Position In Patients Research Articles

Effects of sodium-glucose cotransporter 2 inhibitors on pulmonary hemodynamics in chronic heart failure patients with a pulmonary artery pressure sensor

Abstract Background Approximately 50% of patients with chronic heart failure (HF), either with preserved or reduced left ventricular ejection fraction (LVEF), have secondary pulmonary hypertension, which results in poorer prognosis. In previous studies, sodium-glucose cotransporter 2 inhibitors (SGLT2i) have shown a reduction in cardiovascular death, HF hospitalization and pulmonary artery pressure (PAP) in patients with HF, regardless of LVEF, but exact mechanisms remain unclear. Purpose The main objective of this study is to analyse effects of SGLT2i on PAP in patients with chronic HF followed by a PAP sensor (CardioMEMS HF system). The secondary objective is to analyse effects in subgroups of LVEF. Methods We included chronic HF patients (regardless of LVEF) with previously implanted a PAP sensor, from July 2019 to February 2023. SGLT2i had been added in fourth position in patients with reduced LVEF, since they were previously on optimal HF treatment as chronic patients. Changes in PAP, renal function and N-terminal pro B-type natriuretic peptide (NTproBNP) were compared between two periods of time: "30 days before" and "30 days after" SGLT2i initiation. Patients were then classified in two groups: group 1 (LVEF ≤40%) and group 2 (LVEF >40%) and repeated same analyses. Results Overall, 61 patients were screened, and 17 finally were included, mean age 71.7 ± 9.6 years, 64.7% were men, mean LVEF was 49.4 ± 17.5%, 23.5% had ischaemic aetiology and 64.7% were in NYHA class III (Table 1). There were more men in group 1 than in group 2 (p=0.043), without other differences in basal characteristics between groups (Table 1). Dapagliflozin (10mg daily) was initiated in 14 patients (82.4%), 5 from group 1 and 9 from group 2 (p=1.000), and empagliflozin (10mg daily) in 3 patients (17.6%), 1 from group 1 and 2 from group 2 (p=1.000). Before SGLT2i, mean diastolic PAP (dPAP) was 17.3 ± 5.6 mmHg and median NTproBNP was 2841.5 (289-10515) pg/mL. SGLT2i significantly reduced dPAP; average dPAP ("30 days after" period) was 1.5 mmHg lower (95% CI, 0.26-2.74; p=0.021) compared to "30 days before" period (Figure 1). SGLT2i also reduced systolic PAP (-2.2 mmHg), mean PAP (-1.7 mmHg), NTproBNP (-183 pg/mL) and creatinine (-0.2 mg/dL), but not statistically significant. SGLT2i reduced PAP, NTproBNP and creatinine too in group 1 (6 patients), but did not achieve statistical significance. Reductions were as well observed in group 2 (11 patients), and SGLT2i significantly reduced dPAP (-2.04 mmHg) (95% CI, 0.31-3.77; p=0.025). Conclusions In patients with chronic HF and a PAP sensor, SGLT2i, added to previous HF treatment, significantly reduced dPAP. PAP reductions were observed regardless LVEF, but results were more robust in patients with LVEF >40%.Figure 1

Defibrillation success with a second generation intercostal extravascular ICD lead and commercially available left pectoral pulse generator

Abstract Background/Introduction An investigational intercostal extravascular ICD lead has been developed for compatibility with commercially available pulse generators (PGs) that are placed in a left pectoral position in appropriate patients. This is substantially different from currently available extravascular ICD systems that require a custom PG placed in a left lateral position. Purpose The purpose of this analysis was to evaluate sensing and defibrillation of a second-generation intercostal, extravascular defibrillation lead (EV-ICD Lead) when used with currently available ICD PGs in a traditional left pectoral location. Methods Patients (n=20) undergoing an ICD implant or replacement underwent acute VF EV-ICD Lead connected to a left pectoral pulse generator. Induced VF was sensed and shocked using a 10 J safety margin, with subsequent higher-energy shocks delivered if required. Testing was also conducted in the left lateral pocket for a paired analysis with patients serving as their own control. Results Automatic sensing of acute, induced VF episodes from the left pectoral PG was successful in 19 of 20 patients (95%) whose pre-induction R-waves were greater than 1.0 mV and unsuccessful in one subject with a pre-induction R-wave of 0.3 mV. VF was successfully terminated with a 10 J safety margin in 17 of 20 (83%) patients, a 5 J safety margin in 2 of 20 (10%) patients and failed to convert one patient (BMI 32.9) from the pectoral pocket (however, conversion was successful from a lateral pocket with a 10 J shock, which provides a 30 J safety margin. With a left lateral ICD, 100% of patients demonstrated successful VF termination with ≥10 J safety margin. Conclusion(s) Sensing and defibrillation using a left pectoral PG location is feasible with a new intercostal, extravascular defibrillation lead.

