Prevention of aspiration of gastric contents during attempt in tracheal intubation in the semi-lateral and lateral positions

BACKGROUND:Pulmonary aspiration of gastric contents during tracheal intubation is a lifethreatening complication in emergency patients.Rapid sequence intubation is commonly performed to prevent aspiration but is not associated with low risk of intubation related complications.Although it has been considered that aspiration can be prevented in the lateral position,few studies have evaluated the ability to prevent aspiration.Moreover,this position is not always a favorable position for tracheal intubation.If aspiration can be prevented in a clinically relevant semi-lateral position,it may be advantageous.We assessed the ability to prevent aspiration in the lateral position and various degrees of the semi-lateral position using a vomiting-regurgitation manikin model.METHODS:A manikin's head was placed in the neutral,simple extension,or sniffing position.The amount of aspirated saline into the bronchi during simulated vomiting was measured at semilateral position angles of 0°to 90° in 10° increments.The difference in the vertical height between the mouth corner and the inferior border of the vocal cord was measured radiologically at each semilateral position in the three head-neck positions.RESULTS:Pulmonary aspiration was prevented at the ≥70°,≥80°,and 90° semi-lateral positions in the neutral,simple extension,and sniffing positions,respectively.The mouth was lower than the vocal cord in the semi-lateral position in which aspiration was prevented.CONCLUSION:The lateral or excessive semi-lateral position was necessary to protect the lung from aspiration in the head-neck positions commonly used for tracheal intubation.Prevention of aspiration was difficult within clinically relevant semi-lateral positions.

Lateral position intubation followed by endoscopic ultrasoundguided angiotherapy in acute esophageal variceal rupture: A case report

BACKGROUND Massive esophageal variceal bleeding can be catastrophic,leading to high morbidity and mortality.Patients experiencing massive esophageal variceal bleeding are at high risk of aspiration and hemorrhagic shock in acute episodes.Intubation and bleeding control are the two essential steps for resuscitation of these patients.CASE SUMMARY A 47-year-old male patient was admitted to our hospital with upper digestive tract bleeding.He was diagnosed with alcohol-induced liver cirrhosis and consequent esophagogastric varices.As he did not show a good response to somatostatin and Sengstaken-Blakemore tube placement,the patient was scheduled for endoscopic angiotherapy under anesthesia.Preoperative assessment showed an ASA physical status of III and Child-Pugh classification B.However,massive hemorrhage occurred just after induction of anesthesia.Intubation by video-guided laryngoscopy in the lateral decubitus position was attempted twice and was successful.After that,an experienced endoscopic ultrasound(EUS)specialist performed angiotherapy and occluded the culprit vessel.An ultra-thin gastroscope was then inserted into the endotracheal tube to extract the blood observed in the lobar bronchi.The patient suffered hemorrhagic shock with an estimated blood loss of 1500 mL in 20 min and remained in the intensive care unit for two days.The patient was discharged from our hospital eight days later without major complications.CONCLUSION Intubation in the lateral decubitus position and EUS-guided treatment can be lifesaving procedures in patients with massive upper gastrointestinal hemorrhage.

An effective and safe gastric endoscopic submucosal dissection in the right lateral position using an inverted overtube

Previously, we reported the efficacy of a newly developed inverted overtube in shortening the hemostatic time and obtaining a clear endoscopic view in emergency endoscopic hemostasis. This device also helped us to perform gastric endoscopic submucosal dissection(ESD) more safely by changing the direction of gravity in the right lateral position. To perform a safe ESD, it is important to make an appropriate angle and distance between the electric knife and the gastric mucosa. In this position, the distance to gastric mucosa is reduced, and the angle of the electric knife changes from vertical to somewhat oblique, facilitating safer cutting.

