Supine Position Group Research Articles

Effect of right lateral position with head elevation on tracheal aspirate pepsin in ventilated preterm neonates: randomized controlled trial

Objective: To evaluate the effect of right lateral positioning in comparison with supine positioning on tracheal aspirate pepsin levels as a marker of aspiration of gastric contents in ventilated preterm neonates.Study design: This randomized controlled trial was conducted on 60 ventilated preterm neonates <35 weeks; 30 neonates were nursed in right lateral position for 6 hours while the other 30 neonates were nursed in supine position for 6 hours. Tracheal aspirate sample was obtained from each neonate in both the groups just after the end of 6 hours and pepsin level was measured.Results: Neonates in right lateral position group had significantly lower tracheal pepsin level than neonates in supine position group (6 ng/ml) interquartile range [IQR] (3–20) versus 15 ng/ml [IQR] (5.5–90) (p = .024). There is positive correlation between tracheal aspirate pepsin level and fraction of inspired oxygen (FiO2) needed during the intervention (r = 0.383, p = .040). There is no correlation between tracheal pepsin level and gestational age, birth weight, or duration of mechanical ventilation and other ventilatory settings.Conclusion: Nursing ventilated premature infants in right lateral position is associated with decreased aspiration of gastric contents.

Does Mild Hydronephrosis Induced by Full-Bladder Improve Outcomes in Patients Undergoing Shock Wave Lithotripsy for Lower Calyceal Stones?: A Prospective Randomized Study.

To compare the outcomes, sessions and shock wave numbers in patients undergoing standard procedure shock wave lithotripsy (SWL) and patients undergoing SWL with mild hydronephrosis induced by full-bladderfollowing oral hydration before SWL procedure for lower calyceal stones. Between January 2014- January 2016 a total of 371 patients who underwent SWL, for lower pole calyceal stones ? 2 cm, were included into the study. 127 patients were treated in the supine position (Group A), 123 in the prone position (Group B) and 121 in the prone position with full bladder and mild hydronephrosis checked by ultrasound before procedure (Group C). There were 286 men and 85 women with a mean ± SD age of 36 ± 11 yearsResults: The mean (SD) stone sizes within the group A, group B and group C were 11 mm (±3 mm), 12 mm (±4.1 mm) and 11 mm (± 3.8 mm) respectively. No significant difference was found in age (P = .18) and stone size between 3 groups (P = .07). The median interquartile range (IQR) number of shocks within the group A, group B and group C were 7600 (3855), 6500 (4300) and 6700 (4915) respectively. Significant difference was found in number of shock waves among 3 groups (P < .01). The difference between groups according to stone expulsion rate wasfound significant in all sessions (P = .01). The present study suggests that mild hydronephrotic status induced by full-bladder before SWL can lower cost and patient discomfort by decrease in number of sessions and increase in stone clearance.

Effect of different patient positions on target dose coverage in rectal cancer IMRT

Objective To compare the effect between the supine and prone patient positions upon target dose coverage during intensity-modulated radiotherapy (IMRT) for rectal cancer, aiming to provide clinical reference for the selection of position for rectal cancer patients. Methods Twenty-four patients diagnosed with rectal cancer receiving postoperative adjuvant radiotherapy were selected and divided into the supine (n=12) and prone position groups (n=12). Before and during the IMRT (1-4 weeks), all patients received CT scans, which were defined as: Plan, 1W, 2W, 3W and 4W, respectively. The organs at risk were delineated based on CT scan images. Plan, 1W, 2W, 3W and 4W CT scan images were fused. The CTV and PTV from Plan CT scan were copied to the 1-4W CT scan images, and the therapeutic plans from Plan CT scan were copied as well. The target dose coverage was assessed and the failure rate of target dose coverage was calculated. The couch-position data for each patient during each cycle of IMRT were recorded by using the MOSAIQ network and the overall deviation (S) of couch position was calculated. Results The failure rates of CTV and PTV target dose coverage in the prone position group were higher than those in the supine position group (18.60% VS 0%, 69.76% VS 53.65%). The S value was significantly correlated with the target dose coverage (r=-0.683, P=0.000). The S value in the prone position group was (1.23±0.76) cm, significantly greater than (0.28±0.18) cm in the supine position (P=0.001), and the most significant deviation was noted in the y (head and foot) and z (frontal and dorsal) directions (P=0.003 and 0.003). Compared with the supine group, the V5 and V10 of the small intestine were significantly less (P=0.003 and 0.004) and the chronic toxicity (NTCPC) was considerably reduced (P=0.041) in the prone position group. Conclusions A better target dose coverage can be maintained during IMRT with a supine position during rectal cancer IMRT, whereas the positioning repeatability is worsened with a prone position due to use of the belly board, thereby affecting the target dose coverage. Although the prone position combined with belly board can reduce the tolerated dosage of the small intestine, effective measures should be taken to guarantee the patient positioning repeatability. Key words: Rectal neoplasms/intensity-modulated radiotherapy; Radiotherapy dosage; Belly board

