Lateral Position Research Articles

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.

Evaluation of risk factors for postoperative neurologic intensive care admission after brain tumor craniotomy: A single-center longitudinal study.

Perioperative variable parameters can be significant risk factors for postoperative intensive care unit (ICU) admission after elective craniotomy for intracranial neoplasm, as assessed by various scoring systems such as Cranio Score. This observational study evaluates the relationship between these factors and early postoperative neurological complications necessitating ICU admission. In total, 119 patients, aged 18 years and above, of either sex, American Society of Anesthesiologists (ASA) grades I-III, scheduled for elective craniotomy and tumor excision were included. The primary objective was to evaluate the relationship between perioperative risk factors and the incidence of early postoperative complications as a means of validation of the Cranio Score. The secondary outcomes studied were 30-day postoperative morbidity/mortality and the association with patient-related risk factors. Forty-five of 119 patients (37.82%) required postoperative ICU care with the mean duration of ICU stay being 1.92 ± 4.91 days. Tumor location (frontal/infratemporal region), preoperative deglutition disorder, Glasgow Coma Scale (GCS) less than 15, motor deficit, cerebellar deficit, midline shift >3 mm, mass effect, tumor size, use of blood products, lateral position, inotropic support, elevated systolic/mean arterial pressures, and duration of anesthesia/surgery were associated with a higher incidence of ICU care. Maximum (P = 0.035, AOR = 1.130) and minimum systolic arterial pressures (P = 0.022, Adjusted Odds Ratio (AOR) = 0.861) were the only independent risk factors. Cranio Score was found to be an accurate predictor of complications at a cut-off point of >10.52%. The preoperative motor deficit was the only independent risk factor associated with 30-day morbidity (AOR = 4.66). Perioperative hemodynamic effects are an independent predictor of postoperative ICU requirement. Further Cranio Score is shown to be a good scoring system for postoperative complications.

Body morphometry did not affect the accuracy of a second-generation, miniature imageless navigation system for total hip arthroplasty (THA) using a posterior approach

IntroductionSome modern imageless navigation platforms for total hip arthroplasty (THA) rely on virtual frontal and sagittal planes determined with the patient in the lateral decubitus position. Body morphometry that changes with gender, body mass index, and other demographic factors may affect accuracy in patient positioning and consequently, navigation accuracy. The objective of this study was to analyze the influence of patient factors on the intraoperative accuracy of a second-generation imageless computer-assisted surgery platform. Methods325 consecutive patients undergoing posterior approach, navigated THA arthroplasty for primary osteoarthritis by a single surgeon were retrospectively reviewed. An optic-based imageless navigation system referenced off a generic sagittal and coronal plane was used to determine acetabular inclination and anteversion. Acetabular accuracy was determined by assessing differences between intraoperative values and those obtained from measuring standardized 6-week follow-up radiographs. The effect of age, gender, BMI, race, ethnicity, and laterality on acetabular accuracy was assessed via t-tests, Pearson correlation and ANOVA. ResultsGender had a significant impact on raw inclination accuracy (females and males had an average error of 1.41° and −1.03°, respectively – p < 0.001). There was a weak correlation between acetabular accuracy and patient age and BMI as a continuous variable (both absolute γ < 0.2). No difference was found between acetabular accuracy and BMI groups. ConclusionThis second-generation imageless computer assisted device provided accurate cup positioning regardless of patient's BMI. Gender was the only factor impacting inclination accuracy.

Modified Dunn Osteotomy for Moderate and Severe Slipped Capital Femoral Epiphysis

