Search

Context: The hip adductor and abductor muscles play vital roles as stabilizers in the lower-extremity. Their activation during soccer-specific actions is essential, but local muscular fatigue can hinder athletic performance and increase the risk of injury. Design: This study aimed to observe the variations in frontal plane hip strength in female college soccer players before and after a high-workload soccer-specific training session. Furthermore, the study sought to compare the relative changes in hip strength with the internal and external load measures obtained during that session. Methods: Twenty female college soccer players participated in a retrospective observational study. Isometric hip adductor and abductor strength were measured before and after a training session in the college spring season. Measurements were taken with a handheld dynamometer (MicroFET 2) while the players were supine. Global positioning system sensors (Catapult Vector S7), commonly worn by players during training sessions and competitive matches, were used to measure external and internal loads. Statistical analyses were performed using paired samples t test to assess hip adductor and abductor strength changes before and after the training session. Spearman rank was used to identify correlation coefficients between global positioning system data and isometric hip strength. Results: The findings revealed significant decreases in the strength of the right hip adduction (P =.012, −7% relative change), right abduction (P =.009, −7.6% relative change), and left abduction (P =.016, −4.9% relative change) after the training session. Furthermore, relative decreases in hip isometric adduction and abduction strength are related to the distance covered at high speeds. Conclusion: The results of this study highlight that hip isometric adduction and abduction strength tend to decrease after exposure to high workloads during soccer-specific training. [ABSTRACT FROM AUTHOR]

Previous observations demonstrate New Zealand blackcurrant (NZBC) extract to alter cardiovascular responses at rest without prior exercise. However, the prolonged effects of NZBC on blood pressure and heart rate variability following exercise are not known. Participants (n15 [five women], age: 31 ± 9 years, maximal oxygen uptake: 44 ± 9 ml·kg−1·min−1) undertook a control condition of 2 hr of lying supine rest. Subsequently, in a double-blind, placebo (PLA)-controlled, randomized crossover design participants completed 1 hr of treadmill exercise at 50% maximal oxygen uptake followed by 2-hr supine rest with blood pressure and heart rate variability measurement following a 7-day intake of NZBC and PLA. With NZBC, there was an increase in average fat oxidation (NZBC: 0.24 ± 0.11 vs. PLA: 0.17 ± 0.11 g/min, p =.005), and larger high-frequency relative power during the exercise (p =.037). In the 2-hr rest period, delta change for systolic pressure was larger with NZBC than PLA (Control vs. NZBC: −5.6 ± 6.4, Control vs. PLA: −3.5 ± 6.0 mmHg, p =.033) but was not different for diastolic or mean arterial pressure. There were no alterations in heart rate variabilities during the 2 hr following the exercise with NZBC. A 7-day intake of NZBC causes a larger postexercise hypotension response in young, physically active men and women following 1 hr of treadmill exercise at 50% maximal oxygen uptake. [ABSTRACT FROM AUTHOR]

Summary This study compared the effects of sleeping in the supine position and rapid eye movement sleep on the severity of obstructive sleep apnea, and investigated the effect of sleep stage on position‐dependent obstructive sleep apnea, and of sleep position on rapid eye movement‐dependent obstructive sleep apnea. We analysed epoch‐labelled polysomnographic readouts of 3843 patients, and calculated the apnea–hypopnea index for each sleep position and sleep stage. Subgroup analyses were performed to evaluate whether the proportion of position‐dependent obstructive sleep apnea patients changed during rapid eye movement and non‐rapid eye movement sleep, and whether that of rapid eye movement‐dependent obstructive sleep apnea patients changed during supine/lateral sleep. The apnea–hypopnea index was highest in the rapid eye movement‐supine position (50.7 ± 22.6 events per hr), followed by non‐rapid eye movement‐supine, rapid eye movement‐lateral and non‐rapid eye movement‐lateral (39.2 ± 25.3, 22.9 ± 24.4, 15.9 ± 21.9 events per hr, respectively; p < 0.001). Patients with position‐dependent obstructive sleep apnea had a higher ratio of rapid eye movement sleep, and those with rapid eye movement‐dependent obstructive sleep apnea had a higher ratio of sleep time in the supine position (p < 0.001). During rapid eye movement sleep, position‐dependent obstructive sleep apnea was not observed in 21.1% of patients who otherwise had position‐dependent obstructive sleep apnea. In the lateral position, 36.9% of patients with rapid eye movement‐dependent obstructive sleep apnea did not retain rapid eye movement dependency. Although sleeping in the supine position and rapid eye movement sleep were both associated with more frequent respiratory events, this was the first study to demonstrate that the former had a stronger correlation with obstructive sleep apnea severity. Position dependency in patients with obstructive sleep apnea decreased during rapid eye movement sleep, and worsening of rapid eye movement dependency was alleviated in the lateral position, suggesting potential for personalized obstructive sleep apnea management. [ABSTRACT FROM AUTHOR]

The goal of this study was to compare the advantages of conventional laparoscopic surgery (CLS) and the split-leg supine position single-port plus one laparoscopic surgery (SSP SILS + 1) in esophageal surgery. This study enrolled 73 patients who previously underwent radical esophagectomy for esophageal cancer from August 2021 to February 2023. Among them, 36 patients underwent SSP SILS + 1, whereas the remaining 37 patients underwentCLS. Surgical time, bleeding volume, number of dissected lymph nodes, incision length, and postoperative abdominal pain score between the two groups of patients were compared using either the Student's t-test or chi-square test. Time of abdominal incision (1.4 ± 0.2 min vs. 5.2 ± 0.7 min, p < 0.001) was shorter in patients in the SSP SILS + 1 group compared with those in the CLS group. However, the average incision length was shorter in the SSP SILS + 1 group compared with that in the CLS group (35.4 ± 4.0 cm vs. 4.6 ± 4.1 cm, p < 0.001). Notably, the pain score on postoperative day (POD) 1 was lower in the SSP SILS + 1 group compared with that in the CLS group (5.7 ± 0.7 vs.6.3 ± 0.7, p = 0.001). The SCAR score was also lower in the SSP SILS + 1 group compared with that in the CLS group (3.5 ± 0.9 vs. 8.3 ± 1.4, p = 0.019). There was no significant difference in the number of dissected abdominal lymph nodes and positive lymph nodes (p > 0.01) between the two groups. The SSP SILS + 1 intervention offers multiple benefits over conventional surgical procedures, encompassing shorter incision length and pain scores on POD 1. In accelerated rehabilitation surgery for esophageal cancer, this surgical procedure demonstrated high safety, feasibility. [ABSTRACT FROM AUTHOR]

Background: Over the past decade, the adoption of screening programs, digital mammography, and magnetic resonance imaging (MRI) has increased early-stage breast cancer diagnosis rates. Mortality rates have decreased due to early detection and improved treatments, including personalized therapies. Accelerated partial-breast irradiation (APBI) is emerging as a convenient and effective treatment for some patients, with studies exploring its preoperative use. Preoperative APBI, especially with MRI guidance, offers improved tumor targeting and potentially reduced side effects. Magnetic Resonance Imaging-Guided Single-Fraction Pre-Operative Radiotherapy for Early-Stage Breast Cancer (RICE trial) aims to assess the feasibility and efficacy of MRI-guided single-dose radiotherapy (RT) for early-stage breast cancer. Methods: The RICE study is a prospective, single-arm study evaluating single-fraction preoperative, APBI treatment for patients with early-stage breast cancer using a magnetic resonance imaging linear accelerator (MRI linac). Eligible patients enrolled in this study will have a core biopsy to confirm estrogen receptor-positive and HER2-negative sub-type. RT planning will use a planning computed tomography (CT) co-registered with a MRI with the patient in either the supine or prone position. For the diagnostic workup, [18F] fluorodeoxyglucose positron emission tomography/CT ([18F] FDG PET/CT) and [18F] fluoroestradiol positron emission tomography/CT ([18F] FES PET/CT) will be performed prior to treatment. Thirty patients will receive a single ablative RT dose of 21 Gray to the tumor. Pre-treatment and post-treatment MRI scans will be acquired at baseline and 5 weeks post-RT respectively. Breast-conserving surgery will be scheduled for 6 weeks after APBI treatment using the MRI linac. The primary study endpoint is the successful administration of a single fraction of preoperative breast RT under the guidance of an MRI linac. Secondary endpoints include evaluating the utility of MRI, [18F] FDG PET/CT, and [18F] FES PET/CT as a non-invasive method for assessing treatment response in patients undergoing single-fraction preoperative APBI. Conclusion: The RICE trial represents a significant step in breast cancer treatment, offering insights that could lead to treatment protocols with minimized RT appointments and enhanced patient outcomes. Trial registration: This trial is registered with the Australian New Zealand Clinical Trials Registry (ANZCTR). Registered 31st of May 2021. Registration number: ACTRN12621000659808. [ABSTRACT FROM AUTHOR]

