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1.
Bone Joint J ; 101-B(11): 1348-1355, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31674253

RESUMO

AIMS: A retrospective study was conducted to measure short-term in vivo linear and volumetric wear of polyethylene (PE) inserts in 101 total knee arthroplasty (TKA) patients using model-based radiostereometric analysis (MBRSA). PATIENTS AND METHODS: Nonweightbearing supine RSA exams were performed postoperatively and at six, 12, and 24 months. Weightbearing standing RSA exams were performed on select patients at 12 and 24 months. Wear was measured both linearly (joint space) and volumetrically (digital model overlap) at each available follow-up. Precision of both methods was assessed by comparing double RSA exams. Patient age, sex, body mass index, and Oxford Knee Scores were analyzed for any association with PE wear. RESULTS: Linear wear occurred at 0.015 mm/year (supine) and 0.220 mm/year (standing). Volumetric wear occurred at 10.3 mm3/year (supine) and 39.3 mm3/year (standing). Wear occurred primarily on the medial side of the joint. Weightbearing imaging greatly improved the reliability of measurement. Clinical precision of volumetric wear was 34 mm3. No significant associations were found between patient demographics or function scores and measured wear. CONCLUSION: In vivo volumetric wear of TKAs can be assessed at short-term follow-up using MBRSA. Cite this article: Bone Joint J 2019;101-B:1348-1355.


Assuntos
Artroplastia do Joelho/normas , Prótese do Joelho/normas , Falha de Prótese , Artroplastia do Joelho/instrumentação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Desenho de Prótese , Análise Radioestereométrica , Estudos Retrospectivos , Posição Ortostática , Decúbito Dorsal
2.
Sheng Wu Yi Xue Gong Cheng Xue Za Zhi ; 36(5): 777-784, 2019 Oct 25.
Artigo em Chinês | MEDLINE | ID: mdl-31631626

RESUMO

The tilted supine position has been evaluated to be one of the significantly effective approaches to prevent bedsore of the patients in the bedridden state. Thus, it has deeply positive influences that in view of dynamics this study explores how the position works. Based on the anatomical theories, this study formulates the human dynamic model. Furthermore, the dynamic simulation of three usual postures in tilted supine position including lying on back, lying with one knee bent and lying with the upper and lower limb on one side lifted is carried out. Therefore, the changes of the three driving forces named as chest force, waist force and thigh force in the tilted supine position can be observed. In order to verify the validity of this simulation, this study obtains the electromyogram measurements of ectopectoralis, external obliques and thigh muscles which are respectively close to the chest, waist and thigh by conducting the human force measurements experiment. The result revealed that in terms of range and trend, the experimental data and simulation's data were consistent. In conclusion, the changes of these muscles in the supine position movements are researched efficiently by both this experiment and the dynamic simulation. Besides, the result is crucially key to find the mechanism of human's tilted supine position movements.


Assuntos
Modelos Anatômicos , Movimento , Postura , Decúbito Dorsal , Fenômenos Biomecânicos , Eletromiografia , Humanos , Músculo Esquelético/fisiologia
3.
Int Braz J Urol ; 45(5): 956-964, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31408287

RESUMO

PURPOSE: We aimed to compare the outcomes of supine and prone miniaturized percutaneous nephrolithotomy (m-PNL) in the treatment of lower pole, middle pole and renal pelvic stones. MATERIALS AND METHODS: 54 patients who performed supine m-PNL between January 2017 and March 2018 and 498 patients who performed prone m-PNL between April 2015 and January 2018 were included in the study. Of the 498 patients, 108 matching 1: 2 in terms of age, gender, body mass index, American Association of Anesthesiology score, stone size, stone localization and hydronephrosis according to the supine m-PNL group were selected as prone m-PNL group. The patients with solitary kidney, upper pole stone, urinary system anomaly or skeletal malformation and pediatric patients (<18 years old) were excluded from the study. The success was defined as 'complete stone clearance' and was determined according to the 1st month computed tomography. RESULTS: The operation time and fluoroscopy time in supine m-PNL was significantly shorter than prone m-PNL group (58.1±45.9 vs. 80.1±40.0 min and 3.0±1.7 min vs. 4.9±4.5 min, p=0.025 and p=0.01, respectively). When post-operative complications were compared according to the modified Clavien-Dindo classification, overall and subgroup complication rates were comparable between groups. There was no significant difference between the groups in terms of the success rates (supine m-PNL; 72.2%, prone m-PNL; 71.3%, p=0.902). CONCLUSIONS: Supine m-PNL procedure is more advantageous in terms of operation time and fluoroscopy time in the treatment of lower pole, middle pole and renal pelvic stones.


