Conventional Position Research Articles

Comparison of Prone With Lithotomy Position in Removal of Posterior Myoma in Transvaginal Natural Orifice Endoscopic Surgery: A Prospective Cohort Study

ObjectiveVaginal natural orifice transluminal endoscopic surgery (vNOTES) is considered to have the advantages of completely scarless, less postoperative pain, earlier flatus, and faster postoperative recovery. However, posterior myoma are relatively difficult to operate through vNOTES in the conventional lithotomy position. Thus, we innovated the application of prone position in the removal of posterior myoma in vNOTES. The aim of this study is the comparison of myomectomy outcomes of patient for single posterior myoma in prone and lithotomy position. DesignA single-center, prospective study. SettingA university teaching hospital. PatientsA total of 81 patients with posterior myoma who underwent myomectomy in vNOTES from January 2021 to December 2022. InterventionsThe patients underwent myomectomy in vNOTES in prone or lithotomy position. Measurements and Main ResultsAmong the patients who underwent vNOTES myomectomy, 29 (35.8%) were in the lithotomy position group, and 52 (64.2%) in the prone position group. Of note, 4 (4.9%) patients underwent a conversion to LESS during the operation—3 in the lithotomy and 1 in the prone position group. And a patient in the lithotomy position group underwent resurgery for hemostasis due to postoperative pelvic bleeding. Compared with the lithotomy position, prone position significantly shortens the operation time (12.3, 95% CI: 6.811, 17.761. p = .009) without increasing the complications and postoperative discomfort of patients. ConclusionCompared to the lithotomy position, the prone position provides greater convenience for operation and exhibits a lower rate of surgical conversion during the removal of single posterior myomas via vNOTES. Further, for patients selecting vNOTES, surgeons need to conduct sufficient preoperative evaluation, timely hemostasis during surgery, and timely surgical conversion if necessary to ensure patient safety.

Application of the Left Lateral Decubitus Position in Laparoscopic Right Posterior Lobectomy.

To investigate the value of the left lateral decubitus position in laparoscopic right posterior lobe tumor resection. The clinical data of patients who underwent laparoscopic right posterior lobectomy from January 2020 to March 2023 were retrospectively collected and divided into group A (left lateral decubitus position group, n=30) and group B (conventional position group, n=35) according to different body positions. Intraoperative and postoperative data were collected and compared between the 2 groups. The operation time (210.43±57.56 vs. 281.97±65.89, t =5.887, P <0.05), hilar occlusion time (23.97±14.25 vs. 35.79±12.62, t =4.791, P <0.05), intraoperative blood loss (162.14±72.61 vs. 239.65±113.56, t =5.713, P <0.05), postoperative feeding time (1.13±0.36 vs. 1.57±0.67, t =3.681, P <0.05), postoperative visual analog scale score (5.16±0.89 vs. 7.42±1.31, t =3.721, P <0.05), postoperative abdominal drainage tube indwelling time (4.58±1.34 vs. 5.42±1.52, t =4.553, P <0.05), incidence rate of complications (43.33% vs. 82.86%, χ 2 =11.075, P <0.05) in group A were lower than those in group B ( P <0.05). Symptoms/side effects (32.42±3.42 vs. 27.44±3.31, t =4.331, P <0.05), and there were significant differences in social function (33.55±2.56 vs. 29.31±3.32, t =4.863, P <0.05). For right posterior lobe tumors of the liver, the left lateral decubitus position has many advantages in laparoscopic right posterior lobectomy, such as a wide field of view, simple steps, a short operation time, less bleeding, and a high postoperative quality of life. It is an effective treatment for right posterior lobe tumors of the liver and is worthy of being widely popularized.

