Supine Position Group Research Articles

Effect of prone position on clinical outcomes of nonintubated patients with COVID-19: A randomised clinical trial

Prone positioning (PP) is a well-known respiratory support approach. Limited data are available for the use of PP in non-intubated patients with COVID-19. This study aims to investigate the effect of PP on the clinical outcomes of patients with COVID-19 pneumonia. In This clinical trial, the participants in the PP group (n=41) were asked to lie comfortably in a prone position for 90minutes. In the supine position (SP) group (n=41), the participants were asked to lie comfortably in a supine position for 90minutes. Clinical data such as oxygen saturation, respiratory rate, the severity of dyspnea, mean arterial pressure, and pulse rate were assessed at 0 (immediately before), 30, 60, 90minutes after the start of the intervention and 30min after resuming the supine position. The participants in the PP group were then asked to intermittently stay in a prone position for a total of eight hours per 24hours of hospitalization. The participants in the control group were asked to remain in their usual positions during the hospital stay. Finally, the length of hospital stay, intubation rate, and survival assessed. Prone positioning was associated with significant improvement in oxygen saturation (P = 0.001), respiratory rate (P=0.004), the severity of dyspnea (P=0.014), and mean arterial pressure (P=0.027). There was no significant difference between the two groups in terms of pulse rate (P=0.890), hospital stay (P=0.994), intubation rate (P=0.324), and survival (P=0.091). Our results demonstrated that prone positioning showed marked improvement in some short-term clinical outcomes in non-intubated patients with COVID-19. Prone positioning can be considered an inexpensive, accessible, and simple measure in awake non-intubated patients with COVID-19.

Effect of Surgery in the Steep Trendelenburg Position on Blood Pressure Stability of the Elderly Candidate for Open Radical Prostatectomy: A Randomized Controlled Clinical Trial

Background and Objectives: The stability of blood pressure and maintaining the cerebral perfusion pressure are of particular importance in anesthesia of the elderly. There is scant clinical trials on the advantages of the steep Trendelenburg position in prostatectomy. This study aims to evaluate the effect of surgery in the steep Trendelenburg position on blood pressure stability of the elderly candidate for open radical prostatectomy surgery. Methods: This randomized controlled clinical trial was conducted at Shahid Beheshti Hospital in Hamadan, Iran, in 2022. Sixty older adults candidates for elective open radical prostatectomy were selected by a convenience sampling method and randomly allocated to the steep Trendelenburg position and supine position groups. Patients in the first group were in a 15° steep Trendelenburg position before surgery. Patients in the second position group remained in the supine position during surgery. The mean systolic and diastolic blood pressures were assessed after anesthesia, after positioning, and during surgery at 30-min intervals. The data were analyzed in SPSS software, vertion 22 using independent t-test and repeated measures ANOVA. Results: The mean age of the patients was 60.9±4.2 years, and their mean body mass index was 24.7±3.5 kg/m2. There was no significant difference in the mean systolic and diastolic blood pressures between the two groups (P>0.05). The results of repeated measures ANOVA showed that the differences in the mean systolic and diastolic blood pressures were statistically significant among the evaluation times (P<0.001). Conclusion: The steep Trendelenburg position maintains the blood pressure of the elderly under open radical prostatectomy.

Does surgical position affect infective complications in percutaneous nephrolithotomy?

The downward orientation of the access sheath during supine percutaneous nephrolithotomy (PCNL) allows the faster evacuation of fluids and stone fragments. It theoretically can contribute to the reduction of the high intrarenal pressure-associated complications. We aimed to investigate whether there is a difference between prone and supine PCNL in terms of infective complications. This retrospective study includes 182 patients who underwent supine and prone PCNL due to kidney stones in our clinic between April 2020 and May 2022. Demographic (age, sex, body mass index, comorbidities), radiological (cumulative stone burden, stone density, number of stones, stone localization, stone laterality, presence of hydronephrosis), clinical (previous stone surgery, previous urinary tract) and perioperative (prone or supine position, surgery duration, hospitalization, success, non-infective and infective complications) data of all patients were evaluated. All patients were divided into two groups, the prone position group, and the supine position group. These two groups were compared in terms of pre and postoperative data above. Infective complications were observed in 16 (18%) patients in the prone position group and in 7 (7.5%) patients in the supine position group, and this difference was statistically significant (p = 0.034). Surgery duration (OR = 1.041; 95% CI 1.021-1.061; p < 0.001), number of stones (OR = 4.09; 95% CI 1.093-7.309; p = 0.036), previous urinary tract infection (OR = 6.272; 95% CI 1.936-9.317; p = 0.002) and prone position (OR = 4.511; 95% CI 1.265-7.087; p = 0.02) were found as independent risk factors for infective complications. Prone position was proved as an independent predictor of postoperative infectious events. Supine PCNL will be further adopted as the standard PCNL approach by a continuously growing proportion of endourologists.

