A simple procedure to plan, verify and implement craniospinal irradiation（CSI） with patients supine is presented. Treatment is conducted with a single posterior spinal field abutting two lateral cranial fields. The ...A simple procedure to plan, verify and implement craniospinal irradiation（CSI） with patients supine is presented. Treatment is conducted with a single posterior spinal field abutting two lateral cranial fields. The opposed lateral fields are half-blocked and the inferior line is perpendicular. The posterior field uses some fixed field parameters so that the cephalad edge of the posterior field is coplanar with the caudal edges of the lateral fields and it is independent of the height of the couch. A steel-shot ball is used to measure the size of overlap or gap at the junction using portal images of an electron portal image device or portal films. The results of analyzing the portal images show that the errors of the junction are within ± 1 mm. The dose-volume histograms （DVHs）show that there are not unbearable hot or cold spots in the clinic target volumes （CTVs）. Supine craniospinal treatment is a reliable and convenient alternative to treatment in the prone position and avoids the technical difficulties of the latter. The use of fixed field geometry greatly facilitates treatment planning and effectively reduces the amount of time of setup, verification and treatment.展开更多
Background:The supine position is the most common birth position adopted in China,but the World Health Organization recommends non-supine positions for delivery.The handsand-knees position shows several advantages,suc...Background:The supine position is the most common birth position adopted in China,but the World Health Organization recommends non-supine positions for delivery.The handsand-knees position shows several advantages,such as wide pelvic diameter and easy fetal rotation during delivery.Small trials conducted in China in 2011 revealed that the handsand-knees position resulted in improved maternal and neonate outcomes than those in the supine position.However,a comprehensive study must be conducted before the handsand-knees position can be introduced into clinical practice.Hence,we conducted this multicenter trial to comprehensively examine the benefits of the hands-and-knees position over the supine position during delivery.Methods:Our clinical study was conducted in 11 hospitals in China from May to December 2012.A total of 446 pregnant women who gave birth in the hands-and-knees position were assigned into the experimental group,and 440 women who gave birth in the supine position were classified into the control group.Episiotomy rate was evaluated as the primary outcome,and perineum laceration degree was considered the secondary outcome.Results:Women in the experimental group achieved lower rates of episiotomy and higher rates of intact perineum and first-degree perineum lacerations compared with those in the control.Postpartum bleeding amount,neonatal asphyxia,and APGAR scores at 1 and 5 min were not significantly different between the two groups.Conclusions:This study proves that women who delivered in the hands-and-knees position achieved low rates of episiotomy and intact perineum.Moreover,the rates of neonatal asphyxia and postpartum bleeding did not increase.Pregnant patients who prefer to adopt the hands-and-knees position should be assisted in assuming such position during delivery.展开更多
Background: The concentration of supplemental O2 should be measured during general anesthesia to determine whether patients’ pressure of arterial oxygen (PaO2) is correct. Nevertheless, we do not know standard value ...Background: The concentration of supplemental O2 should be measured during general anesthesia to determine whether patients’ pressure of arterial oxygen (PaO2) is correct. Nevertheless, we do not know standard value of PaO2 by age in supine position during general anesthesia. In this study, we evaluated the PaO2 by age at 33% or 40% O2 concentration. Materials and Methods: We retrospectively reviewed the anesthetic charts of 660 patients who were received general anesthesia from January 2001 to December 2013. Patients were divided into two groups by concentration of fraction of inspiratory oxygen: group at 33% or 40%. Second, patients aged 16 - 85 years were classified into 7 groups by age with each group covering one decade. Results: The PaO2 was 185.1 ± 19.2 mmHg (33%) and 209.8 ± 19.8 mmHg (40%) at age 16 - 25 years, 178.7 ± 23.6 mmHg (33%) and 202.7 ± 26.0 mmHg (40%) at age 26 - 35 years, 165.8 ± 30.6 mmHg (33%) and 188.9 ± 22.2 (40%) mmHg at age 36 - 45 years, 154.1 ± 22.8 mmHg (33%) and 181.8 ± 19.2 (40%) mmHg at age 46 - 55 years, 153.7 ± 21.7 mmHg (33%) and 177.5 ± 18.1 mmHg (40%) at age 56 - 65 years, 152.2 ± 24.5 mmHg and 171.0 ± 22.1 mmHg at age 66 - 75 years, and 154.6 ± 24.3 mmHg and 174.1 ± 20.2 mmHg at age 76 - 85 years. Conclusion: The PaO2 tended to decrease with age at both 33% and 40% O2 concentration.展开更多