Comparison of Clinical Problems in Thoracoscopic Esophagectomy between Prone Position with Pneumothorax Procedure and Lateral Position

Study Objective: We compared the effects of intraoperative body position on blood gas and fluid balance in patients undergoing a thoracoscopic esophagectomy as well as during operation and postoperative laboratory data. Design: Prospective study. Setting: Operating room and intensive care unit. Patients: ASA physical status 1 and 2 patients (n = 26), scheduled for elective thoracoscopic esophagectomy and immediate reconstruction under general anesthesia with one-lung ventilation were enrolled. Interventions: Patients were assigned to either the lateral (n = 16) or prone (n = 10) position groups based on the planned intraoperative body position. A pneumothorax procedure was concomitantly performed only in the prone position group. Measurements: Fluid balance, PaO2/FIO2 ratio (P/F ratio), and maximum PaCO2 during the operation and postoperative laboratory data were analyzed. Main Results: There were no significant differences between the groups for amount of blood loss, blood transfusion, fluid infusion, or urine output. The P/F ratio during one-lung ventilation was significantly higher in the prone than the lateral position group (379 ± 122 vs. 297 ± 67 mmHg, p = 0.017), as was maximum intraoperative PaCO2 (72.2 ± 15.6 vs. 48.3 ± 6.3 mmHg, p Conclusions: A thoracoscopic esophagectomy in the prone position performed concomitantly with a CO2 pneumothorax procedure resulted in a significantly better P/F ratio during one-lung ventilation as compared to the lateral position, indicating that the prone position is more advantageous for oxygenation.

Humerus Nailing in Lateral Position (Operative Technique)

With the advent of good designs of nails, straight and angled in the arena of treatment for fractures from surgical neck of humerus to approximately 5 cm above the olecranon fossa, nailing is gaining popularity in recent literature. Many different nails are available in market with different proximal and distal locking configurations. Beach chair and supine are the main principle positions for antegrade humerus nailing. Beach chair or supine is the preferred position by many, but there is always difficulty in distal locking by free hand technique as it is difficult to locate the distal locking hole due to rounded smooth anatomy of anterior distal humerus and fear of neurovascular complications in both anteroposterior and latero-medial locking. The aim of this article is to demonstrate the utility of lateral position in ease of nailing all types of humerus fractures. The technique and illustrations below describe the positioning of patient, image intensifier and free hand postero-anterior distal locking without injury to neurovascular structures.

Successful fiberoptic orotracheal intubation by lifting large thyroid mass and tongue protrusion in left lateral position:a case report

Introduction:Awake fiberoptic bronchoscopy has long been considered the criterion standard for the management of difficult airways because of large thyroid malignancies.After an unsuccessful attempt to intubate with a fiberoptic bronchoscope in the supine position,the decision to switch to the left lateral position was made.We present this case to propose the utilization of the lateral position for awake intubation.Case presentation:We report a rare case of a patient with a large papillary carcinoma of the thyroid planned for surgical excision.The patient presented to our hospital with complaints of difficulty breathing while lying down in the supine position and oozing blood from the necrotic tissue.The breathing difficulties subsided in the lateral position.Conclusion:We demonstrated how the left lateral position with an adjunct maneuver facilitates intubation in large thyroid malignancies.

Left lateral decubitus sleeping position is associated with improved gastroesophageal reflux disease symptoms: A systematic review and meta-analysis

BACKGROUND A limited number of studies have demonstrated that sleeping in the left lateral decubitus(LLD)decreases nocturnal reflux in patients with gastroesophageal reflux disease(GERD)compared to right lateral decubitus(RLD)and supine.AIM This systematic review summarizes the association between sleeping in the LLD position and nocturnal reflux in patients with GERD.METHODS Studies published up to July 17,2023,in MEDLINE,EMBASE,and CENTRAL were searched.Eligible studies were randomized and nonrandomized studies assessing the effect of sleeping in LLD compared to RLD and supine in reducing nocturnal reflux in GERD patients.Outcomes include the acid exposure time(AET)(%time in pH<4),acid clearance time(ACT)(in sec/episode),number of reflux episodes,and improvement in N-GSSIQ scores.RESULTS Two nonrandomized studies showed decreased AET and ACT in LLD sleep position in comparison to RLD(mean difference[MD]-2.03[95%CI:-3.62 to-0.45];-81.84[95%CI:-127.48 to-36.20],respectively)and supine position(MD-2.71[95%CI:-4.34 to-1.09];-74.47[95%CI:-116.26 to-32.69],respectively).There was no difference in AET and ACT between RLD sleep position and supine.Furthermore,one randomized controlled trial investigating the use of electronic sleep positional therapy,which increased the duration of LLD sleep and decreased the duration of RLD sleep compared to sham,showed nocturnal symptoms improvement(improved N-GSSIQ score,increased reflux-free nights,and resolution of nocturnal reflux symptoms).CONCLUSION Current evidence suggests that sleeping on the left side could reduce nocturnal reflux and improve GERD-related quality of life,therefore warranting interventions that promote LLD sleep position.

