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Thermographic Assessment in Dry Eye Syndrome, Compared with Normal Eyes by Using Thermography (열화상카메라를 이용한 정상안과 건성안의 서모그래피 비교)

  • Park, Chang Won;Lee, Ok Jin;Lee, Seung Won
    • Journal of Korean Ophthalmic Optics Society
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    • v.20 no.2
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    • pp.247-253
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    • 2015
  • Purpose: The purpose of this study was to compare and analyze the ocular surface and the palpebral conjunctiva of categorized subjects, which were divided into normal eye group and dry eye group, by using a thermal camera. Methods: Subjects were 144 eyes of 72 normal university students, who didn't have any corneal disease, abnormal lacrimal ducts, medical records regarding ocular surgeries, or experience of using contact lens. Subjects were divided into two groups, which were normal eye group and dry eye group, based on the results of TBUT, Schirmer I test, and McMonnies test. After categorizing the subjects, the temperature of the subjects' ocular surface and the palpebral conjunctiva were measured and analyzed by using a thermal camera (Cox CX series, Answer co., Korea). Results: In the normal eye group's Central Ar.1, Nasal Ar.2, Temporal Ar.3, Superior Ar.4, Inferior Ar.5, the measured amount of temperature change on each area was $-0.13{\pm}0.08$, $-0.14{\pm}0.08$, $-0.12{\pm}0.08$, $-0.14{\pm}0.08$, $-0.10{\pm}0.09(^{\circ}C/sec)$. The dry eye group's results were $-0.17{\pm}0.08$, $-0.16{\pm}0.07$, $-0.16{\pm}0.08$, $-0.17{\pm}0.09$, $-0.15{\pm}0.08(^{\circ}C/sec)$. When compared with the normal eye group, the values of Ar.1, Ar.3, Ar.5 were significantly different in the dry eye group(p<0.05). The amount of temperature change, which was observed on the palpebral conjunctiva(Ar.1:central, Ar.2: nasal, Ar.3: temporal) of the normal eyes, measured by thermography, was $34.36{\pm}1.12$, $34.17{\pm}1.10$, $34.07{\pm}1.12^{\circ}C$ on each area. Same values taken from the dry eye group was $33.55{\pm}0.94$, $33.43{\pm}0.97$, $33.51{\pm}1.06^{\circ}C$ on each area. The values of Ar.1, taken from the dry eye group, had a significant difference, compared to the values of the normal eye group(p=0.05). Conclusion: The temperature of the ocular surface decreased faster on the dry eyes, compared to the normal eyes. The temperature measured on the palpebral conjunctiva of the dry eyes were also lower than the normal eyes. The temperature changes on the ocular surface, observed with a thermal camera, were objective values to assess the stability of tear films, and might provide useful data for studies related to dry eye syndrome.

The Relationship of Anxiety Symptoms and Depressive Symptoms to Glycemic Control in Diabetic Patients (당뇨병 환자에서 우울증상 및 불안증상과 혈당조절과의 연관성)

  • Jeon, Byung-Hee;Kim, Hyun-Woo;Kim, Hee-Jin;Lim, Myung-Ho;Lee, Seok-Bum;Paik, Ki-Chung;Lee, Kyung-Kyu
    • Korean Journal of Psychosomatic Medicine
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    • v.16 no.2
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    • pp.95-102
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    • 2008
  • Objectives : Diabetes patients suffer from severe stress in maintaining the diet therapy and exercise therapy as well as the disease itself, and this stress has bad effects on controlling the glucose level and causes high prevalence rate of depressive and anxiety disorders. These symptoms again have deleterious effects on blood glucose control. A lot of researches about the relationship between glycemic control and symptoms of depression and anxiety and about the positive effects of the treatments of depression and anxiety disorder on glycemic control in diabetic patients are being performed. In Korea, the research regarding the relationship between glycemic control and depression and anxiety symptoms are seldom performed. In this study, we tried to find out the correlation between the glycemic control and depressive symptom and anxiety symptom. Methods : The study included 65 patients(male 34, female 31) with Diabetes in outpatient clinic of the Department of Endocrinology in Dankook University Hospital. We used the HbA1c levels to check glycemic control through blood sample analysis and used Beck Depression Inventory(BDI) and Beck Anxiety Inventory(BAI). Results : Among the 65 Diabetes patients, 21(32.30%) had mild depressive symptoms, and 6(9.23%) had moderate or severe depressive symptoms. The relation of HbA1c and BDI was not statistically significant, but was significant between HBA1c and BAI, (R=0.567, P<0.001). In the linear regression analysis, BAI had an effect on HbA1c($\beta=0.533$, T=5.012, P=0.00), but BDI, diabetes complications, diabetic morbid period and BMI had no effect on HbA1C. The relationship between HbA1c and BDI was not statistically significant, but the relationship between HbA1c and BAI was statistically significant(R=0.254, P<0.001). Conclusions : In this study, the rates of diabetic patients with depressive symptoms were higher, but those with anxiety symptoms were not higher than the general population. We could not find out significant relationship between depressive symptom and glycemic control, but found the significant relationship between the anxiety symptom and glycemic control in diabetic patients.