Performance Analysis of the Particle Swarm Optimization Algorithm in a VLC System for Localization in Hospital Environments

Localization in hospitals can be valuable in improving different services in medical environments. In this sense, an accurate location system in this environment requires adequately enabling communication technology. However, widely adopted technologies such as Wireless Fidelity (WiFi), Bluetooth, and Radio Frequency Identification (RFID) are considered poorly suited to enable hospital localization due to their inherent drawbacks, including high implementation costs, poor signal strength, imprecise estimates, and potential interference with medical devices. The increasing expenses associated with the implementation and maintenance of these technologies, along with their limited accuracy in dynamic hospital environments, underscore the pressing need for alternative solutions. In this context, it becomes imperative to explore and present novel approaches that not only avoid these challenges but also offer more cost effective, accurate, and interference-resistant connectivity to achieve precise localization within the complex and sensitive hospital environment. In the quest to achieve adequate localization accuracy, this article strategically focuses on leveraging Visible Light Communication (VLC) as a fundamental technology to address the specific demands of hospital environments to achieve the precise localization and tracking of life-saving equipment. The proposed system leverages existing lighting infrastructure and utilizes three transmitting LEDs with different wavelengths. The Received Signal Strength (RSS) is used at the receiver, and a trilateration algorithm is employed to determine the distances between the receiver and each LED to achieve precise localization. The accuracy of the localization is further enhanced by integrating a trilateration algorithm with the sophisticated Particle Swarm Optimization (PSO) algorithm. The proposed method improves the localization accuracy, for example, at a height of 1 m, from a 11.7 cm error without PSO to 0.5 cm with the PSO algorithm. This enhanced accuracy is very important to meet the need for precise equipment location in dynamic and challenging hospital environments to meet the demand for life-saving equipment. Furthermore, the performance of the proposed localization algorithm is compared with conventional positioning methods, which denotes improvements in terms of the localization error and position estimation.

Virtual position predictive control with system delay observer to improve PMLSM position tracking accuracy

AbstractTo improve the position tracking accuracy of permanent magnet linear synchronous motors (PMLSM), this paper introduces a virtual position predictive control (VPPC) with a system delay observer (SDO). Un‐like conventional position predictive control (CPPC), which ignores the complexity of prediction models and velocity adjustments, the proposed VPPC combines a simplified position model with an active variable speed control. This design accelerates mover response and increases maximum reference speeds through active adjustments to better estimate the predicted output. Since the prediction period in CPPC often misaligns with the system delay, resulting in additional prediction errors, this paper further explores the relationship between predictive periods and system delay. Based on this analysis and a unified modelling concept, an SDO is included to observe and compensate for system delay, correcting the prediction period and optimising the control model. Experimental results on a PMLSM platform confirm the superior position tracking performance of the VPPC with SDO compared to conventional controllers.

Crossed raised arm position improves the flow of contrast medium in torso contrast-enhanced computed Tomography

IntroductionThis retrospective cohort study examined the effects of the crossed raised arm (CRA) position in contrast-enhanced computed tomography (CECT) on contrast medium influx and image quality relative to the conventional position. MethodsContrast medium influx into the collateral veins on CECT images was evaluated in 92 participants. The CT values of the pulmonary artery, descending aorta, and spleen were obtained in both positions and compared. Anatomical changes in the diameters and area of the subclavian vein and costoclavicular distance were also analyzed. ResultsContras 27 and 6 patients in the conventional and CRA positions, respectively. The influx risk ratio in the CRA position versus that in the conventional position was 0.22 (95% confidence interval, 0.10–0.51). Elevations in the median CT value of the pulmonary artery, descending aorta, and spleen in the CRA position were 7.0% (p < .001), 7.4% (p < .001), and 9.8% (p < .001), respectively. Enlargements in the major and minor diameters of the subclavian vein, subclavian vein area, and costoclavicular distance in the CRA position versus those in the conventional position were 19.3% (p < .001), 28.1% (p < .001), 53.6%, and 30.0% (p < .001), respectively. ConclusionThe CRA position effectively prevented contrast medium influx into the collateral veins due to SVS and increased CT values in the target organs in CECT. The diameters and area of the subclavian vein and costoclavicular distance were enlarged at the thoracic outlet, which improved the flow of the contrast medium into the targeted organs. Implications for practiceThe CRA position can contribute to obtaining better CECT images during common clinical assessments at no additional cost.

