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1.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 34(9): 1101-1105, 2020 Sep 15.
Artigo em Chinês | MEDLINE | ID: mdl-32929901

RESUMO

Objective: To explore the application value of lithotomy position in the treatment of tibial shaft fracture with closed reduction and interlocking intramedullary nail fixation. Methods: The clinical data of 78 patients with tibial shaft fractures treated with closed reduction and interlocking intramedullary nail fixation between January 2015 and May 2018 were retrospectively analyzed. Among them, 33 patients were treated with lithotomy position (trial group) and 45 patients were treated with traditional supine position (control group). There was no significant difference between the two groups in general data such as gender, age, the cause of injury, the interval between injury and admission, the interval between injury and operation, and fracture type and site ( P>0.05). The operation time, intraoperative blood loss, intraoperative fluoroscopy times, the number of patients with open reduction, postoperative incision infection, and fracture healing were recorded. Pain visual analogue scale (VAS) score and Harris score were used to evaluate the effectiveness. Results: Both groups of operations were successfully completed. The trial group was superior to the control group in terms of operation time, intraoperative blood loss, intraoperative fluoroscopy times, and the number of patients with open reduction ( P<0.05). Incision infection occurred in 1 case (3.03%) of the trial group and 3 cases (6.67%) of the control group after operation. The difference in the incidence of infection was significant ( χ 2=0.139, P=0.045). The incisions of other patients healed by first intention. X-ray film reexamination showed that the fractures of the two groups healed. The fracture healing time of the trial group was (5.30±1.33) months, while that of the control group was (5.98±1.80) months, with no significant difference ( t=-1.815, P=0.073). There was no significant difference in VAS score, Harris scores of knee joint and ankle joint between the two groups before operation and at 3, 6, and 12 months after operation ( P>0.05). At 3 days after operation, the VAS score was lower in the trial group than in the control group, and the Harris scores of knee joint and ankle joint were higher in the trial group than in the control group, and the differences were significant ( P<0.05). Conclusion: Application of lithotomy position in closed reduction and interlocking intramedullary nail fixation for tibial shaft fracture is favorable for fracture reduction, with less bleeding, shorter operation time, and fewer fluoroscopy.


Assuntos
Fixação Intramedular de Fraturas , Pinos Ortopédicos , Consolidação da Fratura , Humanos , Estudos Retrospectivos , Decúbito Dorsal , Resultado do Tratamento
2.
Medicine (Baltimore) ; 99(38): e22111, 2020 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-32957331

RESUMO

INTRODUCTION: Chronic obstructive pulmonary disease (COPD) is a lung disease with the highest incidence and high mortality in the world. Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) can significantly accelerate the progression of the disease. Pulmonary rehabilitation is one of the effective treatment methods in COPD patients, but few studies have focused on the effect of pulmonary rehabilitation in AECOPD patients. Liuzijue can improve the pulmonary function and relieve symptoms of COPD patients. However, due to the influence of disease and non-invasive ventilation (NIV), AECOPD patients have poor compliance with getting out of bed at the early stage. Sitting and lying Liuzijue is more suitable in AECOPD patients with NIV. Therefore, this study will evaluate the effect of sitting and lying Liuzijue for lung function, exercise endurance, and quality of life in AEOPD patients with NIV. METHODS: This study is a clinical randomized controlled trial. Sixty four AECOPD patients with NIV will be randomly divided into the experimental group and the control group. All participants will be treated with routine treatment and nursing according to their specific condition. The experimental group will be combined with sitting and lying Liuzijue on the basis of the control group. The duration of the exercise will be 3 months. The primary outcomes are the pulmonary function test and 6-minute walking test (6MWT). The secondary outcome measures include blood gas parameters, dyspnea index (the Modified Medical Research Council Dyspnea Scale [mMRC]), the body-mass, airflow obstruction, dyspnea and exercise capacity (BODE) index, anxiety, and depression (Hospital Anxiety and Depression Scale [HADS]), and quality of life (St·George Respiratory Questionnaire [SGRQ]). The measurement of outcomes will be evaluated at week 13. DISCUSSION: It's imperative to focus on pulmonary rehabilitation in AECOPD patients. The purpose of this study is to evaluate the effect of sitting and lying Liuzijue for pulmonary rehabilitation in AECOPD patients with NIV. TRIAL REGISTRATION: ChiCTR2000034530, Registered on July 8th, 2020.