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Production and Inhibition of Cellulolytic and Pectolytic Enzymes by Cylindrocarpon destructans(Zins.) Scholten Causing Root Rot of Ginseng (인삼뿌리썩음병균, Cylindrocarpon destructans에 의한 섬유소분해효소 및 펙틴질분해효소의 분필 및 억제)

  • Lee Jin Woo;Chung Hoo Sup
    • Korean journal of applied entomology
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    • v.13 no.1 s.18
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    • pp.1-10
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    • 1974
  • The activities of pectolytic and cellulolytic enzymes produced from slices of ginseng root infected with Cylindrocarpon destructains(Zins.) Scholtern were proportional to each concentration and reaction time. Activities of cellulase(Cx), endo-polygalacturonase(endo-PG), endo-polymethylg-alacturonase(endo-PMG), exo-polygalacturonase(exe-PG), and exe-polymethylgalacturonase(exo-PMG) were maximum on the 4th day after inoculation. No endo-PG and endo-PMG were detected at the first and second days, while exo-PG exo-PMG were active. On the 6th day, all pectic enzymes were completely lost, whereas Cx remained at a high concentration. pH optima of Cx, endo-PG, endo-PMG, exo-PG, and exo-PMG were 6.0, 5.5, 8.0, 7.0 to 7.5, and 8.5, respectively. Temperature optima of Cx, endo-PG, endo-PMG exo-PG, and exo-PMG were $66^{\circ}C\;53^{\circ}C\;41^{\circ}C\;37^{\circ}C\;and\;40^{\circ}C$, respectively. Cx was only inhibited by $0.05M\; Hg^{++}$ among 16 ions tested. Inhibitory effects of ions on pectolytic enzymes varied, however$M Fe^{+++}\;and\;0.05M\;Al^{+++}$ were the best in general. Among 8 fungicides, none of them inhibited all the enzymes studied at $0.1\%$, active ingredients. Exo-PG were highly inhibited by all of the fungicides, of which difolatan was the most inhibitory to all the pectic enzymes. $Ca^{++}\; at\; 0.02M\; and\;Fe^{+++}\;at\;0.02M$ completely inhibited all the pectolytic enzymes, and Cx was inhibited $30\%$ and $70\%$ at the same concentration, respectively Formalin almost inhibited exo-PG and exe-PMG at $0.8\%$ but not the other enzymes especially Cx. Difolatan at $0.8\%$ inhibited all the enzymes concerned above $80\%$. The cellulolytic and pectolytic enzymes of C. destructans must be closely associated with the ginseng root rot and should be inhibited to control the disease effectively.

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THE EFFECTS OF POLYTETRAFLUOROETHYLENE MEMBRANE AND MILLIPORE FILTER COMBINED WITH FIBRIN ON THE REGENERATION OF PERIODONTIUM IN DOGS (Polytetrafluoroethylene membrane 및 millipore filter를 섬유소와 병용사용시 성견 치주조직 재생에 미치는 영향)

