The direct anterior approach to the hip has been suggested to have several advantages compared to previously popular approaches through its use of an intra-muscular and intra-nervous interval betweenthe tensor fasciae...The direct anterior approach to the hip has been suggested to have several advantages compared to previously popular approaches through its use of an intra-muscular and intra-nervous interval betweenthe tensor fasciae latae and sartorius muscles. Recent increased interest in tissue-sparing and minimallyinvasive arthroplasty has given rise to a sharp increase in the utilization of direct anterior total hip arthroplasty. A number of variations of the procedure have been described and several authors have published their experiences and feedback to successfully accomplishing this procedure. Additionally, improved understanding of relevant soft tissue constraints and anatomic variants has provided improved margin of safety for patients. The procedure may be performed using speciallydesigned instruments and a fracture table, however many authors have also described equally efficacious performance using a regular table and standard arthroplasty tools. The capacity to utilize fluoroscopy intraoperatively for component positioning is a valuable asset to the approach and can be of particular benefit for surgeons gaining familiarity. Proper management of patient and limb positioning are vital to reducing risk of intra-operative complications. An understanding of its limitations and challenges are also critical to safe employment. This review summarizes the key features of the direct anterior approach for total hip arthroplasty as an aid to improving the understanding of this important and effective method for modern hip replacement surgeons.展开更多
Acute compartment syndrome(ACS) of the thigh following primary total hip arthroplasty(THA) is a highly uncommon complication and has not yet been reported before with regards to the anterior approach through the anter...Acute compartment syndrome(ACS) of the thigh following primary total hip arthroplasty(THA) is a highly uncommon complication and has not yet been reported before with regards to the anterior approach through the anterior supine interval. We present a case of a 69-year-old male patient with a history of stroke, who developed ACS of the thigh after elective THA while using therapeutic low molecular weight heparin as bridging for regular oral anticoagulation. ACS pathogenesis, diagnostic tools, treatment and relevant literature are discussed. The patient's ACS was recognized in time and treated by operative decompression with fasciotomy of the anterior compartment. Follow-up did not show any neurological deficit or soft-tissue damage.展开更多
AIM： To investigate the difference in kappa angle between sitting and supine positions during laser-assisted in situ keratomileusis（LASIK）.·METHODS： A retrospective study was performed on395 eyes from 215 pat...AIM： To investigate the difference in kappa angle between sitting and supine positions during laser-assisted in situ keratomileusis（LASIK）.·METHODS： A retrospective study was performed on395 eyes from 215 patients with myopia that received LASIK. Low, moderate, and high myopia groups were assigned according to diopters. The horizontal and vertical components of kappa angle in sitting position were measured before the operation, and in supine position during the operation. The data from the two positions were compared and the relationship between kappa angle and diopters were analyzed.· RESULTS： Two hundred and twenty-three eyes（56.5%） in sitting position and 343 eyes（86.8%） in supine position had positive kappa angles. There were no significant differences in horizontal and vertical components of kappa angle in the sitting position or horizontal components of kappa angle in the supine position between the three groups（P 〉0.05）. A significant difference in the vertical components of kappa angle in the supine position was seen in the three groups（P 〈0.01）. Differences in both horizontal and vertical components of kappa angles were significant between the sitting and supine positions. Positive correlations in both horizontal and vertical components of kappa angles（P 〈0.05） were found and vertical components of kappa angle in sitting and supine positions were negatively correlated with the degree of myopia（sitting position： r =-0.109; supine position： r =-0.172; P 〈0.05）.·CONCLUSION： There is a correlation in horizontal and vertical components of kappa angle in sitting and supine positions. Positive correlations in both horizontal and vertical components of kappa angle in sitting and supine positions till the end of the results. This result still needs further observation. Clinicians should take into account different postures when excimer laser surgery needs to be performed.展开更多