Assuntos
Cálculos Renais/cirurgia , Nefrolitotomia Percutânea/métodos , Posicionamento do Paciente/métodos , Decúbito Ventral , Decúbito Dorsal , Adulto , Feminino , Fluoroscopia/métodos , Humanos , Cálculos Renais/patologia , Pelve Renal/cirurgia , Masculino , Análise por Pareamento , Pessoa de Meia-Idade , Duração da Cirurgia , Reprodutibilidade dos Testes , Estatísticas não Paramétricas , Resultado do Tratamento
4.
S D Med ; 72(8): 349-353, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31465639

RESUMO

INTRODUCTION: Safe sleep recommendations for infants have been evolving over the past three decades. It has been shown that physicians' recommendations strongly influence parents' choice of infant sleep position. However, the proportion of physicians and/or nurses giving infant sleep advice to parents is reportedly low. METHODS: A survey was conducted in South Dakota to evaluate pediatricians' and family practitioners' knowledge of safe sleep recommendations for infants. Survey questions assessed their beliefs regarding risk factors for sudden infant death syndrome (SIDS) and their recommendations for safe sleep environments provided to parents/caregivers. RESULTS: Among the respondents, 98 percent felt that it is important to discuss SIDS with every parent and 80 percent of them indicated a need within their profession to have further information on the topic of SIDS. However, 31 percent of physicians with 16 years or more since training and 64.5 percent of those with less than 16 years since training did provide safe sleep advice to parents and caregivers. CONCLUSIONS: Despite the knowledge of SIDS risk factors, gaps were seen in dissemination of information regarding all risk factors to parents. While sleep position, postnatal exposures and breast feeding were more likely to be addressed, other elements of a safe sleep environment such as bedding surface, bed sharing, pacifier use and room ventilation were less likely to be covered. These findings indicate the need for improved health care provider education/communication in South Dakota.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Pediatras/psicologia , Guias de Prática Clínica como Assunto , Morte Súbita do Lactente , Leitos , Humanos , Lactente , Pediatras/normas , Fatores de Risco , Sono , South Dakota , Decúbito Dorsal
5.
Braz J Cardiovasc Surg ; 34(3): 305-310, 2019 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-31310469

RESUMO

OBJECTIVE: The aim of the present study was to investigate the acute response to aerobic exercise on autonomic cardiac control of patients undergoing coronary artery bypass grafting (CABG). METHODS: The study sample consisted of eight patients (age: 58.6±7.7 years; body mass index: 26.7±3.5 kg.m2) who underwent a successful CABG (no complications during surgery and/or in the following weeks). To assess heart rate variability (HRV), participants remained in a supine position with a 30-degree head elevation for 20 minutes. Electrocardiographic signal (protocol with three derivations) was collected from 600 Hz sample rate to obtain beat-to-beat intervals (R-R interval). This assessment was performed before, after one hour and after 24 hours of the exercise session. All patients underwent a 35 minutes aerobic exercise session (AES) (low-moderate intensity) on the cycle ergometer. RESULTS: Significant differences were found in the time domain, with positive changes in root mean square of successive RR interval differences (rMSSD) (ms) (parasympathetic component) (one [P=0.017] and 24 hours [P=0.007] post-session). In the frequency domain, we found a significant difference in high frequency (HF) (ms2) (parasympathetic component) (one hour [P=0.048] post-session). The low frequency (LF)/HF ratio (sympathetic and parasympathetic components with a predominance of the sympathetic component) reached statistical significance only 24 hours (P=0.018) post-session. Additionally, the largest effect size was observed only for the LF/HF ratio at one (d=-0.8) and 24 hours (d=-1.3) after one AES. CONCLUSION: The practice of (acute) aerobic exercise improved autonomic cardiac control in patients undergoing CABG.


Assuntos
Sistema Nervoso Autônomo/fisiopatologia , Reabilitação Cardíaca/métodos , Ponte de Artéria Coronária/reabilitação , Terapia por Exercício/métodos , Exercício/fisiologia , Frequência Cardíaca/fisiologia , Idoso , Análise de Variância , Índice de Massa Corporal , Eletrocardiografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valores de Referência , Reprodutibilidade dos Testes , Estatísticas não Paramétricas , Decúbito Dorsal/fisiologia , Fatores de Tempo , Resultado do Tratamento
6.
Int J Sports Med ; 40(8): 519-527, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31288291

RESUMO

This case study reports the training of an elite 25-km open-water swimmer and the daily heart rate variability (HRV) changes during the 19-week period leading to his world champion title. Training load was collected every day and resting HRV was recorded every morning. The swimmer's characteristics were V̇O2max: 58.5 ml·min-1·kg-1, maximal heart rate: 178 beats per minute, and maximal ventilation: 170 L·min-1. Weekly training volume was 85±21 km, 39±8% was at [La]b<2 mmol · L-1 (Z1), 53±8% was at [La]b 2-4 mmol·L-1 (Z2), and 8±4% was at [La]b>4 mmol·L-1 (Z3). In the supine position, the increase in training volume and Z2 training were related to increases in rMSSD and HF. In the standing position, an increase in parasympathetic activity and decrease in sympathetic activity were observed when Z1 training increased. Seasonal changes indicated higher values in the LF/HF ratio during taper, whereas higher values in parasympathetic indices were observed in heavy workload periods. This study reports extreme load of an elite ultra-endurance swimmer. Improvements in parasympathetic indices with increasing Z2 volume indicate that this training zone was useful to improve cardiac autonomic activity, whereas Z1 training reduced sympathetic activity.


