Xiphoid Process Research Articles

Impact of Operating Table Height on the Difficulty of Mask Ventilation and Laryngoscopic View.

Background/Objectives: Airway management techniques, including mask ventilation and tracheal intubation, are vital across medical settings. However, these procedures can be challenging, especially when environmental conditions are less than ideal. This study explores how the height of the operating table affects the difficulty of anesthesia techniques involving mask ventilation and tracheal intubation. Methods: Twenty anesthesiologists participated in this study. We assessed the difficulty of procedures such as mask ventilation, Macintosh laryngoscopy, and video laryngoscopy using McGRATH and AWS, on a four-level scale. The operating table's height was adjusted at four points: the operator's umbilicus, the inferior margin of the 12th rib, the xiphoid process, and the nipple. Results: Mask ventilation was easiest at the operating table's height aligned with the inferior margin of the 12th rib. Conversely, direct laryngoscopic exposure was perceived as easier at higher table heights, with nipple height being optimal. The McGRATH laryngoscopy showed consistent difficulty across table heights, whereas the AWS tended to be somewhat more difficult at greater heights. Conclusions: The optimal bed height for video laryngoscopy coincided with that for mask ventilation. Video laryngoscopy offers enhanced flexibility in optimal patient positioning compared to Macintosh laryngoscopy, contributing to its advantages in tracheal intubation procedures.

Giant uterine fibroid with phlegmona of the anterior abdominal wall

This report presents a rare case of giant uterine fibroids in a 52-year-old patient, which was complicated by phlegmon of the anterior abdominal wall. Physical examination revealed skin necrosis above the navel, measuring 12×10 cm, with purulent content. On palpation, a space-occupying formation reaching the xiphoid process was noted, indicating an abdominal distension. The patient underwent surgery as planned; a suppurated section of the anterior abdominal wall, extending to the aponeurosis, was placed on the operating table. An inferomedial laparotomy with excision of a necrotic, suppurating area of the anterior abdominal wall was performed. Furthermore, a mass in the abdominal cavity was removed using a blunt and sharp method, and extirpation of the uterus and appendages was conducted. Histological examination revealed a giant uterine leiomyoma with stromal hyalinosis and omentitis. The patient was discharged on postoperative day 10 in satisfactory condition. No complications were observed during the postoperative period. Advanced uterine fibroids are common, and ignoring the need to undergo regular medical examinations and insufficient medical examination coverage can lead to such complications, which can significantly affect the quality of life of patients.

The Influence of Kinesiology Tape on Posture and Breathing Mechanics in Healthy Individuals: A Randomized Trial

Background and Purpose: Kinesiology tape (KT) has been used clinically to improve posture, mobility, and muscle strength. Limited research has investigated the effect of KT on respiratory function. The purpose of this study was to explore the effects of KT on posture and breathing in healthy individuals. Methods: Ninety-two adult participants were randomly assigned to a KT, sham tape (ST), or control group. Data collection occurred over 2 sessions. Baseline measurements included chest wall expansion (CWE) at the sternal angle (SA) and xiphoid process (Xi), maximal inspiratory pressure (MIP), and tragus (TWD) and acromion (AWD) to wall distances. Next, KT or ST was applied to the upper back and neck, or no tape was applied based on group assignment. Measurements were then repeated. Participants returned for a final round of measurements 48 hours later. Mixed-measures ANOVAs were used to determine the influence of tape at baseline (T0), immediately post-taping (T1), and 48 hours post-taping (T2). Post hoc analyses used the Tukey method. Results: Analysis showed significant differences between T0 and T1 (P = .004) and between T1 and T2 (P = .004) for AWD on the left. CWE-Xi data showed within group differences T0-T2 (P = .004) and T1-T2 (P = .004). MIP data showed within group differences between T0 and T1 (P = .001), T0 and T2 (P < .001), and T1 and T2 (P < .001). Discussion: KT had a limited and inconsistent impact on posture where there was a decrease in AWD on the left from T0 to T1 and then an increase from T1 to T2. No other changes in posture were found. Taping did not affect CWE at the SA. There was an evident training effect for CWE-Xi and MIP, where all groups saw increases over time. Conclusion: This method of KT application is not supported as an intervention for influencing posture and enhancing inspiratory breathing mechanics in healthy adults. Further investigation of KT in other populations is needed.