Background: Anesthetists should measure the concentration of supplemental oxygen to determine whether patients’ partial pressure of arterial oxygen (PaO2) is correct during general anesthesia. However, the standard P...Background: Anesthetists should measure the concentration of supplemental oxygen to determine whether patients’ partial pressure of arterial oxygen (PaO2) is correct during general anesthesia. However, the standard PaO2 value in obese patients in the supine position is unknown. We evaluated the PaO2 with respect to the Broca-Katsura obesity index. Materials and Methods: From January 2001 to December 2013, we evaluated 472 patients aged ≥16 years old that underwent general anesthesia in the supine position. The anesthetic charts of 472 patients with an American Society of Anesthesiologists physical status of I or II were retrospectively reviewed to investigate the PaO2. Results: In patients aged 16 to 2 was 165.7 ± 25.6 mmHg at a Broca-Katsura index of 2 was 152.1 ± 23.8 mmHg at a Broca-Katsura index of 2 tended to decrease with age from 16 to 2 tended to decrease with age from 16 to <65 years at a Broca-Katsura index of 20% to <40%.展开更多
AIM:To identify a hypothesis on:Supine sleep,sudden infant death syndrome(SIDS) reduction and association with increasing autism incidence.METHODS:Literature was searched for autism spectrum disorder incidence time tr...AIM:To identify a hypothesis on:Supine sleep,sudden infant death syndrome(SIDS) reduction and association with increasing autism incidence.METHODS:Literature was searched for autism spectrum disorder incidence time trends,with correlation of change-points matching supine sleep campaigns.A mechanistic model expanding the hypothesis was constructed based on further review of epidemiological and other literature on autism.RESULTS:In five countries(Denmark,United Kingdom,Australia,Israel,United States) with published time trends of autism,change-points coinciding with supine sleep campaigns were identified.The model proposes that supine sleep does not directly cause autism,but increases the likelihood of expression of a subset of autistic criteria in individuals with genetic susceptibility,thereby specifically increasing the incidence of autism without intellectual disability.CONCLUSION:Supine sleep is likely a physiological stressor,that does reduce SIDS,but at the cost of impact on emotional and social development in the population,a portion of which will be susceptible to,and consequently express autism.A re-evaluation of all benefits and harms of supine sleep is warranted.If the SIDS mechanism proposed and autism model presented can be verified,the research agenda may be better directed,in order to further decrease SIDS,and reduce autism incidence.展开更多
Background: We investigated the differences between partial pressure of arterial carbon dioxide and end-tidal carbon dioxide (P(a-ET)CO2) with respect to the Broca-Katsura index (BKI), which is an obesity index, in ob...Background: We investigated the differences between partial pressure of arterial carbon dioxide and end-tidal carbon dioxide (P(a-ET)CO2) with respect to the Broca-Katsura index (BKI), which is an obesity index, in obese patients during general anesthesia. Materials and Methods: From January 2003 to December 2013, we studied 601 patients aged 16 years old or over undergoing general anesthesia. Patients had American Society of Anesthesiology physical status I and II and we reviewed their anesthetic charts. The P(a-ET)CO2 with respect to the BKI divided patients into two groups: 16 to 2 values between the two groups. Results: In patients aged 16 to 2 was 2.2 ± 3.1 mmHg at BKI 2 was 3.2 ± 4.1 mmHg at BKI 2 tends to increase in obese patients during general anesthesia with increasing BKI in patients aged 16 to < 65 years old.展开更多