Background: Moderate to severe slipped capital femoral epiphysis is a condition that benefits from treatment with modified Dunn realignment osteotomy and fixation 1,2 . The results are acceptable when the procedure is performed by experienced surgeons 3,4 . Description: The patient is placed in the lateral decubitus position. Surgical hip dislocation is performed after a digastric trochanteric osteotomy. An extended retinacular flap is carefully prepared, and the epiphysis separated from the metaphysis, exposing the entirety of the femoral neck. Following this, an open reduction is performed by excising the posteromedial callus and trimming the femoral neck in order to allow capital realignment while avoiding tension on the retinacular vessels. Finally, the reduced slip is fixed with 6.5 or 7-mm cancellous screws and Kirschner wires. The femoral head is then repositioned in the acetabulum, and the trochanter is fixed distal to its original position with use of 3.5-mm self-tapping cortical screws. Closure is performed in layers after achieving adequate hemostasis. Alternatives: Operative alternatives to this technique include cuneiform osteotomy, compensatory osteotomy of the base of the neck or intertrochanteric osteotomy and controlled repositioning, and osteoplasty 5–7 . Osteotomies performed distally and away from the deformity can still lead to cam impingement, thereby failing to reduce the risk of future joint degeneration. In situ pinning has also been described for use in moderate to severe cases of slipped capital epiphysis, but the residual deformity leads to substantial femoroacetabular impingement and thus affects the prognosis of such a hip 8 . Rationale: This technique accounts for the complex anatomy of the hip joint, especially in terms of its precarious blood supply. Long-term studies have shown that corrective osteotomy performed near the physis can correct the alignment at the head-neck junction, thereby avoiding future femoroacetabular impingement. In the hands of experienced surgeons, results have been shown to be favorable 3,4 . Expected Outcomes: In a series of 30 consecutive hips, including 20 moderate and 10 severe slips, the slip angle improved significantly following the modified Dunn procedure (by 43.63° ± 8.42°; p &lt; 0.001). Osteonecrosis was observed in 2 hips (6.7%), and 1 hip had postoperative subluxation that required intervention 9 . In their series of 23 patients, Slongo et al. encountered 2 cases (9%) of osteoarthritis and osteonecrosis 10 . In their series of 40 patients from 2 different institutions, Ziebarth et al. reported no cases of chondrolysis or osteonecrosis 11 . Important Tips: The steps described need to be followed sequentially and meticulously in order to safely dislocate the hip while preserving the blood supply.The availability of an anterior pouch in draping, to deliver the leg during dislocation, will reduce the dependence on an assistant and maintain sterilityThe trochanteric osteotomy should be started with the help of a saw, completed with an osteotomy and must be about 1 to 1.5 cm thick in order to achieve good, stable fixation following relocation of the femoral head and to achieve good abductor function post-relocation.The use of curved, stout, thick scissors (“episiotomy scissors”) can help to ease the step of cutting the ligamentum teres during dislocation.The retinacular flap should be widely exposed along with removal of the posterior callus so that no tension remains on the blood supply. Acronyms and Abbreviations: SCFE = slipped capital femoral epiphysisFAI = femoroacetabular impingementMDP = modified Dunn procedureAVN = avascular necrosisTHR = total hip replacementFAER = flexion, abduction and internal rotationCT = computed tomographyMRI = magnetic resonance imagingAP = anteroposterior

Arthroscopic Fixation of Bony Bankart Lesion Using Inverted All-Suture Anchor Through Bone Tunnel

A bony Bankart lesion is a condition where the labroligamentous complex is detached from the anterior glenoid rim, often accompanied by a fracture. It is a common occurrence found in up to 70% of traumatic shoulder dislocations. Arthroscopic surgery has become the mainstream approach for treating this condition. However, the commonly used techniques, such as labrum alone, transosseous, and double-row, can encounter difficulties passing sutures and may cause damage to the surrounding tissues, especially when dealing with large bony fragments. In this technical note, we describe our preferred technique for fixing bony Bankart lesions, which involves fixing the bony Bankart fragment through the bone tunnel using an all-suture anchor. The surgery is performed with the patient in the lateral decubitus position. Our technique offers a reliable and effective approach to treat bony Bankart lesions while minimizing the risks of complications associated with conventional techniques.

Comparison of Placental Location on Ultrasound in Preeclampsia and Normotensive Pregnancy in Third Trimester.