Assuntos
Ventilação não Invasiva , Doença Pulmonar Obstrutiva Crônica/reabilitação , Qigong , Postura Sentada , Decúbito Dorsal , Humanos , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Testes de Função Respiratória
3.
J Am Acad Orthop Surg ; 28(16): 651-659, 2020 Aug 15.
Artigo em Inglês | MEDLINE | ID: mdl-32769716

RESUMO

Hip arthroscopy is rapidly growing as a treatment with good outcomes for pathologic conditions such as femoroacetabular impingement syndrome and labral tears. At the same time, it is one of the most technically challenging and demanding procedures in orthopaedics with a technically demanding skill. The first challenge is to safely access the joint, which requires accurate anatomical knowledge, a strong sense of spatial orientation, and repeated practice. Iatrogenic chondrolabral injury has been reported as the most common complication in hip arthroscopy and most frequently occurs during hip joint access. As such, basic foundations cannot be overstated. These complications can be minimized with adequate patient positioning, reproducible hip joint access techniques, and proper portals placement. Nonetheless, these three points are perhaps the greatest hurdles that orthopaedic surgeons face when entering the hip arthroscopy field. In this review, we outlined a stepwise approach for a safe access to hip arthroscopy.


Assuntos
Artroscopia/métodos , Articulação do Quadril/cirurgia , Posicionamento do Paciente/métodos , Decúbito Dorsal , Artroscopia/efeitos adversos , Impacto Femoroacetabular/cirurgia , Articulação do Quadril/anatomia & histologia , Humanos , Doença Iatrogênica/prevenção & controle , Lesões do Manguito Rotador/cirurgia , Segurança
5.
Niger J Clin Pract ; 23(7): 1004-1007, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32620732

RESUMO

Background: Scrotal ultrasonography has high sensitivity in the detection of intra-scrotal abnormalities. Various ultrasonographic parameters such as the spermatic cord diameter, venous diameter, and venous retrograde flow in either supine or upright positions with or without Valsalva maneuver have been investigated to assess patients suspected of having varicocele. Aims: This study aimed at comparing testicular vein diameter in supine and upright positions using ultrasonography. Methodology: This is a prospective multicenter study conducted between September 2018 and June 2019. Eighty-two consenting suspected cases of varicocele, 20 years and above, referred for scrotal ultrasonography were included in this study. Results: The study population had a mean age of 42.9 + 14.89 (SD) with a range of 20-96 years. The highest number of participants fell within the age range of 30-39 years 23 (28%). Varicocele was demonstrated in 96.3% of the patients. More patients showed sonographic evidence of varicocele in the upright position, on the right 50 (61%) as well as left 50 (61%). Bilateral varicocele had a higher frequency in the upright position 45 (54.9%), while supine was 23 (28%). Upright position had the widest diameter in 72% of participants on the right and 82% on the left. The upright position also showed higher average vein diameter of 2.6 mm and 2.9 mm on the right and left, respectively, while it was 2.2 mm and 2.3 mm for right and left in the supine position. Conclusion: The upright position is more predictive of varicocele in scrotal ultrasound examination for suspected cases of varicocele. We recommend an upright position where one position is to be used.


Assuntos
Cordão Espermático/diagnóstico por imagem , Posição Ortostática , Decúbito Dorsal , Testículo/diagnóstico por imagem , Ultrassonografia/métodos , Varicocele/diagnóstico por imagem , Veias/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Prospectivos , Sensibilidade e Especificidade , Cordão Espermático/irrigação sanguínea , Testículo/irrigação sanguínea , Manobra de Valsalva
6.
Cochrane Database Syst Rev ; 7: CD013031, 2020 07 23.
Artigo em Inglês | MEDLINE | ID: mdl-32702777

