Recumbent Position Research Articles

Upright positioning facilitates the absorption of macular hole-related oedema.

To investigate changes in macular hole-related oedema depending on positioning. Prospective interventional study of 40 patients with primary macular hole (MH). Optical coherence tomography scanning was done at 9 a.m., 1 p.m., and 3 p.m. Between the first and second scanning, the patients were instructed to stay upright, whereas they were positioned recumbent thereafter. Automated mean retinal thickness measurements were derived from the ETDRS grid for the central, parafoveal, and perifoveal subfields. Mean ocular perfusion pressure (MOPP) was calculated for all time points. Primary endpoints were changes in MH-related oedema from 9 a.m.-1 p.m., and from 1 p.m.-3 p.m. In upright position from 9 a.m.-1 p.m., the mean parafoveal retinal thickness decreased from 362μm (SD = 56) to 350μm (SD = 51) (P < 0.001). The reduction of MH-related oedema when upright was positively correlated with a reduction in MOPP. Eyes with vitreomacular traction (VMT) exhibited significantly less reduction in MH-related oedema compared to eyes without VMT. In recumbent position from 1 p.m.-3 p.m., the mean parafoveal retinal thickness increased to 356μm (SD = 52) (P = 0.002). MH-related oedema belongs to the non-vasogenic cystoid maculopathies. The decrease in MH-related oedema when upright and its positive correlation to a reduction in MOPP is therefore unexpected. In recumbent position, the situation is reversed, and the oedema increases. This may be related to subtle leakage from the retinal capillaries. The presence of VMT seems to counteract the resolution of the oedema. In a clinical setting, upright positioning after MH surgery facilitates absorption of the oedema which is beneficial for MH closure. What is known: Macular hole formation is associated with cystoid macular oedema, possibly due to hydration of the outer retinal layers exposed to the hypotonic vitreous fluid. This oedema promotes the elevation of the hole edges from the retinal pigment epithelium. Macular hole-related oedema decreases when the patients are upright and increases, in parallel with an increase in mean minimum macular hole diameter, when they are recumbent. The reduction of macular oedema is correlated with a reduction in mean ocular perfusion pressure, indicating that the oedema is influenced by subtle leakage from retinal capillaries. The results suggest that upright positioning might be beneficial in the early postoperative period of macular hole surgery.

Upright versus recumbent lumbar spine MRI: Do findings differ systematically, and which correlates better with pain? A systematic review.

Recumbent MRI is the most widely used image modality in people with low back pain (LBP), however, it has been proposed that upright (standing) MRI has advantages over recumbent MRI because of its ability to assess the effects of being weight-bearing. It has been suggested that this produces systematic differences in MRI parameters and differences in the correlation between MRI parameters and pain or disability in patients thus, potentially adding clinically helpful information. This paper aims to review and summarize the available empirical evidence for or against these two hypotheses. Systematic review of the literature (PROSPERO ID: CRD42017048318). Studies should be based on paired observations of MRI findings in the upright and recumbent positions. Studies needed a minimum of 15 participants. People aged 18 or older with or without low back pain ± radiculopathy OUTCOME MEASURES: All continuous, ordinal, and dichotomous parameters based on MRI images. All measures of pain or disability. Studies assessing MRI parameters both in upright and recumbent positions on the same individuals measured on continuous, ordinal, or dichotomous scales were included. For each parameter, the expected direction of the difference between recumbent and upright position was specified as an increase, no change, or decrease. Information on the observed distribution of individual differences was extracted from included studies and subjected to meta-analyses if sufficient data was available. Observed differences were then compared with the prespecified expectations. Studies were also screened for information on correlations between patients' pain and/or disability and MRI parameters or differences between patient subgroups defined by patients' pain and/or disability. 19 studies were identified, including 5.082 participants with LBP (16 studies) and 166 participants without low back pain (5 studies). Twenty-five MRI parameters were measured on a continuous scale, ten parameters were assessed on an ordinal scale, and 15 parameters were reported as dichotomous data. The observed differences between recumbent and upright MRI were mostly consistent with the prespecified expectations. Correlations between patients' pain or disability level and MRI parameters were reported in only one study, and three studies reported comparisons of MRI parameters across subgroups of patients defined by pain or disability characteristics. Higher correlations or larger effect sizes when using the upright position were observed in most results reported. For most MRI parameters, the direction of the observed difference between assessment in recumbent and upright positions aligned with the pre-specified expectation implied by the weight-bearing position. This confirms the existence of a systematic difference between the two positions. Performing an MRI upright instead of recumbent position may increase the correlation with pain, but final evidence for this property is still missing. The clinical significance of upright MRI is still unclear, and there is a need to directly investigate the impact of MRI findings on clinical decision-making and patient outcomes.

