Tripod position as a novel adjunct clinical management of moderate to severe ARDS in COVID-19 patients: A case series and review

Objective@#The World Health Organization (WHO) recommends prone positioning for mechanically ventilated COVID-19 patients with Acute Respiratory Distress Syndrome (ARDS) to improve oxygenation. Subsequently, researchers facilitated the position to non-intubated COVID-19 patients as early management which showed significant improvement but with discerned limitations. Tripod position is explored as an alternative exhibiting promising results. This present study describes a case series of four COVID-19 patients with moderate to severe ARDS who demonstrated considerable breakthrough.@*Methods@#Four COVID-19 cases of moderate to severe ARDS were instructed to do tripod positioning as long as they can tolerate while under close supervision.@*Results@#An hour after assuming tripod position, all four patients presented a decrease in respiratory rate, increase in peripheral oxygen saturation, and increase in partial oxygen saturation in arterial blood gas. The assumed position was maintained by four patients without discomfort and was maintained with a mean of 12 - 20 hours per day. @*Conclusions@#Our findings confirmed that tripod position is advantageous to non-intubated COVID-19 patients with moderate to severe ARDS and may delay or prevent invasive mechanical ventilation. The position also manifested tolerance to extended duration which permitted time for the medical team to focus on managing their disease in its entirety. Nevertheless, certain aspects such as contraindication, side effects, and other adverse events that may occur have yet to be sufficiently clarified and investigated.

A “flexible tripod” mounted video camera: An economical and effective method to record oculoplastic surgeries

Recording surgical procedures is of value for teaching and training in residency and fellowship programs. Operating external ophthalmic surgeries is not as easy as recording intraocular surgeries. In this communication, we describe the use of a video recorder mounted on a flexible tripod (Gorillapod®), a commonly available photography accessory; which is fixed to an IV fluid stand. This set up was used to record external ophthalmic surgeries and the recorded videos were of high quality in terms of stability and required no change in surgical technique to ensure that the area of interest was in focus. In our experience, early results show that a flexible tripod offers an economical mount for recording external surgeries with reproducible results.

A formação psicanalítica: especificidade e transformações / The psychoanalytical training: specificity and transformations / La formación psicoanalítica: especificidad y transformaciones / La formation psychanalytique: spécificité et transformations

O texto aponta para um diálogo aberto sobre questões que demandam nossa atenção quanto à formação psicanalítica nos dias de hoje. Para além do reconhecimento da relevância inquestionável do clássico tripé, presente nos diferentes modelos de formação, bem como de suas vantagens e limitações, sustenta a tese de que a formação analítica deve ampliar seus horizontes sem perder a sua especificidade. O trabalho justifica essa tese, assim como apresenta possíveis caminhos para sua implementação.

This paper points to an open dialogue on issues that demand our attention concerning psychoanalytical training in our days. Besides the recognition of the unquestionable reputation of the classic tripod and its present in the different training models, its advantages and limitations, it supports the thesis that psychoanalytical training should enlarged (expand) its horizons without losing its specificity. The paper justifies this thesis as well as offer possible pathways and directions for implementation.

El texto apunta a un diálogo abierto sobre cuestiones que demandan nuestra atención en relación a la formación psicoanalítica en los días de hoy. Además del reconocimiento de la importancia incuestionable del clásico trípode, presente en los diferentes modelos de formación, sus ventajas y limitaciones, sostiene la tesis de que la formación analítica debe ampliar sus horizontes sin perder su especificidad. El trabajo justifica esta tesis así como presenta posibles caminos para su implementación.

Le texte suggère un dialogue ouvert sur des questions qui requièrent notre attention par rapport à la formation psychanalytique de nos jours. Outre la reconnaissance de la pertinence incontestable du trépied classique, présent dans les différents modèles de formation, de ses avantages et de ses limites, il soutient la thèse selon laquelle la formation analytique devrait élargir ses horizons sans perdre sa spécificité. Le travail justifie cette thèse ainsi que présente les moyens possibles pour sa mise en œuvre.

