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Body Position (body + position)
Kinds of Body Position Selected AbstractsBody Position and Cardiac Dynamic and Chronotropic Responses to Steady-State Isocapnic Hypoxaemia in HumansEXPERIMENTAL PHYSIOLOGY, Issue 2 2000S. Deborah Lucy Neural mediation of the human cardiac response to isocapnic (IC) steady-state hypoxaemia was investigated using coarse-graining spectral analysis of heart rate variability (HRV). Six young adults were exposed in random order to a hypoxia or control protocol, in supine and sitting postures, while end-tidal PCO2 (PET,CO2) was clamped at resting eucapnic levels. An initial 11 min period of euoxia (PET,O2 100 mmHg; 13.3 kPa) was followed by a 22 min exposure to hypoxia (PET,O2 55 mmHg; 7.3 kPa), or continued euoxia (control). Harmonic and fractal powers of HRV were determined for the terminal 400 heart beats in each time period. Ventilation was stimulated (P < 0.05) and cardiac dynamics altered only by exposure to hypoxia. The cardiac interpulse interval was shortened (P < 0.001) similarly during hypoxia in both body positions. Vagally mediated high-frequency harmonic power (Ph) of HRV was decreased by hypoxia only in the supine position, while the fractal dimension, also linked to cardiac vagal control, was decreased in the sitting position (P < 0.05). However, low-frequency harmonic power (Pl) and the HRV indicator of sympathetic activity (Pl/Ph) were not altered by hypoxia in either position. These results suggest that, in humans, tachycardia induced by moderate IC hypoxaemia (arterial O2 saturation Sa,O2, 85%) was mediated by vagal withdrawal, irrespective of body position and resting autonomic balance, while associated changes in HRV were positionally dependent. [source] Effect of positioning on respiratory synchrony in non-ventilated pre-term infantsPHYSIOTHERAPY RESEARCH INTERNATIONAL, Issue 2 2000Veronica Maynard Senior Lecturer Abstract Background and Purpose Body position can play an important role in an infant's recovery from respiratory disease, but few studies have accounted for sleep state which is known to have a direct influence on the control of respiratory muscles as well as on metabolic and circulatory changes. The purpose of this study was to examine the influence of body position on respiratory function in pre-term infants whilst accounting for sleep state. Method Thoraco-abdominal motion was assessed using respiratory inductance plethysmography (RIP) to provide measures of relative rib cage (RC) and abdominal (AB) movement in ten non-ventilated pre-term infants. Continuous measurements of oxygen saturation (SaO2), pulse and heart rate (HR), were made and sleep state was recorded using behavioural criteria and electro-oculogram (EOG) measurements. Results The results showed a significant increase in HR in supine, but no significant difference in SaO2 as a function of position, compared to the prone position where a significant reduction was found in thoraco-abdominal asynchrony for both groups and a reduction in variability in both HR and SaO2. Intra-subject variability of thoraco-abdominal motion as a function of position demonstrated no significant difference on return to supine or on return to prone, illustrating good repeatability of measures. Conclusions Prone positioning of pre-term infants recovering from respiratory disease may improve respiratory function. As measured, the improvement in respiratory synchrony in prone position brings pre-term infants' breathing pattern into line with that expected in term infants. Copyright © 2000 Whurr Publishers Ltd. [source] Body positions and esophageal sphincter pressures in obese patients during anesthesiaACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 4 2010A. DE LEON Background: The lower esophageal sphincter (LES) and the upper esophageal sphincter (UES) play a central role in preventing regurgitation and aspiration. The aim of the present study was to evaluate the UES, LES and barrier pressures (BP) in obese patients before and during anesthesia in different body positions. Methods: Using high-resolution solid-state manometry, we studied 17 patients (27,63 years) with a BMI,35 kg/m2 who were undergoing a laparoscopic bariatric surgery before and after anesthesia induction. Before anesthesia, the subjects were placed in the supine position, in the reverse Trendelenburg position (+20°) and in the Trendelenburg position (,20°). Thereafter, anesthesia was induced with remifentanil and propofol and maintained with remifentanil and sevoflurane, and the recordings in the different positions were repeated. Results: Before anesthesia, there were no differences in UES pressure in the different positions but compared with the other positions, it increased during the reverse Trendelenburg during anesthesia. LES pressure decreased in all body positions during anesthesia. The LES pressure increased during the Trendelenburg position before but not during anesthesia. The BP remained positive in all body positions both before and during anesthesia. Conclusion: LES pressure increased during the Trendelenburg position before anesthesia. This effect was abolished during anesthesia. LES and BPs decreased during anesthesia but remained positive in all patients regardless of the body position. [source] Development of somatosensory-motor integration: An event-related analysis of infant posture in the first year of independent walkingDEVELOPMENTAL PSYCHOBIOLOGY, Issue 1 2005J. S. Metcalfe Abstract The ability to integrate sensation with action is considered an important factor underlying the development of upright stance and locomotion. While many have studied sensory influences on posture, the nature of these influences and how they change with development have yet to be thoroughly characterized in infancy. Six infants were examined from 1 month prior to walk onset until 9 months of independent walking experience while standing quietly and touching either a static or a dynamic surface. Five adults were examined performing an analogous task. An event-related, time-frequency analysis was used to assess the relationship between postural sway and the motion of the somatosensory stimulus. Phase consistency between sway and stimulus was observed for both adults and infants, and with walking experience the infants increased their phase