290,949 research outputs found
Continuous prolonged prone positioning in COVID-19-related ARDS: a multicenter cohort study from Chile
No full textBACKGROUND: Prone positioning is currently applied in time-limited daily sessions up to 24 h which determines that most patients require several sessions. Although longer prone sessions have been reported, there is scarce evidence about the feasibility and safety of such approach. We analyzed feasibility and safety of a continuous prolonged prone positioning strategy implemented nationwide, in a large cohort of COVID-19 patients in Chile. METHODS: Retrospective cohort study of mechanically ventilated COVID-19 patients with moderate-to-severe acute respiratory distress syndrome (ARDS), conducted in 15 Intensive Care Units, which adhered to a national protocol of continuous prone sessions ≥ 48 h and until PaO(2):FiO(2) increased above 200 mm Hg. The number and extension of prone sessions were registered, along with relevant physiologic data and adverse events related to prone positioning. The cohort was stratified according to the first prone session duration: Group A, 2–3 days; Group B, 4–5 days; and Group C, > 5 days. Multivariable regression analyses were performed to assess whether the duration of prone sessions could impact safety. RESULTS: We included 417 patients who required a first prone session of 4 (3–5) days, of whom 318 (76.3%) received only one session. During the first prone session the main adverse event was grade 1–2 pressure sores in 97 (23.9%) patients; severe adverse events were infrequent with 17 non-scheduled extubations (4.2%). 90-day mortality was 36.2%. Ninety-eight patients (24%) were classified as group C; they exhibited a more severe ARDS at baseline, as reflected by lower PaO(2):FiO(2) ratio and higher ventilatory ratio, and had a higher rate of pressure sores (44%) and higher 90-day mortality (48%). However, after adjustment for severity and several relevant confounders, prone session duration was not associated with mortality or pressure sores. CONCLUSIONS: Nationwide implementation of a continuous prolonged prone positioning strategy for COVID-19 ARDS patients was feasible. Minor pressure sores were frequent but within the ranges previously described, while severe adverse events were infrequent. The duration of prone session did not have an adverse effect on safety. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s13613-022-01082-w
Differences in the evolution of the ischemic penumbra in stroke-prone spontaneously hypertensive and Wistar-Kyoto rats
No full text<p><b>Background and Purpose:</b> Stroke-prone spontaneously hypertensive rats (SHRSP) are a highly pertinent stroke model with increased sensitivity to focal ischemia compared with the normotensive reference strain (Wistar-Kyoto rats; WKY). Study aims were to investigate temporal changes in the ischemic penumbra in SHRSP compared with WKY.</p>
<p><b>Methods:</b> Permanent middle cerebral artery occlusion was induced with an intraluminal filament. Diffusion- (DWI) and perfusion- (PWI) weighted magnetic resonance imaging was performed from 1 to 6 hours after stroke, with the PWI-DWI mismatch used to define the penumbra and thresholded apparent diffusion coefficient (ADC) maps used to define ischemic damage.</p>
<p><b>Results:</b> There was significantly more ischemic damage in SHRSP than in WKY from 1 to 6 hours after stroke. The perfusion deficit remained unchanged in WKY (39.9±6 mm<sup>2</sup> at 1 hour, 39.6±5.3 mm<sup>2</sup> at 6 hours) but surprisingly increased in SHRSP (43.9±9.2 mm<sup>2</sup> at 1 hour, 48.5±7.4 mm<sup>2</sup> at 6 hours; P=0.01). One hour after stroke, SHRSP had a significantly smaller penumbra (3.4±5.8 mm<sup>2</sup>) than did WKY (9.7±3.8, P=0.03). In WKY, 56% of the 1-hour penumbra area was incorporated into the ADC lesion by 6 hours, whereas in SHRSP, the small penumbra remained static owing to the temporal increase in both ADC lesion size and perfusion deficit.</p>
<p><b>Conclusions:</b> First, SHRSP have significantly more ischemic damage and a smaller penumbra than do WKY within 1 hour of stroke; second, the penumbra is recruited into the ADC abnormality over time in both strains; and third, the expanding perfusion deficit in SHRSP predicts more tissue at risk of infarction. These results have important implications for management of stroke patients with preexisting hypertension and suggest ischemic damage could progress at a faster rate and over a longer time frame in the presence of hypertension.</p>
Radiation dose to the nodal regions during prone versus supine breast irradiation