Distribution of the deep-sea genus Bathypterois (Pisces: Ipnopidae) in the Eastern Central Pacific / Distribución del género de profundidad Bathypterois (Pisces: Ipnopidae) en el Pacífico Centro Oriental

Abstract:The genus Bathypterois (tripod fish) comprises 19 species of deep-sea fishes distributed worldwide. The biology and distribution of the species of this genus are relatively poorly known throughout the Eastern Central Pacific (ECP). This work aims to update the geographic and bathymetric distribution of species of Bathypterois throughout the ECP. To describe the influence of depth, temperature and dissolved oxygen concentrations (DO) on latitudinal and depth distribution of members of the genus throughout the Mexican Pacific, 51 specimens of B.atricolor (12 trawls) and 112 of B. ventralis (18 trawls), collected during TALUD project, were analyzed. Bathypterois atricolor had broader environmental niches (depth: 0.47, temperature: 0.46, DO: 0.39), and inhabits deeper and colder sites (Electivity positives: > 1 000 m, < 3.2 °C, 1.0-1.62 mL/L) than B. ventralis, which had narrow environmental niches (depth: 0.34, temperature: 0.32, DO: 0.28), with high affinity to warmer sites and lower DO concentrations (Electivity positives: 778-1 400 m, 3.3-5.8 °C, < 1.0 mL/L). Both species used different environmental strata (niche overlap; depth: 0.34, temperature: 0.32, DO: 0.28). The adaptation of B. atricolor to live in a broad range of DO concentrations explains its almost circumglobal distribution, while B. ventralis lives almost permanently in the Oxygen Minimum Zone (< 0.05 mL/L), so the DO could be a limiting factor, reducing its potential geographic and bathymetric distributions. None of these species had been previously recorded in the central Gulf of California, and B. ventralis had not been recorded along the West coast of Baja California. This study confirms that both species have a continuous distribution within the ECP, our new records extended the known northernmost range for B. atricolor by 886 km (from 22°46' N to 30°45' N) and for B. ventralis by 645 km (from 21°18' N to 27°07' N). Rev. Biol. Trop. 65 (1): 89-101. Epub 2017 March 01.

ResumenEl género Bathypterois (peces trípode) está conformado por 19 especies de peces de profundidad, distribuidas alrededor del mundo. La biología y distribución de las especies de este género son relativamente poco conocidas a lo largo del Pacífico Centro Oriental (POT). Este trabajo tiene el objetivo de actualizar la distribución geográfica y batimétrica de las especies del género Bathypterois a lo largo del POT. Para describir la influencia de la profundidad, temperatura y concentraciones de oxígeno disuelto (OD) sobre la distribución latitudinal y batimétrica de miembros del género Bathypterois en el Pacífico Mexicano, se analizaron 51 especímenes de B.atricolor (12 arrastres) y 112 B. ventralis (18 arrastres), recolectados durante el proyecto TALUD. Bathypterois atricolor presentó nichos ambientales más amplios (profundidad: 0.47, temperatura: 0.46, OD: 0.39) y habita sitios más profundos y fríos (Electividad positiva: > 1 000 m, < 3.2 °C, 1.0 - 1.62 mL/L) en comparación con B. ventralis, que tiene nichos ambientales reducidos (profundidad: 0.34, temperatura: 0.32, OD: 0.28), con alta afinidad por sitios más cálidos y bajas concentraciones de OD (Electividad positiva: 778-1 400 m, 3.3-5.8 °C, < 1.0 mL/L). Estas especies utilizaron distintos estratos ambientales (traslape de nicho; profundidad: 0.34, temperatura: 0.32, OD: 0.28). La adaptación de B. atricolor para vivir en un amplio intervalo de concentraciones de OD explica su distribución casi circunglobal, mientras que B. ventralis vive casi permanentemente en la Zona de Mínimo Oxígeno (< 0.05 mL/L), por lo que el OD puede ser un factor limitante, reduciendo su posible distribución geográfica y batimétrica. Ninguna de estas especies había sido registrada anteriormente en el centro del Golfo de California, así como B. ventralis no había sido reportada a lo largo de la costa occidental de Baja California. Este estudio confirma que ambas especies tienen una distribución continua dentro del POT, nuestros nuevos registros extienden la distribución más norteña conocida para B. atricolor en 886 km (de 22°46' N a 30°45' N) y en 645 km para B. ventralis (de 21°18' N a 27°07' N).

