Social Inequality in Birth Outcomes in Korea, 1995-2008

Social inequality in adverse birth outcomes has been demonstrated in several countries. The present study examined the separate and joint effects of parental education and work in order to investigate the causal pathways of social class effects on adverse birth outcomes in Korea. The occurrence of low birth weight, preterm births, and intrauterine growth retardation was examined among 7,766,065 births in Korea from 1995 to 2008. The effect of social inequality, as represented by parental education and work, was examined against adverse birth outcomes using multivariate logistic regression after controlling for other covariates. Parental education had the most significant and greatest effect on all three adverse outcomes, followed by parental work and employment, which had lesser effects. For adverse birth outcomes, the gap between educational levels increased steadily in Korea from 1995 to 2008. Throughout the analysis, the effect of maternal manual work on adverse birth outcomes was apparent in the study results. Given this evidence of social inequality in education and employment, social interventions should aim at more in-depth and distal determinants of health.     

Hematologic Recovery after Tandem High-Dose Chemotherapy and Autologous Stem Cell Transplantation in Children with High-Risk Solid Tumors

Although the number of studies using tandem high-dose chemotherapy and autologous stem cell transplantation (HDCT/autoSCT) for the treatment of high-risk pediatric solid tumors has been increasing, documentation of hematologic recovery after tandem HDCT/autoSCT is very limited. For this reason, we retrospectively analyzed the hematologic recovery of 236 children with high-risk solid tumors who underwent tandem HDCT/autoSCT. The median numbers of CD34⁺ cells transplanted during the first and second HDCT/autoSCT were 4.3 × 10⁶/kg (range 0.6-220.2) and 4.1 × 10⁶/kg (range 0.9-157.6), respectively (P = 0.664). While there was no difference in neutrophil recovery between the first and second HDCT/autoSCT, platelet and RBC recoveries were significantly delayed in the second HDCT/autoSCT (P < 0.001 and P < 0.001, respectively). Delayed recovery in the second HDCT/autoSCT was more prominent when the number of transplanted CD34⁺ cells was lower, especially if it was < 2 × 10⁶/kg. A lower CD34⁺ cell count was also associated with increased RBC transfusion requirements and a higher serum ferritin level after tandem HDCT/autoSCT. More CD34⁺ cells need to be transplanted during the second HDCT/autoSCT in order to achieve the same hematologic recovery as the first HDCT/autoSCT.     

Effect of repeated use of an implant handpiece on an output torque: An in-vitro study

PURPOSEThis study aimed to evaluate the effect of repeated use of an implant handpiece under an implant placement torque (35 Ncm) and overloading torque condition (50 Ncm) on an output torque.MATERIALS AND METHODSTwo types of implant handpiece systems (Surgicpro/X-DSG20L [NSK, Kanuma, Japan] and SIP20/CRB46LN [SAESHIN, Daegu, South Korea]) were used. The output torque was measured using a digital torque gauge. The height and angle (x, y, and z axes) of the digital torque gauge and implant handpiece were adjusted through a jig for passive connection. The experiment was conducted under the setting torque value of 35 Ncm (implant placement torque) and 50 Ncm (overloading torque condition) and 30 times per set; a total of 5 sets were performed (N = 150). For statistical analysis, the difference between the groups was analyzed using the Mann-Whitney U test and the Friedman test was used to confirm the change in output torque (α=.05).RESULTSNSK and SAESHIN implant handpieces showed significant differences in output torque results at the setting torques of 35 Ncm and 50 Ncm (P<.001). The type of implant handpiece and repeated use influenced the output torque (P<.001).CONCLUSIONThere may be a difference between the setting torque and actual output torque due to repeated use, and the implant handpiece should be managed and repaired during long-term use. In addition, for successful implant results in dental clinics, the output torque of the implant handpiece system should be checked before implant placement.     

Vascular morphology and blood flow signatures for differential artery-vein analysis in optical coherence tomography of the retina

Differential artery-vein (AV) analysis is essential for retinal study, disease detection, and treatment assessment. This study is to characterize vascular reflectance profiles and blood flow patterns of retinal artery and vein systems in optical coherence tomography (OCT) and OCT angiography (OCTA), and establish them as robust signatures for objective AV classification. A custom designed OCT was employed for three-dimensional (3D) imaging of mouse retina, and corresponding OCTA was reconstructed. Radially resliced OCT B-scans revealed two, i.e. top and bottom, hyperreflective wall boundaries in retinal arteries, while these wall boundaries were absent in OCT of retinal veins. Additional OCTA analysis consistently displayed a layered speckle distribution in the vein, which may indicate the venous laminar flow. These OCT and OCTA differences offer unique signatures for objective AV classification in OCT and OCTA.     