Assuntos
Frequência Cardíaca , Condicionamento Físico Humano/métodos , Resistência Física/fisiologia , Natação/fisiologia , Humanos , Ácido Láctico/sangue , Masculino , Consumo de Oxigênio , Sistema Nervoso Parassimpático/fisiologia , Taxa Respiratória , Posição Ortostática , Decúbito Dorsal , Sistema Nervoso Simpático/fisiologia , Adulto Jovem
7.
Eur J Radiol ; 117: 95-101, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31307659

RESUMO

PURPOSE: To compare utility of supine Magnetic Resonance Defecography (MRD) with upright Voiding Cystourethrogram (VCUG) for evaluation of cystocele and urethral hypermobility (UHM). METHODS: This was an IRB-approved, HIPAA-compliant, retrospective study of 51 consecutive patients with symptomatic pelvic organ prolapse (POP) and lower urinary tract symptoms who underwent both upright VCUG and supine MRD. Cystocele height was defined in centimeters with reference to the inferior edge of the pubic bone on VCUG and the pubococcygeal line on MRD. Urethral angle at rest (UAR) and during straining (UAS) was measured in degrees between the urethral axis and a vertical line at the external meatus. Pairedt-test and simple linear regression were applied to compare VCUG and MRD data sets. p < 0.05 was considered significant. RESULTS: The mean cystocele extent was 1.58 cm lower (more inferior to the reference point) (95% CI for the mean difference: 1.21, 1.94;p < 0.0001) on MRD (-2.73 ± 1.99 cm) than on VCUG (-1.16 ± 1.75 cm). Mean UAS on MRD (72.29 ± 26.45) was 31.8 degrees higher compared to that on VCUG (40.45 ± 21.41), (95% CI for mean difference in UAS: 37.57, 26.11; p < 0.0001). Mean UAS-UAR on MRD (74.30 ± 28.50) was 58.6 degrees higher compared to that on VCUG (15.70 ± 11.27) (95% CI for mean difference in UAS-UAR 65.94, 51.26; p < 0.0001). Cystocele size was upgraded in 22 (43.3%) patients on MRD compared to VCUG. Five (9.8%) patients demonstrated UHM on VCUG; 48 (94.1%) patients demonstrated UHM on MRD. The differences between VCUG and MRD scores persisted across the range of VCUG measurements. Cystocele size was significantly larger in POP (+) patients than in POP (-) patients on MRD (p = 0.005) but not on VCUG (p = 0.06). CONCLUSIONS: Supine MRD demonstrates significantly higher prevalence and degree of cystocele and UHM than upright VCUG, and alters the grade of bladder prolapse in a significant portion of the patient population. Cystocele size on MRD correlates with clinical presence of prolapse symptoms.


Assuntos
Cistografia , Defecografia , Espectroscopia de Ressonância Magnética , Prolapso de Órgão Pélvico/diagnóstico por imagem , Doenças Uretrais/diagnóstico por imagem , Feminino , Humanos , Pessoa de Meia-Idade , Prolapso de Órgão Pélvico/fisiopatologia , Estudos Retrospectivos , Posição Ortostática , Decúbito Dorsal , Doenças Uretrais/fisiopatologia
8.
Urol Clin North Am ; 46(3): 409-417, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31277735

RESUMO

Retroperitoneal lymph node dissection (RPLND) is complex; however, recent advances in technology have allowed adoption of the robotic platform for highly select cases. Initial case series have shown improved cosmesis, less blood loss, and decreased length of stay compared with open RPLND. Our preference for performing robotic RPLND is via a transperitoneal approach with the patient in the supine position, thus facilitating a bilateral template dissection identical to that used in all our open procedures. Robotic RPLND should mimic the open approach with regard to oncologic principles and should only be performed by clinicians well versed in open RPLND.


Assuntos
Procedimentos Cirúrgicos Robóticos , Neoplasias Testiculares/cirurgia , Competência Clínica , Medicina Baseada em Evidências , Humanos , Excisão de Linfonodo/métodos , Masculino , Espaço Retroperitoneal/patologia , Decúbito Dorsal , Neoplasias Testiculares/patologia
9.
J Stroke Cerebrovasc Dis ; 28(9): 2580-2584, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31239221

RESUMO

BACKGROUND: Pulse wave velocity is commonly regarded as the most effective and noninvasive indicator for evaluating arterial stiffness, while increased arterial stiffness is known to be related to atherosclerosis, which has been proved to play a significant role on the onset of acute ischemic stroke. However, it is still only used in the assessment of central and peripheral arteries. Our previous studies have found that carotid-cerebral pulse wave velocity measured using transcranial Doppler may be a promising method for the assessment of human cerebral arterial stiffness. This trial was designed to examine the association between carotid-cerebral pulse wave velocity and acute ischemic stroke. METHODS: In a single-center, single-arm, prospective clinical trial, patients with acute ischemic stroke who had anterior circulation infarcts confirmed by magnetic resonance imaging are eligible to receive measurement of carotid-cerebral pulse wave velocity, which is measured in the supine position with transcranial Doppler that using 2-MHz and 4-MHz ultrasound probes by 2 experienced operators. Subjects will be received follow-up for 1 year. Vascular and nonvascular death at follow-up will be assessed as primary outcomes. Secondary outcomes include intracerebral hemorrhage, subarachnoid hemorrhage, transient ischemic attack, recurrence or aggravation of ischemic stroke. CONCLUSION: This trial will be the first to evaluate carotid-cerebral pulse wave velocity in patients with acute ischemic stroke using transcranial Doppler. The results may provide more valuable theoretical basis for the prevention, treatment, and prognosis of acute ischemic stroke.


