Lumbar Puncture in the prone position for Low Birth Weight Neonates

Background Lumbar puncture in the lateral decubitus position will make the neonates uncomfortable and is likely to cause position change and unstable vital signs, and the application of sedative drugs will cause adverse effects. This study explored a novel method for lumbar puncture in the prone position for low weight neonates. Methods The neonates were randomly assigned into the standard position group receiving lumbar puncture in the lateral decubitus position; and the improved position group receiving lumbar puncture in the prone position. The success rate of first time attempts and the overall success rate of lumbar puncture, incidence of adverse effects, NIAPAS scores were collected and compared between these two groups. The difference in success rate and adverse effects incidence rate was analysed through Chi-square. Student’s t-test was used for the test of NIAPAS rating. Results The improved position group had a higher success rate of first attempt and overall success rate, significantly lower incidence of adverse effect and lower NIAPAS scores than those of the standard position group (P<0.05). Conclusion This lumbar puncture in the prone position is safer, more effective, and more comfortable for preterm neonates and those with low birth weight. Thus, this method is worth of further promotion. Trial registration Registration number, ChiCTR2100049923; Date of Registration, August 11, 2021; Retrospectively registered.

Code of practice for medical autopsies: a minimum standard position paper for pathology departments performing medical (hospital) autopsies in adults

The medical autopsy (also called hospital or clinical autopsy) is a highly specialised medical procedure, which requires professional expertise and suitably equipped facilities. To ensure high standards of performance, the Working Group of Autopsy Pathology of the European Society of Pathology (ESP) suggests a code of practice as a minimum standard for centres performing medical autopsies. The proposed standards exclusively address autopsies in adults, and not forensic autopsies, perinatal/or paediatric examinations. Minimum standards for organisation, standard of premises, and staffing conditions, as well as minimum requirements for level of expertise of the postmortem performing specialists, documentation, and turnaround times of the medical procedure, are presented. Medical autopsies should be performed by specialists in pathology, or by trainees under the supervision of such specialists. To maintain the required level of expertise, autopsies should be performed regularly and in a number that ensures the maintenance of good practice of all participating physicians. A minimum number of autopsies per dedicated pathologist in a centre should be at least 50, or as an average, at least one autopsy per working week. Forensic autopsies, but not paediatric/perinatal autopsies may be included in this number. Turnaround time for final reports should not exceed 3 weeks (14 working days) for autopsies without fixation of brain/spinal cord or other time-consuming additional examinations, and 6 weeks (30 working days) for those with fixation of brain/spinal cord or additional examinations.

FINANCIAL ANALYSIS OF THE INVESTMENT ATTRACTIVENESS OF THE ENTERPRISE

The purpose of the article is to study the concept of investment attractiveness of the enterprise. Outline of existing methods and areas of research. Research of existing theoretical approaches to understanding the concept of “investment attractiveness”. Determining areas for assessing investment attractiveness according to the needs of financial analysis. It is advisable to study the company’s position in the market and its business reputation. It is important to calculate the integrated coefficient of investment attractiveness. It is important to calculate the ratio of borrowed and own funds, asset turnover ratio, current liquidity ratio, return on equity. It is important to set the parameters corresponding to the level of the standard position of the enterprise in the market. Emphasis is placed on assessing the level of the company’s dependence on competitors. It is important to study the profitability of products, return on investment. It is important to consider the strengths and weaknesses of the enterprise. It is appropriate to calculate the sales revenue index, the net profit index, the cost index, the long-term liability index. It is proposed to study the dynamics of the characteristics of financial stability, profitability, liquidity of assets and their turnover. The purpose of the article is achieved. Theoretical approaches to the concept are investigated. The directions of assessment are considered. The development of existing directions is offered. The needs of financial analysis are outlined. The directions of financial analysis of investment attractiveness are determined. Some results were obtained. It is proposed to assess the investment attractiveness of the enterprise based on the results of financial analysis. The basis of financial analysis is financial reporting. Analysis of financial condition is the basis for financial analysis. It is expedient to carry out the financial analysis in the following section: the analysis of liquidity of the enterprise, its solvency, financial stability, business and market activity, etc.