Erythropoietin-Producing Hepatoma Receptor Tyrosine Kinase A2 Modulation Associates with Protective Effect of Prone Position in Ventilator-induced Lung Injury.

The erythropoietin-producing hepatoma (Eph) receptor tyrosine kinase A2 (EphA2) and its ligand, ephrinA1, play a pivotal role in inflammation and tissue injury by modulating the epithelial and endothelial barrier integrity. Therefore, EphA2 receptor may be a potential therapeutic target for modulating ventilator-induced lung injury (VILI). To support this hypothesis, here, we analyzed EphA2/ephrinA1 signaling in the process of VILI and determined the role of EphA2/ephrinA1 signaling in the protective mechanism of prone positioning in a VILI model. Wild-type mice were ventilated with high (24 ml/kg; positive end-expiratory pressure, 0 cm; 5 h) tidal volume in a supine or prone position. Anti-EphA2 receptor antibody or IgG was administered to the supine position group. Injury was assessed by analyzing the BAL fluid, lung injury scoring, and transmission electron microscopy. Lung lysates were evaluated using cytokine/chemokine ELISA and Western blotting of EphA2, ephrinA1, PI3Kγ, Akt, NF-κB, and P70S6 kinase. EphA2/ephrinA1 expression was higher in the supine high tidal volume group than in the control group, but it did not increase upon prone positioning or anti-EphA2 receptor antibody treatment. EphA2 antagonism reduced the extent of VILI and downregulated the expression of PI3Kγ, Akt, NF-κB, and P70S6 kinase. These findings demonstrate that EphA2/ephrinA1 signaling is involved in the molecular mechanism of VILI and that modulation of EphA2/ehprinA1 signaling by prone position or EphA2 antagonism may be associated with the lung-protective effect. Our data provide evidence for EphA2/ehprinA1 as a promising therapeutic target for modulating VILI.

Physiological and behavioural effects of preterm infant positioning in a neonatal intensive care unit

AimTo compare the effect of sleeping position on physiological and behvioural responses in preterm infants.MethodsA quasi-experimental study was conducted in a neonatal intensive care unit in the south of Brazil. The sample was 24 preterm newborns with gestational age ≤32 weeks, who were randomly separated into four groups: right side position, supine position, left side position and prone position. The physiological and behavioral variables were evaluated before, during and after positioning.FindingsDuring the intervention, heart rate decreased in right side position, supine position, and prone position. The respiratory rate reduced in all positions and peripheral oxygen saturation remained stable in most positions. Behavioural scores were reduced in supine, left side and prone positions.ConclusionsPositioning according to a standard operating procedure was able to produce more positive responses in prone and supine position groups during the intervention.

Comparative effectiveness of two stabilization exercise positions on pain and functional disability of patients with low back pain.

The study investigated the effects of two stabilization exercise positions (prone and supine) on pain intensity (PI) and functional disability (FD) of patients with nonspecific chronic low back pain (NSCLBP). The 56 subjects that completed the study were randomly assigned into stabilization in prone (SIP) (n=19), stabilization in supine (SIS) (n=20), and prone and supine (SIPS) position (n=17) groups. Subjects in all the groups received infrared radiation for 15 min and kneading massage at the low back region. Subjects in SIP, SIS, and SIPS groups received stabilization exercise in prone lying, supine lying and combination of both positions respectively. Treatment was applied twice weekly for eight weeks. PI and FD level of each subject were measured at baseline, 4th and 8th week of the treatment sessions. Data were analyzed using descriptive and inferential statistics. The alpha level was set at P<0.05. Within-group comparison indicated that PI and FD at the 4th and 8th week were significantly reduced (P<0.001) when compared with baseline in all the three groups. However, the result showed that there was no significant difference in the PI and FD at the 8th week (P>0.05) of the treatment sessions across the three groups when compared. It can be concluded that stabilization exercises carried out in prone, supine and combination of the two positions were equally effective in managing pain and disability of patients with NSCLBP. However, no position was superior to the other.