Assuntos
Isquemia Encefálica/diagnóstico por imagem , Artéria Carótida Primitiva/diagnóstico por imagem , Artéria Cerebral Média/diagnóstico por imagem , Análise de Onda de Pulso/métodos , Acidente Vascular Cerebral/diagnóstico por imagem , Ultrassonografia Doppler Transcraniana/métodos , Rigidez Vascular , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Isquemia Encefálica/fisiopatologia , Artéria Carótida Primitiva/fisiopatologia , China , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Artéria Cerebral Média/fisiopatologia , Posicionamento do Paciente/métodos , Valor Preditivo dos Testes , Estudos Prospectivos , Acidente Vascular Cerebral/fisiopatologia , Decúbito Dorsal , Adulto Jovem
10.
HNO ; 67(9): 679-684, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31165199

RESUMO

BACKGROUND: The severity of position-dependent obstructive sleep apnea (POSA) depends on the nonsupine and supine apnea-hypopnea index (AHI) as well as the time spent in supine position. The latter in particular is susceptible to variation. Several small-scale studies suggest that wearing polysomnography (PSG) apparatus leads to an increase in supine sleeping position. OBJECTIVES: The aim of this study was to evaluate the effect of wearing PSG apparatus on sleeping position and on OSA severity. MATERIAL AND METHODS: A large-scale, retrospective study was performed, including a consecutive series of POSA and non-apneic snoring patients who were prescribed positional therapy (Sleep Position Trainer [SPT]). The effect of wearing PSG apparatus on sleeping position was evaluated by comparing body position during the PSG night and inactive (diagnostic) phase of SPT. RESULTS: The mean percentage of total recording time (TRT) in supine position was 43.1% during the PSG night phase compared with 28.6% of TRT during the inactive (diagnostic) phase of SPT; i.e., a significant decrease of 33.6% (p < 0.001). When adjusting the AHI using TRT in different sleeping positions measured with the SPT, the median AHI decreased from 13.3/h (9.0-20.4) to 10.3/h (6.8-16.2); p < 0.001. When using the adjusted AHI, 33% (N = 66) of all patients had a change in OSA severity. CONCLUSIONS: The results of this study indicate that wearing PSG apparatus leads to an increase in the percentage of supine sleeping position causing an overestimation of OSA severity, especially in patients with POSA. This can have significant impact on both clinical and scientific practice.


Assuntos
Apneia Obstrutiva do Sono , Ronco , Decúbito Dorsal , Humanos , Polissonografia , Estudos Retrospectivos
11.
HNO ; 67(9): 663-669, 2019 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-31190192

RESUMO

BACKGROUND: Many patients suffer from positional obstructive sleep apnea (POSA; 56%). In these cases, positional therapy may be an option. A sleep position trainer (SPT) is a small vibrating device that trains the patient to avoid sleeping in the supine position. This study aimed to compare the efficacy and tolerance of gradual and intensive training onset in POSA patients MATERIALS AND METHODS: Patients with mild to moderate POSA and incompliance with continuous positive airway pressure (CPAP) therapy were included in this prospective double-blind trail. Patients were randomized according to how training was initiated and the SPT was set to either a gradual or an intensive training program. Polygraphy was used to check respiratory parameters after 1 month, and subjective parameters and compliance were assessed prior to and after this time period using a questionnaire. RESULTS: A total of 38 patients were included (20 intensive; 18 gradual; 49 ± 13 years) of whom 31 completed the study protocol. After 1 month the apnea-hypopnea index (AHI) in both groups was significantly reduced, but there was no difference in AHI between the two training modalities (AHI intensive: 16.7 ± 6.3/h to 4.2 ± 3.2/h; AHI gradual: 18.9 ± 11.2/h to 8.4 ± 7.9/h). The same effect was observed for subjective sleepiness. CONCLUSION: The objective severity of OSA and the associated subjective daytime sleepiness was reduced in both groups. There was no difference in terms of clinical outcome or compliance between the gradual or intensive SPT therapy in POSA patients during the observation period. Both training modalities are highly successful and well tolerated.