A Heading Drift Correction Method for Pedestrian Inertial Positioning

Pedestrian inertial positioning is an effective means when satellites fail. Heading accuracy determines the performance of pedestrian inertial positioning. To realize an accurate positioning, a heading drift correction method was proposed. An in-situ active rotation is performed before autonomous positioning, and the error compensation coefficient of biaxial geomagnetic measurement is obtained by using the ellipse fitting correction method to achieve effective suppression of external environmental geomagnetic interference. The corrected biaxial geomagnetic measurement information is used to directly calculate the heading information and combine it with the peak stride detection method and linear step estimation model to achieve autonomous positioning of pedestrians. To verify the effectiveness and stability of the algorithm, several sets of experiments on the autonomous positioning of pedestrians are carried out in an outdoor environment. The experimental results show that the average deviation between the starting point and the endpoint of the proposed algorithm’s positioning trajectory accounts for 0.95% of the total travel in the 150 m positioning experiments.

Operative Benefits of Artificial Pneumothorax in Thoracoscopic Esophagectomy in the Left Lateral Decubitus Position for Esophageal Cancer

Objectives: This study aimed to evaluate operative benefits of artificial pnuemothorax in thoracoscopic esophagectomy in the left lateral decubitus position. Methods: We retrospectively analyzed short-term surgical outcomes including learning curve of 60 consecutive patients who underwent thoracoscopic esophagectomy with artificial pnuemothorax in the left lateral decubitus position between April 2010 and November 2012 in our department. Results: The median operation time and intraoperative blood loss were 443 min and 220 ml, respectively, and these values were 174 min and 95 ml, respectively, in the thoracic phase of surgery. The median number of harvested lymph node was 37. Only 1 patient required conversion to open esophagectomy. The postoperative 30-day mortality rate was 1.7%. The thoracic operation time significantly decreased after an experience of 10 cases and intraoperative blood loss during thoracic phasesignificantly decreased after an experience of 20 cases (p < 0.05), and operation time remained constant for the following cases. The number of harvested lymph nodes did not exhibit significant changes with an increase in the number of case experienced. Conclusions: Artificial pneumothorax provided the shorting of learning curve at the thoracoscopic esophagectomy in the left lateral decubitus position.

Effect of Head Position on the Success Rate of Blind Intubation through Air Q Laryngeal Mask in Morbidly Obese Patients

