Lateral Position Research Articles

Successful Awake Fiberoptic Intubation and Ultrasound Guided Epidural Placement in Anaesthesia Management of a Case of Ankylosing Spondylitis

Ankylosing spondylitis (AS) is a chronic autoimmune spondyloarthropathy involving spine and sacroiliac joints resulting in characteristic bamboo spine (fused and rigid spine). A 41yr old male patient with Ankylosing spondylitis with history of Left THR presented with periprosthetic fracture posted for ORIF with plating. He had a classical bamboo spine with cervical involvement, MPC- 3 and restricted neck mobility. Preoperative Ultrasound scan (USG) of lumbar region done to identify spinal spaces. Awake Fiberoptic Nasal intubation done to secure difficult airway and induction done with Propofol and Vecuronium. Epidural catheter inserted at L1-L2 space using paramedian approach under USG under General Anesthesia in lateral position and Epidural analgesia given with 1% Ropivacaine. Extubation was done uneventfully with Sugammadex 2mg/kg used as reversal at end of surgery. Anaesthetic challenges in AS were both difficult airway and difficult regional anesthesia which was successfully managed with detailed evaluation and planning with USG

A Study on Position and Lumen Geometry at the Origin of External Carotid Artery in Human Adult Cadavers

Background: External carotid artery is the predominant source of blood supply to the structures in the head and neck region. Morphological anomalies in the external and internal carotid arteries may lead to severe complications, when radiographic evaluations and surgical proceedings are done in the neck without any prior knowledge. Normal arterial diameters of external carotid arteries were important in-patient selection, preoperative planning, and design of new endovascular devices for arterial reconstruction. Material and Methods: A descriptive study was performed on 60 formalin fixed male and female Human adult cadavers, aged between 45 to 75 yrs in the department of Anatomy, Dr.Pinnamaneni Siddhartha Institute of Medical Sciences and Research foundation, chinoutapalli and Mamatha academy of medical sciences, Hyderabad , during the academic years, 2018- 2023 during the academic years . Observations from both right and left external carotid arteries (total- 120 sides) were noted. Results: In the present study, positions of external carotid artery observed were, antero-medial in 90%, anterolateral in 6.66% and lateral position in 3.33% of cases. The mean ± standard deviation calculated for the diameter of lumen at the origin of external carotid artery on the right side was 0.623±0.048 cm and on the left side was 0.608±0.050cm. For both right and left sides was 0.616±0.049cm. Conclusion: Positional variations of external carotid artery observed in the present study were anterolateral and lateral positions. In such cases Carotid endarterectomy can be safely done, after transposing the internal carotid artery to normal location. Data on normal arterial diameters were helpful during reconstructive surgeries and manufacture of endovascular devices, respective to different ethnic groups. KEYWORDS: Common Carotid Artery, Carotid Artery External, Positional Variations, Lumen Geometry, Carotid Endarterectomy.

Oral Commissure Ulcer in an Extremely Preterm Infant: A Complication of Endotracheal Tube Fixation at Contralateral Oral Commissure During Lateral Positioning

Oral Commissure Ulcer in an Extremely Preterm Infant: A Complication of Endotracheal Tube Fixation at Contralateral Oral Commissure During Lateral Positioning

The impact of pillow height on neck muscle activity: a pilot study.

Muscle relaxation in the neck during sleep is crucial for achieving quality sleep, and varying pillow heights can significantly influence the myoelectric activity of the neck muscles. This study aims to investigate the effects of different pillow heights on neck muscle activity, with the goal of providing evidence-based recommendations for pillow selection. A total of 15 asymptomatic participants in this study, aged 18 to 30, were assigned to three groups based on pillow height: height 1 (0.5*Shoulder width), height 2 (1.0*Shoulder width), and height 3 (1.5*Shoulder width). Electromyography (EMG) was employed to measure muscle activity in the sternocleidomastoid and trapezius muscles during lateral sleeping positions. Sleep comfort was evaluated using a 100mm visual analog scale (VAS). Statistical analysis was conducted using ANOVA to assess the differences in muscle activity and comfort levels across the various pillow heights. The muscle activation levels revealed that both the sternocleidomastoid and trapezius muscle exhibited the lowest EMG activity in the height 2 (p < 0.001). In contrast, the sternocleidomastoid muscle recorded the highest activation, demonstrating significantly greater average electromyography (AEMG) and integrated electromyography (iEMG) at height 1 (p < 0.001). Meanwhile, the trapezius muscle showed the highest AEMG at height 3 (p < 0.001). Additionally, height 2 was identified as the most comfortable option when compared to height 1 and 3 (p < 0.001). This study concludes that varying pillow heights are linked to neck muscle activity and sleep comfort. These findings underscore the importance of an appropriate pillow height to maintain a healthy cervical spine and promote restful sleep.