Assuntos
Apneia Obstrutiva do Sono , Decúbito Dorsal , Pressão Positiva Contínua nas Vias Aéreas , Método Duplo-Cego , Humanos , Estudos Prospectivos , Apneia Obstrutiva do Sono/terapia
12.
Undersea Hyperb Med ; 46(1): 7-16, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31154681

RESUMO

Purpose: This study examined the independent effects of cold-water submersion and a rehydration strategy on an aerobic endurance performance and orthostatic tolerance following a four-hour dive in cold water (10°C). Methods: Nine male subjects completed a control (CON) performance and lower-body negative pressure test (LBNP) and two water immersion visits with either no rehydration (NR) or a post-immersion rehydration (RH) with 1 L of water. Following submersion, subjects ran to exhaustion and submitted to LBNP. Results: Core body temperature declined during submersion and remained reduced from baseline until the run (P ⟨ 0.001) and was not different between NR and RH (P = 0.13). Total urine output during submersion was not different between groups (1.69 ± 0.49 (NR), 1.75 ± 0.52 (RH) L; P = 0.74) eliciting a body mass reduction of -2.2 ± 0.3 and -0.8 ±; 0.3% (P ⟨ 0.01), respectively. Run duration was not different (547 ± 141 (NR), 566 ± 152 (RH) s; P = 0.79); however, both NR and RH run duration was shorter compared to CON (722 ± 170 s; P = 0.04). Cumulative stress index was suppressed in NR (534 ± 163 mmHg*min) and RH (591 ± 129 mmHg*min) compared to CON (707 ± 170 mmHg*min, P V#8804; 0.03), with no differences between submersion trials (P = 0.23). Conclusion: Compared to a non-submersed state, run duration and orthostatic tolerance was reduced following a four-hour cold-water submersion. Rehydration with 1 L of water following submersion did not offer a performance advantage over no rehydration.


Assuntos
Temperatura Corporal/fisiologia , Temperatura Baixa/efeitos adversos , Hidratação/métodos , Imersão , Resistência Física/fisiologia , Corrida/fisiologia , Água , Análise de Variância , Pressão Sanguínea/fisiologia , Estudos Cross-Over , Água Potável , Eletrocardiografia , Frequência Cardíaca/fisiologia , Humanos , Pressão Negativa da Região Corporal Inferior , Masculino , Decúbito Dorsal/fisiologia , Síncope/diagnóstico , Fatores de Tempo , Micção , Urina , Perda de Peso , Adulto Jovem
13.
Fisioterapia (Madr., Ed. impr.) ; 41(3): 123-130, mayo-jun. 2019. ilus, graf, tab
Artigo em Espanhol | IBECS | ID: ibc-183087

RESUMO

Introducción: La cuantificación del rango de movimiento de la rodilla es una medida clínicamente relevante en el ámbito sanitario, ya que su disminución puede alterar las actividades de la vida diaria. La obtención de una medida fiable del rango de movimiento nos permite valorar la eficacia de las intervenciones, así como la gravedad de la enfermedad. Por esto, el objetivo de este estudio fue conocer la fiabilidad intra e interevaluador de un protocolo para el rango de movimiento articular de la rodilla llevado a cabo con un sensor inercial en sujetos asintomáticos. Métodos: Se midió el rango de movimiento de 32 rodillas en sujetos asintomáticos, se realizaron 2 sesiones de medición, una por evaluador, en el mismo día. En cada sesión se hicieron un total de 8 mediciones (2 medidas para flexión en decúbito supino, 2 medidas para extensión en decúbito supino, 2 medidas para flexión en bipedestación y 2 para la extensión en bipedestación). Resultados: Para la fiabilidad interevaluador se consiguieron buenos resultados con un ICC superior a 0,79 para todos los movimientos. Los datos obtenidos para la fiabilidad intraevaluador en todos los movimientos fueron excelentes (ICC>0,88). Conclusión: Este estudio obtuvo una excelente fiabilidad interevaluador e intraevaluador para los sujetos sanos midiendo con sensores inerciales


Introduction: The quantification of knee range of motion is a clinically relevant measurement in the healthcare setting, as its decrease can alter activities of daily living. Collecting reliable measurements of the range of motion allows us to evaluate the reliability of interventions, or the severity of the pathology. The objective of this study was to obtain the intra- and inter- rater reliability of a protocol for the knee the range of joint motion, measured with an inertial sensor in asymptomatic subjects. Methods: The range of motion of 32 asymptomatic knees was measured. Two measurement sessions were performed by two different evaluators. A total of 8 measurements were made in each session: 2 measurements for flexion in supine decubitus position, 2 measurements for extension in supine decubitus, 2 measurements for flexion in standing position and 2 measurements for extension in standing position. Results: For inter-rater reliability, good results were achieved, with an ICC>0.79 for all movements. The obtained data for intra-rater reliability in all the movements was excellent, with an ICC>0.88. Conclusion: This study obtained excellent inter-rater and intra-rater reliability for healthy subjects


Assuntos
Humanos , Masculino , Feminino , Adulto Jovem , Reprodutibilidade dos Testes , Joelho/fisiologia , Atividade Motora/fisiologia , Movimento , Monitorização Fisiológica/métodos , Retroalimentação Sensorial , Acelerometria/métodos , Estudos Longitudinais , Decúbito Dorsal/fisiologia , Posição Ortostática , Fenômenos Biomecânicos
14.
Ophthalmologe ; 116(8): 766-770, 2019 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-31073678

