57,817 research outputs found
The UN-SUSTAINABLE Match in HCV Recipients. Evidences from the Italian D-MELD Study on Balancing Donor-Recipient Risk Factors
No full textThe UN-SUSTAINABLE Match in HCV Recipients. Evidences from the Italian D-MELD Study on Balancing Donor-Recipient Risk Factor
Effect of prone positioning on the survival of patients with acute respiratory failure.
No full textBACKGROUND: Although placing patients with acute respiratory failure in a prone (face down) position improves their oxygenation 60 to 70 percent of the time, the effect on survival is not known.
METHODS: In a multicenter, randomized trial, we compared conventional treatment (in the supine position) of patients with acute lung injury or the acute respiratory distress syndrome with a predefined strategy of placing patients in a prone position for six or more hours daily for 10 days. We enrolled 304 patients, 152 in each group.
RESULTS: The mortality rate was 23.0 percent during the 10-day study period, 49.3 percent at the time of discharge from the intensive care unit, and 60.5 percent at 6 months. The relative risk of death in the prone group as compared with the supine group was 0.84 at the end of the study period (95 percent confidence interval, 0.56 to 1.27), 1.05 at the time of discharge from the intensive care unit (95 percent confidence interval, 0.84 to 1.32), and 1.06 at six months (95 percent confidence interval, 0.88 to 1.28). During the study period the mean (+/-SD) increase in the ratio of the partial pressure of arterial oxygen to the fraction of inspired oxygen, measured each morning while patients were supine, was greater in the prone than the supine group (63.0+/-66.8 vs. 44.6+/-68.2, P=0.02). The incidence of complications related to positioning (such as pressure sores and accidental extubation) was similar in the two groups.
CONCLUSIONS: Although placing patients with acute respiratory failure in a prone position improves their oxygenation, it does not improve survival
Prospective Comparative Analysis of Supine Versus Prone Percutaneous Nephrolithotomy in Patients with Complex Renal Stone Disease and Difficult Anatomy
No full textObjective: In complex renal stone disease, few studies have shown that supine percutaneous nephrolithotomy (PCNL) is not inferior to prone PCNL. In our study, we evaluated the safety and efficacy of supine versus prone PCNL in patients with complex renal stone disease and patients with difficult anatomy.
Methods: We prospectively analyzed 106 patients over 15 months from October 2022 to December 2023 and divided them as group S (Calcutta position supine arm) and group P (classical prone arm) by simple randomization. The measured data included body mass index (BMI), stone size, location of stone, number of punctures/ access, tract length, bleeding, operative time, stone-free rate (SFR), length of hospital stay, and postoperative complications.
Results: The operative time was 104.722 ± (34.48) versus 124.30 ± (22.67) minutes (group S vs. group P), which was significant (P=.01). The nephroscopy time was 89.722 ± 34.55 in group S vs. 92.212 ± 20.18 minutes, which was also significant (P = .01). The mean postoperative hospital stay was 3.889 ± 1.09 and 4.558 ± 1.33 days in supine and prone group (P = .021), respectively. Four patients in group S required re-look PCNL in comparison to 8 in group P. Overall SFR at 1 month was 76.92% and 68.51% (P .331), respectively in case of group S and P.
Conclusion: The study revealed that supine position in Calcutta position is a viable alternative to classical prone position even in patients with complex renal stone and patients with difficult anatomy as major complications are less, SFR is higher, and need of auxiliary procedures are rare
eminger G, De Sio M, Sodha H, Saussine C, de la Rosette J; CROES PNL study group. Effect of Supine vs Prone Position on Outcomes of Percutaneous Nephrolithotomy in Staghorn Calculi: Results From the Clinical Research Office of the Endourology Society Study.
No full textOBJECTIVE:
To analyze the effect of patient positioning on outcomes of percutaneous nephrolithotomy (PNL) among patients with staghorn stones. The choice of optimal position for these patients undergoing PNL remains challenging. No previous studies exclusively addressing this point have been performed.
METHODS:
From November 2007 to December 2009, prospective data were collected by the Clinical Research Office of the Endourological Society. We included all patients with staghorn stones. Patients were divided on the basis of the position used during PNL (prone/supine). Patient characteristics, stone burden, operative details, and outcomes were compared. Multivariate analysis was performed to evaluate the relationship between patient position and stone-free rate and complication rate adjusting for number of access puncture sites.
