Using Bibliometric Data to Define and Understand Publishing Network Equity in Anesthesiology.

BACKGROUND: Anesthesiology departments and professional organizations increasingly recognize the need to embrace diverse membership to effectively care for patients, to educate our trainees, and to contribute to innovative research. 1 Bibliometric analysis uses citation data to determine the patterns of interrelatedness within a scientific community. Social network analysis examines these patterns to elucidate the network's functional properties. Using these methodologies, an analysis of contemporary scholarly work was undertaken to outline network structure and function, with particular focus on the equity of node and graph-level connectivity patterns. METHODS: Using the Web of Science, this study examines bibliographic data from 6 anesthesiology-specific journals between January 1, 2017, and August 26, 2022. The final data represent 4453 articles, 19,916 independent authors, and 4436 institutions. Analysis of coauthorship was performed using R libraries software. Collaboration patterns were assessed at the node and graph level to analyze patterns of coauthorship. Influential authors and institutions were identified using centrality metrics; author influence was also cataloged by the number of publications and highly cited papers. Independent assessors reviewed influential author photographs to classify race and gender. The Gini coefficient was applied to examine dispersion of influence across nodes. Pearson correlations were used to investigate the relationship between centrality metrics, number of publications, and National Institutes of Health (NIH) funding. RESULTS: The modularity of the author network is significantly higher than would be predicted by chance (0.886 vs random network mean 0.340, P < .01), signifying strong community formation. The Gini coefficient indicates inequity across both author and institution centrality metrics, representing moderate to high disparity in node influence. Identifying the top 30 authors by centrality metrics, number of published and highly cited papers, 79.0% were categorized as male; 68.1% of authors were classified as White (non-Latino) and 24.6% Asian. CONCLUSIONS: The highly modular network structure indicates dense author communities. Extracommunity cooperation is limited, previously demonstrated to negatively impact novel scientific work. 2 , 3 Inequitable node influence is seen at both author and institution level, notably an imbalance of information transfer and disparity in connectivity patterns. There is an association between network influence, article publication (authors), and NIH funding (institutions). Female and minority authors are inequitably represented among the most influential authors. This baseline bibliometric analysis provides an opportunity to direct future network connections to more inclusively share information and integrate diverse perspectives, properties associated with increased academic productivity. 3 , 4.

Anthropometric investigation of cephalic parameters for stature estimation: Through regression analysis.

Background: Stature or body height is one of the most important and useful anthropometric parameters which determines the physical identity of an individual. Cranium encompasses hard tissue components with approximately immortal behavior, reason being cranial measurements were selected for the present study for estimation of stature. Objective: This investigation aimed to assess the stature of unknown using cephalometric parameters by creating equations through regression analysis. Materials and Methods: We selected 361 dental students for the present research; among them, 210 were females and 151 were males in the age range of 21-32 years. Stature and cephalic parameters, i.e., fronto-occipital circumference, head length, and head breadth were measured for each contributor following standard methods and techniques. Cephalic Index was calculated by using the formula: Cephalic Index (CI) = (Head width/Head length) ×100. Karl Pearson's correlation coefficient of stature with cephalic parameters was calculated, and regression analysis was done to generate the formulae for stature estimation. Results: Results indicated that all cephalic measurements have strong correlation with stature, and among them, circumference of head was found to be the most reliable predictor. Conclusion: Stature of unknown or deceased can be identified using cephalic parameters as an auxiliary practice.

Multivariate Machine Learning Models of Nanoscale Porosity from Ultrafast NMR Relaxometry.

Nanoporous materials are of great interest in many applications, such as catalysis, separation, and energy storage. The performance of these materials is closely related to their pore sizes, which are inefficient to determine through the conventional measurement of gas adsorption isotherms. Nuclear magnetic resonance (NMR) relaxometry has emerged as a technique highly sensitive to porosity in such materials. Nonetheless, streamlined methods to estimate pore size from NMR relaxometry remain elusive. Previous attempts have been hindered by inverting a time domain signal to relaxation rate distribution, and dealing with resulting parameters that vary in number, location, and magnitude. Here we invoke well-established machine learning techniques to directly correlate time domain signals to BET surface areas for a set of metal-organic frameworks (MOFs) imbibed with solvent at varied concentrations. We employ this series of MOFs to establish a correlation between NMR signal and surface area via partial least squares (PLS), following screening with principal component analysis, and apply the PLS model to predict surface area of various nanoporous materials. This approach offers a high-throughput, non-destructive way to assess porosity in c.a. one minute. We anticipate this work will contribute to the development of new materials with optimized pore sizes for various applications.