Impact of self-stretching techniques on piriformis muscles tightness in supine vs sitting position

Background and Purpose: Piriformis muscle is the deep gluteus muscle present at the posterior side of the hip joint. Its main function is external rotation of hip joint. Tightness of piriformis muscle is common these days due to sedentary life style. Due to tightness of piriformis muscle, the mobility of external rotation in hip joint also gets altered. The aim of this research is to compare the effect of self-stretching in supine vs sitting position on piriformis muscle in random young adults. Methodology: A sample size of 40 (n=40) random young adults were taken and divided into two groups (n1=20) (n2=20) of 20 each. The first group was asked to do self-stretching in supine position and second group was asked to do self-stretching in sitting position for 30 sec/stretch 10 times/session 2 times in a day. This intervention was given for a week. The outcome measures include piriformis muscle tightness test and goniometer measurement. Result: The result showed significant improvement in tightened piriformis muscle in self-stretching in supine and sitting group. Conclusion: The self-stretching in sitting group showed more improvement on piriformis muscle tightness than self-stretching in supine position.

Colonoscopy Insertion in Patients with Gastrectomy: Does Position Impact Cecal Intubation Time?

A history of abdominal surgery is associated with difficulty in colonoscopy insertion. Few studies have reported effective colonoscopy insertion for patients who underwent abdominal surgery due to stomach cancer. We aimed to compare the impact of supine position (SP) and left lateral position (LLP) as the starting position of colonoscopy insertion in patients who underwent abdominal surgery due to stomach cancer. This was a prospective, randomized controlled trial. Patients undergoing colonoscopy for screening or post-polypectomy surveillance after gastrectomy due to stomach cancer were enrolled and randomized to the SP or LLP group as the starting position of colonoscopy insertion. All colonoscopic examinations were performed with a transparent cap. The primary outcome was to compare the cecal intubation time between the two groups. A total of 224 patients were enrolled. The mean cecal intubation time was not significantly different between the SP and LLP groups (364.5s versus 306.9s; p = 0.105). In patients with a lower body mass index (< 21kg/m2) or who underwent gastrectomy within three years, the mean cecal intubation time of the LLP group was shorter than the SP group. In the multivariate analysis for the factors affecting to increase in the cecal intubation time (> 5min), the starting position was not an independent factor. Either the SP or LLP could serve as a possible starting position of colonoscopy insertion for patients who underwent abdominal surgery due to stomach cancer.

Bilateral Lung Transplantation for Patients With Destroyed Lung and Asymmetric Chest Deformity.

Background: Destroyed lung can cause mediastinal displacement and asymmetric chest deformity. Reports on bilateral lung transplantation (LT) to treat destroyed lung and asymmetric chest deformity are rare. This study presents our surgical experience of bilateral LT among patients with destroyed lung and asymmetric chest deformity.Methods: Six patients with destroyed lung and asymmetric chest deformity who underwent bilateral LT at our center from 2005 to 2020 were included in the study. Demographic data, technical data, perioperative details, and short-term follow-up data were reviewed.Results: Three patients underwent bilateral LT via anterolateral incisions in the lateral position without sternal transection, while three patients underwent bilateral LT via clam-shell incisions in the supine position with sternal transection. Only one patient required intraoperative extracorporeal membrane oxygenation. Four patients underwent size-reduced LT. In the other two patients, we restored the mediastinum by releasing mediastinal adhesions to ensure maximal preservation of the donor lung function. Patients in the lateral position group had a higher volume of blood loss, longer operation time, and longer postoperative in-hospital stay than those in the supine position group. However, these differences were not statistically significant. Postoperative computed tomography in the supine position group revealed that the donor lungs were well expanded and the mediastina were in their original positions.Conclusions: Although bilateral LT in patients with destroyed lung and asymmetric chest deformity is high risk, with sufficient preoperative preparation and evaluation, it is safe and feasible to perform bilateral LT for selected patients. For patients without severe chest adhesions, releasing the mediastinal adhesions and restoring the mediastinum through a clam-shell incision in the supine position is a simple and effective method to maximally preserve the donor lung function without pneumonectomy or lobectomy.