Impact of Exclusive Mouth Route and lateral position on the efficacy of oronasal CPAP to treat Obstructive Sleep Apnea in Patients with Obstructive Sleep Apnea Adapted to Oronasal Mask

BackgroundOronasal masks are widely used for treating OSA with CPAP. However, oronasal CPAP is associated with lower effectiveness and lower adherence than nasal CPAP. Research QuestionWhat is the impact of oral route and lateral position in patients well adapted to oronasal CPAP? Can these patients be switched to nasal CPAP? Study Design and MethodsPatients with OSA on oronasal CPAP underwent 2 CPAP polysomnography (PSG) titrations in random order using an oronasal mask with 2 independent sealed compartments connected to two separate pneumotachographs. One study was done with the nasal and oral compartments opened and the other study with only the oral compartment opened. CPAP titration was done in the supine and lateral position. Finally, the patients were offered a nasal mask. A third PSG was performed using nasal CPAP. ResultsTwenty OSA patients (baseline AHI: 52 ± 21 events/h) adapted to oronasal CPAP were studied. Most patients (75%) were oronasal breathers on optimal CPAP. Oral CPAP was less effective to treat OSA than oronasal CPAP, evidenced by a higher residual AHI (2 (1 - 6.0) vs 12.5 (1.8 - 28.3); P = 0.003), despite a significantly higher CPAP level, (10 (9 - 10) vs 11 (10 - 12) cmH20; P = 0.003). The residual AHI was significantly lower in the lateral position for both oronasal and oral CPAP. Finally, patients (75%) agreed to change and preferred to continue on nasal mask, which resulted in lower CPAP and better OSA control. InterpretationThe effectiveness of oronasal CPAP to abolish OSA is significantly decreased when patients are required to breathe exclusively through the mouth. Oronasal CPAP efficacy is significantly better in the lateral position. The transition to nasal mask results in higher CPAP effectiveness to treat OSA.

Use of a Microelectromechanical Systems Sensor for Objective Measurements of Abnormal Head Posture in Congenital Superior Oblique Palsy Patients.

The purpose of this study was to design an objective method for measurement of head positions as achieved with use of a microelectromechanical systems (MEMS) sensor. In addition, to use this system to observe the abnormal head position (AHP) in patients with congenital superior oblique palsy (SOP) before and after their surgery. An MEMS sensor was designed for recording of the pitch, roll, and yaw values of the head position in real time. The MEMS sensor was then fixed on the synoptophore from -30 degrees to +30 degrees positions horizontally and vertically to test the accuracy of these measurements. Then, we tested 13 participants with AHP using the MEMS method and the photographic method and compared their correlations. Finally, the pitch, roll, and yaw values of head positions were measured using this MEMS sensor in 31 patients with congenital SOP as performed before and after their surgery. The MEMS sensor (LPMS-B2; Alubi, Guangzhou, China; 400 hertz [Hz]), as based on the theory of a gyroscope, was designed and connected to a smartphone via Bluetooth. It was able to conveniently record the patient's pitch, roll, and yaw head positions in real time, recordings which were consistent with the scales of the synoptophore (P > 0.05) and good correlations with the photographic method (P < 0.001). The main preoperative AHP in patients with SOP was roll (22/31, 71%). Pre- and postoperative vertical deviations were 16.4 ± 7.3 prism diopters (PD) and 4.1 ± 4.2 PD, respectively (P = 0.001). The AHP in patients with SOP was positively correlated with the angle of extorsion in the dominant eye (P = 0.01), rather than that of the vertical deviation. The MEMS sensor described in this report is a simple, practical, and accurate objective device for use in head position measurements. In patients with SOP, the AHP is related to the angle of extorsion in the dominant eye. The MEMS sensor was designed as a micro-wireless dynamic high-precision device for AHP measurement, which has the potential for use in a clinic.

Does the utilization of fluoroscopy affect the accuracy of prosthesis position in patients undergoing hip replacement surgery via the direct anterior approach compared to the posterolateral approach for an experienced surgeon? A single-center retrospective study

