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Background: No uniform consensus has been achieved regarding the ambulation protocol after transfemoral cerebral angiography (TFA). Until now, in most hospitals patients are prescribed 8-12 h strict immobilization along with bed rest in the supine position after TFA in China, which causes great discomfort to patients. Objective: To evaluate the effect of an evidence-based early ambulation protocol on the prevention of vascular complications and general discomfort in patients following transfemoral cerebral angiography (TFA). Methods: A prospective quasi-experimental study was conducted on 214 patients undergoing TFA with manual compression. Patients in the experimental group were placed supine position for 2 h with a sandbag placed on the wound dressing, followed by a semi-seated position for another 2 h. After this period, patients took 2 h bed rest (move freely) with the sandbag removed, and were allowed to get out of bed 6 h after TFA. Patients in the control group were restricted to an 8 h bed rest in a supine position with the affected leg straight and immobilized. The vascular complications (bleeding, hematoma, ecchymosis) and levels of comfort (low back pain, leg pain, and blood pressure) were evaluated after the procedure. Numeric Rating Scale (NRS) pain scores, systolic blood pressure (SBP); diastolic blood pressure (DBP) were measured hourly for 8 h after TFA. Results: There was no significant difference in the two groups with regard to vascular complications including bleeding events (P = 0.621), bleeding volume (P = 0.321), and area of hematoma (P = 0.156). The area of ecchymosis in the experimental group was significantly smaller than the control group (P = 0.031). Compared with the control group, the NRS score for low back pain in the 4th, 5th, 6th, 7th, and 8th hour after TFA were significantly lower (P < 0.05), and the NRS score for leg pain in the 5th, 6th, 7th, 8th hour after TFA were significantly lower (P < 0.05). The SBP and DBP in the 6th, 7th, and 8th hour after TFA were significantly lower than the control group (all P < 0.05). Conclusions: The evidence-based early ambulation protocol can effectively and safely increase comfort and decrease the pain level for patients undergoing TFA, without change in the incidence of vascular complications. [ABSTRACT FROM AUTHOR]

To explore the clinical effect of "micromovement" in preventing intraoperative acquired pressure injures (IAPIs) among patients experiencing surgery in supine position. A total of 200 patients accepting elective surgery in supine position from 10 May 2023 to 4 July 2023 at Shulan (Hangzhou) Hospital were selected and randomized into two groups (experimental group, n = 100; control group, n = 100). For control group patients, soft silicone foam dressing was applied to the sacrococcygeal region. On the basis of the treatment for control group patients, "micromovement" was implemented among experimental group patients. During this process, the operating table was tilted for 15° leftwards and rightwards alternately every 1 h, and the tilt angle was maintained for 5 min to prevent IAPIs. Finally, comparisons between the two groups were made in terms of the sacrococcygeal IAPI incidence, relative temperature differences (ΔT) on sacrococcygeal skin, and job satisfaction of nurses. Compared with control group patients, patients from the experimental group exhibited lower IAPI incidence (2% vs. 10%), reduced ΔT between the sacrococcygeal skin and surrounding normal skin [0 (−0.1, 0.1) vs. 0.2 (−0.2, 0.4)], and elevated job satisfaction of nurses (80% vs. 66%). All the differences were statistically significant (p < 0.05). "Micromovement" implemented intraoperatively among patients receiving surgery in supine position is able to lower the IAPI incidence by five times and elevate job satisfaction of nurses. [ABSTRACT FROM AUTHOR]

Introduction. Suicide remains an important public health issue in China. Existing literature on the relationship between individual-familial variables and suicide risk mainly focused on family socioeconomic status, and few studies analyzed the effect of position in family on suicide. In this study, we aimed to explore the association between position in family and suicide among Chinese rural youths. Methods. We conducted a case-control psychological autopsy study. The data collection yielded 392 suicide cases aged 15-34 years and 416 community living controls within the same age range. Personal position in family was assessed by the question "How do you evaluate his/her position in the family?" and categorized as high, general, and low to reflect the relative position in family. Logistic regression models were conducted to explore the association between position in family and suicide risk. Results. The results showed that compared with females (males) having a high position in family, females (males) with a low position in family were 7.1 (9.1) times more likely to commit suicide (p < 0.01). Mental disorders, social support, and coping strain were potentially important mediating factors linking position in family to suicide, with certain heterogeneity among males and females. Low coping strain played the most important role in underlying the association between a low position in family and suicide for both females and males, accounting for 55% (28%) of the contribution to the total effect for females (males). Subgroup analysis revealed that low position in family had more significant impacts on suicide risk among married youths and those with low education levels. Conclusion. The effect of position in family on suicide should receive greater consideration when predicting suicide in rural China. Possible mechanisms underlying the effect of position in family on suicide include mental status, social support, and coping strain. [ABSTRACT FROM AUTHOR]

The East Sea has a vital position for maritime powers worldwide and is a crucial point of strategic competition for significant countries. Currently, the East Sea is where many fierce disputes over sovereignty, sovereign rights, and jurisdiction occur between coastal countries because the views and interests of each side are far apart, and they need help finding a consensus on how to solve the problem. The US interests in the East Sea include diverse interests in freedom of navigation, economics, politics, military, and security. The article aims to systematically analyze and explain the US policy towards the East Sea issue since the US Administration announced the Pivot to Asia-Pacific strategy. The US foreign policy towards the East Sea has changed in the direction of increased US involvement in response to rising tensions over disputes, especially towards increased interests of China in this region. Although the United States does not take sides in sovereignty claims, it nevertheless increases its involvement in the issue, focusing on peaceful control of claims and resolving disputes through peaceful negotiation measures. [ABSTRACT FROM AUTHOR]