consistency rather than changing aspects of response amplitude. It is concluded that walking experience provides opportunities for an active tuning of sensorimotor relations for adequate estimation of body position in space and thus facilitates refined control over temporal aspects of postural sway. © 2004 Wiley Periodicals, Inc. Dev Psychobiol 46: 19,35, 2005. [source] Close Physical Contact of the Heart with Diaphragm Causes Pseudo-Asynergy of Left Ventricular Inferior Wall in Normal SubjectsECHOCARDIOGRAPHY, Issue 7 2004Susumu Sakurai Ph.D. Paradoxical outward movement of left ventricular (LV) inferior wall in systole is occasionally recognized in normal subjects and clinically important in terms of the differential diagnosis between physiological pseudo-asynergy and pathological asynergy. In this study, the potential mechanisms by which pseudo-asynergy of LV inferior wall (PLI) is observed in normal subjects were investigated. PLI was defined as the outward movement of LV inferior wall observed during more than 50% of systole. The incidence of PLI was evaluated in 7843 consecutive subjects in routine echocardiography. The effects of body position and artificial gravity on the manifestation of PLI were also examined. PLI was observed in 0.11% (9/7842) of subjects on left lateral position. Measurement of the angle formed by LV long-axis and the long-axis of the body on frontal plane revealed that hearts in subjects with PLI were in relatively horizontal position. PLI was observed on sitting position in 43% (40/92) of subjects without PLI on left lateral position. The subjects with sitting position-induced PLI exhibited significantly higher obesity index. PLI was also induced by artificial gravity in 67% (14/21) of healthy volunteers on supine position, and the degree of PLI correlated with the intensity of gravity. Although the incidence of PLI in routine echocardiography is relatively low, PLI can be induced in normal subjects by any condition that causes close contact of LV inferior wall to diaphragm. Thus, PLI should be taken into consideration in the differential diagnosis of abnormal LV inferior wall motion, especially when performing exercise echocardiography. [source] The effect of whole-body tilt on sound lateralizationEUROPEAN JOURNAL OF NEUROSCIENCE, Issue 4 2002Jörg Lewald Abstract The effect of passive whole-body tilt in the frontal plane on the lateralization of dichotic sound was investigated in human subjects. Pure-tone pulses (1 kHz, 100 ms duration) with various interaural time differences were presented via headphones while the subject was in an upright position or tilted 45° or 90° to the left or right. Subjects made two-alternative forced-choice (left/right) judgements on the intracranial sound image. During body tilt, the auditory median plane of the head, computed from the resulting psychometric functions, was always shifted to the upward ear, indicating a shift of the auditory percept to the downward ear, that is, in the direction of gravitational linear acceleration. The mean maximum magnitude of the auditory shift obtained with 90° body tilt was 25 µs. On the one hand, these findings suggest a certain influence of the otolith information about body position relative to the direction of gravity on the representation of auditory space. However, in partial contradiction to previous work, which had assumed existence of a significant ,audiogravic illusion', the very slight magnitude of the present effect rather reflects the excellent stability in the neural processing of auditory spatial cues in humans. Thus, it might be misleading to use the term ,illusion' for this quite marginal effect. [source] Body Position and Cardiac Dynamic and Chronotropic Responses to Steady-State Isocapnic Hypoxaemia in HumansEXPERIMENTAL PHYSIOLOGY, Issue 2 2000S. Deborah Lucy Neural mediation of the human cardiac response to isocapnic (IC) steady-state hypoxaemia was investigated using coarse-graining spectral analysis of heart rate variability (HRV). Six young adults were exposed in random order to a hypoxia or control protocol, in supine and sitting postures, while end-tidal PCO2 (PET,CO2) was clamped at resting eucapnic levels. An initial 11 min period of euoxia (PET,O2 100 mmHg; 13.3 kPa) was followed by a 22 min exposure to hypoxia (PET,O2 55 mmHg; 7.3 kPa), or continued euoxia (control). Harmonic and fractal powers of HRV were determined for the terminal 400 heart beats in each time period. Ventilation was stimulated (P < 0.05) and cardiac dynamics altered only by exposure to hypoxia. The cardiac interpulse interval was shortened (P < 0.001) similarly during hypoxia in both body positions. Vagally mediated high-frequency harmonic power (Ph) of HRV was decreased by hypoxia only in the supine position, while the fractal dimension, also linked to cardiac vagal control, was decreased in the sitting position (P < 0.05). However, low-frequency harmonic power (Pl) and the HRV indicator of sympathetic activity (Pl/Ph) were not altered by hypoxia in either position. These results suggest that, in humans, tachycardia induced by moderate IC hypoxaemia (arterial O2 saturation Sa,O2, 85%) was mediated by vagal withdrawal, irrespective of body position and resting autonomic balance, while associated changes in HRV were positionally dependent. [source] Mortuary patterns in burial caves on Mangaia, Cook IslandsINTERNATIONAL JOURNAL OF OSTEOARCHAEOLOGY, Issue 3 2003S. C. Antón Abstract The behavioural, cultural, and political implications of archaeological human remains in non-mortuary, possibly culinary, contexts requires that we understand the range of mortuary practices in a particular region. Although several rockshelter sites on Mangaia, Cook Islands have yielded burned, fragmentary human bones in earth ovens that seem to support archaeological models and ethnohistoric accounts of ritual sacrifice and cannibalism, the absence of data on the range of Mangaian mortuary patterns obscures these interpretations. We describe burial patterns based on 40 above-ground interments representing at least 92 individuals in caves of Mangaia, Cook Islands, in order to begin to develop an island-wide perspective on mortuary patterns. Sampling both pre- and post-European contact sites we found that multiple interments dominate probable pre-contact burials (73%, 19 of 26) and single