Addressing the challenges of complex type III odontoid fractures: Clinical and radiological outcomes of various treatment modalities.

Background: Unlike simple fractures, complex Type III odontoid fractures-characterized by intricate morphology and pathomechanics-pose significant management challenges. This study aims to evaluate the clinical and radiological outcomes of conservative and surgical treatment modalities for these complex fractures, with a focus on assessing factors influencing fracture union. Methods: Following approval of our institutional review board, this retrospective observational cohort study was conducted. All Patients with complex Type III odontoid fractures who were managed at our center from June 2016 to December 2022 were assessed for eligibility. The primary outcome was union status. Secondary outcomes included the ASIA impairment scale, neck disability index (NDI), and complications. Logistic regression analysis was conducted to identify risk factors for adverse union outcomes. Results: A total of 39 patients were included in the final analysis, with a mean age of 36.10 years. Nine patients were managed conservatively, 12 patients underwent anterior odontoid screw (AOS) fixation, and 18 patients received posterior fusion (PF). The rate of bony union varied significantly across the treatment groups, 100 % in the PF group, 58 % in the AOS group and 22 % in the conservative group (p = 0.0012). The NDI revealed superior functional outcomes in the PF group compared to the other groups (p = 0.0436). Failure of primary treatment was observed in seven patients (three from the conservative group and four from the AOS), necessitating secondary treatment with PF. Lateral mass gap >2 mm, coronal tilt >5°, and atlantoaxial instability >50 % were identified as significant risk factors for adverse union outcomes. Conclusions: Surgical treatment, particularly PF, offers superior outcomes in terms of union rates and functional recovery for complex Type III odontoid fractures. The identification of specific radiological measurements as significant risk factors for non-union underscores the need for detailed imaging and careful patient selection for conservative versus surgical management.

Associated Factors of Trauma Severity and Mortality in Pediatric Patients Admitted to Intensive Care Unit; a 10-Year Retrospective Study.

Introduction: Trauma is a significant global public health concern and the leading cause of morbidity and mortality in children. This study aimed to assess the independent predictors of trauma severity as well as mortality in pediatric patients admitted to the intensive care unit (ICU). Methods: In this cross-sectional study, following the STROBE checklist, we retrospectively analyzed the clinical and baseline characteristics of pediatric patients with trauma injuries admitted to the ICU of Children's Hospital of Zhejiang University School of Medicine, China, over a decade. Results: 951 pediatric patients with a mean age of 4.79 ± 3.24 years (60.78% Boys) were studied (mortality rate 8.41%). Significant associations were observed between ISS and place of residence (p = 0.021), location of the injury (p = 0.010), year of injury (p <0.001), and injury mechanism (p <0.001). The two independent factors of trauma severity were the year of injury (ß = 0.47; 95%CI: 0.28 - 0.65) and injury mechanism (ß = -0.60; 95%CI: -0.88 - -0.31). Significant differences were observed between survived and non-survived regarding age (p <0.001), ISS score (p <0.001), time elapsed from injury to ICU (p <0.001), duration of mechanical ventilation (p <0.001), GCS score (p <0.001), and the proportion of patients requiring mechanical ventilation (p <0.001 ). The results of multivariate analysis indicated that age (OR = 0.805; 95%CI: 0.70 - 0.914; p = 0.001) and GCS score at ICU admission (OR = 0.629; 95%CI: 0.53 - 0.735; p < 0.001) acted as protective factors, whereas mechanical ventilation in the ICU (OR = 7.834; 95%CI: 1.766 - 34.757; p = 0.007) and ISS score at ICU admission (OR = 1.088; 95%CI: 1.047 - 1.130; p < 0.001) served as risk factors for mortality. Conclusion: Automobile-related injuries represent the leading cause of trauma in children, with escalating severity scores year over year among pediatric patients admitted to the ICU with trauma injuries. Based on the findings the independent predictors of mortality of pediatric trauma patients admitted to the ICU were age, GCS score at ICU admission; mechanical ventilation in the ICU, and ISS score at ICU admission. Also, the year of injury and injury mechanism were independent predictors of trauma severity.