Objective To investigate sex difference of dynamic cerebral autoregulation (dCA) in different body positions. Methods A total of 130 healthy adults (65 males and 65 females) who underwent physical examination in Xuanwu Hospital Capital Medical University from August 2021 to November 2022 were included. Non-invasive continuous blood pressure monitor and transcranial Doppler ultrasonography (TCD) were used to monitor beat-to-beat blood pressure and middle cerebral artery (MCA) cerebral blood flow velocity (CBFV), respectively. Transfer function analysis (TFA) was used to compare and analyze the dCA parameters (absolute gain value and percentage gain, phase, coherence) in the range of very low frequency (0.02-0.07 Hz), low frequency (0.07-0.20 Hz) and high frequency (0.20-0.50 Hz) of different positions and sex. Results The phase in very low frequency and low frequency were significantly lower in the standing position than in the supine position [(57.37 ± 12.45)° vs. (66.72 ± 16.64)°, t = -6.428, P = 0.000; (36.82 ± 11.59)° vs. (43.02 ± 11.51)°, t = - 6.052, P = 0.000], while the coherence in very low frequency and low frequency were significantly higher in the standing position than in the supine position (0.73 ± 0.06 vs. 0.66 ± 0.06, t = - 8.947, P = 0.000; 0.76 ± 0.06 vs. 0.73 ± 0.07, t = - 2.693, P = 0.007). In both supine and standing positions, absolute gain value of male in the low frequency [(0.91 ±0.23) cm/(s⋅mm Hg) vs. (1.04±0.23)cm/(s⋅mm Hg), t = 3.075, P = 0.003; (0.84±0.19)cm/(s⋅mm Hg) vs. (0.95 ±0.21)cm/(s⋅mm Hg), t = 3.102, P = 0.002] and high frequency [(0.94 ± 0.25) cm/(s⋅mm Hg) vs. (1.11 ± 0.27) cm/(s⋅mm Hg), t = 3.740, P = 0.000; (0.91 ±0.21) cm/(s-mm Hg) vs. (1.05 ±0.23) cm/(s⋅mm Hg), t = 3.747, P = 0.000] was lower than those of female, while the phase in the low frequency was higher than that of female [(45.25 ± 10.21)° vs. (40.81 ± 12.37)°, t = - 2.239, P = 0.027; (38.90 ± 12.25)° vs. (34.74 ± 10.57)°, t = - 2.072, P = 0.040]. Conclusions Postural changes can also affect the cerebral autoregulation, and dCA can be improved in the supine position; there is no significant difference in dCA between male and female in the very low frequency, but there is a certain difference between the sex in the low frequency and high frequency. [ABSTRACT FROM AUTHOR]

BACKGROUND: Previous studies suggest that prone position could improve oxygenation and prevent lung injury. Whether prone position can improve post-extubation clinical outcomes in infants undergoing cardiac surgery is unknown. The aim of our study was to investigate the effects of prone position in preventing extubation failure in noninvasively ventilated infants after cardiac surgery. METHODS: Ninety-six infants who were weaned to nasal CPAP after congenital cardiac surgery were randomly divided into 2 groups: the prone position group (n 5 48) and the supine position group (n 5 48). Primary outcomes measured were extubation failure rate within 48 h of extubation and arterial blood gas values within 6 h of a mandatory prone positioning session. Secondary outcomes included nasal trauma, pressure ulcers, pneumothorax, gastroesophageal reflux, abdominal distention, in-hospital mortality, postoperative nasal CPAP duration, and hospital length of stay. RESULTS: Compared with the supine position group, the prone position group had fewer extubation failure infants (2.0% vs 14.5%, P = .02). Arterial blood gas values after 6 h after a mandatory prone positioning session showed that the PaO2 and PaO2/FIO2 in the prone position group were significantly higher than those in the supine position group (PaO2 93.3 ± 8.5 vs 82.5 ± 9.1, P < .05; PaO2/FIO2 255.8 ± 23.6 vs 235.8 ± 20.7, P < .05). Moreover, nasal CPAP duration and total hospital length of stay in the prone position group were significantly shorter than those in the supine position group (P < .05). CONCLUSIONS: In infants supported with nasal CPAP following cardiac surgery, prone positioning improved postextubation oxygenation, helped reduced extubation failure, and reduced the duration of nasal CPAP ventilation and total hospital length of stay. [ABSTRACT FROM AUTHOR]