Early clinical effect of lateral position direct anterior approach and supine position direct anterior approach in total hip arthroplasty

Objective To compare the lateral position direct anterior approach(DAA)and supine position DAA in total hip arthroplasty(THA). Methods A retrospective study was performed on 55 patients(60 hips)who underwent THA from October 2015 to March 2016.There were 28 cases(30 hips)in lateral position DAA(lateral position group)and 27 cases(30 hips)in supine position DAA(supine position group). The preoperative BMI, operation time, hemoglobin decline before and after operation, postoperation activity time and Harris hip score of 1, 2, 3 months after operation was calculated. Results The comparison of the two groups had no significant differences of BMI(P>0.05). There was no obvious complication in the two groups.There was no statistically significant difference of operation time, hemoglobin decline before and after operation, postoperative activity time and Harris score after 1, 2, 3 months(P>0.05). Conclusion There is no significant difference of early clinical effect in the lateral position DAA and supine position DAA in THA, lateral position DAA has the advantages such as the early learning curve is short, the operation time is short, and no professional orthopedic bed is needed. Key words: Total hip arthroplasty; Lateral position direct anterior approach; Supine position direct anterior approach; Early clinical effect

嚥下訓練開始時の状態と訓練の効果の関連について

In this study, we investigated for a period of 8 years, 884 patients who underwent swallowing rehabilitation in our hospital, and evaluated the factors affecting resumption of oral intake of food. We found that the number of patients undergoing swallowing rehabilitation in our hospital increased over time. Of the included patients, 82.8% were ≥70 years of age and men were more frequent than women (p=0.004). At the end of the rehabilitation, 56.3% patients' main nutrition route was oral. Most (60.5%) patients required <30 days of rehabilitation. We evaluated correlation between the states of patients at starting point of swallowing rehabilitation and the result of the rehabilitation. The patients having a desire for eating were significantly more successful in regaining oral intake of food than those without the desire (p<0.001) and those with desire unknown (p<0.001). We classified the patients as per the Japan Coma Scale into four groups: alert, 1 digit, 2 digits, and 3 digits; the 3-digit group was significantly less successful in resumption of oral ingestion compared to all other groups (p<0.001). Based on the activities of daily living (ADL), we classified the patients into four groups: supine position, possible to semi-sitting group (get-up more than 30°), possible to sit-up group, and possible more than transferring by oneself group. It was proved that the supine position group was significantly less successful in regaining oral intake of food compared to all other groups (p<0.001). Multivariate analysis showed that the strongest correlation for regaining oral ingestion was desire for eating (p<0.001), followed by ADL and level of consciousness. In conclusion, we found that the number of patients undertaking swallowing rehabilitation in our hospital is increasing, and that factors such as desire for eating, ADL, and level of consciousness significantly influence the resumption of oral intake of food.

Evaluation of Endotracheal Intubation with a Flexible Fiberoptic Bronchoscope in Lateral Patient Positioning: A Prospective Randomized Controlled Trial.

Background:There is an unmet need for a reliable method of airway management for patients in the lateral position. This prospective randomized controlled two-center study was designed to evaluate the feasibility of intubation using a flexible fiberoptic bronchoscope in the lateral position during surgery.Methods:Seventy-two patients scheduled for elective nonobstetric surgery in the lateral decubitus position requiring tracheal intubation under general anesthesia at Lishui Central Hospital of Zhejiang Province and Jiaxing First Hospital of Zhejiang Province from April 1, 2015, to September 30, 2015, were enrolled in this study. Patients were randomly assigned to the supine position group (Group S, n = 38) and the lateral position group (Group L, n = 34). Experienced anesthetists performed tracheal intubation with a fiberoptic bronchoscope after general anesthesia. The time required for intubation, intubation success rates, and hemodynamic changes was recorded. Between-group differences were assessed using the Student's t-test, Mann–Whitney U-test, or Chi-square test.Results:The median total time to tracheal intubation was significantly longer in Group S (140.0 [135.8, 150.0] s) compared to Group L (33.0 [24.0, 38.8] s) (P < 0.01). The first-attempt intubation success rate was significantly higher in Group L (97%) compared to Group S (16%). Hemodynamic changes immediately after intubation were more exaggerated in Group S compared to Group L (P = 0.02).Conclusion:Endotracheal intubation with a flexible fiberoptic bronchoscope may be an effective and timesaving technique for patients in the lateral position.Trial Registration:Chinese Clinical Trial Register, ChiCTR-IIR-16007814; http://www.chictr.org.cn/showproj.aspx?proj=13183.