RESUMO

BACKGROUND: Chest X-ray (CXR) is a longstanding method for the diagnosis of pneumothorax but chest ultrasonography (CUS) may be a safer, more rapid, and more accurate modality in trauma patients at the bedside that does not expose the patient to ionizing radiation. This may lead to improved and expedited management of traumatic pneumothorax and improved patient safety and clinical outcomes. OBJECTIVES: To compare the diagnostic accuracy of chest ultrasonography (CUS) by frontline non-radiologist physicians versus chest X-ray (CXR) for diagnosis of pneumothorax in trauma patients in the emergency department (ED). To investigate the effects of potential sources of heterogeneity such as type of CUS operator (frontline non-radiologist physicians), type of trauma (blunt vs penetrating), and type of US probe on test accuracy. SEARCH METHODS: We conducted a comprehensive search of the following electronic databases from database inception to 10 April 2020: Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, MEDLINE, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL) Plus, Database of Abstracts of Reviews of Effects, Web of Science Core Collection and Clinicaltrials.gov. We handsearched reference lists of included articles and reviews retrieved via electronic searching; and we carried out forward citation searching of relevant articles in Google Scholar and looked at the "Related articles" on PubMed. SELECTION CRITERIA: We included prospective, paired comparative accuracy studies comparing CUS performed by frontline non-radiologist physicians to supine CXR in trauma patients in the emergency department (ED) suspected of having pneumothorax, and with computed tomography (CT) of the chest or tube thoracostomy as the reference standard. DATA COLLECTION AND ANALYSIS: Two review authors independently extracted data from each included study using a data extraction form. We included studies using patients as the unit of analysis in the main analysis and we included those using lung fields in the secondary analysis. We performed meta-analyses by using a bivariate model to estimate and compare summary sensitivities and specificities. MAIN RESULTS: We included 13 studies of which nine (410 traumatic pneumothorax patients out of 1271 patients) used patients as the unit of analysis; we thus included them in the primary analysis. The remaining four studies used lung field as the unit of analysis and we included them in the secondary analysis. We judged all studies to be at high or unclear risk of bias in one or more domains, with most studies (11/13, 85%) being judged at high or unclear risk of bias in the patient selection domain. There was substantial heterogeneity in the sensitivity of supine CXR amongst the included studies. In the primary analysis, the summary sensitivity and specificity of CUS were 0.91 (95% confidence interval (CI) 0.85 to 0.94) and 0.99 (95% CI 0.97 to 1.00); and the summary sensitivity and specificity of supine CXR were 0.47 (95% CI 0.31 to 0.63) and 1.00 (95% CI 0.97 to 1.00). There was a significant difference in the sensitivity of CUS compared to CXR with an absolute difference in sensitivity of 0.44 (95% CI 0.27 to 0.61; P < 0.001). In contrast, CUS and CXR had similar specificities: comparing CUS to CXR, the absolute difference in specificity was -0.007 (95% CI -0.018 to 0.005, P = 0.35). The findings imply that in a hypothetical cohort of 100 patients if 30 patients have traumatic pneumothorax (i.e. prevalence of 30%), CUS would miss 3 (95% CI 2 to 4) cases (false negatives) and overdiagnose 1 (95% CI 0 to 2) of those without pneumothorax (false positives); while CXR would miss 16 (95% CI 11 to 21) cases with 0 (95% CI 0 to 2) overdiagnosis of those who do not have pneumothorax. AUTHORS' CONCLUSIONS: The diagnostic accuracy of CUS performed by frontline non-radiologist physicians for the diagnosis of pneumothorax in ED trauma patients is superior to supine CXR, independent of the type of trauma, type of CUS operator, or type of CUS probe used. These findings suggest that CUS for the diagnosis of traumatic pneumothorax should be incorporated into trauma protocols and algorithms in future medical training programmes; and that CUS may beneficially change routine management of trauma.


Assuntos
Pneumotórax/diagnóstico por imagem , Radiografia Torácica/métodos , Decúbito Dorsal , Traumatismos Torácicos/complicações , Ultrassonografia/métodos , Viés , Intervalos de Confiança , Serviço Hospitalar de Emergência , Humanos , Pneumotórax/etiologia , Estudos Prospectivos , Sensibilidade e Especificidade , Ferimentos não Penetrantes/complicações , Ferimentos Penetrantes/complicações
7.
Cochrane Database Syst Rev ; 7: CD012362, 2020 07 07.
Artigo em Inglês | MEDLINE | ID: mdl-32639053

RESUMO

BACKGROUND: Head position during care may affect cerebral haemodynamics and contribute to the development of germinal matrix-intraventricular haemorrhage (GM-IVH) in very preterm infants. Turning the head toward one side may occlude jugular venous drainage while increasing intracranial pressure and cerebral blood volume. It is suggested that cerebral venous pressure is reduced and hydrostatic brain drainage improved if the infant is cared for in the supine 'head midline' position. OBJECTIVES: To assess whether head midline position is more effective than other head positions for preventing (or preventing extension) of GM-IVH in very preterm infants (< 32 weeks' gestation at birth). SEARCH METHODS: We used the standard search strategy of Cochrane Neonatal to search the Cochrane Central Register of Controlled Trials (CENTRAL; 2019, Issue 9), MEDLINE via PubMed (1966 to 12 September 2019), Embase (1980 to 12 September 2019), and the Cumulative Index to Nursing and Allied Health Literature (CINAHL; 1982 to 12 September 2019). We searched clinical trials databases, conference proceedings, and reference lists of retrieved articles. SELECTION CRITERIA: Randomised controlled trials (RCTs) comparing caring for very preterm infants in a supine head midline position versus a prone or lateral decubitus position, or undertaking a strategy of regular position change, or having no prespecified position. We included trials enrolling infants with existing GM-IVH and planned to assess extension of haemorrhage in a subgroup of infants. We planned to analyse horizontal (flat) versus head elevated positions separately for all body positions. DATA COLLECTION AND ANALYSIS: We used standard methods of Cochrane Neonatal. For each of the included trials, two review authors independently extracted data and assessed risk of bias. The primary outcomes were GM-IVH, severe IVH, and neonatal death. We evaluated treatment effects using a fixed-effect model with risk ratio (RR) for categorical data; and mean, standard deviation (SD), and mean difference (MD) for continuous data. We used the GRADE approach to assess the certainty of evidence. MAIN RESULTS: Three RCTs, with a total of 290 infants (either < 30 weeks' gestational age or < 1000 g body weight), met the inclusion criteria. Two trials compared supine midline head position versus head rotated 90° with the cot flat. One trial compared supine midline head position versus head rotated 90° with the bed tilted at 30°. We found no trials that compared supine versus prone midline head position. Meta-analysis of three trials (290 infants) did not show an effect on rates of GM-IVH (RR 1.11, 95% confidence interval (CI) 0.78 to 1.56; I² = 0%) and severe IVH (RR 0.71, 95% CI 0.37 to 1.33; I² = 0%). Neonatal mortality (RR 0.49, 95% CI 0.25 to 0.93; I² = 0%; RD -0.09, 95% CI -0.16 to -0.01) and mortality until hospital discharge (typical RR 0.50, 95% CI 0.28 to 0.90; I² = 0%; RD -0.10, 95% CI -0.18 to -0.02) were lower in the supine midline head position. The certainty of the evidence was very low for all outcomes because of limitations in study design and imprecision of estimates. We identified one ongoing study. AUTHORS' CONCLUSIONS: We found few trial data on the effects of head midline position on GM-IVH in very preterm infants. Although meta-analyses suggest that mortality might be reduced, the certainty of the evidence is very low and it is unclear whether any effect is due to cot tilting (a co-intervention in one trial). Further high-quality RCTs would be needed to resolve this uncertainty.