Imaging of Aspiration: When to Suspect Based on Imaging of Bacterial Aspiration, Chemical Aspiration, and Foreign Body Aspiration.

Aspiration-related syndromes comprise a broad spectrum of diseases affecting the airways and lung parenchyma resulting from inadvertent entry of oropharyngeal or gastric contents into the respiratory tract. The diagnosis can be challenging given lack of self-reported symptoms and unwitnessed or silent aspiration events. Aspiration is a common finding in healthy individuals suggesting that host defenses play a critical role in the pathophysiology. In the absence of strict criterion, a high index of suspicion is necessary based on recognition of established risk factors and identification of characteristic imaging findings. Conditions predisposing to altered levels of consciousness and neuromuscular weakness can lead to dysphagia, impaired cough reflux, and subsequent aspiration. The most salient feature on imaging is the anatomic location of the abnormalities, with the superior segments of the lower lobes and posterior segments of upper lobes involved in the recumbent position, and basilar segments of lower lobes in the upright position. Acute syndromes include pneumonia, pneumonitis, and foreign body aspiration. In the more indolent form of aspiration, bronchiectasis, diffuse bronchiolitis, and interstitial lung disease can develop. A detailed understanding of associated radiographic findings for these syndromes can help to implicate aspiration as the cause for imaging abnormalities and ultimately optimize patient management.

Feasibility of continuous physical activity monitoring: first-month recovery markers following joint replacement surgery.

The role of physical activity (PA) monitoring during the recovery after orthopaedic surgeries is unclear. This study aimed to explore early changes in the pattern and level of PA following orthopedic surgeries. This observational feasibility study included 11 hip replacement patients (four females) with a mean age of 66 years and five knee replacement patients (four females) with a mean age of 65 years. A PA tracker was used to collect the patients' daily PA data, including duration of various activity categories, steps taken, and activity intensity count. The PA tracker recorded data from two weeks prior to surgery until four weeks after the surgery. Ratios of PA parameters for each of the first four weeks following surgery were calculated in relation to preoperative measurements. Compared to preoperative measurements, during the first four weeks after the surgery, the time spent in a recumbent position decreased from 112% to 106%, while continuous walking time and activity intensity count increased from 27% to 77% and from 35% to 73%, respectively. Step counts increased from 18% to 67%, and sit-to-stands rose from 65% to 93%. No significant changes were found in sitting, standing, sporadic walk time, and sporadic steps. Continuously measuring PA using wearable sensors was feasible in orthopedic patients during the perioperative period. Continuous step count, walking time, activity intensity count showed noticeable changes and stable patterns demonstrating their potential for remote monitoring of patients during the early postoperative period.

Focusing on Sedentary Behavior in Comprehensive Cardiac Rehabilitation

In recent years, the adverse effects of prolonged sedentary behavior in daily life, so-called 'sitting too much', on health have been pointed out. Sedentary behavior is defined as 'all waking behavior in which the energy expenditure in a sitting, semi-recumbent, or recumbent position is 1.5 metabolic equivalents or less'. Even if a person engages in the level of physical activity recommended in the guidelines, sitting for too long at other times may increase the risk of developing various diseases and death. For patients with cardiovascular disease, a comprehensive cardiac rehabilitation program that systematically includes not only medical treatment but also exercise therapy, patient education, and disease management is extremely important. Also, differences in sedentary behavior during the acute and recovery phases are known to affect physical function and activities of daily living at the time of hospital discharge. Here, we discuss cardiac rehabilitation that addresses sedentary behavior and review the previous related research.