This survey contains materials reflecting the Chinese practice in private law in 2021. Firstly, regarding changes in the statutory framework of private international law in China, six legislative acts, one administrative regulation on Counteracting Unjustified Extra-Territorial Application of Foreign Legislation and Other Measures, and six judicial interpretations of the Supreme People's Court ("SPC") were adopted or amended in 2021, covering a wide range of matters, including punitive damages, online litigation, online mediation, and international civil procedure. Secondly, five typical cases on Chinese courts' jurisdiction are selected to highlight the development of Chinese judicial practice in respect of consumer contracts, abuse of dominant market position, repeated actions and other matters. Thirdly, this survey considers 18 cases on choice-of-law issues relating, in particular, to capacities of legal persons, proprietary rights, employee contracts, mandatory rules, gambling and public policy. Fourthly, two significant decisions on punitive damages of intellectual property are reported. Fifthly, several key decisions in the recognition and enforcement of foreign judgments, international arbitration agreements and foreign settlement agreements, are reproduced. Lastly, this survey also covers the Summaries of the National Symposium on Foreign-related Commercial and Maritime Trials of Courts published by the SPC, an official document which represents the current judicial practices in the Chinese courts, and which is expected to provide guidance in the adjudication of foreign-related matters in the future. [ABSTRACT FROM AUTHOR]

Purpose: The use of a robotic arm has been well-described in the literature for the placement of pedicle screws in spine surgery as well as implants for sacroiliac joint fusion. There are no reports describing the use of a robotic arm to place screws in osseous fixation pathways (OFPs) employed in the treatment of pelvic ring and acetabular fractures outside of a single center in China. Using a Sawbones model, the authors describe a technique for using a robotic arm widely available in Europe and the Americas for placement of 6.5 mm cannulated screws into two OFPs commonly used in the treatment of pelvic and acetabular fractures. Methods: Using the Mazor X Stealth Edition (MSXE) robot from Medtronic, the authors were able to place a pin into the pelvis onto which the robot was docked. The authors were then able to designate the area of interest using navigated instruments, and in combination with the MSXE "scan and plan" marker, obtain cross-sectional imaging using the O-Arm and successfully register the MSXE robot. We then used the provided software to plan trajectories for the lateral compression type 2 (LC-II) screw pathway as well as a pathway for a trans-ilio-trans-sacral screw. We describe in detail the steps for setup, planning and placement of 6.5 mm cannulated screws using the MSXE robotic arm into these two OFPs. Results: Visual inspection and plain x-rays demonstrated successful placement of the screws into the two planned OFPs. No breach of cortical bone was seen on either visual inspection of the model or demonstrated on post-procedure x-rays. Conclusion: It is possible to use the Mazor X Stealth Edition robot to place screws into the LC-II and trans-ilio-transsacral screw pathways in a Sawbones model. This is only a feasibility study, and should in no way be taken to suggest that clinical application of this technique should be attempted. [ABSTRACT FROM AUTHOR]

Background: This study aims to introduce the clinical application value of popliteal vein puncture in the supine position under ultrasound guidance and compare this method with popliteal vein puncture in the prone position., Methods: Endovascular operations for nonthrombotic iliac vein lesion patients using popliteal vein access were performed during the period from July 2019 to August 2022 at the Zhongshan Hospital (Xiamen), Fudan University, and Shanghai Xuhui District Central Hospital. Patients were randomly divided into supine position group and prone position group. All of the patients were punctured under ultrasound guidance. The procedure duration time for popliteal vein puncture, visual analog scale (VAS) scores, and postoperative complications were recorded and compared between the 2 groups., Results: Totally 120 patients were included in this study, in which 60 patients were enrolled in the supine position group and 60 patients were enrolled in the prone position group. The median procedure time from puncture to iliofemoral venography was 5.97 min (interquartile range 5.78 min-6.03 min) and 28.76 min (interquartile range 26.84 min-29.83 min; P < 0.01 (in the supine position and prone position group, respectively. The median time from puncture to access sheath insertion was 5.05 min (interquartile range 4.88 min-5.13 min) and 5.03 min (interquartile range 4.93 min-5.12 min; P = 0.607) in the supine position and prone position groups, respectively. The median VAS value was 3 (interquartile range 2-3) and 8 (interquartile range 7-9, P < 0.01) in the supine position and prone position groups, respectively. In the supine position group, one case of arterial branch injury was observed after operation and was successfully managed by ultrasound-guided compression., Conclusions: Popliteal vein puncture in the supine position under ultrasound guidance is safe, significantly reduces the overall operation time without changing position, and relieves the discomfort of patients., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Importance: The efficacy of a semirecumbent position (SRP) in reducing postoperative hypoxemia during anesthesia emergence is unclear despite its widespread use., Objective: To determine the differences in postoperative hypoxemia between patients in an SRP and a supine position., Design, Setting, and Participants: This randomized clinical trial was performed at a tertiary hospital in China between March 20, 2021, and May 10, 2022. Patients scheduled to undergo laparoscopic upper abdominal surgery under general anesthesia were enrolled. Study recruitment and follow-up are complete., Interventions: Patients were randomized to 1 of the following positions at the end of the operation until leaving the postanesthesia care unit: supine (group S), 15° SRP (group F), or 30° SRP (group T)., Main Outcomes and Measures: The primary outcome was the incidence of postoperative hypoxemia in the postanesthesia care unit. Severe hypoxemia was also evaluated., Results: Out of 700 patients (364 men [52.0%]; mean [SD] age, 47.8 [11.3] years), 233 were randomized to group S (126 men [54.1%]; mean [SD] age, 48.2 [10.9] years), 233 to group F (122 men [52.4%]; mean [SD] age, 48.1 [10.9] years), and 234 to group T (118 women [50.4%]; mean [SD] age, 47.2 [12.1] years). Postoperative hypoxemia differed significantly among the 3 groups (group S, 109 of 233 [46.8%]; group F, 105 of 233 [45.1%]; group T, 76 of 234 [32.5%]; P = .002). This difference was statistically significant for groups T vs S (risk ratio [RR], 0.69 [95% CI, 0.55-0.87]; P = .002) and groups T vs F (RR, 0.72 [95% CI, 0.57-0.91]; P = .007), but not for groups F vs S (RR, 0.96 [95% CI, 0.79-1.17]; P = .78). Severe hypoxemia also differed among the 3 groups (group S, 61 of 233 [26.2%]; group F, 53 of 233 [22.7%]; group T, 36 of 234 [15.4%]; P = .01). This difference was statistically significant for groups T vs S (RR, 0.59 [95% CI, 0.41-0.85]; P = .005)., Conclusions and Relevance: In this randomized clinical trial of SRP during anesthesia recovery in patients undergoing laparoscopic upper abdominal surgery, postoperative hypoxemia was significantly reduced in group T compared with group F or group S., Trial Registration: Chinese Clinical Trial Registry Identifier: ChiCTR2100045087.