Correlation of the Stature with Arch and Chord Dimensions in Young Subjects using Carrea's Index- An Anthropometric Study.

Background: Forensic identifications have utilized the height or stature of an individual in their field. Teeth and dentition can act as reliable tools to estimate the stature in cases where the only skull is presented as evidence. The Carrea's index assesses the stature in a subject from the lower anterior teeth dimensions. Aim: The present study was aimed to judge the reliability of Carrea's index in Indian subjects. Materials and Methods: From 80 subjects who were undergraduate students, plaster models were made and each was assessed individually making 160 hemiarches. These hemiarches were divided based on the teeth alignment into normal, diastema, and crowded forms. This was followed by measurement with a vernier caliper into chord and arch. Results: In both genders, the difference seen was statistically significant between dental arch types concerning various alignments with 95.23% and 83.75% success for males and females in normal dentition and 92.30% and 85.71% in crowded dentition. Also, a significant difference was seen for the type of arch with P ≤ 0.001 and 0.003, respectively. Lesser success was seen for spacing in both the genders and arches. Conclusion: The present study concludes that Carrea's index is a dependable and efficient tool for estimating height in subjects having arches with crowded and normal dentition which is functional for both the gender on the left and right side of the dental arches. However, in hemiarches with diastema, this method is not reliable.

Bond Strength of Orthodontic Brackets to Temporary Crowns: In vitro Effects of Surface Treatment.

Background: To evaluate bond strength of orthodontic brackets to temporary crowns. Materials and Methods: A bis-acrylic composite was used to create a total of 25 discs, which were then divided into five groups based on how their surfaces were treated with black, blue, green, and sandblasted diamond burs, in addition to a control group. Software called SPSS was used to analyze the outcome. Results: The average pressures measured for the green bur, black bur, and sandblasting, respectively, were 12.05 MPa, 12.87 MPa, and 19.25 MPa. Comparing the control and blue groups, a substantial variation in shear bond strength was only noticed with reference to sandblasting. Conclusion: The binding strength of orthodontic brackets is increased by sandblasting temporary crowns.

Podocytopathies related to either COVID-19 infection or its vaccination, our experience and literature review.

Coronavirus disease 2019 (COVID-19) affects several organs including the kidney resulting in acute kidney injury (AKI) and variants of podocytopathies. From the beginning to the middle period of the COVID-19 pandemic, we have collected eight renal biopsies with various renal diseases including 4 podocytopathies. In addition, from the middle period to the near end of the COVID-19 pandemic, we have seen two of the patients who developed nephrotic syndrome following COVID-19 vaccination. Three of 4 podocytopathies were collapsing glomerulopathy (also called collapsing focal segmental glomerulosclerosis) and the fourth was a minimal change disease (MCD). Two of three collapsing glomerulopathy were found in African American patients, one of who was tested positive for having the high-risk allele APOL-1 G1. In addition, the two renal biopsies showed either MCD or replaced MCD following COVID-19 vaccination. MCD can be a rare complication following COVID-19 infection and COVID-19 vaccination, raising the question if there are similar antigens induced by the infection or by the vaccination that trigger the MCD. This article reports our experience of diagnosing podocytopathies related to either COVID-19 infection or its vaccination and provides a literature review regarding the incidence and potential pathophysiology in the field.

An Adult Patient With Acute Ischemic Stroke and Carotid Stenosis Presenting to a Chiropractor: A Case Report.