Effects of hydrostatic pressure, osmotic pressure, and confinement on extracellular matrix associated responses in the nucleus pulposus cells ex vivo

Spinal movement in both upright and recumbent positions generates changes in physicochemical stresses including hydrostatic pressure (HP), deviatoric stress, and confinement within the intradiscal compartment. The nucleus pulposus (NP) of the intervertebral disc is composed of highly negatively charged extracellular matrix (ECM), which increases osmotic pressure (OP) and generates tissue swelling. In pursuing regenerative therapies for intervertebral disc degeneration, the effects of HP on the cellular responses of NP cells and the ECM environment remain incompletely understood. We hypothesized that anabolic turnover of ECM in NP tissue is maintained under HP and confinement. We first clarified the effects of the relationships among HP, OP, and confinement on swelling NP explants isolated from bovine caudal intervertebral discs over 12 h. We found that the application of confinement and constant HP significantly inhibits the free swelling of NP (p < 0.01) and helps retain the sulfated glycosaminoglycan. Since confinement and HP inhibited swelling, we incubated confined NPs under HP in high-osmolality medium mimicking ECM-associated OP for 7 days and demonstrated the effects of HP on metabolic turnover of ECM molecules in NP cells. The aggrecan core protein gene was significantly upregulated under confinement and constant HP compared to confinement and no HP (p < 0.01). We also found that confinement and constant HP helped to significantly retain smaller cell area (p < 0.01) and significantly prevent the severing of actin filaments compared to no confinement and HP (p < 0.01). Thus, we suggest that NP's metabolic turnover and cellular responses are regulated by the configuration of intracellular actin and fibrillar ECMs under HP.

Classification of windswept posture in daily life using tri-axial accelerometers.

An asymmetric windswept posture is often seen in children with severe cerebral palsy (CP). However, it is still unclear how long children with CP remain in the windswept posture in daily life. Thus, we developed a triple-accelerometer system for detecting windswept posture. The aim of this study was to assess the validity of a system for classifying various body postures and movements. We assessed the accuracy of our system in nine healthy young adults (age range, 21-23 years). The participants wore acceleration monitors on the sternum and both thighs, then spent 3 min each in eight different positions and three physical activities. Once accuracy was confirmed, we assessed the posture and movements for 24 h in six healthy young adults (age range, 21-23 years) in their home environments. The body postures and activities were correctly detected: the agreement across the subjects were 100% compatible with the subjects' activity logs at least 68% of the time, and at least 96% of the time for recumbent positions. We concluded that the proposed monitoring system is a reliable and valid approach for assessing windswept hip posture in a free-living setting.

Fetuses with deceleration of growth improve their growth following maternal rest.

The purpose of this study was to determine if fetuses with deceleration of growth velocity resulting in an EFW <10th percentile increase their growth above the 10th percentile following 2 weeks of maternal rest in the left lateral recumbent position. This was a retrospective observational study of 265 fetuses with the prenatal diagnosis of an EFW <10th percentile. Fetuses were classified by four definitions of abnormal growth velocity: (1) a growth velocity less than 20 g/day, (2) 30 percentile decrease in the EFW, (3) 50 percentile decrease in the EFW, and (4) abnormal growth trajectory. Once the fetuses were identified with an EFW <10th percentile the patient was requested to begin 2 weeks of rest in the left lateral recumbent position during her waking hours following which the EFW was reassessed 2 week later to determine the effect of maternal rest on the EFW. Irrespective of the four types of decreased growth velocity described in the methods section, there was as significant increase (p < 0.001) in the EFW following 2 weeks of maternal rest as follows: (1) growth less than 20 g/day (75%); (2) decrease of 30 or more EFW percentiles (79%); (3) decrease of 50 or more EFW percentiles (64%); and abnormal growth trajectory (77%). This suggests an important role of increased maternal cardiac output as the result of resting in the left lateral recumbent position that may be associated with improved fetal growth. These observations should be the basis for future prospective randomized trials to test this hypothesis.