Trauma

The December 2024 Trauma Roundup360 looks at: Percutaneous lumbopelvic fixation is effective in the management of unstable transverse sacral fractures; A systematic review on autologous matrix-induced chondrogenesis (AMIC) for chondral knee defects; Stable clinical and radiological outcomes at medium and over five-year follow-up of calcaneus fracture open reduction internal fixation using a sinus tarsi approach; Right or left? It might make a difference; Suprapatellar versus infrapatellar tibial nailing – is there a difference in anterior knee pain and function?; Can patients safely weightbear following ankle fracture fixation?; Anterior-to-posterior or a plate fixation for posterior malleous fractures?; Audio distraction for traction pin insertion: a prospective randomized controlled study; Is intramedullary nailing of femoral diaphyseal fractures in the lateral decubitus position as safe and effective as on a traction table?

Polysomnographic Phenotype of Positional Obstructive Sleep Apnea

Background and Objectives: Obstructive sleep apnea (OSA) is a prevalent sleep disorder characterized by recurrent upper airway obstruction, leading to disrupted sleep and various health complications. Positional OSA (POSA) refers to patients whose OSA severity is significantly influenced by body position, especially when lying supine. This study aimed to evaluate the polysomnographic characteristics of POSA and non-positional OSA (non-POSA) and to assess their clinical implications.Methods: This retrospective study included patients diagnosed with OSA who underwent type 1 polysomnography. Patients were categorized into POSA and non-POSA groups based on whether their apnea-hypopnea index (AHI) in the supine position was at least twice as high as that in the lateral position. We collected and analyzed clinical and polysomnographic parameters, including AHI, oxygen desaturation index, arousal index, nadir peripheral oxygen saturation (SpO&lt;sub&gt;2&lt;/sub&gt;), and sleep position proportions. These were compared across different OSA severity levels—mild, moderate, and severe—to assess differences between the POSA and non-POSA groups.Results: In total, 500 patients with OSA were analyzed, of whom 63.4% were classified as having POSA. Patients with POSA exhibited milder disease severity than those without, with an average AHI of 23.3±15.3/h versus 43.9±27.9/h, respectively, and a higher nadir SpO&lt;sub&gt;2&lt;/sub&gt; of 82.8%±6.6% versus 77.1%±9.8%. POSA was more common in patients with mild OSA (76.5%) and moderate OSA (72.8%), while severe OSA cases were predominantly non-POSA (POSA was 47.4%). Moreover, patients with POSA spent significantly more sleep time in the lateral position (43.8%±22.7%) than non-POSA patients (27.2%±28.2%).Conclusion: Patients with POSA generally exhibited milder disease and more favorable polysomnographic profiles than non-POSA patients. POSA is prevalent in mild-to-moderate OSA, and identifying it via polysomnography may inform tailored treatment strategies.

Validation of minimally invasive articular cartilage sparing technique for olecranon osteotomy.

