Cultural variation in factors associated with sudden infant death during sleep.

BACKGROUND: Despite the significant reduction decades ago in sudden unexpected death in infancy (SUDI), decline of rates has slowed and stalled in some countries, including the USA. This led to an appreciation of ethnic variations in SUDI rates and the need to increase cultural sensitivity regarding sleep practices and circumstantial factors of SUDI. The study explored SUDI-related factors, in journal articles from two geo-cultural regions (Asian and Western countries), particularly for factors related to infant sleep practices. METHODS: A systematic review was conducted to identify SUDI-related factors in articles from PubMed, Scopus, and the Korean Citation Index from January 1992 to April 2019. From each article, SUDI-related factors were retrieved and categorized through the identification, aggregation, and categorization of factors into the areas of the triple risk model (TRM) of SUDI by their meanings and commonality. Significant trends in the frequency of factors were analyzed across time and between the two geo-cultural regions (Asian and Western countries) of article. RESULTS: From a review of 218 articles (38 Asian and 180 Western articles), 84 SUDI-related factors were identified: 39 factors for TRM 1, 44 factors for TRM 2, and one factor for TRM 3. Four of the top-ranked 10 factors were found in both cultural zones: sleep position, male sex, bed-sharing, and genetics. Both cultural zones identified sleep position (44.0%), bed-sharing (22.0%), and rooming-in (16.5%) as the three most important sleep-related factors for SUDI. Variations between the cultural zones were observed in the place of SUDI occurrence, overheating, swaddling or bedding standards, and smoking. CONCLUSIONS: Regardless of the urgent need to identify SUDI-related factors in low-SUDI societies, Asian cultures showed a significant lack of articles on SUDI. Several sociocultural issues were recognized such as the meaning of bed-sharing and rooming-in, along with residential styles and traditional health beliefs on sleep-related SUDI factors. Particularly little attention towards smoking was found in Asian articles in terms of frequency, suggesting the need to enhance SUDI reduction strategies by incorporating gender-sensitive smoking cessation interventions. This review of SUDI factors requests child health professionals to be alert to sociocultural variations in sleep practices and SUDI factors.

A prospective study about the discrepancy between postmortem inspections conducted by emergency physicians and forensic pathologists.

BACKGROUND: In South Korea, most postmortem examination certificates (death certificates) are issued by attending physicians working in the emergency department (ED). However, ED overcrowding has made continuous education and quality control of the postmortem examination certificate difficult. In this context, the National Forensic Service (NFS) is conducting an on-site postmortem inspection (OPI) project. AIMS: In this study, we analyzed the discrepancy between postmortem inspection conducted by emergency physicians and forensic pathologists and identified the effects of the OPI project. METHOD: The study examined cases where OPIs were conducted by NFS medical examiners (forensic pathologists) on patients who died on arrival or died in the ED where the OPI project is being conducted. The case reports written by emergency physicians were compared with the postmortem examination certificates written by medical examiners to analyze the discrepancy in cause and manner of death between the two groups. RESULT: A total of 75 field examinations were conducted during the study period, with a 56% agreement rate between the two groups regarding cause of death. Manner of death was consistent at 73.3% and the most common reason for requesting an OPI was that the cause of death was presumed to be natural, but what that cause may be was unclear. CONCLUSION: The discrepancy in postmortem examinations between emergency physicians and medical examiners is attributed to various factors. To ensure more reliable postmortem examinations, emphasis should be placed on improving the death investigation system and quality control activities for physicians.

Study on death certificates and postmortem examination certificates written by Korean emergency physicians.

INTRODUCTION: Statistics on death are the basis of a country's health, safety, and welfare policies. Emergency physicians issue a postmortem examination certificate (PEC) for death outside the hospital as well as a death certificate (DC) for death in the hospital. This study investigated the actual conditions and criteria for writing a DC and PEC, writing environment, and doctor's experience. MATERIAL AND METHODS: The physicians' DC and PEC writing experience and demographic data were analyzed. The questions focused on CPR, patient's medical certificate, time and place of death, difficulty in writing the PEC and DC, and education in certificate writing. RESULTS: 229 emergency physicians were included. Physicians' opinions differed for CPR patients in terms of time of death, location, and whether or not to issue DC/PEC. The causes of death were also different. Further, 76.9% of the doctors did not have enough time to write a medical certificate and about 45% of them wrote it within 30 min; 76% had DC-related complaints, and 7.0% faced legal problems due to the DC; 93.3% of the emergency physicians stated that a coroner system is needed in South Korea. CONCLUSION: Emergency physicians are responsible for writing DCs and PECs. The standards vary from physician to physician at the time of writing. Writing DCs and PECs is also burdensome. In South Korea, it is necessary to separate the DC and PEC, to develop national data management networks, and to introduce a postmortem examination system.