Background: Percutaneous coronary intervention (PCI) is currently the most common intervention for cardiovascular disease. Standard care after PCI typically involves a period of bed rest in the supine position, but this position creates voiding difficulties. Objective: This study aimed to determine whether a modified supine position could facilitate bladder emptying after PCI. Method: A randomized controlled trial involving 300 patients was conducted. Patients in the intervention group were nursed in the supine position with the bed tilted 20° upright and with a pillow between their feet and the end of the bed. Patients in the control group received standard care, which was supine positioning. Results: One hundred fifty patients were allocated to the intervention group (100 men, 50 women), and 150 were allocated to the control group (103 men, 47 women). Baseline data did not differ between the 2 groups. Patients in the intervention group had significantly better bladder function as evidenced by a shorter time to the first void (5 vs 15 minutes) and fewer patients requiring voiding assistance (8.6% vs 35.3%). Residual urinary volumes were also much lower in the intervention group (88.71 vs 248.22 mL, P < .001). Conclusions: This study demonstrates that a modified supine position can reduce the incidence of impaired micturition and the preservation of normal bladder function after PCI. [ABSTRACT FROM AUTHOR]

Aims and objectives To investigate whether positioning the body in a lateral decubitus position will facilitate nasogastric tube insertion in unconscious patients. Background Inserting a nasogastric tube into unconscious patients can be challenging because these patients cannot cooperate with the operator. The piriform sinus and arytenoid cartilage are the most commonly reported impaction sites. However, we found that the first impaction site was the backward displaced tongue when inserting a nasogastric tube in unconscious patients who often exhibited glossoptosis. Performing an intubation in the lateral decubitus position could make this procedure easy. Design This prospective, double-blind, parallel, randomised controlled trial was conducted in Hengshui City, Hebei Province, China. Methods A total of 110 cases of unconscious patients were enrolled. The patients were randomly assigned to a conventional group (group C) or a lateral decubitus position group (group L). In group C, the nasogastric tube was inserted while the patients were in a supine position using the conventional technique, and in group L, the tube was inserted in a lateral decubitus position or further tilting the body to a prone decubitus position 20-30°. We discussed reasonable intubation methods in unconscious patients by comparing the success rate on first insertion, the overall success rate, the intubation time and the complication rates between the two groups. Results Group L had a higher success rate on first insertion and overall success rate than group C ( p < .05). The intubation time in group L was shorter than that in group C ( p < .001), and the complication rate in group L was lower than that in group C ( p < .05). The differences were statistically significant. Conclusions The backward displaced tongue blocks the pharyngeal passage. Nasogastric tube insertions in the lateral decubitus position are recommended in unconscious patients because of the higher success rate, reduced intubation time and lower complication rate. Relevance to clinical practice This study provides an effective method for nasogastric tube insertions in unconscious patients. [ABSTRACT FROM AUTHOR]