AIM:To analyze the therapeutic effect of combined abinterno trabeculectomy and cataract surgery on intraocular pressure(IOP)levels in supine and sitting postures during a 24-hour IOP profile.METHODS:Twenty-six eyes of...AIM:To analyze the therapeutic effect of combined abinterno trabeculectomy and cataract surgery on intraocular pressure(IOP)levels in supine and sitting postures during a 24-hour IOP profile.METHODS:Twenty-six eyes of twenty-six patients receiving ab-interno trabeculectomy using electroablation of the trabecular meshwork combined with cataract surgery or stand-alone were included in this retrospective analysis.IOP change during 24-hour IOP profiles within two years postoperatively were analyzed for eyes receiving surgery(“study eyes”)and compared to fellow eyes,which had not received surgery.Clinical data including mean sitting IOP(siIOP),mean supine IOP(su IOP)and the number of topical antiglaucomatous medications(TAM)were extracted from patients’files.RESULTS:Preoperatively,si IOP was 17.6±5.3 mm Hg in study and 17.1±4.7 mm Hg in fellow eyes(P=0.347).Patients were treated with an average of 2.8±1.0 TAM.Best corrected visual acuity(BCVA)was significantly worse in study eyes(P<0.001),visual field function was marginally not significantly dif ferent(P=0.057).Af ter surger y 9.6±6.8 mo,study eyes had a mean si IOP of 14.5±3.6 mm Hg(IOP reduction:-3.2 mm Hg,P=0.009),a mean su IOP of 18.0±3.5 mm Hg,and an average of 1.3±1.34 TAM(P<0.001),while in fellow eyes,mean si IOP was 16.2±3.4 mm Hg and mean su IOP was 20.5±5.1 mm Hg.Postoperatively,the relative IOP increase between sitting and supine postures was approximately 30%in both study and fellow eyes(P=0.99).CONCLUSION:IOP after ab-interno trabeculectomy shows a comparable relative reduction in both supine and sitting position.Classical trabeculectomy is known to lower su IOP overproportionally.展开更多
Objective The aim of the study was to compare the dose to lung volume in the supine and prone posi- tion while designing CyberKnife treatment plans to treat metastatic tumors in the spinous processes of the thoracic v...Objective The aim of the study was to compare the dose to lung volume in the supine and prone posi- tion while designing CyberKnife treatment plans to treat metastatic tumors in the spinous processes of the thoracic vertebrae, and offer a reference for reducing damage to normal tissues. Methods Nine cases of metastatic tumors in the spinous processes of the thoracic vertebrae were selected, and then we designed treatment plans based on the supine and prone positions and compared the results. Results In contrast with the treatment plan based on the prone position, the one for the supine position required 14862-36337 MU more; the lung D5% was 5.20-7.90 Gy higher; and the lung D20% was 2.61-5.73 Gy higher. The difference of dose to spine volume between the two plans was -2.21-2.67 Gy; to the skin volume was -3.93-7.85 Gy; and to the esophagus was 0.28-6.39 Gy. Conclusion The treatment plan based on the prone position of patients can better protect lung tissues than the one based on the supine position, and can also improve the avaUabilitv of beams.展开更多
Objective The purpose of the study was to evaluate the efficiency of the supine roll test(SRT)and alternative positional tests(APTs)including the bow and lean test(BLT),pseudo-spontaneous nystagmus(PSN),and lying down...Objective The purpose of the study was to evaluate the efficiency of the supine roll test(SRT)and alternative positional tests(APTs)including the bow and lean test(BLT),pseudo-spontaneous nystagmus(PSN),and lying down nystagmus(LDN)to identify the affected side in horizontal canal benign paroxysmal positional vertigo(HC-BPPV).Methods In our prospective study,we performed a testing profile(PSN,BLT,LDN,SRT)on 59 HC-BPPV patients using videonystagmography.We compared the accuracy and sensitivity of these tests in HC-BPPV lateralization.Data from 30 healthy patients were collected as the control group.Results When performing positional tests,the elicited nystagmus coinciding with Ewald’s second law was defined as a“positive response”.In 44 patients with geotropic nystagmus,the rates of positive response in LDN,PSN,and BLT were 22/44(50%),19/44(43%),and 18/44(41%),respectively,while in 15 patients with apogeotropic nystagmus,the positive response rates of these three tests were 10/15(66.7%),9/15(60%),and 4/15(27.00%),respectively.The sensitivity of LDN(54.38%)was higher than that of PSN(47.37%)and BLT(38.60%)but lower than that of SRT(89.47%).Notably,the accuracy rate of PSN(71.8%)was higher than that of the other APTs.In 6 patients with symmetrical nysgtamus during the roll test,5 patients showed a positive response in both LDN and BLT(83.34%),whereas 4 patients showed a positive response in PSN(66.67%).Conclusion All positional tests are helpful for determining the affected side of HC-BPPV,but SRT carries the highest accuracy of lateralization followed by PSN.展开更多