interments dominate post-contact contexts (80%, eight of ten burials), probably reflecting the influence of Christianity on mortuary ritual. Subadults were more frequent in all post-contact contexts suggesting alternative burial places, probably church cemeteries, for adults. Burial cave remains are broadly consistent with ethnohistoric accounts of interment in caves, however, they also illustrate additional burial practices and differences between time periods, such as primary body position and the role of multiple-individual interments, which are not discussed ethnohistorically. The mortuary practices in Mangaian burial caves differ from burials associated with marae and seem completely unrelated to the presence of highly fragmentary and burnt human remains in pre-contact rockshelter middens elsewhere on the island. Copyright © 2003 John Wiley & Sons, Ltd. [source] Body positions and esophageal sphincter pressures in obese patients during anesthesiaACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 4 2010A. DE LEON Background: The lower esophageal sphincter (LES) and the upper esophageal sphincter (UES) play a central role in preventing regurgitation and aspiration. The aim of the present study was to evaluate the UES, LES and barrier pressures (BP) in obese patients before and during anesthesia in different body positions. Methods: Using high-resolution solid-state manometry, we studied 17 patients (27,63 years) with a BMI,35 kg/m2 who were undergoing a laparoscopic bariatric surgery before and after anesthesia induction. Before anesthesia, the subjects were placed in the supine position, in the reverse Trendelenburg position (+20°) and in the Trendelenburg position (,20°). Thereafter, anesthesia was induced with remifentanil and propofol and maintained with remifentanil and sevoflurane, and the recordings in the different positions were repeated. Results: Before anesthesia, there were no differences in UES pressure in the different positions but compared with the other positions, it increased during the reverse Trendelenburg during anesthesia. LES pressure decreased in all body positions during anesthesia. The LES pressure increased during the Trendelenburg position before but not during anesthesia. The BP remained positive in all body positions both before and during anesthesia. Conclusion: LES pressure increased during the Trendelenburg position before anesthesia. This effect was abolished during anesthesia. LES and BPs decreased during anesthesia but remained positive in all patients regardless of the body position. [source] Bed articles for nursing care , state of the art in two German hospitalsJOURNAL OF CLINICAL NURSING, Issue 3 2004Thomas Boggatz MA Background., Bed articles are basic instruments for positioning. Research about this topic has concentrated on evidence for better practice. However, little is known about what practitioners really do. Aims and objectives., This study intended to identify the most common bed articles used for positioning in two German hospitals, and to determine the decision-maker for their application and the purposes and criteria for their choice. Methods., Nursing experts from 100 wards were interviewed with the help of a structured questionnaire and based on these data a list of the 10 most frequent devices was compiled. Results., Supporting the body position was the most frequent intervention performed by German nurses, mainly with the help of hydraulic beds, pillows and blankets. Nurses were the main decision-makers for the use of these bed articles. Their choice was mainly based on work experience and patients' desires. Guidelines and literature played a minor role in this process. Relevance to clinical practice., If nurses, despite the medical doctors' role as the main decision-maker in German hospitals, exert significant influence on this aspect of care, they can support their position by evidence-based practice. [source] Gravity-dependent signal gradients on MR images of the lung in supine and prone positions: A comparison with isogravitational signal variabilityJOURNAL OF MAGNETIC RESONANCE IMAGING, Issue 2 2006Alexander A. Bankier MD Abstract Purpose To investigate the tendency of proton MR signal intensity (SI) gradients to be steeper in the supine than in the prone body position, and to quantify the relation between gravity-related and isogravitational changes of SI on proton MR images of the lung. Materials and Methods In eight healthy volunteers, MR images were obtained in the supine and prone positions using a multiple inversion recovery turbo spin-echo (TSE) sequence. The variation in SI along the gravity-dependent direction and within isogravitational planes was measured on a pixel-by-pixel basis. Ratios of slopes were calculated for comparisons among volunteers. Comparisons of ratios were made using Fisher's exact test. Isogravitational variability was compared with the mean SI, the signal-to-noise ratio (SNR), and the image noise. Results The average ratios of slopes showed that the overall SI gradient was steeper in the supine than the prone position, with a substantial difference in the supine/prone ratios between inspiration (1.21) and expiration (1.72). In both the supine and prone positions, gravity-dependent gradients were steeper in expiration than in inspiration (P = 0.001). The SI variability along the gravitational direction was larger than the isogravitational variability. The isogravitational variability in turn was larger than the image noise but smaller than the mean SI of the MR images. Conclusion Gravity-dependent gradients in proton MR SI are steeper in the supine than in the prone position. The magnitudes of these gradients were larger than the isogravitational signal variability, showing that MRI is sensitive to gravitationally induced effects. J. Magn. Reson. Imaging 2006. © 2006 Wiley-Liss, Inc. [source] The relationship between bed rest and sitting orthostatic intolerance in adults residing in chronic care facilitiesJOURNAL OF NURSING AND HEALTHCARE OF CHRONIC ILLNE SS: AN INTERNATIONAL INTERDISCIPLINARY JOURNAL, Issue 3 2010Mary T Fox MSc fox mt, sidani s & brooks d (2010) Journal of Nursing and Healthcare of Chronic Illness2, 187,196 The relationship between bed rest and sitting orthostatic intolerance in adults residing in chronic care facilities Aim., To examine the