Assuntos
Hemorragia Cerebral Intraventricular/prevenção & controle , Cabeça , Doenças do Prematuro/prevenção & controle , Posicionamento do Paciente/métodos , Decúbito Dorsal , Leitos , Hemorragia Cerebral Intraventricular/epidemiologia , Hemorragia Cerebral Intraventricular/etiologia , Circulação Cerebrovascular/fisiologia , Humanos , Lactente , Mortalidade Infantil , Recém-Nascido , Recém-Nascido Prematuro , Doenças do Prematuro/epidemiologia , Doenças do Prematuro/etiologia , Viés de Publicação , Ensaios Clínicos Controlados Aleatórios como Assunto , Retinopatia da Prematuridade/epidemiologia , Rotação
8.
J Comput Assist Tomogr ; 44(4): 553-558, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32697525

RESUMO

OBJECTIVE: To assess the limitations of single-energy metal artifact reduction algorithm in the oral cavity and evaluate the availability of a solution by setting the patient in a lateral position (LP) with the use of a gantry tilt (GT). METHODS: We analyzed 88 patients with dental metals retrospectively in study 1, and 74 patients prospectively in study 2. Patients were classified: metal I with dental metals in 1 region, metal II in 2 regions, and metal III in 3 regions. Patients underwent neck computed tomography examinations in a supine position (SP) in study 1, and 2 positions, an LP with a GT and an SP, in study 2. All images were reconstructed with this algorithm. Image quality was scored using a 4-point scale: 1 = severe artifact, 2 = moderate artifact, 3 = slight artifact, 4 = no artifact. The scores were compared between metal I, metal II, and metal III using the Mann-Whitney U test in study 1, and between an LP with a GT and an SP using the Wilcoxon signed ranks test in study 2. RESULTS: The scores outside the dental arch were significantly higher in metal I than in metal II and metal III (3.0 ± 0.6 vs 2.3 ± 0.5 vs 2.2 ± 0.4; P < 0.0001 for metal I vs metal II and for metal I vs metal III) and significantly higher in an LP with a GT than an SP (3.2 ± 0.4 vs 2.3 ± 0.4; P < 0.0001). CONCLUSIONS: Single-energy metal artifact reduction algorithm could reduce metal artifacts adequately in patients with dental metals in 1 region, but not in 2 or more regions. However, even for the latter, combination of this algorithm and an LP with a GT could further improve the image quality.


Assuntos
Boca/diagnóstico por imagem , Posicionamento do Paciente/métodos , Tomografia Computadorizada por Raios X/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Algoritmos , Meios de Contraste , Materiais Dentários , Feminino , Humanos , Processamento de Imagem Assistida por Computador/métodos , Masculino , Metais , Pessoa de Meia-Idade , Imagens de Fantasmas , Estudos Retrospectivos , Decúbito Dorsal
10.
J Laryngol Otol ; 134(5): 447-452, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32493527