A 59-year-old male, with a recent history of acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia, presented to a chiropractor with a one-week history of numbness in the right upper and lower extremity that was triggered by neck movement, and lightheadedness/dizziness. On examination, the chiropractor noted limited, painful cervical spine range of motion, right upper extremity weakness, patellar hyperreflexia, positive Hoffman's and Trömner's signs bilaterally, nystagmus, a sluggish right pupillary light reflex, and carotid bruit. Cervical radiographs were suggestive of Klippel-Feil syndrome. The chiropractor suspected a vascular cause such as a transient ischemic attack and referred the patient to the emergency department, which the patient visited the following day. The patient was admitted, and MRI revealed multiple tiny acute to subacute cortical infarcts of the left frontal and parietal lobes while sonography demonstrated left internal carotid artery stenosis. The patient was treated with anticoagulant and antiplatelet medications and carotid endarterectomy with a positive outcome. Given the overlap between symptoms of stroke and those of the cervical spine, chiropractors should be prepared to recognize potential stroke patients and refer them for emergent medical management.

An Interactive Spectral Analysis Tool for Chemical Identification and Quantification of Gas-Phase Species in Complex Spectra.

A spectral analysis tool has been developed to interactively identify and quantify individual gas-phase species from complex infrared absorbance spectra obtained from laboratory or field data. The SpecQuant program has an intuitive graphical interface that accommodates both reference and experimental data with varying resolution and instrumental lineshape, as well as algorithms to readily align the wavenumber axis of a sample spectrum with the raster of a reference spectrum. Using a classical least squares model in conjunction with reference spectra such as those from the Pacific Northwest National Laboratory (PNNL) gas-phase infrared database or simulated spectra derived from the HITRAN line-by-line database, the mixing ratio of each identified species is determined along with its associated estimation error. After correcting the wavelength and intensity of the field data, SpecQuant displays the calculated mixing ratio versus the experimental data for each analyte along with the residual spectrum with any or all analyte fits subtracted for visual inspection of the fit and residuals. The software performance for multianalyte quantification was demonstrated using moderate resolution (0.5 cm-1) infrared spectra that were collected during the time-resolved infrared photolysis of methyl iodide.

Prevalence and outcomes of heparin-induced thrombocytopenia in hospitalized patients with venous thromboembolic disease: Insight from national inpatient sample.

OBJECTIVE: The mainstay of therapy for patients with venous thromboembolic disease (VTE) is anticoagulation. In the inpatient setting, majority of these patients are treated with heparin or low molecular weight heparin. The prevalence and outcomes of heparin-induced thrombocytopenia (HIT) in hospitalized patients with venous thromboembolic disease (VTE) is unknown. METHODS: This nationwide study identified patients with VTE from the National Inpatient Sample database between January 2009 and December 2013. Among these patients, we compared in-hospital outcomes of patients with and without HIT using a propensity score-matching algorithm. The primary outcome was in-hospital mortality. Secondary outcomes included rates of blood transfusions, intracranial hemorrhage, gastrointestinal bleed, length of hospital stay, and total hospital charges. RESULTS: Among 791,932 hospitalized patients with VTE, 4948 patients (0.6%) were noted to have HIT (mean age, 62.9 ±16.2 years; 50.1% female). Propensity-matched comparison showed higher rates of in-hospital mortality (11.01% vs 8.97%; P < .001) and blood transfusions (27.20% vs 20.23%; P < .001) in patients with HIT compared with those without HIT. No significant differences were noted in intracranial hemorrhage rates (0.71% vs 0.51%; P > .05), gastrointestinal bleed (2.00% vs 2.22%; P > .05), length of hospital stay (median, 6.0 days; interquartile range [IQR], 3.0-11.0 vs median, 6.0 days; IQR, 3.0-10.0 days; P > .05), and total hospital charges (median, $36,325; IQR, $17,798-$80,907 vs median, $34,808; IQR, $17,654-$75,624; P > .05). CONCLUSIONS: This nationwide observational study showed that 0.6% of hospitalized patients with VTE in the United States have HIT. The presence of HIT was associated with higher in-hospital mortality and blood transfusion rates compared with those without HIT.

PARASIAS: A new method for analyzing higher-order tensors with shifting profiles.