BackgroundThe direct anterior approach (DAA) for total hip arthroplasty (THA) has gained popularity due to perceived advantages in achieving better early outcomes. However, the theoretical benefits such as precise implant positioning and accurate leg length restoration are still inconsistent. In this study, we compared implant position and leg length discrepancy (LLD) of the DAA and posterolateral approach (PLA) conducted by a single surgeon who had mastered both approaches.MethodsThis study retrospectively reviewed the medical records and radiographic images of 244 patients who underwent THA between 2012 and 2021 by a single experienced surgeon using either the DAA (n = 120) or PLA (n = 124). Postoperative pelvic anteroposterior radiographs at 6 months follow-up were used to assess acetabular component inclination and anteversion, as well as LLD. Mann-Whitney U tests and Chi-squared test were performed to compare outcomes between the two approaches.ResultsNo significant differences were observed in patient demographics between the two groups. The DAA group demonstrated significantly lower postoperative LLD (0.00 mm) compared to the PLA group (5.00 mm, p < 0.0001). No significant difference was observed in the Lewinnek zone for cup anteversion and inclination angles between the two groups.ConclusionsFor experienced surgeons in other approaches, our findings suggest transferring to the DAA may not substantially improve cup positioning, but it might slightly enhance limb length measurement. For surgeons already proficient in other approaches and deciding to maintain those approaches, their primary concern for optimal THA outcome should be striving for leg length equivalence.

Prone position applied to COVID-19 patients: Systematic review-meta-analysis.

Position change and interventions to increase lung capacity should be considered in mechanically ventilated patients. The most effective of these is the prone position. This systematic review and meta-analysis aimed to determine the effects of the prone position on respiratory parameters and outcomes and to guide nurses working in the intensive care unit. This systematic review-meta-analysis was conducted in accordance with the Preferred Reporting in Systematic Reviews and Meta-Analyses guideline. ScienceDirect, CINAHL, Academic Search Complete (EBSCOhost), MEDLINE, EMBASE, Web of Science, Cochrane and PubMed databases were searched between January 2022 and January 2023 to access studies related to prone position in COVID-19 patients. Twenty-three studies were included. This meta-analysis shows that a prone position is feasible and can achieve improvements in gas exchange. Prone position increases PaO2/FiO2 in the majority of patients followed with a diagnosis of COVID-19 and severe hypoxemic. The study has shown that the prone position is effective in improving patients' respiratory function and oxygenation. The results presented in this article support the notion that the prone position can be an effective strategy in the clinical management of COVID-19 patients.

Pelvic and Lower Limb Kinematics in Individuals With Chronic Low Back Pain During Sit-to-Stand Function: A Cross-Sectional Study

ObjectivesThe aim of this study was to investigate the 3-dimensional movement kinematics of pelvic and lower limb joints in CLBP subjects, compared to healthy individuals, utilizing a functional data analysis (FDA) approach. MethodsIn this study, a 7-camera Qualisys motion capture system was employed to record the kinematics of the pelvic, hip, knee, and ankle joints in 20 patients with low back pain (LBP) and 20 control subjects on both sides during the sit-to-stand motion. An FDA statistical approach was utilized to compare the data collected over time between the 2 groups. The STS task was divided into two distinct phases: the prelift off phase (pre-Lo) and the postlift off phase (post-Lo). ResultsDuring the “pre-Lo phase” of the STS motion, our statistical analysis revealed that the only significant difference between the two groups was a decreased medial rotation (P = .00) in the hip joint position of LBP patients on their dominant side, in comparison to healthy subjects. As for the “post-Lo phase,” the LBP group exhibited a more anterior pelvic tilt position (P = .00) and increased pelvic counterclockwise rotation (P = .03) in the sagittal and transverse planes when compared to the control group. Regarding hip joints, the LBP group demonstrated a more flexed position (indicative of reduced extension) on both the dominant (P = .00) and nondominant (P = .00) sides, coupled with diminished abduction (P = .04) and internal rotation (P = .03) of the hip on the dominant side. In relation to the knee and ankle joints, the results indicated a more adducted knee position (P = .00) and decreased ankle joint flexion (P = .02) on the dominant side in CLBP subjects when compared to the healthy group during the STS motion. ConclusionOur findings indicate that patients with CLBP exhibited distinct kinematic patterns in the pelvic and lower limb joints during the STS motion. These kinematic alterations primarily manifest in the joints of the dominant limb, with most of the differences observed during the second phase (postlift off phase) of the motion. It appears that these changes in pelvic and lower limb joint kinematics should be taken into account when planning future rehabilitation programs for CLBP patients engaged in this task.