RESUMO

OBJECTIVES: This paper aimed to: retrospectively analyse single-centre results in terms of surgical success, respiratory outcomes and adverse events after short-term follow up in obstructive sleep apnoea patients treated with upper airway stimulation; and evaluate the correlation between pre-operative drug-induced sleep endoscopy findings and surgical success. METHODS: A retrospective descriptive cohort study was conducted, including a consecutive series of obstructive sleep apnoea patients undergoing implantation of an upper airway stimulation system. RESULTS: Forty-four patients were included. The total median Apnoea-Hypopnea Index and oxygen desaturation index significantly decreased from 37.6 to 8.3 events per hour (p < 0.001) and from 37.1 to 15.9 events per hour (p < 0.001), respectively. The surgical success rate was 88.6 per cent, and did not significantly differ between patients with or without complete collapse at the retropalatal level (p = 0.784). The most common therapy-related adverse event reported was (temporary) stimulation-related discomfort. CONCLUSION: Upper airway stimulation is an effective and safe treatment in obstructive sleep apnoea patients with continuous positive airway pressure intolerance or failure. There was no significant difference in surgical outcome between patients with tongue base collapse with or without complete anteroposterior collapse at the level of the palate.


Assuntos
Terapia por Estimulação Elétrica/métodos , Apneia Obstrutiva do Sono/terapia , Pressão Positiva Contínua nas Vias Aéreas , Terapia por Estimulação Elétrica/efeitos adversos , Endoscopia/métodos , Feminino , Humanos , Nervo Hipoglosso , Masculino , Pessoa de Meia-Idade , Polissonografia , Cuidados Pós-Operatórios , Cuidados Pré-Operatórios , Estudos Retrospectivos , Sono/efeitos dos fármacos , Decúbito Dorsal , Resultado do Tratamento
11.
Zhongguo Gu Shang ; 33(4): 327-31, 2020 Apr 25.
Artigo em Chinês | MEDLINE | ID: mdl-32351086

RESUMO

OBJECTIVE: To investigate the effect and feasibility of closed reduction and internal fixation with PFNA in the treatment of intertrochanteric fracture of femur in the supine position without traction bed. METHODS: From June 2014 to March 2018, 45 patients with intertrochanteric fracture of femur who were treated and followed up were analyzed retrospectively. There were 21 males and 24 females, with an average age of 67.4 years (43 to 92 years);18 cases on the left side and 27 on the right side. According to Evans Jensen classification, there were 7 patients of type Ⅱ, 17 patients of type Ⅲ, 16 patients of type Ⅳ and 5 patients of type Ⅴ. The time from injury to operationwas 2 to 6 days. The operation time, blood loss and fracture healing, closing time, postoperative complications and Harris score of hip joint were recorded. RESULTS: The operation time of 45 patients was 35 to 80 min, with an average of 52.6 min;the intraoperative bleeding volume was 40 to 110 ml, with an average of 68.7 ml;the hospitalization time was 6 to 11 days, with an average of 8.4 days;the follow up time was 12 to 18 months, with an average of 14.7 months;the internal fixation of 2 patients failed, and 43 patients achieved bony healing;the deep vein thrombosis of the lower extremity in the perioperative period was 1 case, and the inferior vena cava filter was inserted;the internal fixation of 2 patients was cut out, and the hip was renovated. The incidence of complications was 8.9%(4 / 45). At the final follow up, Harris score of hip joint was 56 to 95 (81.30±8.40), including excellent 15 cases, good 26 cases, fair 2 cases and poor 2 cases. CONCLUSION: It is safe and feasible to treat intertrochanteric fracture of femur with closed reduction and anti rotation intramedullary nailing under the bed without traction in a supine position. It has the advantages of small trauma and low complications, and the clinical effect is satisfactory. It is worth popularizing and using in basic hospitals.


Assuntos
Fraturas do Quadril , Adulto , Idoso , Idoso de 80 Anos ou mais , Pinos Ortopédicos , Feminino , Fixação Intramedular de Fraturas , Fraturas do Quadril/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Decúbito Dorsal , Resultado do Tratamento
12.
Int J Cardiovasc Imaging ; 36(7): 1377-1384, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32246388

RESUMO

Transient ischemic dilation (TID), a marker of severe coronary artery disease (CAD), is the post-stress to rest left ventricular (LV) volume ratio quantified using non ECG gated single photon emission computerized tomography (SPECT). Although prone positioning causes physiological reduction of LV volume in normal subjects, we hypothesize this may not occur in TID with underlying severe CAD as cardiac hemodynamics worsen when prone. We aim to evaluate the utility of the non ECG gated supine to prone LV volume ratio (SPLVr) for identifying severe CAD. Retrospective data analysis from 130 patients with TID ratio ≥ 1.21 and both post-stress supine and prone images. SPLVr had a significant negative correlation with summed stress (r = - 0.221, p = 0.011) and rest (r = - 0.292, p = 0.001) scores. Of the 129 cases with follow-up invasive or computed tomography coronary angiography, 52 (40.3%) had severe CAD (left main ≥ 50% stenosis, 3-vessel with ≥ 70% stenosis or 2-vessel with proximal left anterior descending ≥ 70% stenosis). Mean SPLVr was significantly lower in severe CAD cases (1.05 ± 0.14 vs 1.12 ± 0.17, p = 0.012). SPLVr predicted severe CAD on univariate [OR 0.12 (95% CI 0.00-0.35) p = 0.01] but not in multivariate analysis. SPLVr is a novel marker that negatively correlates with extent of perfusion abnormalities and is lower amongst TID patients with severe CAD. Larger studies are needed to assess if SPLVr can reliably identify underlying severe CAD amongst TID cases.