Comparison of outcomes after total hip arthroplasty in hip fracture versus elective cases in patients over 60 years of age.

Background: Total hip arthroplasty (THA) allows for the replacement of impaired parts of the hip joint with artificial ones. This study aimed to compare the differences in preoperative patient profiles, postoperative complications, and clinical outcomes of two patient groups: those who underwent THA for fractures and those who underwent THA electively for diseases such as osteoarthritis (OA) and avascular necrosis (AVN). Methods: We retrospectively analyzed the data of patients who underwent THA between March 2012 and December 2021. Of 232 patients, 173 patients who met the exclusion and inclusion criteria were included. Patients were divided into two groups (Group 1: 113 patients diagnosed with OA or AVN; Group 2: 60 patients diagnosed with hip fracture). Pre- and postoperative Visual Analogue Scale (VAS), Koval scores, and postoperative modified Harris Hip Score (mHHS) were used to assess clinical outcomes. Demographic data and postoperative complications of the two groups were compared. After surgery, a rehabilitation protocol was initiated. Results: Patients in Group 2 (fracture) had more preoperative comorbidities than those in Group 1 (elective). Follow-up months are 26.22 ± 19.78 (Group 1), and 27.42 ± 17.02 (Group 2) respectively (P > 0.05). There were no statistical differences in the prevalence of postoperative complications between two groups (P > 0.05). Compared with Group 1(elective), Group 2(fracture) showed lower VAS (P < 0.01) at last follow-up, and no difference in Koval score (P = 0.77) and mHHS (P = 0.96) at last follow-up. Conclusion: Considering the characteristics of the two groups and their perioperative multidisciplinary care, THA for hip fractures can provide good clinical results compared to those with elective THA.

3D-Printed-Cryogel-Impregnated Functionalized Scaffold Augments Bone Regeneration in Critical Tibia Fracture in Goat.

Critical-size bone trauma injuries present a significant clinical challenge because of the limited availability of autografts. In this study, a photocurable composite comprising of polycaprolactone, polypropylene fumarate, and nano-hydroxyapatite (nHAP) (P─P─H) is printed, which shows good osteoconduction in a rat model. A cryogel composed of gelatin-nHAP (GH) is developed to incorporate osteogenic components, specifically bone morphogenetic protein-2 (BMP-2) and zoledronic acid (ZA), termed as GH+B+Z, which is investigated for osteoinductive property in a rat model. Further, a 3D-printed P─P─H scaffold impregnated with GH+B+Z is designed and implanted in a critical-size defect (25 × 10 × 5 mm) in goat tibia. After 4 months, the scaffold is well-integrated with adjacent native bone, with osteoinduction observed in the cryogel-filled region and osteoconduction over the printed scaffold. X-ray radiography and micro-CT analysis showed bone in-growth in the treatment group with 45 ± 1.4% bone volume/tissue volume (BV/TV), while the defect remained unhealed in the control group with BV/TV of 10.5 ± 0.5%. Histology showed significant cell infiltration and matrix deposition over the printed P─P─H scaffold and within the GH cryogel site in the treatment group. Immunohistochemical staining depicted significantly higher normalized collagen I intensity in the treatment group (34.45 ± 2.61%) compared to the control group (4.22 ± 0.78).

Analyzing the Burden of Midface Fractures Due to Road Traffic Accidents in Vietnam: An Epidemiological Approach.

BACKGROUND: Road traffic accidents have significantly impacted public health in Vietnam. This study investigated the patterns of midface fractures in Vietnam and their correlation with road traffic accidents in the country. METHODOLOGY: This retrospective cross-sectional study reviewed 2187 medical records of patients with midface fractures in Ho Chi Minh City. After applying exclusion criteria, the fractures were categorized. Statistical analyses, including chi-squared and logistic regression, were conducted to identify associations and relationships among the types and causes of fractures. RESULTS: The study found that 89.3% of midface fractures stemmed from road traffic accidents, with 55.2% and 14.4% zygomatic complex fractures and Le Fort type II fractures, respectively. Adults aged 19-39 accounted for 65.1% of patients, with males at 80.5%. Traffic accidents were significantly associated with an 18.7 times higher risk of concomitant mandibular fractures and a 10.5 times higher risk of Le Fort type II fractures, irrespective of age and gender. CONCLUSION: This study underscores the need for targeted prevention strategies to decrease the incidence of maxillofacial injuries resulting from road traffic accidents in Vietnam, particularly among high-risk groups such as males and young adults.