Hypertensive disorders in pregnancy account for 15%-20% maternal and 20%-25% perinatal mortality. There is interest in predicting preeclampsia (PE) early in pregnancy to reduce PE and its subsequent complications. There is no cheap and easily available, reliable predictor for PE. Some studies have shown that the lateral location of placenta is associated with adverse pregnancy outcomes due to PE. The lateral placenta is yet to be proven as a strong predictor of PE to initiate preventive measures. Placental localization can be easily done on routine ultrasonography during pregnancy. In the light of these observations, a prospective study was done to study any association between PE and placental location by ultrasound in third trimester. Research Question: Is there any association between placental location on ultrasound and preeclampsia in third trimester? The objective is to study association between location of placenta and preeclampsia and compare placental location in normotensive pregnancies with that in PE in third trimester. A prospective comparative, case-control, observational study was conducted in the Department of Obstetrics and Gynecology at North DMC Medical College and Hindu Rao Hospital, Delhi, India, from August 2019 to April 2020. The study population included 200 pregnant women with singleton pregnancy in third trimester, without any medical disorders such as diabetes mellitus, hypertension, renal disease, cardiac disease, and coagulation disorder or smoking. One hundred women had preeclampsia and 100 were normotensive controls. Ultrasound was done after filling F form as per the Government of India guidelines to rule out sex determination, and placenta was localized by ultrasound. Placenta was classified as central when it was equally distributed between the right and left sides of the uterus irrespective of anterior, posterior, or fundal position and lateral when 75% or more of the placental mass was on one side of the midline. Placental location was compared in hypertensive and normotensive pregnancies. Out of the total 200 women, 152 (76%) had central and 48 (24%) had lateral placenta. Ninety-two percent of controls and 60% of cases had central placenta. Forty percent of cases and only 8% normotensive women had lateral placenta. Lateral placenta was five times more frequent in presence of PE as compared to normotensive controls. Out of 152 women with central placenta, 92 (60.5%) women were normotensive but with lateral placenta, only 8 (16.7%) had normal blood pressure. PE was present in 83% of women with lateral placenta and in only 39.47% with central placenta. This difference was statistically significant as P < 0.0001 as per Chi-square test. This reflects a significant association between lateral position of placenta and occurrence of PE. As per odds ratio (0.1304) patients without lateral placenta had 90% protection against preeclampsia. Central placenta is more common than lateral placenta. Lateral placenta is seen five times more frequently among hypertensive women and this difference is statistically significant. The absence of lateral placenta provides 90% protection against PE but the severity of PE was not affected by placental location..

Cooled Radiofrequency Ablation of the Glenohumeral Joint in lateral Position: A Case Report

Background: Shoulder pain due to adhesive capsulitis is a prevalent musculoskeletal condition, necessitating innovative treatments. Radiofrequency ablation (RFA) offers an effective approach to alleviate chronic shoulder pain. This case report focuses on Cooled Radiofrequency ablation of articular branches of the glenohumeral joint, performed with hybrid technique using fluoroscopy and ultrasonography, while the patient remains in a lateral position. Case Presentation: A 56-year-old female presented with chronic right shoulder pain and restricted motion diagnosed with right shoulder adhesive capsulitis. Diagnostic blocks of sensory articular nerves provided significant pain relief, leading to Glenohumeral joint sensory articular nerve denervation via Cooled Radiofrequency Ablation. The procedure was performed with the patient in a lateral position, as lying prone was intolerable due to pain. The patient showed substantial pain relief and improved range of motion post-procedure. Discussion: Cooled radiofrequency ablation (CRFA) has shown promise in treating Adhesive Capsulitis and Glenohumeral joint osteoarthritis. While the traditional approach involves changing the patient's position from prone to supine, this case report introduces a novel lateral position technique. Benefits include improved patient comfort, strict asepsis maintenance, reduced procedure time, and decreased radiation exposure. However, challenges in C-arm positioning were encountered. Additionally, hydrodilatation of the glenohumeral joint was performed, resulting in further pain reduction and range of motion improvement. Conclusion: This case report demonstrates the efficacy and safety of Cooled Radiofrequency Ablation for the Glenohumeral joint, utilizing a lateral position approach. The findings support its potential advantages over traditional methods, offering a valuable addition to the management of chronic shoulder pain. Further research and clinical experience will refine its role in addressing this common and debilitating condition.