Lateral decubitus versus supine position in treatment of intertrochanteric fractures with proximal femoral nail antirotation

Objective To compare the lateral decubitus and supine position in the treatment of femoral intertrochanteric fractures with femoral proximal nail antirotation (PFNA). Methods A retrospective analysis was performed of the 85 patients with intertrochanteric fracture who had been treated at our hospital between September 2013 and September 2014. They were 24 men and 61 women, 28 to 99 years of age (average, 78.5 years). By Evans-Jensen classification, one case was type Ⅰ, 15 cases were type Ⅱ, 40 type Ⅲ, 23 type IV, and 6 type V. All the patients were treated with internal fixation with PFNA. Lateral decubitus position was adopted in 45 cases and supine position in 40. The 2 groups were compared in terms of operation time, intraoperative bleeding volume, difference between preoperative and postoperative hemoglobin values, tip-apex distance (TAD), calcar tip-apex distance (Cal-TAD), fracture healing time, and Harris score of the hip joint. Results The 85 patients were followed up for 9 to 21 months (average, 13.6 months). Both 2 groups obtained fracture healing, with no screw cut-out. The lateral decubitus group had significantly less operation time (60.3±17.5 min) and intraoperative bleeding volume (70.8±37.8 mL) than the supine position group (72.7±19.7 min and 90.3±20.9 mL, respectively) (P 0.05). Conclusion In the treatment of femoral intertrochanteric fractures with PFNA, lateral decubitus position may be associated with shorter operation time and less intraoperative blood loss compared with supine position. Key words: Hip fractures; Fracture fixation, intramedullary; Bone nails; Position

Prone position results in enhanced pressor response to ephedrine compared with supine position during general anesthesia

Study ObjectiveTo elucidate and compare the pressor response to ephedrine in the prone or supine position during general anesthesia (GA). DesignProspective cohort study. SettingDepartment of General Surgery or Spine Surgery, Zhongda Hospital, Southeast University, Nanjing, China. PatientsFifty-six patients who were scheduled to undergo elective surgery in the supine or prone position (n = 28 each) and using a generic GA protocol. InterventionsDuring surgery, the patients received intravenous (IV) ephedrine when their systolic blood pressure (SBP) decreased to 90 to 110 mm Hg. MeasurementsHemodynamic changes were measured at 1-minute intervals for 10 minutes and were compared with baseline. Main ResultsForty-nine patients (23 in the prone position and 26 in the supine position) completed the study. There were no significant differences between the groups with regard to demographic characteristics, hemodynamic parameters, end-tidal concentration of sevoflurane, and dose of propofol and remifentanil (all P> .05). After the bolus injection of ephedrine, a significant increase in SBP was observed in both groups compared to baseline, but the duration and magnitude of the increase in SBP were longer and greater in the prone position than in the supine position. The magnitude of increase of the mean blood pressure was significantly greater in the prone position compared to the supine position at 2 to 7 minutes after ephedrine injection. Ephedrine could cause significant increase in diastolic blood pressure 2 minutes after IV injection, which could last until at least 9 minutes in the prone position group compared to only for 5 minutes in the supine position group (all P< .05). Conclusion:Compared to the supine position, the prone position could augment the pressor response to IV ephedrine during GA. Further studies are recommended to identify its association with other confounding factors such as surgery type or duration, patient history of cardiovascular disease, or patient hydration status.

Ventilator-associated pneumonia in ARDS patients: the impact of prone positioning. A secondary analysis of the PROSEVA trial