relationship between orthostatic intolerance and bed rest as it was used by/with 65 adults residing in chronic care facilities. Background., The evidence on the relationship between bed rest and orthostatic intolerance has been obtained from aerospace studies conducted in highly controlled laboratory settings, and is regarded as having high internal validity. In the studies, prolonged and continuous bed rest, administered in a horizontal or negative tilt body position, had a major effect on orthostatic intolerance in young adults. However, the applicability of the findings to the conditions of the real world of practice is questionable. Methods., Participants were recruited over the period of April 2005 to August 2006. A naturalistic cohort design was used. The cohorts represented different doses of bed rest that were naturally occurring. Comparisons were made between patients who had no bed rest (comparative dose group, n = 20), two to four days (moderate dose, n = 23) and five to seven days of bed rest (high dose, n = 22) during a one-week monitoring period. Orthostatic intolerance was measured by orthostatic vital signs and a self-report scale. Bed rest dose was measured by the total number of days spent in bed during one week. Results.,Post hoc comparisons, using Bonferroni adjustments, indicated significant differences in adjusted means on self-reported orthostatic intolerance between the comparative and high (CI: ,4·12, ,0·85; p < 0·001), and the moderate and high (CI: 0·35, 3·56, p < 0·01) bed rest dose cohorts. No group differences were found on orthostatic vital signs. Conclusions., A moderate dose of bed rest with intermittent exposure to upright posture may protect against subjective orthostatic intolerance in patients who are unable to tolerate being out of bed every day. Future research may examine the effects of reducing bed rest days on orthostatic intolerance in individuals with high doses of five to seven days of bed rest. [source] Ambulatory polysomnography for the assessment of sleep bruxismJOURNAL OF ORAL REHABILITATION, Issue 8 2008S. DOERING Summary, Ambulatory polysomnography (PSG) is introduced as a new method for assessing sleep bruxism. Nocturnal recordings of masseter electromyography (EMG), electro-encephalography, electro-oculography, electrocardiography, thoracic effort and body position allow for the detection of typical nocturnal masseter activity as well as the determination of sleep stages. Twelve patients with a clinical diagnosis of bruxism were assessed with the ambulatory PSG, all of them fulfilled diagnostic PSG criteria according to Kato et al. (Dent Clin North Am. 2001; 45: 657,684). Per hour of sleep patients showed 34·2 (±10·6) EMG bursts and 5·6 (±1·3) sleep bruxism episodes. Because of the ability to determine sleep stages and the application in the home environment the ambulatory PSG represents a cost-saving alternative to sleep laboratory investigations that might be especially useful in field studies and clinical application. [source] Rear gunners and troubled privates: Wordplay in a dick joke competition1JOURNAL OF SOCIOLINGUISTICS, Issue 1 2007Mike Lloyd A humorous competition called ,The Adventures of Naked Man' ran in a Wellington (New Zealand) newspaper from 1999 to 2000. The competition's protagonist is the sole naked person in a drawn setting where, because of some convenient object or body position, his penis is obscured from sight. Entrants to the competition submitted a caption to go with the drawn setting, the point being to make humour. Without explicit instruction, most entrants constructed some form of dick joke, the interesting questions being, just how, and with what variations? These questions are pursued by drawing on the full corpus of Naked Man settings and captions. Basic principles of conversation analysis, including some early work of Sacks on punning, are used to analyse the nature and popularity of the Naked Man competition. The article also offers some more speculative comments to do with gender and the organisation of language about sexuality. [source] Effects of Body Positioning on Swallowing and Esophageal Transit in Healthy DogsJOURNAL OF VETERINARY INTERNAL MEDICINE, Issue 4 2009C.M. Bonadio Background: Contrast videofluoroscopy is the imaging technique of choice for evaluating dysphagic dogs. In people, body position alters the outcome of videofluoroscopic assessment of swallowing. Hypothesis/Objective: That esophageal transit in dogs, as measured by a barium esophagram, is not affected by body position. Animals: Healthy dogs (n= 15). Methods: Interventional, experimental study. A restraint device was built to facilitate imaging of dogs in sternal recumbancy. Each dog underwent videofluoroscopy during swallowing of liquid barium and barium-soaked kibble in sternal and lateral recumbancy. Timing of swallowing, pharyngeal constriction ratio, esophageal transit time, and number of esophageal peristaltic waves were compared among body positions. Results: Transit time in the cervical esophagus (cm/s) was significantly delayed when dogs were in lateral recumbency for both liquid (2.58 ± 1.98 versus 7.23 ± 3.11; P= .001) and kibble (4.44 ± 2.02 versus 8.92 ± 4.80; P= .002). In lateral recumbency, 52 ± 22% of liquid and 73 ± 23% of kibble swallows stimulated primary esophageal peristalsis. In sternal recumbency, 77 ± 24% of liquid (P= .01 versus lateral) and 89 ± 16% of kibble (P= .01 versus lateral) swallows stimulated primary esophageal peristalsis. Other variables were not significantly different. Conclusions and Clinical Importance: Lateral body positioning significantly increases cervical esophageal transit time and affects the type of peristaltic wave generated by a swallow. [source] The cell cycle control protein cdc25C is present, and phosphorylated on serine 214 in the transition from germinal vesicle to metaphase II in human oocyte meiosis,MOLECULAR REPRODUCTION & DEVELOPMENT, Issue 7 2008S. Cunat Abstract Cdc25C is a dual specificity phosphatase essential for dephosphorylation and activation of cyclin-dependent kinase 1 (cdk1), a prerequisite step for mitosis in all eucaryotes. Cdc25C activation requires phosphorylation on at least six sites including serine 214 (S214) which is essential for metaphase/anaphase transit. Here, we have investigated S214 phosphorylation during human meiosis