Examination of plasma biomarkers of amyloid, tau, neurodegeneration, and neuroinflammation in former elite American football players.

INTRODUCTION: Blood-based biomarkers offer a promising approach for the detection of neuropathologies from repetitive head impacts (RHI). We evaluated plasma biomarkers of amyloid, tau, neurodegeneration, and inflammation in former football players. METHODS: The sample included 180 former football players and 60 asymptomatic, unexposed male participants (aged 45-74). Plasma assays were conducted for beta-amyloid (Aß) 40, Aß42, hyper-phosphorylated tau (p-tau) 181+231, total tau (t-tau), neurofilament light (NfL), glial fibrillary acidic protein (GFAP), interleukin-6 (IL-6), Aß42/p-tau181 and Aß42/Aß40 ratios. We evaluated their ability to differentiate the groups and associations with RHI proxies and traumatic encephalopathy syndrome (TES). RESULTS: P-tau181 and p-tau231(padj = 0.016) were higher and Aß42/p-tau181 was lower(padj = 0.004) in football players compared to controls. Discrimination accuracy for p-tau was modest (area under the curve [AUC] = 0.742). Effects were not attributable to AD-related pathology. Younger age of first exposure (AFE) correlated with higher NfL (padj = 0.03) and GFAP (padj = 0.033). Plasma GFAP was higher in TES-chronic traumatic encephalopathy (TES-CTE) Possible/Probable (padj = 0.008). DISCUSSION: Plasma p-tau181 and p-tau231, GFAP, and NfL may offer some usefulness for the characterization of RHI-related neuropathologies. HIGHLIGHTS: Former football players had higher plasma p-tau181 and p-tau231 and lower Aß42/ptau-181 compared to asymptomatic, unexposed men. Younger age of first exposure was associated with increased plasma NfL and GFAP in older but not younger participants. Plasma GFAP was higher in participants with TES-CTE possible/probable compared to TES-CTE no/suggestive.

Parental History of Childhood Maltreatment and Offspring Attachment Insecurity and Disorganization: Two Meta-Analyses.

Research findings have shown that parental history of childhood maltreatment (CM) increases the risk of insecure and disorganized attachment in offspring. However, the extent of the detrimental effects of childhood trauma on attachment in the next generation is unclear. The current meta-analyses aimed at synthesizing the available literature on the link between parental history of CM and offspring attachment insecurity and disorganization (with no restriction of offspring age). In total, 25 studies (23 unique samples; N = 2,592) comprising u = 61 effect sizes were included. Offspring age ranged from 12 to 79 months (Mweighted = 18.69; SDweighted = 11.53). Findings from two three-level random effects meta-analyses revealed a weak but significant combined effect of parental history of CM on child attachment insecurity (k = 20, u = 35, r = .06) and a non-significant effect on child attachment disorganization (k = 12, u = 26, r = .03). For the meta-analysis on disorganization, effect sizes were weaker in more recent studies, and trim and fill analyses provided evidence of publication bias. These findings provide a nuanced view of the intergenerational transmission of childhood trauma phenomenon, whereby parents' self-reported history of CM does not appear decisive for child attachment. Conclusions could not be drawn for specific types of CM because of the small number of studies. Research with more objective measures of parental exposure to CM is needed to gain a more comprehensive view of the possible intergenerational effects of CM on child attachment.

[Surgical management of severe noncompressible torso and organ hemorrhages]. / Chirurgisches Management von schweren nichtkomprimierbaren Stamm- und Organblutungen.