Behavioral and Physiological Pain Responses in Brain-Injured Patients Who Are Unable to Communicate in the Intensive Care Unit

BackgroundAssessing pain of critically ill patients with brain injuries who are unable to communicate is a challenge. Current behavioral scales are limited in accurate pain assessments for this population.AimsThis study sought to investigate the behavioral and physiological responses induced by routine painful procedures in patients with brain injuries who are unable to communicate.MethodsUsing a repeated-measure within-subject observational study design, 12 participants admitted to an intensive care unit were observed before, during, and 15 minutes after a nonnociceptive (noninvasive blood pressure measurement) procedure and three nociceptive (suctioning, turning, and trapezius pinch) procedures. During each assessment, patients’ behavioral and physiological responses were observed using video cameras and bedside monitors.ResultsIn the overall behavioral responses to the nociceptive procedures, clenched teeth with tense jaw, frowning, orbit tightening, closing of eyes, eye movement, fixation-staring, flushing, flexion withdrawal of arm, flexion withdrawal of leg, muscle rigidity, twitching, and coughing were more frequently observed during procedures than before and after procedures (p < .01). Regarding physiological responses, significant increases in systolic blood pressure, diastolic blood pressure, mean arterial pressure, heart rate, and respiratory rate were identified across assessments (p < .001).ConclusionsThe findings can be used as a basis for pain assessment and the development of pain assessment tools for brain-injured patients who are unable to communicate. However, since physiological responses may be influenced by various factors besides pain, physiological changes may be used as a sign of the need for pain assessment rather than being used alone as a basis for pain assessment.     

Ultrasound-Guided Percutaneous Removal of Wooden Foreign Bodies in the Extremities with Hydro-Dissection Technique

ObjectiveWe described the technique of ultrasound (US)-guided percutaneous removal of the foreign bodies (FB) with hydro-dissection in the radiologic department and presented video files of several cases.ResultsThe mean time required for the entire procedure was approximately 20 minutes. There were no significant complications during the US-guided removal or long-term complications after the procedure. All 4 FBs were successfully removed from the soft tissue under US guidance.ConclusionUltrasound-guided percutaneous removal of the FBs with hydro-dissection in the radiology department is a less invasive and safe method over surgical removal in the operating room. Additionally, the use of a guide wire and serial dilator may help minimize soft tissue injury and facilitate the introduction of forceps.     

The laboratory performance of the enFLOW®, buddy lite™ and ThermoSens® fluid warmers

We measured heating of isotonic saline by three fluid warmers in six experiments: saline at 5 °C or 20 °C delivered at 30, 50 or 100 ml.min^?1. At the three flow rates, the enFLOW^®, buddy lite^? and ThermoSens^® systems heated 5 °C saline to mean (SD) temperatures of: 41.1 (0.5) °C, 37.7 (0.6) °C and 39.1 (0.6) °C; to 40.3 (0.8) °C, 33.9 (1.6) °C and 39.3 (0.7) °C; and to 37.1 (0.8) °C, 24.0 (1.3) °C and 37.6 (1.0) °C, respectively, p < 0.0001 for each experiment. The mean (SD) times taken to heat 5 °C saline were: 16.6 (1.7) s, 258.4 (58.9) s and 134.2 (79.6) s; 16.9 (1.8) s, 256.2 (62.2) s and 182.5 (74.5) s; and 21.5 (1.5) s, 275.9 (49.3) s and 313.5 (18.0) s, respectively, p < 0.0003 for each experiment. The results for saline at 20 °C were similar. The enFLOW system heated saline above 36 °C faster than the ThermoSens system, whereas the buddy lite often failed to achieve 36 °C.     

Evaluation of the Performance and Safety of a Newly Developed Intravenous Fluid Warmer

To evaluate the performance and safety of a newly developed blood warmer (ThermoSens), we tested its heating capability under various conditions using isotonic saline and hemolysis analysis with swine blood. The following two in vitro tests were performed: (i) To investigate the performance of the device, the inflow and outflow temperatures were measured at various flow rates (30, 50, and 100 mL/min) using cold (5°C) and room temperature (20°C) isotonic saline (0.9%). Several parameters were measured including the highest temperature of the outlet, the time required to reach the highest temperature, and the temperature of the intravenous line. (ii) To investigate the safety of the device, a hemolysis test was performed using swine blood. We obtained 320 mL of whole blood from swine and refrigerated the blood for 35 days at 3°C. In order to replicate the clinical situation, blood flow by gravity and pressure (300 mm Hg) was used. Before and after the heating test, blood samples were obtained and a comparison was made between these samples. Hemoglobin, hematocrit, lactate dehydrogenase, and plasma hemoglobin were used for red blood cell (RBC) damage analysis. The highest outlet temperatures obtained using flow rates of 30, 50, and 100 mL/min were 39.10 ± 0.59, 39.25 ± 0.69, and 37.63 ± 1.03°C, respectively, with cold saline, and 39.40 ± 0.40, 39.66 ± 0.36, and 39.49 ± 0.49°C, respectively, with room temperature saline. Hemolysis tests showed no significant changes in hemoglobin, hematocrit, lactate dehydrogenase, or plasma hemoglobin (P > 0.05) between before and after heating for both gravity and pressure blood flow. The ThermoSens blood warmer warms isotonic saline effectively, reaching temperatures up to 36°C under various conditions. Hemolysis tests showed no RBC damage. Therefore, the newly developed ThermoSens has good heating performance and is safe for RBC products.