Aim: To evaluate the effect of head positioning whether neutral or sniffing position on the conduct of intubation through air Q in morbidly obese patients. Patients and method: This study was conducted on 90 patients with body mass index equal or above 40 who were scheduled for surgery under GA and were randomly divided into 2 equal groups: Group N (Gn) in which blind intubation through air Q was done in neutral position. Group S (Gs) in which blind intubation was done in sniffing position. Proper airway assessment of the patients was done. Basic monitoring was attached;Induction of anaesthesia was achieved by Fentanyl 2 ug/kg, Propofol 1.5 - 2.5 mg/kg and Atracurium 0.5 mg/kg. Maintenance of anaesthesia was achieved by Sevoflurane, Atracurium, oxygen and air. When neuromuscular blockade was complete, the head of the patient was adjusted according to their group. The supraglottic device was inserted and connected to capnography, thereafter a well lubricated proper sized ETT was passed through the air Q. We recorded a baseline reading of HR, SBP, DBP, MBP, and oxygen saturation. A second reading was taken after induction of anesthesia, just before intubation. The third reading was recorded after intubation while further readings were measured 1, 3, 5, 10, 15 min after intubation. After ETT removal, we observed the patients in the recovery room at 0, 3 & 24 hours for possible postoperative complications. Results: There was no statistical difference between the two groups regarding the demographic data. Although the intubation in sniffing position has a higher success rate from the first time than the neutral position, the results were statistically insignificant, regarding the mean duration of blind intubation trials through the Air Q and postoperative complications. Conclusion: Although the sniffing position improves glottic visualization, the change of head position had no effect on the success rate of blind intubation through air Q in obese patients.

Head Position of Patients with Right Hemisphere Damage during a Visual Search Task in a Large Field

Spatial neglect syndrome with cerebral lesions is characterized by the ina-bility to orient, report, or respond to relevant visual stimuli contralateral to the lesions. In this study, we investigated the pattern of horizontal visual search in a large space;this search was performed by patients with right hemisphere damage caused by cerebrovascular disease. The neck rotation angle and search time in each increment were continuously recorded during the task, and quantitative data of the measurements were collected. Head position during the visual search task in a large space (%) was then calculated. We set angular bands in increments of 5 degrees from the midline on the left and right sides, and calculated the total search time in each angular band. In patients with unilateral spatial neglect (USN), the search time in the angular band of 5 - 9 on the right side was significantly longer (with USN 16.7%, without USN 4.5%, t = 2.52, df = 16, p < 0.05). Furthermore, in patients with neglect in the leftmost end area in a large space, the search time was significantly shorter in the angular band of 1 - 4 degrees to the left (with neglect 13.1%, without neglect 23.7%, t = 2.13, df = 16, p < 0.05), and tended to be long in the angular band of 5 - 9 to the right. The neck rotation angle and pattern during the search task in a large field deviated slightly to the right, and the search time slightly to the left was short. We believe that these results support the rightward deviation of the search pattern and frame of USN patients.

Precise perception of virtual object position in real world

There is a deviation between actual and theoretical perceived positions of virtual object in stereoscop-ic display.Therefore,methods for precise position perception in real world are proposed in this paper.The causes for the deviation are analyzed on the basis of geometrical optics .Then deviation correctionsare performed by error compensation with mathematic method and by remodeling virtual viewpoint dynami-cally with the movement of physical viewpoint.Experimental results show that these methods can reducethe position deviation to less than 10 millimeter,meeting the requirements for direct manipulation in mul-ti-sensory virtual environment.

Ultrasonographic identification of lateral femoral cutaneous nerve anatomical variation in persistent meralgia paresthetica:A case report

BACKGROUND Meralgia paresthetica(MP)is an entrapment mononeuropathy of the lateral femoral cutaneous nerve(LFCN).Although structural abnormalities in nerve tissues can be confirmed using ultrasonography,this is not routinely performed.CASE SUMMARY Herein,we present the case of a 52-year-old woman who developed MP after laparoscopic gynecological surgery.The patient was referred to our clinic from an obstetrics and gynecology clinic with symptoms of numbness and a tingling sensation in the left anterolateral thigh,which developed after surgery performed 5 mo earlier.Tests were performed to assess the disease status and determine the underlying causes.Ultrasonographic examination revealed an anatomical variation,where the left LFCN was entrapped within the inguinal ligament.This case suggests that performing ultrasonographic examination before and after surgery in the lithotomy position could help prevent MP.CONCLUSION This case demonstrates the value of ultrasonography in detecting anatomical variation and diagnosing persistent MP.Ultrasonography should be considered an adjunct to electromyography for optimal MP management.Further,this case would help other clinicians determine patient prognosis and decide on targeted treatment strategies.