CPR with restricted patient access using alternative rescuer positions: a randomised cross-over manikin study simulating the CPR scenario after avalanche burial

Background The aim of this manikin study was to evaluate the quality of cardiopulmonary resuscitation (CPR) with restricted patient access during simulated avalanche rescue using over-the-head and straddle position as compared to standard position. Methods In this prospective, randomised cross-over study, 25 medical students (64% male, mean age 24) performed single-rescuer CPR with restricted patient access in over-the-head and straddle position using mouth-to-mouth ventilation or pocket mask ventilation. Chest compression depth, rate, hand position, recoil, compression/decompression ratio, hands-off times, tidal volume of ventilation and gastric insufflation were compared to CPR with unrestricted patient access in standard position. Results Only 28% of all tidal volumes conformed to the guidelines (400–800 ml), 59% were below 400 ml and 13% were above 800 ml. There was no significant difference in ventilation parameters when comparing standard to atypical rescuer positions. Participants performed sufficient chest compressions depth in 98.1%, a minimum rate in 94.7%, correct compression recoil in 43.8% and correct hand position in 97.3% with no difference between standard and atypical rescuer positions. In 36.9% hands-off times were longer than 9 s. Conclusions Efficacy of CPR from an atypical rescuer position with restricted patient access is comparable to CPR in standard rescuer position. Our data suggest to start basic life-support before complete extrication in order to reduce the duration of untreated cardiac arrest in avalanche rescue. Ventilation quality provided by lay rescuers may be a limiting factor in resuscitation situations where rescue ventilation is considered essential.

Effect of Eccentric Calcification of an Aortic Valve on the Implant Depth of a Venus-A Prosthesis During Transcatheter Aortic Valve Replacement: A Retrospective Study

ObjectOur goal was to assess the implant depth of a Venus-A prosthesis during transcatheter aortic valve replacement (TAVR) when the areas of eccentric calcification were distributed in different sections of the aortic valve.MethodsA total of 53 patients with eccentric calcification of the aortic valve who underwent TAVR with a Venus-A prosthesis from January 2018 to November 2019 were retrospectively analyzed. The patients were divided into three groups (A, B, and C) according to the location of the eccentric calcification, which was determined by preprocedural computerized tomography angiography (CTA) images. The prosthesis release process and position were evaluated by contrast aortography during TAVR, and the differences in valve implant depths were compared among the three groups. The effects of different aortic root structures and procedural strategies on prosthesis implant depth were analyzed.ResultsEleven patients had eccentric calcification in region A; 19 patients, in region B; and 23 patients, in region C. The patients with eccentric calcification in region B had a higher risk of prosthesis migration (10.5% upward and 21.1% downward), and the position of the prosthesis after TAVR in group B was the deepest among the three groups. When eccentric calcification was located in region A or C, the prosthesis was released at the standard position with more stability, and the location of the prosthesis was less deep after TAVR (region A: 4.12 ± 3.4 mm; region B: 10.2 ± 5.3 mm; region C: 8.4 ± 4.0 mm; region A vs. region B, P = 0.0004; region C vs. region B; and P = 0.0360). In addition, the left ventricular outflow tract (LVOT) (P = 0.0213) and aortic root angulation (P = 0.0263) also had a significant effect on implant depth in the aortic root structure of the patients. The prosthesis size was 28.3 ± 2.4 in the deep implant group and 26.4 ± 2.0 in the appropriate implant group (P = 0.0068).ConclusionThe implant depth of the Venus-A prosthesis is closely related to the distribution of eccentric calcification in the aortic valve during TAVR. Surgeons should adjust the surgical strategy according to aortic root morphology to prevent prosthesis migration.