Motorcycle related cranio-maxillofacial injuries at a tertiary hospital in the Philippines

@#<p style="text-align: justify;"><strong>OBJECTIVE:</strong> To describe the type and determine the number of motorcycle related cranio-maxillofacial injuries that were seen by the ORL service in the emergency room of a tertiary hospital from January 2013 to December 2013.<br /><strong>METHODS: </strong> <br /><strong>Design:</strong> Cross sectional retrospective chart review<br /><strong>Setting:</strong> Tertiary National University Hospital<br /><strong>Participants:</strong> One hundred nine (109) charts of patients seen atr the emergency room from Jnuary 2013 to December 2013 were reviewed<br /><strong>RESULTS:</strong> Of the 109 charts of patients involved in vehicular accidents, there were 76 documented cases of motorcycle related accidents. Of these, 91% involved males and 9% involved females. Seventy one percent (71%) did not wear helmets of whom 36% were young adult males between the ages of 18-30 years. Those that wore helmets had a total of 27 different facial fracture sites: 19% zygomatic tripod fractures, 15% temporal bone fractures and 11% with no fractures noted. Among those who did not wear helmets 75 fractures were noted. Twenty four percent (24%) were tripod fractures, 15% temporal bone fractures and 12% maxillary fractures. only one did not incur any fractures.<br /><strong>CONCLUSION:</strong> Most cranio-maxillofacial fractures seen at the emergency room were from motorcycle related injuries (70%). Despite implementation of Republic Act 10054 (The Motorcycle Helmet Act of 2009) majority of motorcycle-related accidents are still incurred by riders without helmets.</p>

Transmissão e formação: apontamentos sobre o tripé analítico / Transmission and training: notes on the analytical tripod / Transmisión y formación: notas sobre el trípode analítico

O trabalho parte da experiência da transmissão da psicanálise e da formação psicanalítica no Departamento de Psicanálise do Instituto Sedes Sapientiae para apresentar os fundamentos teóricos do chamado tripé analítico. Defende que um projeto institucional de formação deve se alicerçar em convicções epistemológicas acerca do objeto da psicanálise, do fazer analítico e das condições institucionais adequadas. Todos os elementos do tripé devem, de diferentes maneiras, produzir efeitos analíticos. Além disso, os dispositivos institucionais subjacentes à formação devem funcionar de forma solidária ao tripé, criando um ambiente que seja acolhedor, mas que não favoreça a alienação...

This paper stems from the psychoanalytical transmission experience and training in the Psychoanalysis Department of Sedes Sapientiae Institute, in order to present the theoretical grounds of the so-called analytical tripod. The paper claims that an institutional project on psychoanalytical training should be grounded on epistemological convictions about the object of psychoanalysis, the analytical practice and the appropriate institutional conditions. All the elements of the tripod should result in analytical effects. Moreover, the subjacent institutional devices should also work in agreement with the tripod, creating a friendly atmosphere, however not leading to alienation...

El trabajo toma como base la experiencia de transmisión del psicoanálisis y la formación psicoanalítica del Departamento de Psicoanálisis del Instituto Sedes Sapientiae, para presentar los fundamentos teóricos del llamado trípode analítico. Sostiene que un proyecto institucional de formación psicoanalítica debe basarse en convicciones epistemológicas sobre el objeto del psicoanálisis, del hacer analítico y de condiciones institucionales adecuadas. Todos los elementos del trípode deben, en diferentes formas, producir efectos analíticos. Además, los dispositivos institucionales subyacentes a la formación deben trabajar de manera solidaria con el trípode, creando un ambiente acogedor, pero que no favorezca la alienación...