Objective To discuss semilateral supine position for retroperitoneoscopic adrenalectomy. Methods From Jan. 2006 to Dec. 2008,36 patients ( 20 males and 16 females with mean age of 43 years) underwent retroperito-neosc...Objective To discuss semilateral supine position for retroperitoneoscopic adrenalectomy. Methods From Jan. 2006 to Dec. 2008,36 patients ( 20 males and 16 females with mean age of 43 years) underwent retroperito-neoscopic adrenalectomy in 60° - 70°semilateral展开更多
文摘A simple procedure to plan, verify and implement craniospinal irradiation（CSI） with patients supine is presented. Treatment is conducted with a single posterior spinal field abutting two lateral cranial fields. The opposed lateral fields are half-blocked and the inferior line is perpendicular. The posterior field uses some fixed field parameters so that the cephalad edge of the posterior field is coplanar with the caudal edges of the lateral fields and it is independent of the height of the couch. A steel-shot ball is used to measure the size of overlap or gap at the junction using portal images of an electron portal image device or portal films. The results of analyzing the portal images show that the errors of the junction are within ± 1 mm. The dose-volume histograms （DVHs）show that there are not unbearable hot or cold spots in the clinic target volumes （CTVs）. Supine craniospinal treatment is a reliable and convenient alternative to treatment in the prone position and avoids the technical difficulties of the latter. The use of fixed field geometry greatly facilitates treatment planning and effectively reduces the amount of time of setup, verification and treatment.
文摘Background:The supine position is the most common birth position adopted in China,but the World Health Organization recommends non-supine positions for delivery.The handsand-knees position shows several advantages,such as wide pelvic diameter and easy fetal rotation during delivery.Small trials conducted in China in 2011 revealed that the handsand-knees position resulted in improved maternal and neonate outcomes than those in the supine position.However,a comprehensive study must be conducted before the handsand-knees position can be introduced into clinical practice.Hence,we conducted this multicenter trial to comprehensively examine the benefits of the hands-and-knees position over the supine position during delivery.Methods:Our clinical study was conducted in 11 hospitals in China from May to December 2012.A total of 446 pregnant women who gave birth in the hands-and-knees position were assigned into the experimental group,and 440 women who gave birth in the supine position were classified into the control group.Episiotomy rate was evaluated as the primary outcome,and perineum laceration degree was considered the secondary outcome.Results:Women in the experimental group achieved lower rates of episiotomy and higher rates of intact perineum and first-degree perineum lacerations compared with those in the control.Postpartum bleeding amount,neonatal asphyxia,and APGAR scores at 1 and 5 min were not significantly different between the two groups.Conclusions:This study proves that women who delivered in the hands-and-knees position achieved low rates of episiotomy and intact perineum.Moreover,the rates of neonatal asphyxia and postpartum bleeding did not increase.Pregnant patients who prefer to adopt the hands-and-knees position should be assisted in assuming such position during delivery.
文摘Background: The concentration of supplemental O2 should be measured during general anesthesia to determine whether patients’ pressure of arterial oxygen (PaO2) is correct. Nevertheless, we do not know standard value of PaO2 by age in supine position during general anesthesia. In this study, we evaluated the PaO2 by age at 33% or 40% O2 concentration. Materials and Methods: We retrospectively reviewed the anesthetic charts of 660 patients who were received general anesthesia from January 2001 to December 2013. Patients were divided into two groups by concentration of fraction of inspiratory oxygen: group at 33% or 40%. Second, patients aged 16 - 85 years were classified into 7 groups by age with each group covering one decade. Results: The PaO2 was 185.1 ± 19.2 mmHg (33%) and 209.8 ± 19.8 mmHg (40%) at age 16 - 25 years, 178.7 ± 23.6 mmHg (33%) and 202.7 ± 26.0 mmHg (40%) at age 26 - 35 years, 165.8 ± 30.6 mmHg (33%) and 188.9 ± 22.2 (40%) mmHg at age 36 - 45 years, 154.1 ± 22.8 mmHg (33%) and 181.8 ± 19.2 (40%) mmHg at age 46 - 55 years, 153.7 ± 21.7 mmHg (33%) and 177.5 ± 18.1 mmHg (40%) at age 56 - 65 years, 152.2 ± 24.5 mmHg and 171.0 ± 22.1 mmHg at age 66 - 75 years, and 154.6 ± 24.3 mmHg and 174.1 ± 20.2 mmHg at age 76 - 85 years. Conclusion: The PaO2 tended to decrease with age at both 33% and 40% O2 concentration.