The aim of this study was to investigate the normal high-resolution manometry and impedance ( HRi M) values in the supine and sitting positions in the population of Northern China, and to investigate the influence of different body positions and bolus consistency on esophageal HRi M findings. In this study, healthy volunteers in the supine position underwent esophageal HRi M examination of 10 swallows of 5 mL normal saline solution and 10 swallows of 5 mL synthetic gel of known viscosity, and in the sitting position of an additional five swallows of a synthetic gel of known viscosity. Total bolus transit time ( TBTT), complete bolus transit rate ( CBTR), distal contractile integral ( DCI), distal esophageal amplitude ( DEA), and integrated relaxation pressure ( IRP) were measured. Sixty-two healthy volunteers were examined in the supine position and 45 of these performed additional swallows of the viscous gel in the sitting position. In the supine position, normal values for swallowing the liquid and viscous boli were as follows: TBTT 6.9 ± 0.9 and 8.0 ± 1.2 s ( P < 0.001), CBTR 90.3 ± 14.0 and 77.9 ± 20.3% ( P < 0.001), DCI 1891.5 ± 1131.9 and 1967.8 ± 1140.1 mmHg.s.cm ( P = 0.227), DEA 95.3 ± 35.4 and 98.7 ± 37.5 mmHg ( P = 0.148), and IRP 10.4 ± 4.9 and 9.0 ± 4.2 mmHg ( P < 0.001), respectively. For swallows of the viscous boli in the sitting position, TBTT, DCI, DEA, and IRP were significantly decreased, while CBTR was unchanged ( P = 0.075). Normal HRi M values of the population of Northern China were established. Esophageal transit times of viscous boli were significantly slower, more often incomplete and produced less normal peristalsis in the supine position than swallows of liquid boli. Independent reference values for different manometric systems, body positions, and population need to be established before clinical application. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the prevalence, characteristics, and respiratory arousal threshold (ArTH) of Chinese patients with positional obstructive sleep apnea (POSA) according to the Cartwright Classification (CC) and Amsterdam Positional Obstructive Sleep Apnea Classification (APOC)., Methods: A large-scale cross-sectional study was conducted in our sleep center from 2007 to 2018 to analyze the clinical and polysomnography (PSG) data of Chinese POSA patients. Low ArTH was defined based on PSG indices., Results: Of 5,748 OSA patients, 36.80% met the CC criteria, and 42.88% the APOC criteria, for POSA. The prevalence of POSA was significantly higher in women than men (40.21% and 46.52% vs. 36.13% and 42.18% for CC and APOC, respectively). Chinese POSA patients had a lower apnea hypopnea index (AHI) and lower oxygen desaturation index, shorter duration of oxygen saturation (SaO 2 ) < 90%, and a higher mean SaO 2 and higher lowest SaO 2 value compared to subjects with non-positional OSA (NPOSA). More than 40% of the POSA patients had a low ArTH; the proportion was extremely high in the supine-isolated-POSA (si-POSA) group and APOC I group. In multivariate logistic regression analyses, higher mean SaO 2 and lower AHI during sleep were positive predictors of POSA., Conclusions: According to the CC and APOC criteria, more than 1/3 of our Chinese subjects with OSA had POSA. Chinese POSA patients had less severe OSA and nocturnal hypoxia. Compared to NPOSA patients, significantly more patients with POSA had a low ArTH. A low ArTH may be an important endotype in the pathogenesis of POSA, especially in patients with si-POSA and APOC I. Further studies are necessary to develop personalized management strategies for POSA patients., Trial Registration: Chinese Clinical Trial Registry; URL: http://www.chictr.org.cn ; No. ChiCTR1900025714 (retrospectively registered)., (© 2022. The Author(s).)

Objectives: This study sought to explore the characteristics of de qi using electroacupuncture at acupoints with different properties in the meridian category, histological type, and nerve innervations. Methods: Electroacupuncture was performed on 21 healthy volunteers at paired acupoints of ST36-GB34, CV4-CV12, ST36-ST28, PC6-PC7, and ST36-CV4. Upon acupuncture de qi, the intensities and the prevalence of individual sensations, sensation transmission, and the amplitude of electrical current were recorded. Chi-square, Fischer's exact test, Wilcoxon test, and two-sample paired t test were used to compare the components of de qi within each paired group. Results: Overall intensities and prevalence of individual sensations are fullness, numbness, soreness, tingling, heaviness, pressure, dull pain, warmness, and coolness in decreasing order. No significant difference was found in the prevalence of needling sensations between the two paired points ( p>0.05). However, significant intensity differences ( p<0.05) were showed in soreness, fullness, and heaviness between ST36-ST28, in fullness and numbness between ST36-CV4, and in fullness between CV4-CV12. Tingling sensation was stronger than heaviness and pressure at acupoints PC6-PC7 and ST36 (as paired with CV4). Sharp pain occurred in 10/216 tests (4.63%). Sensation transmission occurred highly (77.78%) on participants, and sensations mostly propagate over one joint but no further than two joints. Overall electrical current was 2.35±0.07 mA (mean±standard error). No significant difference was found between paired acupoints for the distance of sensation transmission and the amplitude of electrical current. Conclusions: Fullness, numbness, and soreness were the most common and obvious sensations associated with electroacupuncture. The difference of sensation intensities may be associated with different nerve innervations. [ABSTRACT FROM AUTHOR]

Background: Atrial fibrillation (AF) is the most prevalent cardiac dysrhythmia with high morbidity and mortality rate. Evidence shows that in every three patients with AF, one is asymptomatic. The asymptomatic and paroxysmal nature of AF is the reason for unsatisfactory and delayed detection using traditional instruments. Research indicates that wearing a dynamic electrocardiogram (ECG) recorder can guide accurate and safe analysis, interpretation, and distinction of AF from normal sinus rhythm. This is also achievable in an upright position and after exercises, assisted by an artificial intelligence (AI) algorithm., Methods: This study enrolled 114 participants from the outpatient registry of our institution from June 24, 2020 to July 24, 2020. Participants were tested with a wearable dynamic ECG recorder and 12-lead ECG in a supine, an upright position and after exercises for 60 s., Results: Of the 114 subjects enrolled in the study, 61 had normal sinus rhythm and 53 had AF. The number of cases that could not be determined by the wristband of dynamic ECG recorder was two, one and one respectively. Case results that were not clinically objective were defined as false-negative or false-positive. Results for diagnostic accuracy, sensitivity, and specificity tested by wearable dynamic ECG recorders in a supine position were 94.74% (95% CI% 88.76-97.80%), 88.68% (95% CI 77.06-95.07%), and 100% (95% CI 92.91-100%), respectively. Meanwhile, the diagnostic accuracy, sensitivity and specificity in an upright position were 97.37% (95% CI 92.21-99.44%), 94.34% (95% CI 84.03-98.65%), and 100% (95% CI 92.91-100%), respectively. Similar results as those of the upright position were obtained after exercise., Conclusion: The widely accessible wearable dynamic ECG recorder integrated with an AI algorithm can efficiently detect AF in different postures and after exercises. As such, this tool holds great promise as a useful and user-friendly screening method for timely AF diagnosis in at-risk individuals., (© 2021. The Author(s).)