  • Joo, Sang-Don;Park, Jae-Wan;Suh, Jo-Young
    • Journal of Periodontal and Implant Science
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    • v.23 no.3
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    • pp.577-594
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    • 1993
  • The ultimate goal of periodontal therapy is the regeneration of the periodontium that have been destroyed as a result of periodontal disease. This study were done in order to determine the healing status of periodontium under Polytetrafluoroethylene and millipore fillter combined with fibrin and the effect of the guided tissue regeneration procedures were performed as follows : 1) flap operation using PTFE membrane(control group) 2) flap operation using PTFE membrane which was fixed with fibrin(experimental group 1) 3) flap operation using millipore filter which was fixed with suture(experimental group II) 4) flap operation using millipore filter which was fixed with fibrin(experimental group II) After 1, 2, 4, 8, 12 weeks, dogs were sacrificed by perfusion technique and tissue block was excised including the tooth and prepared for light microscope with H-E & Masson’s trichrome staining. The result were as follows : In control and experimental group, there is no siginificant difference on epithelial cell down growth within 1st week, but more epithelial cell downgrowth in millipore or millipore combined with fibrin group. In this experiment, there were no significant difference in new cementum and alveolar bone formation whether PTFE membrane was fixed with suture or fibrin. In control and each experimental group, bone maturation appeared in 4 weeks, bone width increased bucco-lingually in control and experimental 1 group especially. Both control group and experimental group showed mild mew cementum formation on root surface and irregular arrangement of collagen fiber at 4 weeks, that showed obvious increased cementum formation at 8 weeks, and that was observed the functional arrangement of collagen fiber between new cementum and new alveolar bone at 12 weeks.

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Bone Metastasis after a Curative Resection for Gastric Cancer (위암의 근치적 절제술 후 발생한 골 전이)

  • Kim Jin Jo;Song Kyo Young;Chin Hyung Min;Kim Wook;Chun Hae Myung;Park Cho Hyun;Park Seung Man;Park Woo Bae;Lim Keun Woo;Kim Seung Nam
    • Journal of Gastric Cancer
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    • v.5 no.1
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    • pp.23-28
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    • 2005
  • Purpose: Bone metastasis is not a common event in patients with gastric cancer. Therefore, most studies of bone metastasis in such patients have been in the form of case reports, so the clinical features of the bone metastasis are not well understood. To clarify metastatic patterns, the efficacy of radiation or chemotherapy, and the prognosis, we analyzed 29 cases of patients with bone metastases after curative surgery for gastric cancer. Materials and Methods: Twenty-nine (29) gastric cancer patients with bone metastasis who underwent curative resection from January 1989 to December 2002 at the Departments of Surgery, Kangnam St. Mary's Hospital and Our Lady of Mercy's Hospital, The Catholic University of Korea, were analyzed. Results: Nineteen (19) patients were males and, 10 patients were females. The mean age of the patients was $53\pm12$ years. There were more Borrmann type-3 and type-4 cancers and more undifferentiated histologic types. Most of the original cancers were stage III or IV. The most frequently involved bone was the spine. Treatment after recurrence was done in 16 patients ($55.2\%$). The median survival time after recurrence of the patients who received treatment was seven (7) months ($0\∼75$ months in range), which was significantly longer than that of the patients who did not received treatment (P=0.019). However, there was no difference according to the treatment modality (P=0.388). Conclusion: Bone metastasis after a curative resection of gastric cancer tends to occur in Borrmann type-3 and type-4 cancers, cancers with undifferentiated histology and, in stage III/IV disease. The prognosis of bone metastasis is dismal, and aggressive treatment is the only way to prolong survival.

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Eotaxin mRNA Expression in Bronchial Mucosa of Patients with Asthma (천식 환자의 기관지 조직에서 Eotaxin mRNA 발현에 관한 연구)

  • In, Kwang-Ho;Cho, Jae-Yun;Kang, Sae-Yong;Lee, Sang-Youb;Shim, Jae-Jeong;Kang, Kyung-Ho;Yoo, Se-Hwa;Na, Young-Soon;Kim, Han-Gyum
    • Tuberculosis and Respiratory Diseases
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    • v.45 no.4
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    • pp.697-704
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    • 1998
  • Background: Asthma is a chronic inflammatory disease of the airways characterized by a marked infiltration of eosinophils in the bronchial mucosa. Asthmatic bronchial mucosa produces many factors described as being chemotactic for inflammatory cells. IL-5, RANTES, and MCP-1 alpha are the chemotactic factors for eosinophils, but their roles are controversial. Recently eotaxin that is a potent eosinophil chemoattractant cytokine was detected in a guinea-pig model of allergic airway inflammation, and human eotaxin was cloned. Eotaxin is a specific chemoattractant for eosinophils, but its role in asthma is not confirmed. We examined the in vivo expression of eotaxin in bronchi of asthmatic patients. Methods : 11 asthmatics and 2 normal controls were enrolled. All subjects were underwent bronchoscopy with bronchial biopsies in 2nd or 3rd carina. RNA extraction from biopsy samples was done by acid-guanidium method. Semi-quantitaive RT-PCR was done for evaluation of eotaxin mRNA expression The extent of eosinophil infiltration was evaluated by counting the eosinophils in submucosa in HPF of microscope. Results : Eotaxin mRNA expressed in symptomatic, uncontrolled asthma. Steroid inhibited expression of eotaxin mRNA in asthma. Expression of eotaxin mRNA correlated with eosinophil infiltration in bronchial tissues. Conclusion: Expression of eotaxin mRNA increases in uncontrolled asthma and eotaxin is involved in the recruitment of eosinophils.