Risk Factors for Sudden Infant Death Syndrome and Sleeping Practices in Korea.

Sudden infant death syndrome (SIDS) in Korea remains a poorly-understood subject for both professionals and the public. Recent reports have emphasized ethnic differences in SIDS rates, suggesting that making adjustments in child-rearing practices may contribute substantially to SIDS reduction. Two of the three major risk factors for SIDS-vulnerability of the infant and exogenous factors-need to be understood in particular depth due to their broad scope and sociocultural grounding. This paper presents substantial issues regarding preterm birth and male gender on infants' vulnerability to SIDS in Korea. Practices of caring for healthy infants are addressed in the context of sleeping practices, including sleeping position, bedding arrangements, sleeping on the floor, the back-to-sleep position, high indoor temperatures and ondol floor heating, and swaddling. Professional and social awareness about how to reduce SIDS should be raised by promoting a better understanding of risk factors in the context of ethnic and cultural variations in child-rearing practices.

Postmortem Computed Tomography and Computed Tomography Angiography: Cardiothoracic Imaging Applications in Forensic Medicine.

With the introduction of modern imaging technology into the forensic field, postmortem imaging, particularly postmortem computed tomography (PMCT), has gained increasing importance in forensic investigations of deaths. In recent years, PMCT, which aims to provide observer-independent, reproducible forensic assessment in a minimally invasive manner, has been incorporated into routine forensic practice in many medicolegal institutions worldwide as a complement to autopsy. To address questions with regard to vascular pathologies, postmortem computed tomography angiography (PMCTA) has been developed and has become a useful tool for exploring the vascular system. Currently, these techniques play roles in screening for potential pathologies for later autopsy confirmation, facilitating focused dissection of the target area, and visualizing lesions that would be difficult or impossible to detect during autopsy. Adequate image interpretation requires knowledge and understanding of postmortem changes in the body and artefacts related to PMCT and PMCTA. This article reviews the PMCT and PMCTA techniques in terms of their indications, applications, advantages, and limitations for cardiothoracic applications. Our findings will enhance readers' understanding of emerging CT techniques in forensic radiology.

Retrospective Genetic Analysis of 200 Cases of Sudden Infant Death Syndrome and Its Relationship with Long QT Syndrome in Korea.

BACKGROUND: There has been a campaign by the National Education on Sleeping Habits and Living Environment, to reduce the incidence of sudden infant death syndrome (SIDS). However, more than 100 infants die suddenly and unexplainably before the age of 1 year in Korea. Long QT syndrome (LQTS), an inheritable cardiac disease, has been reported to likely be associated with up to 14% of SIDS cases. However, genetic studies of the association between SIDS and LQTS have not yet been conducted in Korea. METHODS: We conducted genetic analysis using genomic DNA extracted from paraffin-embedded tissue blocks from 200 SIDS cases autopsied between 2005 and 2013. We analyzed the following genetic mutations associated with LQTS, KCNQ1, SCN5A, KCNE1, KCNE2, KCNJ2, and CAV3. RESULTS: Of the 200 SIDS cases, 58% involved male infants (116 male and 84 female infants, respectively), the mean age was 140 days (median, 107 days; range, 24-270 days), and they were all of Asian-Korean ethnicity. SIDS IA category criteria comprised 45 cases (22.5%) while the rest were SIDS IB. Fifteen infants (7.5%) had R1193Q in SCN5A, of doubtful pathogenicity, and no pathogenic LQTS variants were observed. CONCLUSION: This genetic investigation of LQTS in SIDS showed a low diagnostic yield. These findings suggest that LQTS molecular autopsy could be cautiously conducted in selected cases with family involvement to improve the available genetic counseling information. Meanwhile, a national SIDS registry should be established to document and evaluate the genetic risk of SIDS in Korea.

Characteristics of sauna deaths in Korea in relation to different blood alcohol concentrations.