Effect of Patient Position during Spinal Anesthesia on the Incidence of Post-Dural Puncture Headache after Cesarean Section

Objective: To compare the incidence of post-dural puncture headache (PDPH) following spinal anesthesia in parturients undergoing elective cesarean section between the sitting and left lateral decubitus positions. Methodology: This quasi-experimental study was conducted at Holy Family Hospital, Rawalpindi, Pakistan, from May 2022 to October 2022. A total of 120 parturients undergoing elective cesarean section under spinal anesthesia were randomly assigned to either the sitting or left lateral decubitus position group. The primary outcome was the occurrence of PDPH within 5 days postoperatively. Secondary outcomes included adverse effects such as hypotension, nausea/vomiting, and bradycardia. Data were analyzed using SPSS version 25.0. Categorical variables were compared using the chi-square test or Fisher's exact test, as appropriate, with a significance level set at p &lt; 0.05. Results: The incidence of PDPH post-procedure was significantly higher in the sitting group compared to the left lateral decubitus group (33.3% vs. 6.7%). In the sitting position group, 63.3% of women experienced hypotension, 26.7% had bradycardia, and 30.0% reported nausea/vomiting, whereas in the left lateral decubitus group, these figures were 58.3%, 21.7%, and 23.3%, respectively. Conclusion: This study concludes that the left lateral decubitus position during spinal anesthesia for cesarean section is associated with a lower incidence of PDPH compared to the sitting position.

Accuracy of cup placement and pelvic motion in total hip arthroplasty in the lateral decubitus position using a new computed tomography-based navigation system with augmented reality technology.

This study aimed to investigate the accuracy of cup position and assess the changes in pelvic tilt during primary total hip arthroplasty (THA) in the lateral decubitus position using a new computed tomography (CT)-based navigation system with augmented reality (AR) technology. There were 37 cementless THAs performed using a CT-based navigation system with AR technology in the lateral decubitus position and 63 cementless THAs performed using manual implant techniques in the lateral decubitus position in this retrospective study. Postoperative cup radiographic inclination and anteversion were measured using postoperative CT, and the proportion of hips within Lewinnek's safe zone was analyzed and compared between the two groups. The mean absolute values of navigation error were assessed. Intraoperative pelvic tilt angles were also recorded using navigation system. The percentage of cups inside Lewinnek's safe zone was 100% in the navigation group and 35% in the control group (p < 0.001). The mean absolute values of navigation error in inclination and anteversion were 2.9° ± 2.1° and 3.3° ± 2.4°, respectively. The mean abduction angle of the pelvis was 5.1° ± 4.8° after placing the patients in the lateral decubitus position and 4.1° ± 6.0° after cup placement. The mean posterior tilt angle was 6.8° ± 5.1° after placing the patients in the lateral decubitus position and 9.3° ± 5.9° after cup placement. The mean internal rotation angle was 14.8° ± 7.4° after cup placement. There were no correlations between the navigation error in inclination or anteversion and the absolute values of changes of the pelvic tilt angle at any phase. Although progressive pelvic motion occurred in THA in the lateral decubitus position, especially during cup placement, the CT-based navigation system with AR technology improved cup placement accuracy.

Characterization of Typical Behaviors of Mares in the Opening Phase of Parturition-Influence of Parity and Dystocia.

The identification of typical behaviors in stage I of parturition, the opening phase, can be used to improve birth monitoring in the mare. Therefore, this study aimed to comprehensively analyze mare behavior during the opening phase. Real-time recordings of 66 births involving 56 warmblood mares were analyzed using camera footage. Behaviors such as increased locomotor activity, pawing with front hooves, lifting the tail, rolling, kicking with the hind legs toward the abdomen, and looking at the abdomen increased significantly (p < 0.001) in the four hours preceding parturition. Within the last hour of the observation period, a statistically significant change was observed for the duration of lying in the sternal and lateral position (p < 0.001). Significant correlations were observed between parity and the total number of repetitions of lying in the sternal position (p < 0.05). Furthermore, the birth process influenced the repetitions of lying in the lateral position (p < 0.05). These findings indicate distinct behavioral patterns during the opening phase of parturition, which were evident across the observed mares. Nonetheless, notable individual differences were also identified among the mares.