Pressure Pain Hyperalgesia Expressed by Topographical Pressure Pain Sensitivity after Cardiac Surgery.

We aim to evaluate changes in pressure pain sensitivity before and after cardiac surgery using topographical sensitivity maps utilizing a pressure algometer. Pressure pain thresholds over 17 thoracic points and 4 distant pain-free points were assessed in 70 patients (women: 29, age: 67.5 years), before and at 1, 3, and 7 postoperative days. Thoracic topographical pressure pain sensitivity maps were calculated at all follow-ups. Postoperative pain was recorded at each follow-up on a numerical pain rate scale. Postoperative pain intensity decreased from 6.4 (SD 1.0) on the first postoperative day to 5.5 (SD 1.9) on the third and to 4.5 (SD 1.7) on the seventh day (p < 0.001). The mixed-model ANOVA revealed that the lowest pressure pain thresholds were observed one day after surgery, increased slightly during follow-up, and were lower at the xiphoid process. Significant negative correlations between postoperative pain intensity and pressure pain thresholds were observed at each time point in thoracic measures (all, p < 0.01), but not with pressure pain thresholds from distant pain-free areas. Postoperative pain after cardiac surgery can be objectively quantified using algometry. Pressure pain hyperalgesia was associated with the intensity of postoperative pain.

Study of the somatic, neurological and osteopathic status of full-term newborns born by cesarean section in a planned and emergency manner

Introduction. Currently, the frequency of cesarean section (CS) in the world is at least 25 %, in Russia — at least 30 %. It is known that newborns after CS are a special risk group for the development of somatic dysfunctions (SD), which should be considered comprehensively, taking into account their somatic and neurological status.The aim is to study the effect of emergency CS on the somatic, neurological and osteopathic status of newborns and on the course of the early neonatal period.Materials and methods. 60 patients of the Department of Neonatal Physiology, aged 3–5 days of life, without structural pathology or malformations, born by cesarean section, were examined. Children are divided into 2 groups of 30 people. Group 1 — children born by emergency caesarean section (ECS). Group 2 — children born by planned (elective) caesarean section (PCS). A complex of examination methods was used in both groups. The anamnestic method included an assessment of the main risk factors during pregnancy and features of the early neonatal period. The clinical method included assessment of the somatic status of newborns; neurological assessment. Assessment of osteopathic status according to clinical guidelines. Assessment of functional disorders — using neuro-sonography, ultrasound of the hip joints, ultrasound of the abdominal organs. Statistical data processing was carried out using Microsoft Excel and the Medstatistic statistical software package. To study the relationships between the characteristics, a comparison of the populations was carried out based on qualitative characteristics. Fisher′s exact test was used for statistical processing of data. The analysis used a significance level of p&lt;0,05, which reflects the strength of the dependence of the characteristics being compared. Pearson′s coefficient was used as a criterion for the strength of connection.Results. When analyzing risk factors in both groups, a predominance of women over 30 years of age with a complicated pregnancy was noted among mothers. Extragenital pathology (most often pathology of the endocrine system) was detected in 70 % of mothers. In the ECS group, early and more intense jaundice was observed significantly more often (p&lt;0,05) (12 out of 30 children versus 4 out of 30 children in the PCS group); muscular dystonia with a tendency to increase muscle tone in the upper extremities and decrease in the lower extremities (in 22 out of 30 children in this group versus 12 out of 30 children in the PCS group); SD of the head region (13 cases in this group versus 4 cases in the second group). In the PCS group, autonomic disorders were observed significantly more often (p&lt;0,05) (12 out of 30 children versus 2 out of 30 children in the ECS group); SD of the pelvic region (visceral component, 9 cases versus 2 in the ECS group). In children of the ECS group, a statistically significant (p&lt;0,05) relationship was revealed between breech presentation and SD of the pelvic region (somatic component) — contingency coefficient 0,44; structural features of the chest (asymmetry, protruding xiphoid process) and SD of the thoracic region (visceral component) — 0,43; characteristics of the neurological status (hyperexcitability syndrome) and SD of the head region — 0,45. In children of the PCS group, a statistically significant (p&lt;0,05) relationship was revealed between morpho-functional immaturity and SD of the thoracic region (visceral component) — contingency coefficient 0.39; features of the skeletal system of the skull (Gothic palate, combination of Gothic palate and suture entry) and SD of the dura mater — 0,5; structural features of the chest (asymmetry, protruding xiphoid process) and SD of the thoracic region (somatic component) — 0,6; characteristics of the hip joints (asymmetry of the gluteal folds, difficulty in abduction, hypermobility) and SD of the pelvic region (somatic component) — 0,45; postural disorders (flexion, extension, latero-flexion to the right, latero-flexion to the left) and SD of the pelvic region (somatic component) — 0,49; increased muscle tone of the arms and SD of the thoracic region (visceral component) — 0,41.Conclusion. A comparative assessment of the osteopathic status of children born by cesarean section in a planned manner and for emergency indications was carried out, and an analysis of the possible connection of the identified somatic dysfunctions with risk factors for pregnancy and features of the early neonatal period was carried out. Based on the identified relationships between the somatic, neurological and osteopathic statuses of newborns in the first day of life, in the future it is possible to develop optimal timing for consultation with an osteopath for the purpose of earlier diagnosis and correction of somatic dysfunctions.