with the objectives of determining if this mitotic phosphatase cdc25C participates in final meiotic divisions in human oocytes. One hundred forty-eight human oocytes from controlled ovarian stimulation protocols were stained for immunofluorescence: 33 germinal vesicle (GV), 37 metaphase stage I (MI), and 78 unfertilized metaphase stage II (MII). Results were stage dependent, identical, independent of infertility type, or stimulation protocol. During GV stages, phospho-cdc25C is localized at the oocyte periphery. During early meiosis I (MI), phosphorylated cdc25C is no longer detected until onset of meiosis I. Here, phospho-cdc25C localizes on interstitial microtubules and at the cell periphery corresponding to the point of polar body expulsion. As the first polar body reaches the periphery, phosphorylated cdc25C is localized at the junction corresponding to the mid body position. On polar body expulsion, the interior signal for phospho-cdc25C is lost, but remains clearly visible in the extruded polar body. In atresic or damaged oocytes, the polar body no longer stains for phospho-cdc25C. Human cdc25C is both present and phosphorylated during meiosis I and localizes in a fashion similar to that seen during human mitotic divisions implying that the involvement of cdc25C is conserved and functional in meiotic cells. Mol. Reprod. Dev. 75: 1176,1184, 2008. © 2007 Wiley-Liss, Inc. [source] Effect of positioning on respiratory synchrony in non-ventilated pre-term infantsPHYSIOTHERAPY RESEARCH INTERNATIONAL, Issue 2 2000Veronica Maynard Senior Lecturer Abstract Background and Purpose Body position can play an important role in an infant's recovery from respiratory disease, but few studies have accounted for sleep state which is known to have a direct influence on the control of respiratory muscles as well as on metabolic and circulatory changes. The purpose of this study was to examine the influence of body position on respiratory function in pre-term infants whilst accounting for sleep state. Method Thoraco-abdominal motion was assessed using respiratory inductance plethysmography (RIP) to provide measures of relative rib cage (RC) and abdominal (AB) movement in ten non-ventilated pre-term infants. Continuous measurements of oxygen saturation (SaO2), pulse and heart rate (HR), were made and sleep state was recorded using behavioural criteria and electro-oculogram (EOG) measurements. Results The results showed a significant increase in HR in supine, but no significant difference in SaO2 as a function of position, compared to the prone position where a significant reduction was found in thoraco-abdominal asynchrony for both groups and a reduction in variability in both HR and SaO2. Intra-subject variability of thoraco-abdominal motion as a function of position demonstrated no significant difference on return to supine or on return to prone, illustrating good repeatability of measures. Conclusions Prone positioning of pre-term infants recovering from respiratory disease may improve respiratory function. As measured, the improvement in respiratory synchrony in prone position brings pre-term infants' breathing pattern into line with that expected in term infants. Copyright © 2000 Whurr Publishers Ltd. [source] The effect of flexion on the level of termination of the dural sac in paediatric patientsANAESTHESIA, Issue 10 2009B-N. Koo Summary Although the anatomy of the spinal cord and its associated structures have been well defined, the effects of body position relevant to neuraxial blockade have not been elucidated. This study was designed to determine the effect of body position on the end of the dural sac in children. After induction of anaesthesia, ultrasound examination was performed to evaluate the location of the dural sac end in the lateral position with a straight back and knee, and in the lateral position with the knees, legs, and neck flexed. The level of the end of the dural sac was determined in relation to the vertebrae. Our data demonstrate that the dural sac shifts significantly cephalad in the lateral flexed position used for neuraxial blockade (p < 0.001). These results suggest that the safety margin to avoid dural puncture during hiatal or S2-3 approach for caudal block can be increased in younger children. [source] No cerebrocervical venous congestion in patients with multiple sclerosis,ANNALS OF NEUROLOGY, Issue 2 2010Florian Doepp MD Objective: Multiple sclerosis (MS) is characterized by demyelination centered around cerebral veins. Recent studies suggested this topographic pattern may be caused by venous congestion, a condition termed chronic cerebrospinal venous insufficiency (CCSVI). Published sonographic criteria of CCSVI include reflux in the deep cerebral veins and/or the internal jugular and vertebral veins (IJVs and VVs), stenosis of the IJVs, missing flow in IJVs and VVs, and inverse postural response of the cerebral venous drainage. Methods: We performed an extended extra- and transcranial color-coded sonography study including analysis of extracranial venous blood volume flow (BVF), cross-sectional areas, IJV flow analysis during Valsalva maneuver (VM), and CCSVI criteria. Fifty-six MS patients and 20 controls were studied. Results: Except for 1 patient, blood flow direction in the IJVs and VVs was normal in all subjects. In none of the subjects was IJV stenosis detected. IJV and VV BVF in both groups was equal in the supine body position. The decrease of total jugular BVF on turning into the upright position was less pronounced in patients (173 ± 235 vs 362 ± 150ml/min, p < 0.001), leading to higher BVF in the latter position (318ml/min ± 242 vs 123 ± 109ml/min; p < 0.001). No differences between groups were seen in intracranial veins and during VM. None of the subjects investigated in this study fulfilled >1 criterion for CCSVI. Interpretation: Our results challenge the hypothesis that cerebral venous congestion plays a significant role in the pathogenesis of MS. Future studies should elucidate the difference between patients and healthy subjects in BVF regulation. ANN NEUROL 2010;68:173,183 [source] Observer Variability and Optimal Criteria of Transient Ischemia During ST Monitoring with Continuous 12-lead ECGANNALS OF NONINVASIVE ELECTROCARDIOLOGY, Issue 3 2002Ph.D., Tomas Jernberg M.D. Background: ST monitoring with continuous 12-lead