Although the benefits of sauna bathing have been demonstrated in epidemiological studies, sauna deaths have been reported. The aim of this study was to determine the demographic and forensic characteristics associated with different blood alcohol concentrations (BACs) in sauna deaths in Korea. In this retrospective analysis, data were collected from a nationwide pool in Korea between January 2008 and December 2015 to determine the role of alcohol intoxication in sauna deaths based on the subjects' BAC and to evaluate the demographic and forensic characteristics associated with different BACs. One hundred and three deaths were classified into 2 groups: the non-intoxication (NI) group (BAC,<0.08%; n = 27) and the intoxication (I) group (BAC,≥0.08%; n = 76). Demographic and forensic characteristics were compared between the groups using a multinomial logistic regression analysis. The proportions of decedents who were male (odds ratio: 17.4, 95.0% confidence interval: 3.8-79.8) and in a prone position at the scene of death (odds ratio: 11.3, 95.0% confidence interval: 2.1-60.1) were significantly higher (P < 0.001 and P < 0.05, retrospectively) in the I group than in the NI group. However, no significant differences were observed with respect to obesity, coronary artery narrowing, and liver pathology. Sauna deaths exhibited different characteristics according to BACs detected at autopsy. The differences in sauna deaths between the I and NI groups may have implications for the targeted prevention of sauna deaths associated with alcohol consumption.

Influence of Epidemiologic and Patient Behavior-Related Predictors on Amputation Rates in Diabetic Patients: Systematic Review and Meta-Analysis.

Amputation of patients with diabetic foot is a major issue worldwide, particularly from a medical and economic standpoint. This meta-analysis aimed to identify significant risk factors of high amputation rate among epidemiologic and patient behavior-related predictors in diabetic patients. A systematic literature review and meta-analysis were performed using MEDLINE, EMBASE, and Cochrane databases. Seven variables were extracted from the included studies and evaluated based on amputation rate. The Newcastle-Ottawa scale was used to assess the quality of the studies. The search strategy identified 101 publications. After screening, 33 articles were selected for review. Male sex and smoking were identified as significant risk factors of high amputation rate of diabetic foot. Although further investigation of long-term and randomized controlled studies is needed, we identified 2 variables as significant risk factors for high amputation rate in diabetic patients in this meta-analysis.

Estimation of stature from femur length measured using computed tomography after the analysis of three-dimensional characteristics of femur bone in Korean cadavers.

Estimation of stature is a basic and important forensic procedure in identifying decomposed or skeletonized bodies. Due to advances in radiologic equipment, forensic science frequently uses computed tomography (CT) and software to apply these findings to investigations. Technical developments have increased the accuracy of the measurement of various bones. However, there are still some inaccuracies, such as defining correct landmarks in three-dimensional (3D) images. Femur length is frequently used for calculation of stature, but because it is a 3D structure, the digital image may not always correlate with the femur length measured with an osteometric board. However, more studies are now showing that the maximum femur length calculated in 3D imagery is comparable to the maximum femur length calculated using an osteometric board. This study used digitalized data of the femur obtained from the CT image through the specialized software. The digitalized femur images were put on the virtual osteometric board, which helped us to understand the anatomic characteristics of the femur and to confirm that the maximum femur lengths calculated in 3D images are similar to the results obtained using an osteometric board. These data were used to obtain a stature estimation formula for the Korean population.

Osmidrosis Treatment Approaches: A Systematic Review and Meta-Analysis.

BACKGROUND: There are many treatment modalities associated with osmidrosis. The purpose of this study was to identify and compare effective osmidrosis treatments. METHODS: A systematic literature review and meta-analysis were performed using MEDLINE, EMBASE, and Cochrane databases. The osmidrosis treatment modalities were extracted as predictor variables, and recurrence and complications were extracted as outcome variables. Subgroup analysis was performed with regard to combined curettage, and fixed and random effect models were applied. RESULTS: Forty studies published prior to February 2016 were identified. The group that received surgery had the lowest incidence of recurrence as 3.0%, followed by the liposuction and laser groups (5.5%, 8.2%, respectively). The liposuction group had the lowest incidence of complications (hematoma, 1.6%; necrosis, 1.5%), followed by the surgery (hematoma, 1.9%; necrosis, 2.1%) and laser groups (hematoma, 3.1%; necrosis, 4.5%). When combining curettage, the recurrence rate was lower in the surgery (P = 0.06) and liposuction groups (P < 0.01). CONCLUSIONS: Surgery treatment has been demonstrated as the most effective result for treating osmidrosis. Liposuction has been identified as the most effective treatment, with the lowest number of associated complications. Combining the curettage method was an effective option for lowering recurrence rate in surgery and liposuction treatments. Finally, laser treatment was not significantly associated with benefits.

Predisposing factors for poor prognosis of angiosarcoma of the scalp and face: Systematic review and meta-analysis.