Higher-order tensor data analysis has been extensively employed to understand complicated data, such as multi-way GC-MS data in untargeted/targeted analysis. However, the analysis can be complicated when one of the modes shifts e.g., the elution profiles of specific compounds often with respect to retention time; something which violates the assumptions of more traditional models. In this paper, we introduce a new analysis method named PARASIAS for analyzing shifted higher-order tensor data by combining spectral transformation and the simple PARAFAC modeling. The proposed method is validated by applications on both simulated and real multi-way datasets. Compared to the state-of-art PARAFAC2 model, the results indicate that fitting of PARASIAS is 13 times faster on simulated datasets and more than eight times faster on average on the real datasets studied. PARASIAS has significant advantages in terms of model simplicity, convergence speed, the robustness to shift changes in the data, the ability to impose non-negativity constraint on the shift mode and the possibility of easily extending to data with multiple shift modes. However, the resolved profiles of PARASIAS model are always a little worse when the number of components in the data are larger than three and without using additional factors in PARASIAS model. In such cases, more components are necessary for PARASIAS to model the data than that would be needed e.g., by PARAFAC2. The reason for this is also discussed in this work.

Assessment of Impact of Fluoride on Mechanical Properties of NiTi and CuNiTi Orthodontic Archwires: An In Vitro Study.

AIM: The current study was carried out to assess the impact on the mechanical properties of orthodontic wires such as the nickel-titanium (NiTi) and copper-nickel-titanium (CuNiTi) wires by fluoride available in various prophylactic products. MATERIALS AND METHODS: Fifty-six wire specimens were randomly divided into two groups-control group in which deionized water was used as a medium and study group in which Phos-Flur gel was used. Both study group and control group were divided into two subgroups-NiTi wire group: 0.019 × 0.025 inch NiTi archwires (14 specimens) and CuNiTi wire group: 0.019 × 0.025 inch CuNiTi archwires (14 specimens). Testing of all the wires was done under a universal force testing machine. RESULTS: Mean loading force among NiTi wire group and CuNiTi wire group specimens with deionized water as a medium was 682.6 and 397.4 MPa, respectively, while the mean loading force among NiTi wire group and CuNiTi wire group specimens with Phos-Flur gel as a medium was 596.1 and 368.4 MPa, respectively. While comparing between study group and control group among NiTi wires, significant results were obtained. Also, while comparing between study group and control group among CuNiTi wires, significant results were obtained. CONCLUSION: Following exposure to fluoride agents, NiTi wires and CuNiTi wires are significantly associated with reduced mechanical properties. CLINICAL SIGNIFICANCE: Although fluoride acts as a vital adjunct in maintaining oral hygiene, particularly among patients undergoing fixed orthodontic treatment, its influence on the mechanical properties of the wires is an area to be explored further; thereby, its use is to be monitored.

Increasing Patient Age, Ambulatory Surgery Center Setting, and Surgeon Experience Are Associated With Shorter Operative Duration for Anterior Cruciate Ligament Reconstruction.

Purpose: To identify variables associated with operative duration and intraoperative or perioperative complications after primary anterior cruciate ligament reconstruction (ACLR). Methods: Surgeons who performed a minimum of 20 arthroscopic cases per month were recruited for participation through the Arthroscopy Association of North America from 2011 through 2013. All participants agreed to voluntarily submit data for 6 months of consecutive knee and shoulder arthroscopy cases. Only subjects coded for ACLR were analyzed, whereas revision cases were excluded. ACLRs were subdivided into isolated ACLR, ACLR with minor concomitant procedures, and ACLR with major concomitant procedures. Patient, surgeon, and surgical variables were analyzed for their effect on operative duration and complications. Results: One hundred thirty-five orthopaedic surgeons participated, providing 1,180 primary ACLRs (399 isolated ACLRs, 441 ACLRs plus minor procedures, and 340 ACLRs plus major procedures). Most surgeons were in private practice (72.8%). Most patients were male patients (58.8%), and the mean body mass index (BMI) was 26.2 ± 5.1. The overall mean operative duration was 95.9 ± 42.0 minutes (isolated ACLRs, 88.4 ± 36.8 minutes; ACLRs plus minor concomitant procedures, 90.1 ± 37.6 minutes; and ACLRs plus major concomitant procedures, 118.5 ± 112.4 minutes; P < .001). Patient age was inversely correlated with operative duration (ρ = -0.221, P < .001). Surgical procedures performed in an ambulatory surgery center had a shorter mean operative duration (91.5 ± 40.4 minutes) compared with those performed in a hospital setting (105.0 ± 43.8 minutes, P < .001). There were 22 intraoperative and 47 early postoperative complications, with the most common being deep vein thrombosis (n = 15). Surgical volume (knee arthroscopy cases per month) correlated inversely with operative time (ρ = -0.200, P = .001) and complication rate (ρ = -0.112, P < .001). Patient BMI was associated with increased odds of early postoperative complications on multivariate analysis (odds ratio, 1.060; P = .044; 95% confidence interval, 1.002-1.121). Conclusions: Increasing patient age, private practice, ambulatory surgery center setting, and surgeon experience are associated with a shorter operative duration for ACLR. Although an increasing number of arthroscopic knee procedures performed by surgeons correlated with fewer complications, only increasing patient BMI significantly predicted odds of complications. Level of Evidence: Level IV, prognostic case series.