Background: The intraoperative 15° left-tilt position during cesarean delivery has more recently been questioned regarding its effect on fetal acid-base balance and is a frequent source of complaints by surgeons. We hypothesized that a 30° left-tilt position during surgical preparation could improve the acid-base balance of the fetus compared with the 15° left-tilt or supine position during surgical preparation., Methods: Women undergoing elective cesarean delivery under combined spinal epidural anesthesia were randomized to a supine position, 15° left-lateral tilt position or 30° left-lateral tilt position; the position was changed to supine before the incision. Anesthetic management was standardized and included fluid loading with 10 mL/kg of normal saline followed by colloid loading. Hypotension (systolic blood pressure [SBP] reduction >20% baseline value or SBP <90 mm Hg) was treated with boluses of phenylephrine or ephedrine according to maternal heart rate. The primary outcome was umbilical arterial blood pH and the secondary outcomes included maternal SBP within 15 minutes after induction of anesthesia, the amount of vasoactive drug administered before end of the surgery, and the incidence of hypotension during cesarean delivery., Results: Seventy-five patients were included. After testing by analysis of variance, there was no significant difference in the umbilical arterial pH among the 3 groups (supine group: 7.31 ± 0.03 vs 15° group: 7.30 ± 0.04 vs 30° group: 7.31 ± 0.02, P = .28). The 30° group required significantly less phenylephrine (P = .007) and ephedrine (P = .005) before the end of surgery than the supine group; however, the only benefit observed in the 15° group was that the mean SBP at 3 minutes after spinal injection was significantly improved compared with the supine group., Conclusions: Compared with the supine position, the 30° left-tilt position during surgical preparation did not significantly improve the fetal acid-base status, but it significantly reduced the use of phenylephrine and ephedrine and reduced the incidence of hypotension; however, these benefits were not observed in the 15° left-tilt group., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2021 International Anesthesia Research Society.)

The epidemic of coronavirus disease 2019 (COVID-19) has become a major public health disaster worldwide. From January 23 to March 20, total 17 patients with TMJ dislocation were treated in dental emergency department in School and Hospital of Stomatology, Wuhan University. Almost half of the patients are older than 80 years of age and they have recurrent joint dislocations. They are also at high risk for the COVID-19. The supine position technique method is suggested. The authors consider it necessary to recommend a practical management for TMJ dislocation.

Purpose: To evaluate the influence of body posture change on the peripherally inserted central catheter tip position in Chinese cancer patients., Methods: A prospective observational trial was conducted in a tertiary cancer hospital from August to September 2018. After the insertion of peripherally inserted central catheter, chest X-ray films were taken to check the catheter tip in the upright and supine positions, respectively. The distance from the carina to the catheter tip was separately measured on both chest films by nurses. The primary study outcome was the distance and direction of the catheter tip movement. The secondary study outcome was to analyze the influence factors on the catheter tip movement. The third study outcome was to observe the related adverse events caused by the catheter tip movement., Results: A total of 79 patients were included, the results showed that 61 moved cephalad, 14 moved caudally, and 4 did not move with body change from the supine to the upright position. When moved cephalad, the mean distance was 19.34 ± 11.95 mm; when moved caudally, the mean distance was -15.83 ± 8.97 mm. The difference between the two positions was statistically significant ( p  < 0.001). There was also a statistically significant difference between catheter tip movement direction and body mass index ( p  = 0.009) and height ( p  = 0.015). Two patients developed arrhythmias; no cardiac tamponade was found due to body posture change., Conclusion: The results of this work implied that the tips of the catheter tend to shift toward the cephalad with body change from the supine to the upright position. A study involving a larger sample size is needed to find more information in the future.

Background: Pulse wave velocity is commonly regarded as the most effective and noninvasive indicator for evaluating arterial stiffness, while increased arterial stiffness is known to be related to atherosclerosis, which has been proved to play a significant role on the onset of acute ischemic stroke. However, it is still only used in the assessment of central and peripheral arteries. Our previous studies have found that carotid-cerebral pulse wave velocity measured using transcranial Doppler may be a promising method for the assessment of human cerebral arterial stiffness. This trial was designed to examine the association between carotid-cerebral pulse wave velocity and acute ischemic stroke., Methods: In a single-center, single-arm, prospective clinical trial, patients with acute ischemic stroke who had anterior circulation infarcts confirmed by magnetic resonance imaging are eligible to receive measurement of carotid-cerebral pulse wave velocity, which is measured in the supine position with transcranial Doppler that using 2-MHz and 4-MHz ultrasound probes by 2 experienced operators. Subjects will be received follow-up for 1 year. Vascular and nonvascular death at follow-up will be assessed as primary outcomes. Secondary outcomes include intracerebral hemorrhage, subarachnoid hemorrhage, transient ischemic attack, recurrence or aggravation of ischemic stroke., Conclusion: This trial will be the first to evaluate carotid-cerebral pulse wave velocity in patients with acute ischemic stroke using transcranial Doppler. The results may provide more valuable theoretical basis for the prevention, treatment, and prognosis of acute ischemic stroke., (Copyright © 2019. Published by Elsevier Inc.)