Introduction: In the early postoperative period after total knee arthroplasty (TKA), joint range of motion (ROM) limitation and increased stiffness due to pain are commonly observed. Previous studies have reported that a single bout of foam rolling (FR) can acutely increase ROM and pain threshold on the contralateral (non-intervention) side in healthy participants. In this study, we aimed to expand this knowledge for TKA rehabilitation and investigated the acute effects of FR intervention on the non-operative side on ROM, stiffness, and pain of the operative side in postoperative patients within the first week after TKA. Materials and methods: The study employed a randomized crossover design: 20 patients (mean age 75.0 ± 7.8 years) in the first postoperative week after TKA were divided alternately into Roll_Break and Break_Roll groups in the order of prescription. In the Roll_Break group, after the initial evaluation, a 180-s (60-s × three sets) FR intervention using a roller massager by a physiotherapist for the knee extensors was performed on the contralateral side (non-operative side), followed by the measurement. Afterwards, after 180-s of supine at rest, the measurement was performed again (i.e., control phase). In the Break_Roll group, after the initial evaluation, each patient was placed in a seated resting position for 180-s, and then another measurement was performed (i.e., control phase). After this, the FR intervention was performed for 180-s, and then the measurement was performed again. The intensity of the FR intervention was set to the maximum intensity that did not cause pain. We measured pain using the visual analogue scale at rest and during the knee joint ROM measurements, knee joint active movement ROM, knee joint passive ROM, and stiffness during the knee joint active movement. Results: All outcome variables showed significant improvements after the FR intervention (intervention phase) when compared pre- to post-intervention, and significantly favourable effects were found compared to the control condition. Conclusion: The results showed significant improvements in ROM, pain, and stiffness of the operative side after the FR intervention on the non-operative side. For future therapy approaches for TKA patients, FR treatment of the non-operative side should be employed in the first weeks after surgery. [ABSTRACT FROM AUTHOR]

Introduction: Psoriasis is a prevalent, long-lasting inflammatory skin condition characterised by various clinical manifestations and arising from the interaction of genetic, environmental, and immunological factors. It has been found to be associated with several medical conditions, such as hypertension, diabetes, Cardiovascular (CV) diseases, and metabolic syndrome. Aim: To compare the Electrocardiographic P Wave Dispersion (PWD) in individuals with and without psoriasis and to correlate PWD with the Psoriasis Area Severity Index (PASI) score. Materials and Methods: This was a hospital-based crosssectional study comparing the electrocardiographic PWD in 30 patients with psoriasis to that of 30 age- and gender-matched subjects without psoriasis who attended Government Medical College, Trivandrum, Kerala, India, during a period of one year (February 2021 to January 2022). A structured questionnaire was used to record history and examination findings. A 12-lead Electrocardiogram (ECG) was performed on study participants from both groups in a supine position following 15 minutes of rest. Categorical and quantitative variables were expressed as frequency (percentage) and mean±SD, respectively. The Karl Pearson test was used to find correlations. A p-value of ≤0.05 was considered statistically significant. Results: Ten (33.3%) patients belonged to the age group of 41-50 years. The duration of the disease ranged from six months to 21 years. Seventeen (56.7%) patients had a PASI score between 10-20, and 5 (16.7%) patients had a PASI score of less than 10. The maximum value of the P wave and PWD was higher in the case group and was statistically significant (p≤0.001 and p≤0.001, respectively). A statistically significant correlation was found between the severity of psoriasis and PWD (r=0.564, p≤0.001) and between the duration of psoriasis and PWD (r=0.372, p=0.04) in this study. Conclusion: PWD was found to be higher in psoriasis patients, with a significant correlation between PWD and both the severity and duration of the disease. Therefore, ECG should be considered as a screening test for Atrial Fibrillation (AF) in all psoriasis patients. [ABSTRACT FROM AUTHOR]

Background: For patients receiving one lung ventilation in thoracic surgery, numerous studies have proved the superiority of lung protective ventilation of low tidal volume combined with recruitment maneuvers (RM) and individualized PEEP. However, RM may lead to overinflation which aggravates lung injury and intrapulmonary shunt. According to CT results, atelectasis usually forms in gravity dependent lung regions, regardless of body position. So, during anesthesia induction in supine position, atelectasis usually forms in the dorsal parts of lungs, however, when patients are turned into lateral decubitus position, collapsed lung tissue in the dorsal parts would reexpand, while atelectasis would slowly reappear in the lower flank of the lung. We hypothesize that applying sufficient PEEP without RM before the formation of atelectasis in the lower flank of the lung may beas effective to prevent atelectasis and thus improve oxygenation as applying PEEP with RM. Methods: A total of 84 patients scheduled for elective pulmonary lobe resection necessitating one lung ventilation will be recruited and randomized totwo parallel groups. For all patients, one lung ventilation is initiated the right after patients are turned into lateral decubitus position. For patients in the study group, individualized PEEP titration is started the moment one lung ventilation is started, while patients in the control group will receive a recruitment maneuver followed by individualized PEEP titration after initiation of one lung ventilation. The primary endpoint will be oxygenation index measured at T4. Secondary endpoints will include intrapulmonary shunt, respiratory mechanics, PPCs, and hemodynamic indicators. Discussion: Numerous previous studies compared the effects of individualized PEEP applied alone with that applied in combination with RM on oxygenation index, PPCs, intrapulmonary shunt and respiratory mechanics after atelectasis was formed in patients receiving one lung ventilation during thoracoscopic surgery. In this study, we will apply individualized PEEP before the formation of atelectasis while not performing RM in patients allocated to the study group, and then we're going to observe its effects on the aspects mentioned above. The results of this trial will provide a ventilation strategy that may be conductive to improving intraoperative oxygenation and avoiding the detrimental effects of RM for patients receiving one lung ventilation. Trial registration: www.Chictr.org.cn ChiCTR2400080682. Registered on February 5, 2024. [ABSTRACT FROM AUTHOR]

Cerebral hemodynamics have been quantified during exercise via transcranial Doppler ultrasound, as it has high-sensitivity to movement artifacts and displays temporal superiority. Currently, limited research exists regarding how different exercise modalities and postural changes impact the cerebrovasculature across the cardiac cycle. Ten participants (4 females and 6 males) ages 20–29 completed three exercise tests (treadmill, supine, and upright cycling) to volitional fatigue. Physiological data collected included middle cerebral artery velocity (MCAv), blood pressure (BP), heart rate, and respiratory parameters. Normalized data were analyzed for variance and effect sizes were calculated to examine differences between physiological measures across the three exercise modalities. Systolic MCAv was greater during treadmill compared to supine and upright cycling (p < 0.001, (large) effect size), and greater during upright versus supine cycling (p < 0.017, (large)). Diastolic MCAv was lower during treadmill versus cycling exercise only at 60% maximal effort (p < 0.005, (moderate)) and no differences were observed between upright and supine cycling. No main effect was found for mean and diastolic BP (p > 0.05, (negligible)). Systolic BP was lower during treadmill versus supine cycling at 40% and 60% intensity (p < 0.05, (moderate–large)) and greater during supine versus upright at only 60% intensity (p < 0.003, (moderate)). The above differences were not explained by partial pressure of end-tidal carbon dioxide levels (main effect: p = 0.432). The current study demonstrates the cerebrovascular and cardiovascular systems respond heterogeneously to different exercise modalities and aspects of the cardiac cycle. As physiological data were largely similar between tests, differences associated with posture and modality are likely contributors. [ABSTRACT FROM AUTHOR]

Previous research has identified a specific subtype known as failure of pelvic compensation (FPC) in patients with adult spinal deformity (ASD). However, the criteria for assessing FPC remain inconsistent, and its impacts on spinal sagittal alignment and health-related quality-of-life (HRQoL) scores remain unclear. To propose a novel criterion for identifying FPC based on variations in spinopelvic alignment during the transition from the supine to upright position and to evaluate the effects of FPC on patients' spinal sagittal alignment and HRQoL scores. Retrospective cross-sectional study. Patients with ASD from a monocenter database. Radiographic measures, including thoracic kyphosis (TK), lumbar lordosis (LL), sacral slope (SS), pelvic tilt, pelvic incidence (PI), and sagittal vertical axis (SVA), were measured on lateral whole-spine radiographs. LL and SS were also measured on reconstructed lumbar computed tomography images in the sagittal view taken in the supine position. The relative functional cross-sectional area (rFCSA) of paraspinal muscles was evaluated via lumbar magnetic resonance imaging. HRQoL measures, encompassing visual analog scale for back pain (VAS-BP), Oswestry Disability Index (ODI), and Scoliosis Research Society-22R (SRS-22R), were collected. A total of 154 patients were enrolled. Based on the calculated minimum detectable change of SS, FPC was defined as the change in SS of less than 3.4° between supine and upright positions. Patients were divided into 3 groups: sagittal balance with pelvic compensation (SI-PC), sagittal imbalance with pelvic compensation (SI-PC), and sagittal imbalance with failure of pelvic compensation (SI-FPC). Radiographic parameters and HRQoL scores were compared among the groups. Thirty-six patients were categorized into the SB-PC group, 87 into the SI-PC group, and 31 into the SI-FPC group. Patients with low PI and small paraspinal muscles rFCSA were more prone to experiencing FPC accompanied by severe sagittal imbalance. The SI-FPC group exhibited less TK and a larger SS than the SI-PC group exhibited and had a similar SVA as that of the SI-PC group. Additionally, they displayed worse VAS-BP, ODI, SRS-function, and SRS-22 total scores than the SB-PC group displayed. In patients with ASD, an inherently low pelvic compensatory reserve and a high fatty infiltration in paraspinal muscles are pivotal factors contributing to FPC. Compared with SI-PC patients, SI-FPC patients demonstrate a thoracic-dominant compensatory pattern for sagittal malalignment. In addition, these patients experienced more severe pain and functional decline than the SB-PC patients experienced. [ABSTRACT FROM AUTHOR]

In this study, we conducted a literature review to deepen our understanding of the sweating response of the thermoregulatory system, focusing on the influence of individual characteristics and local body functions. Among the factors related to individual characteristics, improvement in aerobic fitness had a positive effect on the sweating response, whereas aging exerted an inhibitory effect. Short-term artificial acclimation and seasonal heat acclimatization promoted sweating, whereas long-term geographical acclimatization suppressed sweating. Male exhibited higher sweat rates than female when the metabolic heat production was high. Individuals with smaller surface area-to-mass ratios tended to have higher sweat rates than those with larger ratios. Regarding local body functions, sweat distribution in the resting state showed high regional sweat rates in the lower limbs and torso, with higher values in the lower limbs when in the supine position and higher values in the torso when in the seated position. During exercise, the regional sweat rates was high in the torso, whereas the limbs exhibited relatively low sweat rates. These differences in sweat distribution stem from the thermoregulatory potential of each body region, which aims to efficiently regulate body temperature. Local effects have only been examined in the thigh and forearm, with temperature coefficient Q10 ranging from 2 to 5. Only the forehead showed significantly high thermosensitivity among all body regions. [ABSTRACT FROM AUTHOR]