目的系统评价改良仰卧位下行经皮肾镜碎石取石术(PCNL)的安全性和有效性。方法检索Pub Med,Web of Science,中国生物医学文献服务系统,中国期刊全文数据库及万方电子期刊全文数据库,按照纳入和排除标准筛选关于改良仰卧位与俯卧位PCNL...目的系统评价改良仰卧位下行经皮肾镜碎石取石术(PCNL)的安全性和有效性。方法检索Pub Med,Web of Science,中国生物医学文献服务系统,中国期刊全文数据库及万方电子期刊全文数据库,按照纳入和排除标准筛选关于改良仰卧位与俯卧位PCNL的临床对照研究,提取纳入研究中关于手术时间、住院时间、结石清除率及围手术期并发症发生率的数据并进行Meta分析。结果最终纳入18项研究,共2696个病例,Meta分析显示改良仰卧位组的手术时间较俯卧位组缩短(WMD=-19.24,95%CI:-29.09^-9.39,P<0.01),两组在住院时间(WMD=-0.81,95%CI:-0.85~0.41,P=0.59)、结石清除率(OR=0.95,95%CI:0.76~1.19,P=0.65)和围手术期并发症发生率(OR=0.77,95%CI:0.59~1.01,P=0.06)方面差异无统计学意义。结论改良仰卧位行PCNL安全有效,可缩短手术时间,值得推广应用。展开更多
AIM:To describe the clinical and radiologic features of retrolaminar migration silicone oil(SiO)and observe the dynamic position of ventricular oil accumulation in supine and prone.METHODS:For this retrospective study...AIM:To describe the clinical and radiologic features of retrolaminar migration silicone oil(SiO)and observe the dynamic position of ventricular oil accumulation in supine and prone.METHODS:For this retrospective study,29 patients who had a history of SiO injection treatment and underwent unenhanced head computed tomography(CT)were included from January 2019 to October 2022.The patients were divided into migration-positive and negative groups.Clinical history and CT features were compared using Whitney U and Fisher’s exact tests.The dynamic position of SiO was observed within the ventricular system in supine and prone.CT images were visually assessed for SiO migration along the retrolaminar involving pathways for vision(optic nerve,chiasm,and tract)and ventricular system.RESULTS:Intraocular SiO migration was found in 5 of the 29 patients(17.24%),with SiO at the optic nerve head(n=1),optic nerve(n=4),optic chiasm(n=1),optic tract(n=1),and within lateral ventricles(n=1).The time interval between SiO injection and CT examination of migration-positive cases was significantly higher than that of migration-negative patients(22.8±16.5mo vs 13.1±2.6mo,P<0.001).The hyperdense lesion located in the frontal horns of the right lateral ventricle migrated to the fourth ventricle when changing the position from supine to prone.CONCLUSION:Although SiO retrolaminar migration is unusual,the clinician and radiologist should be aware of migration routes.The supine combined with prone examination is the first-choice method to confirm the presence of SiO in the ventricular system.展开更多
Background:The supine position is the most common birth position adopted in China,but the World Health Organization recommends non-supine positions for delivery.The handsand-knees position shows several advantages,suc...Background:The supine position is the most common birth position adopted in China,but the World Health Organization recommends non-supine positions for delivery.The handsand-knees position shows several advantages,such as wide pelvic diameter and easy fetal rotation during delivery.Small trials conducted in China in 2011 revealed that the handsand-knees position resulted in improved maternal and neonate outcomes than those in the supine position.However,a comprehensive study must be conducted before the handsand-knees position can be introduced into clinical practice.Hence,we conducted this multicenter trial to comprehensively examine the benefits of the hands-and-knees position over the supine position during delivery.Methods:Our clinical study was conducted in 11 hospitals in China from May to December 2012.A total of 446 pregnant women who gave birth in the hands-and-knees position were assigned into the experimental group,and 440 women who gave birth in the supine position were classified into the control group.Episiotomy rate was evaluated as the primary outcome,and perineum laceration degree was considered the secondary outcome.Results:Women in the experimental group achieved lower rates of episiotomy and higher rates of intact perineum and first-degree perineum lacerations compared with those in the control.Postpartum bleeding amount,neonatal asphyxia,and APGAR scores at 1 and 5 min were not significantly different between the two groups.Conclusions:This study proves that women who delivered in the hands-and-knees position achieved low rates of episiotomy and intact perineum.Moreover,the rates of neonatal asphyxia and postpartum bleeding did not increase.Pregnant patients who prefer to adopt the hands-and-knees position should be assisted in assuming such position during delivery.展开更多