A Comprehensive Description of the Lateral Patellofemoral Complex: Anatomy and Anisometry.

BACKGROUND: The lateral patellofemoral complex (LPFC) is an important stabilizer of the patella composed of the lateral retinacular structures including the lateral patellofemoral ligament (LPFL), the lateral patellomeniscal ligament (LPML), and the lateral patellotibial ligament (LPTL). While the isolated anatomy of the LPFL has been previously described, no previous study has investigated the entirety of the LPFC structure, length changes, and radiographic landmarks. An understanding of LPFC anatomy is important in the setting of LPFL injury or previous lateral release resulting in iatrogenic medial instability requiring LPFC reconstruction. PURPOSE: To both qualitatively and quantitatively describe the anatomy and length changes of the LPFC on gross anatomic dissections and standard radiographic views. STUDY DESIGN: Descriptive laboratory study. METHODS: Ten nonpaired cadaveric specimens were utilized in this study. Specimens were dissected to identify distinct attachments of the LPFL, LPML, and LPTL. Ligament lengths, footprints, and centers of each attachment were described with respect to osseous landmarks using a 3-dimensional coordinate measuring device. Ligament length changes were also assessed from 0° to 90° of flexion. Radiopaque markers were subsequently utilized to describe attachments on standard anteroposterior and lateral radiographic views. RESULTS: The individual elements of the LPFC were identified in all specimens. The LPFL patellar attachment had an average total length of 22.5 mm (range, 18.3-27.5 mm), involving a mean of 59% (range, 50%-75%) of the sagittal patella. Based on the average patellar size, a mean of 63% of the LPFL attached to the patella, and the remainder (11.1 ± 1.4 mm) inserted into the patellar tendon. The femoral attachment of the LPFL had a mean maximum length of 24.4 ± 4.3 mm. The center of the LPFL femoral attachment was a mean distance of 13.5 ± 3.2 mm anterior and distal to the lateral epicondyle. The LPFL demonstrated significant shortening, especially in the first 45° of flexion (7.5 ± 5.1 mm). In contrast, the LPTL (5.5 ± 3.0 mm) and LPML (10.0 ± 3.3 mm) demonstrated significant shortening from 45° to 90°. On lateral radiographs, the center of the femoral attachment of the LPFL was a mean total distance of 19.2 ± 7.2 mm from the lateral epicondyle. CONCLUSION: The most important findings of this study were the correlative anatomy of 3 distinct lateral patellar ligaments (LPFL, LPML, and LPTL) and their anisometry through flexion. All 3 components demonstrated significant shortening during flexion. The quantitative and radiographic measurements detailed the LPFL osseous attachment on the patella; soft tissue attachment on the patellar tendon; and finally, the osseous insertion on the femur distal and anterior to the lateral epicondyle. Similarly, the authors documented the meniscal insertion of the LPML and defined a patellar insertion of the LPTL and LPML as a single attachment. These data allow for reproducible landmarks to aid in the understanding and reconstruction of the lateral patellar restraints. CLINICAL RELEVANCE: The data produced from this investigation provide a comprehensive description of these 3 lateral patellar stabilizers (LPFL, LPML, LPTL). These data can be used intraoperatively to facilitate anatomic reconstructions of the lateral patellar stabilizers.