The goal of this study was to assess the impact of prone positioning on the incidence of ventilator-associated pneumonia (VAP) and the role of VAP in mortality in a recent multicenter trial performed on patients with severe ARDS. An ancillary study of a prospective multicenter randomized controlled trial on early prone positioning in patients with severe ARDS. In suspected cases of VAP the diagnosis was based on positive quantitative cultures of bronchoalveolar lavage fluid or tracheal aspirate at the 10(4) and 10(7)CFU/ml thresholds, respectively. The VAP cases were then subject to central, independent adjudication. The cumulative probabilities of VAP were estimated in each position group using the Aalen-Johansen estimator and compared using Gray's test. A univariate and a multivariate Cox model was performed to assess the impact of VAP, used as a time-dependent covariate for mortality hazard during the ICU stay. In the supine and prone position groups, the incidence rate for VAP was 1.18 (0.86-1.60) and 1.54 (1.15-2.02) per 100days of invasive mechanical ventilation (p=0.10), respectively. The cumulative probability of VAP at 90days was estimated at 46.5% (27-66) in the prone group and at 33.5% (23-44) in the supine group. The difference between the two cumulative probability curves was not statistically significant (p=0.11). In the univariate Cox model, VAP was associated with an increase in the mortality rate during the ICU stay [HR 1.65 (1.05-2.61), p=0.03]. HR increased to 2.2 (1.39-3.52) (p<0.001) after adjustment for position group, age, SOFA score, McCabe score, and immunodeficiency. In severe ARDS patients prone positioning did not reduce the incidence of VAP and VAP was associated with higher mortality.

Position in the second stage of labour and de novo onset of post-partum urinary incontinence.

The aim of this study was to evaluate the role of the maternal position at the time of delivery on the onset of de novo symptoms of urinary incontinence (UI) in the post-partum period. This prospective study evaluated the data of consecutive women undergoing labour and delivery, between January 2014 and July 2014. We included only women with a singleton pregnancy undergoing vaginal delivery. During the study period, patients chose to deliver in the position that they considered the most comfortable. The onset of UI was evaluated according to the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-sf). Overall, 716 primiparous women were included in the study. Sixty women refused the 12-week post-partum interview (8.4%). Women were divided in two groups: 296 women (45.1%) who chose an upright position during delivery (group 1) and 360 women (54.9%) who chose a supine position (group 2). Group 1 had a significantly lower episiotomy rate, but a higher rate of greater than second degree perineal tears. In group 1 we found a significantly lower rate of de novo UI (40.5% vs 48.9%, p = 0.03) and in particular of stress urinary incontinence. Via multivariate analysis, birth position was the only factor correlating with the occurrence of urinary incontinence in the post-partum period (OR: 1.52; 95%CI: 1.06, 2.18; p = 0.02). Upright positions at delivery are related to a lower episiotomy rate and a higher rate of greater than second degree perineal tears. Supine positions are an independent risk factor for the onset of de novo UI.

The technique and development of total skin electron irradiation—Taiwan experiences

Objective The aim of this study is to present two novel technique-Lying on position and rotational board TSEI in which uniform dose to the whole body as well as the soles and vertex of scalp can be achieved in one electron beam treatment fraction. Methods Patients are treated with two groups in prone and supine position by leaning on inner rotational board in prone and supine position, each group can further be separated into two subgroup with tilting and rotation positions for treatment. By incorporating all these setting on the aswirl board with the optimal gantry angle, the patient will final accumulate compensated dosages on whole body surface. Results The dose uniformity for the rotational board-TSET or Lying on position could be control within ±10%. Conclusions The two TSEItechnique-Lying on and Rotational board TSEI techniques presented in this study is able to deliver a uniform dose to the patient ’ s skin surface as well as to the vertex and the soles all in one time, eliminating the troubles of having to further boost fields for these two regions when using the Stanford Six Field Technique. Key words: Skin neoplasms/total skin electron therapy; Lying on position; Rotational board position

Influence of prone-position combined with message on the feeding intolerance of premature infants with nasal continuous positive airway pressure

Objective To discuss prone-position combined with massage impacted on the feeding intolerance of premature infant with nasal continuous positive airway pressure. Methods The objects of study were the 134 premature infants with nasal continuous positive airway pressure (NCPAP) in Neonatal Intensive Care Unit (NICU) the Second Affiliated Hospital of Wenzhou Medical University from January to December 2013. According to the single-blinded and random number table, they were divided into 4 groups, namely prone position group (33 cases), supine position group (34 cases), prone-position combined massage group (32 cases) and supine-position combined massage group (35 cases). All these 4 groups were given NCPAP and relevant nursing treatment; the feeding effects of 4 groups were compared. Results With regard to feeding intolerance concerning vomit, abdominal distension and gastric retention in 4 groups, prone-position combined massage group was lower than the other groups with statistical significance (P<0.05). The time of NCPAP, days of hospitalization, length of nasogastric tube indwelling, time of regaining birth weight and time of reaching full enteral nutrition existed differences in 4 groups, in which infants of prone-position combined with message used least time with statistical significance (P<0.05). Conclusions The prone-position combined with massage group attributes to the gastrointastinal tract function and feeding intolerance condition of premature infant and reduces mechanical ventilation time and length of hospitalization. Key words: Premature infant; Feeding intolerance; Prone-position; Message; Nasal continuous positive airway pressure

