nuclei in each intestinal cell consistent with the 3rd-stage larva of G. spinigerum. The patient did not have any special history of travel abroad except a recent trip, 4 months before surgery, to China where she ate only cooked food. The patient is the first recorded autochthonous case of G. spinigerum infection in Korea.

Objective : The purpose of this report is to know the effect of Jibaekjihwang-tang(知栢地黃湯) on progressive pigmented purpuric dermatosis. Methods : We experienced one case of progressive pigmented purpuric dermatosis treated with Jibaekjihwang-tang(知栢地黃湯). We used visual analogue scale(VAS). Results : After the treatment the grade of VAS was decreased and purpuras, pruritus and dryness of skin were disappeared. Conslusion : Jibaekjihwang-tang(知栢地黃湯) can be used on the treatment of progressive pigmented purpuric dermatosis.

Objective : This study reports the effect of oriental medicine with depletion and cupping therapy on post-herpetic neuralgia(PHN) 1 case. Methods : We experienced one case of PHN treated by oriental medical treatment with depletion and cupping therapy. To evaluate the effectiveness of this treatment, we used the Visual Analogue Scale(VAS). Result : After the treatment the grade of VAS was decreased and clinical symptoms were improved. Conclusion : Oriental medicine with depletion and cupping therapy can be available for relieving symptoms related with PHN.

Background Among all facial fractures, nasal bone fractures are the most common, and they have been reduced by closed reduction (CR) for a long time. But several authors have reported suboptimal results when using CR, and the best method of nasal bone reduction is still being debated. We have found that indirect open reduction (IOR) through an endonasal incisional approach is a useful method for more accurate reduction of the nasal bone. Methods A retrospective chart review was performed of 356 patients who underwent reduction of a nasal bone fracture in our department from January, 2006, to July, 2011. We treated 263 patients with IOR. We assessed patients' and doctors' satisfaction with surgical outcomes after IOR or CR. We evaluated the frequency of nasal bleeding owing to mucosal injury, and followed the surgical outcomes of patients who had simultaneous dorsal augmentation rhinoplasty. Results According to the analysis of the satisfaction scores, both patients and doctors were significantly more satisfied in the IOR group than the CR group (P Conclusions IOR enables surgeons to manipulate the bony fragment directly through the endonasal incisional approach. However, we propose that CR is the proper technique for patients under 16 and for those with comminuted nasal bone fractures because submucosal dissection in IOR can damage the growth or circulation of nasal bone.

OBJECTIVE To evaluate the association between coffee consumption and the risk of prostate cancer. METHODS We searched PubMed, EMBASE, and the bibliographies of relevant articles in August 2009. Two evaluators independently reviewed and selected articles based on predetermined selection criteria. RESULTS Twelve epidemiological studies (eight case-control studies and four cohort studies) were included in the final analysis. In a meta-analysis of all included studies, when compared with the lowest level of coffee consumption, the overall relative risk (RR) of prostate cancer for the highest level of coffee consumption was 1.16 (95% confidence interval [CI] 1.01-1.33). In subgroup meta-analyses by study design, there was a significant positive (harmful) association between coffee consumption and prostate cancer risk in seven case-control studies using both crude and adjusted data (RR 1.20, 95% CI 1.02-1.40; and RR 1.21, 95% CI 1.03-1.43, respectively), whereas there was no significant association in four cohort studies using crude or adjusted data (RR 0.97, 95% CI 0.68-1.38; and RR 1.06, 95% CI 0.83-1.35, respectively). CONCLUSION Given that a cohort study gives a higher level of evidence than a case-control study, there is no evidence to support a harmful effect of coffee consumption on prostate cancer risk. Further prospective cohort studies are required.