Respiratory effects of prone position in COVID-19 acute respiratory distress syndrome differ according to the recruitment-to-inflation ratio: a prospective observational study

BackgroundImprovements in oxygenation and lung mechanics with prone position (PP) in patients with acute respiratory distress syndrome (ARDS) are inconstant. The objectives of the study were (i) to identify baseline variables, including the recruitment-to-inflation ratio (R/I), associated with a positive response to PP in terms of oxygenation (improvement of the ratio of arterial oxygen partial pressure over the inspired oxygen fraction (PaO2/FiO2) ≥ 20 mmHg) and lung mechanics; (ii) to evaluate whether the response to the previous PP session is associated with the response to the next session.MethodsIn this prospective, observational, single-center study in patients who underwent PP for ARDS due to COVID-19, respiratory variables were assessed just before PP and at the end of the session. Respiratory variables included mechanical ventilation settings and respiratory mechanics variables, including R/I, an estimate of the potential for lung recruitment compared to lung overinflation.ResultsIn 50 patients, 201 PP sessions lasting 19 ± 3 h were evaluated. Neuromuscular blockades were used in 116 (58%) sessions. The PaO2/FiO2 ratio increased from 109 ± 31 mmHg to 165 ± 65 mmHg, with an increase ≥ 20 mmHg in 142 (71%) sessions. In a mixed effect logistic regression, only pre-PP PaO2/FiO2 (OR 1.12 (95% CI [1.01–1.24])/every decrease of 10 mmHg, p = 0.034) in a first model and improvement in oxygenation at the previous PP session (OR 3.69 (95% CI [1.27–10.72]), p = 0.017) in a second model were associated with an improvement in oxygenation with PP. The R/I ratio (n = 156 sessions) was 0.53 (0.30–0.76), separating lower- and higher-recruiters. Whereas PaO2/FiO2 improved to the same level in both subgroups, driving pressure and respiratory system compliance improved only in higher-recruiters (from 14 ± 4 to 12 ± 4 cmH2O, p = 0.027, and from 34 ± 11 to 38 ± 13 mL/cmH2O, respectively, p = 0.014).ConclusionsA lower PaO2/FiO2 at baseline and a positive O2-response at the previous PP session are associated with a PP-induced improvement in oxygenation. In higher-recruiters, lung mechanics improved along with oxygenation. Benefits of PP could thus be greater in these patients.

Study of the Diagnostic Accuracy Between the Position of the Articular Disc According to Magnetic Resonance Imaging and Arthroscopy Findings for Temporomandibular Disorders.

The aim of this study was to prospectively evaluate the diagnostic accuracy between the position of the disc in the temporomandibular joint (TMJ) according to findings on magnetic resonance (MRI) imaging and the position of the disc depending on the "roofing" in arthroscopic evaluation in patients who underwent arthroscopy for a temporomandibular disorder (TMD). This relationship was analyzed in 298 patients diagnosed with internal derangements. The concordance between the 2 methods was evaluated using the κ coefficient. A significant agreement was observed between the findings in MRI and roofing in arthroscopy with an excellent concordance between the variables (κ=0.83, P<0.05). This indicates that both diagnostic methods are equally valid in the precise description and evaluation of the disc position for patients with a TMD undergoing arthroscopy.

Comparison of supine and prone mini percutaneous nephrolithotomy in obese patients: a retrospective study.

To compare the safety and effectiveness of Mini Percutaneous Nephrolithotomy (m-PNL) operations performed in the supine and prone positions in obese patients. We retrospectively analysed data from obese patients (BMI ≥ 30) who underwent prone or supine mPCNL between January 2014 and June 2021 in our clinic. Kidney anomalies, coagulopathy, solitary kidney, skeletal deformity, and patients under 18 were excluded. Outcomes measures included operation time, fluoroscopy time, duration of hospitalisation, stone-free rate, and complications classified by Clavien-Dindo. Statistical analysis was performed using SPSS version 26. The study included 338 patients (100 supine, 238 prone). Supine mPCNL had a shorter mean operation time (89.6 vs. 100.3 minutes, p=0.001), fluoroscopy time, and duration of hospitalisation (60.7 vs. 112.0 hours, p=0.001). Overall complication rates were comparable, but major complications were higher in the prone group (p=0.041). Logistic regression identified stone size >25 mm and prone position as significant risk factors for major complications. Supine and prone mPCNL are both effective for treating kidney stones in obese patients. Supine mPCNL offers benefits, such as shorter operation time, reduced radiation exposure, and fewer major complications. Careful monitoring is recommended for patients with high CCI scores or larger stones due to increased complication risks.

Initial Defibrillator Pad Position and Outcomes for Shockable Out-of-Hospital Cardiac Arrest