Repercussions of SARS-CoV-2 infection on intrapulmonary shunt in patients undergoing one-lung ventilation

BackgroundHypoxic pulmonary vasoconstriction is the most important regulatory mechanism by which right-to-left shunts decrease during one-lung ventilation (OLV), but the effects of pulmonary microarterial thrombosis and impaired HPV after SARS-CoV-2 infection on intrapulmonary shunt during OLV remain unknown. The aim of this study was to observe the changes of intrapulmonary shunt in patients undergoing thoracoscopic partial pneumonectomy at different periods after SARS-CoV-2 infection compared with patients without SARS-CoV-2 infection history.MethodsA total of 80 patients who underwent elective thoracoscopic partial lung resection and were classified as American Society of Anaesthesiologists (ASA) grades I-II were selected and divided into 4 groups (n = 20 in each group): patients not infected with SARS-CoV-2 (Group A), patients infected with SARS-CoV-2 for 5–8 weeks (Group B), patients infected with SARS-CoV-2 for 9–12 weeks (Group C), and patients infected with SARS-CoV-2 for 13–16 weeks (Group D). For all patients, the same anaesthesia method was adopted, and anaesthesia was maintained with propofol, remifentanil, and cisatracurium. Radial artery and mixed venous blood gases were measured at 10 min of two-lung ventilation (TLV), 15 min of one-lung ventilation (OLV15), and 30 min of OLV (OLV30) in the lateral recumbent position to calculate the intrapulmonary shunt. Multiple linear regression analysis was employed to investigate the association between intrapulmonary shunt and SARS-CoV-2 infection.ResultsQs/Qt at TLV was significantly higher in Groups B and C than in Group A (P < 0.05), and PaO2 at TLV was significantly lower in Groups B and C than in Group A (P < 0.05). Qs/Qt values at OLV15 and OLV30 were significantly higher in Group B, C or D than in Group A (P < 0.05), and PaO2 values at OLV15 and OLV30 were significantly lower in Groups B, C or D than in Group A (P < 0.05). Multiple linear regression analysis revealed that SARS-CoV-2 infection (95%CI -4.245 to -0.679, P = 0.007) was an independent risk factor for increased intrapulmonary shunt during TLV, while SARS-CoV-2 infection (95%CI 0.124 to 3.661, P = 0.036), exacerbation of COVID-19 clinical classification (95%CI -5.203 to -1.139, P = 0.003), and persistent symptoms (95%CI -12.122 to -5.522, P < 0.001) were independent risk factors for increased intrapulmonary shunt during OLV after SARS-CoV-2 infection.ConclusionSARS-CoV-2 infection increased intrapulmonary shunt and reduced oxygenation. Although oxygenation improved at TLV after 13–16 weeks of infection, intrapulmonary shunt and oxygenation under OLV took longer to recover.Trial registrationChinese Clinical Trial Registry, Retrospectively registered, Full date of first registration: 17/05/2023, Registration number: ChiCTR2300071539.

Fluid distribution during surgery in the flat recumbent, Trendelenburg, and the reverse Trendelenburg body positions.

The distribution and elimination of infused crystalloid fluid is known to be affected by general anesthesia, but it is unclear whether changes differ depending on whether the patient is operated in the flat recumbent position, the Trendelenburg ("legs up") position, or the reverse Trendelenburg ("head up") position. Retrospective data on hemodilution and urine output obtained during and after infusion of 1-2 L of Ringer's solution over 30-60 min were collected from 61 patients undergoing surgery under general anesthesia and 106 volunteers matched with respect to the infusion volume and infusion time. Parameters describing fluid distribution in the anesthetized and awake subjects were compared by population volume kinetic analysis. General anesthesia decreased the rate constant for urine output by 79% (flat recumbent), 91% (legs up) and 91% (head up), suggesting that laparoscopic surgery per se intensified the already strong anesthesia-induced fluid retention. General anesthesia also decreased the rate constant governing the return of the distributed fluid to the plasma by 32%, 15%, and 70%, respectively. These results agree with laboratory data showing a depressive effect of anesthetic drugs on lymphatic pumping, and further suggest that the "legs up" position facilitates lymphatic flow, whereas the "head up" position slows this flow. Both Trendelenburg positions increased swelling of the "third fluid space". General anesthesia caused retention of infused fluid with preferential distribution to the extravascular space. Both Trendelenburg positions had a modifying influence on the kinetic adaptations that agreed with the gravitational forces inflicted by tilting to body.

In-Vivo MRI in Rodents: A Protocol for Optimal Animal Positioning.