Controlling a bio-inspired miniature blimp using a depth sensing neural-network camera

Miniature blimps are lighter-than-air vehicles which have become an increasingly common unmanned aerial system research platform due to their extended endurance and collision tolerant design. The UNSW-C bio-inspired miniature blimp consists of a 0.5 m spherical mylar envelope filled with helium. Four fins placed along the equator provide control over the three translatory axes and yaw rotations. A gondola attached to the bottom of the blimp contains all the electronics and flight controller. Here, we focus on using the UNSW-C blimp as a platform to achieve autonomous flight in GPS-denied environments. The majority of unmanned flying systems rely on GPS or multi-camera motion capture systems for position and orientation estimation. However, such systems are expensive, difficult to set up and not compact enough to be deployed in real environments. Instead, we seek to achieve basic flight autonomy for the blimp using a low-priced and portable solution. We make use of a low-cost embedded neural network stereoscopic camera (OAK-D-PoE) for detecting and positioning the blimp while an onboard inertia measurement unit was used for orientation estimation. Flight tests and analysis of trajectories revealed that 3D position hold as well as basic waypoint navigation could be achieved with variance (<0.1 m). This performance was comparable to that when a conventional multi-camera positioning system (VICON) was used for localizing the blimp. Our results highlight the potentially favorable tradeoffs offered by such low-cost positioning systems in extending the operational domain of unmanned flight systems when direct line of sight is available.

Effect of intubation in lateral position on placement of a double-lumen tube in patients undergoing unilateral video-assisted thoracic surgery: a randomied clinical trial

Approximately one-third of patients who undergo double-lumen tube (DLT) intubation in the conventional supine position experience DLT malposition. No randomized study investigates the effect of DLT intubation in the lateral position. We therefore aimed to evaluate the effect of intubation in lateral position on placement of a DLT compared to supine intubation, and to test primary hypothesis that lateral DLT intubation could reduce the incidence of DLT malposition. We randomly allocated 108 patients undergoing video-assisted thoracic surgery to receive DLT intubation in the comfortable and surgically required lateral position (lateral group) or in the supine position (supine group) from October to December 2022. The primary outcome was the incidence of DLT malposition defined as movement >1.0cm to correct the DLT position. The secondary outcomes included intubation time, the frequency and duration of fibreoptic bronchoscopy, the need for re-intubation, intra-operative vital signs, and post-operative recovery. This trial is registered with the Chinese Clinical Trial Registry (ChiCTR2200060794). The incidence of DLT malposition was significantly lower in the lateral group (1/53 [2%]) than that in the supine group (16/53 [30%]; RR [95% confidence interval] of 0.06 [0.01-0.46]; P<0.001). Lateral DLT intubation decreased the intubation time, the frequency and duration of fibreoptic bronchoscopy. The incidence of hypotension, post-operative sore throat, and upper-arm discomfort was lower in the lateral group. Other secondary outcomes were similar between groups. Lateral DLT intubation reduced the incidence of DLT malposition for patients undergoing video-assisted thoracic surgery. These results support that lateral DLT intubation offers more benefits and may be a superior option compared to conventional supine intubation. National Natural Science Foundation of China and of Zhejiang Province.

Sensorless Speed Control of PMSM in Low-Speed by High Frequency Pulsating Injection with Double Modulation Error Compensation

A novel improvement scheme for the High Frequency Pulsating Injection-Sinusoidal (HFPI-S) method that considers the error function is proposed and implemented for PMSM sensorless control. The limitations in extracting the error function and dealing with signal noise at low-speed could appear the estimation errors in rotor position within the HFPI-S system. In this study, a new model for the proposed method, including the addition of dual modulation as error compensation in the process of extracting rotor position and enhancing the observer for conventional rotor position signals was focused. The results of this study showed that the extraction of the error function that is expanded could obtain more accurate results. Therefore, the addition of dual modulation and the observer enhancement could be effectively applied to maintain the accuracy of rotor position estimation even under low-speed and loaded conditions.

Clinical value of flexion-extension radiographs with bracket support for lumbar stability assessment.