基于CED-YOLOv5s模型的煤矸识别方法研究

由于煤矿井下高噪声、低照度、运动模糊的复杂工况和煤矸易聚集现象,导致煤矸目标检测模型特征提取困难及煤矸分类、定位不准确问题。针对该问题,提出一种基于CED-YOLOv5s模型的煤矸识别方法。首先,在YOLOv5s主干网络中引入坐标注意力(CA)机制,通过将坐标信息嵌入信道关系和长程依赖关系中对特征图进行编码,充分利用通道注意力信息和空间注意力信息,使模型更加关注重要特征,抑制无用信息。其次,在YOLOv5s的检测头部引入EIoU回归损失函数,将目标框与锚框的宽高差异最小化,以增强目标的位置和边界信息,提高模型在密集目标下的定位精度和收敛速度;最后,在YOLOv5s的检测头部引入轻量化解耦头,解耦出单独的特征通道,分别用于分类任务和回归任务,解决了原模型中耦合头部分类任务与回归任务的相互干扰问题,进一步提升了模型的并行运算效率与检测精度。实验结果表明:CED-YOLOv5s模型与其他YOLO系列目标检测模型相比,综合性能最佳,平均检测精度达94.8%,相较于YOLOv5s模型提升了3.1%,检测速度达84.8帧/s,可充分满足煤矿井下煤矸实时检测需求。

良性阵发性位置性眩晕患者七年大数据回顾分析

目的良性阵发性位置性眩晕(BPPV)是最常见的外周性前庭疾病,但目前我国尚缺乏对BPPV大样本数据的回顾性分析,本研究旨在为BPPV患者家庭疾病预警和防范提供相应的理论依据。方法回顾性选取2014年6月—2021年6月中国人民解放军总医院眩晕诊疗中心数据库中眩晕患者45807例的临床资料,其中符合BPPV诊断患者5883例,根据其类型分类,统计患者年龄、性别、就诊时间、首诊BPPV类型、复诊BPPV类型等信息。使用Python 3.7进行数据可视化。结果BPPV患者中,女性3909例,男性1974例,50~59岁人群BPPV患者最多,且各BPPV类型中,女性患者比例均高于男性患者。所有眩晕患者位置性试验(+)阳性率为12.8%。不同类型BPPV比例中后管BPPV比例为64.5%,水平管BPPV比例为30.9%。有1092例BPPV复诊记录,首次诊断BPPV至复诊阴性有411例,234例患者BPPV类型在2~6次的就诊过程中有改变,BPPV类型转换比较常见的是左右耳PC-BPPV之间变化(71例)。结论本研究大数据显示,BPPV患者主要分布在50岁左右人群,女性患者约为男性的2倍。LC-BPPV患者比例远高于前期研究数据,约占所有BPPV患者的30.9%。在长期随访中,除大部分患者的BPPV类型没有发生变化外,主要的耳石变化存在后管侧别之间、后管与水平管之间进行转换的趋势。

基于地标点匹配的高精度室内定位算法

针对基于惯导的行人室内定位算法定位误差大的问题,提出了一种基于地标点匹配的行人高精度三维室内定位算法。该算法仅使用惯性测量单元(IMU)这一单一传感器,包含速度约束、航向角约束、水平位置约束和高度约束四个模块。水平位置约束模块可根据航向角变化实时检测并建立地标点,并设计了一种地标点匹配度函数,提高了地标匹配的准确度。多楼层行走实验表明所提算法能够提升行人室内定位精度,其终点误差为0.3421 m,相较于ZUPT算法和ZUPT+HDE算法分别减小了82.6%和68.3%,具有一定的工程应用价值.