Percutaneous Nephrolithotripsy in the Position of the Patient Lying on His Back

The objective: evaluation of the effectiveness and safety of percutaneous nephrolithotripsy in patients in the supine position. Materials and methods. For the period 2017–2021, 521 mini-PNL were performed according to the standard technique, where in 458 (87,9%) cases the operation was performed in the patient’s prone position, and in 63 (12,1%) cases on the supine position (group 1). The control group (2 group) consisted of 70 patients, sporadically selected among 458 patients to whom PML performed in a standard prone position. Mini-PNL was performed under combined regional (spinal-epidural) anesthesia in 98,7% (514) cases, in 1,3% (7) under endotrachial anesthesia. Results. The average time of surgery was 41,1±11,4 minutes in the 1st group and 57,4±10,3 minutes in the 2nd group (р&lt;0,05), due to the lack of need to revolutionize the patient on the abdomen. Statistically greater (p&lt;0,05) of the ability to perform/ additional percutaneous access in patients in the supaine position. Infectious complications (9,5 vs. 7,1%; p&gt;0,05), stone-free conditions (96,4 vs. 98,2%; p&gt;0,05) and average hospital stays (2,3 vs. 2,2 days; p&gt;0,05). None of the patients in both groups had complications higher than Clavien IIIa. When performing PNL in the supine position, in contrast to performing PNL on the prone position, there is always the possibility of using combined endoscopic methods. Where 3 (4,8%) patients underwent combined retro- and antegrade approaches for combination of nephrolithiasis with «wedged» calculi of the pyelourethral segment and in distal ureter, and retrograde laser endoureterotomy was performed in one (1,6%) patient. The limitation of our study includes a small sample size and a lack of group randomization. Conclusions. The patient’s position on the supine position, during the implementation of PNL, is a safe technique and can be a particularly attractive option for the category of patients with high anesthesiological risk; in the case of planned simultane (transurethral and percutaneous) interventions on the UMP; in patients who are obese or with severe deformityof the spine.

Effects of seated lumbar rotation manipulation in treating degenerative lumbar instability: a protocol for a randomized controlled trial

BackgroundDegenerative lumbar instability (DLI) is a common disease that causes low back pain (LBP) in clinic. It is difficult to completely recover from DLI, and it occurs repeatedly, which seriously affects the quality of life of patients. The epidemiological survey showed that 20–30% of low back pain was related to lumbar instability. Increasing evidence shows that seated lumbar rotation manipulation can effectively improve the clinical symptoms of patients with low back pain. The primary aim of this clinical trial is to observe the intervention effect of seated lumbar rotation manipulation on DLI patients.Method/designA total of 60 participants with DLI will be recruited and randomly allocated into the seated lumbar rotation manipulation group (the intervention group) or lumbar traction in supine position group (the control group) in this prospective, outcome assessor-blind, two-arm randomized controlled clinical trial. The treatment of the two groups lasted for 3 weeks, and the manipulation of the intervention group would be carried out once every other day, three times a week, a total of 9 times; the control group would be given lumbar traction once a day, five times a week, a total of 15 times. JOA (Japanese Orthopaedic Association) and VAS (Visual Analogue Scales) scores will be recorded as the primary outcomes before the treatment and at the 1st, 3rd, 5th, 8th, 10th, 12th, 15th, 17th, and 19th days after treatment and follow-up visit at the first, third, and sixth months. JOA efficacy evaluation standard will be used to evaluate the overall efficacy as the secondary outcomes.DiscussionThe results of this prospective, randomized controlled trial will provide a clinical evidence for the treatment of DLI with seated lumbar rotation manipulation.Trial registrationChinese Clinical Trial Registry ChiCTR2000032017. Registered on 18 April 2020, Prospective registration.

