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.     

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 Feasibility of Extracorporeal Membrane Oxygenation in the Variant Airway Problems

Introduction: Extracorporeal membrane oxygenation (ECMO) is widely used to treat respiratory distress during cardiac or respiratory arrest; moreover, its use is being extended to a wide variety of clinical fields. In this study we assess the utility of ECMO in the management of airway obstruction.Patients and Methods: 15 patients underwent ECMO for airway obstruction. We retrospectively analyzed and evaluated the feasibility of ECMO in the treatment of airway problems.Results: Seven patients received ECMO to facilitate respiration and promote stability during trachea surgery. In six cases ECMO ceased immediately following the operation; in the remaining case ECMO cessation was delayed due to post-operative ARDS. In three cases emergency ECMO was used in response to respiratory arrest; two patients died. In five cases ECMO was emergently inserted to prevent death, following airway blockade by massive hemoptysis. One patient was not discharged from the intensive care unit. Another patient was transferred to a general ward but died from other causes.Conclusion: ECMO is useful during anesthesia in patients at high risk of airway blockade, for example due to endobronchial bleeding, and during complex thoracic surgery. ECMO confers a safer environment during airway surgery, and its complication rate is acceptable.     

Korean mistletoe (Viscum album coloratum) extract extends the lifespan of nematodes and fruit flies

Viscum album coloratum (Korean mistletoe) is a semi-parasitic plant that grows on various trees and has a variety of biological functions such as immunomodulation, apoptosis, and anti-tumor activity. In this study, we investigated the effects of Korean mistletoe extract (KME) on lifespan in experimental models using Caenorhabditis elegans and Drosophila melanogaster. Supplementation of KME at 50 μg/ml extended the mean survival time by 9.61 and 19.86 % in worms and flies, respectively. The longevity benefit of KME was not due to reduced feeding, reproduction, and/or locomotion in flies and worms. The supplementation of KME also did not increase resistance to various stresses including heat shock, oxidative, or starvation stresses. Furthermore, KME did not further extend the lifespan of flies fed a dietary restricted diet but did increase the expression of Sir2, one of the target genes of dietary restriction, suggesting that KME may function as a putative dietary restriction mimetic. These results also suggest that the longevity promoting effects of KME may be an example of mild stress-induced hormesis.     

Overview of Surgical Scar Prevention and Management

Management of incisional scar is intimately connected to stages of wound healing. The management of an elective surgery patient begins with a thorough informed consent process in which the patient is made aware of personal and clinical circumstances that cannot be modified, such as age, ethnicity, and previous history of hypertrophic scars. In scar prevention, the single most important modifiable factor is wound tension during the proliferative and remodeling phases, and this is determined by the choice of incision design. Traditional incisions most often follow relaxed skin tension lines, but no such lines exist in high surface tension areas. If such incisions are unavoidable, the patient must be informed of this ahead of time. The management of a surgical incision does not end when the sutures are removed. Surgical scar care should be continued for one year. Patient participation is paramount in obtaining the optimal outcome. Postoperative visits should screen for signs of scar hypertrophy and has a dual purpose of continued patient education and reinforcement of proper care. Early intervention is a key to control hyperplastic response. Hypertrophic scars that do not improve by 6 months are keloids and should be managed aggressively with intralesional steroid injections and alternate modalities.

Graphical Abstract

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