Drug-induced sleep endoscopy (DISE) is used for evaluating upper airway anatomy and determining airway obstruction patterns. It is typically performed with the patient in the supine position. Airway collapse severity is influenced by body position and level of consciousness; the resultant dynamic changes may vary across patients. In this study, we evaluated the severity of upper airway collapse through awake endoscopy and DISE and identified factors affecting the pattern of airway collapse severity. This study included 66 patients with obstructive sleep apnea. The patients underwent type 1 polysomnography, tongue strength assessment, awake endoscopy in the sitting and supine positions, and DISE. Group-based trajectory modeling was performed to identify patients with different collapse severity patterns in different body positions and at different levels of consciousness. Patient with similar severity trajectory were assigned to the same group. Two different severity trajectories (group 1 and group 2) were identified at the tongue base level. Tongue depression strength varied significantly between groups 1 and 2 (47.00 vs. 35.00 kPa; P =.047). During awake endoscopy, collapse severity was significantly higher in group 2 than in group 1. Group 1 had lower rapid eye movement/nonrapid eye movement apnea–hypopnea index ratios and higher tongue depression strength than did group 2. In patients with obstructive sleep apnea, tongue strength may vary depending on body position. Our results should be interpreted with caution because of the limited sample size. Future studies should investigate the effect of oropharyngeal rehabilitation on tongue strength and collapse severity. [ABSTRACT FROM AUTHOR]

Background/Objectives: Cesarean section (C-section) scars can lead to chronic pain due to changes in tissue properties. Combining elastography and algometry can assess these scars comprehensively by identifying areas of increased rigidity and quantifying pain sensitivity. This study aims to evaluate the efficacy of using elastography and algometry together to assess cesarean scar tissue, correlating tissue stiffness with pain thresholds for targeted pain management. Methods: Thirty-one non-pregnant women who had undergone a C-section between six months and two years prior participated. Elastography measured tissue stiffness, while algometry provided quantitative measures of pain sensitivity on and around the scar. The correlation between tissue stiffness and pain thresholds was analyzed. Results: Elastography identified areas of increased rigidity within the scar tissue, which corresponded with lower pain thresholds measured by algometry, indicating higher pain sensitivity. A significant correlation was found between increased tissue stiffness and reduced pain thresholds (p < 0.05). Conclusions: Combining elastography and algometry offers a powerful diagnostic tool for evaluating C-section scars. This approach identifies areas that may benefit from targeted pain management interventions, enhancing understanding and treatment of pain associated with cesarean scars. Incorporating these techniques into clinical practice could improve patient outcomes and quality of life. [ABSTRACT FROM AUTHOR]

BACKGROUND: Trolley bags have gained popularity among students, but there is limited research comparing them to backpack-style school bags. OBJECTIVE: This study aimed to compare how carrying a backpack versus a trolley bag affects the activity of trunk and lower limb muscles in secondary school students. METHODS: Electromyographic activity was measured in 25 students (13.4±1.1 years) as they walked on level ground and up/down stairs while carrying both types of bags. The activity of the gastrocnemius, tibialis anterior, semitendinosus, rectus femoris, lumbar erector spinae, and rectus abdominis muscles was assessed on both the dominant and non-dominant sides. RESULTS: The study found significantly reduced muscle activation in most of the targeted muscles when walking on level ground with the trolley bag and when going up/down stairs with the backpack. CONCLUSIONS: Lifting a trolley bag depends on the slope of the walking surface and is more efficient on level ground, while carrying a backpack is more efficient when going up and down stairs. Since it is not practical to switch bags when encountering stairs in schools, a bag with a mixed model design incorporating features of both trolley and backpack may be more beneficial and practical for students to use. Students, parents, and teachers should be aware of the injury risks associated with carrying different types of bags. [ABSTRACT FROM AUTHOR]

Background: In patients undergoing breast-conserving therapy without surgical clip implantation, the accuracy of tumor bed identification and the consistency of clinical target volume (CTV) delineation under computed tomography (CT) simulation remain suboptimal. This study aimed to investigate the feasibility of implementing preoperative magnetic resonance (MR) simulation on delineations by assessing interobserver variability (IOV). Methods: Preoperative MR and postoperative CT simulations were performed in patients who underwent breast-conserving surgery with no surgical clips implanted. Custom immobilization pads were used to ensure the same supine position. Three radiation oncologists independently delineated the CTV of tumor bed on the images acquired from MR and CT simulation registration and CT simulation alone. Cavity visualization score (CVS) was assigned to each patient based on the clarity of the tumor bed on CT simulation images. IOV was indicated by generalized conformity index (CIgen), denoted as CIgen−CT and CIgen−MR/CT, and the distance between the centroid of mass (dCOM), denoted as dCOMCT and dCOMMR/CT. The variation of IOV in different CVS subgroups was analyzed. Results: A total of 10 patients were enrolled in this study. The median and interquartile range (IQR) of maximum pathological diameter of the tumors in all patients were 1.55 (0.80–1.92) cm. No statistical significance was found between the volumes of CTVs on CT simulation and on MR/CT simulation registration images (p = 0.387). CIgen−MR/CT was significantly larger than CIgen−CT (p = 0.005). dCOMMR/CT was significantly smaller than dCOMCT (p = 0.037). The median and IQR of CVS in all patients were 2.34 (2.00–3.08). The difference of CIgen between CIgen−MR/CT and CIgen−CT was larger in the low CVS group (p = 0.016). The difference of dCOM showed a decreasing trend when CVS was lower, although it did not reach statistical significance (p = 0.095). Conclusions: For patients who underwent breast-conserving surgery without surgical clip implantation, the use of preoperative MR simulation in delineating the CTV of tumor bed decreased the IOV among observers. The consistency of tumor bed identification was improved especially in cases where the margins of tumor bed were challenging to visualize on CT simulation images. The study findings offer potential benefits in reducing local recurrence and minimizing tissue irritation in the surrounding areas. Future investigation in a larger patient cohort to validate our results is warranted. [ABSTRACT FROM AUTHOR]

Background and Purpose Methods Results Conclusions Patients with postural tachycardia syndrome report position‐dependent visual symptoms. Despite their impact on daily life, these symptoms have remained largely unexplored in research. The aim of this study was to investigate the nature of visual symptoms in postural tachycardia syndrome and possible underlying pathophysiological mechanisms.Fifteen patients with postural tachycardia syndrome and 15 healthy controls were included in the study. Through a comprehensive array of measurements, including haemodynamics, subjective symptom assessments, eye movement tracking and pupil diameter analysis, participants were assessed during free image exploration in both supine and 60° head‐up tilt positions.During head‐up tilt, patients showed a decreased number and duration of fixations, as well as a decreased number, peak velocity and amplitude of saccades compared to the supine position and the control group. This reduction in visual exploration occurred primarily in the peripheral field of view and coincided with the occurrence of subjective visual symptoms. No significant differences in the saccade main sequence were observed between the two groups in either body position.Patients with postural tachycardia syndrome have a reduced exploration of the peripheral field of view when in an upright body position, potentially leading to tunnel vision. Since the normality of the saccade main sequence in patients combined with the focus on the centre of the field of view and the lower saccade amplitudes points to an intact brainstem function, the decrease in peripheral visual exploration may be attributed to a position‐dependent dysfunction of the frontal eye field. [ABSTRACT FROM AUTHOR]

ABSTRACT Background and Objectives Methods Results Conclusion Preterm infants need nutritional support due to their premature digestive system, undeveloped anatomy and functional limitations. Neonatal positioning in the proper position is one of the nurses' main principles that affect the residual volume. We performed our systematic review and network meta‐analysis to determine the best feeding position for preterm infants in reducing gastric residual volume and increasing the rate of gastric emptying.We systematically searched PubMed, Cochrane, CINHAL, Scopus and Web of Science from their inception to August 2023. We included studies that assess the effect of different feeding positions for preterm infants on gastric residuals. The Cochrane risk of bias tool (ROB2) appraised the included clinical trials. Cohort studies were assessed by the NIH tool and quasi‐experimental studies by the relevant items from (Downs and Black) checklist. RevMan Version 5.4 was used for analysing the pooled data. Our study included a frequentist network meta‐analysis of the aggregate data to obtain network estimates for the outcomes of interest. Network meta‐analysis was done using R software.We included 16 studies with 1139 premature infants, comparing six preterm feeding positions. The pooled MD and 95% CI for GRV at 30 min for right lateral, prone, right anterior oblique and left lateral compared to supine position were as follows: (−12.08 [−20.09, −4.07]), (−11.14 [−18.26, −4.01]), (−9.02 [−21.66, 3.61]) and (−0.18 [−7.87, 7.5]), respectively. Moreover, the pooled MD and 95% CI for GRV at 180 min for right lateral, prone and left lateral compared to supine position were as follows: (−0.69 [−1.29, −0.09]), (−0.56 [−1.22, 0.1]) and (0.09 [−0.63, 0.81]), respectively. Nevertheless, the pooled MD and 95% CI for GRV at 120 min for right anterior oblique, prone, right lateral and left lateral compared to supine position were as follows: (−6.09 [−11.33, −0.86]), (−5.07 [−7.71, −2.43]), (−3.08 [−5.89, −0.27]) and (−0.44 [−3.41, 2.53]), respectively.We concluded that the best nursing position after preterm infants feeding for lower gastric residuals and higher gastric emptying rate is the right lateral position after 30 and 180 min post‐feeding. Also, the right anterior oblique was the best after 120 min. Although the prone position can lower the GRV better than the left lateral and supine positions, it is not advisable to use this position because it raises the SIDS risk. Our results could help healthcare professionals to provide the appropriate positioning of preterm infants. [ABSTRACT FROM AUTHOR]