The authors present a cadaveric validation of a minimally invasive articular cartilage preserving olecranon osteotomy technique for use in the operative management of distal humeral fractures. Twenty-four elbows in six male and six female formaldehyde embalmed cadavers were dissected. With the cadaver placed in a lateral decubitus position, a posterior sub-periosteal dissection was performed to the medial and lateral aspects of the olecranon at the level of the joint and Mini Hohmann retractors were inserted into each side of the ulnohumeral joint. The medial (M) and the lateral (L) points where the retractors touch the articular surface were marked with a fine marker pen (Crown point) and a line drawn between the two points. The midpoint formed the apex of the chevron osteotomy. An osteotomy was performed and analysis of the osteotomy relative to the ulnar bare area (UBA) was undertaken. The distal boundary of the UBA can be reliably found at a distance of 4.8 ± 0.4 mm (females) and 5.4 ± 0.8 mm (males) distal to the Crown point using this technique. Identifying the Crown of the olecranon articular surface is a reliable and accurate technique which identifies the ulnar bare area reproducibly for the safe performance of a cartilage sparing, and minimally invasive, olecranon osteotomy for the surgical management of distal humeral fractures.

Modified trident-shaped electrode design for particle lateral position detection in microfluidic impedance flow cytometry

Modified trident-shaped planar electrodes were developed for the detection of particles and their lateral positions inside a microfluidic flow channel. The electrodes generated time-of-flight measurements of individual moving particles in the form of a double peak, where each peak varies in amplitude and duration depending on particle trajectories. The amplitude ratio of the two peaks indicates the lateral positions of particles when crossing the electrode pairs. In particular, the ratio is 1 for particles near the channel centerline, >1 for particles displaced laterally to one-half of the channel, and < 1 for particles to the opposite half. This was confirmed by numerical simulations and detection of microspheres (6 – 10 µm ø) using proposed electrodes embedded in a polydimethyl siloxane (PDMS) microfluidic device. The device could count individual microspheres at a rate of at least 1151 per minute while identifying microspheres of the same material but differing in size based on peak amplitudes.

Examining the Lateral Positioning and Clearance of Cyclists and Motor Vehicles in Christchurch, New Zealand

The New Zealand government has introduced cycleways on existing narrow roads, leading to disruptions and inconsistencies for both motorists and cyclists. The effect on their behaviour about positioning, however, remains uncertain. This research paper investigated lateral positioning and lateral clearance using multiple Internet of Things (IoT) prototypes to quantify the relationship between motor vehicles and cyclists. Two methods were used, (1) sensors mounted on the pavement curb to collect positioning data, and (2) sensors mounted on a cyclist to collect lateral clearance data. Results show that heavy vehicles have the highest encroachment rate. Additionally, the cycleway helps steer motorists slightly farther away from cyclists while passing. The lateral clearance between cyclists and motorists on roads with cycle lanes is higher than on roads without cycle lanes. It was found that over 90% of motor vehicles meet the 1-meter separation standard, as recommended by the NZ Cycling Safety Panel.

Effect of using a birth ball on birth satisfaction and pain in pregnant women during labor: a randomized controlled trial.

This study was applied to evaluate the effect of birth ball use on birth satisfaction and pain levels of pregnant women during labor. The type of study is randomized controlled. The data of the study were collected in the delivery room of a state hospital in Konya/Türkiye between March 2020 and December 2021. The sample of the study consisted of 57 pregnant women for the intervention group and 54 pregnant women for the control group. During labor, intervention group was seated on the birth ball in an upright position; control group was laid on the bed in semi-fawler or lateral positions. In the study, Descriptive Information Form, Birth Process Follow-up Form, Visual Analog Scale and Birth Satisfaction Scale-Revised were used as data collection tools. It was determined that the pain scores of the pregnant women in the intervention group were lower during the first and second follow-up than the control group. The duration of the active phase of labor in the intervention group was shorter than in the control group, and a statistically significant difference was found between them. It was found that the Birth Satisfaction Scale-Revised total score, the sub-dimensions of quality of care, women's attributes and stress experienced during labor of the pregnant women in the intervention group were higher than the control group. According to the results of the study, the use of a birth ball during the active phase of labor reduces the pain level during labor and increases the level of birth satisfaction of pregnant women.