Magnetic resonance imaging (MRI) is a potentially powerful novel peripheral nerve diagnosis technique. To determine its validity, in-vivo preclinical studies are necessary. However, when using a rodent model, positioning rats and achieving high-resolution images can be challenging. We present a short report that outlines an optimal protocol for positioning rats for in-vivo MRI acquisition. Female Sprague-Dawley rats with sciatic nerve injury were induced into anesthesia using 4% isoflurane in oxygen and maintained at 1.5%. Rats were placed into a plexiglass cradle in a right lateral recumbent position, and a surface coil was placed over the left leg. Respiration rate and body temperature were monitored throughout the scan. Our protocol was successful as rats were able to undergo MRI scanning safely and efficiently. There were no adverse reactions, and clear images of the left sciatic nerve were obtained. Animal positioning took 30 minutes, and 5 different acquisitions were obtained in 2 hours. The total time from anesthesia induction to recovery was under 3 hours. Given the increasing interest in MRI diagnostic techniques, we hope this report aids other researchers studying peripheral nerve injury imaging in rat models.

Advanced Sensing System for Sleep Bruxism across Multiple Postures via EMG and Machine Learning.

Diagnosis of bruxism is challenging because not all contractions of the masticatory muscles can be classified as bruxism. Conventional methods for sleep bruxism detection vary in effectiveness. Some provide objective data through EMG, ECG, or EEG; others, such as dental implants, are less accessible for daily practice. These methods have targeted the masseter as the key muscle for bruxism detection. However, it is important to consider that the temporalis muscle is also active during bruxism among masticatory muscles. Moreover, studies have predominantly examined sleep bruxism in the supine position, but other anatomical positions are also associated with sleep. In this research, we have collected EMG data to detect the maximum voluntary contraction of the temporalis and masseter muscles in three primary anatomical positions associated with sleep, i.e., supine and left and right lateral recumbent positions. A total of 10 time domain features were extracted, and six machine learning classifiers were compared, with random forest outperforming others. The models achieved better accuracies in the detection of sleep bruxism with the temporalis muscle. An accuracy of 93.33% was specifically found for the left lateral recumbent position among the specified anatomical positions. These results indicate a promising direction of machine learning in clinical applications, facilitating enhanced diagnosis and management of sleep bruxism.

Laparoscopic resection for retroperitoneum ganglioneuroma with Supine hypotension syndrome

BackgroundSupine hypotension syndrome (SHS) has been reported to occur due to compression by a giant tumor such as ovarian tumor. We herein report a case of retroperitoneal ganglioneuroma with SHS treated with laparoscopic resection.Case presentationThe patient was an 11-year-old male with right-sided abdominal pain. He had a pale complexion and tachycardia while falling asleep. Computed tomography (CT) and magnetic resonance imaging (MRI) showed a giant mass lesion (60 × 35 mm) with compression of the inferior vena cava (IVC) and duodenum ventrally and the right kidney caudally. The IVC was flattened by mass compression. Abdominal ultrasonography (US) revealed narrowing of the IVC due to the mass and accelerated blood flow after IVC stenosis in the supine and left lateral recumbent position. His pale complexion and tachycardia while falling asleep was thought to be due to decreased venous return caused by the tumor compressing the IVC, resulting hypotension. 123I-MIBG scintigraphy revealed no abnormal findings. Tumor markers were normal. He was diagnosed with SHS due to a right adrenal gland tumor. The tumor compressed the IVC from the dorsal side, and hemostasis was expected to be difficult during bleeding. Therefore, a guidewire was inserted from the right femoral vein into the IVC for emergency balloon insertion during bleeding. A laparoscopic tumor resection was performed. A histopathological examination confirmed the diagnosis of primary retroperitoneal ganglioneuroma.ConclusionsThe treatment of symptomatic retroperitoneal tumors requires a multidisciplinary approach.