This study proposes a novel standardized technique to evaluate lumbar stability in lumbar lateral flexion-extension radiographs and determine whether the most reliable intraoperative reference level of extension can be attained. A total of 104 patients undergoing surgical treatment for lumbar degenerative disease were included in the study. Radiographs in the conventional extension position (CE) and the extension position with bracket support (CEB) and intraoperative prone fluoroscopic radiographs of patients were included in this study. The slip angle (SA) and slip percentage (SP) were compared for these three radiographic methods. Furthermore, the correlation of differences in the SA and SP were examined among different spinal segments. Among 104 patients (mean age 58 years, 54% women) with a total of 147 operated segments examined, the average SA (10.65°±3.65°) and SP (12.18%±4.91%) with bracket support and SA (10.62°±3.67°) and SP (12.19%±4.90%) during intraoperative muscle relaxation were not significantly different (P=0.54; 0.91). However, the SA and SP in the CEB and intraoperative muscle relaxation conditions were significantly increased compared with the SA (6.46°±3.23°) and SP (7.87%±4.26%) obtained in the CE condition (all P<0.001). Both surgeons demonstrated high reliability, with intraclass correlation coefficient values ranging from 0.8 to 1.0 (P<0.001) for SP and SA measurements. CE radiographs underestimate the degree of displacement of lumbar instability. The CEB position reduces patient back pain and increases the feeling of safety, leading to a greater level of extension. This outcome aligns with the intraoperative muscle relaxation findings.

A Safe Laparoscopic Approach for Ovarian Tumors during Pregnancy.

Surgery for pregnant women with ovarian tumors poses the risk of uterine irritation. We aimed to demonstrate the superiority of our laparoscopic technique over conventional methods and to compare the outcomes of laparoscopy with those of laparotomy for ovarian tumors during pregnancy. This retrospective study included 50 patients undergoing procedures for ovarian tumors during pregnancy at the Tokushima University Hospital between January 2005 and December 2021. We compared surgical outcomes between laparoscopic procedures and laparotomy, along with complications. In addition, we compared the frequency of uterine stimulation with the conventional trocar position to that with the currently used trocar position in laparoscopic surgery. Forty patients in the laparoscopy group and 10 in the laparotomy group underwent procedures. The laparoscopy group had less bleeding (16.4 ± 28.8 vs. 58 ± 72.2 mL, P < 0.05) and shorter hospital stays (7.6 ± 1.7 vs. 12.8 ± 13.1 days, P < 0.05) compared with those of the laparotomy group. The outcomes showed no significant differences between groups. All laparoscopies and laparotomies were successful and without complications. Furthermore, the current trocar position tended to stimulate the uterus less frequently. The results suggested that, compared to laparotomy, laparoscopy for ovarian tumors during pregnancy had better outcomes. The trocar position in our technique allows for easy operation of ovarian tumors without interference by forceps or cameras, resulting in minimal irritation of the uterus. Our original laparoscopic method may be safer with superior outcomes over the conventional method.

Comparison of ultrasound-guided and traditional localisation in intraspinal anesthesia: a systematic review and network meta-analysis

ObjectivesThe optimal puncture technique for neuraxial anaesthesia in different populations is unclear. We sought to obtain data from randomised controlled trials comparing the impact of ultrasound-guided technology and traditional positioning...

A novel method for diaphragm-based electrode belt position of electrical impedance tomography by ultrasound