Background: IV access is a commonly performed procedure that is often taught based on tradition rather than evidence. The effect of arm retroflexion on vein width, either alone or in combination with a tourniquet or general anesthesia (GA), remains unclear. In this case, the sonographically measured vein width is a surrogate parameter for the success of the puncture. Methods: Prospective, cross-sectional study involving 57 patients scheduled for surgery in general anesthesia. We analyzed the impact of arm retroflexion, tourniquet, general anesthesia, and their combinations on the antebrachial veins in supine patients by ultrasound. Measurements were taken awake and during general anesthesia, each with and without the application of a tourniquet, and in three different arm positions (0°, 30°, and max° retroflexion) each. Data are presented as median and interquartile range [IQR]. Results: Tourniquet application (AT) had the greatest single effect on Cubital vein outer diameter compared to the baseline value of all measures (3.9 mm [3.4–5.1]; 4.8 mm [4.1–5.7], P = 0.001, r = 0.515). This effect was surpassed by the combination of AT and GA (5.1 mm [4.6–6.6], P = 0.001, r = 0.889). In contrast, retroflexion alone did not result in an increase at either 30° (4.2 mm [3.7–5.1], p = 1.0, r = 0.12) or max° (4.2 mm [3.6–4.9], p = 0.72, r = 0.23). With GA and AT, no further enlargement was measurable by 30° (5.4 mm [4.6–6.6], p = 1.0, r = 0.15) or max° (5.4 mm [4.6–6.6], p = 1.0, r = 0.07) retroflexion compared to GA-AT-0° (5.1 mm [4.6–6.6], p = 1.0, r = 0.15). Conclusions: This study provides evidence that retroflexion of the arm in supine patients, whether alone or in addition to a tourniquet or general anesthesia, does not have any additional effect on vein width as a surrogate parameter for successful IV success. It shows for the first time that general anesthesia effectively increases vein diameter. Trial registration: DRKS00029603 (date of registration 07.07.2022). [ABSTRACT FROM AUTHOR]

Although heart rate variability (HRV) is a valid method to evaluate the behavior of the autonomic nervous system in individuals with temporomandibular disorder (TMD), the measurement can easily be biased by factors involving the analysis methodology, such as the removal of artifacts. Therefore, the objective of this investigation is to evaluate the impact of using different levels of threshold-based artifact correction to process HRV data in individuals with TMD. This cross-sectional observational study. Adults aged 18 to 55 years old with a diagnosis of myogenic TMD, score ≥ 50 on the Fonseca Anamnestic Index (FAI) and pain ≥ 3 on the Numerical Pain Scale (NPS) participated. The HRV was registered in the supine position (short-term) using a Polar S810i. Kubios software was used for HRV analysis using all filters. One-way ANOVA with Tukey-Kramer post-hoc was used to test the differences in HRV using the different Kubios Software artifact correction filters. The effect size was calculated based on the Cohen d. The very strong filter was statistically different (p < 0.05) compared to the no filter in all overview and time domain variables. In the frequency domain, the variables VLF, LF, HF and Total Power showed statistical differences (p < 0.05) when using the very strong filter. The same occurred with the variables SD1, SD2 and DFA α2 of the non-linear analysis (p < 0.05). The most restrictive filter of the Kubios software (very strong) significantly impacts the quantification of HRV parameters in individuals with TMD. [ABSTRACT FROM AUTHOR]

In addition to the fact that the significance of the nephrolitometric scoring systems (NSSs) remains unclear, no study has been conducted to assess the effectiveness of these scoring systems in percutaneous nephrolithotomy (PNL) performed in the supine position. We aimed to compare the CROES, Guy's scoring system (GSS), S.T.O.N.E., and S-ReSC NSSs for success and complications in patients undergoing supine mini-PNL (m-PNL). The prospectively recorded data of the patients who underwent supine m-PNL was reviewed retrospectively, and a total of 112 patients were included in the study. Demographic, operation, post-procedure data, and CROES, GSS, S.T.O.N.E., and S-ReSC scores were assessed and compared between the stone-free (SF) and residuel groups. There were significant differences between the SF and residual groups in terms of mean CROES, S.T.O.N.E., and S-ReSC scores (p = 0.003, p = 0.009, and p = 0.015, respectively). Similarly, there were significant differences between the grades of these scoring systems and the success of the procedure (p = 0.035, p = 0.007, and p = 0.007, respectively). However, the GSS was insignificant. The area under curve values in ROC analysis of CROES, S.T.O.N.E., and S-ReSC NSSs were 0.695, 0.665, and 0.656, respectively (p = 0.003, p = 0.011, and p = 0.017, respectively). No statistically significant difference was found between the grades of all four NSSs and the complication rates. The study showed a strong correlation between CROES, STONE, and S-ReSC NSSs in predicting SF status after supine m-PNL. However, none of the NSSs could predict the complications. [ABSTRACT FROM AUTHOR]

Background: Fixation of trochanteric fractures with an intramedullary nail in a non-physiological position can cause poor functional outcomes. The aim of this study is to evaluate the effect of intraoperative patient position on rotational alignment in intramedullary nail fixation of trochanteric fractures. Methods: The femoral rotational alignment of 84 trochanteric fracture patients who underwent intramedullary nailing was measured by computed tomography (CT) images. Patients were divided into two groups: the supine position on the fracture table (FT) (Group 1, n = 42) and the lateral decubitus (LD) position (Group 2, n = 42). Femoral malrotation angles were measured and divided into three subgroups: insignificant, significant, and excessive. The number of intraoperative fluoroscopy images, preparation time, surgery time, and anesthesia time in both groups were compared. Results: The malrotation degrees of patients in Group 1 ranged from 17° external rotation (ER) to 57° internal rotation (IR), with a mean of 10° IR. Of the patients in Group 1, 27 were insignificant, 5 were significant, and 10 were in the excessive subgroup. The malrotation degrees of patients in Group 2 ranged from 33° ER to 47° IR, with a mean of 11° IR. Of the patients in Group 2, 21 were insignificant, 12 were significant, and 9 were in the excessive subgroup. There was no statistically significant relationship between patient position and malrotation angle. The number of intraoperative fluoroscopy images, preparation time, and anesthesia time were statistically lower in Group 2. There was no statistically significant difference between Group 1 and Group 2 in terms of surgery time. Conclusion: Intramedullary nailing in the LD position is a reliable and practical surgical method in the treatment of femoral trochanteric fractures since there is no need for the use of a FT, the surgeon is exposed to less radiation, there is no risk of complications related to the traction of the FT, and there is a shorter operation time. [ABSTRACT FROM AUTHOR]

Background: A robotic arm-assisted and a computed tomography (CT)- based navigation system have been reported to improve the accuracy of component positioning in total hip arthroplasty (THA). However, no study has compared robotic arm-assisted THA (rTHA) to CT-based navigated THA (nTHA) concerning accuracy of cup placement and acetabular fractures using the direct anterior approach (DAA). This study aimed to compare the accuracy of cup placement and the presence of intraoperative acetabular fractures between rTHA and nTHA using DAA in the supine position. Methods: We retrospectively investigated 209 hips of 188 patients who underwent rTHA or nTHA using DAA (rTHA using the Mako system: 85 hips of 79 patients; nTHA: 124 hips of 109 patients). After propensity score matching for age and sex, each group consisted of 73 hips. We evaluated clinical and radiographic outcomes, comparing postoperative cup orientation and position, measured using a three-dimensional templating software, to preoperative CT planning. Additionally, we investigated the prevalence of occult acetabular fracture. Results: Clinical outcomes were not significantly different between the groups at 1 year postoperatively. The mean absolute error of cup orientation was significantly smaller in the rTHA group than in nTHA (inclination: 1.4° ± 1.2° vs. 2.7° ± 2.2°, respectively; p = 0.0001, anteversion: 1.5° ± 1.3° vs. 2.2° ± 1.7°, respectively; p = 0.007). The cases within an absolute error of 5 degrees in both RI and RA were significantly higher in the rTHA (97.3%) than in nTHA group (82.2%) (p = 0.003). The absolute error of the cup position was not significantly different between the two groups. The prevalence of occult acetabular fracture did not differ significantly between the two groups (rTHA: n = 0 [0%] vs. nTHA: n = 1 [1.4%]). Conclusion: Cup placement using DAA in the supine position in rTHA was more accurate with fewer outliers compared to nTHA. Therefore, rTHA performed via DAA in a supine position would be useful for accurate cup placement. [ABSTRACT FROM AUTHOR]

Background: The variety of airway devices are available today which may be broadly classified as supraglottic airway devices which are employed to protect the airway in both elective as well as emergency situations. Present study was aimed to study I- Gel Device in patients posted for short duration elective surgeries in a tertiary care center. Material and Methods: Present study was prospective, interventional study, conducted in patients aged 21- 60 years of both sexes, with BMI range of 20-25 kg/m2, American society of anaesthesiologist classification 1 and 2, Mallampatti grade 1 and 2, undergoing different surgical procedures under general anesthesia, with spontaneous ventilation in supine position for not more than 1 hour. Results: In the study 77 patients were studied. It was observed that in 85% of patients insertion of I-Gel was successful in the first attempt. The heart rate, Mean Arterial Blood pressure (MAP), Mean Tidal Carbon dioxide & mean Oxygen Saturation percentage was observed before administration I-Gel, immediately after administration & after 5, 10 and 15 minutes from insertion and the mean was calculated. The gastric insufflation was absent in all patients after the administration of I-Gel, which shows that I-Gel has better sealing pressure and it fits well with the laryngeal anatomy. It was observed that only 12 % of patients reported sore throat after the removal of I– Gel, 10 % of patients had reported post-operative cough and only 7% patients reported dysphagia. Conclusion: Use of proper sized I-Gel suits to be ideal and seems to be an efficient and safe device for adult airway management in short duration (up to 30 minutes) minor surgeries while patient breathing spontaneously. [ABSTRACT FROM AUTHOR]