Cardiac Time Intervals under Motion Using Bimodal Chest E-Tattoos and Multistage Processing.

We present a thin, soft, and chest conformable bimodal sensor, known as the chest e-tattoo, coupled with an advanced signal processing framework to accurately identify various cardiac events, and thereby extract cardiac time intervals even during body motion. We built a wireless electronic tattoo that features synchronous electrocardiography (ECG) and seismocardiography (SCG). The SCG measures chest vibrations due to heartbeat, providing information on cardiovascular health that is complementary to the ECG. However, the efficacy of the SCG is compromised by motion-induced artifacts. The slim and stretchy design of the e-tattoo allows it to be strategically placed near the xiphoid process, facilitating high-quality monitoring of the ECG and SCG for increased signal quality. Nine participants were measured during walking and cycling. We propose a multistage signal processing framework, integrating an adaptive Normalized Least Mean Squares (NLMS) filter, ensemble averaging, and Empirical Mode Decomposition (EMD), together named the FAD framework, to accurately extract cardiac time intervals (CTIs).

Using computed tomography to evaluate anatomic landmarks in taiwanese trauma patients for insertion of resuscitative endovascular balloon occlusion of the aorta: A retrospective cohort study.

Hemorrhage, particularly from non-compressible torso hemorrhage (NCTH) in the abdominopelvic region, is a leading cause of preventable trauma deaths. Resuscitative endovascular balloon occlusion of the aorta (REBOA), designed for aortic occlusion, has emerged as a tool for temporary hemorrhage control in recent years. However, attaining optimal REBOA placement in diverse demographic groups, such as Asian populations, may pose challenges owing to unique anatomical and physiological differences. This retrospective study analyzed trauma patients who underwent torso computed tomography (CT) at tertiary hospitals in Taiwan from January 2014 to January 2017. The OsiriX software was used to measure the endovascular lengths in the CT images. Among the 223 patients, the median vascular lengths and body measurements were higher in males. The optimal fixed insertion length was identified as 47.5cm for zone 1 with 99.43% accuracy and 25.5cm with 82.1% accuracy for zone 3. The landmark-guided method showed 100% accuracy for zone 1 when using the mid-sternum and 94.6% for zone 3 with the umbilicus as the guide with the distance between the umbilicus, xiphoid process, and pubic ramus. External validation confirmed the accuracy of the landmark-guided method. For zone 1 occlusions, a range of 44-48cm insertion length cross-referenced with the mid-sternal landmark is recommended. For zone 3 occlusions, using the umbilicus as a guide with the distance between the umbilicus, xiphoid process, and pubic ramus provided the highest accuracy.

Mind the gap: treating post-surgical scar tissue in post-mastectomy patients – a randomized clinical trial