Comparison between Pendant Positions versus Traditional Sitting Positions for Successful Spinal Puncture in Patients Undergoing Caesarean Deliveries

Aim: To determine the effectiveness among pendant position and traditional sitting position in term of successful spinal puncture in patients underwent caesarean deliveries. Study Design: Randomized control trial Place and Duration of Study: Department of Anaesthesia, Ghurki Trust Teaching Hospital, Lahore from 1st April 2020 to 31st March 2021. Methodology: One hundred and eighty patients were included. Patient’s detailed demographics were recorded after taking written consent. Patients were aged between 20-50 years. Patients were equally divided into two groups, group I had 90 patients underwent pendant position and group II had 90 patients and underwent for traditional sitting. Randomly one of two positions was performed with the L3-L4 interface in spinal puncture. Time for successful spinal puncture, number of needle to bone contacts and total number of attempts were calculated. Results: Mean age of the patients in group I was 27.6±17.04 years with mean BMI 24.25±2.63 kg/m2 and in group II, mean age was 29.23±14.24 years with mean BMI 26.55±6.36 kg/m2. Mean height of patients in group I was 2.6524±1.0054 meter and in group II was 2.6516±1.0042 meter. Weight of the patients in group I 63.48±22.13 kg and in group II was 65.46±17.19 kg. Success rate after first attempt in group I was 80 (94.44%) and group II was 72 (80%). For spinal needle insertion, fewer mean times was observed in group I 19.55±11.221 sec as compared to group II 28.14±18.226 sec. Number of needle to bone contacts was higher 66.7% in group I and in group II 40%. Number of attempt was less in group I as compared to group II. Conclusion: The pendant position in the pregnant women who had a caesarean sector was much better than the standard position in order to provide the 1st attempt of spinal puncture. Keywords: Caesarean, Spinal anaesthesia, Traditional sitting, Pendant position

Sitting Position as an Alternative for Sagittal Balance Assessment: A Cross-Sectional Study

Background: The sagittal vertical axis (SVA) is used for spinal sagittal balance evaluation. Patients with sagittal imbalance are assessed by whole spine standing lateral radiography, with some patients demonstrating standing difficulty during the examination. We propose new positioning methods to facilitate SVA assessment in patients with sagittal imbalance who cannot tolerate the standing position.Methods: Thirty healthy subjects had their SVA evaluated by whole spine lateral radiography in four positions: standard position by standing with the hands on the clavicles with elbows touching the trunk (TC), standing with the hands holding on to a front stationary railing within arm’s reach (TS), sitting with the hands on the clavicles (IC), and sitting with the hands holding on to a stationary railing (IS). The SVA was evaluated for differences and correlations between the standard position (TC) and the new proposed positions.Results: The mean difference in the SVA between the TC and TS group was 1.55 mm, with a limit of agreement of -36.62 to 39.72 mm and Lin’s correlation of 0.63. The mean difference in the SVA between the TC and IC or IS positions indicated greater positive SVA difference with no correlation. The TS position had good regional spinal parameter correlation with the TC position, as well as pelvic parameter correlation. The IC and IS positions showed poor pelvic and other regional spinal parameter correlations. Conclusions: The TS position can be used as an alternative method in measuring the SVA in patients with standing difficulty during radiography. Though measurement using the sitting position can be conveniently performed, this position does not correlate well with the standard SVA measurement.

Designation speed of movement by language units in Russian and Persian languages

В статье анализируются языковые единицы, обозначающие темп движения в русском и персидском языках. Информация о темпе присутствует у большинства глаголов со значением движения. Анализ показывает, что языковые единицы в явном или скрытом виде обозначают перемещение субъекта и объекта с нормальным, быстрым и медленным темпом. В семантике глаголов, обозначающих перемещение с нормальным темпом, выделяется информация о стандартном положении в пространстве, отсутствии или наличии средств перемещения, добровольном перемещении, характеристике шагов (размеренность, выделенность) и т.д. Глаголы, обозначающие перемещение с медленным темпом, передают информацию о перемещении с трудом, о физическом недостатке, перемещении относительно опоры и т.д. Глаголы, обозначающие быстрый темп движения, сообщают о перемещении в направлении удаления от субъекта и о среде перемещения, намерении попасть в цель, скорости, принудительном перемещении, о намеренном погружении в жидкость, о полном отрыве от поверхности двух ног одновременно и т.д. In this work, the linguistic units denoting the pace of movement in Russian and Persian languages are subject to analysis. Information on the pace of movement is present in most verbs denoting movement. The analysis shows that linguistic units in explicit or latent form indicate the movement of the subject and the object with a normal, fast and slow pace. In the semantics of the verbs denoting moving at a normal pace, information is highlighted about the standard position in space, the absence of means of movement, the availability of means of movement, voluntary movement, characteristic steps (dimensionality, emphasis), etc. Verbs indicating movement at a slow pace transmit information about movement with difficulty, physical disability, movement relative to a support, etc. Verbs indicating a fast pace of movement report movement in the direction of moving away from the subject and the environment of movement, the intention to hit the target, speed, forced movement, intentional immersion in a liquid, complete separation from the surface of two legs at the same time, etc.