The effect of patient positioning (prone or supine) on the dose received by small bowel in pelvic radiotherapy in rectal cancer patients

PurposeThe small bowel is a main dose-limiting organ in pelvic radiotherapy in the patients with rectal cancer. Conventionally, pelvic radiotherapy of patients with rectal cancer is performed in the prone position. Material and MethodsThirty-nine patients underwent CT planning scan in the treatment position (20 patients in prone position group and 19 patients in supine position group). After radiation treatment planning optimization, the volumes of the irradiated small intestines were investigated. ResultsThe volume of irradiated small bowel was higher in the supine position (mean difference; 36,274 cm3). However, it was not statistically significant (P value=0.187) ConclusionSupine position could be accepted for the patients undergoing preoperative rectal cancer chemo-radiation.

Lateral position: a friendly surgical position for intramedullary nailing of tibial shaft fractures via infrapatellar approach

BackgroundThe conventional infrapatellar approach to intramedullary nailing of tibial fractures adopts the supine high-flexion knee position. However, this has disadvantages including difficulty in obtaining the proximal tibial anteroposterior view during intraoperative fluoroscopy, prolonged duration of fluoroscopy. Accordingly, the present study investigated the utility of the lateral position in the infrapatellar approach to intramedullary nailing of tibial shaft fractures.MethodsThe present study was a retrospective analysis of 112 patients who sustained closed tibial shaft fractures and treated with intramedullary nailing via the infrapatellar approach. Patients were divided into two groups according to surgical position: lateral or supine. The demographic and clinical data were collected and analyzed.ResultsThere were 54 patients in the lateral and 58 in the supine position groups. The duration of surgery and fluoroscopy was shorter in the lateral group than the supine group (p < 0.05). Blood loss during surgery was lower in the lateral compared with supine position group (p < 0.05). The malunion rate was lower in the lateral position group as compared with the supine position group (p < 0.05); moreover, fewer surgical assistants were needed than in the supine group (p < 0.05). There were no significant differences in fracture healing time, other complications between the two groups (p > 0.05).ConclusionsThe lateral position was a more convenient choice for intramedullary nailing of tibial shaft fractures via infrapatellar approach.

Reverse Trendelenburg position applied prior to pneumoperitoneum prevents excessive increase in optic nerve sheath diameter in laparoscopic cholecystectomy: randomized controlled trial.

The aim of this randomized controlled trial was to determine whether applying the reverse Trendelenburg position before pneumoperitoneum has a preventive effect on increased intracranial pressure using optic nerve sheath diameter (ONSD) measurement as a noninvasive parameter. Seventy-nine patients were allocated to two groups according to whether pneumoperitoneum was applied in the supine position (group S, n = 40) or in the reverse Trendelenburg position (group RT, n = 39). The ONSD was measured at the following time points: T0: before anesthesia; T1: after endotracheal intubation; T2: after pneumoperitoneum in group S and after positioning in group RT; T3: after positioning in group S and after pneumoperitoneum in group RT; T4: 30min after endotracheal intubation, and T5: after desufflation. The end-tidal carbon dioxide (EtCO2), regional cerebral oxygen saturation (rSO2), peripheral oxygen saturation (SpO2), mean arterial pressure (MAP), heart rate (HR), peak inspiratory pressure (Ppeak), and dynamic compliance (Cdyn) were recorded. Background and perioperative characteristics were similar in both groups. In group S, the ONSD was higher at T2, T3, T4, and T5 than that in group RT (p < 0.001, p = 0.002, p = 0.001, and p = 0.012, respectively). In the same group, the number of patients with an ONSD above 5.8mm was higher at T2, T3, and T4 (p < 0.001, p = 0.042, p = 0.036, respectively). The rSO2 and SpO2 were not different between the groups. The mean arterial pressure was lower in group RT at T2, and the HR was not different between the groups (p < 0.001). In group S, Ppeak was higher and Cdyn was lower at T2 (p < 0.001). The number of patients with nausea was higher in group S (p = 0.027). The present study demonstrates that applying the reverse Trendelenburg position before pneumoperitoneum prevented an increase in the ONSD in patients undergoing laparoscopic cholecystectomy.Trial registration The trial was registered prior to patient enrollment at https://register.clinicaltrials.gov (NCT04224532, Date of the registration: January 8, 2020).