Interobserver Reliability and Change in the Sagittal Tibial Tubercle-Trochlear Groove Distance with Increasing Knee Flexion Angles.

The tibial tubercle-trochlear groove (TT-TG) distance is currently utilized to evaluate knee alignment in patients with patellar instability. Sagittal plane pathology measured by the sagittal tibial tubercle-trochlear groove (sTT-TG) distance has been described in instability but may also be important to consider in patients with cartilage injury. This study aims to (1) describe interobserver reliability of the sTT-TG distance and (2) characterize the change in the sTT-TG distance with respect to changing knee flexion angles. In this cadaveric study, six nonpaired cadaveric knees underwent magnetic resonance imaging (MRI) studies at each of the following degrees of knee flexion: -5, 0, 5, 10, 15, and 20. The sTT-TG distance was measured on the axial T2 sequence. Four reviewers measured this distance for each cadaver at each flexion angle. Intraclass correlation coefficients were calculated to determine interobserver reliability and reproducibility of the sTT-TG measurement. Analysis of variance (ANOVA) tests and Friedman's tests with a Bonferroni's correction were performed for each cadaver to compare sTT-TG distances at each flexion angle. Significance was defined as p < 0.05. There was excellent interobserver reliability of the sTT-TG distance with all intraclass correlation coefficients >0.9. The tibial tubercle progressively becomes more posterior in relation to the trochlear groove (more negative sTT-TG distance) with increasing knee flexion. The sTT-TG distance is a measurement that is reliable between attending surgeons and across training levels. The sTT-TG distance is affected by small changes in knee flexion angle. Awareness of knee flexion angle on MRI is important when this measurement is utilized by surgeons.

Patellar tilt does not affect patient reported outcomes after modern total knee arthroplasty.

BACKGROUND: The focus of patella maltracking after total knee arthroplasty (TKA) has traditionally been on patella polyethylene damage and failure mechanisms rather than functional outcomes. The purpose of this study was to evaluate the effect of patellar tilt on patient reported outcomes (PROMS) after primary TKA performed with patellar resurfacing. METHODS: A retrospective review using a single implant design was performed. Patella tilt was radiographically measured according to a standardized protocol. PROMS related to pain, function, and satisfaction were evaluated preoperatively and at minimum 1-year follow-up. RESULTS: A total of 468 TKAs were included for analysis. Mean age and BMI were 64 years and 35 kg/m2; respectively while 63% of patients were female. The median follow-up period was 12.7 months. Overall, patellar tilt was corrected from a median of 5.0 degrees preoperatively to a median of 3.0 degrees postoperatively. Preoperative, postoperative, and the change in patellar tilt had no significant effects on PROMS at minimum 1-year follow-up (p ≥ 0.092). Satisfaction in knee function while getting out of bed was higher for patients with approximately the same patellar tilt before and after TKA compared to patients with an increase in lateral patellar tilt (95% vs 80%, p = 0.025). CONCLUSIONS: The range of patellar tilt studied in this cohort had little to no effect on PROMS. However, suboptimal patellar tracking may potentiate edge loading of the polyethylene and contribute to implant damage in the long-term. These results are helpful to focus efforts on the tibiofemoral articulation as the predominant determinant of patient outcomes.

Knotless Suture Anchor Fixation of a Traumatic Osteochondral Lesion of the Lateral Femoral Condyle.

Osteochondral injuries commonly occur after lateral patellar instability events. Recognition and early intervention of displaced fragments is key to maintaining the viability of the fragment and congruency of the articular surface. Multiple fixation techniques exist for achieving stable fixation of displaced osteochondral lesions, including metal or bioabsorbable screws and all suture techniques. In this Technical Note, we describe a technique for internal fixation of a displaced osteochondral fragment of the lateral femoral condyle using knotless suture anchors. This technique affords minimally invasive restoration of the native anatomy with excellent stability of the fracture fragment, allowing early range of motion and ambulation.

Viscoelastic Testing and Coagulopathy of Traumatic Brain Injury.