A simple procedure to plan, verify and implement craniospinal irradiation（CSI） with patients supine is presented. Treatment is conducted with a single posterior spinal field abutting two lateral cranial fields. The ...A simple procedure to plan, verify and implement craniospinal irradiation（CSI） with patients supine is presented. Treatment is conducted with a single posterior spinal field abutting two lateral cranial fields. The opposed lateral fields are half-blocked and the inferior line is perpendicular. The posterior field uses some fixed field parameters so that the cephalad edge of the posterior field is coplanar with the caudal edges of the lateral fields and it is independent of the height of the couch. A steel-shot ball is used to measure the size of overlap or gap at the junction using portal images of an electron portal image device or portal films. The results of analyzing the portal images show that the errors of the junction are within ± 1 mm. The dose-volume histograms （DVHs）show that there are not unbearable hot or cold spots in the clinic target volumes （CTVs）. Supine craniospinal treatment is a reliable and convenient alternative to treatment in the prone position and avoids the technical difficulties of the latter. The use of fixed field geometry greatly facilitates treatment planning and effectively reduces the amount of time of setup, verification and treatment.展开更多
AIM:To identify a hypothesis on:Supine sleep,sudden infant death syndrome(SIDS) reduction and association with increasing autism incidence.METHODS:Literature was searched for autism spectrum disorder incidence time tr...AIM:To identify a hypothesis on:Supine sleep,sudden infant death syndrome(SIDS) reduction and association with increasing autism incidence.METHODS:Literature was searched for autism spectrum disorder incidence time trends,with correlation of change-points matching supine sleep campaigns.A mechanistic model expanding the hypothesis was constructed based on further review of epidemiological and other literature on autism.RESULTS:In five countries(Denmark,United Kingdom,Australia,Israel,United States) with published time trends of autism,change-points coinciding with supine sleep campaigns were identified.The model proposes that supine sleep does not directly cause autism,but increases the likelihood of expression of a subset of autistic criteria in individuals with genetic susceptibility,thereby specifically increasing the incidence of autism without intellectual disability.CONCLUSION:Supine sleep is likely a physiological stressor,that does reduce SIDS,but at the cost of impact on emotional and social development in the population,a portion of which will be susceptible to,and consequently express autism.A re-evaluation of all benefits and harms of supine sleep is warranted.If the SIDS mechanism proposed and autism model presented can be verified,the research agenda may be better directed,in order to further decrease SIDS,and reduce autism incidence.展开更多
Background: The concentration of supplemental O2 should be measured during general anesthesia to determine whether patients’ pressure of arterial oxygen (PaO2) is correct. Nevertheless, we do not know standard value ...Background: The concentration of supplemental O2 should be measured during general anesthesia to determine whether patients’ pressure of arterial oxygen (PaO2) is correct. Nevertheless, we do not know standard value of PaO2 by age in supine position during general anesthesia. In this study, we evaluated the PaO2 by age at 33% or 40% O2 concentration. Materials and Methods: We retrospectively reviewed the anesthetic charts of 660 patients who were received general anesthesia from January 2001 to December 2013. Patients were divided into two groups by concentration of fraction of inspiratory oxygen: group at 33% or 40%. Second, patients aged 16 - 85 years were classified into 7 groups by age with each group covering one decade. Results: The PaO2 was 185.1 ± 19.2 mmHg (33%) and 209.8 ± 19.8 mmHg (40%) at age 16 - 25 years, 178.7 ± 23.6 mmHg (33%) and 202.7 ± 26.0 mmHg (40%) at age 26 - 35 years, 165.8 ± 30.6 mmHg (33%) and 188.9 ± 22.2 (40%) mmHg at age 36 - 45 years, 154.1 ± 22.8 mmHg (33%) and 181.8 ± 19.2 (40%) mmHg at age 46 - 55 years, 153.7 ± 21.7 mmHg (33%) and 177.5 ± 18.1 mmHg (40%) at age 56 - 65 years, 152.2 ± 24.5 mmHg and 171.0 ± 22.1 mmHg at age 66 - 75 years, and 154.6 ± 24.3 mmHg and 174.1 ± 20.2 mmHg at age 76 - 85 years. Conclusion: The PaO2 tended to decrease with age at both 33% and 40% O2 concentration.展开更多
Background: We investigated the differences between partial pressure of arterial carbon dioxide and end-tidal carbon dioxide (P(a-ET)CO2) with respect to the Broca-Katsura index (BKI), which is an obesity index, in ob...Background: We investigated the differences between partial pressure of arterial carbon dioxide and end-tidal carbon dioxide (P(a-ET)CO2) with respect to the Broca-Katsura index (BKI), which is an obesity index, in obese patients during general anesthesia. Materials and Methods: From January 2003 to December 2013, we studied 601 patients aged 16 years old or over undergoing general anesthesia. Patients had American Society of Anesthesiology physical status I and II and we reviewed their anesthetic charts. The P(a-ET)CO2 with respect to the BKI divided patients into two groups: 16 to 2 values between the two groups. Results: In patients aged 16 to 2 was 2.2 ± 3.1 mmHg at BKI 2 was 3.2 ± 4.1 mmHg at BKI 2 tends to increase in obese patients during general anesthesia with increasing BKI in patients aged 16 to < 65 years old.展开更多