Observation of hemodynamic parameters using a non-invasive cardiac output monitor system to identify predictive indicators for post-spinal anesthesia hypotension in parturients undergoing cesarean section.

The administration of high-level spinal anesthesia for cesarean section may lead to significant hemodynamic changes. Bioreactance-based non-invasive cardiac output monitoring (NICOM™) provides an accurate monitoring system for parturients under spinal anesthesia. The present study hypothesized that baseline hemodynamic parameters obtained via the NICOM™ system could serve as predictive indicators for post-spinal anesthesia hypotension. Therefore, 80 full-term parturients with singleton pregnancies who underwent scheduled cesarean section were enrolled and allocated to either a supine position group or a 15˚ left tilt group. All parturients received standard pre-hydration with 750 ml of 0.9% saline. Baseline cardiac output index (CI), total peripheral resistance index (TPRI) and stroke volume (SV) were recorded using the NICOM™ system. Subsequently, spinal anesthesia with 2.4 ml of 0.5% hyperbaric bupivacaine, 10 µg of fentanyl and 0.2 mg of morphine was administered. Receiver operating characteristic (ROC) curves and multivariate logistic regression were used to analyze the data. A total of 40 parturients (51.9%) developed hypotension. The areas under the ROC curves were 0.666, 0.594 and 0.622 for the CI, TPRI and SV, respectively. The optimal cut-off value of the CI in predicting hypotension was 3.68 l/min/m2 (ROC, sensitivity=85.0%, specificity=48.6%). Furthermore, CI was considered as an independent factor for post-spinal anesthesia hypotension. In conclusion, the baseline CI obtained via the bioreactance-based NICOM™ system may serve as a predictor of post-spinal anesthesia hypotension in parturients regardless of patient position.

Clinical study on the treatment of calculous renal colic through external physical vibration lithecbole under different position

Objective: To observe the clinical efficacy of external physical vibration lithecbole (EPVL) in the treatment of calculous renal colic under different positions. Method: A total of 120 calculous renal colic patients who underwent EPVL from September 2018 to September 2019, were randomly divided into three groups utilizing random number table: supine position group, the lateral position group and the hybrid position group, with 40 cases in each group. Prior to the EPVL, each patient was given an intravenous injection of 20 mg furosemide. When the patients accumulated enough urine, they began to undergo EPVL. Numeric Rating Scale (NRS) was applied to assess the pain intensity before and after the treatment. Furthermore, all the patients were examined by B-ultrasound or urinary CT a day and a week after the treatment. The NRS score, side effects, stone discharge rate, time of pain relief, and pain recurrence rate were compared among different groups. Results: Prior to the treatment, there was no significant difference of the pain intensity among three groups (P>0.05). After the treatment, the pain intensity considerably alleviated in all the groups. The NRS score decreased by 4.05±0.24, 3.23±0.23 and 2.90±0.21 in supine, lateral and hybrid position groups, respectively. The time of pain relief was (8.88±0.46) min, (10.33±0.44) min and (10.38±0.50) min in supine, lateral and hybrid position groups, respectively. Overall, the efficacy of lateral position group was better than the other two groups in terms of speed and degree of pain relief (P< 0.05). The total pain relief rate was 91.7%. However, the pain recurrence rate was 15.0% (6/40), 15.0% (6/40) and 12.5% (5/40) in supine, lateral and hybrid position groups, respectively, however, there was no significant difference among three groups (P>0.05). But the hybrid position group had a relatively low rate of pain recurrence. The aggregate stone discharge rate of three groups was 25.8% and 62.5% a day and a week after the treatment respectively. The calculus clearance rate of surgical day was 22.5% (9/40), 35% (14/40) and 20% (8/40) in supine, lateral and hybrid position groups, respectively. Moreover, the stone removal rate was 60% (24/40), 75% (30/40) and 52.5% (21/40) in supine, lateral and hybrid position groups, respectively. The result indicated that the supine position group had the highest stone discharge rate (P<0.05). Overall, there was no case with severe complications, and there was no significant difference of side effects among three groups (P>0.05). Conclusion: EPVL can safely and effectively improve calculous renal colic and assist the removal of stone. When calculous renal colic was treated under EPVL, the patients can benefit from all three positions, and thus it is crucial to decide which position is more appropriate in different scenarios.