Background: The use of intranasal dexmedetomidine is hampered by a limited understanding of its absorption pharmacokinetics. Methods: We examined the pharmacokinetics and feasibility of intranasal dexmedetomidine administered in the supine position to adult patients undergoing general anaesthesia. Twenty‐eight patients between 35 and 80 years of age, ASA 1–3 and weight between 50 and 100 kg, who underwent elective unilateral total hip or knee arthroplasty under general anaesthesia were recruited. All patients received 100 μg of intranasal dexmedetomidine after anaesthesia induction. Six venous blood samples (at 0, 5, 15, 45, 60, 240 min timepoints from dexmedetomidine administration) were collected from each patient and dexmedetomidine plasma concentrations were measured. Concentration‐time profiles after nasal administration were pooled with earlier data from a population analysis of intravenous dexmedetomidine (n = 202) in order to estimate absorption parameters using nonlinear mixed effects. Peak concentration (CMAX) and time (TMAX) were estimated using simulation (n = 1000) with parameter estimates and their associated variability. Results: There were 28 adult patients with a mean (SD) age of 66 (8) years and weight of 83 (10) kg. The mean weight‐adjusted dose of dexmedetomidine was 1.22 (0.15) μg kg−1. CMAX 0.273 μg L−1 was achieved at 98 min after intranasal administration (TMAX). The relative bioavailability of dexmedetomidine was 80% (95% CI 75–91%). The absorption half‐time (TABS = 120 min; 95% CI 90–147 min) was slower than that in previous pharmacokinetic studies on adult patients. Perioperative haemodynamics of all patients remained stable. Conclusions: Administration of intranasal dexmedetomidine in the supine position during general anaesthesia is feasible with good bioavailability. This administration method has slower absorption when compared to awake patients in upright position, with consequent concentrations attained after TMAX for several hours. [ABSTRACT FROM AUTHOR]

Introduction The prevalence of moderate to severe sleep-disordered breathing is of 17% among men aged between 50 and 70-years, and of 9% among women in the same age group. In Brazil, obstructive sleep apnea (OSA) is also highly prevalent, and it is associated with metabolic and cardiovascular impacts, excessive daytime sleepiness, and increasing risk of traffic accidents. Laboratory-based polysomnography is the gold standard test for OSA diagnosis. However, its complexity has led to the search for alternatives to simplify the diagnosis, such as the out-of-center sleep test (OCST). Objectives To discusses the minimum OCST recording time and the potential effects of the supine position on this parameter. Data Synthesis We conducted a search on the PubMed, Web of Science, Scopus, and Embase databases to identify relevant studies on OCST recording time and a possible association with body position. We used a combination of terms, including Obstructive Sleep Apnea and Home Monitoring OR Home Care Services OR Portable Monitoring AND Supine OR Position OR Recording Time OR Positional Obstructive Sleep Apnea. The references of the selected articles were also reviewed to find other relevant studies. Through our approach, eighteen articles were retrieved and included in the present study. Conclusion Since OCSTs are conducted in an unattended environment, with potential signal loss during the night, it is crucial to determine the minimum recording time to validate the test and assess how the time spent in the supine position affects this parameter. After reviewing the literature, this topic remains to be clarified, and additional studies should focus on that matter. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to characterize the relationship between a novel radiographic measurement on initial AP pelvis radiograph (termed "bladder shift," BS) to intraoperative blood loss (IBL) during acetabular surgical fixation. Methods: All adult patients receiving unilateral acetabular fixation (Level 1 academic trauma; 2008–18) were reviewed. AP pelvis radiographs were reviewed for visible bladder outlines and then measured to determine the percentage deformation toward the midline. Hemoglobin & hematocrit data were then used to calculate quantitative blood loss between pre- and post- operative blood counts for data analysis. Results: 371 patients with unilateral traumatic acetabular fractures requiring fixation were reviewed; 99 of these had visible bladder outlines, complete blood count and transfusion data (2008–2018; 66% associated patterns). Median bladder shift (BS) was 13.3%. Every 10% of bladder shift was associated with 123 mL greater IBL. Patients with full bladder shift to midline sustained a median 1.5L IBL (interquartile range [IQR] 0.8 to 1.6). Associated patterns had a threefold greater median BS (associated: 16.5% [15.4 to 45.9] vs. elementary: 5.6% [1.1 to 15.4], p < 0.05) and received intraoperative pRBC twice as frequently (57% vs. 24%, p < 0.01). Conclusions: Radiographic bladder shift is an easily available visual marker, in patients sustaining acetabular fractures, that may predict intraoperative hemorrhage and need for transfusions. [ABSTRACT FROM AUTHOR]

Background: Supracostal puncture could be the most effective method for accessing the upper pole posterior calyx, which is considered the ideal route for staghorn and large complex renal stones. We aimed at this work to assess the efficacy, safety as well as the outcome of supine supracostal Percutaneous Nephrolithotomy (PCNL) in managing the renal calculi. Methods:We carried out this prospective cohort study on 25 patients with renal stones larger than 2 cm who underwent percutaneous nephrolithotripsy as indicated and attended the Urology Outpatient clinic, they underwent PCNL through supra costal puncture in supine position. Postoperative chest X-ray, Kidney, ureter as well as bladder (KUB) x-ray, in addition to pelvi-abdominal ultrasonography were done for all patients. Results: The incidence of postoperative complications was as follows: Out of 25 patients, 3 patients (12%) developed hydrothorax. Significant intraoperative bleeding occurred in 12% of cases, one of which required blood transfusion. The success rate was 76 % at 24 hours and raised to 84% at four weeks as 2 cases passed the stone spontaneously, two cases 8.0% had 2nd look PNL, and two cases 8.0% needed Extracorporeal Shock Wave Lithotripsy (ESWL). We found no significant injuries to adjacent organs, attributed to the use of preoperative helical CT and careful puncture techniques. Conclusions: The supracostal approach in PCNL in modified supine position is a safe procedure and effective in case of upper calyceal and staghorn stones. It demonstrates accepted stone-free rates, with considerable complication rates, so the approach must be put in consideration. [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusion Percutaneous nephrolithotomy (PCNL) is the recommended treatment for stones >2 cm in size. The majority of PCNL are still conducted with larger telescopes using tracts up to 30F in size. We have conducted a randomized pilot study comparing mini PCNL with our standard 22F PCNL for renal stones between 10 and 25 mm in diameter.Patients were randomized to either PCNL (24F Amplatz sheath/22F nephrosocope) or mini PCNL (18F Amplatz sheath/11F nephroscope). All operations were performed in the modified supine position. Patients were reviewed with imaging to assess stone clearance and complications.Eighteen well matched patients were randomized. All procedures were completed as planned and all were tubeless with no complications. There were no differences in operative time, analgesia requirements or length of stay. Seven of nine (77.75%) standard PCNL were completely stone free at CT review with a 2 mm and a 5 mm fragments in the other patients. Four (44.4%) of the mini PCNL group were stone free, with stone fragments 4–10 mm remaining in the others. 40 patients/arm would be required for an adequately powered study.There was no advantage in using mini PCNL compared to our standard 24F PCNL in this pilot study. There may be benefits in using mini PCNL compared to the more widely used 30F PCNL and it may be a more cost‐effective alternative to laser pyeloscopic stone procedures. [ABSTRACT FROM AUTHOR]

Copyright of Journal of the Society of Plant Engineers Japan is the property of Society of Plant Engineers Japan and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of West China Journal of Stomatology is the property of Sichuan University, West China College of Stomatology and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Previous research highlighted variability in electrocardiogram (ECG) readings across patient positions, particularly in the context of COVID‐19 patients with pulmonary complications requiring prone positioning as part of the treatment. Objective: This study aimed to elucidate the effects of prone positioning on ECG parameters and explore its association with the severity of COVID‐19. Methods: A prospective cohort study involved 60 patients diagnosed with COVID‐19 and presenting pulmonary complications. ECGs were recorded in both supine and prone positions, and analyzed for various parameters including heart rate, QRS axis, and QTc interval. Clinical severity was assessed using APACHE II scores and SpO2/FiO2 ratios. Results: Prone positioning led to an increase in heart rate (mean difference: 2.100, 95% CI: 0.471–3.729, p = 0.012), with minor shifts in the QRS axis. Heart rate and QRS axis demonstrated strong positive correlations between positions, with Pearson's correlation coefficients of 0.927 and 0.894, respectively. The study also found a significant association between prolonged QTc intervals in the prone position and elevated APACHE II scores, with a relative risk of 10.75 (95% CI: 1.82–63.64, p = 0.008). Conclusions: The prone positioning caused minor yet significant changes in heart rate and QRS axis. The correlation of prolonged QTc intervals in the prone position with higher APACHE II scores suggests the prognostic relevance of prone ECG in COVID‐19 patients. However, further research is needed to fully understand the clinical implications and mechanisms of these findings. [ABSTRACT FROM AUTHOR]