Assessment of the pelvic and body interface pressure during different recumbent and semi-recumbent birthing positions

BackgroundChildbirth, a multifaceted physiological event, undergoes dynamic changes influenced significantly by the chosen birthing position, impacting comfort and maternal and neonatal outcomes among other factors. This study aimed to investigate the bed-body interface pressure across five commonly adopted birthing positions, particularly focusing on their influence on pelvic expansion biomechanics during labour. MethodsTwenty healthy participants, aged between 18 and 49 years, were evaluated. Interface pressure across multiple regions of interest, including the head, shoulder, pelvis, and full body, were meticulously assessed under different combinations of leg and back positioning. FindingsSignificant variations in interface pressure were observed based on chosen positions. Post hoc pairwise comparisons showed different pressure distributions for all regions of interest, with the combination of legs in stirrups and a flat back resulting in the lowest average pressure in the pelvic region. During the closed glottis pushing task, this combination exhibited lower peak pressure and peak pressure index in the pelvic region compared to other positions. InterpretationWhile upright positions are conventionally preferred, the study underscores the nuanced implications of recumbent and semi-recumbent positions. Although using stirrups with a flat back exerts less pressure, lying flat can impede blood flow and exacerbate pain, while stirrups might lead to discomfort and potential complications. Given these complexities, healthcare providers must consider multiple factors to determine optimal birthing positions. The interplay between birthing positions and obstetric outcomes awaits further exploration and refinement, marking an exciting frontier in maternal care.

Investigation of the Usefulness of Implants With Locking Mechanisms for Diffuse Idiopathic Skeletal Hyperostosis (DISH)-Induced Thoracic and Lumbar Fractures in Patients Operated in the Prone Position.

Background Diffuse idiopathic skeletal hyperostosis (DISH) is a disease that causes bone growth in the spine and musculoskeletal system, and even minor trauma can cause fractures that often require surgery. DISH-induced fractures show a tendency for bone loss when operated in the prone position, which can lead to poor fusion and implant failure; therefore, surgery in the lateral recumbent position is often recommended. However, inserting a pedicle screw (PS) in the lateral recumbent position is technically difficult. This study examined the effectiveness of the repair and fixation of thoracic and lumbar spine fractures using implants with locking mechanisms in the prone position in patients with DISH. Methods We retrospectively analyzed the data from 11 patients (six males and five females; mean age: 87 years) who underwent surgery for thoracic and lumbar fractures caused by DISH between December 2023 and June 2024. Surgery was performed in the prone position using PSs or transdiscal screws (TSDs) for DISH. Ennovate® implants manufactured by B-BRAUN were used. The fixed range was three above-three below for PSs and two above-two below for TSDs. The evaluation parameters were the height/level of injury, operative time, blood loss, local kyphosis angle, anterior wall height ratio, and complications. The local kyphosis angle was measured as the angle between the upper and lower endplates of the fractured vertebrae. The ratio of the anterior wall height was evaluated. Results The average operative time was 87 min (52-172 min), and the average blood loss was 40ml (10-140 ml). The preoperative and postoperative local kyphosis angle was -8.7° and -2.4°, respectively, and the average local kyphosis angle improvement was 6.3° (0.1-14°). The preoperative and postoperative anterior wall height ratio was 132% and 110%, respectively, and the average anterior wall height ratio improvement was 22% (2-82%). No complications, such as screw deviation, implant loosening, loss of correction, or skin problems, were observed. Conclusion This study demonstrated that DISH-induced thoracic and lumbar spine fractures could be repaired and fixed using implants with locking mechanisms in the prone position. The prone position is familiar to spine surgeons and is considered safe. Additionally, screw migration may occur due to decreased bone density in the vertebral bodies with DISH; in such cases, it would be better to fix the screw without forcing it to be repositioned.

Association between postoperative shoulder pain and left-side laparoscopic urologic surgery: a single-center retrospective cohort study.