RESULTS:
A total of 1079 PNLs were performed in prone and 232 in supine positions. There were no differences in comorbidities or preoperative stone burden. A higher percentage of patients in the prone position had access through the upper pole (P <.001). Surgical time was shorter (P <.001) and stone-free rate was higher (P <.001) for patients in the prone position. There were no differences in complication rates. In multivariate analysis, patients in prone position had a higher stone-free rates (P = .0013) after adjusting for the method used for determining stone-free status and number of renal access.
CONCLUSION:
Higher stone-free rates are achieved in the prone position during PNL for patients with staghorn calculi. Complication rates were similar for both positions
All repair and reconstruction. Techniques from the SANTI study group
No full textBackground: Combining an anterior cruciate ligament (ACL) reconstruction with an anterolateral ligament (ALL) reconstruction results in significant advantages including reduced graft rupture rates, a lower risk of reoperation for secondary meniscectomy, improved knee stability, and higher rates of return to preinjury levels of sport. Indications: The previously reported indications for combined ACL and ALL reconstruction are as follows: ACL reconstruction revision; high-grade pivot shift test; long-term ACL rupture; young patients; pivoting activities; concomitant medial meniscus repair, and, specifically, regarding the ALL repair, it must be an acute surgery (within 15 days from injury). Technique Description: Several modern techniques have been described to repair and reconstruct the ALL. This technical note details a number of these techniques performed by the Scientific Anterior Cruciate Ligament Network International (SANTI) Study Group. Results: First, we describe a combined ACL reconstruction and double-bundle ALL reconstruction using hamstring autograft. Secondly, we describe a single-bundle ALL reconstruction using gracilis autograft. Thirdly, we describe an ALL reconstruction technique using a knotless soft anchor, which provides shallow fixation and prevents tunnel convergence. Finally, we describe a technique for ALL repair. Conclusion: Several techniques have been described to repair and reconstruct the ALL, all offering significant advantages over an isolated ACL reconstruction. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication
Robust automated detection of microstructural white matter degeneration in Alzheimer’s disease using machine learning classification of multicenter DTI data
No full textDiffusion tensor imaging (DTI) based assessment of white matter fiber tract integrity can support the diagnosis of Alzheimer’s disease (AD). The use of DTI as a biomarker, however, depends on its applicability in a multicenter setting accounting for effects of different MRI scanners. We applied multivariate machine learning (ML) to a large multicenter sample from the recently created framework of the European DTI study on Dementia (EDSD). We hypothesized that ML approaches may amend effects of multicenter acquisition. We included a sample of 137 patients with clinically probable AD (MMSE 20.6±5.3) and 143 healthy elderly controls, scanned in nine different scanners. For diagnostic classification we used the DTI indices fractional anisotropy (FA) and mean diffusivity (MD) and, for comparison, gray matter and white matter density maps from anatomical MRI. Data were classified using a Support Vector Machine (SVM) and a Naïve Bayes (NB) classifier. We used two cross-validation approaches, (i) test and training samples randomly drawn from the entire data set (pooled cross-validation) and (ii) data from each scanner as test set, and the data from the remaining scanners as training set (scanner-specific cross-validation). In the pooled cross-validation, SVM achieved an accuracy of 80% for FA and 83% for MD. Accuracies for NB were significantly lower, ranging between 68% and 75%. Removing variance components arising from scanners using principal component analysis did not significantly change the classification results for both classifiers. For the scanner-specific cross-validation, the classification accuracy was reduced for both SVM and NB. After mean correction, classification accuracy reached a level comparable to the results obtained from the pooled cross-validation. Our findings support the notion that machine learning classification allows robust classification of DTI data sets arising from multiple scanners, even if a new data set comes from a scanner that was not part of the training sample
Clinical Interpretation of Positional Nystagmus Provoked by both Dix-Hallpike and Supine Head-Roll Tests