Copyright of Retos: Nuevas Perspectivas de Educación Física, Deporte y Recreación is the property of Federacion Espanola de Asociaciones de Docentes de Educacion Fisica and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Purpose: To minimize radiation exposure to the small bowel (SB) in patients undergoing treatment for gynecological tumors by adopting a comfortable positioning method. Methods and patients: All 76 women undergoing Intensity-Modulated Radiation Therapy (IMRT) were included in this study. Patients were immobilized in a supine position using a vacuum bag and thermoplastic cast formation. In the trial group (n = 36), patients raised their buttocks and a solid foam pad was placed under the sacral tail before immobilization. The control group (n = 40) received treatment in the standard supine position. The SB was delineated from the pubic symphysis to the total iliac bifurcation in computed tomography (CT) scans. Result: In the trial group, a significant reduction in SB volume within the pelvic cavity was observed (mean 399.17 ± 158.7 cc) compared to the control group (mean 547.48 ± 166.9 cc), with a p-value less than 0.001. The trial group showed a statistically significant reduction in the absolute volume of irradiated SB at each dose, ranging from the low dose (10 Gy) to the high dose (45 Gy). In the control group, a negative correlation was found between SB and bladder volumes (R = -0.411, P = 0.008), whereas in the trial group, this correlation was weaker (R = -0.286, P = 0.091), with no significant relationship observed between bladder volume and SB. Conclusion: The high buttocks supine position effectively reduces SB radiation exposure without the need for bladder distension. This positioning method holds promise for reducing SB irradiation in various pelvic tumors. [ABSTRACT FROM AUTHOR]

Copyright of Clinical Neuroscience / Ideggyógyászati Szemle is the property of LifeTime Media Kft. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

This document is a correction to a previously published article on the reliability of pulmonary diffusing capacity for carbon monoxide (DLCO) and nitric oxide (DLNO) during exercise and in different body positions. The correction addresses errors in the reported values of alveolar-capillary membrane diffusing capacity (DM) and pulmonary capillary blood volume (Vc) in the original article. The authors found that the equipment used for measurement reported DM differently than assumed, affecting the Vc estimates. The corrected article suggests that DLNO may be a useful index of alveolar-capillary reserve and that DLNO during exercise or in the supine position should be the preferred outcome measure for investigating this reserve. [Extracted from the article]

Paralympic cross-country sit-skiing is a discipline of the Paralympic Winter Games where athletes use a specialized sledge. Athletes are classified into different groups according to their functional abilities. The double poling technique is used to push the sledge forward and generate speed. Different sitting positions in the sledge are used based on the individual impairment. To date there is no data available on the effects of these different positions on muscle activation patterns. The aim of this study was to analyze the muscle activation patterns of the trunk and upper body muscles in relation to the poling force. Nine Able-bodied athletes were tested on a treadmill at submaximal speed in three sitting positions for 4 min in a flat and uphill condition. Sitting positions included a "knee-high" position, a "knee-low" position, and a "neutral" position with the sitting platform parallel to the ground. Unilateral pole forces and surface EMG from three trunk muscles, two upper limb muscles, and one lower limb muscle were recorded simultaneously on the dominate side. Data were segmented into individual cycles and mean values and standard deviations calculated for each subject and condition. Statistical analyses, including a Friedman test and Bonferroni correction, were applied to examine significant differences across different sitting positions. Our findings demonstrate that while certain muscle groups such as the erector spinae and triceps show consistent patterns of activation across different sitting positions, there is considerable variability among individual athletes, suggesting individualized strategies for task execution. Overall, force application was most efficient in the "knee low" position with 691.33 ± 148.83 N and least efficient in the "knee high" position with 582.81 ± 115.11 N. Testing impaired athletes will be the next step in understanding the neurophysiological aspects of the poling movement. This experimental protocol provides a basis for understanding the movement of paralympic cross-country sit-skiing in greater depth. [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusion The coeliac plexus is often approached due to the diagnosis and treatment of the intractable pain associated with cancerous or non‐cancerous pathology of the pancreas or neighbouring organs. Various methods of coeliac plexus blocks are used and the variations in its structure are causes of the failures of such procedures.Twenty human cadavers (17 male, 3 females, age range 30–86 years, without any abdominal pathology) were dissected in the supine position. The abdominal autonomics was studied bilaterally after the incision of the abdominal wall the peritoneal sac was cut and the abdominal organs were removed. The coeliac plexus becomes visible after removing the hepatogastric and hepatoduodenal ligaments and pulling the stomach to the left and the pancreas downward.The largest coeliac ganglion was 45 mm on the right and 25 mm on the left. The average distance of the ganglia from the coeliac trunks was 6–9 mm from the right and left. The size of coeliac ganglia varies from 5 to 45 mm and their number from 2 to 12. Ganglia can be diffusely or concentrically organized. The coeliac plexus almost always receives the branches from the greater splanchnic and vagus nerves. Sometimes the contributions from the lesser splanchnic nerve, phrenic nerve, and accessory phrenic nerve (60%) were observed. Very rarely are missing both phrenic nerves.Sympathectomy (splanchnicectomy), as well as the coeliac blocks (under US, CT control, or laparotomic) aimed at pain relief usually by pancreatic cancer, should consider these possible variabilities. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective Design Setting and Population Methods Main Outcome Measures Results Conclusions Trial Registration To assess the effectiveness and acceptability of a pillow‐like position modification device to reduce supine sleep during late pregnancy, and to determine the impacts on the severity of sleep‐disordered breathing (SDB) and foetal well‐being.Randomised cross‐over study.Individuals in the third trimester of pregnancy receiving antenatal care at a tertiary maternity hospital in Australia.Participants used their own pillow for a control week and an intervention pillow for a week overnight, in randomised order. Sleep position and total sleep time for each night of both weeks were objectively monitored, with a sleep study and foetal heart rate monitoring performed on the last night of each week.Primary outcome = percentage of sleep time in the supine position; secondary outcomes = apnoea–hypopnoea index, foetal heart rate decelerations and birthweight centile.Forty‐one individuals were randomised with data collected on 35 participants over 469 nights. There was no difference in percentage of total sleep time in the supine position overnight between the control or intervention pillow week (13.0% [6.1, 25.5] vs. 16.0% [5.6, 27.2], p = 0.81 with a mean difference of 2.5% [95% CI] = −0.7, 5.6, p = 0.12), and no difference in the severity of SDB or foetal heart rate decelerations across weeks. However, increased supine sleep was significantly related to a higher apnoea–hypopnoea index (rs = 0.37, p = 0.003), lower birthweight (rs = −0.45, p = 0.007) and lower birthweight centile (rs = −0.45, p = 0.006). The proportion of supine sleep each night of the week varied widely both within and across participants, despite awareness of side‐sleeping recommendations.We found no evidence to suggest that the adoption of a pillow designed to discourage supine sleep was effective in late pregnancy, with women spending an average of 1 h per night supine. Alternative devices should be investigated, incorporating lessons learnt from this study to inform trials of supine sleep minimisation in pregnancy.Clinical Trial: (Australia New Zealand Clinical Trials Registry): ACTRN12620000371998 [ABSTRACT FROM AUTHOR]

Introduction Material and Methods Results Conclusions Digital vaginal examination (DVE) is considered the standard of care for assessing labor progress and cervical dilatation. However, it may be painful and is a subjective method that can increase the risk of chorioamnionitis. Known inter‐ and intra‐observer variability exists in measurements of cervical dilatation obtained digitally. However, little is known about the inter‐ and intra‐observer variability when using intrapartum transperineal ultrasound (TPUS). Our objectives were to investigate the relationship between cervical dilatation as assessed by TPUS and DVE. To assess inter‐ and intra‐observer variability in both single and repeated ultrasound assessments of cervical dilatation during active labor.This single‐center study was conducted at an inner‐city maternity unit in London, UK. Nulliparous participants at term with a live, singleton fetus in cephalic presentation were recruited between May 2021 and November 2022. During active labor, TPUS was performed subsequent to DVE. Repeat ultrasound assessments were performed where feasible. Participants were in a supine position, with flexed hips and knees and with an empty bladder. The ultrasound transducer was placed transversely on the maternal perineum. The anteroposterior (AP) diameter of the cervix was measured, and two‐dimensional (2D) cine‐loop videos were analyzed to obtain accurate measurements. Data were excluded if the time difference between DVE and TPUS exceeded 60 min.Of the 206 participants who consented to the study, complete data were obtained from 110 participants, yielding 147 paired TPUS and DVE observations. Ninety‐six participants were excluded. The absolute difference between TPUS and DVE assessments was 0 cm in 34% of the observations, 1 cm in 46.3%, and between 2 and 4 cm in 19.7%. The mean difference was −0.9 cm (intraclass correlation coefficient = 0.85; p < 0.001). Data from 30 participants, with 50 cervical dilatation measurements, were used to assess inter‐ and intra‐observer variability. The mean difference for the first ultrasound assessment was 0.07 cm (95% limit of agreement = −0.96 to 1.10, p < 0.001), for inter‐observer variability, and 0.01 cm (95% limit of agreement = −0.29 to 0.30; p < 0.001) for intra‐observer variability.Assessment of the cervix with TPUS during active labor is feasible and shows a strong correlation with DVE measurements. The majority of ultrasound measurements yielded readings within 1 cm of the corresponding DVE values, demonstrating high intraclass correlation and good inter‐ and intra‐observer agreement. [ABSTRACT FROM AUTHOR]

Introduction and purpose Sleep apnea is a disturbance of sleep that affects about 10% of adult population and is not easily detected due to unspecific symptoms. The aim of this literature review is to present, respectively, obstructive sleep apnea and central sleep apnea symptoms and integrate the available data in the literature regarding the pathogenesis and treatment methods. Materials and methods A review of literature was performed using PubMed and Google Scholar database. The search criteria included keywords such as sleep apnea, obstructive sleep apnea treatment, central sleep apnea treatment. State of knowledge Sleep disturbances that involve breathing can be categorized as obstructive sleep apnea (OSA) and central sleep apnea. First one is associated with the obstruction of the upper airways and the second one -- with malfunctioning breathing generator in the pontomedullary breathing pacemaker. Symptoms are unspecific which makes diagnostic process difficult. However, the right diagnosis and treatment may prevent patients from developing many cardiovascular diseases. Treatment options for OSA include: CPAP, reducing body weight, changing sleep position, braces and surgeries; for CSA: CPAP and acetazolamide. Conclusions OSA and CSA need to be further investigated in order to find more precise ways of diagnosis and treatment, as these diseases remain underreported. It is worth noting, that these conditions predispose to serious diseases, e.g. stroke. Therefore, developing new treatment techniques would beneficial for the health of population. [ABSTRACT FROM AUTHOR]