BackgroundThis aim of study was to introduce a diaphragm-based EIT-belt placement method based on diaphragm position by ultrasound, and to evaluate the difference between diaphragm-based EIT-belt placement and conventional EIT-belt placement.MethodThe diaphragm position (L0) determined by ultrasound was taken as zero reference level. The direction of headward is defined as positive, and toward feet is negative. For EIT data collection, the electrode belt was placed at 7 different levels, respectively (denoted as L−2 cm, L0, L2cm, L4cm, L6cm, L8cm, L10cm) at supine position in healthy volunteers. The diaphragm-based EIT-belt level (Lxcm) was defined where highest tidal impedance variation (TV) was achieved. Subsequently, EIT measurements were conducted at diaphragm-based EIT-belt levels and traditional EIT-belt level in 50 critically ill patients under mechanical ventilation.ResultThe highest TV was achieved at L6cm and the smallest at L−2 cm., so the L6cm were taken as diaphragm-based EIT-belt level by ultrasound in 8 healthy volunteers. In 23 patients, the diaphragm-based EIT-belt plane agreed with the conventional planes (4th–6th ICS), which was defined as the Agreed group. Other patients were classified to the Disagreed group (above 4th ICS). The Disagreed group has a significantly higher BMI and lower global TV at the diaphragm-based EIT-belt plane compared to the Agreed group.ConclusionsThe diaphragm-based EIT-belt position by ultrasound was feasible and resulted in different belt positions compared to the conventional position in > 50% of the examined subjects, especially in patients with higher BMI. Further study is required to validate the impact on EIT images with this novel method on clinical management.

Surgical treatment of spondylolisthesis by oblique lumbar interbody fusion and transpedicular screw fixation: Comparison between conventional double position versus navigation-assisted single lateral position.

Oblique lumbar interbody fusion (OLIF) procedures involve anterior insertion of interbody cage in lateral position. Following OLIF, insertion of pedicle screws and rod system is performed in a prone position (OLIF-con). The location of the cage is important for restoration of lumbar lordosis and indirect decompression. However, inserting the cage at the desired location is difficult without reduction of spondylolisthesis, and reduction after insertion of interbody cage may limit the amount of reduction. Recent introduction of spinal navigation enabled both surgical procedures in one lateral position (OLIF-one). Therefore, reduction of spondylolisthesis can be performed prior to insertion of interbody cage. The objective of this study was to compare the reduction of spondylolisthesis and the placement of cage between OLIF-one and OLIF-con. We retrospectively reviewed 72 consecutive patients with spondylolisthesis for this study; 30 patients underwent OLIF-one and 42 underwent OLIF-con. Spinal navigation system was used for OLIF-one. In OLIF-one, the interbody cage was inserted after reducing spondylolisthesis, whereas in OLIF-con, the cage was inserted before reduction. The following parameters were measured on X-rays: pre- and postoperative spondylolisthesis slippage, reduction degree, and the location of the cage in the disc space. Both groups showed significant improvement in back and leg pains (p < .05). Transient motor or sensory changes occurred in three patients after OLIF-con and in two patients after OLIF-one. Pre- and postoperative slips were 26.3±7.7% and 6.6±6.2% in OLIF-one, and 23.1±7.0% and 7.4±5.8% in OLIF-con. The reduction of slippage was 74.4±6.3% after OLIF-one and 65.4±5.7% after OLIF-con, with a significant difference between the two groups (p = .04). The cage was located at 34.2±8.9% after OLIF-one and at 42.8±10.3% after OLIF-con, with a significant difference between the two groups (p = .004). Switching the sequence of surgical procedures with OLIF-one facilitated both the reduction of spondylolisthesis and the placement of the cage at the desired location.

The design and energy saving effect of partial duct and unconventional pre-swirl fin and their combination system

The present work investigates two pre-swirl devices; partial duct and pre-swirl fins and their combination system. Commercial CFD code STARCCM+ is used to solve the Reynolds Averaged Navier-Stokes (RANS) equations for the ship flow problem. The influence of duct inclination and longitudinal distance from propeller plane on duct performance are investigated. An unconventional pre-swirl fin is proposed which could be suitable for both port and starboard. The fin is fixed at an angle of attack with respect to a horizontal plane as opposed to conventional angular position around the propeller shaft. A partial ducts consisting two half-ducts is investigated. Improvement in energy saving from 3.69% (duct acting on both sides) to 4.26% (duct acting on port side only) were recorded and the port duct has superior saving effect compared to the starboard duct. For improved saving effect, the port and starboard fins are mounted at opposite angles of attack, −10.45° and +10.45° respectively for the right hand propeller. The saving effect is further improved when the duct and pre-swirl fin are in combination with duct mounted on the port and the pre-swirl fin on the starboard. A validation study using this combination system is in close agreement with numerical method.