IntroductionPost-mastectomy physiotherapy typically includes massage, exercise, and stretching, but often fails to treat post-surgical scar tissue, a significant contributor to long-term disability. This study aimed to compare conventional therapy with myofascial manual therapy for treating post-surgical scar tissue in post-mastectomy patients and to determine the effectiveness of these treatments.MethodsThe study was an experimental controlled study with pre- and post-testing of two parallel groups. Forty-eight women experiencing shoulder and/or upper torso impairment following mastectomy were randomly allocated to either a control group (&lt;i&gt;n&lt;/i&gt; = 21) or a myofascial therapy group (&lt;i&gt;n&lt;/i&gt; = 27). Conventional physiotherapy involving exercise and massage or myofascial therapy was used. Pre- and post-therapy measurements included muscle length, pain intensity, range of motion (ROM), and scar mobility.ResultsMyofascial therapy was superior to conventional physiotherapy in reducing the percentage of patients with below-normal muscle lengths at several sites. Significant decreases from baseline were observed in the treatment group for the pars clavicularis, descending trapezius, pars sternocostalis, latissimus dorsi, and levator scapulae muscles. Myofascial therapy also improved mobility in the scar area, with increases of 3 mm relative to the xiphoid process and 4 mm relative to the coracoid.ConclusionsOur study indicates that myofascial interventions improve upper limb ROM and muscle elasticity in the upper limb girdle of post-mastectomy patients. These findings provide empirical evidence supporting the benefits of myofascial intervention over conventional physiotherapy in the treatment of post-surgical scar tissue in this patient group.

Topography and morphology of the Eira barbara diaphragm

BackgroundThe diaphragm, the main muscle involved in respiration and one of those responsible for maintaining life, is still little explored in terms of its morphology in wild animals. There are few studies on the anatomy of Eira barbara, a carnivorous mustelid that is a victim of the urbanization process. In order to contribute to the conservation of the species, we described the topography and morphology of the diaphragm, which may be involved in injuries caused by the impacts of human activities.ResultsWe studied five specimens of Eira barbara, whose diaphragmatic muscle had a dorsal insertion on the 14th thoracic vertebra, laterally between the 8th and 13th intercostal space (EIC) and ventrally on the 8th EIC, with attachment to the xiphoid process. Consisting of three muscle regions (lumbar, costal and sternal), the diaphragm in Eira barbara showed radially arranged bundles, with the right costal muscle being slimmer than the left; the left pillar wider than the right and between them were the aortic and esophageal hiatuses. The Y-shaped tendinous center housed the foramen of the vena cava bordering the right costal region. In the most dorsal portion of the diaphragm, between the costal regions and the diaphragmatic pillar, we found two triangular-shaped regions devoid of muscle.ConclusionsOur findings, when compared with the current literature, indicate that the location and positioning of the diaphragm are independent of the physical conformation of the species, and that the right costal region, as well as the triangular areas devoid of musculature, may be fragile points for herniation in cases of Eira barbara being run over.

Revisiting morphology of xiphoid process of the sternum in human: a comprehensive anatomical study.

The xiphoid process (XP) in animals such as sheep and rats are well known to have cartilage called xiphoidal cartilage (XC). In humans, the cartilage in the xiphoid process is considered an anatomical variant and is not well understood. The aim of this study was to investigate the morphology of the XP. A total of twenty embalmed European descendant cadaveric sterna (aged 52 to 98 years) were used. Transilluminated XPs and midsagittal sections of XPs were used to examine the bone and cartilage. Subsequently, a sagittally-sectioned XP was harvested for histology and stained with Masson's trichrome. The results of the transillumination and histological examinations were compared qualitatively. The dark area visible in transilluminated XPs was consistent with the bony part in the midsagittal XP sections, which contained bone marrow; the bright area was consistent with the cartilage part in the midsagittal XP sections. This was all demonstrated histologically. Most of the XPs (85%) had some portion of cartilage. The XP was classified into four types based on its proportions of bone and cartilage: Type I, no ossification (< 1/3 ossification) 45%; Type II, minor ossification (1/3 - 1/2 ossification) 20%; Type III, major ossification (1/2-2/3 ossification) 20%; Type IV, complete ossification (> 2/3 ossification) 15%. Most of the XPs (85%) had bone and cartilage, which could have been overlooked in studies using skeletons or CT. Previous studies probably underestimated or overestimated the size of the XP. The XC needs to be considered as normal anatomy.

