Neonatal Acute Kidney Injury: A Survey of Neonatologists' and Nephrologists' Perceptions and Practice Management.

BACKGROUND: Neonatal acute kidney injury (AKI) occurs in 40 to 70% of critically ill neonatal intensive care admissions. This study explored the differences in perceptions and practice variations among neonatologists and pediatric nephrologists in diagnostic criteria, management, and follow-up of neonatal AKI. METHODS: A survey weblink was emailed to nephrologists and neonatologists in Australia, Canada, New Zealand, India, and the United States. Questions consisted of demographic and unit practices, three clinical scenarios assessing awareness of definitions of neonatal AKI, knowledge, management, and follow-up practices. RESULTS: Many knowledge gaps among neonatologists, and to a lesser extent, pediatric nephrologists were identified. Neonatologists were less likely to use categorical definitions of neonatal AKI (p < 0.00001) or diagnose stage 1 AKI (p < 0.00001) than pediatric nephrologists. Guidelines for creatinine monitoring for nephrotoxic medications were reported by 34% (aminoglycosides) and 62% (indomethacin) of respondents. Nephrologists were more likely to consider follow-up after AKI than neonatologists (p < 0.00001). Also, 92 and 86% of neonatologists and nephrologists, respectively, reported no standardization or infrastructure for long-term renal follow-up. CONCLUSION: Neonatal AKI is underappreciated, particularly among neonatologists. A lack of evidence on neonatal AKI contributes to this variation in response. Therefore, dissemination of current knowledge and areas for research should be the priority.

Bony fragments in the uterus: an association with secondary subfertility.

Bone within the uterine cavity is an unusual finding in women with secondary subfertility, and is usually associated with a past history of termination of pregnancy. The etiology is unknown, but theories include retained fetal bone and osseous metaplasia of endometrial tissue. We describe the cases of three subfertility patients, all with a history of surgical termination of pregnancy. Each patient underwent a hysteroscopy after highly echogenic foci were seen in the uterus on transvaginal ultrasound examination. During hysteroscopy, several coral-like bony fragments were seen and removed by sharp curettage. On histological examination, these fragments were found to be mature, necrotic bone. This case report confirms the importance of routine baseline evaluation of the endometrium in subfertile women with a history of termination of pregnancy.

Vector quantization for compression of multichannel ECG.

We propose a scheme based on vector quantization (VQ) for the data-compression of multichannel ECG waveforms. N-channel ECG is first coded using m-AZTEC, a new, multichannel extension of the AZTEC algorithm. As in AZTEC, the waveform is approximated using only lines and slopes; however, in m-AZTEC, the N-channels are coded simultaneously into a sequence of N + 1 dimensional vectors, thus exploiting the correlation that exists across channels in the AZTEC duration-parameter. Classified vector quantization (CVQ) of the m-AZTEC output is next performed to exploit the correlation in the other AZTEC parameter, namely, the value-parameter. CVQ preserves the waveform morphology by treating the lines and slopes as two perceptually-distinct classes. Both m-AZTEC and CVQ provide data-compression and their performance improves as the number of channels increases. Moreover, the final output differs little from the AZTEC output and hence ought to enjoy the same acceptability.