Parametric Observer Controlled Motor Invariant Electronic Commutation of Photovoltaic Powered BLDCM Without Position Sensor

The development of parameter independent position sensor free control of permanent magnet brushless DC (PMBLDC) motor is one of the most challenging tasks. A motor parameter independent parametric observer based electronic commutation control is developed here without using rotor position sensor. The effect of motor parameter variation along with the change of motor, on electronic commutation control without using the rotor position sensor is considered as the disruption parameter for the developed control algorithm to mitigate the external disruption. Mitigation of control loop disturbances is done using the parametric observer based feedback control. A hybrid maximum power extraction algorithm using traverse and incremental conductance is implemented here for effective solar maximum power extraction. The implemented parametric observer motor invariant (POMI) based position sensor free control algorithm is verified using experimental process. Performance of the implemented POMI control is observed better in performance in comparison with the conventional position sensor free control as parametric variation is not considered in conventional control. The solution proves to be the best fit for any type of BLDC motor based water pumping solution irrespective of the pump configuration.

A Comparative Study of the Modified Lateral Position of Javelin and the Conventional Position of Body in the Operation of Pediatric Ureteropelvic Junction Obstruction with Da Vinci Xi Platform

Background: To explore the comparative study of different positioning methods in robot assisted laparoscopic pyeloplasty.

Machine-learning-enabled optimization of atomic structures using atoms with fractional existence

We introduce a method for global optimization of the structure of atomic systems that uses additional atoms with fractional existence. The method allows for movement of atoms over long distances bypassing energy barriers encountered in the conventional position space. The method is based on Gaussian processes, where the extrapolation to fractional existence is performed with a vectorial fingerprint. The method is applied to clusters and two-dimensional systems, where the fractional existence variables are optimized while keeping the atomic positions fixed on a lattice. Simultaneous optimization of atomic coordinates and existence variables is demonstrated on copper clusters of varying size. The existence variables are shown to speed up the global optimization of large and particularly difficult-to-optimize clusters.

The Reformed and Celibate Pastor: Richard Baxter’s Argument for Clerical Celibacy, by Seth D. Osborne

Richard Baxter was a dominant figure in seventeenth-century English religion, and his influence and importance are now coming into sharper focus with the publication of a splendid modern edition of his autobiography Reliquiae Baxterianae in five volumes in 2020, the prospect of a critical edition of his letters, and the creation of a global and aptly named Baxter Association which meets biannually online to share scholarly work on the man and his times. Seth D. Osborne’s book is an impressive contribution to the current reassessment of Baxter’s thinking. It addresses two central and linked questions. Why did Baxter advocate clerical celibacy, in contrast to many of his protestant contemporaries, and how should we best understand Baxter’s decision to marry in later life (which surprised many friends and foes), and his considered view after his wife’s death that, notwithstanding their happiness together, the case for ministerial celibacy still stood? Osborne demonstrates that Baxter prized matrimony and ‘the soul care’ it should provide for building up household units of Christian devotion and discipline. Where he differed from many was in his view that both clergy and laity should consider whether marriage or celibacy was the most expedient for exercising Christian piety. Matrimony was a sin for those who could foresee that it would limit their service to God, in contrast to the conventional protestant position that marriage was the default option and staying single required a clear call. Very few clergy, Baxter claimed, could serve God better as married men. Osborne sees Baxter’s celebrated ministry at Kidderminster (1647–60) as a decisive influence here. The minister should know the spiritual state of every parishioner, exercise ecclesiastical discipline and be active in local ministerial associations: in short, he should undertake tireless pastoral work which would be necessarily compromised by the distractions and competing demands of family life. To this Baxter added the standard argument that marriage would inevitably limit a minister’s charity. As he stated in Gildas Salvianus: The Reformed Pastor (1656), only now was the ‘kingdom of darkness’ beginning to totter, so there could be no rest or respite for his pastoral mission. Osborne identifies what he calls ‘particularities’ of Baxter’s character which, he argues, reinforced his views: among them were his awareness of time’s winged chariot, underpinned by recurrent illnesses, his emphasis on the comforts of heaven over earth, and his unswerving pursuit of truth, as he saw it, however singular or controversial that might be.