No full textBACKGROUND: Both the Dix-Hallpike test and the supine head-roll test can provoke positional nystagmus in a group of benign paroxysmal positional vertigo patients, including but not limited to those with multiple canal involvement. This study aimed to determine the incidence and interpret the clinical significance of positional nystagmus provoked by both the Dix-Hallpike and the supine head-roll tests. METHODS: The results of video-nystagmography sessions recorded in the computer database that included both the Dix-Hallpike and the supine head-roll tests were examined. RESULTS: The records belonging to 2880 video-nystagmography sessions of 2387 patients were examined. Nystagmus was detected in both the Dix-Hallpike and the supine head-roll tests of 131 (5.5%) patients. The video images belonging to 142 session records of 122 patients were accessed and further analyzed. The diagnosis was posterior canal BPPV in 9.0%, and lateral canal BPPV in 62.3%. More than one canal was involved in 3.3%, one rehabilitation maneuver was performed in 75.0%, and recurrence was observed in 7.4% of those patients. CONCLUSION: In both geotropic and apogeotropic variants of lateral canal BPPV, nystagmus can be observed during the Dix-Hallpike test in addition to the supine head-roll test. In patients with posterior canal benign paroxysmal positional vertigo, nystagmus can also be observed in the head-roll test. To reach a correct and comprehensive diagnosis and apply appropriate treatment in benign paroxysmal positional vertigo, the Dix-Hallpike test and the head-roll test should be completely performed on both sides, and the results of those tests must be interpreted concomitantly
Effectiveness of brief schema group therapy for borderline personality disorder symptoms : a randomized pilot study
No full textBackground and objectives Schema group therapy is a potentially cost-effective treatment for borderline personality disorder (BPD). We piloted the feasibility and effectiveness of a 20-session schema group therapy without individual therapy among psychiatric BPD outpatients in a randomized pilot study registered as a clinical trial (ISRCTN76381242). Methods Altogether 42 psychiatric outpatients diagnosed with BPD were randomized 2:1 to a 20-session weekly schema group therapy plus treatment as usual (TAU) (n = 28) vs. a control group with TAU alone (n = 14). The primary outcome was decline of BPD symptoms in the short Borderline Symptom List (BSL-23) score. Secondary outcomes were decline in symptoms of anxiety, depression, alcohol use, and improvement in functioning and schema modes. Two external experts evaluated validity of the intervention based on videotaped sessions. Results Overall, 23 schema group therapy patients (82%) and 12 controls (86%) completed their treatment. Treatment validity good or very good. However, no significant differences emerged in the primary outcome mean BSL-23 decline (6.95 [SE 5.91] in group schema therapy vs. 12.55 [4.85] in TAU) or in any of the secondary outcome measures. Limitations Despite randomization, the TAU subgroup had non-significantly higher baseline scores in most measures. Small sample size predisposing to type II errors; reliance on self-reported outcomes. Conclusions Schema group therapy was feasible for psychiatric outpatients with BPD. However, in this small pilot study we did not find it more effective than TAU. Effectiveness of this short intervention remains open.Peer reviewe
Comparison of Supine and Prone Positioning in Female Patients Undergoing Urethral Diverticulum Excision
No full textObjective:Transvaginal excision of urethral diverticulum (UD) is the gold standard treatment for symptomatic women with UD. Complete UD excision can be challenging due to poor access to the surgical field, especially with proximal, circumferential and recurrent UD. Prone patient positioning has been suggested as an effective way of improving surgical access and vision compared to the traditional supine positioning. However, direct comparison of the two positions is yet to be performed. This study aimed to compare patients who underwent UD excision in prone and supine positions.Materials and Methods:Prospectively recorded data of 79 women undergoing urethral diverticulectomy between 2004 and 2017 in a single referral centre were reviewed. Patients were operated either in supine or prone positions based on the surgeon’s preference. Data collected included patient demographics, UD characteristics on magnetic resonance imaging, intraoperative details and postoperative outcomes. Operative time was calculated from the electronic theatre records starting from the entry of the patient into the operating room to their exit.Results:The mean patient age was 42.38 (±15.24) years. More than half of the patients had a recurrent UD at presentation (51.89%). The mean size of the diverticulum was 25.06 (±1.2) mm, and the mean operative time was 146.18 (±6.0) min. UD excision was undertaken in prone position in 50 (63.3%) and supine position in 29 (36.7%) patients. Patients in the prone position group were older and had relatively larger and proximal UD. In the multivariable analysis, it was found that a proximally located UD was the main indicator for undergoing surgery in the prone position.Conclusion:Despite longer operative times, prone patient positioning appears to be the preferred option for patients with larger and proximal UD, presumably because it offers better access to the surgical field
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