The aim of this study was to compare clinical effect of posterior approach and anterior approach surgery for patients with thoracolumbar spinal tuberculosis. It was a descriptive, analytical study carried out at the Third People's Hospital of Shenzhen City, China, from March 2012 to March 2015. A total of 84 patients with thoracolumbar spinal tuberculosis were randomly divided into group A and group B, each group having 42 patients. Group A was treated with posterior approach surgery, while group B was treated with anterior approach surgery. The results showed that operation time, bleeding condition, length of stay of group A were lower than those of group B (p<0.001, p<0.001 and p=0.013, respectively). Compared with group B, the Cobb angle of group A after surgery was lower (p<0.001). At the 28th day after treatment, the serum bone alkaline phosphatase (BAP), bone gla protein (BGP), procollagen type I carboxy terminal peptide (CTX) levels of group A were lower than those of group B (p<0.001, p<0.001 and p=0.002, respectively). As compared to anterior approach surgery, posterior approach surgery was an effective method to treat thoracolumbar spinal tuberculosis and reduce serum levels of BAP, BGP and CTX.

Background: The oblique-supine position for percutaneous nephrolithotomy (PCNL) has advantages, but the position fixation methods are inadequate. This study aimed to analyze the PCNL outcomes using a patented self-made frame for oblique-supine position., Methods: This was a prospective study of patients scheduled to undergo PCNL at 2 hospitals in China between November 2009 and December 2016. The patients underwent PCNL in the oblique-supine position using the self-made position frame (n = 94). Operative time, stone clearance rate, intraoperative average systolic pressure, intraoperative average heart rate, intraoperative average airway pressure, intraoperative average intrapelvic pressure, and complications were observed., Results: The patients were 45.3 ± 19.7 years old and 71% were male. Stones were of the size 2.5 ± 1.1 cm. The operative time was 95.6 min and the stone clearance rate was 81.9%. Intraoperative systolic blood pressure was 15.13 ± 1.68 kPa. Intraoperative airway pressure was 15.5 ± 2.3 cm H2O. Postoperative fever was observed in 3.2% of the patients. None had organ injury. Postoperative stay was 4.8 ± 0.6 days. The nephrostomy tube was routinely removed on the 5th day after surgery and the patients were discharged on the following day., Conclusion: The self-made surgical position frame met the position requirements for the oblique-supine PCNL operation. This surgical position frame deserves clinical application and promotion., (© 2019 S. Karger AG, Basel.)

Background: Incisional double-eyelid blepharoplasty is widely applied because of its extensive indications and robust results. The orbicularis-levator fixation method is an incisional approach that provides stronger adhesion than traditional techniques. However, there remains the risk of postoperative relapse or suture spitting out., Methods: The authors introduced a modified technique for supratarsal crease formation. When necessary soft tissue removal was completed, the orbicularis oculi muscle was anchored on the tarsus. Then the muscle edges near canthus were reattached to prevent muscle retraction. For skin closure, the skin-pretarsal fascia-skin maneuver was adopted to enhance cicatricial adhesion., Results: Six hundred and fifty-nine patients underwent double eyelidplasty by the same surgeon using this modified technique. Patients were followed up from 2 to 38 months, with a mean period of 15 months. Short-term complications included mild edema, bruising or reddish change of the upper eyelid, yet all gradually relieved in 6-8 weeks. Fourteen cases of palpebral fold asymmetry and nine cases of unsatisfactory fold formation near the inner canthus were encountered, and all the defects had been well improved by revision surgeries. Ninety-five percent of the patients were satisfied with the long-term outcomes, which showed as natural and well-defined palpebral folds without scar hypertrophy, suture spitting out or crease depression. Besides, no supratarsal crease drooping or disappearing was observed 3 years postoperatively., Conclusions: The authors introduced an orbicularis-tarsus fixation method for upper eyelid blepharoplasty. It is a reliable technique that enables high feasibility and long-lasting result, and with lower risk of suture spitting out., Level of Evidence Iv: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Objective: The purpose of this study was to determine the airway resistance in Chinese children with obstructive sleep apnea hypopnea syndrome (OSAHS) by impulse oscilloetry (IOS) and investigate the association of the severity of OSAHS with the airway resistance and allergic sensitization., Method: A total of 120 children (92 boys) treated for snoring in Beijing Children's Hospital between October 2010 and March 2011 were included in this study. Ninety-three children were diagnosed with OSAHS and 27 did not show OSAHS. Total airway resistance (R5), proximal airway resistance (R20), and peripheral airway resistance (X5) were determined by IOS. Serum levels of total IgE and allergen-specific IgE (sIgE) were also determined., Results: R5 in the OSAHS group was significantly higher than that in the non-OSAHS group (P = 0.0025), whereas R20 and X5 were similar in the two groups. R5 was positively correlated with apnea hypopnea index and obstructive apnea index and negatively correlated with the lowest arterial oxygen saturation significantly (all P < 0.05). The percentage of children with abnormal serum levels of total IgE or abnormal allergen-specific IgEs was comparable in OSAHS and non-OSAHS groups. The proportions of abnormal R5 and of abnormal serum levels of total IgE were significantly higher in children with severe OSAHS compared with children with mild or moderate OSAHS (all P < 0.05)., Conclusions: Total airway resistance was significantly increased in Children with OSAHS. Allergic sensitization might contribute to the exacerbation of existing OSAHS in children. Large scale studies are required to further validate these findings., (© 2015 Wiley Periodicals, Inc.)