Worsened survival in the head-up tilt position cardiopulmonary resuscitation in a porcine cardiac arrest model.

ObjectiveHead elevation at an angle of 30° during cardiopulmonary resuscitation (CPR) was hemodynamically beneficial compared to supine position in a previous porcine cardiac arrest experimental study. However, survival benefit of head-up elevation during CPR has not been clarified. This study aimed to assess the effect of head-up tilt position during CPR on 24-hour survival in a porcine cardiac arrest experimental model.MethodsThis was a randomized experimental trial using female farm pigs (n=18, 42±3 kg) sedated, intubated, and paralyzed on a tilting surgical table. After surgical preparation, 15 minutes of untreated ventricular fibrillation was induced. Then, 6 minutes of basic life support was performed in a position randomly assigned to either head-up tilt at 30° or supine with a mechanical CPR device, LUCAS-2, and an impedance threshold device, followed by 20 minutes of advanced cardiac life support in the same position. Primary outcome was 24-hour survival, analyzed by Fisher exact test.ResultsIn the 8 pigs from the head-up tilt position group, one showed return of spontaneous circulation (ROSC); all eight pigs expired within 24 hours. In the eight pigs from the supine position group, six had the ROSC; six pigs survived for 24 hours and two expired. The head-up position group showed lower 24-hour survival rate and lower ROSC rate than supine position group (P<0.01).ConclusionThe use of head-up tilt position with 30 degrees during CPR showed lower 24-hour survival than the supine position.

Immediate Prone Positioning After Massive Gastric Aspiration Reduces Lung Injury Possibly by Attenuating Interleukin-6-Mediated Lung-Tissue Inflammation in Pigs.

Gastric aspiration, which can cause acute, diffuse, inflammatory lung injury, is of particular concern in critically ill patients. This study aimed to determine the effects of immediate prone positioning on the degree of lung injury and inflammatory response induced by gastric aspiration. Following induction of gastric aspiration by injection of gastric fluid, 16 healthy pigs were randomized to one of two groups: supine position (SP) or prone position (PP). After ventilation and monitoring for 6 hr, all pigs were euthanized. The ratio of the partial pressure of arterial oxygen/fraction of inspired oxygen (PaO2/FIO2) and the partial pressure of arterial carbon dioxide (PaCO2) were recorded during the 6-hr study period. Serum levels of interleukin (IL)-6 were measured every 2 hr, and the mean optical density (MOD) of IL-6 in lung tissues and lung-injury scores were measured at the end of the experiment. The PP group showed a significantly higher PaO2/FIO2 ratio, lower serum IL-6 concentration (p = .015), lower lung-injury scores (p = .012), and lower IL-6 concentration and MOD of IL-6 in lung tissue, especially in dorsal (p = .001, p = .021, respectively) and nondependent regions (p = .005, p = .035, respectively) than the SP group. There were no statistically significant differences in PaCO2 between the groups. Lung-injury severity was positively correlated with the IL-6 concentration and MOD of IL-6 in lung tissues (p < .05). These results suggest that immediate prone positioning alleviated the degree of aspiration-induced lung injury, possibly through mitigating IL-6-mediated lung inflammation.