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A Study on Principle of Kigong mentioned in the lecture on Truth of ${\ll}$Samilshingo${\gg}$(三一神誥) and its Interrelationship with Oriental Medicine (${\ll}$삼일신고(三一神誥).진리훈(眞理訓)${\gg}$에 나타난 氣功原理(氣功原理) 및 한의학(韓醫學)과 의 상관성(相關性)에 관(關)한 연구(硏究))

  • Ban Chang-Youl;Jee Seon-Young;Gang Go-Sin
    • Journal of Korean Medical Ki-Gong Academy
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    • v.4 no.2
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    • pp.153-186
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    • 2000
  • Jigam(止感), Josik(調息), Kumchock(禁觸), from the lecture on Truth of ${\ll}Samilshingo{\gg}$(三一神誥) treat three elements of Kigong, regulation of mental activties, regulation of breathing and adjustment of posture and there are some similar mentions with the view of human body based on oriental medicine like those Samjin(三眞), Sammang(三妄), Samdo(三途) and Sippalkyoung(十八境) ect. Thus as a result of comparison and observation about the interrelationships between principle of Kigong in the lecture on Truth of ${\ll}Samilshingo{\gg}$(三一神誥) and oriental medicine. I have conclusion as follows. 1. According to the lecture on Truth, the components of human body are the one and only Samjin(三眞), Sammang(三妄) and Samdo(三途) resulted from facing Samjin(三眞) to Sammang(三妄) and Sippalkyoung(十八境). This fact presents the principle of human change. 2. the principle of Kigong mentioned in the lecture on Truth shows the original Ilshin(一神) on the basis of Samjin(三眞), Sammang(三妄), Samdo(三途) and Sippalkyoung(十八境). This makes common, unity and sound Sim(心), Ki(氣) and Shin(身), Sammang(三妄) through Jigam(止感), Josik(調息) and Kumchock(禁觸), be versed, intellected and guaranteed Sung(性), Myoung(命) and Jung(精), Samjin(三眞) and emit Kyun(見), Mun(聞), Ji(知) and haeng(行), Sadaeshingi(四大神機) and finally all these are harmonized into Duk(德), Hye(慧) and Ryuk(力), Samdae(三大) which is the entity of God. 3. Samsipyookjongmyowhasang(三十六種妙化相) is an ascetic practice done after a chulin(哲人) deduce Ji(止), Jo(調) and Kum(禁), Sambup(三法) on the basis of the lecture on Truth. So I suppose it correlates nature's six elements. Kong(空)(Chun(天)). Yol(熱)(Wha(火)). Jin(震(Jeon(電)), Seup(濕)(Shoo(水)), Han(寒)(Poong(風)) and Ko(固)(Ji(地)), human's Samjin(三眞), Sung(性), Myoung(命) and Jung(精) and Sammang(三妄), Sim(心), Ki(氣) and Shin(身) and makes clear the principle of discipline. 4. In comparison with Samjin(三眞) and Sammang(三妄) says from the lecture on Truth and the Three Essential Elements of the body construction(三寶) from oriental medicine, Samjin(三眞) and Sammang(三妄) as factors of human body in the concept of practical knowledge. That is the one and only Samjin(三眞) in terms of the Three Essential Elements of the body construction(三寶) is considered a structural principle for every single person and Sammang(三妄) is considered a functional form for each individual. And it can be Sung(性)+Sim(心)=Spirit(神), Myoung(命)+Ki(氣)=Vital Force(氣) and Jung(精)+Shin(身)=True Essence(精). 5. In comparison with Sippalkyoung(十八境) of Samdo(三途) from the lecture on Truth and three medical causes of disease, Gamdoyookkyoung(感途六境) is similar with endopathic cause caused by Naesangchiljung(內傷七情), Sikdoyukkyoung(息途六境) is similar with exopathic cause by six climatic conditions in excess as pathogenic factors(六淫) and Yoegi(?氣) and Chokdoyukkyoung(觸途六境) is similar with non-endo-exopathogenic causes by diet imbalance, fatigue, intemperance in sexual life and trauma etc. 6. In the lecture on Truth, the Chulin(哲人) who discipline Sambup(三法), Sangchul(上哲), Choongchul(中哲) and Hachul(下哲) can be compared with Kigong expert(health preserving expert) such as the Spiritual Men(眞人), the Sapients(至人), the Sages(聖人) and the Men of Exellent Virtue(寶人) in the Sang Gu Tian Zhen Lun of the Huang Ti Nei Ching Su Wen(素問 上古天眞論) and then Sangchul(上哲) is the Spiritual Men(眞人), Choongchul(中哲) is the Sapients(至人) and Hachul(下哲) is the Sages(聖人) while the men of Exellent Virtue(賢人) is inferior to Chulin(哲人) when he goes to extremes.