Ventricular fibrillation (VF) or pulseless ventricular tachycardia (pVT) are the most treatable causes of out-of-hospital cardiac arrest (OHCA). Yet, it remains unknown if defibrillator pad position, placement in the anterior-posterior (AP) or anterior-lateral (AL) locations, impacts patient outcomes in VF or pVT OHCA. To determine the association between initial defibrillator pad placement position and OHCA outcomes for patients presenting with VF or pVT. This prospective cohort study included patients with OHCA and VF or pVT treated by a single North American emergency medical services (EMS) agency from July 1, 2019, through June 30, 2023. The study included patients with OHCA treated by a large suburban fire-based EMS agency that covers a population of 550 000. Consecutive patients with an initial EMS-assessed rhythm of VF or pVT receiving EMS defibrillation were included. Pediatric patients (younger than 18 years), interfacility transfers, arrests of obvious traumatic etiology, and patients with preexisting do-not-resuscitate status were excluded. AP or AL pad placement. Return of spontaneous circulation (ROSC) at any time with secondary outcomes of pulses present at emergency department (ED) arrival, survival to hospital admission, survival to hospital discharge, and functional survival at hospital discharge (cerebral performance category score of 2 or less). Measures included adjusted odds ratios (aOR), multivariable logistic regressions, and Fine-Gray competing risks regression. A total of 255 patients with OHCA were included (median [IQR] age, 66 [55-74] years; 63 females [24.7%]), with initial pad positioning documented as either AP (158 patients [62.0%]; median [IQR] age, 65 [54-74] years; 37 females [23.4%]) or AL (97 patients [38.0%]; median [IQR] age, 66 [57-74] years; 26 females [26.8%]). Patients with AP placement had higher adjusted odds ratio (aOR) of ROSC at any time (aOR, 2.64 [95% CI, 1.50-4.65]), but not significantly different odds of pulses present at ED arrival (1.34 [95% CI, 0.78-2.30]), survival to hospital admission (1.41 [0.82-2.43]), survival to hospital discharge (1.55 [95% CI, 0.83-2.90]), or functional survival at hospital discharge (1.86 [95% CI, 0.98-3.51]). Competing risk analysis found significantly greater cumulative incidence of ROSC among those at risk with initial AP placement compared with AL (subdistribution hazard ratio, 1.81 [95% CI, 1.23-2.67]; P = .003). In this cohort study of patients with OHCA and VF or pVT, AP defibrillator pad placement was associated with higher ROSC compared with AL placement.

Efficacy of D33 Sealed Foam in Preventing Skin Injury from Surgical Positioning: Randomized Clinical Trial.

Objective: To evaluate the efficacy of density-33 (D33) sealed foam in preventing skin injuries from surgical positioning. Approach: The study, reported according to the Consolidated Standards of Reporting Trials, is characterized as a randomized clinical trial, double mask, with 64 adult patients undergoing elective surgery, 35 allocated to the control group (CG), positioned on a conventional surgical table, and 29 to the experimental group (EG), positioned on a conventional surgical table overlaid with a D33 sealed foam support surface (SS) in the occipital, sacral, and heel regions. Simple randomization was carried out, as was masking of the researcher who evaluated the skin of the patient and the statistician. Data collection was carried out immediately preoperatively, intraoperatively, and postoperatively until the third day or until patient discharge. Statistical analysis included measures of association in contingency tables, χ2, and relative risk to compare the incidence of injuries between groups. Results: Skin injuries were greater in the CG, with blanchable erythema being the main injury. The use of D33 sealed foam reduced the incidence of injury in the EG by 61.2% (relative risk: 0.39; 95% confidence interval: 0.220-0.684; p < 0.001). Innovation: One of the first clinical studies to demonstrate that using a D33 sealed foam SS decreased the incidence of blanchable erythema from surgical positioning. Conclusion: D33 sealed foam was effective in preventing skin injury from surgical positioning in patients undergoing elective surgeries.

Comparative Evaluation and Correlation of Hyoid Bone Position, Airway Dimension, and Psychological Status in Class II Vertical and Horizontal Malocclusion Cases With Temporomandibular Disorder Compared to Class I Non-Temporomandibular Disorder Cases.

Introduction Temporomandibular disorder (TMD) involves discomfort and impaired function in the masticatory muscles and temporomandibular joint (TMJ), with a multifaceted etiology that includes biomechanical, neuromuscular, psychological, and biological factors. This research aims to assess and correlate the hyoid bone position, airway dimensions, and psychological status in class II Hz (horizontal) and Vt (vertical) malocclusion cases with TMD in contrast to non-TMD class I cases. Methodology This research was carried out at the Orthodontics Department, Sharad Pawar Dental College and Hospital, Sawangi, with consent obtained from the ethical committee. A total of 63 adult patients with class I, class II horizontal, and class II vertical malocclusions were selected. TMD was diagnosed using the Helkimo index, and patients were categorized accordingly. Psychological status was evaluated using the Warwick-Edinburgh scale, while the placement of hyoid bone and airway dimensions were assessed using lateral cephalograms. Statistical analysis involved descriptive and inferential statistics using SPSS version 27.0, with a significance level ofp < 0.05. Results The research showed a noteworthy difference in the hyoid bone's location, airway dimensions, and psychological status among the three groups. Class II TMD patients (both vertical and horizontal) exhibited higher hyoid bone positions and larger Go-Hy-Me angles (angle formed by the gonion-hyoid line and the hyoid-menton line)compared to class I patients. In addition, class II vertical TMD patients showed the most reduced airway dimensions. Psychological assessments indicated higher stress, anxiety, and depression levels in class II TMD patients, particularly in the vertical group, compared to class I non-TMD patients. Conclusion This study highlights the intricate relationships between hyoid bone position, airway dimensions, and psychological status in TMD patients. TMD patients present with hyoid bones positioned closer to the cranium and mandible, larger Go-Hy-Me angles, and reduced airway dimensions. Psychological distress exacerbates TMD symptoms, negatively impacting overall well-being and quality of life. Orthodontists should consider these interrelated factors when devising treatment plans to improve patient outcomes. Future longitudinal studies with larger samples and advanced imaging techniques are recommended to further elucidate these interactions.