Background and Objectives: Hypertension develops as a result of cardiac hypertrophy and fibrosis or as a result of exchange of the extracellular matrix. In particular, matrix metalloproteinase (MMP)-3 is a major enzyme involved in the reconstruction of the arterial intima through activation of other MMPs. We analyzed MMP-3 genotypes in hypertensive and normotensive adolescents and sought to determine if a particular genotype is a predictor of cardiovascular complications. Subjects and Methods: Forty-four hypertensive adolescents and 59 healthy adolescents were included in this study. Serum aldosterone, renin, insulin, angiotensin converting enzyme (ACE), insulin, homocysteine, vitamin B12, folate, MMP-1, MMP-2, MMP-3, MMP-9, tissue inhibitors of matrix metalloproteinases (TIMP)-1, and TIMP-2 were measured. MMP-3 genotypes were analyzed using a polymerase chain reaction (PCR) primer. The carotid intima media thickness (IMT), diameter, and brachial ankle pulse wave velocity (baPWV) were evaluated using ultrasound. Results: In hypertensive adolescents, blood pressure, anthropometric data, carotid IMT, baPWV, serum pro-MMP-1, MMP-2, MMP-9, TIMP-1, and TIMP-2 were no different between the 6A/6A group and the 5A/6A group. Serum MMP-9 was higher in the 5A/6A group than in the control group. Aldosterone, insulin, and homocysteine were higher in the 6A/6A group than in the control group, and vitamin B12 and folate were lower in the 6A/6A group than in the control group. Conclusion: In conclusion, serum MMP-3 levels were not significantly different in different MMP-3 genotypes in hypertensive adolescents. However, few patients were included in this study. Further investigation is necessary to clarify the relationship between MMP-3 genotype and cardiovascular risk. (Korean Circ J 2009;39:328-334)

A Case of Childhood Sleep-Related Rhythmic Movement Disorder Tae Yeon Kim, M.D., Hyun Hee Lee, M.D., Sung Ku Kim, M.D., Kon Hee Lee, M.D. Department of Pediatrics, Kangnam Sacred Heart Hospital, School of Medicine Hallym University Sleep-related rhythmic movement disorder (SRMD) is defined by uniformed, repetitive movements, which occurs from onset of sleep to light sleep and sometimes during deep sleep. We experienced a 21 month-old girl complained of the rhythmic movements during sleep. After controlling her circadian rhythm for 45days, her symptoms dramatically improved; there was no more hitting her head or legs on the floor. We considered that rhythmic movement would be related to circadian rhythm without medication.

Although hair growth medications have been developed, these medications have some side effects and usability problems. Recently there has been a growing interest in hair loss remedies from natural materials. This Study was carried out to investigate the effect of SM-215 on hair growth by hair follicle stimulation. We divided the 8-week-old ICR mice into a Control Group (CG), a Non-Treatment Group (NTG), and a SM-215 application Group (SMG). 100μl/day of SM 215 was applied for 3 weeks to SMG. After 3 weeks, we found a change to the sebaceous gland, the capillaries around the hair follicles (Vascularity and Vasodilation of capillaries), and changes in the hair follicle activity (Growth-promoting hormones, Neurotransmitters) in a tissue sample excised from the dorsal skin. A large number of hair and hair follicles in the subcutaneous layer of SMG was observed as compared to the NTG. Sebum secretions around the hair follicles and sebaceous gland distribution of SMG were observed more clearly than in NTG. A large number of capillaries, especially in the hip region versus the neck region in SMG, were also observed compared to the NTG as noted through external capillaries observation. Positive responses of IGF-1, serotonin, and neuropeptide Y in SMG were increased compared to the NTG in immunohistochemistry. Based on these studies and analysis, we suppose that SM-215 improves a hair growth activity by increasing the distribution of the sebaceous glands, capillaries around the hair follicles, and the vasodilation to assist in forming the necessary environment for hair growth, thereby promoting hair growth by stimulating at hair follicles.

BR-TD-1001 was developed as a booster for the immunity maintenance of diphtheria and tetanus. The aim of this study was to evaluate the safety and immunogenicity of BR-TD-1001 (test vaccine) in comparison with placebo and an active comparator in healthy Korean adults. A randomized, double-blind, placebo-controlled, active comparator, phase I clinical trial was conducted. Fifty subjects were randomly assigned to one of 3 treatment groups in a ratio of 2:2:1, and were administered a single intramuscular dose of test vaccine, active comparator, or placebo, respectively. All subjects were monitored for 4 weeks after injection. The antibody titers of the patients 2 and 4 weeks after vaccination were compared with the baseline. The frequencies of all adverse events including adverse drug reactions in the test group were not statistically different from those of the other treatment groups (P = 0.4974, 0.3061). No serious adverse event occurred, and no subject was withdrawn from the study for safety. The seroprotection rates against both tetanus and diphtheria at 4 weeks after vaccination were over 0.95. For anti-tetanus antibody, the geometric mean titer in the test group was significantly higher than those of the other groups (P = 0.0364, 0.0033). The geometric mean titer of anti-diphtheria antibody in the test group was significantly higher than the value of the placebo (P = 0.0347) while it was not for the value of the active comparator (P = 0.8484). In conclusion, BR-TD-1001 was safe, well-tolerated, and showed sufficient immunogenicity as a booster for diphtheria and tetanus.