The effect of gravity on the lungs has been evaluated using computed tomography (CT) in the supine and prone positions but not the standing position. However, as humans spend most of the daytime in the standing position, we aimed to compare lung attenuation gradients between the supine and standing positions, and to assess the correlations between the lung attenuation gradients and participant characteristics, including pulmonary function test results. Overall, 100 healthy participants underwent conventional/supine and upright CT, and lung attenuation gradients were measured. Lung attenuation gradients in anteroposterior direction were greater in the supine position than in standing position (all p values < 0.0001) in both upper lobes at the level of the aortic arch (right: standing/supine, -0.02 ± 0.19/0.53 ± 0.21; left: standing/supine, -0.06 ± 0.20/0.51 ± 0.21); in the right middle (standing/supine, -0.26 ± 0.41/0.53 ± 0.39), left upper (standing/supine, -0.35 ± 0.50/0.66 ± 0.54), and lower lobes at the level of the inferior pulmonary vein (right: standing/supine, -0.22 ± 0.30/0.65 ± 0.41; left: standing/supine, -0.16 ± 0.25/0.73 ± 0.54); and in both lower lobes just above the diaphragm (right: standing/supine, -0.13 ± 0.22/0.52 ± 0.32; left: standing/supine, -0.30 ± 0.57/0.55 ± 0.37). Craniocaudal gradients were greater in the standing position (right: standing/supine, 0.41 ± 0.30/0.00 ± 0.16; left: standing/supine, 0.35 ± 0.30/-0.02 ± 0.16, all p values < 0.0001). No moderate to very high correlations were observed between age, sex, height, weight, body index mass, or pulmonary function test results and each lung attenuation gradient. Lung attenuation gradients in anteroposterior direction, which was observed in the supine position, disappeared in the standing position. However, the craniocaudal lung attenuation gradient, which was not present in the supine position, appeared in the standing position. [ABSTRACT FROM AUTHOR]

Introduction: This article attempts to provide a comprehensive review of the learning objectives and importance of the supine percutaneous nephrolithotomy (PCNL) technique. Material method: We retrospectively reviewed the cases of Supine PCNL between January 2018 and January 2024. We divided the groups into 3: residents between 2 and 3 years (Group 1), residents between 4 and 5 years (Group 2), and endourologist (Group 3). The 2–3-year resident started to perform PCNL for the first time, while the 4–5-year resident started to perform Supine PCNL for the first time while previously performing prone PCNL. Results: Access, fluoroscopy, and operation time were higher in Group 1, shorter in Group 2, and shortest in Group 3 (p < 0.001). Postoperative length of stay and the need for additional treatment were found to be shorter (p < 0.001), and the stone-free rate (SFR) increased (p < 0.001) from Group 1 to Group 3. The highest complication rates were observed in Group 1 (p = 0.002). SFR rate increased as the number of cases increased in Group 1 patients. Success was stable after 46–60 cases in terms of SFR. In Group 2, the SFR rate was stable after 31–45. cases. The most complications were observed in Group 1 and the least in Group 3. Conclusion: In 2-3-year residents, access time and fluoroscopy time decrease with experience. In 4-5-year residents, due to their expertise in prone PCNL, the operation time and fluoroscopy time decrease with the number of cases performed. SFR is higher after 46–60 cases for 2-3-year residents and 31–45 cases for 4-5-year residents. [ABSTRACT FROM AUTHOR]

Background. Preoxygenation prior to induction of general anesthesia is intended to increase the oxygen reserve in the lungs. This technique delays the onset of hypoxemia during the placement of the tracheal tube. Objective. To observe the benefits of oxygen through nasal cannula when used as an adjunct during preoxygenation. Methods. We enrolled 30 healthy volunteers and conducted a sequence of six preoxygenation tests. These included 3‐minute tidal volume breathing and 8 vital capacity breaths, with and without oxygen flowing through the nasal cannula as an adjunct. Subjects were kept at a supine position with a face mask on their faces. Their baseline vitals were measured and end‐tidal O2 (ETO2) was recorded at the end of each test. The comfort of each technique was also assessed. Results. When comparing the efficacy of the two preoxygenation methods, we found that the addition of oxygen through the nasal cannula improved the efficacy of preoxygenation with both the 3‐minute tidal volume breathing method and the 8 vital capacity method (p < 0.001). The three‐minute tidal volume breathing technique had higher end‐tidal oxygen when compared to the eight vital capacity breaths. Conclusions. The administration of oxygen through a nasal cannula during preoxygenation improves the efficacy of preoxygenation in healthy volunteers. Tidal volume breathing for three minutes achieves a higher end‐tidal oxygen concentration compared to eight vital capacity breaths over one minute. [ABSTRACT FROM AUTHOR]

Sudden infant death syndrome (SIDS) is an unexplained and distressing phenomenon that has plagued parents for years until research determined there was a link between the infant's sleeping position and sudden death. The risk of SIDS doubled when infants were placed on their stomachs to sleep. In 1994, the "Back to Sleep" campaign was introduced to teach caregivers and parents about the dangers of sudden infant death and sleep positions. Despite the wealth of knowledge and information on safe sleep education, there continues to be an alarming number of SIDS deaths in the United States. [ABSTRACT FROM AUTHOR]

Background & objectives: Notably, 17-hydroxy progesterone (17-OHP) (17-OHP) is a precursor for testosterone (T) synthesis, and intratesticular testosterone (ITT) is essential for spermatogenesis. Varicocele (Vx) has an estimated prevalence of 15% in the general population and 35% in those with primary infertility. We aimed to evaluate the correlation between changes of serum 17-OHP after sub-inguinal micro-varicocelectomy and improvement of semen parameters. Patients and methods: The current prospective study included 45 infertile men attending the andrology clinic form February 2021 to August 2021. Two semen analyses and hormonal profile were evaluated. Colored duplex ultasonography (CDUS) was done in standing and supine position for accurate measurements of testicular volumes and confirmation of Vx. Patients underwent sublinguinal micro-varicocelectomy using a surgical microscope HB Surgitech. We followed them prospectively up for three months following micro-varicocelectomy with serum TT and 17-OHP. Results: Sperm concentration improved significantly from 8.36 ± 5.04 million/ml to 12.52 ± 8.42 million/ml after 3 months following sub-inguinal micro-varicocelectomy (p = 0.001), with normalization of concentration in 15/45 (33%) patients. Total motility did not improve significantly but progressive motility improved significantly from 8.62 ± 8.74% to 16.24 ± 14.45% (p = 0.001). Abnormal forms significantly declined from 96.67 ± 2.03% to 95.75 ± 2.47% (p = 0.009). Serum 17 OHP and 17 OHP/total testosterone (TT) improved significantly from 1.21 ± 0.45 ng/ml and 0.26 ± 0.09 to 1.42 ± 0.76 ng/ml and 0.3 ± 0.16 (p = 0.013, p = 0.004), respectively, while serum TT did not improve significantly. A significant correlation was found between improvement in sperm concentration and both serum 17 OHP and 17 OHP/TT ratio (p = 0.001, p = 004). Furthermore, change in abnormal sperm forms showed significant correlations with changes in both 17-OHP and 17-OHP/TT. Conclusions: 17 OHP and 17OHP/ TT ratio can be used as biomarkers to detect improvement in semen parameters following sub-inguinal micro-varicocelectomy. [ABSTRACT FROM AUTHOR]

Ballistocardiography (BCG) studies ballistic forces on the body generated during a heartbeat. As it is an unobtrusive detection method, that requires sensors measuring small dynamic forces. Piezoelectric sensors are ideal, but improvements in sensitivity are needed. Here, a universal method is demonstrated to obtain enhanced effective transverse charge constants by utilizing thin and long sensors fabricated upon compliant substrates. This approach is validated using the uniquely printable and patternable piezoelectric polymer, poly(vinylidene fluoride‐co‐trifluoroethylene) (P(VDF‐TrFE). Discrete sensors detect displacements of less than 1 µm, dynamic forces of ∼mN, and accelerations of ≈1 mm−1 s2. Since the sensor is screen‐printable, it is upscaled to a human‐sized array (60 × 90 cm, 255 sensors). High quality spatially resolved BCG measurements of a person is demonstrated in seated and supine positions. The obtained heart rate is verified using photoplethysmography. This development opens the door to ever‐more sensitive piezoelectric sensors, crucial for applications including and beyond healthcare. [ABSTRACT FROM AUTHOR]

