Retroperitoneoscopic adrenalectomy in semilateral supine position

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

Comparing maternal and neonatal outcomes between hands-and-knees delivery position and supine position

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.

Kappa angles in different positions in patients with myopia during LASIK

AIM： To investigate the difference in kappa angle between sitting and supine positions during laser-assisted in situ keratomileusis（LASIK）.·METHODS： A retrospective study was performed on395 eyes from 215 patients with myopia that received LASIK. Low, moderate, and high myopia groups were assigned according to diopters. The horizontal and vertical components of kappa angle in sitting position were measured before the operation, and in supine position during the operation. The data from the two positions were compared and the relationship between kappa angle and diopters were analyzed.· RESULTS： Two hundred and twenty-three eyes（56.5%） in sitting position and 343 eyes（86.8%） in supine position had positive kappa angles. There were no significant differences in horizontal and vertical components of kappa angle in the sitting position or horizontal components of kappa angle in the supine position between the three groups（P 〉0.05）. A significant difference in the vertical components of kappa angle in the supine position was seen in the three groups（P 〈0.01）. Differences in both horizontal and vertical components of kappa angles were significant between the sitting and supine positions. Positive correlations in both horizontal and vertical components of kappa angles（P 〈0.05） were found and vertical components of kappa angle in sitting and supine positions were negatively correlated with the degree of myopia（sitting position： r =-0.109; supine position： r =-0.172; P 〈0.05）.·CONCLUSION： There is a correlation in horizontal and vertical components of kappa angle in sitting and supine positions. Positive correlations in both horizontal and vertical components of kappa angle in sitting and supine positions till the end of the results. This result still needs further observation. Clinicians should take into account different postures when excimer laser surgery needs to be performed.

Clinical evaluation of prone position ventilation in the treatment of acute respiratory distress syndrome induced by sepsis

BACKGROUND Acute respiratory distress syndrome(ARDS)is an acute,diffuse,inflammatory lung injury.Previous studies have shown prone position ventilation(PPV)to be associated with improvement in oxygenation.However,its role in patients with ARDS caused by sepsis remains unknown.AIM To analyze the clinical effects of PPV in patients with ARDS caused by sepsis.METHODS One hundred and two patients with ARDS were identified and divided into a control group(n=55)and a PPV treatment group(n=47).Outcomes included oxygenation index,lung compliance(Cst)and platform pressure(Pplat),which were compared between the two groups after ventilation.Other outcomes included heart rate(HR),mean arterial pressure(MAP),central venous pressure(CVP),left ventricular ejection fraction(LVEF),the length of mechanical ventilation time and intensive care unit(ICU)stay,and levels of C-reactive protein(CRP),procalcitonin(PCT),and interleukin-6(IL-6)after ventilation.Finally,mortality rate was also compared between the two groups.RESULTS On the first day after ventilation,the oxygenation index and Cst were higher and Pplat level was lower in the PPV group than in the conventional treatment group(P<0.05).There were no significant differences in oxygenation index,Cst,and Pplat levels between the two groups on the 2^(nd),4^(th),and 7^(th) day after ventilation(P>0.05).There were no significant differences in HR,MAP,CVP,LVEF,duration of mechanical ventilation and ICU stay,and the levels of CRP,PCT,and IL-6 between the two groups on the first day after ventilation(all P>0.05).The mortality rates on days 28 and 90 in the PPV and control groups were 12.77% and 29.09%,and 25.53% and 45.45%,respectively(P<0.05).CONCLUSION PPV may improve respiratory mechanics indices and may also have mortality benefit in patients with ARDS caused by sepsis.Finally,PPV was not shown to cause any adverse effects on hemodynamics and inflammation indices.

Comparing posture induced intraocular pressure variations in normal subjects and glaucoma patients

AIM:To compare the posture-induced variations in intraocular pressure(IOP)between the primary open angle glaucoma(POAG)and non-glaucomatous eyes.METHODS:A case-controlled age matched study was conducted in 55 successive newly diagnosed POAG and 56 non-glaucomatous patients seen in glaucoma clinic and general outpatient eye clinic in the Alex Ekwueme University Teaching Hospital,Abakaliki.The IOPs of eligible correspondents were measured with Perkin’s hand-held tonometer in the sitting,supine flat and supine with pillow positions respectively.Measurement of IOP in each position was done after 15 min of assuming such posture.RESULTS:The IOP difference between the sitting and supine flat position was significantly higher in the POAG than non-glaucoma subjects(7.68±2.08 vs 4.03±0.13 mm Hg,P<0.001).The IOP difference between the sitting and supine with pillow positions was 2.61±1.49 mm Hg for POAG and 1.44±0.70 mm Hg in non-glaucoma(P<0.001),while difference between supine flat and supine with pillow positions was 5.07±2.24 mm Hg in POAG and 2.59±0.66 mm Hg in non-glaucomatous patients(P<0.001).CONCLUSION:Greater variations in posture induced IOP occurred in POAG patients than non-glaucomatous.The posture induced IOP variation is lowest in the sitting position and highest in the supine flat position.Evaluation of posture induced IOP changes may be an important tool in the management of glaucoma.