Background: Anesthetists should measure the concentration of supplemental oxygen to determine whether patients’ partial pressure of arterial oxygen (PaO2) is correct during general anesthesia. However, the standard P...Background: Anesthetists should measure the concentration of supplemental oxygen to determine whether patients’ partial pressure of arterial oxygen (PaO2) is correct during general anesthesia. However, the standard PaO2 value in obese patients in the supine position is unknown. We evaluated the PaO2 with respect to the Broca-Katsura obesity index. Materials and Methods: From January 2001 to December 2013, we evaluated 472 patients aged ≥16 years old that underwent general anesthesia in the supine position. The anesthetic charts of 472 patients with an American Society of Anesthesiologists physical status of I or II were retrospectively reviewed to investigate the PaO2. Results: In patients aged 16 to 2 was 165.7 ± 25.6 mmHg at a Broca-Katsura index of 2 was 152.1 ± 23.8 mmHg at a Broca-Katsura index of 2 tended to decrease with age from 16 to 2 tended to decrease with age from 16 to <65 years at a Broca-Katsura index of 20% to <40%.展开更多
BACKGROUND Acute respiratory distress syndrome(ARDS)is an acute,diffuse,inflammatory lung injury.Previous studies have shown prone position ventilation(PPV)to be associated with improvement in oxygenation.However,its ...BACKGROUND Acute respiratory distress syndrome(ARDS)is an acute,diffuse,inflammatory lung injury.Previous studies have shown prone position ventilation(PPV)to be associated with improvement in oxygenation.However,its role in patients with ARDS caused by sepsis remains unknown.AIM To analyze the clinical effects of PPV in patients with ARDS caused by sepsis.METHODS One hundred and two patients with ARDS were identified and divided into a control group(n=55)and a PPV treatment group(n=47).Outcomes included oxygenation index,lung compliance(Cst)and platform pressure(Pplat),which were compared between the two groups after ventilation.Other outcomes included heart rate(HR),mean arterial pressure(MAP),central venous pressure(CVP),left ventricular ejection fraction(LVEF),the length of mechanical ventilation time and intensive care unit(ICU)stay,and levels of C-reactive protein(CRP),procalcitonin(PCT),and interleukin-6(IL-6)after ventilation.Finally,mortality rate was also compared between the two groups.RESULTS On the first day after ventilation,the oxygenation index and Cst were higher and Pplat level was lower in the PPV group than in the conventional treatment group(P<0.05).There were no significant differences in oxygenation index,Cst,and Pplat levels between the two groups on the 2^(nd),4^(th),and 7^(th) day after ventilation(P>0.05).There were no significant differences in HR,MAP,CVP,LVEF,duration of mechanical ventilation and ICU stay,and the levels of CRP,PCT,and IL-6 between the two groups on the first day after ventilation(all P>0.05).The mortality rates on days 28 and 90 in the PPV and control groups were 12.77% and 29.09%,and 25.53% and 45.45%,respectively(P<0.05).CONCLUSION PPV may improve respiratory mechanics indices and may also have mortality benefit in patients with ARDS caused by sepsis.Finally,PPV was not shown to cause any adverse effects on hemodynamics and inflammation indices.展开更多
Objectives:To compare operative times,safety,and effectiveness of percutaneous nephrolithotomy in the supine versus prone position.Materials and methods:An observational study of 100 patients was conducted in our inst...Objectives:To compare operative times,safety,and effectiveness of percutaneous nephrolithotomy in the supine versus prone position.Materials and methods:An observational study of 100 patients was conducted in our institution for 2years from 2018 to 2020 divided into 2 groups:50 patients underwent modified supine percutaneous nephrolithotomy(PCNL)and 50 patients underwent standard prone PCNL.The inclusion criteria included a renal calculus(calyx or pelvis)of any size for which PCNL was indicated and exclusion criteria were patients having contraindications for PCNL such as bleeding disorders,pregnancy,high risk,and co-morbid conditions.The measured data included operative time,number of punctures,stone-free rate,length of hospital stays,and rate of complications.Results:The 2 groups were comparable in mean age,male to female ratio,calculus size,number of punctures,residual calculi,and postoperative fever and pain.The mean difference of hemoglobin in the supine PCNL group was 0.37 g/dL whereas in the prone PCNL group it was 0.61 g/dL.The p value was significant at 0.043.The mean time to finish from initial postion was 72.24 minutes in supine PCNL and 88.12 minutes in prone PCNL.The p value was significant(p<0.001).The mean time before puncture was 20.92 minutes in the supine position and 31.84 minutes in the prone position.The p value was significant(p<0.001).The mean time from puncture to finish was 51.32 minutes in the supine position and 56.28 minutes in the prone position.The p value was significant(p<0.001).Conclusions:As observed from this study,supine PCNL is associated with a significantly reduced operating time when compared to conventional prone position PCNL procedures.The postoperative complications such as pain and fever were not significantly different.Hence,the supine PCNL is an equally effective modality for treatment of a renal calculus with benefits of simultaneous retrograde access and less operative time compared to the prone PCNL.展开更多