Is intramedullary nailing of femoral diaphyseal fractures in the lateral decubitus position as safe and effective as on a traction table?

ObjectivesThe aim of this study was to compare the radiological and clinical results of femoral diaphyseal fractures operated in the lateral decubitus position with those operated in the supine position on a traction table and to detail the perioperative surgical technique. Patients and methodsBetween October 2018 and January 2022, in this prospective, randomized, and single-blind comparative study, 75 patients diagnosed with adult femoral diaphyseal fractures to whom intramedullary nails were applied were operated in the lateral decubitus position without a traction table (Group 1, 37 patients) and in the supine position with a traction table (Group 2, 38 patients). Preoperative age, gender, fracture mechanism, fracture type, and surgical waiting times were determined. Perioperative anesthesia type, surgery preparation time, surgical time, number of fluoroscopy doses, amount of bleeding, and type of reduction were evaluated, and detailed observational descriptions of the surgical techniques were made. In the postoperative period, radiological evaluations were made with x-ray radiography and orthoroentgenogram, while in the clinical evaluation, hip–knee joint range of motion and rotational evaluation were made with the Craigs test. Follow-up periods were determined and complications noted. ResultsThe average age was 32 in Group 1 and 28 in Group 2, the female/male ratio was 1:36 in Group 1 and 5:33 in Group 2, and the follow-up period was 18.2 months Group 1 and 21.7 months in Group 2. No significant difference was detected between the groups in terms of age, gender, fracture mechanism, fracture type, anesthesia type, surgical waiting time, and follow-up period (p > 0.05). Compared to Group 2, the shorter preparation time, surgical time, and number of fluoroscopy doses in Group 1 were found to be statistically significant (p < 0.05). The differences in the amount of bleeding and need for open reduction were not statistically significant between the groups (p > 0.05), and no statistical difference was found in joint range of motion and rotational evaluation in clinical evaluation in both groups (p > 0.05). There was no significant difference in terms of complications between groups. ConclusionsWe found the lateral decubitus method without a traction table to be a safe and effective alternative to the supine method with a traction table in terms of the radiological and clinical results and that it also has the advantages of shortening the surgical time, reducing radiation exposure. Level of evidenceLevel 1 prospective, randomized, single-blind controlled study

Effect of trunk posture on external and internal oblique muscles’ activities during forced expiration

IntroductionThe activities of external oblique (EO) and internal oblique (IO) muscles during forced expiration in a trunk-neutral posture are insufficient for muscle strengthening. Furthermore, these activities during forced expiration may be affected by trunk postures, which can change respiratory muscle activity. Therefore, this study aimed to evaluate the effects of trunk posture on the EO and IO muscles’ activities during forced expiration. MethodsThirty healthy males participated in this study. The participants were placed in the supine position with their trunks in the neutral, right rotation, or right lateral trunk flexion position, and their bilateral EO and IO muscles’ activities during forced expiration were measured using surface electromyography. ResultsThe right EO muscle's activity during forced expiration was significantly higher in the right trunk flexion position than in the neutral trunk and right trunk rotation positions (p < 0.05 and p < 0.001, respectively) but was significantly lower in the right trunk rotation than in the neutral trunk (p < 0.01). In contrast, the left EO muscle's activity was significantly higher in the right trunk rotation position than in the neutral trunk and right lateral trunk flexion positions (p < 0.001 for both) but was significantly lower in the right lateral trunk flexion position than in the neutral trunk position (p < 0.01). The bilateral IO muscles' activity during forced expiration did not significantly differ among the three postures. ConclusionThe findings indicated that the bilateral EO muscles’ activity during forced expiration was affected by trunk posture.