Evaluation under loading detects medial meniscus extrusion in patients with reconstructed anterior cruciate ligament and restricted knee extension.

Some patients who undergo anterior cruciate ligament (ACL) reconstruction experience abnormal mechanical stress in the meniscus. Medial meniscal extrusion (MME) is reflected in the pathological condition of the meniscus, which expands owing to repetitive mechanical stress. Thus, the effect of the reconstructed ACL on increasing MME under weight-bearing conditions remains unclear. This study investigated the effect of ACL reconstruction on meniscal extrusion under non-weight-bearing and weight-bearing conditions. Seventeen patients who underwent unilateral ACL reconstruction (ACL group) and 20 age-matched healthy volunteers (control group) were enrolled. Ultrasonography was performed in the supine, standing, and walking positions in preoperative and postoperative ACL patients. MME during walking was evaluated based on the dynamic behavior of extrusion, and kinetic and kinematic data were synchronously obtained. Moreover, the ACL group underwent magnetic resonance imaging (MRI) evaluation at two points: preoperatively and 12months postoperatively, and the ultrasound findings were compared. MME in the supine position measured using both ultrasonography and MRI was not significantly different preoperatively and postoperatively in the ACL group. However, postoperative MME and dynamic behavior of extrusion under standing and walking conditions were significantly higher than those in the preoperative state (dynamic behavior: 0.9 ± 0.4mm preoperatively, 1.2 ± 0.4mm postoperatively). Moreover, the deficits in knee extension during walking persisted postoperatively and were significantly higher than those in the control group. MME in patients with ACL reconstruction including meniscus repair was different under mechanical stress compared to the non-weight bearing condition.

Effect of Lavender Oil Leg Massage on Physical, Cognitive, and Psychological Variables of Patients with Hypertension: A Randomized Controlled Trial.

Hypertension (HTN) is one of the most important non-communicable risk factors that cause cardiovascular diseases. Complementary therapies including massage and aromatherapy are widely used in the management of HTN. However, studies on aromatherapy massage in HTN are limited. Thus, this study was conducted to evaluate the effect of lavender oil leg massage on physical (cardiopulmonary function), cognitive, and psychological variables of patients with HTN. A parallel-group randomized controlled trial, comprising 100 HTN patients aged 44.99 ± 5.39 years who were recruited and randomly divided into the study group (SG) and control group (CG), was conducted. The SG received lavender oil leg massage, while the CG received supine rest for 20 min. Outcome variables like blood pressure (BP), pulse rate (PR), random blood sugar (RBS) level, oxygen saturation, pulmonary function, oral temperature, trail making test (TMT) A and B, and state anxiety and mindfulness were assessed before and after the intervention. The within-group analysis showed a significant improvement in systolic blood pressure, diastolic blood pressure, PR, RBS, TMT-A, TMT-B, and state mindfulness both in the SG and CG. However, a significant reduction in state anxiety was observed only in the SG unlike the CG. Moreover, the between-group analysis showed a significant improvement in state mindfulness and state anxiety in the SG compared to the CG. The results of this study suggest that lavender oil leg massage is effective in reducing BP and RBS, and improving cognitive function in hypertensive patients. In addition, it is more effective in reducing anxiety and improving mindfulness than rest in supine position in patients with HTN.