文摘Background: Anesthetists should measure the concentration of supplemental oxygen to determine whether patients’ partial pressure of arterial oxygen (PaO2) is correct during general anesthesia. However, the standard PaO2 value in obese patients in the supine position is unknown. We evaluated the PaO2 with respect to the Broca-Katsura obesity index. Materials and Methods: From January 2001 to December 2013, we evaluated 472 patients aged ≥16 years old that underwent general anesthesia in the supine position. The anesthetic charts of 472 patients with an American Society of Anesthesiologists physical status of I or II were retrospectively reviewed to investigate the PaO2. Results: In patients aged 16 to 2 was 165.7 ± 25.6 mmHg at a Broca-Katsura index of 2 was 152.1 ± 23.8 mmHg at a Broca-Katsura index of 2 tended to decrease with age from 16 to 2 tended to decrease with age from 16 to <65 years at a Broca-Katsura index of 20% to <40%.
文摘AIM:To identify a hypothesis on:Supine sleep,sudden infant death syndrome(SIDS) reduction and association with increasing autism incidence.METHODS:Literature was searched for autism spectrum disorder incidence time trends,with correlation of change-points matching supine sleep campaigns.A mechanistic model expanding the hypothesis was constructed based on further review of epidemiological and other literature on autism.RESULTS:In five countries(Denmark,United Kingdom,Australia,Israel,United States) with published time trends of autism,change-points coinciding with supine sleep campaigns were identified.The model proposes that supine sleep does not directly cause autism,but increases the likelihood of expression of a subset of autistic criteria in individuals with genetic susceptibility,thereby specifically increasing the incidence of autism without intellectual disability.CONCLUSION:Supine sleep is likely a physiological stressor,that does reduce SIDS,but at the cost of impact on emotional and social development in the population,a portion of which will be susceptible to,and consequently express autism.A re-evaluation of all benefits and harms of supine sleep is warranted.If the SIDS mechanism proposed and autism model presented can be verified,the research agenda may be better directed,in order to further decrease SIDS,and reduce autism incidence.
文摘Background: We investigated the differences between partial pressure of arterial carbon dioxide and end-tidal carbon dioxide (P(a-ET)CO2) with respect to the Broca-Katsura index (BKI), which is an obesity index, in obese patients during general anesthesia. Materials and Methods: From January 2003 to December 2013, we studied 601 patients aged 16 years old or over undergoing general anesthesia. Patients had American Society of Anesthesiology physical status I and II and we reviewed their anesthetic charts. The P(a-ET)CO2 with respect to the BKI divided patients into two groups: 16 to 2 values between the two groups. Results: In patients aged 16 to 2 was 2.2 ± 3.1 mmHg at BKI 2 was 3.2 ± 4.1 mmHg at BKI 2 tends to increase in obese patients during general anesthesia with increasing BKI in patients aged 16 to < 65 years old.