Accuracy of SEEG Electrodes Implanted in Lateral Position Versus Supine Position

Abstract INTRODUCTION Accuracy during SEEG implantations is critical as several electrodes will cross narrow corridors between cerebral blood vessels. Previous studies have compared the accuracy of different techniques such as frame-based, frameless, and robot-assisted implantations and overall SEEG has been reported to be quite safe, with a major complication incidence of less than 1%. Typically, the supine position is utilized for implantation; however, the lateral position may be more comfortable and ergonomic for trajectories with a posterior entry point (eg, posterior approach to the insula). To our knowledge, this is the first study to compare the accuracy of SEEG electrodes implanted in supine position vs lateral position. METHODS About 22 patients who underwent SEEG electrode implantation using Leksell frame fixation and Neuromate robot were included in this study and clustered according to the supine (n = 11) or lateral (n = 11) position. A total of 284 electrodes (Supine: n = 139; Lateral: n = 145) were analyzed. Postoperative Oarm images were co-registered with the preoperative plan on Voxim software. Cartesian coordinates of the entry point (EP) and target point (TP) were obtained from the planned trajectory and the implanted electrode. Three-dimensional error (Euclidian distance) and radial error for EP and TP were calculated. Wilcoxon rank sum test was used to compare lateral versus supine group. RESULTS Radial errors were similar between both groups. EP three-dimensional error was higher in the lateral position group (1.3 mm vs 1.7 mm, P = .004), whereas TP three-dimensional error was higher in the supine position group (2.9 mm vs 1.8 mm, P &lt; .001). CONCLUSION SEEG electrode implantation using frame-based fixation and robot-assisted technique in the lateral position has similar accuracy compared to implantation in the supine position.

Effects of shooting position on X-ray evaluation index of developmental hip dysplasia

Objective To explore the impacts of the imaging positions on the sagittal tilt of the pelvis and the imaging parameters of the hip joint. Methods From December 2015 to October 2016, a total of 78 female DDH patients (DDH group) who received Bernese periarticular osteotomy were enrolled, aged 28.41±9.91 years (range 18-49 years) with 135 hips. There were 21 cases on one side and 57 cases on both sides. Another 26 female volunteers without spinal and hip disease were enrolled as the control group, aged 23.54±5.58 years (range 18-49 years) with 52 hips. X-ray films of the anterior and posterior pelvis were performed in both groups. The pelvic sagittal tilt was evaluated by measurement (pubic symphysis to sacrococcygeal distance, PSSC), with lateral center-edge angle of Wiberg (LCEA), Tonnis angle (TA), and Sharp angle (angle of Sharp, SA) assessed the degree of hip dysplasia and assessed the horizontal positional relationship between the femoral head and the acetabulum using tear drop distance (TD). All data were measured twice by two measurers independently. The correlation between hip parameters and X-ray position was analyzed. Results The average PSSC in the supine and standing positions of the control group were 53.73±16.22 mm and 36.45±14.21 mm, respectively with significant difference-17.28±8.07 mm (t=-10.913, P=0.000). The PSSC of the supine and standing positions of the DDH group were 56.76±13.54 mm and 48.62±15.44 mm, respectively with significant difference-8.13±13.02 mm (t=-5.516, P=0.000). The PSSC of the standing DDH group was larger than that in the control group. There was no significant difference in the PSSC between the two groups in the supine position. Furthermore, there were no significant difference in the supine and standing PSSC between the unilateral and bilateral DDH patients (P>0.05). In the control group, the hip in supine and standing position, LCEA averaged 30.33°±4.69° and 29.70°±3.83° (P>0.05), and TA averaged 4.05°±3.51° and 4.36°±3.07° (P>0.05), respectively. SA averaged 40.53°±4.34° and 41.79°±3.16° (P>0.05), and TD averaged 6.80±0.98 mm and 6.65±1.30 mm (P>0.05), respectively. In the DDH group, the hip in supine and standing positions, LCEA averaged 3.07°±12.07° and 1.69°±12.11° (P 0.05), respectively. SA averaged 48.01°±4.68° and 48.49°±4.74° (P>0.05), respectively, and TD averaged 10.51±3.51 mm and 10.93±4.23 mm (P>0.05), respectively. Conclusion From supine to standing, the pelvis backward is the main trend in sagittal plane. In standing, the pelvis of female DDH patients is forward contrast with normal women. There was no difference in pelvic tilt between unilateral and bilateral DDH patients. Female DDH patients from the supine to standing, hip coverage decreased, while the femoral head appeared horizontally outward. The hip joint of DDH patients is unstable. Key words: Hip dislocation, congenital; Pelvis; Photogrammetry; Osteotomy

Impact of the supine position versus left horizontal position on colonoscopy insertion: a 2-center, randomized controlled trial