As surgery grew to become a respected medical profession in the eighteenth century, medical ethics emerged as a response to the growing need to protect patients and maintain the public's trust in physicians. The early influences of John Gregory and Thomas Percival were instrumental in the formulation of patient-centered medical ethics. In the late nineteenth century, the modern surgical advances of anesthesia and antisepsis created the need for a discipline of ethics specific to surgery in order to confront new and evolving ethical issues. One of the founding initiatives of the American College of Surgeons in 1913 was to eliminate unethical practices such as fee-splitting and itinerant surgery. As surgery continued to advance in the era of solid organ transplantation and minimally invasive surgery in the latter half of the twentieth century, surgical innovation and conflict of interest have emerged as important ethical issues moving forward into the twenty-first century. Surgical ethics has evolved into a distinct branch of medical ethics, and the core of surgical ethics is the surgeon-patient relationship and the surgeon's responsibility to advance and protect the well-being of the patient.

종양성 석회증은 특발성 피부석회증의 일종으로 관절 주변 조직에 인산 칼슘이 침착되는 질환이다. 병인으로 명확히 알 려진 것은 없으나 특별한 대사 질환이나 외상 없이 특발성으 로 발생되는 경우가 대부분으로 주로 고관절, 어깨 관절, 팔꿉 관절, 무릎 관절처럼 큰 관절 주변에 발생하며, 수부에는 매우 드물게 발생한다. 종양성 석회증은 서서히 자라며 단단한 형태의 결절형으로 이루어지며 표면의 피부는 정상 소견을 보이는 경우가 대부분 이다. 환자는 특별한 대사 질환이나 외상이 없는 경우가 대부 분이며 특히 수지에 발생한 종양성 석회증은 압통 및 원위부 의 저린감 외에는 특별한 증상을 호소하지 않는다. 단순방사 선 검사상 불투과성의 경계가 명확한 다엽성의 특징적인 소견 을 보이며 이를 통해 결절종, 거대세포종, 상피낭종, 지방종 등과 감별을 할 수 있는데, 일반적으로 종양성 석회증은 수지 에서는 거의 발생하지 않으며, 또한 임상 양상상 단순 양성 종 양으로 생각하여 특별한 검사 없이 외과적 절제술을 시행하 Tumoral Calcinosis of the Index Finger: A Case Report

The rapid stimulation of the specific activity of the brain type isozyme of creatine kinase (CK BB) is an almost universal marker of cell stimulation. We have studied its stimulation in skeletal-derived cells and shown that the increase in its activity is closely correlated with the biochemical parameter of cell proliferation — [ 3 thymidine incorporation into DNA — and with the morphological parameters of bone growth, increase in thickness of cortical bone and of the number of cells in the proliferating zone of the epiphyseal growth plate. We have used the increase in CK activity to demonstrate sex specific stimulation of diaphyseal bone, exclusively by estrogens in females and by androgens in males, and the dependence of sex steroid stimulation on an adequate level of vitamin D. After finding that parathyroid hormone can act as a mitogen via a phospholipase-C-phosphoinositide turnover pathway, we collaborated with colleagues at the GBF in Braunschweig to find that mid-region fragments of PTH could act exclusively as mitogens, without stimulating cAMP production leading to bone resorption. hPTH (28–48) variants designed to be resistant to proteolysis were efficient in stimulating CK specific activity in vitro and in vivo and increased cortical bone thickness and the number of proliferating epiphyseal cartilage cells in rat long bones. These results are put into an historical context and compared with recent studies, in this short, selective review.