BACKGROUND: Noncompressible torso hemorrhages (NCTH) are now recognized as the leading cause of preventable death in the context of severe military and civilian injuries. Approximately 20% of all trauma patients still die from uncontrolled bleeding associated with rapidly evolving disorders of blood coagulation function. OBJECTIVE: Summary of recent advances in the field of nonsurgical and surgical management, presentation of current treatment concepts and future research directions. MATERIAL AND METHODS: Selective literature review and analysis. RESULTS: The concepts for the early treatment of NCTH have considerably evolved over the last decade. The updated definition of NCTH includes a combination of high-grade anatomic body trunk injury, hemodynamic instability, urgent need for hemorrhage control, and aggressive hemostatic treatment. The treatment concepts consider the following 3 aspects: controlling the source of bleeding (close the tap), maintaining organ perfusion and restoring hemostasis (fill the tank) and increasing the body's resistance to ischemia (upgrade the armor). New tools, well-established damage control concepts and early and aggressive therapeutic intervention for hemostatic failure have significantly improved the outcomes. CONCLUSION: Future research needs to refine and validate the current concepts for further clinical application.

Total Pulpotomy Using a Newer Mineral Trioxide Aggregate for Managing Complicated Crown Fractures in Mature Permanent Incisors: A Case Report.

Crown fractures with pulp exposure in mature permanent teeth present a challenging situation that requires immediate attention. Mineral trioxide aggregate (MTA) as a sealing material after pulpotomy has proven to be a reliable treatment in these cases compared to traditional root canal therapy. This case report emphasizes the importance of early diagnosis and careful treatment planning for complicated crown fractures and concussion injuries in a mature permanent incisor of a young child. Total pulpotomy using MTA has proven to be an effective treatment for fractures in young mature incisors with pulp exposure, as evidenced by a one-year follow-up in our case, which showed no discoloration.

First Experience With Catheter-Directed Thrombolysis for Massive Pulmonary Embolism at Teaching Hospital Jaffna, Sri Lanka: A Case Report.

Catheter-directed thrombolysis (CDT) is one of the modes of treatment for massive pulmonary embolism (PE). This case report shares the new experience of CDT for massive PE at Teaching Hospital Jaffna, Sri Lanka. A 54-year-old woman developed massive PE two days after a traumatic tibial fracture. She was hemodynamically unstable with hypotension and hypoxemia. The multidisciplinary team decided to go for CDT, administering alteplase. Follow-up imaging demonstrated complete thrombus resolution and significant clinical improvement. This case emphasizes the efficacy and safety of CDT for massive PE, particularly in patients at high risk for bleeding. Our experience at Teaching Hospital Jaffna accentuates the significance of individualized treatment strategies and the adoption of advanced techniques in resource-limited settings.

Clinical characteristics of adults with alcohol dependence syndrome comorbid with antisocial personality disorder: a cross-sectional study.

Introduction: Antisocial Personality Disorder (ASPD) is characterized by a pervasive pattern of disregard for and violation of the rights of others, typically emerging by age 15 years and involving behaviors such as deceitfulness, impulsivity, and aggressiveness. The present study sought to examine the prevalence of the comorbid ASPD in adult people with Alcohol Dependence Syndrome (ADS) and identify clinical characteristics associated with ASPD. Methods: A cross-sectional study of 100 consecutive subjects diagnosed with ADS was conducted. Subjects were examined between August 2023 and September 2023. Various assessments and questionnaires were employed, including the Montreal Cognitive Assessment (MoCA), Alcohol Use Disorders Identification Test (AUDIT), and Structured Clinical Interview for DSM-IV (SCID-II). A computed tomography (CT) scan of the brain was performed on 47.5% participants. Results: Out of the 100 individuals screened for the study, 20 were excluded. The study found that 35% of the examined study participants had a comorbid ASPD. Individuals with both ADS and ASPD were more likely to be younger, started drinking at an earlier age, had higher hospitalization rates, and scored higher on the AUDIT test (all P < 0.05%). Also, they had lower education levels, higher rates of unemployment, and lower marriage rates (all P < 0.05%). In addition, they reported more family members with ADS, incarceration, or mental illness and a higher frequency of traumatic experiences (all P < 0.05%). Depression, anxiety, stress (all P < 0.05%), and sleep problems (P = 0.058) were correlated with ASPD. Participants with the comorbid ASPD had lower MoCA scores (P = 0.046) and struggled with attention and linguistic subtests compared to subjects with ADS only. Conclusion: The study highlights the high prevalence of comorbid ASPD in participants with ADS, shedding light on their demographic and psychometric characteristics. Individuals with the comorbid ASPD are more likely to face cognitive deficits, especially in linguistic and attention-related tasks. The findings underline the importance of considering the comorbidity of ASPD in ADS subjects. The study implies that the understanding of the associated risk factors can aid in developing more targeted treatment interventions.