RESUMO

BACKGROUND: Diurnal or nocturnal fluctuations of intraocular pressure (IOP), which are especially common in glaucoma patients, often require hospitalization of the patient in order to be detected. This is often inconvenient for the patient. Therefore, this study evaluated the usefulness of a rebound tonometer (RT) designed for IOP self-tonometry (RT-Home) in an outpatient department, especially in the supine position and out of office hours. METHODS: Over a period of 6 months unselected open-angle glaucoma patients were equipped with a RT-home device for one night each. At the beginning IOP values measured by medical personnel (RT-Home(o)) were compared with IOP measured by the patient (RT-Home(p)), as well as measured by applanation tonometry according to Goldmann (GAT). Patients also completed a questionnaire regarding subjective comfort during use of the RT-Home. RESULTS: The RT-Home(o) showed a bias of -1.1 mm Hg (-7.9 to 5.7 mm Hg) compared to GAT and RT-Home(p) showed a bias of -1.6 mm Hg (-8.9 to 5.9 mm Hg) compared to GAT. The measurement differences between GAT and RT-Home(o) as well as RT-Home(p) showed a stong correlation with the IOP and the central corneal thickness (IOP: r = 0.481, P > 0.0001, RT-Home(o) vs. GAT; corneal thickness: r = 0.612, P < 0.0001, RT-Home(o) vs. GAT). The RT-Home(p) in a supine position showed significantly elevated IOP levels than during the day (P < 0.0001). The RT-Home showed no qualitative differences between measurements in supine and sitting positions. DISCUSSION: The RT-Home is effective and precise for use in an outpatient department to gain a general overview over patients' IOP out of office hours and also in the supine position. In the long term it seems possible that RT-Home can avoid hospitalization for diurnal and nocturnal IOP evaluation especially of young, mobile patients; however, interpretation of the data always requires professional knowledge.


Assuntos
Pressão Intraocular , Decúbito Dorsal , Tonometria Ocular , Córnea , Humanos , Manometria , Reprodutibilidade dos Testes
15.
Cochrane Database Syst Rev ; 5: CD010990, 2019 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-31041813

RESUMO

BACKGROUND: The modalities of therapy for obstructive sleep apnoea (OSA) include behavioural and lifestyle modifications, positional therapy, oral appliances, surgery and continuous positive airway pressure therapy (CPAP). Though CPAP has proven efficacy in treating OSA, adherence with CPAP therapy is suboptimal. Positional therapy (to keep people sleeping on their side) is less invasive and therefore expected to have better adherence. This review considered the efficacy of positional therapy compared to CPAP as well as positional therapy against no positional therapy. Devices designed for positional therapy include lumbar or abdominal binders, semi-rigid backpacks, full-length pillows, a tennis ball attached to the back of nightwear, and electrical sensors with alarms that indicate change in position. OBJECTIVES: To compare the efficacy of positional therapy versus CPAP and positional therapy versus inactive control (sham intervention or no positional therapy intervention) in people with OSA. SEARCH METHODS: We identified studies from the Cochrane Airways' Specialised Register (including CENTRAL, MEDLINE, Embase, CINAHL, AHMED and PsycINFO), ClinicalTrials.gov, and the World Health Organization trials portal (ICTRP). It also contains results derived from handsearching of respiratory journals and abstract books of major annual meetings. We searched all databases from their inception to September 2018, with no restrictions on language of publication or publication type. SELECTION CRITERIA: We included randomised controlled trials comparing positional therapy with CPAP and positional therapy with inactive control. DATA COLLECTION AND ANALYSIS: Two review authors independently selected studies and extracted the data. We used a random-effects model in the meta-analysis to estimate mean differences and confidence intervals. We assessed certainty of evidence using the GRADE approach. MAIN RESULTS: We included eight studies. The studies randomised 323 participants into two types of interventions. The comparison between positional therapy and CPAP included 72 participants, while the comparison between positional therapy and inactive control included 251 participants. Three studies used supine vibration alarm devices, while five studies used physical positioning like specially designed pillows or semirigid backpacks.Positional therapy versus CPAPThe three studies included for this comparison were randomised cross-over trials. Two studies found that there was no difference in Epworth Sleepiness Scale (ESS) scores between CPAP and positional therapy. Two studies showed that CPAP produced a greater reduction in Apnoea-Hypopnoea Index (AHI) with a mean difference (MD) of 6.4 events per hour (95% CI 3.00 to 9.79; low-certainty evidence) compared to positional therapy. Subjective adherence, evaluated in one study, was found to be significantly greater with positional therapy (MD 2.5 hours per night, 95% CI 1.41 to 3.59; moderate-certainty evidence).In terms of secondary outcomes, one study each reported quality-of-life indices and quality-of-sleep indices with no significant difference between the two groups. One study reported cognitive outcomes using multiple parameters and found no difference between the groups. There were insufficient data to comment on other secondary outcomes like respiratory disturbance index (RDI), and frequency and duration of nocturnal desaturation. None of the studies clearly reported adverse effects.Positional therapy versus inactive controlThree studies of positional therapy versus no intervention were randomised cross-over trials, while two studies were parallel-arm studies. Data from two studies showed that positional therapy significantly improved ESS scores (MD -1.58, 95% CI -2.89 to -0.29; moderate-certainty evidence). Positional therapy showed a reduction in AHI compared with control (MD -7.38 events per hour, 95% CI -10.06 to -4.7; low-certainty evidence). One study reported adherence. The number of participants who continued to use the device at two months was no different between the two groups (odds ratio (OR) 0.80, 95% CI 0.33 to 1.94; low-certainty evidence). The same study reported adverse effects, the most common being pain in the back and chest, and sleep disturbance but there was no significant difference between the two groups in terms of device discontinuation (OR 1.25, 95% CI 0.5 to 3.03; low-certainty evidence). One study each reported quality-of-life indices and quality-of-sleep indices, with no significant difference between the two groups. One study reported cognitive outcome, and found no difference between the groups. There was insufficient evidence to comment on other secondary outcomes (RDI, frequency and duration of nocturnal desaturation). AUTHORS' CONCLUSIONS: The review found that CPAP has a greater effect on improving AHI compared with positional therapy in positional OSA, while positional therapy was better than inactive control for improving ESS and AHI. Positional therapy may have better adherence than CPAP. There were no significant differences for other clinically relevant outcomes such as quality of life or cognitive function. All the studies were of short duration. We are unable to comment on the long-term effects of the therapies. This is important, as most of the quality-of-life outcomes will be evident only when the therapies are given over a longer period of time. The certainty of evidence was low to moderate.