Assuntos
Doença da Artéria Coronariana/diagnóstico por imagem , Estenose Coronária/diagnóstico por imagem , Imagem de Perfusão do Miocárdio/métodos , Posicionamento do Paciente , Decúbito Ventral , Volume Sistólico , Decúbito Dorsal , Tomografia Computadorizada de Emissão de Fóton Único , Função Ventricular Esquerda , Idoso , Angiografia por Tomografia Computadorizada , Angiografia Coronária , Doença da Artéria Coronariana/fisiopatologia , Estenose Coronária/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Estudos Retrospectivos , Índice de Gravidade de Doença
13.
J Vasc Res ; 57(3): 143-151, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32235116

RESUMO

BACKGROUND: The dynamics ofpulsatile waveforms travelling the central aorta are governed by pressures and arterial compliance. Arterial stiffness, the inverse of compliance, is an independent risk factor for cardiovascular disease and has been suggested as a superior risk index compared to brachial blood pressure (BP). Arterial stiffness is typically measured via carotid-femoral pulse wave velocity (cfPWV) in the supine position; however, different body positions alter orthostatic column height, impacting heart rate and BP. The purpose of this investigation was to examine different body positions and associated measures of cfPWV. METHODS: Measures of resting cfPWV were acquired simultaneously with BP during supine, head-up tilt (HUT), head-down tilt (HDT), and Fowler's position, all at 45 degrees from vertical. RESULTS: Relative to supine, cfPWV was increased 1.1 ± 1.0 and 1.5 ± 1.1 m/s (both p ≤ 0.001) in HUT and Fowler's positions, respectively. Supine to HDT cfPWV was unaltered (p = 0.1), despite an increase in mean arterial pressure (MAP) (10 ± 9 mm Hg). When cfPWV was normalized to MAP, the same effects persisted (p ≤ 0.001). CONCLUSION: Increasing orthostatic column height by changing posture independently increases resting cfPWV, concurrent with increases in BP. This data demonstrates the impact of body position on measures of central artery stiffness, which may have clinical relevance.


Assuntos
Velocidade da Onda de Pulso Carótido-Femoral , Posicionamento do Paciente , Postura , Rigidez Vascular , Adulto , Pressão Arterial , Feminino , Decúbito Inclinado com Rebaixamento da Cabeça , Humanos , Masculino , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Fatores Sexuais , Decúbito Dorsal , Teste da Mesa Inclinada , Adulto Jovem
14.
World Neurosurg ; 138: 174-177, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32147546

RESUMO

BACKGROUND: Resection of vestibular schwannomas with good functional outcome remains a neurosurgical challenge. In this study, we report on our initial experience with a suction spatula, which allows free bimanual dissection of small tumors in a clear, bloodless surgical field in supine position. METHODS: Forty-one patients underwent vestibular schwannoma surgery in supine position, using a suction spatula. To analyze its feasibility, 11 aspects of the device were compared with the regular retractor. RESULTS: The suction spatula was successfully applied in all surgeries. Compared with a common spatula, the suction spatula showed superior performance during meatotomy, microsurgical and endoscopic tumor dissection, and management of bleedings. We noted no difference in ergonomics, compatibility, instrumental conflict, costs, reusability, and sterilization issues. Minor performance was related to its thickness/size. There were no significant disadvantages according to our data. There were no surgical complications related to this device. CONCLUSIONS: The main advantage of the suction spatula is in the treatment of small, mainly intrameatal vestibular schwannomas in supine patient position. It gives the surgeon a "third hand" while enabling a continuous bimanual dissection with 2 microinstruments without the use of a regular suction tip.