THE EFFECT OF SARCOPENIC OBESITY AND VISUAL IMPAIRMENT ON BASIC FUNCTIONAL ACTIVITY

Age-associated cataracts and diabetic retinopathy in combination with sarcopenic obesity, formed mainly against the background of physical inactivity due to vision deficiency, potentially contribute to a decrease in patients' activity in daily life, but the latter has not been studied practically by special tests taking into account visual impairment. Objective. Assess the impact of diabetic retinopathy and cataracts on the daily activities of elderly patients with sarcopenic obesity. Materials and methods. The study involved 128 patients aged 60–74 years with cataracts and sarcopenic obesity and 125 patients of the same age with diabetic retinopathy and sarcopenic obesity. All patients underwent a comprehensive clinical and instrumental ophthalmological examination. The appropriate criteria presented in the clinical guidelines were used in the diagnosis of cataracts and diabetic retinopathy. Sarcopenia was determined by the European Working Group on Sarcopenia in older people scale, supplemented by carpal dynamometry, and obesity was determined by body mass index. Results. A more significant effect of cataracts combined with sarcopenic obesity, causing complete dependence on others (12,18 scores) in daily life activities, was found than the effect of diabetic retinopathy combined with sarcopenic obesity, causing moderate dependence (10,18 scores) (p&lt;0.01). Patients of the compared groups also have statistically significant differences in all types of activities in everyday life, including leading ones – threading a needle and cutting nails. In particular, restrictions on threading into a needle in patients with cataracts and sarcopenic obesity have 1,84±0,03 scores, which is significantly higher than in patients with diabetic retinopathy and sarcopenic obesity (p 0,01). A similar pattern has been established for nail clipping, the limits for which are 1,75±0,03 and 1,43±0,04 scores, respectively. However, the following ranking places of the considered limitations of activity in everyday life differ statistically significantly, and in the third position in patients with cataracts and sarcopenic obesity is self–writing (1,68±0,04 scores), and in patients with diabetic retinopathy and sarcopenic obesity – reading the text (1,38±0,03 scores) (p&lt;0,01). The fourth rank also differs when in patients with cataracts and sarcopenic obesity it corresponds to reading the text (1,53±0,04 scores), and in patients with diabetic retinopathy and sarcopenic obesity – writing the text (1,32±0,02 scores) (p&lt;0,01). Factor analysis of the effect of cataracts combined with sarcopenic obesity and diabetic retinopathy combined with sarcopenic obesity showed the greatest factor load in both groups on the formation of dependence on others when threading a needle (0,829 and 0,572, respectively) and when performing nail clipping (0,807 and 0,469, respectively), however, the effect of cataracts and sarcopenic obesity on The development of limitations of these types of activities in everyday life is more significant than diabetic retinopathy and sarcopenic obesity. Conclusion. Among the considered age-associated ophthalmic diseases in the elderly, cataracts combined with sarcopenic obesity significantly limit the activity of patients in everyday life.

Effect of transcutaneous electrical nerve stimulation therapy on condylar position and myofascial pain in patients with temporomandibular joint disorders-A pilot clinical trial.

Temporomandibular joint disorders (TMD) are a type of disorder that affects the temporomandibular joint, muscles, and nerves leading to persistent facial pain. Transcutaneous electrical nerve stimulation (TENS) therapy is an alternative treatment for pain relief in TMD patients. The aim of the study was to assess the condylar position changes and pain levels occurring in TMD patients after TENS therapy. According to the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) criteria, a total of seven patients with TMD were included in this study. Routine diagnostic investigations were taken for each patient along with joint vibration analysis (JVA), electromyography (EMG), and a cone beam computed tomography (CBCT) at rest position. Using the Dolphin software (version 11.95), the temporomandibular joint spaces were measured on the CBCT for the right and left sides individually for each patient. These patients were then subjected to TENS therapy, and an EMG reading was taken post-TENS therapy to evaluate the effect on muscle strain. A CBCT was taken after the TENS therapy to assess its effect on the condylar position. The statistical significance of the pre- and post-temporomandibular joint spaces and the EMG readings post-TENS therapy were assessed using paired t-tests, respectively. There was a change in the anterior, middle, and posterior dimensions observed radiographically, before and after TENS. However, the results were found to be statistically significant only in the anterior region on the right joint space (P = 0.03) and posterior region of the left joint space (P = 0.04). TENS therapy has been found to bring about a change in the condylar position and pain intensities by relieving inadvertent muscle activity in the temporomandibular region. Therefore, further studies with larger sample sizes and control are required to fully ascertain the role of inadvertent muscle activity on the TMJ.

Clinical efficacy study of position-responding mandibular advancement device in patients with obstructive sleep apnea.