Navigation system for orchard spraying robot based on 3D LiDAR SLAM with NDT_ICP point cloud registration

Autonomous navigation of orchard spraying robots can effectively improve operational efficiency and reduce workload. The conventional robot navigation solutions based on the Global Navigation Satellite System (GNSS) are susceptible to signal loss in orchards due to interference from the canopy of fruit trees. In this paper, an autonomous navigation scheme for orchard spraying robots based on multi-sensor devices and the three-dimensional (3D) LiDAR Simultaneous Localization and Mapping (SLAM) technology. The initial step of the scheme involved the construction of a 3D point cloud map of the orchard using the 3D LiDAR SLAM algorithm. Subsequently, a designed point cloud map transformation algorithm was used to convert the 3D point cloud map of the orchard into a two-dimensional (2D) grid map containing key feature information of the orchard. To enhance the mapping accuracy of the orchard point cloud, a point cloud registration algorithm combining Iterative Closet Point (ICP) and Normal Distributions Transform (NDT) was proposed. This algorithm initially utilized the NDT algorithm for coarse point cloud registration to obtain transformation parameters. Then, the ICP algorithm was applied in conjunction with the obtained parameters for fine registration. Regarding obstacle avoidance, a cooperative obstacle avoidance algorithm based on the Robot Operating System (ROS) multithreaded communication mechanism was introduced. Experimental trials conducted in a standardized spindle-shaped peach orchard validated the successful completion of the SLAM mapping trajectory, which was achieved through the utilization of the proposed NDT_ICP point cloud registration algorithm. The average absolute pose error between the mapped trajectory and the reference trajectory was 1.173 m, with a standard deviation of 0.498 m. The robot's positioning and navigation errors increased with higher speeds, with the largest positioning deviation observed at 1.2 m/s speed, with a maximum lateral positioning error of 7.04 cm. The robot's average lateral navigation error did not exceed 16 cm, and the average heading deviation was less than 8° at different speeds of 0.4, 0.8 and 1.2 m/s. Both the positioning and navigation accuracies of the robot were sufficient to meet the autonomous operational requirements of orchard spraying robots.

Effects of unilateral superimposed high-frequency jet ventilation on porcine hemodynamics and gas exchange during one-lung flooding.

Superimposed high-frequency jet ventilation (SHFJV) is suitable for respiratory motion reduction and essential for effective lung tumor ablation. Fluid filling of the target lung wing one-lung flooding (OLF) is necessary for therapeutic ultrasound applications. However, whether unilateral SHFJV allows adequate hemodynamics and gas exchange is unclear. To compared SHFJV with pressure-controlled ventilation (PCV) during OLF by assessing hemodynamics and gas exchange in different animal positions. SHFJV or PCV was used alternatingly to ventilate the non-flooded lungs of the 12 anesthetized pigs during OLF. The animal positions were changed from left lateral position to supine position (SP) to right lateral position (RLP) every 30 min. In each position, ventilation was maintained for 15 min in both modalities. Hemodynamic variables and arterial blood gas levels were repeatedly measured. Unilateral SHFJV led to lower carbon dioxide removal than PCV without abnormally elevated carbon dioxide levels. SHFJV slightly decreased oxygenation in SP and RLP compared with PCV; the lowest values of PaO2 and PaO2/FiO2 ratio were found in SP [13.0; interquartile range (IQR): 12.6-5.6 and 32.5 (IQR: 31.5-38.9) kPa]. Conversely, during SHFJV, the shunt fraction was higher in all animal positions (highest in the RLP: 0.30). In porcine model, unilateral SHFJV may provide adequate ventilation in different animal positions during OLF. Lower oxygenation and CO2 removal rates compared to PCV did not lead to hypoxia or hypercapnia. SHFJV can be safely used for lung tumor ablation to minimize ventilation-induced lung motion.

Effects of osteopathic manipulative treatment on maternal-fetal hemodynamics in third trimester pregnant women: A prospective study.