文摘The direct anterior approach to the hip has been suggested to have several advantages compared to previously popular approaches through its use of an intra-muscular and intra-nervous interval betweenthe tensor fasciae latae and sartorius muscles. Recent increased interest in tissue-sparing and minimallyinvasive arthroplasty has given rise to a sharp increase in the utilization of direct anterior total hip arthroplasty. A number of variations of the procedure have been described and several authors have published their experiences and feedback to successfully accomplishing this procedure. Additionally, improved understanding of relevant soft tissue constraints and anatomic variants has provided improved margin of safety for patients. The procedure may be performed using speciallydesigned instruments and a fracture table, however many authors have also described equally efficacious performance using a regular table and standard arthroplasty tools. The capacity to utilize fluoroscopy intraoperatively for component positioning is a valuable asset to the approach and can be of particular benefit for surgeons gaining familiarity. Proper management of patient and limb positioning are vital to reducing risk of intra-operative complications. An understanding of its limitations and challenges are also critical to safe employment. This review summarizes the key features of the direct anterior approach for total hip arthroplasty as an aid to improving the understanding of this important and effective method for modern hip replacement surgeons.
文摘Acute compartment syndrome(ACS) of the thigh following primary total hip arthroplasty(THA) is a highly uncommon complication and has not yet been reported before with regards to the anterior approach through the anterior supine interval. We present a case of a 69-year-old male patient with a history of stroke, who developed ACS of the thigh after elective THA while using therapeutic low molecular weight heparin as bridging for regular oral anticoagulation. ACS pathogenesis, diagnostic tools, treatment and relevant literature are discussed. The patient's ACS was recognized in time and treated by operative decompression with fasciotomy of the anterior compartment. Follow-up did not show any neurological deficit or soft-tissue damage.
文摘AIM： To investigate the difference in kappa angle between sitting and supine positions during laser-assisted in situ keratomileusis（LASIK）.·METHODS： A retrospective study was performed on395 eyes from 215 patients with myopia that received LASIK. Low, moderate, and high myopia groups were assigned according to diopters. The horizontal and vertical components of kappa angle in sitting position were measured before the operation, and in supine position during the operation. The data from the two positions were compared and the relationship between kappa angle and diopters were analyzed.· RESULTS： Two hundred and twenty-three eyes（56.5%） in sitting position and 343 eyes（86.8%） in supine position had positive kappa angles. There were no significant differences in horizontal and vertical components of kappa angle in the sitting position or horizontal components of kappa angle in the supine position between the three groups（P 〉0.05）. A significant difference in the vertical components of kappa angle in the supine position was seen in the three groups（P 〈0.01）. Differences in both horizontal and vertical components of kappa angles were significant between the sitting and supine positions. Positive correlations in both horizontal and vertical components of kappa angles（P 〈0.05） were found and vertical components of kappa angle in sitting and supine positions were negatively correlated with the degree of myopia（sitting position： r =-0.109; supine position： r =-0.172; P 〈0.05）.·CONCLUSION： There is a correlation in horizontal and vertical components of kappa angle in sitting and supine positions. Positive correlations in both horizontal and vertical components of kappa angle in sitting and supine positions till the end of the results. This result still needs further observation. Clinicians should take into account different postures when excimer laser surgery needs to be performed.