Colonoscopy insertion is painful for some patients and is one of the main barriers to screening colonoscopy. Few studies have assessed the impact of the supine position (SP) on colonoscopy insertion, especially for unsedated patients. The aim of this randomized controlled trial was to clarify this issue. Unsedated patients were randomized to SP or left horizontal position (LHP) as the starting position of colonoscopy insertion. The primary outcome measure was cecal intubation time (CIT), and the secondary outcome measures were descending colon intubation time (DIT), pain score of patients, difficulty score according to the endoscopist, and patients' acceptance of unsedated colonoscopy. A total of 347 patients were randomized to the SP group (175) or the LHP group (172). The CIT in the SP group was significantly shorter than that in the LHP group (275.0 seconds [interquartile range (IQR), 234.0-328.5 seconds] versus 316.0 seconds [IQR, 261.0-370.0 seconds], P< .001). The DIT was also shorter in the SP group (64.5 seconds [IQR, 52.0-86.3 seconds] versus 74.0 seconds [IQR, 62.0-92.0 seconds], P= .001). Compared with the LHP, the SP had a lower pain score (3.3 versus 3.9, P= .002), a lower difficulty score (3.1 versus 3.7, P< .001), a lower frequency of position change (7.1% versus 38.0%, P< .001), and less need for abdominal compression (39.1% versus 45.5%, P= .02). SP was the only modifiable and independent factor identified to reduce CIT and pain score and improve patients' acceptance of unsedated colonoscopy. As an economical and convenient method, SP can reduce CIT, ease pain, and improve patients' acceptance of unsedated colonoscopy. (Clinical trial registration number: NCT03289442.).

Effect of patient position during virtual-assisted lung mapping.

Virtual-assisted lung mapping (VAL-MAP) is a preoperative multi-spot bronchoscopic dye-marking technique. Marking failure reportedly occurs in approximately 10% of marks. The aim of the present study was to investigate whether the patient position during dye injection in VAL-MAP affected the quality of markings. This study was a retrospective review of patients with barely palpable pulmonary nodules who underwent VAL-MAP at a single institution between December 2016 and September 2017. Easily visible markings without bulla formation were defined as "appropriate", while other markings were defined as "inappropriate". Patients were divided in accordance with the position during dye injection into the supine position group (n=6) and the lateral position group (n=8). The two groups were compared regarding the appropriate markings rate. The Fisher exact test and logistic regression model were used for statistical analyses. Fourteen patients with 17 nodules underwent VAL-MAP with a total of 48 markings (3.4±0.9 markings per patient). Of these, 21 markings were performed in supine position, whereas 27 were performed in lateral position. There were no significant differences between the two groups in lesion size, depth, and characteristics. Almost all of the performed procedures were thoracoscopic wedge resections (94%), while one procedure was thoracoscopic left upper division segmentectomy. The appropriate markings rate was significantly greater in the lateral position group than in the supine position group (88% vs. 57%, P=0.02). Among the markings located in dorsal and ventral lung segments, the appropriate markings rate in the lateral position group tended to be greater than that in the supine position group (89% vs. 59%, P=0.06). Multivariate logistic regression analysis revealed that the lateral position was independently associated with appropriate markings (P=0.014). The lateral position may enable the creation of better quality markings in VAL-MAP.

Effects of early prone positioning on oxygenation and safety on the porcine model with gastric aspiration

Objective To explore the effects of early prone positioning on oxygenation and safety on the porcine model with gastric aspiration, so as to provide evidence for clinical nursing practice. Methods A total of 16 female miniature pigs were selected as experimental animals. Gastric aspiration model was created by ejecting 3 ml/kg gastric contents fluids. Pigs were immediately randomly assigned into either the supine position (SP) or prone position (PP) , and were monitored for up to 6 hours after aspiration for oxygenation index, static compliance (Cst) and dyanamic compliance (Cdyn) of respiratory system, heart rate (HR) and blood pressure (BP) . Results Oxygenation index of both groups decreased rapidly after aspiration. Oxygen index in PP group was higher than that in SP group 1 hour after aspiration. There was significant difference in the trend of oxygenation index with time between the two groups during the experimental observation period (P 0.05) . There was no significant difference in HR and BP between the two groups within 6 hours after aspiration (P>0.05) . Conclusions Early prone position (especially immediate prone position) could improve oxygenation, and cause no deterioration of hemodynamics, which is a safe treatment for patients with gastric aspiration. Key words: Animal experimentation; Gastric aspiration; Prone position; Oxygenation index; Safety