The Immediate Effect of Chest Mobilization Technique on Chest Expansion in Patients of COPD

Introduction: Chronic Obstructive Pulmonary Disease (COPD) is characterized by chronic airflow obstruction. Patients with COPD often experience reductions in lung volumes and vital capacity due to chronic respiratory muscle weakness. Additionally, they may exhibit decreased lung distensibility, leading to restrictions in lung volume. The passive recoil of the thoracic cage is influenced by gross muscle weakness, altering the neutral position at which lung and cage recoil pressures are balanced. Mobilizing rib cage joints is a specific therapeutic goal, as it aims to improve reduced rib cage mobility commonly observed in obstructive lung disease. Method: A study was conducted on COPD patients aged over 40 years, specifically including males with VC&lt;80%. Participants with unstable vital parameters, active lung infections, or those requiring continuous oxygen therapy or mechanical ventilation were excluded. The participants were divided into two groups: Group 1 received chest mobilization and breathing exercises, while Group 2 received only breathing exercises. Chest expansion measurements were taken at the 2nd intercostal space, 4th intercostal space, and xiphoid process in both groups before and after the procedures. Result: Result obtained from SPSS20. Mean-age of Group1 was (61.9+6.0) &amp; of Group2 was (62.05+6.1). Comparison between groups found using independent t-tests. There was significant difference of chest-expansion at 2nd IC, 4th IC and xiphoid process between both the groups. Chest-expansion at 2nd IC(M=2.0), 4th IC(M=2.85) and xiphoid process (M=3.43) was increased in group1 than group2 (M=1.58), (M=2.01) &amp; (M=2.49) having significant difference of p&lt;0.05. Conclusion: This study concludes that Chest Wall mobilization has significant effect on Chest-expansion in COPD patients. Hence Chest-Mobilization is definite tool for the improving condition of COPD patients, so it should be included as a part of management in COPD patients with other exercise treatment-programs. Keywords: Chest mobilization, COPD, Chest expansion, Cloth tape measurement

Chronic clinical performance of a novel subxiphoidal pacemaker system: Early feasibility study design.

Extravascular and leadless pacemakers are a new class of cardiac devices that may reduce the rate of complications common to traditional cardiac pacemakers with intracardiac leads. These devices also have the potential of expanding access to cardiac pacing therapy by simplifying the complexity and cost of implantation. The objective of this study is to evaluate the implantation, chronic safety, and performance of a novel subxiphoidal pacemaker. This study is an open-label, non-randomized, early feasibility study. Ten patients indicated for implantation of a single-chamber ventricular pacemaker will be enrolled and implanted with the investigational device. The pacemaker will be inserted underneath the ribcage and clipped to the xiphoid process, with stimulation electrodes positioned on the cardiac pericardium. Patients will be programmed to chronic pacing; pacing capture threshold, sensing amplitude, and lead impedance will be measured at implant and regularly scheduled follow-up visits. 24-h Holter ECG and cardiac troponin will also be periodically measured. Adverse events will be recorded throughout the study period. This study is designed to assess the feasibility, safety, and chronic performance of a novel extravascular pacemaker, and will provide valuable data on whether this device has the potential to be a viable alternative to conventional pacemakers.

Immediate effects of Kinesio Taping ® on respiratory parameters in healthy individuals

BackgroundKinesio taping® (KT) could facilitate respiratory muscle contraction, improving breathing. Therefore, this study aimed to analyze the immediate effects of KT application on thoracoabdominal mobility, vital capacity, and respiratory muscle strength of healthy young individuals. MethodsThis clinical trial included 19 healthy individuals, measuring their maximum inspiratory and expiratory pressure, vital capacity, and thoracoabdominal mobility using cirtometry. Participants were evaluated, and KT was applied below the xiphoid process; then, they were reassessed 15 min after the application. ResultsThe thoracoabdominal mobility did not significantly change the axillar (84.2 ± 6.6 cm vs 83.6 ± 6.1 cm; p = 0.116), xiphoid process (74.2 ± 8.8 cm vs 74.2 ± 8.63 cm; p = 0.805), and umbilical (73.7 ± 8.1 cm vs 74.2 ± 8.35 cm; p = 0.344) circumferences. Additionally, the vital capacity (3.8 ± 1.0 L vs 3.5 ± 1.3 L; p = 0.097), the maximal inspiratory pressure (−85.3 ± 31.7 cmH2O vs −79.5 ± 34.7 cmH2O; p = 0.265), and maximal expiratory pressure (63.9 ± 31.8 cmH2O vs 59.5 ± 36.1 cmH2O; p = 0.277) were not significantly different. ConclusionsKT showed no immediate effect on thoracoabdominal mobility, vital capacity, and respiratory muscle strength of healthy young adults. Future studies should investigate the effects of KT applied for a longer time (i.e., long-term effects). Furthermore, individuals with respiratory diseases could be evaluated, especially those presenting dysfunction in the rib cage morphology.

