Puberty is a complex and coordinated biologic process of sexual development that leads to complete gonadal maturation and function, and attainment of reproductive capacity. The pubertal activation of pulsatile gonadotropin-releasing hormone (GnRH) secretion requires coordinated changes in excitatory and inhibitory neurotransmitters, growth factors, and a group of transcriptional regulators. Kisspeptin and its putative receptor, G protein-54 signaling complex, have recently emerged as essential gatekeepers of GnRH activation. Precocious puberty is defined as the onset of secondary sexual characteristics before the age of 8 years for girls and 9 years for boys. The prevalence of precocious puberty is rapidly increasing in Korea. Factors affecting early puberty include genetic traits, nutrition, and exposure to endocrine disrupting chemicals. Precocious puberty may cause psychosocial problems with inappropriate early biological maturation and significant impairment of final height due to accelerated bone maturation. In rapidly progressing central precocious puberty, GnRH agonists appear to increase final height without significant side effects, if administered in the early stages. Further large-scale randomized controlled studies of the long-term safety and efficacy of GnRH agonist treatment are needed.
Adolescent ; Endocrine Disruptors ; Female ; Gonadotropin-Releasing Hormone ; Gonads ; Humans ; Intercellular Signaling Peptides and Proteins ; Korea ; Neurotransmitter Agents ; Prevalence ; Puberty ; Puberty, Precocious* ; Sexual Development

Metabolic syndrome (MetS) is a cluster of metabolic abnormalities that include hypertension, altered glucose metabolism, dyslipidemia, and abdominal obesity and is strongly associated with an increased risk for diabetes and cardiovascular disease onset in obese adults and children. A progressively greater number of children and adolescents are being affected by this syndrome due to the constant increase in the prevalence of obesity. Like obesity, childhood MetS highly tracks to adulthood. The pathogenesis of MetS includes the interaction between obesity, insulin resistance, and inflammation. Early diagnosis and intervention are important in order to conduct lifestyle modification. In this article, we review the definition and pathophysiology of MetS, the importance of screening, and prevention and treatment options for MetS in childhood.

Pediatric obesity has increased over the decades, and in particular, severe pediatric obesity has become a serious public health problem. A concern has arisen that the COVID-19 pandemic may exacerbate the incidence of childhood obesity.Current Concepts: The consequences of severe pediatric obesity are more devastating than those of moderate obesity. Children with severe obesity are at a greater risk for hypertension, type 2 diabetes, metabolic syndrome, non-alcoholic fatty liver disease, atherosclerosis, and adult obesity. Correct assessment and diagnosis of a child with severe obesity is key to successful therapy. A thorough history and physical examination are important in identifying monogenic obesity or metabolic syndrome. Eating behaviors and psychosocial factors should be assessed to improve weight management outcomes. Treatment options for severe pediatric obesity include lifestyle modification, pharmacotherapy, and metabolic and bariatric surgery. Even though progress has been made with regard to the treatment of obesity, safe and effective treatment of severe pediatric obesity is challenging.Discussion and Conclusion: More efforts and innovations are needed to find a solution for the huge medical and emotional burden the children with severe obesity and their families are enduring.

Pediatric obesity has increased over the decades, and in particular, severe pediatric obesity has become a serious public health problem. A concern has arisen that the COVID-19 pandemic may exacerbate the incidence of childhood obesity.Current Concepts: The consequences of severe pediatric obesity are more devastating than those of moderate obesity. Children with severe obesity are at a greater risk for hypertension, type 2 diabetes, metabolic syndrome, non-alcoholic fatty liver disease, atherosclerosis, and adult obesity. Correct assessment and diagnosis of a child with severe obesity is key to successful therapy. A thorough history and physical examination are important in identifying monogenic obesity or metabolic syndrome. Eating behaviors and psychosocial factors should be assessed to improve weight management outcomes. Treatment options for severe pediatric obesity include lifestyle modification, pharmacotherapy, and metabolic and bariatric surgery. Even though progress has been made with regard to the treatment of obesity, safe and effective treatment of severe pediatric obesity is challenging.Discussion and Conclusion: More efforts and innovations are needed to find a solution for the huge medical and emotional burden the children with severe obesity and their families are enduring.

Ever since recombinant human growth hormones (GH) were produced in the 1980s, many studies on their metabolic effects have been performed. GH has been shown to have a diabetogenic action resulting in glucose intolerance. Even though there is no evidence that GH increases the risk of diabetes, HbA1c, glucose, insulin tests should be carried out during GH treatment. GH increases free fatty acids and glycerol, and inhibits fat formation. Moreover, GH degrades abdominal fat and redistributes it to peripheral areas. GH increases amino acid intake via IGF1, increases protein synthesis by directly enhancing the translation of the transcription mRNA, and inhibits protein degradation to form a positive nitrogen balance. GH produces sodium and water retention effects through the activation of Na+ K+ ATPase in distal nephron and renin-angiotensin-aldosterone axes and ANP receptor down-regulation. Metabolic side-effects with clinical significance due to GH treatment do not occur, however such side-effects of long-acting or high-dose GH treatment should be investigated. GH treatment can be used safely in children, yet it requires continuous and vigilant monitoring.
Abdominal Fat ; Adenosine Triphosphatases ; Atrial Natriuretic Factor ; Child ; Down-Regulation ; Fatty Acids, Nonesterified ; Glucose ; Glucose Intolerance ; Glycerol ; Growth Hormone ; Humans ; Insulin ; Nephrons ; Nitrogen ; Proteolysis ; RNA, Messenger ; Sodium