An integrated longitudinal and lateral control of vehicle platoons

This paper proposes an integrated longitudinal and lateral control scheme for a vehicle platoon with the predecessor-leader communication topology. Both longitudinal and lateral dynamics are established, where the lateral dynamics considers the influence of variance of the longitudinal velocity. The decoupled longitudinal and lateral controllers are designed, respectively. The longitudinal controller adopts the distributed model predictive control algorithm, which regulates the following vehicles to track the longitudinal velocity of the leading vehicle and to keep the inter-vehicle desired spacing. Both the recursive feasibility of optimization problem and the asymptotic consensus of vehicle platoons are analyzed. Furthermore, the lateral controller adopts a feedforward and robust feedback control strategy to track the reference path without offset of the lateral position error. Simulation results in joint of MATLAB/Simulink and TruckSim verify the effectiveness of the proposed scheme.

On the microdosimetric characterisation of the radiation quality of a carbon-ion beam and the effect of the target volume thickness.

Objective - Microdosimetry is gaining increasing interest in particle therapy. Thanks to the advancements in microdosimeter technologies and the increasing number of experimental studies carried out in hadron therapy frameworks, it is proving to be a reliable experimental technique for radiation quality characterisation, quality assurance, and radiobiology studies. However, considering the variety of detectors used for microdosimetry, it is important to ensure the consistency of microdosimetric results measured with different types of microdosimeters.&#xD;Approach - This work presents a novel multi-thickness microdosimeter and a methodology to characterise the radiation quality of a clinical carbon-ion beam. The novel device is a diamond detector made of three sensitive volumes (SV) of different thicknesses: 2, 6 and 12 μm. The SVs, which operate simultaneously, were accurately aligned and laterally positioned within 3mm. This allignement allowed for a comparison of the results with a negligible impact of the SVs alignment and their lateral positioning, ensuring the homogeneity of the measured radiation quality. An experimental campaign was carried out at MedAustron using a carbon-ion beam of typical clinical energy (284.7MeV/u).&#xD;Main results - The measurement results allowed for a meticulous interpretation of its radiation quality, highlighting the effect of the SV thickness. The consistency of the microdosimetric spectra measured by detectors of different thicknesses is discussed by critically analysing the spectra and the differences observed.&#xD;Significance - The methodology presented will be highly valuable for future experiments investigating the effects of the target volume size in radiobiology and could be easily adapted to the other particles employed in hadron therapy for clinical (i.e. protons) and for research purposes (e.g. helium, lithium and oxygen ions).

Relationship Between Sleep Position and Glaucoma Progression

&amp;lt;i&amp;gt;Introduction&amp;lt;/i&amp;gt;: Glaucoma, a leading cause of irreversible blindness worldwide, is strongly influenced by intraocular pressure (IOP), with recent studies suggesting that nocturnal IOP fluctuations and body position during sleep may play a critical role in disease progression. The purpose of the study was to explore the relationship between sleep position and glaucoma progression. &amp;lt;i&amp;gt;Aim of the study&amp;lt;/i&amp;gt;: The aim of the study was to evaluate the relationship between sleep position and glaucoma progression. Methods: This cross-sectional observational study was conducted at the Department of Ophthalmology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh, over a 1-year period from mid-2023 to mid-2024. A total of 40 patients were included. Data were collected retrospectively from medical records, focusing on demographic characteristics, sleep position preferences, and intraocular pressure (IOP) measurements. Descriptive statistics, chi-square tests used for data analysis, with statistical significance set at p &amp;lt; 0.05. &amp;lt;i&amp;gt;Result&amp;lt;/i&amp;gt;: Among the patients, 35.00% were aged 60-70 years, with a significant male predominance (87.50%). The most preferred sleep position was the right lateral decubitus position (LDP), chosen by 45.00% of patients, and it was associated with a mean intraocular pressure (IOP) increase of 1.8 mmHg and a 50.00% progression rate of glaucoma. Notably, patients with higher baseline IOP, representing 30.00% of the sample, experienced a mean IOP increase of 2.0 mmHg. &amp;lt;i&amp;gt;Conclusion&amp;lt;/i&amp;gt;: The study highlights that the right lateral decubitus position is strongly associated with increased intraocular pressure and higher glaucoma progression, emphasizing the need to consider sleep position and individual risk factors in glaucoma management.