Incarcereted Epigastric Hernia with Liver Content: a Case Report

The epigastric hernia sac usually contains preperitoneal fat tissue, omentum, and intestines, but the presence of liver tissue is extremely rare. Epigastric hernia is a type of hernia in the midline of the abdominal wall between the umbilicus and the xiphoid process. It may be asymptomatic in some patients and cause complaints such as pain and nausea in most patients, but serious complications such as incarceration and strangulation are rare. In the present case, a 74-year-old woman was examined and found to have an irreduced omentum, transverse colon and liver tissue inside the hernia sac. She underwent an open procedure with onlay mesh-assisted hernia repair. Rare but serious complications, such as liver tissue incarceration, should be considered in epigastric hernia patients.

First-in-man clinical implantation and acute pacing performance of a novel subxiphoidal pacemaker system.

Intravascular cardiac pacemakers are an established therapy for bradycardic indications. Recently, a new class of leadless pacemakers have mitigated some of the complications related to pacemaker leads. In this study, we evaluate the implantation and performance of a novel extravascular technology that delivers epicardial pacing through a subxiphoidal approach. Fifteen patients undergoing non-emergent open-heart surgery were enrolled. A midline incision was made just below the xiphoid process, and substernal tunneling was used to create a pocket for the device and to access the anterior pericardium over the right ventricle. The test device (Calyan Technologies, Oakdale, MN) was temporarily inserted underneath the ribcage and clipped to the xiphoid process. The sensing and pacing electrode (FlexArm) was positioned on the anterior pericardium. Ventricular sensing and pacing capture thresholds were measured. The test device was successfully implanted in all 15 patients. There were no device or procedure-related adverse events. The first five implanted patients had no pacing capture at maximum stimulation intensity. Design changes were made to the device, including different electrode size and shape, and successful ventricular capture was achieved in 9 of the subsequent 10 patients. In these patients, pacing threshold was 3.8 ± 1.6mA with a pulse width of 0.5 ms. All devices were successfully explanted at the end of the procedure. In a first-in-human experience with a novel extravascular pacemaker, this study demonstrated the feasibility of pericardial ventricular pacing via a subxiphoidal approach. Further chronic studies are required to evaluate the safety and performance of this novel pacing technology.

Risk factors for diaphragmatic injury in subxiphoid video-assisted thoracoscopic surgery.

Subxiphoid video-assisted thoracoscopic surgery (VATS) is considered a safe and feasible operation for anterior mediastinal mass resection. However, diaphragmatic injury, presented as tearing or puncturing, may occur during subxiphoid VATS despite of low incidence. This study aims to explore risk factors for diaphragmatic injury in subxiphoid VATS, as well as strategies to reduce occurrence of the injury. We retrospectively reviewed clinical records of 44 consecutive adult patients who underwent subxiphoid VATS. These patients were divided into two groups: diaphragmatic injury group and non-injury group. Perioperative outcomes and anatomic features derived from 3D CT reconstructions were compared between the two groups. Significant differences were observed in operation time (223.25 ± 92.57 vs. 136.28 ± 53.05, P = 0.006), xiphoid length (6.47 ± 0.85 vs. 4.79 ± 1.04, P = 0.001) and length of the xiphoid below the attachment point on the diaphragm (24.86 ± 12.02 vs. 14.61 ± 9.25, P = 0.029). Odds ratio for the length of the xiphoid below the attachment point on the diaphragm was 1.09 (1.001-1.186), P = 0.048 by binary logistic regression analysis. We identified the length of the xiphoid below the attachment point on the diaphragm as an independent risk factor for diaphragm injury during subxiphoid VATS. Prior to subxiphoid VATS, a 3D chest CT reconstruction is recommended to assess the patients' anatomic variations within the xiphoid process. For patients with longer xiphoid process, a higher incision at the middle and upper part of the xiphoid process, and partial xiphoid process resection or xiphoidectomy is preferred.