Assuntos
Pressão Positiva Contínua nas Vias Aéreas , Apneia Obstrutiva do Sono/terapia , Decúbito Dorsal , Humanos , Avaliação de Resultados (Cuidados de Saúde) , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto
17.
Medicine (Baltimore) ; 98(21): e15794, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31124975

RESUMO

BACKGROUND: We evaluated the relationship between ultrasonographical acquired parameters and short-term postoperative cognitive function in patients undergoing robotic-assisted radical prostatectomy (RALP). METHODS: Ninety elderly patients scheduled for RALP had their optic nerve sheath diameter (ONSD), the cross-sectional area (CSA) of the internal jugular vein (IJV) and the IJV valve (IJVV) competency assessed by ultrasound. The patients were analyzed in 2 groups based on whether displayed IJVV incompetency (IJVVI). The 3 parameters were measured before anesthesia (T0), immediately after induction of general anesthesia (T1), 5 minutes after establishing pneumoperitoneum (T2), 5 minutes after placing the patient in the Trendelenburg position (T3), and 5 minutes after the release of the pneumoperitoneum in the supine position (T4). Regional cerebral tissue oxygen saturation (rSO2) was also measured by near-infrared spectroscopy intraoperatively. The Mini-Mental State Examination (MMSE) and Confusion Assessment Method (CAM) were performed the day before surgery and on postoperative days 1, 3, and 7. RESULTS: We found that 52% of patients had evidence of IJVVI after being placed in the Trendelenburg position after pneumoperitoneum was established (T4). Patient with IJVVI showed a significant increase of ONSD and CSA at T1, T2, T3, T4 but there was no associated decrease in rSO2. MMSE scores were reduced at postoperative day 1 and the 7 patients that developed postoperative delirium came from Group IJVVI. CONCLUSIONS: Our observations suggest that elderly patients that show IJVVI after adequate positioning for RALP may develop elevated intracranial pressure as well as mildly compromised postoperative cognitive function in the short term.


Assuntos
Decúbito Inclinado com Rebaixamento da Cabeça/efeitos adversos , Laparoscopia/efeitos adversos , Pneumoperitônio Artificial/efeitos adversos , Prostatectomia/efeitos adversos , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Idoso , Circulação Cerebrovascular , Disfunção Cognitiva/etiologia , Hemodinâmica , Humanos , Hipertensão Intracraniana/etiologia , Laparoscopia/métodos , Masculino , Pessoa de Meia-Idade , Nervo Óptico/patologia , Nervo Óptico/cirurgia , Posicionamento do Paciente/efeitos adversos , Posicionamento do Paciente/métodos , Pneumoperitônio Artificial/métodos , Complicações Pós-Operatórias/etiologia , Período Pós-Operatório , Prostatectomia/métodos , Procedimentos Cirúrgicos Robóticos/métodos , Decúbito Dorsal , Resultado do Tratamento
18.
Int J Surg ; 66: 62-71, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31034987

RESUMO

OBJECTIVE: To compare the safety and efficacy of percutaneous nephrolithotripsy (PCNL) in supine versus prone position for patients with renal or upper ureteral calculi. METHODS: A systematic search of Pubmed, Embase and Cochrane Central Register of Controlled Trials was performed to identify all eligible studies. All included randomized controlled trials (RCTs) were evaluated based on the inclusion and exclusion criteria. After quality assessment and date extraction, a meta-analysis was performed using RevMan 5.3 software. RESULTS: A total of 15 RCTs with 1474 patients were included in our meta-analysis. Pooled data showed that PCNL in supine position could significantly reduce the operative time [weighted mean difference (WMD) -12.02, 95% confidence interval (CI) -20.49 to -3.54, p = 0.005] and rate of fever [risk ratio (RR) 0.67, 95% CI 0.46 to 0.97, p = 0.03] compared to prone position. In addition, no significant differences could be found between groups in stone-free rate (p = 0.31), hospital stay (p = 0.59) and rate of overall complications (p = 0.11), mainly including urinary leakage (p = 0.83), pleural effusion (p = 0.74) and blood transfusion (p = 0.58). CONCLUSIONS: The current study found comparable stone-free rate and significant lower rate of postoperative fever in supine PCNL compared with prone PCNL. PCNL in supine position could be a safe and efficient choice for patients with renal or upper ureteral calculi.