High Variability of Lateral Extra-articular Tenodesis Femoral Tunnel Position With Landmark-Based Techniques

Background: The utilization of lateral extra-articular tenodesis (LET) augmentation for anterior cruciate ligament reconstruction has increased. Various fixation points have been recommended based on tactile and anatomic landmarks; however, there is limited reporting of the accuracy or precision of these techniques in clinical practice. Purpose/Hypothesis: The purpose of this study was to evaluate whether LET fixation points identified using anatomic landmarks and tactile techniques would fall within a predefined radiographic zone. It was hypothesized that the majority of LET fixation points would be inside the radiographic zone. Study Design: Cross-sectional study; Level of evidence, 4. Methods: Postoperative lateral knee radiographs of patients who underwent anterior cruciate ligament reconstruction with LET using a landmark-based technique without fluoroscopy between January 2018 and September 2023 were reviewed. Fixation points were measured by 2 raters based on their distance from an extension of the posterior femoral cortex line (PFCL) distally and a line perpendicular to the PFCL at the posterior condylar flare (PCF). Patients were excluded if the tunnel position could not be identified or if postoperative radiographs were malrotated. The mean LET position and percentage of points within the radiographic isometric zone, defined as 4 ± 4 mm posterior and 4 ± 3 mm anterior to the PFCL and 6 ± 4 mm distal and 20 ± 5 mm proximal to the PCF were calculated. Results: Complete data sets were obtained for 47 cases. The mean LET position was 6.4 ± 7.1 mm (range, –9 to 27.3 mm) anterior to the PFCL and 1.8 ± 7.6 mm (range, –16.7 to 12.6 mm) proximal to the PCF. Overall, 53% of LET fixation points were within the predefined radiographic zone. Of the malpositioned tunnels (n = 22), their locations relative to the radiographic zone were anterior (n = 18), posterior (n = 2), proximal (n = 1), and anterior and distal (n = 1). Conclusion: This study found large variation in the location of LET fixation points, and almost half of fixation points were outside the predefined radiographic zone. Accurate and precise tunnel placement is one of multiple factors that may be important to minimize the risk of lateral compartment overconstraint, anterior cruciate ligament graft failure, and anisometry leading to LET graft loosening.

Preoperative Multivariable Model for Risk Stratification of Hypoxemia During One-Lung Ventilation

BACKGROUND: Hypoxemia occurs with relative frequency during one-lung ventilation (OLV) despite advances in airway management. Lung perfusion scans are thought to be one of the most accurate methods to predict hypoxemia during OLV, but their complexity and costs are well-known limitations. There is a lack of preoperative stratification models to estimate the risk of intraoperative hypoxemia among patients undergoing thoracic surgery. Our primary objective was to develop a risk stratification model for hypoxemia during OLV based on preoperative clinical variables. METHODS: This is a single-center, retrospective cohort study including 3228 patients who underwent lung resections with OLV from 2017 to 2022, at a tertiary academic health care center in the United States. Vital signs and ventilator settings were retrieved minute by minute. Intraoperative hypoxemia was defined as an episode of oxygen desaturation (Spo 2 &lt;90%) for at least 5 minutes. Demographic and clinical characteristics were included in a stepwise logistic regression, which was used for the selection of predictors of the risk score model. All patients included in this cohort underwent elective lung surgery in lateral decubitus position, with double lumen tube and placement confirmation with fiberoptic bronchoscopy. Our model was validated internally using area under the receiver operating curves (AUC) with bootstrapping correction. RESULTS: The incidence of hypoxemia during OLV was 8.9% (95% confidence interval [CI], 8.0–10.0). Multivariable logistic regression identified 9 risk factors with their corresponding scoring: preoperative Spo 2 &lt;92% (15 points), hemoglobin &lt;10 g/dL (6 points), age &gt;60 years old (4 points), male sex (4 points), body mass index &gt;30 kg/m2 (8 points), diabetes mellitus (4 points), congestive heart failure (7 points), hypertension (3 points), and right-sided surgery (3 points). The AUC of the model after bootstrap correction was 0.708 (95% CI, 0.676–0.74). Based on the highest Youden index, the optimal score for predicting intraoperative hypoxemia was 13. The risk of hypoxemia increased from 4.7% in the first quartile of scores (0–13 points), to 32% in the third quartile (27–39 points), and 83.3% in the fourth quartile (&gt;39 points). At scores of 20 or greater, the specificity of the model exceeded 90% and reached a positive predictive value of 80%. CONCLUSIONS: The risk of hypoxemia during OLV can be stratified preoperatively using accessible clinical variables. Our risk model is well calibrated but showed moderate discrimination for predicting intraoperative hypoxemia. The accuracy of preoperative models for risk stratification of hypoxemia during OLV should be explored in prospective studies.