BACKGROUND: Angiosarcoma of the scalp and face is an aggressive tumor with a high rate of local recurrence. Although many previous studies have demonstrated risk factors for poor prognosis, debate remains. We identified the predisposing factors for poor prognosis through comprehensive review of selected studies with meta-analysis. METHODS: A systematic literature review and meta-analysis were performed using MEDLINE, EMBASE, and Cochrane databases. Nine variables were extracted from the included studies and evaluated based on a 5-year survival rate. The Newcastle-Ottawa scale was used to assess the quality of the studies. RESULTS: The search strategy identified 89 publications. After screening, 11 articles were selected for review. Age, size, site of tumor, margin status, and surgery associated with poor angiosarcoma prognosis were identified. CONCLUSION: Although further investigation of long-term and prospective studies is needed, we identified 5 variables as predisposing factors for poor prognosis of angiosarcoma through meta-analysis. © 2016 Wiley Periodicals, Inc. Head Neck 39: 380-386, 2017.

Efficacy of 2 Representative Topical Agents to Prevent Keloid Recurrence After Surgical Excision.

PURPOSE: Keloids are difficult to remove successfully and there is no universally accepted treatment. After surgical excision of the keloid, there are various management methods for prevention of keloid recurrence, such as intralesional injection, radiation, and topical agents. A few studies have compared topical agents with other treatments. The aim of this study was to investigate effective topical agents for the prevention of recurrent keloid after surgical excision. MATERIALS AND METHODS: Eligible articles were sought using core databases, including Medline, Embase, and Cochrane databases, up to April 2016. The predictor variables were mitomycin C (MC) and imiquimod cream treatment after keloid excision. The outcome variable was keloid recurrence rate. RESULTS: The search strategy identified 120 publications. After screening, 9 articles were selected for review. Articles were divided into 2 groups: MC and imiquimod cream. The recurrence rate after surgical excision in the MC group was estimated to be 16.5%, and that in the imiquimod cream group was estimated to be 24.7%. CONCLUSION: If intralesional injection or radiation is not available, then MC or imiquimod 5% cream could be an effective alternative in preventing keloid recurrence.

Negative Pressure Wound Therapy as Effective and Comfortable Management After Treatment of Osmidrosis.

Although osmidrosis has been widely discussed in respect to its treatment modalities, there has been no definite consideration of postoperative management after the treatment of osmidrosis. We have tested the 40-125 mmHg range of negative pressure. We present negative pressure wound therapy (NPWT) of 70 mmHg for postoperative management in osmidrosis because NPWT has a role in removing fluid, such as blood or seroma, and diminishing the dead space between the skin and subcutaneous tissue. Patients who receive NPWT have shown successful treatment outcomes and no skin necrosis or hematoma formation. Additionally, NPWT could improve postoperative daily activity compared with conventional compressive dressings. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Iatrogenic Through-and-Through Conchal Defect Secondary to Auricular Cartilage Graft.

BACKGROUND: Over the past few years, conchal cartilage has been most often used in rhinoplasty. The donor site complications following conchal cartilage graft harvesting are scar formation, hematoma formation, and delayed wound healing, although hematoma is one of the most important and common complications. A complete conchal defect as a complication of auricular cartilage graft harvesting has not been previously reported in the literature. The authors report an unusual case of an iatrogenic conchal defect resulting from conchal cartilage graft harvesting that was treated using a posterior auricular island flap. METHODS: A 24-year-old male with a left conchal inflammation and perforation visited our plastic surgery department after receiving augmentation rhinoplasty and tip plasty using a conchal cartilage graft. A tight dressing had been applied to the ear, and postoperative infection was uncontrolled, which resulted in iatrogenic conchal perforation. RESULTS: A tie-over bolster dressing has been widely used to prevent hematoma following conchal cartilage graft harvesting with an associated donor site complication. However, a tight tie-over dressing and inappropriate postoperative care can cause complete through-and-through conchal defects. The posterior auricular island flap provides an elegant means of reconstructing conchal defects. CONCLUSIONS: In the described case, aesthetic reconstruction of a conspicuous iatrogenic conchal defect was achieved with minimal scarring using the posterior auricular island flap. To the best of our knowledge, this report is the first to describe reconstruction of an iatrogenic defect in the concha as a complication of auricular cartilage graft harvesting. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Biomechanical Analysis of Barbed Suture in Flexor Tendon Repair versus Conventional Method: Systematic Review and Meta-Analysis.