A unique coagulopathy often manifests following traumatic brain injury, leading the clinician down a difficult decision path on appropriate prophylaxis and therapy. Conventional coagulation assays-such as prothrombin time, partial thromboplastin time, and international normalized ratio-have historically been utilized to assess hemostasis and guide treatment following traumatic brain injury. However, these plasma-based assays alone often lack the sensitivity to diagnose and adequately treat coagulopathy associated with traumatic brain injury. Here, we review the whole blood coagulation assays termed viscoelastic tests and their use in traumatic brain injury. Modified viscoelastic tests with platelet function assays have helped elucidate the underlying pathophysiology and guide clinical decisions in a goal-directed fashion. Platelet dysfunction appears to underlie most coagulopathies in this patient population, particularly at the adenosine diphosphate and/or arachidonic acid receptors. Future research will focus not only on the utility of viscoelastic tests in diagnosing coagulopathy in traumatic brain injury, but also on better defining the use of these tests as evidence-based and/or precision-based tools to improve patient outcomes.

Myeloperoxidase immunohistochemical staining can identify glomerular endothelial cell injury in dense deposit disease.

BACKGROUND: Previous studies have demonstrated residual complement-mediated deposits in repeat kidney biopsies of C3 glomerulopathies (C3G) (dense deposit disease (DDD) and C3 glomerulonephritis) following eculizumab treatment, despite some clinical improvement. With residual complement deposition, it is difficult to determine whether there is a reduced complement-mediated endothelial cell injury. We validated that myeloperoxidase (MPO) immunohistochemical staining identified glomerular endothelial cell injury in crescentic glomerulonephritis and C3G. CASE (DIAGNOSIS/TREATMENT): We report that MPO staining in the glomerular endothelium of the post-treatment kidney biopsy was significantly reduced after 3 years of eculizumab treatment and clinical improvement in a 5-year-old boy with initial DDD and secondary crescent formation. CONCLUSION: We find that immunostaining for MPO is a useful method to compare glomerular endothelial injury in C3G following eculizumab treatment. This finding also supports the notion that eculizumab, a C5 blocker, may not mainly block C3 deposits in the glomeruli but significantly blocks final activation of the complement cascade, thus reducing glomerular endothelial cell injury.

Modification of oxytocin use through a coaching-based intervention based on the WHO Safe Childbirth Checklist in Uttar Pradesh, India: a secondary analysis of a cluster randomised controlled trial.

OBJECTIVE: To understand the prevalence of intrapartum oxytocin use, assess associated perinatal and maternal outcomes, and evaluate the impact of a WHO Safe Childbirth Checklist intervention on oxytocin use at primary-level facilities in Uttar Pradesh, India. DESIGN: Secondary analysis of a cluster-randomised controlled trial. SETTING: Thirty Primary and Community public health facilities in Uttar Pradesh, India from 2014 to 2017. POPULATION: Women admitted to a study facility for childbirth at baseline, 2, 6 or 12 months after intervention initiation. METHODS: The BetterBirth intervention aimed to increase adherence to the WHO Safe Childbirth Checklist. We used Rao-Scott Chi-square tests to compare (1) timing of oxytocin use between study arms and (2) perinatal mortality and resuscitation of infants whose mothers received intrapartum oxytocin versus who did not. MAIN OUTCOME MEASURES: Intrapartum and postpartum oxytocin administration, perinatal mortality, use of neonatal bag and mask. RESULTS: We observed 5484 deliveries. At baseline, intrapartum oxytocin was administered to 78.2% of women. Two months after intervention initiation, intrapartum oxytocin (I) was administered to 32.1% of women compared with 70.6% in the control (C) (P < 0.01); this difference diminished after the end of the intervention (I = 48.2%, C = 74.7%, P = 0.03). Partograph use remained at <1% at all facilities. Resuscitation was performed on 7.5% of infants whose mother received intrapartum oxytocin versus 2.0% who did not (P < 0.0001). CONCLUSIONS: In this setting, intrapartum oxytocin use was high despite limited maternal/fetal monitoring or caesarean capability, and was associated with increased neonatal resuscitation. The BetterBirth intervention was successful at decreasing intrapartum oxytocin use. Ongoing support is needed to sustain these practices. TWEETABLE ABSTRACT: Coaching + WHO Safe Childbirth Checklist reduces intrapartum oxytocin use and need for newborn resuscitation.