国有企业负责人经营业绩考核:制度特征分析与指标维度优化

业绩考核制度是落实企业责任、激发企业活力,并由此推动经济社会运行的重要机制。在对比股东主导和市场主导两种业绩考核逻辑,分析、认知国有企业负责人经营业绩考核制度的基础上,探究了业绩考核制度的本质特征,即国有企业负责人经营业绩考核制度是一项以考核为抓手的产权管理体系,是以目标设定与过程管理为核心的“自驱式”机制设计。强调应唯经营(而非考核)出业绩,并且正向激励与风险容错是业绩考核赋能企业发展的重要属性。现行业绩考核指标体系还难以引导国有企业高质量发展,建议围绕“产业布局、经营生态、创新驱动、风险管理、财务收益”五个维度进一步优化国有企业负责人经营业绩考核指标,且以年度考核为核心,形成导向明确、相对稳定、可预期的考核指标体系,并赋予企业负责人一定的自由裁量权,以提高考核制度效果,助力中国经济高质量发展。

基于位置误差模型的机场侧向跑道碰撞风险评估

针对侧向跑道相关运行模式下航空器进离场安全间隔问题进行碰撞风险评估。为保证航空器之间的安全运行,对机场侧向跑道运行模式进行分析,计算两跑道航空器之间的动态间隔,并考虑导航误差、速度误差等因素建立位置误差碰撞风险模型。以成都天府机场侧向跑道为例,利用MATLAB软件对航空器间的碰撞风险进行仿真,并进一步得到碰撞风险值与侧向跑道汇聚交叉角度的关系。仿真结果表明:在起降相关运行模式下,当终端区航空器起始水平间隔距离为6 km,侧向跑道交叉角度为90°时,总的碰撞风险为5.14×10^(-9),满足航空器之间安全水平要求,且随着侧向跑道汇聚交叉角的增大,跑道上两架航空器的碰撞风险逐渐减小。

定位装置对头面部医学摄影一致性的影响

目的:探讨定位装置对整形美容外科头面部医学摄影一致性的影响。方法:于2021年3月,选取志愿者20例作为研究对象,采用自身对照研究法,每位志愿者先使用传统拍摄法拍摄三组照片,每组照片拍摄角度为左、右45°和左、右90°;30 min后,每位志愿者再使用定位装置拍摄法拍摄三组照片,记录每组拍摄时间。通过Image J软件对每组照片进行距离及角度的测量,对两种拍摄方法测量数据的差值及所用时间进行统计学分析。结果:定位装置拍摄法中左、右45°照的角度差,左、右90°照的角度差,以及左、右45°照的距离差均小于传统拍摄法,拍摄时间也明显短于传统拍摄法(P<0.05)。结论:摄影定位装置的运用,大大提升了整形美容外科头面部医学摄影的一致性,使影像资料更加标准、规范,还缩短了拍照时间,提升了工作效率,提高医、护、患三方满意度。

20°上臂倾斜位摄片法在肱骨外髁骨折中的应用价值

目的浅析20°上臂倾斜位摄片法在肱骨外髁骨折中的应用价值。方法选取2022年6月至2023年5月江西省儿童医院收治的50例肱骨外髁骨折患儿作为研究对象,所有患儿均采用传统正位与20°上臂倾斜位摄片法,手术结果作为金标准。并根据Jakob分类法进行二次评估,测量不同体位X线正位平片中骨块内侧与外侧的移位距离。结果50例肱骨外髁骨折患儿中,标准位摄片法的Jakob分型为:Ⅰ度29例、Ⅱ度17例、Ⅲ度4例;20°上臂倾斜位摄片法的Jakob分型为:Ⅰ度19例、Ⅱ度27例、Ⅲ度4例。经过测量可知,20°上臂倾斜位摄片法的异位距离大于标准位摄片法,差异有统计学意义(P<0.05)。20°上臂倾斜位摄片法准确率高于标准位摄片法,差异有统计学意义(P<0.05)。50例肱骨外髁骨折患儿中,手术结果为金标准,45例结果正确,5例结果错误;20°上臂倾斜位摄片法灵敏度为97.73%、特异度为66.67%、准确度为94.00%。结论在肱骨外髁骨折中采用20°上臂倾斜位摄片法,能够快速显示患儿肱骨外髁骨折的骨块移位程度,提高诊断的准确率,为临床治疗提供有利的参考依据。