Assuntos
Cálculos Renais/cirurgia , Nefrostomia Percutânea/métodos , Posicionamento do Paciente/métodos , Cálculos Ureterais/cirurgia , Adulto , Febre/etiologia , Humanos , Tempo de Internação/estatística & dados numéricos , Nefrostomia Percutânea/efeitos adversos , Razão de Chances , Duração da Cirurgia , Complicações Pós-Operatórias , Decúbito Ventral , Ensaios Clínicos Controlados Aleatórios como Assunto/métodos , Decúbito Dorsal , Resultado do Tratamento
19.
Sensors (Basel) ; 19(7)2019 Apr 11.
Artigo em Inglês | MEDLINE | ID: mdl-30978955

RESUMO

The further exploration of the capacitive ECG (cECG) is hindered by frequent fluctuations in signal quality from body movement and changes in sleep position. The processing framework must be fundamentally adapted to make full use of this signal. Therefore, we propose a new signal-processing framework that determines the signal quality for short signal segments (2 and 4 seconds) using a multi-class classification model (qua_model) based on a convolutional neural network (CNN). We built another independent deep CNN classifier (pos_model) to classify the sleep position. In the validation, 12 subjects were recruited for a 30-minute experiment, which required the subjects to lie on a bed in different sleeping positions. The short segments, classified as clear (C1 class) by the qua_model, were used to determine sleep positions with the pos_model. In 10-fold cross-validation, the qua_model for signals of 4-second length could recognize the signal of the C1 class at a 0.99 precision and a 0.99 recall; the pos_model could recognize the supine sleep position, the left, and right lateral sleep positions at a 0.99 averaged precision and a 0.99 averaged recall. Given the amount of data accumulated per night and the instability in the signal quality, this fully automatic processing framework is indispensable for a personal healthcare system. Therefore, this study could serve as an important step for cECG technique trying to explore the cECG for unconstrained heart monitoring.


Assuntos
Eletrocardiografia , Redes Neurais (Computação) , Sono/fisiologia , Decúbito Dorsal/fisiologia , Adulto , Algoritmos , Humanos , Masculino , Movimento/fisiologia , Posicionamento do Paciente/métodos , Processamento de Sinais Assistido por Computador , Adulto Jovem
20.
BMC Neurol ; 19(1): 64, 2019 Apr 13.
Artigo em Inglês | MEDLINE | ID: mdl-30987603

RESUMO

BACKGROUND: To evaluate whether a shorter time of lying supine without a pillow and fasting for solids and liquids (LSFSL) after a lumbar puncture (LP) is associated with a higher risk of post-lumbar puncture headache (PLPH) and post-lumbar puncture lower back pain (PLPBP) in a randomized, assessor-blinded, controlled trial. METHODS: Paediatric patients who underwent their first LP after hospital admission were randomly allocated to either the group with half an hour of LSFSL (0.5 h LSFSL) or 4 h of LSFSL (4 h LSFSL) immediately after LP. The primary outcome is PLPH after LP. The incidence of PLPH, PLPBP, and vomiting; vital signs (respiratory rate, heart rate, blood pressure); and other post-procedure conditions after LP were measured as the outcomes. The Non-inferiority test and Wilcoxon rank-sum test were used to analyse the outcome data. RESULTS: In total, 400 patients (201 in the 0.5-h LSFSL group and 199 in the 4-h LSFSL group) were included in this trial. Twelve (5.97%) of 201 patients experienced PLPH in the 0.5 h LSFSL group versus 13 (6.53%) of 199 patients in the 4 h LSFSL group (difference 0.56, 95% CI -4.18 to 5.31; p = 0·0108 for the non-inferiority test). Fourteen (6.97%) of 201 patients experienced PLPBP in the 0.5 h LSFSL group versus 17 (8.54%) of 199 patients in the 4 h LSFSL group (difference 1.57, 95% CI -3.66 to 6.82; p = 0.007 for the non-inferiority test). The changes in heart rate (HR), respiratory rate (RP) and systolic blood pressure (SBP) before and after the LP were not different between the 0.5-h LSFSL group and the 4-h LSFSL group. No other adverse events were reported. CONCLUSIONS: Compared with 4 h of LSFSL after LP, 0.5 h of LSFSL was not associated with a higher risk of PLPH, PLPBP or other adverse events. In conclusion, 0.5 h of LSFSL is sufficient for children undergoing LP. TRIAL REGISTRATION: Clinical trial NCT02590718 . The date of registration was 08/25/2015.


Assuntos
Cefaleia Pós-Punção Dural/prevenção & controle , Punção Espinal/efeitos adversos , Criança , Jejum , Feminino , Humanos , Masculino , Decúbito Dorsal , Fatores de Tempo
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