Background: The 6th International Consensus Statement on Concussion in Sport guidelines identified that measuring autonomic nervous system dysfunction using orthostatic vital signs (VSs) is an important part of the clinical evaluation; however, there are limited data on the frequency of autonomic nervous system dysfunction captured via orthostatic VSs after concussion. Purpose: To compare orthostatic changes in heart rate (HR), systolic blood pressure (SBP), and diastolic blood pressure (DBP) between athletes with acute sport-related concussion (SRC) and control athletes. Study Design: Cross-sectional study; Level of evidence, 3. Methods: We compared 133 athletes (mean age, 15.3 years; age range, 8-28 years; 45.9% female) with acute SRC (<30 days after injury) with 100 control athletes (mean age, 15.7 years; age range, 10-28 years; 54.0% female). Given the broad age range eligible for study inclusion, participants were subdivided into child (younger than 13 years of age), adolescent (13-17 years of age), and adult (18 years of age and older) age groups for subanalyses. Participants completed a single standard orthostatic VS evaluation including HR, SBP, and DBP in the supine position then immediately and 2 minutes after standing. Linear regression was used to compare delayed supine-to-standing changes in HR, SBP, and DBP as a continuous variable (ΔHR, ΔSPB, and ΔDBP) between groups, and logistic regression was used to compare patients with positive orthostatic VS changes (sustained HR increase ≥30 beats per minute [bpm], SBP decrease ≥20 mm Hg, and DBP ≥10 mm Hg at 2 minutes) between groups, accounting for age and sex. Results: Between-group differences were present for delayed ΔHR (18.4 ± 12.7 bpm in patients with SRC vs 13.2 ± 11.0 bpm in controls; P =.002) and ΔSPB (–3.1 ± 6.6 bpm in patients with SRC vs –0.4 ± 6.5 bpm in controls; P =.001), with positive orthostatic HR changes present more frequently in patients with SRC (18% vs 7%; odds ratio, 2.79; P =.027). In the SRC group, a weak inverse relationship was present between age and ΔHR (r = –0.171; P =.049), with positive orthostatic HR findings occurring primarily in the child and adolescent SRC subgroups. Conclusion: Patients with acute SRC had greater orthostatic VS changes compared with controls, the most prominent being sustained HR elevations. Clinical evaluation of autonomic change after SRC via standard orthostatic VS assessment may be a helpful clinical biomarker in the assessment of SRC, especially in children and adolescents. [ABSTRACT FROM AUTHOR]

Background: Acetabular retroversion is associated with impingement and instability. An adequate interpretation of acetabular version and coverage on radiographs is essential to determine the optimal treatment strategy (periacetabular osteotomy vs hip arthroscopic surgery). The crossover sign (COS) has been associated with the presence of acetabular retroversion, and the anterior wall index (AWI) and posterior wall index (PWI) assess anteroposterior acetabular coverage. However, the radiographic appearance of the acetabulum is sensitive to anterior inferior iliac spine (AIIS) morphology and pelvic tilt (PT), which differs between the supine and standing positions. Purpose: To (1) identify differences in the acetabular appearance between the supine and standing positions among patients presenting with hip pain; (2) determine factors (acetabular version, AIIS morphology, and spinopelvic characteristics) associated with the crossover ratio (COR), AWI, and PWI; and (3) define relevant clinical thresholds to guide management. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Patients who presented to a hip preservation surgical unit (n = 134) were included (mean age, 35 ± 8 years; 58% female; mean body mass index, 27 ± 6). All participants underwent supine and standing anteroposterior pelvic radiography to assess the COS, COR, AWI, and PWI as well as standing lateral radiography to determine standing PT. Computed tomography was used to measure supine PT, acetabular version, and AIIS morphology. Acetabular version was measured at 3 transverse levels, corresponding to the 1-, 2-, and 3-o'clock positions. The correlation between radiographic characteristics (COR, AWI, and PWI) and acetabular version, AIIS morphology, and PT was calculated using the Spearman correlation coefficient. Receiver operating characteristic curve analysis was performed to define thresholds for the COR, AWI, and PWI to identify retroversion (version thresholds: <10°, <5°, and <0°). Results: The COS was present in 55% of hips when supine and 30% when standing, with a mean difference in the COR of 12%. The supine COR (rho = −0.661) and AWI/PWI ratio (rho = −0.618) strongly correlated with acetabular version. The COS was more prevalent among patients with type 2 AIIS morphology (71%) than among those with type 1 AIIS morphology (43%) (P =.003). COR thresholds of 23% and 28% were able to identify acetabular version <5° (sensitivity = 81%; specificity = 80%) and <0° (sensitivity = 88%; specificity = 85%), respectively. An AWI/PWI ratio >0.6 was able to reliably identify acetabular version <0° (sensitivity = 83%; specificity = 84%). In the presence of a COR >30% and an AWI/PWI ratio >0.6, the specificity to detect retroversion was significantly increased (>90%). Conclusions: The presence of the COS was very common among patients with hip pain. False-positive results (high COR/normal version) may occur because of AIIS morphology/low PT. Relevant thresholds of COR >30% and AWI/PWI ratio >0.6 can help with diagnostic accuracy. In cases in which either the COR or AWI/PWI ratio is high, axial cross-sectional imaging can further help to avoid false-positive results. [ABSTRACT FROM AUTHOR]

Background The radiographic appearance of the acetabulum differs between the supine and standing positions in patients with hip conditions. The pelvis undergoes a change in tilt when transitioning between positions, resulting in variations in version and acetabular coverage. However, the extent of these variations in well-functioning volunteers without compensatory patterns caused by pain is unknown. Questions/purposes We performed this study to (1) quantify differences in radiographic acetabular measurements when transitioning between supine and standing among asymptomatic, well-functioning volunteers; (2) assess differences in pelvic tilt between positions; and (3) test whether individual anatomic parameters are associated with the change in tilt. Methods This was a prospective, single-center study performed at an academic referral center. One hundred volunteers (students, staff, and patients with upper limb injuries) with well-functioning hips (Oxford hip score ≥ 45) were invited to participate. A total of 45% (45) of them were female, their mean age was 37 ± 14 years, and their mean BMI was 25 ± 2 kg/m². Supine and standing AP pelvic radiographs were analyzed to determine numerous acetabular parameters including the lateral center-edge angle (LCEA), acetabular index (AI), anterior wall index (AWI), posterior wall index (PWI), crossover sign (COS), crossover ratio (COR), posterior wall sign (PWS), ischial spine sign (ISS), and femoroepiphyseal acetabular roof index (FEAR), as well as pelvic parameters including the sacrofemoral-pubic angle (SFP). Spinopelvic parameters were measured from lateral standing spinopelvic radiographs. Radiographic measurements were performed by one hip preservation research fellow and a fellowship-trained staff surgeon. Differences in parameters were determined, and correlations between postural differences and morphological parameters were tested. Clinically important differences were defined as a difference greater than 3° for acetabular angle measurements and 0.03 for acetabular ratio measurements, based on previous studies. Results Lateral coverage angles did not show a clinically important difference between positions. AWI decreased when standing (0.47 ± 0.13 versus 0.41 ± 0.14; p < 0.001), whereas acetabular retroversion signs were more pronounced when supine (COS: 34% [34 of 100], PWS: 68% [68 of 100], and ISS: 34% [34 of 100] versus COS: 19% [19 of 100], PWS: 38% [38 of 100], and ISS: 14% [14 of 100]; all p values < 0.05). Pelvic tilt increased by a mean of 4° ± 4° when standing, but the range of change was from -15° to 7°. The change in AWI (ρ = 0.47; p < 0.001), PWI (ρ = -0.45; p < 0.001), and COR (ρ = 0.52; p < 0.001) between positions correlated with ΔSFP. Volunteers with spinal imbalance (pelvic incidence lumbar lordosis > 10°) demonstrated greater change in pelvic tilt (ΔSFP) (-7° ± 3° versus -4° ± 4°; p = 0.02) and a greater reduction in AWI (by 10%). These volunteers demonstrated reduced standing lumbar lordosis angles (45° ± 11° versus 61° ± 10°; p = 0.001). Conclusion Acetabular version increases from supine to standing because of an increase in pelvic tilt. The change in pelvic tilt between positions exhibited substantial variability. Individuals with reduced lumbar lordosis for a given pelvic incidence value demonstrated greater pelvic mobility. No features on supine radiographs were associated with the change in tilt. Clinical Relevance Performing standing radiographs in addition to supine views can help identify aberrant physiologic patterns in patients with diagnostic dilemmas and might thus help with management. Normative data of pelvic tilt change can help clinicians identify patients who demonstrate excessive change in tilt that contributes to abnormal hip pathomechanics. [ABSTRACT FROM AUTHOR]

Our prior study reveals that the distension-contraction profiles using high-resolution manometry impedance recordings can distinguish patients with dysphagia symptom but normal esophageal function testing ("functional dysphagia") from control subjects. The aim of this study was to determine the diagnostic value of the recording protocol used in our prior studies (10-mL swallows with subjects in the Trendelenburg position) against the standard clinical protocol (5-mL swallows with subjects in the supine position). We used advanced machine learning techniques and robust metrics for classification purposes. Studies were performed on 30 healthy subjects and 30 patients with functional dysphagia. A custom-built software was used to extract the relevant distension-contraction features of esophageal peristalsis. Ensemble methods, i.e., gradient boost, support vector machines (SVMs), and logit boost, were used as the primary machine learning algorithms. Although the individual contraction features were marginally different between the two groups, the distension features of peristalsis were significantly different. The receiver operating characteristic (ROC) curve values for the standard recording protocol and the distension features ranged from 0.74 to 0.82; they were significantly better for the protocol used in our prior studies, ranging from 0.81 to 0.91. The ROC curve values using three machine learning algorithms were far superior for the distension than the contraction features of esophageal peristalsis, revealing a value of 0.95 for the SVM algorithm. Current patient classification for esophageal motility disorders, based on the contraction phase of peristalsis, ignores a large number of patients who have an abnormality in the distension phase of peristalsis. Distension-contraction plots should be the standard for assessing esophageal peristalsis in clinical practice. NEW & NOTEWORTHY: Our findings underscore the superiority of distension features over contraction metrics in diagnosing esophageal dysfunctions. By leveraging state-of-the-art machine learning techniques, our study highlights the diagnostic potential of distension-contraction plots of peristalsis. Implementation of these plots could significantly enhance the accuracy of identifying patients with esophageal motor disorders, advocating for their adoption as the standard in clinical practice. [ABSTRACT FROM AUTHOR]