No full textMelinda Csenki, Dóra Újhidy, Adrienn Cserháti, Zsuzsanna Kahán, Zoltán Varga Department of Oncotherapy, University of Szeged, Szeged, Hungary Background: Prone positioning for breast radiotherapy is preferable when the aim is a reduction of the dose to the ipsilateral lung or the heart in certain left-sided cases. Materials and methods: In 100 breast cancer cases awaiting postoperative whole-breast radiotherapy, conformal radiotherapy plans were prospectively generated in both prone and supine positions. The axillary nodal region (levels I–III) and internal mammary (IM) lymph-node region in the upper three intercostal spaces were retrospectively contoured. The mean doses to the nodal regions and the volume receiving 25 Gy (V25Gy), V45Gy, and V47.5Gy were compared between the two treatment positions. Results: In most cases, the doses to axillary levels I–III and the IM lymph nodes were inadequate, regardless of the treatment position. The nodal doses were significantly lower in the prone than in the supine position. The radiation doses to levels II–III and IM nodes were especially low. The V45Gy and V47.5Gy of the level I axillary lymph nodes were 54.6% and 40.2%, respectively, in the supine, and 3.0% and 1.7%, respectively, in the prone position. In the supine position, only 17 patients (17%) received a mean dose of 45 Gy to the axillary level I nodes. Conclusion: The radiation dose to the axillary and IM lymph nodes during breast radiotherapy is therapeutically insufficient in most cases, and is significantly lower in the prone position than in the supine position. Keywords: axillary lymph nodes, breast radiotherapy, internal mammary nodes, prone positioning, supine positionin
The Shoulder Prone I Exercise
No full textThe prone shoulder I exercise, also known as shoulder extension in external rotation, is one of four very basic activities known as the T-Y-I-W series of upper body exercises typically performed in a prone position, which activate and strengthen posterior shoulder girdle muscles
Going Beyond Counting First Authors in Author Co-citation Analysis
No full textThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Prone position in anaesthesia and intensive care
No full textThe prone position has been introduced in healthy anaesthetised subjects to expose the surgical area and also during acute respiratory failure (ARF) to improve the drainage of secretions. Literature reports are now appearing on the effects of the prone position either on gas exchange or on respiratory mechanics. In this paper the authors discuss the data obtained when normal subjects or ARF patients are turned from supine to prone, and present the 'state of the art' concerning the use of the prone position either in anaesthesia or in intensive car
A study on junior high school student?s depression prone and deviant behavior ?of a remote junior high school in Miaoli county
No full text[[abstract]]The purpose of this research is to study the levels and determinants of depression prone and deviant behavior among students of a junior high school located at remote Miaoli County. The relationship of depression prone and deviant behavior is further explored. The tool for measuring deviant behavior is developed by this author and depression prone is based on the Beck?s melancholia quantity sheet version 2.The total number of students in this research is 152. They are all students of grade 7 to 9 of this school.
The main results are as follows:
1) Current levels of depression prone among students are categorized as normal, slight or medium. Overall speaking, 32.2% of students are showing some degree of depression prone.
2) Those students of grade 9, whose mothers are businesswomen; the parents? attitudes toward students are permissive; with lower grades in study; and with a bad relation with his/her classmates are more likely to be depression.
3) Those students of grade 8, the parents? attitudes toward students are permissive; those with a bad grade in study; and with a bad relation with his/her classmates are more likely with deviant behaviors.
4) To sum each deviant behavior adjusted by its weight given by teachers is a better measure for over all deviant behavior.
5) The result of this research showing that the degree of depression prone and the deviant behavior score are highly correlated.
Depression prone and deviant behaviors both are serious problems of students. Schools, parents, governments are suggested to face these problems positively. More researches of this regards and to develop a most suitable measurement tool for measuring deviant behavior is rgently needed
Response to letter by Yao (Differences in the evolution of the ischemic penumbra in stroke-prone spontaneously hypertensive and Wistar-Kyoto rats)
No full textProtecting Animals 36: Author Witi Ihimaera
No full textIn this very special episode of Knowing Animals I am joined by beloved New Zealand author Witi Ihimaera. Witi has written many books featuring nonhuman animals. He offers us a non-colonial lens through which to think about the human/nonhuman relationship
- …