Analysis of respiratory properties using the low-frequency piezoelectric sensor in patients undergoing intravenous sedation: a prospective observational study

BackgroundPatients who undergo general anesthesia may experience respiratory failure postoperatively because of respiratory depression or upper airway obstruction. AimWe investigated whether a piezoelectric sensor (AYA-P sensor) can be used to detect upper airway obstruction in patients undergoing intravenous sedation. MethodsThis prospective observational study included 26 patients who underwent dental treatment under sedation at a dental clinic. Participants were evaluated using a newly defined airway obstruction score (AOS). The AYA-P sensors were attached to the suprasternal notch and the midpoint between the umbilicus and xiphoid process. The patient's respiratory status was classified into four categories based on thoracic movements, capnography, and breathing sounds from recorded data (S1: no airflow, S2: hypoventilation, S3: normal breathing, and S4: artifact). The data obtained from the AYA-P sensors were processed using a 0.4-Hz low-pass filter, calculated using the moving standard deviation (MSD) method, and further processed using a 0.1-Hz low-pass filter (fMSD). Next, these data were differentiated (D-fMSD). We defined the positive predictive value (PPV) as fMSD or D-fMSD values higher than a threshold α in categories S1 and S2. PPV(αMAX) was defined as the maximum PPV, and the negative predictive value (NPV[αMAX]) was defined using the same αMAX. ResultsWe compared each of the apnea-hypopnea time ratio (AHT%) and AOS with PPV(αMAX) and NPV(αMAX). The AHT% and AOS were correlated with PPV(αMAX) and NPV(αMAX) in the neck and abdomen, respectively. These findings suggest that an AYA-P sensor attached to the neck and abdomen can detect a patient's respiratory status. ConclusionProcessed data obtained from AYA-P sensors can predict upper airway obstruction in patients, and the predicted data may be dependent on individual anatomical differences. Clinical trial registrationThis study was registrated in the University Hospital Medical Information Network Clinical Trials Registry (UMIN-CTR) clinical trial: Unique ID: UMIN000047007.

Determining the Optimal Position of Surface Electrodes for Diaphragm Electromyography: A Cross-Sectional Study.

Placing electrodes on different aspects of the chest determines the motor firing from the diaphragm. The electrode placement close to the extent of the muscle gave promising readings as compared to the ones that were placed away. The position with the maximum amplitude and least duration was chosen. Positions of the electrodes were decided as per the extent of the muscle. The aim is to determine the appropriate position of surface electrodes for surface diaphragm electromyography (EMG). Thirty healthy individuals of age ranging from 21 to 45 years were included in the study. Participants were made to lie down in a supine position and different positions like G1 (recording electrode) 5 cm superior to the tip of the xiphoid process and G2 (reference) 16 cm along the costal margin from G1, G1 over the xiphoid tip and G2 at the seventh intercostal space at the costochondral junction and G1 over the xiphoid tip and G2 at the eight intercostal space at the costochondral junction were used for assessing maximum amplitudes and durations were observed by using a Octopus New Wave EMG machine (Octopus Medical Technologies, Vadodara, IND). After observing all the positions, an optimum position for maximum amplitude and least duration was analyzed. As per the study, out of the four positions, the electrode placements on the tip of the xiphoid process and 16 cm away diagonally on the sixth intercostal space showed maximum amplitude and the least duration with maximum mean amplitude and less mean duration of 232.35 and 7.316. On the seventh intercostal space it was 199.15 and 7.887 and on the eighth intercostal space was 176.055 and 8.639. The tip of the xiphoid process and 16 cm away diagonally on the sixth intercostal space is chosen as the appropriate position for electrode placement for EMG of the diaphragm. We conclude that the best electrode position was when the electrodes were placed 5 cm superior to the xiphoid process, i.e., G1, and 16 cm away from the recording electrode on the costochondral junction, i.e., G2, at the sixthintercostal space. Ground electrode placement is the nearest bony prominence, i.e., xiphisternum.

Anatomical features of a crossing vein connecting left and right internal mammary veins: A preliminary study with computerized tomography or magnetic resonance imaging.