Improving birth experiences and provider interactions: Expert opinion on critical links in Maternity care.

This article explores the Quality of Provider Interaction (QPI) within maternity care, spotlighting its crucial role in positive childbirth experiences. It emphasizes the need for trust-based relationships between women and their care providers, a necessity amplified by the profound neurohormonal sensitivities experienced during labor. Drawing from the 'Optimizing the birth environment' COST DEVOTION CA18211 Working Group, this article aims to provide insights and stimulate discussion on how to mitigate birth trauma and improve childbirth experiences. The study evolved through discussions on QPI, engagement with the group, a review of COST Action research, and conference contributions, leading to essential recommendations. From our dialogue and evaluation of existing literature, we identified four pivotal aspects critical to enhancing QPI: 1) Empathy and emotional availability, 2) Trauma-informed maternity care, 3) Integrating woman-centered individual and institutional attitudes, and 4) Empowering language use. We examine how these elements influence women's emotional and psychological well-being throughout childbirth and beyond, underscoring their critical contribution. This article proposes a framework to improve maternity care by enhancing the Quality of Provider Interaction (QPI). It offers practical recommendations for refining care protocols and language guidelines, emphasizing the importance of respectful, secure birthing environments. Adopting care models that prioritize high-quality provider interactions is crucial for the well-being of women and their families.

Splenic rupture secondary to pancreatic malignancy invasion: A rare case.

Malignancy is a rare etiology of splenic rupture, with most documented cases resulting from hematologic cancers. There have been very few reports of splenic rupture resulting from invasion or metastasis of adenocarcinoma and even fewer reports resulting from specifically pancreatic adenocarcinoma. In this case report, we outline the clinical course of a 60-year-old male with splenic rupture and hemoperitoneum following a ground level fall who was transferred to the Shock Trauma Center (STC) from a local emergency department. Outside of the ruptured spleen, no other traumatic injuries were found on examination or imaging. Due to the initial concern for traumatic etiology, exploratory laparotomy was performed with splenectomy and distal pancreatectomy. Postoperative pathology results revealed pancreatic adenocarcinoma with splenic invasion staged pT3N0. This report provides a novel example of splenic rupture in the background of locally advanced pancreatic adenocarcinoma and further solidifies the importance of maintaining a broad differential in cases of seemingly innocuous trauma.

Secondary removal of intramedullary metal debris from a defective Reamer-Irrigator-Aspirator (RIA) reamer head: A case report.

The Reamer-Irrigator-Aspirator (RIA) device represents a safe and efficient method to harvest autologous bone for grafting. However, hardware failure may occur, for example by breakage of the reamer head with metal debris remaining in the intramedullary canal. This case report describes the uncomplicated secondary removal of femoral intramedullary metal debris from a broken RIA reamer head; three weeks after the final surgery of a two-stage Masquelet procedure for the treatment of posttraumatic segmental bone loss at the tibia.

Effectiveness of written exposure therapy for Korean patients with post-traumatic stress disorder: non-randomized treatment-as-usual waitlist-controlled study.