Postoperative shoulder pain is a common problem after laparoscopic surgery. This study aimed to investigate the association between operative side and postoperative shoulder pain following urologic laparoscopic surgery performed in the lateral recumbent position. This was a retrospective cohort study conducted at a single tertiary care center. A total of 506 patients who underwent urologic laparoscopic surgery (including adrenalectomy, radical nephrectomy, partial nephrectomy, and pyeloplasty) between January 2010 and December 2019 were included. Patients who underwent total nephroureterectomy or resection of other organs were excluded. The primary outcome was the incidence of postoperative shoulder pain. A multivariable logistic regression analysis investigated the association between the operative side and postoperative shoulder pain. Among the 506 included patients, there were an equal number of surgeries on the left and right sides. Eighty-eight patients had postoperative shoulder pain. The incidence of postoperative shoulder pain in the left-side group was significantly higher than that in the right-side group (21.3% [54/253] versus 13.4% [34/253], crude odds ratio = 1.75, 95% confidence interval [CI] 1.07-2.89). After adjustment for potential confounders (age, sex, body mass index, operation duration, operative technique, epidural block, peripheral nerve block, American Society of Anesthesiologists physical status classification, and intraoperative rocuronium dose), the left operative side was found to be associated with postoperative shoulder pain (adjusted odds ratio = 1.89, 95% CI 1.15-3.09). The left operative side is associated with an increased incidence of postoperative shoulder pain after urologic laparoscopic surgery performed in the lateral recumbent position.

Modified dorsal recumbent position versus lithotomy position for flexible ureteroscopic lithotomy: a multicenter prospective randomized controlled clinical trial.

The lithotomy position (LP) may pose limitations and discomfort for elderly patients and those with a history of lower limb surgery, potentially leading to an increased risk of complications. And the LP is the conventional position during flexible ureteroscopic lithotomy for the treatment of ureteral calculi. However, it has some disadvantages, such as peripheral nerve injury and deep venous thrombosis in the lower limbs, etc. Therefore, we performed a new approach, which is named as modified dorsal recumbent position (MDRP). Currently, there is a lack of systematic analysis and standardization regarding the surgical positioning for flexible ureteroscopic lithotripsy. The objective of the study was to assess whether there were any disparities in the overall duration of the procedure when comparing the MDRP with the LP. The investigation of the optimal position for flexible ureteroscopic lithotomy is essential for enhancing patient safety and comfort. This is a prospective, multicenter, randomized clinical trial. A total of 144 patients with renal or ureteral calculi from April 2021 to June 2022 were enrolled. Eligible patients were randomized to the MDRP group (n=72) or LP group (n=72). The patient's demographics, the placement of the surgical position (time of position placement, time of disinfection and towel laying, time of position return, degree of medical fatigue) and the operation safety (time of operation, time of ureteroscope from bladder neck to ureteral orifice, heart rate, blood pressure) of two groups were compared and analyzed. Between the two groups, the body positioning time (93.8±31.6 vs. 134.8±40.1 s, P=0.02), operation time (71.8±36.7 vs. 77.7±48.6 min, P=0.04), the time from the bladder neck to the ureteral orifice of the flexible ureteroscope spent by the doctors (3.4±4.7 vs. 10.3±14.7 s, P<0.001) and incidence rate of patient's lower limb soreness (19.4% vs. 49.7%, P=0.01) in the MDRP group were significantly shorter than those in the LP group. However, there was no significant difference in the stone removal rate (87.6% vs. 85.4%, P=0.09) or postoperative hospitalization days (4.3±1.4 vs. 4.1±1.6 d, P=0.08) between the two groups. This trial showed that the MDRP could not only effectively shorten the operation time, shorten the time from the bladder neck to the ureteral orifice of the ureteroscopic lithotripsy, but also place the patient's body in a functional position, stabilize the blood pressure during the operation, improve the comfort of the patient. Chinese Clinical Trial Registry (No. ChiCTR2100053416).

Upright Versus Recumbent Position in the Second Stage of Labor for Women With Epidural Analgesia: A Randomized Clinical Trial

Epidural analgesia (EA) is an effective and common method of pain relief during labor. However, EA may also have some adverse effects like prolonged labor, increased risk of operative delivery, and some unwanted complications. It's unclear how maternal position affects the outcomes of natural birth with EA. This study aimed to compare mode of delivery and maternal and neonatal outcomes between recumbent and upright positions in nulliparous women with EA. This randomized clinical trial involved 540 women who received EA at cervical dilatation of 4 to 6 cm. During the second stage of labor, they were instructed to adopt upright or recumbent position. The main outcome was the mode of delivery. The secondary outcomes included duration of labor, pain intensity, the Apgar score, and other maternal and neonatal complications. Finally, 528 women were included in the final analysis. The upright group had a higher rate of cesarean section than the recumbent group. The duration of the labor stages did not differ between the groups. The pain intensity in the second stage was higher in the upright position. The Apgar score at 1 and 5 minutes was higher in the recumbent group. There was no difference in terms of other outcomes between the groups. Recumbent positions are beneficial in the case of rate of cesarean, mother’s pain, and Apgar score in women with EA. So, adopting a recumbent position during the second stage of labor may be preferable for women with EA.