MR defecography: comparison of HMO system measurement between supine and lateral decubitus patient position

Background Pelvic floor dysfunction (PVD), a prevalent clinical issue impacting quality of life, can be effectively assessed using magnetic resonance defecography (MRD) with the patient either supine or in the lateral decubitus position. Purpose To compare the measurement value and grading in dynamic MRD within the closed-magnet system of PFD patients performed in supine versus lateral decubitus position using the H line, M line, and organ prolapse (HMO) classification system. Material and Methods During 2017–2019, 100 patients with PFD underwent MRD during defecation in both supine and lateral decubitus positions. MR images were measured and graded by two blinded radiologists. The mean value of each HMO parameter and grading severity were compared between supine and lateral positions. Image quality (IQ) between two positions was also evaluated. Paired t-test and Wilcoxon ranked test were performed for significant difference. P &lt; 0.05 was considered statistically significant. Results For HMO measurement, M-line, levator plate angle (LPA), urethral hypermobility (UH), uterine prolapse, and peritoneocele had significantly higher mean values when measured in the lateral decubitus position than in the supine position. For grading, M-line, uterine prolapse, and peritoneocele also had more grading severity in the lateral decubitus than supine position with statistical significance ( P = 0.002, 0.004, and 0.001, respectively). Only anterior rectocele had a mean value and grading severity in the supine more than the lateral position ( P = 0.003 and P = 0.005). IQ in the supine was better than in the lateral decubitus position ( P &lt; 0.001). Conclusion MRD in lateral decubitus showed a more severe degree of PFD in most parameters based on the HMO grading system irrespective of inferior imaging quality.

Differential effects of sleep position and sleep stage on the severity of obstructive sleep apnea.

This study compared the effects of sleeping in the supine position and rapid eye movement sleep on the severity of obstructive sleep apnea, and investigated the effect of sleep stage on position-dependent obstructive sleep apnea, and of sleep position on rapid eye movement-dependent obstructive sleep apnea. We analysed epoch-labelled polysomnographic readouts of 3843 patients, and calculated the apnea-hypopnea index for each sleep position and sleep stage. Subgroup analyses were performed to evaluate whether the proportion of position-dependent obstructive sleep apnea patients changed during rapid eye movement and non-rapid eye movement sleep, and whether that of rapid eye movement-dependent obstructive sleep apnea patients changed during supine/lateral sleep. The apnea-hypopnea index was highest in the rapid eye movement-supine position (50.7 ± 22.6 events per hr), followed by non-rapid eye movement-supine, rapid eye movement-lateral and non-rapid eye movement-lateral (39.2 ± 25.3, 22.9 ± 24.4, 15.9 ± 21.9 events per hr, respectively; p < 0.001). Patients with position-dependent obstructive sleep apnea had a higher ratio of rapid eye movement sleep, and those with rapid eye movement-dependent obstructive sleep apnea had a higher ratio of sleep time in the supine position (p < 0.001). During rapid eye movement sleep, position-dependent obstructive sleep apnea was not observed in 21.1% of patients who otherwise had position-dependent obstructive sleep apnea. In the lateral position, 36.9% of patients with rapid eye movement-dependent obstructive sleep apnea did not retain rapid eye movement dependency. Although sleeping in the supine position and rapid eye movement sleep were both associated with more frequent respiratory events, this was the first study to demonstrate that the former had a stronger correlation with obstructive sleep apnea severity. Position dependency in patients with obstructive sleep apnea decreased during rapid eye movement sleep, and worsening of rapid eye movement dependency was alleviated in the lateral position, suggesting potential for personalized obstructive sleep apnea management.