Written exposure therapy (WET) is a five-session exposure-based protocol for treating post-traumatic stress disorder (PTSD). The brevity and tolerability of WET present the potential to overcome barriers in implementing evidence-based therapy for PTSD within the Korean mental healthcare system. This study investigated the effectiveness of WET in Korean patients with PTSD through a waitlist-controlled trial (KCT0008112). A total of 57 patients with PTSD were allocated non-randomly to either WET (n = 27) or treatment-as-usual waitlist groups (n = 30). Both groups were followed up until the twenty-fourth week after the initial session. Primary outcomes assessed included PTSD symptoms, depressive symptoms, and general function. In the WET group, significant improvements were observed in PTSD symptoms, depressive symptoms, and general function compared to the control group. After the waiting period, the waitlist group also participated in WET, and exhibited significant improvement in all scores. The between- and within-group effect sizes were large. The dropout rate in both groups was 10.9%, and the mean satisfaction ratings were 28.24 ± 3.33 (range 22-32; scale range 8-32). The present study provides evidence of WET successfully reducing PTSD and depressive symptoms and improving general function among Korean patients with PTSD. Moreover, WET was well tolerated and received by Korean patients with PTSD.

Impact of the COVID-19 Pandemic on the Incidence, Etiology, Demographics, and Treatment of Craniomaxillofacial Trauma.

OBJECTIVE: To compare the incidence, etiology, demographics, and treatment of craniomaxillofacial (CMF) trauma before, during, and after COVID-19. STUDY DESIGN: Retrospective cohort. SETTING: Eighty-three health care organizations across the United States. METHODS: The TriNetX Research Network identified 77,977,880 patients during 2017 to 2022. CMF fractures and soft tissue injuries during March to August of each year, aligning with the 2020 pandemic lockdown, were analyzed. RESULTS: In 2020, compared to immediately prepandemic in 2019, there were significant reductions of -17.5% in facial fractures and -19.0% in soft tissue injuries (P < .001). Conversely, in 2021, both injury types increased by +16.7% and +16.3%, respectively, compared to 2020 (P < .001). Changes in injury mechanisms in 2020 included significant decreases in athletic injuries (-57.6%), falls (-16.8%), assaults (-15.5%), motor vehicle collisions (-8.7%), and pedestrian accidents (-6.9%) (P < .01), while off-road vehicle (+48.4%), bicycle (+16.2%), and motorcycle (+8.9%) accidents increased (P < .01). The 10- to 14- and 5- to 9-year-old age groups experienced the most substantial reductions in facial fractures (-39.7% and -29.9%, respectively) and soft tissue injuries (-29.2% and -28.3%, respectively) in 2020 compared to 2019 (P < .001). Operative management of fractures and soft tissue injuries dropped by -20.3% and -12.4%, respectively, in 2020 versus 2019, and then rebounded with +15.8% and +14.6% increases in 2021 compared to 2020 (P < .001). In 2022, compared to prepandemic rates of 2019, there were fewer patients with facial fractures (-2.8%), soft tissue injuries (-4.5%), and operative repairs (-6.9% for fractures, -1.2% for soft tissue injuries) (P < .03). CONCLUSION: CMF trauma decreased in 2020, with subsequent years showing a rebound to levels slightly below those immediately prior to pandemic onset. Changes in etiology, demographics, and treatment highlight the complex dynamics of traumatic injuries during periods of societal disruption.

Dental education in nursing schools: A pan-Canadian study.

OBJECTIVES: The aim of this study was to gather data on Canadian nursing programs regarding oral health curriculum and attitudes towards oral health curriculum to evaluate the level of oral health education in nursing programs and provide a reference for understanding dental and oral health in the nursing field. METHODS: Data to inform models for oral health curriculum in nursing were collected through an online survey using a secured google form. The web-based questionnaire examined main aspects of dental and oral health in nursing educational institutions. Eligibility criteria for this study included faculty members of an accredited nursing program in Canada. RESULTS: Of the 76 institutions approached, a total of 47 nursing faculty members from 35 nursing programs responded to the online survey. The vast majority (85.1 %) of the participants stated they believe oral health should be taught within nursing programs. Relating to the current curriculum, 70.2 % of the respondents stated their institution currently teaches anatomy relating to the oral cavity, but only 38.3 % reported their institution implemented oral diseases and pathology into the curriculum. Moreover, 48.9 % of the participants noted that dental screening was not covered in the nursing curriculum; 27.7 % of the respondents stated that their institution implemented education regarding gum disease, 25.5 % noted implementing education regarding oral cancer and oral lesions screening. Overall, 80.9 % of the participants noted that future nurses should be educated about oral cancer and disease prevention. However, in order to implement dental and oral health curriculums, participants noted certain needs such as time to implement curriculum (87.2 %) and more knowledge about the topic (83 %). CONCLUSIONS: There is a current lack of content regarding dental and oral health in the curriculum of nursing programs throughout Canada. Due to this deficiency, many nursing graduates lack general knowledge about various aspects of dental and oral health.