A Clinical Analysis of Femur Neck Fracture in Elderly Patients (노년층에서 대퇴경부 골절의 치료)

  • Ihin, Joo-Choul;Ahn, Myun-Whan;Seo, Jae-Sung
    • Journal of Yeungnam Medical Science
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    • v.2 no.1
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    • pp.11-22
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    • 1985
  • Femur neck fracture is well known as one of the major death cause after trauma in elderly patients, and unsolved fracture due to its frequent association with complications such as avascular necrosis and nonunion. Through meticulous evaluation of the patient, hip and surgeon's experiences, reduction of mortality and morbidity as well as rapid recovery of the patient to the preinjury social and ambulatory status without local complications and revision after treatment is urgently needed. Many factors about this fracture In itself were noted, but we have analyzed 18 femur neck fractures of the patients older than 50 years preliminarily according to age, fracture pattern, osteoporosis, etiology and method of treatment with its delay in association with major complications especially avascular necrosis and nonunion. The results are as follows; 1. Of these 18 fractures, 11 were in females, 8 were caused by minor trauma such as slip-down accident and 4 were associated with definite osteoporosis according to the Sing's classification. 2. Fracture pattern of these 18 are undisplaced in 4, displaced subcapital in 11, displaced transcervical in 3. 11 fractures in the patients older than 60 year are composed of 3 undisplaced or impacted fractures and 8 displaced subcapital fractures. 3. These 18 fractures were treated by closed reduction and Internal fixation with multiple pins in 13, and hemiarthroplasty in 4, but one was not treated to die after discharge from hospital. 4. 4 undisplaced or impacted fractures and 3 displaced transcervical fractures were not associated with any complications such as avascular necrosis or nonunion. But 4 of 6 displaced subcapital fractures were complicated by avascular necrosis, 3 of which were reduced in the varus position within 1 week, and the other was reduced in the good position on 1 week after trauma. There was no complication in 2 displaced subcapital fractures reduced in valgus position within 3 days after trauma. According to the above results, the prognosis of the femur neck fracture is dependent upon the fracture pattern and delay in its treatment. So it is inevitable to reduce the fracture in anatomical or valgus position as early as possible. But the arthroplasty may be needed in displaced subcapital fractures delayed for several days, with its reluction in extreme varus position or impossible and with pre-existing disease in the same hip Joint (total hip replacement).

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Diffusion-Weighted MR Imaging of Various Intracranial Diseases : Clinical Utility (다양한 두개강내 질환의 확산강조 자기공명영상 : 임상적 유용성)