Effect of tripod position on objective parameters of respiratory function in stable chronic obstructive pulmonary disease.

Objective. To examine changes in respiratory dynamics in patients with chronic obstructive pulmonary disease (COPD) sitting leaning forward with hands supported on the knees (tripod position), a posture frequently assumed by patients in respiratory distress. Methods. Spirometry, maximal inspiratory and expiratory pressures (MIP and MEP) generated at the mouth, and diaphragmatic excursion during tidal and vital capacity maneuver breathing measured by B-mode ultrasonography were studied in 13 patients with stable COPD in sitting, supine and tripod positions. Results. Mean±SD age of patients was 52.2±6.8 years. Median disease duration was three years. There was no statistically significant difference in spirometry for sitting, supine and tripod positions (FEV1: 1.11±0.4L, 1.14±0.5L and 1.11±0.4L; p=0.99), respectively, (FEV1/FVC: 49.2±11.0, 53.7±8.5 and 48.5±11.3, p=0.37), mouth pressures (MIP: 102.9±28.9, 90.6±29.1 and 99.2±32.9 cm H2O, p=0.61 and MEP: 100.8±29.9, 100.4±34.4 and 90.6±32.6 cmH2O, p=0.74) and diaphragmatic movements during tidal (16.1±5.9, 20.1±6.8 and 16.6±6.2 mm, p=0.22) and forced breathing (33.9±11.0, 43.1±19.6 and 37.4±17.1 mm, p=0.35). Conclusion. Commonly measured indices of respiratory function were not different in the tripod compared to sitting and supine positions.

Photoelastic stress analysis of implant supported fixed prostheses with different placement configurations in mandibular posterior region / 대한치과보철학회지

STATEMENT OF PROBLEM: More than 70% of patients who need the implant supported restoration are parially edentulous. The principles of design for implant supported fixed partial denture in mandibular posterior region are many and varied. Jurisdiction for their use is usually based on clinical evaluation. There are several areas of interest regarding the design of implant supported fixed partial denture in mandibular posterior region. 1) Straight and tripod configuration in implant placement, 2) Two restoration types such as individualized and splinted restorations. PURPOSE: The purpose of this study was to compare the amount and distribution of stress around the implant fixtures placed in the mandibular posterior region with two different arrangements and to evaluate the effects of splinting using the photoelastic stress analysis. MATERIALS AND METHODS: 1) Production of study model: Mandibular partially edentulous model was waxed-up and duplicated with silicone and two models were poured in stone. 2) Fixture installation and photoelastic model construction: Using surveyor(Ney, USA), 3 fixtures(two 4.0x13 mm, one 5.0x10 mm, Lifecore, USA) were installed in straight and tripod configurations. Silicone molds were made and poured in photoelastic resin (PL-2. Measurements group, USA). 3) Prostheses construction: Four 3-unit bridges (Type III gold alloy, Dongmyung co., Korea) were produced with nonhexed and hexed UCLA abutments and fitted with conventional methods. The abutments were tightened with 30 Ncm torque and the static loads were applied at 12 points of the occlusal surface. 4) Photoelastic stress analysis: The polarizer analyzer system with digital camera(S-2 Pro, Fujifilm, Japan) was used to take the photoelastic fringes and analysed using computer analysis program. RESULTS: Solitary hexed UCLA restoration developed different stress patterns between two implant arrangement configurations, but there were no stress transfer to adjacent implants from the loaded implant in both configurations. However splinted restorations showed lesser amount of stresses in the loaded implants and showed stress transfer to adjacent implants in both configurations. Solitary hexed UCLA restoration with tripod configuration developed higher stresses in anterior and middle implants under loading than implants with straight configurations. Splintied 3 unit fixed partial dentures with tripod configuration showed higher stress development in posterior implant under loading but there were no obvious differences between two configurations. CONCLUSIONS: The tripod configuration of implant arrangement didn't show any advantages over the straight configuration. Splinting of 3 unit bridges with nonhexed UCLA abutments showed less stress development around the fixtures. Solitary hexed UCLA restoration developed tilting of implant fixture under offset loads.