Mild and Severe Blood Alcohol Concentration Effects on Trauma and Traumatic Brain Injury Outcomes.

INTRODUCTION: Reported outcomes for trauma patients (TPs) with elevated blood alcohol concentration (BAC) have been mixed. Previous studies suggest that positive BAC might lead to lower venous thromboembolism (VTE) rates and mortality. This study expands upon these findings by examining the association of various levels of BAC, with additional emphasis on traumatic brain injury (TBI) patients. We hypothesize that both mild and severe-BAC levels in TPs are associated with decreased risk of VTE and mortality. METHODS: A retrospective review of the 2017 Trauma Quality Improvement Program was performed on adults (≥18 y old) screened for BAC on admission. Patients deceased on arrival and positive for drugs were excluded. We compared three groups: no-BAC, mild-BAC (0-70 mg/dL), and-severe BAC (>80 mg/dL) for associated risk of VTE and mortality. RESULTS: From 203,535 tested patients, 118,427 (58.2%) had no-BAC, 19,813 (9.7%) had mild-BAC, and 65,295 (32.1%) had severe-BAC. The associated risk of VTE was lower for mild-BAC (odds ratios [OR] 0.69, 0.58-0.82, P < 0.001) and severe-BAC (OR 0.80, 0.72-0.89, P < 0.001). This persisted in TBI patients, with mild-BAC (OR 0.67, 0.51-0.89, P = 0.006) and severe-BAC (OR 0.75, 0.64-0.89, P < 0.001) groups exhibiting lower associated VTE risk. However, the associated mortality risk was lower only in severe-BAC patients (OR 0.90, 0.83-0.97, P = 0.009). CONCLUSIONS: A positive BAC is linked to a reduced associated risk of VTE in TPs, including those with TBI. Notably, only the severe-BAC group demonstrated a lower associated risk of mortality. This merits future research including identification of basic science pathways that may be targeted to improve outcomes.

The association of obstetric anal sphincter injury and mediolateral episiotomy with increasing birth weight and duration of second stage of labour in spontaneous vaginal delivery.

OBJECTIVES: Analysis of the association of mediolateral episiotomy (MLE) with obstetric anal sphincter injury (OASI) in women with spontaneous vaginal delivery. DESIGN: Population-based cohort study with data from the Netherlands Perinatal Registry, describing 541 055 women who delivered a singleton live born infant in cephalic presentation spontaneously at term. Risk indicators for OASI were tested using univariate and multivariate analysis. Additional analysis for the interaction of MLE with other risk indicators was performed. RESULTS: The rate of OASI was 4.2 % in 215 241 nulliparous and 1.4 % in 325 814 multiparous women. In nulliparous and multiparous women MLE was associated with a reduction of OASI (adjusted OR (aOR) 0.3, 95 % CI 0.30-0.34 and aOR 0.32, 95 % CI 0.30-0.34). The association of MLE with a reduced rate of OASI was stronger in high birthweight and in prolonged 2nd stage groups. In nulliparous women, the number needed to treat (NNT) for the use of MLE to prevent one OASI is 31 in general. With MLE, the OASI rate reduced from 11.5 % to 2.9 with a NNT of 12 in the group with a birth weight ≥ 4000 g and a duration of the second stage of labour of 60-120 min. The NNT is 9 In the group with a birth weight ≥ 4000 g and a duration of the second stage of labour ≥ 120 min (reduction rate of OASI from 14.2 % to 3.5 %). CONCLUSIONS: Use of MLE is associated with a reduction of OASI in spontaneous vaginal delivery. In nulliparous women, an episiotomy with an anticipated birth weight > 4000 g and a duration of the 2nd stage of more than 60 min should be considered.