No abstract available.
Meals ; Obesity, Abdominal

Over the past two decades, there have been numerous reports on the increasing incidence of type 2 diabetes mellitus (T2DM) in children and adolescents. This trend, which parallels the increase in the prevalence and degree of pediatric obesity, is causing significant concern. This review focuses on the characteristics andcurrent management strategies for juvenile patients with T2DM. Current Concepts: Juvenile T2DM differs from type 1 diabetes mellitus (T1DM) in children and T2DM in adults as it is an aggressive disease with rapidly progressive β-cell decline, high treatment failure rate, and accelerated development of complications. Current management approaches include lifestyle changes such as improved diet and increased physical activity, and pharmacological interventions such as metformin, insulin, and liraglutide.Discussion and Conclusion: Early diagnosis and prevention of T2DM in children and adolescents are essential. Furthermore, compared to adults, there is still a lack of available treatment drugs or research in children and adolescents. Therefore, long-term research on the efficacy and safety of various drug treatments for T2DM in children and adolescents is required. Additionally, as it is often asymptomatic in its early stages, significant efforts by physicians are required for the early diagnosis and prevention of T2DM.

In 1999 Kayikcioglu and his colleagues invented the oblique nerve coaptation technique which increases coaptation surface and proved that their technique is superior to conventional vertical coaptation technique. This method is useful but it is not fit for a clinical application because the sciatic nerve was cut obliquely and repaired immediately in their experiment. In that case, we couldn't exclude the possibility of the improved effect by increased orientation of nerve fiber. Using different nerves we could exclude the effect by orientation improvement and prove the superiority of the oblique nerve coaptation technique in functional restoration. Ten Sprague-Dawley rats were used. The tibial nerve and the peroneal nerve were cut randomly to 30 degree and 90 degree on each side. The distal stump of the tibial nerve and the proximal stump of the peroneal nerve were repaired with 10-0 nylon under microscopic view. 12 weeks after nerve coaptation, nerve conduction velocity of extensor digitorum longus muscle, moist weight and histological analysis of extensor digitorum longus muscle, and myelinated axonal count and histological analysis of peroneal nerve were investigated. The results showed the nerves of oblique coaptation(30 degree transection angle) group are more regenerated than those of vertical coaptation(90 degree transection angle) group and nerve conduction velocity and moist weight of extensor digitorum longus muscle are also increased in oblique coaptation group. From these results we came to a conclusion that the oblique nerve coaptation technique is superior to the conventional technique and may be helpful in innervated free flap or nerve graft.
Axons ; Free Tissue Flaps ; Myelin Sheath ; Nerve Fibers ; Neural Conduction ; Nylons ; Peroneal Nerve ; Rats, Sprague-Dawley ; Sciatic Nerve ; Tibial Nerve ; Transplants

Despite the careful regulation of serum calcium, calcification of cutaneous and subcutaneous tissues may occur. Calcification is the deposition of insoluble calcium salts; when it occurs in cutaneous tissues, it is known as calcinosis cutis. Calcinosis cutis is classified into four types: metastatic calcinosis cutis, dystrophic calcinosis cutis, idiopathic calcinosis cutis, and subepidermal calcified nodule. From January 2000 to May 2001, we have experienced 3 patients with calcinosis cutis. Two cases were dystrophic calcinosis cutis associated with radiation therapy and old burn scar with complications of delayed wound healing after punch biopsy, despite of conservative treatment for several weeks. Another was idiopathic calcinosis cutis. We performed surgical treatments in all cases: wide excision and pectoralis major muscle rotational flap coverage, wide excision and split-thickness skin graft, and excision and direct closure. No patients experienced wound healing problems. We believed surgical excision and appropriate reconstruction procedure is an effective theraphy in localized or ulcerated and chronic infected calcinosis cutis.
Biopsy ; Burns ; Calcinosis* ; Calcium ; Cicatrix ; Humans ; Salts ; Skin ; Subcutaneous Tissue ; Transplants ; Ulcer ; Wound Healing

BACKGROUND: Post-intubation injury is known to be the most common cause of tracheal stenosis. Treatment strategy for tracheal stenosis varies accoring to the extent of pathologic lesion. Focal mucosal lesion can be treated with laser photoablation, but full thickness tracheal lesion should be treated with resection and anastomosis. MATERIAL AND METHOD: From Aptil 1998 to May 1999, twelve patients suffering from tracheal stenosis as a complication of endotracheal intubation were managed by resection and end-to-end anastomosis in the Department of Thoracic and Cardiovascular Surgery, Gyeongsang National University Hospital. RESULT: There was no operative mortality. Five temporary vocal cord paralysis and one wound infection occurred as early complications. During 18 months of follow-up, re-stenosis was not found. CONCLUSION: Tracheal resection and anastomosis can be considered as an excellent surgical treatment for tracheal stenosis which developed as a complication of endotracheal intubation.
Follow-Up Studies ; Humans ; Intubation, Intratracheal ; Mortality ; Tracheal Stenosis* ; Vocal Cord Paralysis ; Wound Infection