Variation of Femoral Component Size by Reference Points and Target Alignments in Total Knee Arthroplasty

Selecting appropriately sized components is important in total knee arthroplasty because they can affect postoperative knee function and pain. This study investigated size differences of 19 different femoral component placements from the standard position by three-dimensional virtual surgery using three-dimensional bone models of 101 varus osteoarthritic knees. Distal femoral bone was cut perpendicular to the femoral mechanical axis (MA) in the coronal plane. Twenty different component placements consisting of five cutting directions (perpendicular to MA, 3° and 5° extension/flexion relative to MA in the sagittal plane), two rotational alignments (clinical and surgical epicondylar axes), and two rotational types of anterior reference guide (central and medial) were simulated. The mean anteroposterior dimension of the standard position was 55.5 mm which means that the difference compared to 19 different methods ranged from -1.2 ± 0.2 mm to 7.1 ± 1.3 mm. Multiple regression analysis revealed that flexion cutting direction, surgical epicondylar axis, and central were associated with smaller component size. In conclusion, the femoral component size can be affected easily by not only cutting direction but also the reference guide type and the target alignment. Our findings could provide surgeons with clinically useful information to fine-tune for unintended loose or tight joint gaps by adjusting the component size.

Substantiation of the method for determining the clinical and radiographic parameters of the hip joint in patients with cerebral palsy

Background. The difficulties of diagnosis that arise when choosing therapeutic measures aimed at preventing sublu-xation, dislocation, and contractures of the hip joint in patients with cerebral palsy are a topical object of the research. The purpose was to improve the results of the diagnosis of the hip joint pathology by establishing objective radiographic parameters. Materials and methods. The total number of patients was 20 (40 joints), 10 boys and 10 girls aged 3 to 15 years. Sixteen joints were operated. Radiographically, we have determined neck-shaft angle and torsion of the thigh, projection and true according to Koval (using tables), acetabular angle, angle of inclination (Sharpe’s angle). Hip torsion was determined clinically according to Ruwe. Torsion was evaluated intraoperatively in our own way (patent No. a200512793). All patients were examined using our method (patent No. 137567). Results. Using the Student’s t-test for independent samples, the parameters of the hip joints were compared and significant differences were found between the neck-shaft angle in the standard position and the neck-shaft angle in our own position (p < 0.05), as well as between the neck-shaft angle in the standard position and the neck-shaft angle true according to Koval (p < 0.05). According to Fisher’s test, it was found that the torsion according to Ruwe and the torsion according to Koval are significantly different (p < 0.05): Femp 1.87 > Fkr 1.7. Using the method of odds ratio (OR), we determined that the sensitivity of torsion measurement by Ruwe was 0.7, the specificity of torsion measurement by Ruwe was 0.83 (OR = 11.67, confidence interval [1.94–70.18]) indicating that the chance of getting a coincidence by measuring torsion by Ruwe is 11.67 times higher than accor-ding to Koval, compared with intraoperative data. A well-defined amount of torsion of the thigh according to Ruwe provides true indicators of the hip joint using our own method. Conclusions. The own method provides the determination of objective clinical and radiographic (diagnostic) parameters in patients with patho-logy of the hip joint. When performing one roentgenogram, it is possible to define all basic parameters of the hip joint (torsion of the hip, neck-shaft angle, Wiberg’s angle, Reimers’ index, index of vertical migration, acetabular angle, angle of inclination) and to standardize examinations of patients with cerebral palsy who are subject to screening throughout the whole period of their development. In this way, you can get radiographic indicators of patients with severe neuromuscular disorders (Gross Motor Function Classification System levels III and IV).