To evaluate the maternal-fetal hemodynamic effects after osteopathic manipulative treatment by measuring vital signs and Doppler velocimetry in third-trimester pregnant women. This is a prospective study with pregnant women undergoing outpatient follow-up and hospitalized in a ward at Instituto Fernandes Figueira/Fiocruz, between August 2021 to August 2022, during the SARS-CoV-2 pandemic. This study was registered in REBEC under Register Number RBR-9q7kvg and approved by the ethics committee under number 32216620.0.0000.5269. The study population was composed of 51 pregnant women between 28 and 40 weeks of gestation, over 18 years of age, allocated in a single group. Pregnancies with multiple fetuses, malformations, premature rupture of the membrane, and active labor were excluded. The procedures evaluated maternal-fetal hemodynamics using three consecutive measures of ultrasound examination with Doppler velocimetry, and three maternal vital signs measured by an electronic blood pressure monitor. Most vital signs changed after osteopathic treatment. However, only the systolic blood pressure (109.92 ±14.42 to 110.71±12.8, p = 0.033), diastolic blood pressure (79.8±11.54 to 77.57±9.44, p = 0.018) and heart rate (87.59±11.93 to 81.12±10.26, p = 0.000) in the sitting position, systolic blood pressure (110.75±13.26 to 108.59±13.07; p = 0.034) in the supine, and heart rate (83.22±11.29 to 80.39±11.0; p = 0.013) in left lateral decubitus reached statistical significance. The oximetry measures (98.55±0.64 to 98.67±0.68; p = 0.098) stayed stable during all three positions. All artery values remained stable after treatment, and no statistically significant difference was recorded in the artery results. Responses to osteopathic treatment in women in the third trimester of pregnancy did not affect uteroplacental and fetoplacental circulation. However, some maternal vital signs had statistically significant results, with a decrease in diastolic blood pressure and heart rate, and an increase in systolic blood pressure in the sitting position, a decrease of heart rate in the left lateral decubitus position, and systolic blood pressure in the supine position. All the results observed were maintained in the normal parameters. The study responses attest to the safety of using the osteopathic manipulative treatment for the fetus and for pregnant women with comorbidities.

Relationship between Body Posture Assessed by Dynamic Baropodometry and Dental Occlusion in Patients with and without Dental Pathology.

Body biomechanics and dental occlusion are related, but this interaction is not fully elucidated. The aim of this study was to investigate the association between body posture and occlusion in patients with and without dental pathology. A cross-sectional study was carried out with 29 patients divided into a control group and a group with pathology (malocclusions). Body posture was evaluated by dynamic baropodometry, analyzing parameters such as the line of gait and the anteroposterior and lateral position of the center of pressure (CoP). Occlusion was classified radiographically according to the sagittal skeletal relationship. Results showed significant differences in mean position phase line between groups (p = 0.01-0.02), with means of 115.85 ± 16.98 mm vs. 95.74 ± 24.47 mm (left side) and 109.03 ± 18.03 mm vs. 91.23 ± 20.80 mm (right side) for controls and pathologies, respectively. The effect size was large (Cohen's d 0.97 and 0.92). There were no differences in the anteroposterior (p = 0.38) or lateral (p = 0.78) position of the CoP. In gait analysis, significant differences were observed in left (548.89 ± 127.50 N vs. 360.15 ± 125.78 N, p < 0.001) and right (535.71 ± 131.57 N vs. 342.70 ± 108.40 N, p < 0.001) maximum heel strength between groups. The results suggest an association between body posture and occlusion, although further studies are needed to confirm this relationship. An integrated postural and occlusal approach could optimize the diagnosis and treatment of dental patients.

Scapula harvest in the supine position for immediate mandibular reconstruction.

The scapula is the second most popular donor site for mandibular reconstruction after the fibula. Scapula harvest is generally performed in the lateral decubitus position and the requirement of positional changes hamper the widespread use of the scapula. This study compared scapula harvest for immediate mandibular reconstruction between the supine and lateral decubitus positions. We reviewed the outcomes of 16 patients who underwent segmental mandibulectomy and immediate reconstruction of the scapula based on the angular branch of the thoracodorsal artery. The scapula was harvested in the lateral decubitus (lateral decubitus group) or supine position (supine group) in eight patients each. Several perioperative parameters were compared between the two groups. One scapula was lost because of inadvertent injury of the angular branch in the supine group. The operative time was significantly shorter in the supine group than in the lateral decubitus group. Harvesting of the scapula in the supine position is a feasible option for immediate mandibular reconstruction. Although deep anatomic knowledge and technical expertise are necessary, this strategy can eliminate positional change and significantly reduce the operative time.