ECG is a well-established method in patients with unstable coronary artery disease (CAD). However, the method lacks documentation on optimal criteria for episodes of transient ischemia and on observer variability. Methods: Observer variability was evaluated in 24-hour recordings from 100 patients with unstable CAD with monitoring in the coronary care unit. Influence on ST changes by variations in body position were evaluated by monitoring 50 patients in different body positions. Different criteria of transient ischemia and their predictive importance were evaluated in 630 patients with unstable CAD who underwent 12 hours of monitoring and thereafter were followed for 1 to 13 months. Two sets of criteria were tested: (1) ST deviation , 0.1 mV for at least 1 minute, and (2) ST depression , 0.05 mV or elevation , 0.1 mV for at least 1 minute. Results: When the first set of criteria were used, the interobserver agreement was good (kappa = 0.72) and 8 (16%) had significant ST changes in at least one body position. Out of 100 patients with symptoms suggestive of unstable CAD and such ischemia, 24 (24%) had a cardiac event during follow-up. When the second set of criteria were used, the interobserver agreement was poor (kappa = 0.32) and 21(42%) had significant ST changes in at least one body position. Patients fulfilling the second but not the first set of criteria did not have a higher risk of cardiac event than those without transient ischemia (5.3 vs 4.3%). Conclusions: During 12-lead ECG monitoring, transient ischemic episodes should be defined as ST deviations , 0.1 mV for at least 1 minute, based on a low observer variability, minor problems with postural ST changes and an important predictive value. A.N.E. 2002;7(3):181,190 [source] DETERMINING NORMAL VALUES FOR INTRA-ABDOMINAL PRESSUREANZ JOURNAL OF SURGERY, Issue 12 2006Joanne J. L. Chionh Background: Intra-abdominal pressure (IAP) measurements can be used for the early detection and management of the abdominal compartment syndrome. IAP values are widely thought to be atmospheric or subatmospheric. However, there are no reports that describe normal IAP values using urinary bladder pressure measurements in patients not suspected of having a raised IAP level. This study sought to determine these normal values to aid our interpretation of IAP measurements in post-surgical patients or patients with suspected increased IAP. Methods: Urinary bladder pressure measurements were carried out in 40 men and 18 women awake medical or non-abdominal surgery inpatients with existing indwelling catheters. Measurements were made in the supine, 30° and 45° sitting positions. Comparisons were carried out to determine the effects on urinary bladder pressure of body position, sex and a suspected diagnosis of benign prostatic hypertrophy. Results: Median values for IAP were higher if measured in a more upright position (P < 0.0001). Median values were supine, 9.5 cmH2O (range, 1,18 cmH2O); 30° upright, 11.5 cmH2O (range, 3,19 cmH2O); and at 45° upright, 14.0 cmH2O (range, 4,22 cmH2O). Measurements recorded were neither atmospheric nor subatmospheric. IAP was higher in men compared with women in the supine and 30° positions (P < 0.05) but not in the 45° position (P = 0.083). There was no significant difference between patients with and without suspected benign prostatic hypertrophy. Conclusions: Normal IAP using urinary bladder pressure in awake patients are above atmospheric pressure. As a patient is moved from the supine into the upright position, IAP measurements increase. [source] 2326: Influence of change in body position on choroidal blood flow in patients with obstructive sleep apnea syndromeACTA OPHTHALMOLOGICA, Issue 2010A ALMANJOUMI Purpose Obstructive sleep apnea syndrome (OSA) has been reported to be associated with ischemic and glaucomatous optic neuropathy (especially normal tension glaucoma). OSA per se is able to generate hypertension, atherosclerosis and autonomic dysfunction, all conditions possibly interacting with ocular vascular regulation. The aim of our study was to characterize the choroidal vascular reactivity to change in body position in OSA patients, as compared with matched healthy control subjects. Methods Eighteen newly diagnosed OSA patients were included in this prospective study. Control subjects were matched with OSA patients for body mass index (BMI), gender and age. At the screening visit, each subject underwent a general exam, cardiovascular, neurologic and ophthalmological examinations, and overnight polysomnography. The LDF instrument used in this study to measure subfoveal choroidal blood flow (ChBF), ChBVel , velocity (kHz); and volume, ChBVol (in arbitrary units, AU) Vascular choroidal reactivity was tested during the change in body position from the sitting to the supine position (10 min). Results OSA patients exhibited a similar choroidal reactivity during change in body position than controls with increased ChBVel (+15%), decreased ChBVol (-11.6%), and unchanged ChBF. IOP increased by 14.2% in the supine position whereas ocular perfusion pressure remained stable. Conclusion This prospective comparative study showed for the first time unimpaired choroidal vascular reactivity in otherwise healthy OSA patients. This suggests OSA patients, without comorbidities, has long-term adaptive mechanisms active in ocular microcirculation. [source] Interactions among peripheral perfusion, cardiac activity, oxygen saturation, thermal profile and body position in growing low birth weight infantsACTA PAEDIATRICA, Issue 1 2010R Sahni Abstract Aims:, To investigate the correlation between the ,perfusion index' (PI) and other commonly used estimates of cutaneous blood flow [heart rate (HR), surface temperatures (ST) and central-to-peripheral thermal gradients (C-P grad)] and to use this new non-invasive tool to compare differences between prone and supine sleep position in low birth weight (LBW) infants. Methods:, Six-hour continuous recordings of pulse oximetry, cardiac activity and absolute ST from three sites (flank, forearm and leg), along with minute-to-minute assessment of behavioural states were performed in 31 LBW infants. Infants were randomly assigned to the prone or supine position for the first 3 h and then reversed for the second 3 h. PI data were correlated with HR and C-P grad, and compared