文摘目的观察颈椎牵引在不同加载质量和牵引角度时颈部肌肉表面肌电(electromyography,EMG)信号的变化特点,并与Any Body软件颈椎建模仿真所得的相关肌肉力活性变化特点进行对比,验证仿真结果的合理性。方法选取10例青年志愿者,行仰卧位颈椎牵引,JE-TB0810表面肌电仪测试颈部双侧胸锁乳突肌、斜方肌上部EMG信号,利用平均肌电值(average EMG,AEMG)和平均功率频率(mean power frequency,MPF)分析颈部EMG信号的变化规律。结果斜方肌上部和胸锁乳突肌AEMG均随着加载质量和牵引角度的增大而增大,差异均具有统计学意义(P<0.05),斜方肌上部AEMG较胸锁乳突肌高,差异有统计学意义(P<0.05);2对肌肉在不同牵引角度和加载质量下MPF比较,差异无统计学意义(P>0.05);实验结果与颈椎牵引建模仿真所得斜方肌上部和胸锁乳突肌肌肉力活性特点相符。结论仿真结果具有一定的合理性,临床上可根据颈部肌肉的兴奋程度和疲劳时间合理施加牵引重量,既达到治疗效果,也提高患者的舒适性,为颈椎牵引设备的进一步研制和改进提供重要参考。
文摘目的系统评价改良仰卧位下行经皮肾镜碎石取石术(PCNL)的安全性和有效性。方法检索Pub Med,Web of Science,中国生物医学文献服务系统,中国期刊全文数据库及万方电子期刊全文数据库,按照纳入和排除标准筛选关于改良仰卧位与俯卧位PCNL的临床对照研究,提取纳入研究中关于手术时间、住院时间、结石清除率及围手术期并发症发生率的数据并进行Meta分析。结果最终纳入18项研究,共2696个病例,Meta分析显示改良仰卧位组的手术时间较俯卧位组缩短(WMD=-19.24,95%CI:-29.09^-9.39,P<0.01),两组在住院时间(WMD=-0.81,95%CI:-0.85~0.41,P=0.59)、结石清除率(OR=0.95,95%CI:0.76~1.19,P=0.65)和围手术期并发症发生率(OR=0.77,95%CI:0.59~1.01,P=0.06)方面差异无统计学意义。结论改良仰卧位行PCNL安全有效,可缩短手术时间,值得推广应用。
基金Supported by Key Research and Development Project of Zhejiang Province of China(No.2020C01058)Medical Science and Technology Project of Zhejiang Province(No.2022PY038,No.2023KY493).
文摘AIM:To describe the clinical and radiologic features of retrolaminar migration silicone oil(SiO)and observe the dynamic position of ventricular oil accumulation in supine and prone.METHODS:For this retrospective study,29 patients who had a history of SiO injection treatment and underwent unenhanced head computed tomography(CT)were included from January 2019 to October 2022.The patients were divided into migration-positive and negative groups.Clinical history and CT features were compared using Whitney U and Fisher’s exact tests.The dynamic position of SiO was observed within the ventricular system in supine and prone.CT images were visually assessed for SiO migration along the retrolaminar involving pathways for vision(optic nerve,chiasm,and tract)and ventricular system.RESULTS:Intraocular SiO migration was found in 5 of the 29 patients(17.24%),with SiO at the optic nerve head(n=1),optic nerve(n=4),optic chiasm(n=1),optic tract(n=1),and within lateral ventricles(n=1).The time interval between SiO injection and CT examination of migration-positive cases was significantly higher than that of migration-negative patients(22.8±16.5mo vs 13.1±2.6mo,P<0.001).The hyperdense lesion located in the frontal horns of the right lateral ventricle migrated to the fourth ventricle when changing the position from supine to prone.CONCLUSION:Although SiO retrolaminar migration is unusual,the clinician and radiologist should be aware of migration routes.The supine combined with prone examination is the first-choice method to confirm the presence of SiO in the ventricular system.
文摘Background:The supine position is the most common birth position adopted in China,but the World Health Organization recommends non-supine positions for delivery.The handsand-knees position shows several advantages,such as wide pelvic diameter and easy fetal rotation during delivery.Small trials conducted in China in 2011 revealed that the handsand-knees position resulted in improved maternal and neonate outcomes than those in the supine position.However,a comprehensive study must be conducted before the handsand-knees position can be introduced into clinical practice.Hence,we conducted this multicenter trial to comprehensively examine the benefits of the hands-and-knees position over the supine position during delivery.Methods:Our clinical study was conducted in 11 hospitals in China from May to December 2012.A total of 446 pregnant women who gave birth in the hands-and-knees position were assigned into the experimental group,and 440 women who gave birth in the supine position were classified into the control group.Episiotomy rate was evaluated as the primary outcome,and perineum laceration degree was considered the secondary outcome.Results:Women in the experimental group achieved lower rates of episiotomy and higher rates of intact perineum and first-degree perineum lacerations compared with those in the control.Postpartum bleeding amount,neonatal asphyxia,and APGAR scores at 1 and 5 min were not significantly different between the two groups.Conclusions:This study proves that women who delivered in the hands-and-knees position achieved low rates of episiotomy and intact perineum.Moreover,the rates of neonatal asphyxia and postpartum bleeding did not increase.Pregnant patients who prefer to adopt the hands-and-knees position should be assisted in assuming such position during delivery.