Although mandibular advancement device (MAD) treatment is effective in patients with obstructive sleep apnea (OSA), there are still some concerns about its potential therapeutic and side effects. Thus, we developed a novel MAD that auto-titrates depending on its position in patients with OSA. Therefore, we conducted a clinical trial to determine the efficacy of an auto-titrating mandibular advancement device (AMAD) for treating OSA. Fourteen patients with OSA were enrolled in this study. Polysomnography (PSG) was conducted at the start of the clinical trial, and PSG with AMAD in situ was performed after three months of treatment. The mean Epworth Sleepiness Scale (ESS) and STOP-Bang scores were 8.21 ± 4.21 and 5.00 ± 1.00, respectively. After 3 months of treating AMAD, STOP-Bang scores improved to 3.75 ± 1.06; however, there was no significant change in ESS scores. Additionally, we found statistically significant improvements in several respiratory parameters in the PSG data after AMAD treatment. The AHI (32.85 ± 21.71 to 12.93 ± 10.70), supine AHI (45.91 ± 23.58 to 15.59 ± 12.76), lateral AHI (13.94 ± 10.95 to .49 ± 7.40), lowest O2 saturation (79.71 ± 6.22 to 84.00 ± 5.71), total arousal number (191.14 ± 112.07 to 86.57 ± 48.80), and arousal index (33.76 ± 21.00 to 15.05 ± 8.42) were recorded. However, there were no significant changes in total sleep time, sleep efficiency, or mean oxygen saturation. Additionally, we did not observe any major side effects during treatment, specifically related to tooth or jaw pain. Our clinical trial revealed that AMAD improved PSG parameters and reduced the incidence of common side effects. Therefore, AMAD may be an effective alternative treatment for OSA.

Binocular Visual Deficits at Low to High Spatial Frequency in Intermittent Exotropia After Surgery.

To investigate binocular visual deficits at low to high spatial frequencies in patients with intermittent exotropia (IXT) after surgical correction, using the binocular orientation combination task. Thirteen patients whose IXT has been aligned surgically (17 ± 4.8 years old; 7 females) and 13 normal individuals (21.8 ± 2.5 years old; 6 females) were recruited. All participants had normal or corrected-to-normal visual acuity. The IXT patients had undergone surgery at least one month prior to the study and achieved successful eye alignment post-surgery. We measured participants' balance points (BPs), defined as the interocular contrast ratio (nondominant eye/dominant eye) when both eyes contributed equally to binocular combination, using the binocular orientation combination task at three spatial frequencies (0.5, 4.0, and 8.0 cycles/degree). The absolute values of log10(BP) (i.e., |logBP|) and the area under of the |logBP| versus spatial frequency curve were used to quantify the extent of binocular imbalance. Surgery aligned the eye position of patients with IXT, with a postoperative exodeviation of -4.92 ± 4.29 prism diopters at distance. Participants' |logBP| values showed significant differences between groups, F(1,24) = 9.175, P = 0.006, and across spatial frequencies, F(2,48) = 7.127, P = 0.002. However, the interaction between group and spatial frequency was not significant, F(2,48) = 0.379, P = 0.687. Patients whose IXT has been alighted surgically experience binocular imbalance across a wide range of spatial frequencies, with greater binocular imbalance occurring at high spatial frequencies than low spatial frequencies.

Effects of individualized positive end-expiratory pressure on intraoperative oxygenation and postoperative pulmonary complications in patients requiring pneumoperitoneum with Trendelenburg position: A systematic review and meta-analysis.

Whether individualized positive end-expiratory pressure (PEEP) improves intraoperative oxygenation and reduces postoperative pulmonary complications (PPCs) remains unclear. This systematic review and meta-analysis examined whether individualized PEEP is associated with improved intraoperative oxygenation and reduce PPCs for patients needing pneumoperitoneum with the Trendelenburg position during surgery. Medline, Embase, the Cochrane Library, and www.clinicaltrials.gov were searched for randomized controlled trials evaluating the effects of individualized PEEP on intraoperative oxygenation and PPCs in patients who required Trendelenburg positioning with pneumoperitoneum. The primary outcome was the oxygenation (PaO2/FiO2) during the procedure. Secondary outcomes included PPCs, intraoperative respiratory mechanics (driving pressure, compliance), and vasopressor consumption. DerSimonian-Laird random effects models were used to calculate mean differences (MDs) and log risk ratios (log RRs) with 95% confidence intervals (CIs). The Cochrane Risk-of-Bias tool 2.0 was applied to assess the risk of bias in included studies. The protocol of this meta-analysis has been registered in PROSPERO. We included 14 studies (1121 patients) that employed different individualized PEEP strategies. Compared with control groups, individualized PEEP groups exhibited a significantly improved intraoperative PaO2/FiO2 (MD=56.52mm Hg, 95% CI: [33.98, 79.06], P<0.001) and reduced incidence of PPCs (log RR=-0.50, 95% CI: [-0.84, -0.16], P=0.004). Individualized PEEP reduced driving pressure while improving respiratory compliance. Intraoperative vasopressor consumption was similar between both groups. The weighted mean PEEP in the individual PEEP groups was 13.2 [95% CI, 11.7, 14.6] cmH2O. No evidence indicated that one individualized PEEP strategy is superior to others. Individualized PEEP seems to work positively for lung protection in the Trendelenburg position and pneumoperitoneum in patients undergoing general anesthesia.