Post-shock acute electrical parameters of left bundle branch area defibrillation (LBBAD) leads

Abstract Funding Acknowledgements Type of funding sources: None. Background Conduction system pacing is a growing field in bradycardia-treatment. Evidence for His bundle pacing (HBP) and left bundle branch area pacing (LBBAP) to prevent pacing induced cardiomyopathy is growing. Promising data is also emerging to use CSP as an additional tool in cardiac-resynchronisation therapy (CRT). (1-5). Very often patients requiring an ICD also have an indication for bradycardia or resynchronisation pacing. Adding CSP-treatment to these patients requires an additional pacing lead (HBP or LBBAP) and the use of a CRT-D device. As opposed to HBP, in LBBAP atrial oversensing cannot occur. Using an ICD-lead in this position could reduce the number of intracardiac leads needed while maintaining the possibility of sensing and treating ventricular arrhythmias. Purpose We evaluated the acute electrical parameters before and after delivering an ICD shock with an ICD-lead positioned in the left bundle branch area (LBBA). As this ICD-lead position has never been described before, no data is available on dislocation after shock-delivery. We looked at the electrical parameters of the successful LBBAP ICD-lead implants in our LBBAD (Left Bundle Branch Area Defibrillator) pilot-trial which is a proof-of-concept study for LBBA-ICD lead implantation. Methods In the LBBAD pilot trial, we implant an ICD lead in the LBBA to evaluate for feasibility of implantation and functionality of defibrillation. As this is a proof of concept trial, after testing the lead is re-implanted in a conventional ventricular position. In this abstract we report the evaluation of the electrical parameters of the first 3 successfully implanted LBBAD-leads (n=3). Results After LBBA implantation initial electrical parameters were measured. The pacing threshold was 0,8 +/- 0,6 V @ 0,4 ms, while the sensed R-wave and the impedance measured 7,0 +/- 2,7 mV and 512,3 +/- 38,8 Ohms respectively. The shock-coil impedance was 68,0 +/- 7,0 Ohms. All these parameters are in range with the parameters seen in conventional ICD-lead implantation. After performing the defibrillation threshold test (DFT) all electrical parameters were re-evaluated. Sensing, threshold and impedance were 7,6 +/- 2,2 mV, 0,8 +/- 0,7 V @ 0,4 ms, 516,3 +/- 47,8 Ohms and 71,7 +/- 8,2 Ohms respectively. These post-shock measurements remained stable within normal ICD-lead functioning range precluding acute dislocation. Conclusions Our LBBAD pilot trial is the first-in-human experience with ICD-leads implanted in the LBBA. This pilot trial evaluates for implant-feasibility and also looked at the pre- and post shock electrical parameters of the ICD-lead. As the parameters remained in normal working range, precluding acute shock-induced dislocation, these results open the possibility in patients with an LBBAP-indication as well as an ICD-indication, for a follow-up study to implant an LBBAD-lead and perform longer-term evaluation.

Alternative Birthing Positions Compared to the Conventional Position in the Second Stage of Labor: A Review.

The position in which the woman delivers has a lot of impact on the ease of delivery.Women's satisfaction with their birthing experience and the care they receive is significantly impacted by the fact that giving birth is frequently a challenging experience. Birthing positions refer to various postures which can be assumed at the time of delivery by a pregnant woman.Currently, the majority of women give birth either while lying flat on their backs or in a semi-sitting position.Upright positions, which include standing, sitting, or squatting along with side-lying and hands-and-knees, are less common birth positions. Doctors, nurses, and midwives are among the most important healthcare professionals, having a significant influence in deciding which position the woman will give birth in and on the physiological and psychological effects of the experience of a woman in labor. There isn't much research to back up the best position for mothers during the second stage of labor. This review article aims to review and compare the advantages and risks of common birthing positions and know about the knowledge of alternative birthing positions among pregnant women.