Introduction: The objective of this study was to observe the differences in the biodynamic responses of male and female crewmembers during a simulated Soyuz spacecraft (short-duration flights) impact landing., Methods: There were 16 volunteers (8 men and 8 women) recruited to sit in a pseudo-supine position and be exposed to several impact acceleration pulses. The acceleration peaks ranged from 7.7 to 11.8 g with a duration of around 50 ms. Acceleration responses from the drop platform and seat, and at the volunteers' head, shoulder, chest, and ilium were measured., Results: Results indicated that there were significant gender-based differences in the peak acceleration measured from volunteers' shoulders and iliums. The peak decelerations measured at the head and ilium were relatively higher than those measured at other levels on the seat., Discussion: It was recommended that more attention be focused on the sex differences of biodynamic responses of crews in the study of new protective designs for space capsule and personal life support equipment.

The objective of this study was to compare the clinical results and complications of proximal femoral nail antirotation (PFNA) on treatment of intertrochanteric fractures in 120 elderly Chinese patients using Randomized Controlled Trials (RCTs). Totaly 120 cases enrolled were randomly assigned to a lateral decubitus position group and supine position group. The hospital stay, operating time, intraoperative blood loss, length of incision, X-ray fluoroscopy time, and out-of-bed activity time in the lateral decubitus position group were significantly lower than those in the supine position group. There was not statistical significance on union time and Harris values in the two position groups. Moreover, only complications of superficial wound infection were observed in the lateral decubitus position group, but two complications of deep venous thrombosis and wound deep infection were found in the supine position group. The present findings suggested that PFNA applied in elderly patients with intertrochanteric fracture can get satisfactory effects, and the treatment of intertrochanteric fractures using lateral decubitus position showed a satisfactory clinical outcome and a lower radiological complication rate.

The purpose of our study was to confirm that forearm bone mineral density (BMD) results obtained with the patient in the supine position are equivalent to results obtained with patient in the sitting position. The subjects were a Chinese sample of 82 healthy adults (35 males and 47 females; age: 22.5-59.8 yr; body mass index: 17.6-32.4). Forearm BMD was measured by dual-energy X-ray absorptiometry, with the forearm positioned in the sitting and supine positions. Repeated measurements were available for some subjects, and the average of the repeats for those subjects were used in the analysis. The standard enCORE software (GE Lunar, Madison, WI) adjustment for supine position was applied to the BMD values obtained in the supine position for 33% radius, ultradistal (UD) radius, and radius total regions of interest (ROIs) to give sitting-equivalent values. The supine sitting-equivalent results were regressed on the sitting values through the origin. There were statistically significant differences in the UD and total-radius forearm results between supine sitting-equivalent BMD and sitting BMD. The correlation coefficients of UD and total radius were 0.967 and 0.976, respectively. There was no significant difference between supine sitting-equivalent BMD and sitting BMD in the 33% radius forearm BMD. The correlation coefficient of 33% radius was 0.956. For Chinese subjects, there was no significant difference in BMD for the 33% radius, the only ROI recommended for diagnosis by ISCD. Forearm scans could be accomplished with the patient suitably positioned for the routine lumbar spine and proximal femur scans., (The International Society for Clinical Densitometry. All rights reserved.)

Aim: To investigate differences in sleeping behaviours in school-age children between urban and rural Chinese communities., Methods: Children aged between 6 and 12 years old were selected from rural (n= 472) and urban communities (n= 576). Children's sleep habits questionnaire was completed by the parents to assess sleep patterns and sleep problems of the children., Results: In the 6-8 and 9-12 years groups, the average sleep time in urban children was shorter than in the children from rural areas (9.0 +/- 1.1 vs. 11.3 +/- 1.1 h, and 9.2 +/- 1.0 vs. 10.2 +/- 0.9 h, respectively, all P < 0.01). The rate of abnormal sleep behaviour in the urban and rural cohort was 82.8 and 70.1%, respectively (P < 0.05). The prevalence of sleep delays in the 6- to 8-year-old children from urban areas was higher than in the rural areas (60.3 vs. 40.3%, P < 0.01). In the urban 9-12 years group, the rate of day-time sleepiness was higher than in the rural group (52.6 vs. 26.8%, P < 0.01), whereas the night waking rate was lower (43.8 vs. 58.6%, P < 0.01). Multivariate logistic regression analysis showed that the location of the residence, mother's age, parent's sleep habits and education levels predict the sleeping problems in these children., Conclusion: Children from urban communities appear to have sleeping problems than children from a rural setting. A parent's sleep habits, education levels and the location of children's residence have significant impact on the children's sleep behaviour and habits.