BACKGROUND: The barbed suture technique uses newly developed materials for flexor tendon repair. In this study, the authors examine the effectiveness of using barbed sutures in flexor tendon repair compared with conventional methods. METHODS: A systematic literature review and meta-analysis was performed using MEDLINE, Embase, and Cochrane databases. Barbed suture and conventional suture methods were extracted as predictor variables, and maximum force, gap formation force, and cross-sectional area were extracted as outcome variables. Subgroup analyses were performed according to the source of suture materials and the number of strands. The Newcastle-Ottawa Scale was used to assess the quality of studies. Publication bias was evaluated using funnel plots. RESULTS: The search strategy identified 86 publications. After screening, 12 articles were selected for review. Barbed sutures are comparable in effectiveness to conventional methods in terms of maximum force, gap formation force, and cross-sectional area. In the subgroup analysis, barbed sutures also have comparable effects to conventional methods in terms of maximum force and gap formation force. CONCLUSIONS: The authors' meta-analysis found that the use of barbed sutures in flexor tendon repair was competitive compared to conventional methods in terms of maximum force and gap formation force. Long-term in vivo studies are needed to confirm these findings. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, V.

Is obesity a predisposing factor for free flap failure and complications? Comparison between breast and nonbreast reconstruction: Systematic review and meta-analysis.

Obesity is a risk factor for postoperative morbidity in breast reconstruction. Although existing studies about nonbreast reconstruction are limited, previous research has demonstrated that obesity is not an important factor in poor outcomes in nonbreast reconstruction. Our study evaluates the effects of obesity on postoperative morbidity in nonbreast reconstruction in comparison to breast reconstruction. A systematic literature review and meta-analysis was performed using Medline, EMBASE, and Cochrane databases. Obesity was extracted for predictor variables and partial, total loss of flap, and complication were extracted for outcome variables. Subgroup analyses were performed according to reconstruction site. The Newcastle-Ottawa scale (NOS) was used to assess the quality of the studies, and the Cochrane risk of bias tool was used. Publication bias was evaluated using funnel plots. The search strategy identified 944 publications. After screening, 19 articles were selected for review. Partial flap loss, total flap loss, and complications in breast reconstruction occurred significantly more often in obese patients in comparison to nonobese patients (OR = 2.479, P = 0.021 for partial loss, OR = 3.083, P = 0.002 for total loss, OR = 2.666, P = 0.001 for complications). In contrast, partial flap loss, total flap loss, and complications in nonbreast reconstruction were not significantly different in obese patients in comparison to nonobese patients (OR = 0.786, P = 0.629 for partial loss, OR = 0.960, P = 0.961 for total loss, and OR = 1.009, P = 0.536 for complications). In contrast to the relationship between obesity and poor outcomes in breast reconstruction, our study suggests the obesity is not a predisposing factor for poor outcomes in nonbreast reconstruction. Long-term studies are needed to confirm these findings.

A Rare Case of Pulmonary Epithelioid Hemangioendothelioma Presenting with Skin Metastasis.

Epithelioid hemangioendothelioma (EHE) is a well-differentiated and rare vascular tumor. Systemic metastases are uncommon. Herein, we present a patient with skin metastasis of pulmonary EHE (PEH) that was treated by wide excision. A 76-year-old male was evaluated due to pulmonary thromboembolism and a solitary pulmonary nodule. A biopsy was performed and pathological examination of the mass confirmed EHE. No metastasis was observed. The patient returned to care approximately two years later due to a painful nodule in the right lower leg. A skin biopsy showed metastatic EHE from the lung. We used a safety margin of 1 cm based on clinical experience, because no prior case had been reported regarding the resection margin appropriate for primary cutaneous EHE and skin metastases of PEH. At four months after surgery, the patient recovered without complications or recurrence. Skin metastasis of PEH is extremely rare, and only two cases have been reported in the literature. In this case, we report a rare case of PEH with histologically diagnosed skin metastasis that was successfully treated by curative resection. It is expected that this case report will provide a helpful contribution to the extant data regarding PEH metastases.

A Comparison of the Effectiveness of Triamcinolone and Radiation Therapy for Ear Keloids after Surgical Excision: A Systematic Review and Meta-Analysis.

BACKGROUND: The ear is a common site for keloid formation, usually after trauma or ear piercing. This study is a meta-analysis to identify effective treatments for ear keloids after surgical excision. METHODS: A systematic literature review and meta-analysis were performed using core databases. Postoperative adjuvant treatment modalities for ear keloids and recurrence rates were extracted and analyzed. Fixed and random effect models were applied. RESULTS: Twenty-five studies published before August of 2015 were identified. The recurrence rate after surgical excision of an ear keloid in the triamcinolone group was estimated as 15.4 percent (95 percent CI, 9.4 to 24.1 percent; p < 0.001). The recurrence rate in the radiation therapy group was estimated as 14.0 percent (95 percent CI, 9.6 to 19.9 percent; p < 0.001). CONCLUSION: Although a large-scale, randomized study is required for confirmation, both triamcinolone and radiation therapy provided outstanding treatment for ear keloids after surgical excision without a significant difference between the two treatments.