文摘A simple procedure to plan, verify and implement craniospinal irradiation（CSI） with patients supine is presented. Treatment is conducted with a single posterior spinal field abutting two lateral cranial fields. The opposed lateral fields are half-blocked and the inferior line is perpendicular. The posterior field uses some fixed field parameters so that the cephalad edge of the posterior field is coplanar with the caudal edges of the lateral fields and it is independent of the height of the couch. A steel-shot ball is used to measure the size of overlap or gap at the junction using portal images of an electron portal image device or portal films. The results of analyzing the portal images show that the errors of the junction are within ± 1 mm. The dose-volume histograms （DVHs）show that there are not unbearable hot or cold spots in the clinic target volumes （CTVs）. Supine craniospinal treatment is a reliable and convenient alternative to treatment in the prone position and avoids the technical difficulties of the latter. The use of fixed field geometry greatly facilitates treatment planning and effectively reduces the amount of time of setup, verification and treatment.
文摘AIM:To identify a hypothesis on:Supine sleep,sudden infant death syndrome(SIDS) reduction and association with increasing autism incidence.METHODS:Literature was searched for autism spectrum disorder incidence time trends,with correlation of change-points matching supine sleep campaigns.A mechanistic model expanding the hypothesis was constructed based on further review of epidemiological and other literature on autism.RESULTS:In five countries(Denmark,United Kingdom,Australia,Israel,United States) with published time trends of autism,change-points coinciding with supine sleep campaigns were identified.The model proposes that supine sleep does not directly cause autism,but increases the likelihood of expression of a subset of autistic criteria in individuals with genetic susceptibility,thereby specifically increasing the incidence of autism without intellectual disability.CONCLUSION:Supine sleep is likely a physiological stressor,that does reduce SIDS,but at the cost of impact on emotional and social development in the population,a portion of which will be susceptible to,and consequently express autism.A re-evaluation of all benefits and harms of supine sleep is warranted.If the SIDS mechanism proposed and autism model presented can be verified,the research agenda may be better directed,in order to further decrease SIDS,and reduce autism incidence.
文摘Background: The concentration of supplemental O2 should be measured during general anesthesia to determine whether patients’ pressure of arterial oxygen (PaO2) is correct. Nevertheless, we do not know standard value of PaO2 by age in supine position during general anesthesia. In this study, we evaluated the PaO2 by age at 33% or 40% O2 concentration. Materials and Methods: We retrospectively reviewed the anesthetic charts of 660 patients who were received general anesthesia from January 2001 to December 2013. Patients were divided into two groups by concentration of fraction of inspiratory oxygen: group at 33% or 40%. Second, patients aged 16 - 85 years were classified into 7 groups by age with each group covering one decade. Results: The PaO2 was 185.1 ± 19.2 mmHg (33%) and 209.8 ± 19.8 mmHg (40%) at age 16 - 25 years, 178.7 ± 23.6 mmHg (33%) and 202.7 ± 26.0 mmHg (40%) at age 26 - 35 years, 165.8 ± 30.6 mmHg (33%) and 188.9 ± 22.2 (40%) mmHg at age 36 - 45 years, 154.1 ± 22.8 mmHg (33%) and 181.8 ± 19.2 (40%) mmHg at age 46 - 55 years, 153.7 ± 21.7 mmHg (33%) and 177.5 ± 18.1 mmHg (40%) at age 56 - 65 years, 152.2 ± 24.5 mmHg and 171.0 ± 22.1 mmHg at age 66 - 75 years, and 154.6 ± 24.3 mmHg and 174.1 ± 20.2 mmHg at age 76 - 85 years. Conclusion: The PaO2 tended to decrease with age at both 33% and 40% O2 concentration.
文摘Background: We investigated the differences between partial pressure of arterial carbon dioxide and end-tidal carbon dioxide (P(a-ET)CO2) with respect to the Broca-Katsura index (BKI), which is an obesity index, in obese patients during general anesthesia. Materials and Methods: From January 2003 to December 2013, we studied 601 patients aged 16 years old or over undergoing general anesthesia. Patients had American Society of Anesthesiology physical status I and II and we reviewed their anesthetic charts. The P(a-ET)CO2 with respect to the BKI divided patients into two groups: 16 to 2 values between the two groups. Results: In patients aged 16 to 2 was 2.2 ± 3.1 mmHg at BKI 2 was 3.2 ± 4.1 mmHg at BKI 2 tends to increase in obese patients during general anesthesia with increasing BKI in patients aged 16 to < 65 years old.