Assuntos
Neuroma Acústico/cirurgia , Procedimentos Neurocirúrgicos/instrumentação , Sucção/instrumentação , Adulto , Idoso , Feminino , Humanos , Masculino , Microcirurgia/instrumentação , Microcirurgia/métodos , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos/métodos , Decúbito Dorsal
15.
Int J Sports Physiol Perform ; 15(6): 896-899, 2020 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-32163924

RESUMO

OBJECTIVE: To evaluate the accuracy of the smartphone application (app) HRV Expert (CardioMood) and a chest strap (H10 Polar) for recording R-R intervals compared with electrocardiogram (ECG). METHODS: A total of 31 male recreational runners (age 36.1 [6.3] y) volunteered for this study. R-R intervals were recorded simultaneously by the smartphone app and ECG for 5 minutes to analyze heart-rate variability in both the supine and sitting positions. Time-domain indexes (heart rate, mean R-R, SD of RR intervals, count of successive normal R-R intervals differing by more than 50 ms, percentage of successive normal R-R intervals differing by more than 50 ms, and root mean square of successive differences between normal R-R intervals), frequency-domain indexes (low frequency, normalized low frequency, high frequency, normalized high frequency, low-frequency to high-frequency ratio, and very low frequency), and nonlinear indexes (SD of instantaneous beat-to-beat variability and long-term SD of continuous R-R intervals) were compared by unpaired t test, Pearson correlation, simple linear regression, and Bland-Altman plot to evaluate the agreement between the devices. RESULTS: High similarity with P value varying between .97 and 1.0 in both positions was found. The correlation coefficient of the heart-rate-variability indexes was perfect (r = 1.0; P = .00) for all variables. The constant error, standard error of estimation, and limits of agreement between ECG and the smartphone app were considered small. CONCLUSION: The smartphone app and chest strap provide excellent ECG compliance for all variables in the time domain, frequency domain, and nonlinear indexes, regardless of the assessed position. Therefore, the smartphone app replaces ECG for any heart-rate-variability analysis in runners.


Assuntos
Frequência Cardíaca/fisiologia , Aplicativos Móveis , Monitorização Ambulatorial/métodos , Corrida/fisiologia , Dispositivos Eletrônicos Vestíveis , Adulto , Eletrocardiografia , Humanos , Masculino , Monitorização Ambulatorial/instrumentação , Postura Sentada , Smartphone , Decúbito Dorsal
17.
PLoS One ; 15(3): e0229049, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32119678

RESUMO

Cerebrovascular reactivity and cerebral autoregulation are two major mechanisms that regulate cerebral blood flow. Both mechanisms are typically assessed in either supine or seated postures, but the effects of body position and sex differences remain unclear. This study examined the effects of body posture (supine vs. seated vs. standing) on cerebrovascular reactivity during hyper and hypocapnia and on cerebral autoregulation during spontaneous and slow-paced breathing in healthy men and women using transcranial Doppler ultrasonography of the middle cerebral artery. Results indicated significantly improved cerebrovascular reactivity in the supine compared with seated and standing postures (supine = 3.45±0.67, seated = 2.72±0.53, standing = 2.91±0.62%/mmHg, P<0.0167). Similarly, cerebral autoregulatory measures showed significant improvement in the supine posture during slow-paced breathing. Transfer function measures of gain significantly decreased and phase significantly increased in the supine posture compared with seated and standing postures (gain: supine = 1.98±0.56, seated = 2.37±0.53, standing = 2.36±0.71%/mmHg; phase: supine = 59.3±21.7, seated = 39.8±12.5, standing = 36.5±9.7°; all P<0.0167). In contrast, body posture had no effect on cerebral autoregulatory measures during spontaneous breathing. Men and women had similar cerebrovascular reactivity and similar cerebral autoregulation during both spontaneous and slow-paced breathing. These data highlight the importance of making comparisons within the same body position to ensure there is not a confounding effect of posture.


Assuntos
Circulação Cerebrovascular/fisiologia , Posição Ortostática , Decúbito Dorsal/fisiologia , Adolescente , Adulto , Feminino , Voluntários Saudáveis , Homeostase , Humanos , Hipercapnia/metabolismo , Hipocapnia/metabolismo , Masculino , Pessoa de Meia-Idade , Artéria Cerebral Média/diagnóstico por imagem , Adulto Jovem
18.
Epilepsia ; 61(3): e17-e22, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32030739

RESUMO

Excess mortality due to epilepsy is greatest among young adults. However, the relative proportions of sudden unexpected death in epilepsy (SUDEP) and other epilepsy-related causes of death are not well defined. We prospectively adjudicated cause of death in all 18- to 45-year-olds with a history of seizure/epilepsy who underwent medicolegal investigation in San Diego County between 2014 and 2017. We identified 108 decedents with definite or probable epilepsy; 62% died from an epilepsy-related cause. SUDEP accounted for 42.6% (N = 46) of deaths, which were usually unwitnessed deaths, at home in bed. Other frequent causes of death were drug overdose (N = 23), suicide (N = 8), trauma (N = 8), and drowning (N = 6). SUDEP autopsies were similar to those of decedents from other causes. Most deaths in young adults with epilepsy that undergo medico-legal investigation are epilepsy-related, and SUDEP is the leading cause. Improved seizure control can potentially save many lives.