  • 김영준
    • Investigative Magnetic Resonance Imaging
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    • v.2 no.1
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    • pp.104-112
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    • 1998
  • Purpose : To evaluate the clinical utility of diffusion-weighted imaging by analyzing the signal intersity of lesions in patients with various intracranial diseases. Materials and Methods : difusion-weighted MR imaging was prospectively perormed in randomly selected 70 patients with various intracranial idseases. They consisted of 20 patients with acute infarct, 21 patients with chronic infarct of small vessel disease, 14 patients with primary intracranial tumor, three patients with brain metastasis, five patient with brain abscess, five patients with brain abscess, five patients with cerebral hemorrhage, one patient with neurocysticercosis, and one patient with epidermoid cyst. the diffusion-weighted images were obtained immediately after routine T2-weighted imaging on a 1.5T MR unit using single shot spin echo EPI technique with 6500 ms TR, 107ms TE, $128{\times}128$ matrix, 1 number of excitation, $24{\times}24$ field of view, 5-7 mm slice thickness, 2-3 mm inter-slice gap. The diffusion-gradients (b value of ($1000s{\;}/{\;}textrm{mm}^2$)) were applied along three directions(x, y, z). On visual inspection of diffusion-weighted images, the signal intersity of lesions was arbitrarily graded as one of 5 grades. In quantitative assessment, we measured the signal intensity of all the lesions and the contralateral corresponding normal area using round region of interest(ROI), and then calculated the signal intensity ratio of the lesion to the normal brain parenchyma. Results : On visual inspection, markedly hyperintense signals were seen in all cases of acute infarct, brain abscess, epidermoid cyst, and neurocysticercosis in degenerating stage. In all cases of cerebral hematoma, the very high signal internsity was intermingled with low signal intensity. focal very high signal intersity was also seen in a solid portion of the tumor in a patient. the mean signal intensity ratios of all those lesions to the normal brain parenchyma were above 2.5. Gliosis, solid component of brain tumor, brain metastasis, and vasogenic dedma appeared isointense to the normal brain parenchyma in 71%, 64%, 100%, and 67%, respectively ; the mean signal intensity ratios of those lesions to the normal brain parenchyma ranged 1.15 to 1.28 and there was no significant difference among these(p>0.1). Cystic cerebromalacia and necrotic or cystic portions in tumor were markedly or slightly hypointense, and the mean signal intensity ratios were 0.45 and 0.42, respectively. Conclusion : Very high signal intensity of acute infarct, brain abscess, epidermoid cyst, and cystic neurocysticercosis in degenerating stage on diffusion-weighted images may be helpful in differentiating from other diseases that are hypointense or isointense to the normal brain parenchyma. It may be especially useful differentiation of brain abscess from brain tumor with necrotic or cystic portion.

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Antioxidant Activity of Rubus crataegifolius Bge. Fruit Extracts (Rubus crataegifolius Bge. 열매 추출물의 항산화 활성)

  • Moon, Kyoung-Mi;Kim, Ji-Eun;Kim, Hae-Young;Lee, Jae-Seol;Son, Gi-Ae;Nam, Soo-Wan;Kim, Byung-Woo;Lee, Jong-Hwan
    • Journal of Life Science
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    • v.21 no.9
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    • pp.1214-1218
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    • 2011
  • We investigated the fruits of Rubus crataegifolius Bge, a plant which has been traditionally used in Korea in phytotherapy, to describe antioxidant materials from plant sources. R. crataegifolius fruits were extracted with methanol and further fractionated into n-hexane, diethyl ether, and ethyl acetate. The antioxidant activity of each fraction and the residue was assessed using a 1,1-diphenyl-2-picrylhydrazyl (DPPH), $H_2O_2$ radical scavenging method, and their cytotoxicity on human primary kerationcyte (HK) was determined by an MTS assay. The R. crataegifolius fruit methanol extract showed strong antioxidant activity (75.04%, 50%) compared with vitamin C (79.9%, 54.1%) by the DPPH, and $H_2O_2$ method, respectively. The measured activity from the subsequent extracts of the methanol extract were 20.3% for n-hexane fraction (HF), 68.8% for diethyl ether fraction (DF), 67.1% for ethyl acetate fraction (EF), and 67.1% for the residue fraction (RE) by DPPH and 2.2% for HF, 1.6% for DF, 10% for EF, and 50% for the RE by $H_2O_2$ assay. An oxidative stress model of HK was established under a suitable concentration (1 mM). The cell viability of the RE treated group increased and the percentage of apoptotic cells decreased at concentrations of 0.005-0.02% RE compared with the $H_2O_2$ treated group. Fruit extracts of the medicinal plant R. crataegifolius showed potent antioxidant activity and the ability to relieve cell damage from $H_2O_2$ induced injury to HK.