Continuous cuff pressure control on middle-aged and elderly patients undergoing endoscopic submucosal dissection of the esophagus effect of airway injury.

Assessment of the effect of continuous cuff pressure control on airway injury in middle-aged and elderly patients undergoing endoscopic submucosal dissection (ESD). A total of 104 eligible middle-aged and elderly patients requiring esophageal ESD from July 2022-September 2023 at the First Affiliated Hospital of Nanchang University were selected and randomly divided into two groups: the group undergoing general anesthesia tracheal intubation with continuous control of cuff pressure after intubation (Group A, n = 51) and the group undergoing general anesthesia tracheal intubation with continuous monitoring without control of cuff pressure (Group B, n = 53). After endotracheal intubation in Group A, under the guidance of an automatic cuff pressure controller, the air was used to inflate the tracheal cuff until the cuff pressure was 25-30cmH2O. The cuff pressure after intubation was recorded, and then the cuff pressure parameters were directly adjusted in the range of 25-30cmH2O until tracheal extubation after the operation. After endotracheal intubation, patients in Group B inflated the tracheal cuff with clinical experience, then monitored and recorded the cuff pressure with a handheld cuff manometer and instructed the cuff not to be loosened after being connected to the handheld cuff manometer-continuous monitoring until the tracheal extubation, but without any cuff pressure regulation. The patients of the two groups performed esophageal ESD. The left recumbent position was taken before the operation, and the cuff's pressure was recorded. Then, insert the gastrointestinal endoscope to find the lesion site and perform appropriate CO2 inflation to display the diseased esophageal wall for surgical operation fully. After determining the location, the cuff pressure of the two groups was recorded when the cuff pressure was stable. After the operation, the upper gastrointestinal endoscope was removed and the cuff pressure of the two groups was recorded. Postoperative airway injury assessment was performed in both groups, and the incidence of sore throat, hoarseness, cough, and blood in sputum was recorded. The incidence of postoperative airway mucosal injury was also observed and recorded in both groups: typical, episodic congestion spots and patchy local congestion. The incidence of normal airway mucosa in Group A was higher than that in Group B (P < 0.05). In comparison, the incidence of occasional hyperemia and local plaque congestion in Group A was lower than in Group B (P < 0.05). Continuous cuff pressure control during operation can reduce airway injury in patients with esophageal ESD and accelerate their early recovery after the operation.

The Effect of Postoperative Sleeping Position on Knee Extension and Range of Motion Following Primary Total Knee Arthroplasty.

Total knee arthroplasty (TKA) is an orthopaedic operation that improves quality of life and reduces pain in patients with disabling arthritis of the knee. One commonly recognized complication is flexion contracture of the knee. Early physical therapy helps prevent flexion contracture and improve range of motion (ROM) postoperatively. This study evaluated postoperative sleeping position and its effect on terminal knee extension and ROM following primary TKA. We hypothesized that patients who slept in the supine position would achieve earlier knee extension and greater ROM when compared to those in the lateral recumbent position. A total of 150 consecutive primary TKAs were performed by a single surgeon (J.M.C.) from April 2014 to December 2014. The data were collected prospectively to determine preoperative ROM, postoperative ROM, and sleeping position. Mean postoperative terminal extension ROM at 1 month was 2.9 degrees in the supine group versus 6.0 degrees (p<.001) in the lateral group. No significant demographic differences between the two groups at baseline were found. Our results demonstrate that sleeping position affects initial postoperative terminal extension, however, not overall ROM. We found a statistically significant difference in extension when comparing patients in the supine versus lateral group. Patients who slept in the lateral position lacked 6 degrees of extension which is greater than the 5 degrees needed for normal gait mechanics. Those in the supine group lacked 2.9 degrees of extension, allowing for normal gait mechanics. This study identifies an easy, effective means of increasing patients initial ability to achieve knee extension and satisfaction following TKA.