文摘Background: Anesthetists should measure the concentration of supplemental oxygen to determine whether patients’ partial pressure of arterial oxygen (PaO2) is correct during general anesthesia. However, the standard PaO2 value in obese patients in the supine position is unknown. We evaluated the PaO2 with respect to the Broca-Katsura obesity index. Materials and Methods: From January 2001 to December 2013, we evaluated 472 patients aged ≥16 years old that underwent general anesthesia in the supine position. The anesthetic charts of 472 patients with an American Society of Anesthesiologists physical status of I or II were retrospectively reviewed to investigate the PaO2. Results: In patients aged 16 to 2 was 165.7 ± 25.6 mmHg at a Broca-Katsura index of 2 was 152.1 ± 23.8 mmHg at a Broca-Katsura index of 2 tended to decrease with age from 16 to 2 tended to decrease with age from 16 to <65 years at a Broca-Katsura index of 20% to <40%.
基金Supported by Science and Technology Plan of Jiangxi Provincial Health Commission,No.202130095.
文摘BACKGROUND Acute respiratory distress syndrome(ARDS)is an acute,diffuse,inflammatory lung injury.Previous studies have shown prone position ventilation(PPV)to be associated with improvement in oxygenation.However,its role in patients with ARDS caused by sepsis remains unknown.AIM To analyze the clinical effects of PPV in patients with ARDS caused by sepsis.METHODS One hundred and two patients with ARDS were identified and divided into a control group(n=55)and a PPV treatment group(n=47).Outcomes included oxygenation index,lung compliance(Cst)and platform pressure(Pplat),which were compared between the two groups after ventilation.Other outcomes included heart rate(HR),mean arterial pressure(MAP),central venous pressure(CVP),left ventricular ejection fraction(LVEF),the length of mechanical ventilation time and intensive care unit(ICU)stay,and levels of C-reactive protein(CRP),procalcitonin(PCT),and interleukin-6(IL-6)after ventilation.Finally,mortality rate was also compared between the two groups.RESULTS On the first day after ventilation,the oxygenation index and Cst were higher and Pplat level was lower in the PPV group than in the conventional treatment group(P<0.05).There were no significant differences in oxygenation index,Cst,and Pplat levels between the two groups on the 2^(nd),4^(th),and 7^(th) day after ventilation(P>0.05).There were no significant differences in HR,MAP,CVP,LVEF,duration of mechanical ventilation and ICU stay,and the levels of CRP,PCT,and IL-6 between the two groups on the first day after ventilation(all P>0.05).The mortality rates on days 28 and 90 in the PPV and control groups were 12.77% and 29.09%,and 25.53% and 45.45%,respectively(P<0.05).CONCLUSION PPV may improve respiratory mechanics indices and may also have mortality benefit in patients with ARDS caused by sepsis.Finally,PPV was not shown to cause any adverse effects on hemodynamics and inflammation indices.
文摘Objectives:To compare operative times,safety,and effectiveness of percutaneous nephrolithotomy in the supine versus prone position.Materials and methods:An observational study of 100 patients was conducted in our institution for 2years from 2018 to 2020 divided into 2 groups:50 patients underwent modified supine percutaneous nephrolithotomy(PCNL)and 50 patients underwent standard prone PCNL.The inclusion criteria included a renal calculus(calyx or pelvis)of any size for which PCNL was indicated and exclusion criteria were patients having contraindications for PCNL such as bleeding disorders,pregnancy,high risk,and co-morbid conditions.The measured data included operative time,number of punctures,stone-free rate,length of hospital stays,and rate of complications.Results:The 2 groups were comparable in mean age,male to female ratio,calculus size,number of punctures,residual calculi,and postoperative fever and pain.The mean difference of hemoglobin in the supine PCNL group was 0.37 g/dL whereas in the prone PCNL group it was 0.61 g/dL.The p value was significant at 0.043.The mean time to finish from initial postion was 72.24 minutes in supine PCNL and 88.12 minutes in prone PCNL.The p value was significant(p<0.001).The mean time before puncture was 20.92 minutes in the supine position and 31.84 minutes in the prone position.The p value was significant(p<0.001).The mean time from puncture to finish was 51.32 minutes in the supine position and 56.28 minutes in the prone position.The p value was significant(p<0.001).Conclusions:As observed from this study,supine PCNL is associated with a significantly reduced operating time when compared to conventional prone position PCNL procedures.The postoperative complications such as pain and fever were not significantly different.Hence,the supine PCNL is an equally effective modality for treatment of a renal calculus with benefits of simultaneous retrograde access and less operative time compared to the prone PCNL.