文摘AIM:To analyze the therapeutic effect of combined abinterno trabeculectomy and cataract surgery on intraocular pressure(IOP)levels in supine and sitting postures during a 24-hour IOP profile.METHODS:Twenty-six eyes of twenty-six patients receiving ab-interno trabeculectomy using electroablation of the trabecular meshwork combined with cataract surgery or stand-alone were included in this retrospective analysis.IOP change during 24-hour IOP profiles within two years postoperatively were analyzed for eyes receiving surgery(“study eyes”)and compared to fellow eyes,which had not received surgery.Clinical data including mean sitting IOP(siIOP),mean supine IOP(su IOP)and the number of topical antiglaucomatous medications(TAM)were extracted from patients’files.RESULTS:Preoperatively,si IOP was 17.6±5.3 mm Hg in study and 17.1±4.7 mm Hg in fellow eyes(P=0.347).Patients were treated with an average of 2.8±1.0 TAM.Best corrected visual acuity(BCVA)was significantly worse in study eyes(P<0.001),visual field function was marginally not significantly dif ferent(P=0.057).Af ter surger y 9.6±6.8 mo,study eyes had a mean si IOP of 14.5±3.6 mm Hg(IOP reduction:-3.2 mm Hg,P=0.009),a mean su IOP of 18.0±3.5 mm Hg,and an average of 1.3±1.34 TAM(P<0.001),while in fellow eyes,mean si IOP was 16.2±3.4 mm Hg and mean su IOP was 20.5±5.1 mm Hg.Postoperatively,the relative IOP increase between sitting and supine postures was approximately 30%in both study and fellow eyes(P=0.99).CONCLUSION:IOP after ab-interno trabeculectomy shows a comparable relative reduction in both supine and sitting position.Classical trabeculectomy is known to lower su IOP overproportionally.
基金Supported by a grant of 2013 the General Logistics Department Military Logistic Research Project Key Programs(No.BWS13J031)
文摘Objective The aim of the study was to compare the dose to lung volume in the supine and prone posi- tion while designing CyberKnife treatment plans to treat metastatic tumors in the spinous processes of the thoracic vertebrae, and offer a reference for reducing damage to normal tissues. Methods Nine cases of metastatic tumors in the spinous processes of the thoracic vertebrae were selected, and then we designed treatment plans based on the supine and prone positions and compared the results. Results In contrast with the treatment plan based on the prone position, the one for the supine position required 14862-36337 MU more; the lung D5% was 5.20-7.90 Gy higher; and the lung D20% was 2.61-5.73 Gy higher. The difference of dose to spine volume between the two plans was -2.21-2.67 Gy; to the skin volume was -3.93-7.85 Gy; and to the esophagus was 0.28-6.39 Gy. Conclusion The treatment plan based on the prone position of patients can better protect lung tissues than the one based on the supine position, and can also improve the avaUabilitv of beams.
基金the National Natural Science Foundation of China(No.81500794,No.81271078 and No.81500791)Scientific Research Project of Hubei Province Health and Family Planning(No.WJ2015MB062).
文摘Objective The purpose of the study was to evaluate the efficiency of the supine roll test(SRT)and alternative positional tests(APTs)including the bow and lean test(BLT),pseudo-spontaneous nystagmus(PSN),and lying down nystagmus(LDN)to identify the affected side in horizontal canal benign paroxysmal positional vertigo(HC-BPPV).Methods In our prospective study,we performed a testing profile(PSN,BLT,LDN,SRT)on 59 HC-BPPV patients using videonystagmography.We compared the accuracy and sensitivity of these tests in HC-BPPV lateralization.Data from 30 healthy patients were collected as the control group.Results When performing positional tests,the elicited nystagmus coinciding with Ewald’s second law was defined as a“positive response”.In 44 patients with geotropic nystagmus,the rates of positive response in LDN,PSN,and BLT were 22/44(50%),19/44(43%),and 18/44(41%),respectively,while in 15 patients with apogeotropic nystagmus,the positive response rates of these three tests were 10/15(66.7%),9/15(60%),and 4/15(27.00%),respectively.The sensitivity of LDN(54.38%)was higher than that of PSN(47.37%)and BLT(38.60%)but lower than that of SRT(89.47%).Notably,the accuracy rate of PSN(71.8%)was higher than that of the other APTs.In 6 patients with symmetrical nysgtamus during the roll test,5 patients showed a positive response in both LDN and BLT(83.34%),whereas 4 patients showed a positive response in PSN(66.67%).Conclusion All positional tests are helpful for determining the affected side of HC-BPPV,but SRT carries the highest accuracy of lateralization followed by PSN.
文摘Objective To discuss semilateral supine position for retroperitoneoscopic adrenalectomy. Methods From Jan. 2006 to Dec. 2008,36 patients ( 20 males and 16 females with mean age of 43 years) underwent retroperito-neoscopic adrenalectomy in 60° - 70°semilateral