Assuntos
Afogamento/mortalidade , Overdose de Drogas/mortalidade , Epilepsia/epidemiologia , Morte Súbita Inesperada na Epilepsia/epidemiologia , Suicídio/estatística & dados numéricos , Ferimentos e Lesões/mortalidade , Acidentes por Quedas/mortalidade , Acidentes de Trânsito/mortalidade , Adulto , Afro-Americanos , Encéfalo/patologia , California/epidemiologia , Sistema Cardiovascular/patologia , Causas de Morte , Grupo com Ancestrais do Continente Europeu , Feminino , Patologia Legal , Hispano-Americanos , Humanos , Pulmão/patologia , Masculino , Pessoa de Meia-Idade , Decúbito Ventral , Decúbito Dorsal , Adulto Jovem
19.
Odontology ; 108(4): 617-625, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32040653

RESUMO

Many modified Mallampati tests have been developed to date. Samsoon's modified Mallampati test (standard Mallampati test) is currently widely used. We newly designed seven types of assessment protocol of Mallampati test, in addition to standard Mallampati test. In this study, we studied the correlation between eight types of protocol (standard and seven alternative protocols) of Mallampati test and Cormack-Lehane test. We newly designed assessment protocols as new Mallampati test. These are different protocols depending on the presence or absence of phonation, those of protrusion of tongue, and sitting position or supine position. The oropharyngeal structures visualized by these eight types of Mallampati test for total of 145 patients undergoing dental oral surgery were evaluated. The scores derived via eight types of Mallampati test were recorded. The influence of phonation, tongue protrusion and body position on Mallampati test score was analyzed, respectively. The relationships between eight types of Mallampati test and Cormack-Lehane test were analyzed. Tongue protrusion, phonation and sitting position tended to lower the score of Mallampati test (p < 0.001, respectively). The standard Mallampati test was not correlated with Cormack-Lehane test. In the new Mallampati tests, assessment protocol with tongue protrusion, phonation and sitting position, that with tongue protrusion and supine position, or that with tongue protrusion, phonation and supine position were significantly correlated with Cormack-Lehane test, respectively. (p = 0.020, p = 0.007 and p = 0.004, respectively). The standard Mallampati test did not correlate with Cormack-Lehane test. Mallampati test with phonation, tongue protrusion and supine position were most correlated with Cormack-Lehane test.


Assuntos
Intubação Intratraqueal , Laringoscopia , Humanos , Orofaringe , Fonação , Decúbito Dorsal
20.
Aliment Pharmacol Ther ; 51(7): 706-718, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32056267

RESUMO

BACKGROUND: Standard high-resolution manometry (HRM) protocols are based on 10 single water swallows acquired in the supine position. AIMS: To assess the impact of position, rapid drink challenge and solid test meal on the diagnosis of oesophageal motility disorders. METHODS: Seventy-two healthy volunteers (20-76 years) and 366 consecutive patients (18-90 years) completed HRM with 10 single water swallows in the supine and upright positions. Rapid drink challenge was performed twice, before and after the solid test meal. Diagnosis based on single water swallows in the supine position (Chicago Classification v3.0) was compared with results in the upright position and with provocative tests. RESULTS: Overall, diagnostic agreement in the supine and upright positions was present in 296/438 (67.6%) subjects. This increased to 90.0% when ineffective oesophageal motility was considered with normal motility. Integrated relaxation pressure was 4 mm Hg higher in the supine position. There was a higher prevalence of inconsistent, likely false positive, diagnoses of outlet obstruction in the supine compared to the upright position (16/20 vs 1/4 patients, P = 0.0007). Similarly, the difference in concordance for the diagnosis of oesophago-gastric junction obstruction or achalasia between single water swallows in the supine and upright positions with solid test meal was significant (12/29 (41.4%) vs 12/14 (85.7%), P = 0.0087). CONCLUSION: Diagnostic agreement for oesophageal motility disorders based on single water swallows in the upright and supine positions was moderate, with frequent discordant findings for ineffective motility and outlet obstruction. HRM studies can be performed in either position, using appropriate reference values. Rapid drink challenge or solid test meal can resolve diagnostic discrepancies.


Assuntos
Técnicas de Diagnóstico do Sistema Digestório , Testes Diagnósticos de Rotina/métodos , Transtornos da Motilidade Esofágica/diagnóstico , Manometria/métodos , Postura/fisiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Deglutição , Técnicas de Diagnóstico do Sistema Digestório/normas , Testes Diagnósticos de Rotina/normas , Feminino , Humanos , Masculino , Manometria/normas , Pessoa de Meia-Idade , Estudos Prospectivos , Valores de Referência , Decúbito Dorsal/fisiologia , Adulto Jovem
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