Determinants of gastric residual volume before elective surgery in diabetic patients: An observational study.

We investigated factors affecting the low- and high-risk groups for aspiration by measuring gastric volume with ultrasound in diabetic patients who fasted for elective surgery. The study was conducted as an observational study. Sixty-five patients scheduled for elective surgery, aged 18-86 years, with American Society of Anesthesiologists (ASA) scores II-III, and who have diabetes were included after local ethics committee approval. Written informed consent was obtained from all participants. Demographic data of cases were recorded. Patients whose gastric residual volume (GRV) was calculated using the pupils equal, round, reactive to light, and accommodation (PERLA) formula following gastric antrum measurement in the right lateral decubitus and supine position by ultrasound were categorized as low or high risk for aspiration. Thirty-one patients were in the low-risk group, and 34 patients were in the high-risk group. Sex, weight, body mass index (BMI), hemoglobin A1c (HbA1c) values, and duration of diabetes were not statistically significant (p > 0.5). Age (p = 0.006) and fasting blood glucose (FBG) (p = 0.005) were statistically significant. The risk of aspiration decreases with age. Hyperglycemia is related to delayed gastric emptying and a high risk for aspiration. The duration of fasting, GRV, and cross-sectional area (CSA) were statistically significant (p = 0.017, p = 0.000, and p = 0.000, respectively). Gastric emptying might be delayed in diabetic patients resulting in a high risk for aspiration pneumonia. The risk of aspiration increases in young diabetic patients, and preoperative FBG measurements can provide an idea about gastric emptying in diabetic patients. Gastric ultrasound (USG) may contribute to guidelines for determining more appropriate fasting times for other patient populations, such as obese, pregnant, or child patients.

Single ferroelectric liquid crystal compounds targeted for optical voltage sensing

Nine compounds containing fluorine or chlorine atoms in the lateral position in the rigid core with a chiral terminal octyloxy-chain were synthesized mainly using Suzuki-Miyaura coupling, Mitsunobu, hydrogenation, and esterification reactions. New compounds were investigated using polarized optical microscopy (POM), differential scanning calorimetry (DSC), spectrophotometry, and electro-optical methods. A computational analysis of the effect of lateral substitution by halogen atoms on the phenyl ring on the dipole moment of the compound was provided and discussed. The designed compounds exhibit a wide temperature range of the ferroelectric phase (>40.0 °C), a low melting point (in most cases below 50.0 °C), low melting enthalpy (around 10.0–20.0 kJ/mol), a short helical pitch (in most cases below 200 nm at room temperature) and high tilt angle that ensures a cone angle of up to 90°; all those properties make them of great potential for the deformed helix ferroelectric (DHF) mode. Revealed features allow synthesized compounds in fully integrated polarization-based photonic transducers to have excellent linearity and the highest sensitivity observed in ferroelectric liquid crystals for DHF mode. For the first time, the DHF effect was reached for the single molecule FLC material in a broad temperature range down to 38 °C. These findings pave the way for a new class of optical sensors for, among others, industrial monitoring networks and brain/machine interfaces with unprecedented performance.

Arthroscopic repair of large and massive rotator cuff tears-"sandwich augmentation" with the long head of the biceps tendon: a technical note.

For most shoulder surgeons, addressing massive rotator cuff tears that have retracted ends poses a significant challenge. This study introduces a technique, termed the "sandwich augmentation technique," which incorporates the long head of the biceps tendon (LHBT) into a single-row rotator cuff repair. The procedure, performed arthroscopically with the patient in the lateral decubitus position, involves attaching the LHBT and rotator cuff tissues together to the greater tuberosity. This effectively sandwiches them within the rotator cuff footprint. The goal of this technique is to enhance the thickness of the fully interposed cuff margin, thereby providing better support for the repair. The sandwich augmentation technique, which integrates the biceps into the rotator cuff repair, has demonstrated positive clinical outcomes and moderate anatomical results. It also prevents superior migration of the humeral head in cases of large or massive rotator cuff tears. Further research is required to assess the long-term effectiveness of this procedure.