Effects of maternal position in the second stage of labor on delivery outcomes

Objective To evaluate the effects of the non-supine position and the supine position during the second stage of labor on delivery outcomes.Methods In total,642 singleton term primiparas in the Fourth Hospital of Hebei Medical University between January 2013 and March 2014 were divided into the non-supine position group (n=320),which included the lateral (n=204) and hands-and-knees position (n=116),and the supine position group (n=322) according to primipara's choice.Delivery outcomes in the two groups were compared using the Student's t test,Mann-Whitney rank sum test and the x2 test.Results The incidence of caesarean section was similar in the non-supine position and supine position groups [0.9％(3/320) vs 1.9％ (6/322),x2=0.438,P=0.508].Compared with the supine position group,women in the non-supine position group had a higher incidence of perineal lacerations grede Ⅰ [85.2％ (270/317) vs 65.2％ (206/316),x2=33.884],longer duration of the second stage of labor [48.0 min (31.0-78.0 min) vs 41.0 min (25.0 67.3 min),Z=-3.066] and greater blood loss after 2 hours of labor [240.0 ml (200.0-287.5 ml) vs 210.0 ml (160.0-260.0 ml),Z=-3.736],but a significant reduction in posterolateral episiotomies [5.3％(17/317) vs 23.4％ (74/316),x2=41.908],perinealedema [13.6％ (43/317) vs 21.2％ (67/316),x2=6.430] and meconiumstained liquor [20.8％ (66/317) vs 33.2％ (105/316),x2=12.356] (all P＜0.05).In the non supine position group,fetal heart rate showed fewer early decelerations,variable decelerations and late decelerations than in the supine position group [10.1％ (32/317) vs 17.1％ (54/316),x2=6.593; 2.8％ (9/317) vs 6.6％ (21/316),x2=5.079; 3.2％ (10/317) vs 7.6％ (24/316),x2 6.139; all P＜0.05,respectively].Conclusions The non supine position during the second stage of labor may improve delivery outcomes. Key words: Labor stage, second; Natural childbirth; Posture; Prognosis

Effect of nasal continuous positive airway pressure in prone position on the premature infants with apnea

Objective The aim of this study is to assess the effect of nasal continuous positive airway pressure （ NCPAP） in prone position on the treatment of the premature infants with apnea .Methods Totals of 80 premature infants treated with NCPAP in the NICU from January to December , 20±2 were observed . According to the random number table method , the premature infants were divided into prone position group and supine position group . Each group was treated with NCPAP and aminophylline , and relevant nursing intervention.The changes of their frequencies of apnea , PEEP, FiO2 , PaO2 , and PaCO2 , etc.were observed and compared.Results The effective rate of the prone group was 9±.5% and the effective rate of the supine group was 82.5%.The difference was significant （χ2 =8.4±, P±lt±0.05）.The PaO2 and PaO2/FiO2 in the prone group were （77.24±9.56）,（171.25±31.13）mmHg, respectively, which were higher than （67.52±8.61）,（143.26±26.34）mmHg in the supine group.The differences were significant （t =2.16, 2.14, respectively;P〈0.05）.The time of ventilation, hospital stays and use of aminophylline were （3.65±2.01）,（28.25±3.98）,（10.82±9.08）d, which were lower than （4.83±3.51）,（30.14±12.61）,（12.2±9.37）d in the supine group, the differences were significant （t=0.23, 1.96, 2.37, respectively;P〈0.05）. Conclusions Compared with the traditional supine position , treating the neonate with NCPAP in prone position can not only improve their oxygenation , PaO2 and oxygenation indexes , but also reduce the risk of apnea , as well as shortening the time of ventilation and using of aminophylline .It also reduces the treatment of intubation and ventilation, and relieves the financial burden of hospitalization on the infant ’ parents. Key words: Prone position; Nasal continuous positive airway pressure; Apnea; Premature infants

The effect of patient position during trauma surgery on fat embolism syndrome: An experimental study.