across sleep positions during quiet sleep (QS) and active sleep (AS). Results:, Perfusion index correlated significantly with HR (r2 = 0.40) and flank-to-forearm thermal gradient (r2 = 0.28). In the prone position during QS, infants exhibited higher PI (3.7 ± 0.9 vs. 3.1 ± 0.7), HR (158.4 ± 8.9 vs. 154.1 ± 8.8 bpm), SpO2 (95.8 ± 2.6 vs. 95.2 ± 2.6%), flank (36.7 ± 0.4 vs. 36.5 ± 0.4°C), forearm (36.1 ± 0.6 vs. 35.5 ± 0.4°C) and leg (35.4 ± 0.7 vs. 34.7 ± 0.7°C) temperatures and narrower flank-to-forearm (0.6 ± 0.4 vs. 0.9 ± 0.3°C) and flank-to-leg (1.3 ± 0.6 vs. 1.8 ± 0.7°C) gradients, compared to those of the supine position. Similar differences were observed during AS. Conclusion:, Perfusion index is a good non-invasive estimate of tissue perfusion. Prone sleeping position is associated with a higher PI, possibly reflecting thermoregulatory adjustments in cardiovascular control. The effects of these position-related changes may have important implications for the increased risk for sudden infant death syndrome in prone position. [source] Aetiologic and clinical characteristics of syncope in Chinese childrenACTA PAEDIATRICA, Issue 10 2007Li Chen Abstract Aim: This study aimed to improve diagnostic efficacy of syncope in children by analyzing the aetiology and clinical characteristics of syncope in Chinese children. Methods: We retrospectively analyzed the causes of syncope and diagnostic workup in 154 consecutive children seen in the Department of Pediatrics, Peking University First Hospital, China, because of a syncope-related event. Results: In all patients with transient loss of consciousness (TLOC), there were 136 (88.31%) patients attributing to syncope, and 18 (11.69%) belonging to nonsyncopal cases. Neurally mediated syncope (NMS) was the most common cause of syncope (99 cases; 64.3%), with cardiac causes ranking second (10 cases; 6.5%). Other nonsyncopal causes included psychiatric problems and neurological and metabolic disorders. In 25 cases (16.2%), the cause was uncertain. Cases of NMS often had clear inducement of syncope and prodromes. Children with cardiac syncope often had a history of cardiac disease, were often younger than those with NMS, and showed exercise-related syncope, syncope spells in any body position or at an early age, or sudden death in family members but no prodromes. Neurological disorder was suspected in cases of TLOC with seizures, TLOC spells in any position, postictal phase of disorientation or abnormal neurological signs. A metabolic cause is suspected with a history of metabolic disease, prolonged anger, or violent vomiting and diarrhoea. Children with psychiatric disorders were adolescent girls, with prolonged TLOC spells, who had more frequent TLOC. Although many tests were used in diagnosis, most were not goal directed. Now, electrocardiography is recommended in almost all children with syncope. Neurological testing, including electroencephalography and computed tomography were rarely helpful unless with evidence of neurological signs and symptoms. Head-up tilt test (HUTT) was most useful in children with recurrent syncope in whom heart disease was not suspected. Conclusion: NMS was the most common cause of syncope. We recommended HUTT as the important basis of the TLOC workup. [source] The role of history, Epworth Sleepiness Scale Score and body mass index in identifying non-apnoeic snorersCLINICAL OTOLARYNGOLOGY, Issue 4 2000P.V.H. Lim Seventy-one adults referred with snoring over a 9-month period were assessed and their apnoeic-status determined by clinical assessment using symptoms suggestive of the obstructive sleep apnoea,hypopnoea syndrome, the Epworth Sleepiness Scale score (ESS) and body mass index (BMI). The results of clinical assessment were compared to that of overnight six-channel polysomnography where snoring noise level, pulse rate, capillary oxygen saturation, breathing effort, oronasal airflow and body position were monitored. Polysomnography detected an apnoea-hypopnoea index (AHI) of < 15 episodes/h in 61(86%) patients and an AHI of , 15 episodes/h in 10 (14%) patients. Clinical assessment alone identified 57 patients with AHI of < 15 episodes/h as ,non-apnoeic snorers' and six patients with AHI of , 15 episodes/h as ,apnoeic snorers'. The sensitivity of this method of clinical assessment in identifying the ,non-apnoeic snorers' from amongst patients referred with snoring was 93.4% and its specificity was 60% (P < 0.001). [source] Effect of body position on foot and ankle volume in healthy subjectsCLINICAL PHYSIOLOGY AND FUNCTIONAL IMAGING, Issue 6 2004Ivy O. W. Man Summary Physical therapy treatments for and evaluation of lower limb swelling are usually performed in supine lying position. However, the limb is usually treated or assessed in the dependent position, i.e. sitting or standing. The purpose of this study was to determine the possible confounding effect of subject positioning on foot and ankle volume. Sixty healthy individuals were randomly positioned into motionless standing, sitting or supine lying for 30 min. Volumetric measurements of the dominant leg were taken with a foot and ankle volumeter before and after 30 min of positioning. A significant difference between the three groups for foot and ankle volume change (F2,53 = 35·41, P<0·001) was found. A post-hoc Tukey HSD test revealed that the difference was statistically significant between sitting and standing as well as supine lying and standing (P<0·001). No statistical significance was found between sitting and supine lying (P = 0·90). Standing caused the greatest increase in foot and ankle volume followed by sitting then supine lying. The results indicate that treating or assessing a limb with the subject in a sitting position would not be significantly different from a subject who is positioned in supine lying. However, it is not known whether the height and the distance from the heart to the feet were comparable between the groups, and so it is recommended that, where possible, treatment and assessment of lower leg swelling should be undertaken with the leg in a non-dependent position and definitely not in standing. [source] Cognitive strategy use by children with Asperger's syndrome during intervention for motor-based goalsAUSTRALIAN OCCUPATIONAL THERAPY JOURNAL, Issue 2 2009Sylvia Rodger Background:,Cognitive Orientation for (daily) Occupational Performance (CO-OP) is a cognitive approach utilised by occupational therapists to help guide children in the discovery of appropriate strategies for effective task performance through a structured problem-solving process. There has been limited research into its utility for children with Asperger's syndrome (AS). These children often present with motor difficulties, although these are not required for diagnosis of the syndrome. A recent study found that children with AS were able to use the CO-OP framework to enhance their performance of motor-based goals. Methods:,This paper presents two case studies demonstrating the use of CO-OP with children with AS, and explores the global and domain-specific strategies and types of guidance utilised to improve their task performance. Two children with AS, aged 9 and 11, with above average intellectual ability, engaged in 10 sessions of CO-OP. All sessions were videotaped. One hundred minutes of randomly selected footage were coded per child using the Observer Software Package version 5.0. Results:,The mean interrater agreement for the two children was 94.06% and 89.30%. Both children (i) utilised the global strategies ,do', followed by ,plan' and ,check', (ii) used at least three domain-specific strategies in each session with ,task specification/modification' and ,body position' utilised most, and (iii) used limited verbal self-guidance. Conclusion:,These two children with AS were able to utilise cognitive strategies to effectively solve their motor performance problems. Children with AS and those with DCD used similar strategies to achieve motor goals. CO-OP appears to have potential as an effective intervention for children with AS. Study limitations, clinical implications and directions for future research are discussed. [source] Body Position and Cardiac Dynamic and Chronotropic Responses to Steady-State Isocapnic Hypoxaemia in HumansEXPERIMENTAL PHYSIOLOGY, Issue 2 2000S. Deborah Lucy Neural mediation of the human cardiac response to isocapnic (IC) steady-state hypoxaemia was investigated using coarse-graining spectral analysis of heart rate variability (HRV). Six young adults were exposed in random order to a hypoxia or control protocol, in supine and sitting postures, while end-tidal PCO2 (PET,CO2) was clamped at resting eucapnic levels. An initial 11 min period of euoxia (PET,O2 100 mmHg; 13.3 kPa) was followed by a 22 min exposure to hypoxia (PET,O2 55 mmHg; 7.3 kPa), or continued euoxia (control). Harmonic and fractal powers of HRV were determined for the terminal 400 heart beats in each time period. Ventilation was stimulated (P < 0.05) and cardiac dynamics altered only by exposure to hypoxia. The cardiac interpulse interval was shortened (P < 0.001) similarly during hypoxia in both body positions. Vagally mediated high-frequency harmonic power (Ph) of HRV was decreased by hypoxia only in the supine position, while the fractal dimension, also linked to cardiac vagal control, was decreased in the sitting position (P < 0.05). However, low-frequency harmonic power (Pl) and the HRV indicator of sympathetic activity (Pl/Ph) were not altered by hypoxia in either position. These results suggest that, in humans, tachycardia induced by moderate IC hypoxaemia (arterial O2 saturation Sa,O2, 85%) was mediated by vagal withdrawal, irrespective of body position and resting autonomic balance, while associated changes in HRV were positionally dependent. [source] Triadic nonverbal communication in mother,infant consultations: Two contrasted cases,INFANT MENTAL HEALTH JOURNAL, Issue 3 2009M.J. Hervé The aim of the present case study was to present and discuss the analysis of triadic nonverbal communication between mother, infant, and therapist in two early consultations as an indicator of the therapeutic alliance. The analysis explored nonverbal triadic interactions (body positions and facial orientations of the mother, infant, and therapist, and expressive behaviors of the infant) and triadic affective sharing (via a microanalytic interview of the therapist). The quality of the therapeutic alliance and clinical outcome for each case are described. The description of the two cases illustrates the importance of the progressive development of nonverbal "engagement" by the three people (triadic alliance) and of moments with triadic emotional sharing. The contribution of the therapist appears to be crucial, in particular via his or her body and affective engagement with the infant. The triadic alliance appears to be both an indicator of the therapeutic alliance and an element that can foster it. [source] Body positions and esophageal sphincter pressures in obese patients during anesthesiaACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 4 2010A. DE LEON Background: The lower esophageal sphincter (LES) and the upper esophageal sphincter (UES) play a central role in preventing regurgitation and aspiration. The aim of the present study was to evaluate the UES, LES and barrier pressures (BP) in obese patients before and during anesthesia in different body positions. Methods: Using high-resolution solid-state manometry, we studied 17 patients (27,63 years) with a BMI,35 kg/m2 who were undergoing a laparoscopic bariatric surgery before and after anesthesia induction. Before anesthesia, the subjects were placed in the supine position, in the reverse Trendelenburg position (+20°) and in the Trendelenburg position (,20°). Thereafter, anesthesia was induced with remifentanil and propofol and maintained with remifentanil and sevoflurane, and the recordings in the different positions were repeated. Results: Before anesthesia, there were no differences in UES pressure in the different positions but compared with the other positions, it increased during the reverse Trendelenburg during anesthesia. LES pressure decreased in all body positions during anesthesia. The LES pressure increased during the Trendelenburg position before but not during anesthesia. The BP remained positive in all body positions both before and during anesthesia. Conclusion: LES pressure increased during the Trendelenburg position before anesthesia. This effect was abolished during anesthesia. LES and BPs decreased during anesthesia but remained positive in all patients regardless of the body position. [source] | |||||||||||||||||||||||||||||||||||||