In breast reconstruction with free flaps, retrograde venous anastomosis into the internal mammary vein (IMV) is often unavoidable. Utility of a crossing vein between the right and left IMV, one of the anatomical foundations which make retrograde flow possible, has been reported but only with a few detailed features. This study evaluated the presence, actual location, and diameter of the crossing veins using preoperative imaging such as contrast-enhanced computed tomography (CECT), or contrast-enhanced magnetic resonance imaging (CEMRI). Moreover, this is a preliminary non-invasive study to clarify these processes on a larger scale. We included 29 cases of unilateral breast reconstruction performed between July 2018 and September 2023 at our institution using unipedicled or bipedicled free deep inferior epigastric artery perforator (DIEP) flaps with retrograde venous anastomosis to only one IMV at the level of anastomosis. No congestion or necrosis was observed. In the final 24 cases with sufficient imaging coverage of preoperative contrast-enhanced images (15 CECT and 9 CEMRI), the crossing veins of IMVs were detected and the number, localization, and diameter were measured. In 20 cases of 24 images, the crossing veins between IMVs were completely identified (83%). In 18 of the cases, only one crossing vein was established immediately ventral to the xiphoid process, averaging 19.3 ± 7.18 mm caudal to the fibrous junction between the sternal body and xiphoid process. The average diameter of the veins was 1.57 ± 0.42 mm. In two other cases, the second crossing vein originated on the dorsal surface of the sternum, but it was a very thin vein of about 0.4 mm. Three images indicated incomplete identification of the crossing vein at the xiphoid process, and in one case, no crossing vein was observed between bilateral IMVs. The contrast-enhanced imaging study revealed an anatomic feature that the crossing veins (about 1.5 mm in diameter) connecting the right and left IMVs are located just ventral to the xiphoid process. Furthermore, the crossing veins can be identified on contrast-enhanced images, and refinement of this method is expected to lead to future non-invasive anatomical investigations in an even larger number of cases.

ASSESSMENT OF A SELF-PACED PROTOCOL FOR TESTING AEROBIC CAPACITY IN SCI INDIVIDUALS

https://youtu.be/u89x4ivgoIc BACKGROUND Underwater treadmill (UT) exercise is a recent and sparsely tested modality that may be beneficial for those with incomplete spinal cord injury (iSCI). Currently, VO2max and HRmax have not been assessed during UT exercise among those with iSCI. This study's purpose was to determine if a rating of perceived exertion (RPE) based max exertion protocol used with a motorized UT can elicit criterion-based max physiological responses among those with and without iSCI. METHODS Healthy adult males with iSCI (n=4; Age=49.8 +/- 3.9 yrs) and without iSCI (n=4; Age=50.0 +/- 7.2 yrs) participated. Borg OMNI RPE scale was used by participants to estimate intensity of exercise. Each participant reported to the lab on two occasions. On visit one, they completed informed consent papers and familiarization with the RPE scale and UT exercise. On visit two, they completed a speed-based, self-regulated incremental exercise test on the UT. Prior to all testing, the UT was filled and set to 92°F. Upon arrival, HR monitor and mask for gas collection were donned. Water height was modified to the xiphoid process. The test consisted of rest, warm-up, incremental exercise, and active recovery phases. For warm-up, treadmill speed was adjusted to 0.5 mph for 3 minutes. After walking 3 minutes, speed was increased to 0.75 mph for another 3 minutes. The incremental exercise phase consisted of four stages, 3 minutes in duration, totaling 12 minutes. For each stage, participants self-selected a speed perceived to correspond to RPE levels: 3, 5, 7, and 10. Treadmill speed was hidden from participants. At each stage's start, speed was only adjusted during the first minute until reaching the proper RPE. During the final stage, treadmill speed could be changed freely until volitional exhaustion. The test ended when volitional exhaustion was reached, at which point the speed was lowered for an active recovery. An independent samples t-test was used to compare time (minutes) until volitional exhaustion. Separate independent samples t-tests were used to compare the highest achieved HR and VO2 values. RESULTS All iSCI participants achieved a VO2peak. Only 1 participant without iSCI achieved a VO2max. Mean VO2 was significantly lower, t(6)=3.81, p=.027, for those with iSCI (13.88 +/- 10.57 mL/kg/min) than those without iSCI (34.50 +/- 2.38 mL/kg/min). CONCLUSION This study shows that the UT is a safe modality for graded exercise testing for those with and without iSCI. An RPE-regulated protocol may not be effective for eliciting criterion-based maximal aerobic results with the UT, but was well tolerated by those with iSCI. Those with iSCI may have lacked lower limb strength to achieve max workloads. Being able to use the UT to test peak aerobic fitness allows clinicians to track improvements in economy following UT training. More research of this modality is encouraged with larger samples to further evaluate potential testing protocols among this population.