Reliability of Sensorimotor Control Tests in Individuals with Adolescent Idiopathic Scoliosis

Background: The presence of sensorimotor control deficits in adolescent idiopathic scoliosis compared to typically developed adolescents is supported by the literature but lacks reliability studies for assessment in this population. This study aimed to assess the reliability of eight sensorimotor control tests, in terms of static and dynamic balance, joint position sense (JPS) tests of the extremities and the spine, and a functional upper extremity proprioceptive test in adolescent idiopathic scoliosis subjects. Methods: Sixty adolescent idiopathic scoliosis subjects were divided into four groups. Each group underwent two tests by the same examiner, repeated at 15 min intervals. Reliability was measured using the intraclass correlation coefficient (ICC), standard error of measurement (SEM), and smallest detectable difference (SDD). Results: The results showed high reliability for the upper extremity functional proprioception test, for the dynamic and static balance test, and for the spinal lateral flexion joint position sense test in both directions. On the other hand, the shoulder external rotation, knee extension, elbow flexion, and spinal flexion joint position sense tests demonstrated poor reliability in adolescent idiopathic scoliosis subjects. Conclusions: Therapists are recommended to use the functional upper extremity proprioception test, the Fukuda test, the static balance test using a force footplate, and the spinal lateral flexion joint position sense test for assessing treatment progress in this population.

Prevalence and characteristics of positional obstructive sleep apnea in a Saudi population-based cohort.

Obstructive sleep apnea (OSA), significantly impacts public health, with varying prevalence rates across populations. Positional obstructive sleep apnea (POSA) is a subtype in which OSA predominantly occurs in the supine position. This study investigated the prevalence and characteristics of exclusive positional obstructive sleep apnea (e-POSA) in a representative Saudi population. Data from a previous cohort study on the prevalence of OSA in Saudi Arabia were utilized. A 2-phase approach was used: the first phase involved a screening questionnaire, and the second phase involved confirmatory polysomnography (PSG). E-POSA was defined as an apnea-hypopnea index (AHI) in the supine position at least twice as high as that in the lateral position, with the lateral AHI not exceeding 5. Then, an exploration method was used to estimate the prevalence of e-POSA. There were 235 OSA patients included in this study. The prevalence of e-POSA among the OSA patients was 21.28%, with a higher prevalence in females (26.76%) than in males (18.90%). However, the estimated prevalence of e-POSA in the Saudi population was 1.86%. Patients with e-POSA tended to be younger and to have lower AHI, Epworth Sleepiness Scale (ESS) and arousal index scores (P < .001). Multivariate analysis revealed that the rapid eye movement (REM) related AHI and nonsupine AHI were predictors of e-POSA (P < .01). E-POSA is common in patients with OSA. However, the estimated prevalence of e-POSA across the general population was 1.86%. Patients with e-POSA have milder disease, and the AHI-REM and AHI-nonsupine were identified as predictors.

Differentiating Essential and Dystonic Head Tremor: Exploring Arm Position Effects.

Head tremor poses diagnostic problems, especially when present as an isolated or predominant symptom. To assess how maneuvers activating upper limb postural tremor can help differentiate head tremor in essential tremor (ET) from dystonic tremor (DT) in cervical dystonia. 48 patients with head tremor (25 ET, 23 DT), underwent clinical examination and accelerometric evaluation of head and upper limb tremor during routine tremor-inducing tasks. While accelerometric power and clinical scores of head tremor did not significantly differ between patient groups, task-induced variations revealed distinctions. ET patients exhibited increased head tremor power and clinical scores during forward outstretched and lateral wing-beating arm positions, unlike DT patients. Coherence between head and upper limb tremor remained consistent. Tremor stability index showed no significant differences. Task-induced changes in head tremor could aid in distinguishing between ET and DT. Further research is needed to refine diagnostic approaches for head tremor.