Application of Portable X-ray Machine in the Field / 医疗卫生装备

Through making a summary of using the portable X-ray machine in the earthquake relief,the equipment of the advantages and disadvantages in the field are analyzed and introduces the problems and solutions in application,and gives some improved suggestions for tripod.

Development of multi-body-position tripod of X-ray apparatus for field battle / 医疗卫生装备

Objective To develop new-type multi-body-position tripod of X-ray appratus for field battle.Methods One screw was added to the bottom of axis stayer of the original tripod for the inversion of fixed bulb so that the bulb could vertically project.Three support feet were porlonged at the same time.Results The X-ray appratus of the new-type multi-body-position tripod could project for patients in satnding or lying position and the range of focus adjustmet was enlarged,which could meet nomal requirements.The new-added crew was firm and its support quality was greatly over the quality of X-ray appratus.Compared with the original one,the barycenter of the appratus was lower,and the hemline length was longer.It remaind portable for the overall quality and length didn't change apparantly.Conclusion The new-type multi-body-position tripod of X-ray appratus for field battle meets the practical field requirments.

Operative Results in Orbital Floor Fracture Associated with Malar Tripod Fracture

17 patients underwent operations in malar tripod fracture combined with orbital floor fracture from January 1995 to June 1998. Age distribution was from 16 to 62. Sexual distribution was 15 males and 2 females. 11 cases were due to slip or all down. All orbital floors were reconstructed with silastic sheet through subciliary incision. In case of type I and type II, one-point fixation was performed with miniplate and screws on zygomaticomaxillary suture, In type III and IV, two-point fixation was done with miniplate and screws on zygomaticomaxillary and zygomaticofroptal suture by Gillies' approach and lateral eyebrow incision. Among 9 patients with preoperative diplopia, 5 patients improved within 1 week, 2 patients within 1 month. Among 3 patients with severe preoperative diplopia, 2 patients remained with mild diplopia, but no interference with daily work was encountered. In postoperative apperance and X-ray findings, excellent results were noted in 4 cases(24%), good cases in 10 cases (59%), fair cases in 3 cases (18%), but no poor case was found. 5 cases with Preoperative mouth opening limitation improved during postoperative period. In patients with malar tripod fracture with orbital floor fracture, it can serve as a good surgical method that bony fragment reduction by Gillies' approach and fixation with miniplate and screws.

The Clinical Study of the Method on the Stabilization of the Hemodynamic Response to Tripod Pin Fixation / 대한마취과학회지

We have observed that the tripod pin fixation for craniotomy is frequently accompanied by tachycardia and arterial hypertension, despite an apparently uate depth of general anesthesia beforehand. The method on the stabilization of the hemodynamic response to tripod pin fixation was studied in 73 adult normotensive patients. They were divided into four groups' 1) a control group (C group), 2) a group of bupivacaine loeal infiltration (B group), 3) a group receiving fentanyl 2 mg/kg intravenously (F group), and 4) a group receiving thiopental sodium 3 mg/kg intravenously (T group). Before the tripod pin fixation, we measured systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP) and heart rate (HR). After the tripod pin fixation we observed those parameters one minute interval till 7 minutes. B group and F group showed the significant stability of SBP, DBP and MAP in comparision to C group and T group. In the B group, all the parameters returned to pre-pin fixation level rapidly compared to F group. In conclusion, to prevent hemodynamic response to tripod pin fixation, bupivacaine local infilteration method is most effective in this study.