Background:The aim of this study was to compare the effect of supine versus lateral position on clinical signs of fat embolism during orthopedic trauma surgery. Dogs served as the current study model, which could be extended and/or serve as a basis for future in vivo studies on humans. It was hypothesized that there would be an effect of position on clinical signs of fat embolism syndrome in a dog model.Materials and Methods:12 dogs were assigned to supine (n = 6) and lateral (n = 6) position groups. Airway pressures, heart rate, blood pressure, cardiac output, pulmonary artery pressure, pulmonary artery wedge pressure, right atrial pressure, arterial and venous blood gases, white blood count, platelet count and neutrophil count were obtained. Dogs were then subjected to pulmonary contusion in three areas of one lung. Fat embolism was generated by reaming one femur and tibia, followed by pressurization of the canal.Results:No difference was found in any parameters measured between supine and lateral positions at any time (0.126 < P < 0.856).Conclusions:The position of trauma patients undergoing reamed intramedullary nailing did not alter the presentation of the features of the lung secondary to fat embolism.

Influence of different position on oxygen inhalation effect for premature infants in the warm box

Objective To explore the best position of oxygen inhalation for premature infants so as to reduce the time of oxygen inhalation .Methods Fifty premature infants who needed oxygen inhalation in the warm box were divided into the prone position group （singular） and the supine position group （dual） according to the order of sequence .The transcutaneous oxygen/carbon dioxide pressure （ TcPaO2/TcPaCO2 ） and HR were monitored by transcutaneous oxygen/carbon dioxide partial pressure monitoring equipment and electrocardiogram monitor before and one hour after oxygen inhalation , and the transcutaneous oxygen saturation （ TcSpO2 ） were monitored before the oxygen inhalation , and the time of TcSpO 2 stabilized at 88%-93% were monitored one hour after oxygen inhalation.The changes of TcPaO2, TcPaCO2, the index of oxygenation index （PaO2/FiO2）, HR and the time of TcSpO 2 stabilized at 88%-93%were compared in two groups .Results No difference was found in the TcSpO2, TcPaO2, TcPaCO2, HR in two groups before the oxygen inhalation （P＞0.05）.The time of TcSpO2 stabilized at 88%-93%, TcPaO2, TcPaCO2, HR and PaO2/FiO2 were （92.3 ±177;3.2）min, （65.2 ±177; 11.6）mmHg, （36.7 ±177;4.2）mmHg, （120 ±177;9）beats/min, （179.3 ±177;10.4） one hour after oxygen inhalation in the prone position group, and were respectively （97.3 ±177;5.5） min, （55.5 ±177;9.7） mmHg, （33.1 ±177;3.5） mmHg, （132 ±177;10） beats/min, （ 170.5 ±177;9.5 ） in the supine position group , and the differences were statistically significant （t=3.77, 3.01, 3.88, 4.40, 3.18, respectively;P＜0.01）.Conclusions Prone position of oxygen inhalation can significantly improve the oxygenation state of premature infants so as to stop oxygen inhalation as soon as early . Key words: Infant,premature; Prone position; Oxygen inhalation in the warm box; Oxygenation

Is the supine position superior to the prone position for percutaneous nephrolithotomy (PCNL)?

The objective of this study is to update the two previous meta-analyses in order to evaluate the efficacy and safety of percutaneous nephrolithotomy (PCNL) for patients in the prone position versus supine position. An electronic database search of MEDLINE, EMBASE, google scholar, and the Cochrane library was performed up to June, 2013. All studies comparing prone with supine position for PCNL were included. The outcome measures were stone-free rate, operative time, complication and hospital stay. Two randomized controlled trials (RCTs) and 7 non-RCTs, including 6,413 patients (4,956 patients in the prone position group and 1,457 patients in the supine position group), met the inclusion criteria. Meta-analysis of extractable data showed that PCNL in the supine position was associated with a significantly shorter operative time (WMD: 21.7; 95% CI 2.46-40.94; p = 0.03) but lower stone-free rate (OR: 1.36; 95% CI 1.19-1.56; p < 0.0001) than PCNL in the prone position. There was no difference between the two positions regarding hospital stay (WMD = 0.05; 95% CI -0.16-0.25; p = 0.66) and complication rate (OR: 1.1; 95% CI 0.94-1.28; p = 0.24). In conclusion, the present study found different results from the two previous meta-analyses results regarding stone-free rate; PCNL in the supine position had a significantly lower stone-free rate than that in prone position.