We reported a case of a 30-year-old man who reportedly sustained electrical burns and fell from a high voltage electric pole about 50 meter high onto a metal that caused impalement injury.In addition,he sustained full...We reported a case of a 30-year-old man who reportedly sustained electrical burns and fell from a high voltage electric pole about 50 meter high onto a metal that caused impalement injury.In addition,he sustained full-thickness burns of the right upper limb(7%),the right hemithorax,the perineum(sparing the penis),the anterior abdominal wall and the lateral aspect of both thighs.There was 43%burned surface area in total.Radiographic examination revealed a slender curved object extending from his perineum into the pelvis.The management of this case was a challenging one which was described in this article.展开更多
Background: Tactile imaging provides biomechanical mapping of soft tissues. Objective biomechanical and anatomical assessment of critical structures within the vagina and pelvis may allow development and validation of...Background: Tactile imaging provides biomechanical mapping of soft tissues. Objective biomechanical and anatomical assessment of critical structures within the vagina and pelvis may allow development and validation of a clinical tool that could assist with clinical decisions regarding obstetrical procedures and mode of delivery. Objective: To assess intraobserver reproducibility of measurements of perineal elasticity and pubic bone-perineal critical distance with a novel tactile probe in pregnant women. Methods: An Antepartum Tactile Imager (ATI) was designed with a vaginal probe resembling a fetal skull. The probe comprises 128 tactile sensors on a double curved surface and measures 46 mm in width and 72 mm in length. The probe has a motion tracking sensor that allows acquisition of 3D tactile images. There were two arms of the study. In the first arm, biomechanical mapping of the perineum and pelvic bone location was performed in 10 non-pregnant women for purposes of demonstrating safety and feasibility. In the second arm, biomechanical mapping was performed in 10 pregnant women to explore intraobserver reproducibility. Each subject had two standardized examinations over 3 - 5 minutes by the same observer. Examination comfort and pain levels were assessed by post-procedure survey. Reproducibility was analyzed by intraclass correlation coefficients (ICC) with 95% confidence intervals and Bland-Altman plots. Bias and the 95% limits of agreement were also calculated. Results: The safety and feasibility arm of the study demonstrated high degree of safety and tolerability and reliable acquisition of tactile signals. In the reproducibility arm, 10 pregnant women were recruited at mean gestational age of 34.2 ± 6.5 weeks. The mean perineum elasticity (Young’s modulus, E) was 9.8 ± 5.9 kPa, and the mean pubic bone-perineal critical distance (D) at 20 kPa load was 34.6 ± 6.2 mm. The ICC was 0.97 [95% confidence interval (CI) 0.91, 0.99] and 0.82 [CI 0.44, 0.95] for E and D respectively, consistent with excellent intrarater agreement. The bias and the 95% limits of agreement of E were -6.3% and -29.4% to +16.7%, respectively. The bias and the 95% limits of agreement of D were -2.6% and -25.3% to +20.2%, respectively. Conclusions: The tactile imaging data obtained in the study reproducibly characterized perineal elasticity and pubic bone-perineal critical distance. Further evaluation of this tool in clinical settings is warranted.展开更多
目的探讨在第二产程中使用产时超声测量产程进展角(AOP)和胎头-会阴距离(HPD)对分娩方式的预测价值。方法选取2022年9月—2024年6月在山东第一医科大学附属省立医院分娩的145例足月单胎初产妇,其中自然分娩129例(自然分娩组),器械助产...目的探讨在第二产程中使用产时超声测量产程进展角(AOP)和胎头-会阴距离(HPD)对分娩方式的预测价值。方法选取2022年9月—2024年6月在山东第一医科大学附属省立医院分娩的145例足月单胎初产妇,其中自然分娩129例(自然分娩组),器械助产和剖宫产16例(手术产组)。产妇在产程中均接受药物分娩镇痛,且在宫口开全进入第二产程时采用经会阴超声确定胎方位为枕前位,并于宫缩间期测量AOP和HPD。比较自然分娩组与手术产组AOP和HPD。绘制受试者工作特征(ROC)曲线,分析AOP和HPD对分娩方式的预测效能。结果自然分娩组年龄(29.22±3.42)岁,体质指数(27.11±3.20)kg/m^(2),第一产程时间(9.31±3.23)h,分娩孕周(39.87±0.82)周,出生体重(3329.61±322.98)g,1 min Apgar评分(9.78±0.49)分,5 min Apgar评分(9.98±0.20)分;手术产组年龄(30.56±3.35)岁,体质指数(28.55±2.18)kg/m^(2),第一产程时间(9.63±2.99)h,分娩孕周(40.21±0.82)周,出生体重(3746.25±408.47)g,1 min Apgar评分(9.50±0.52)分,5 min Apgar评分(9.94±0.25)分。自然分娩组与手术产组的年龄、体质指数、第一产程时间、分娩孕周及5 min Apgar评分比较差异均无统计学意义(均P>0.05)。自然分娩组与手术产组的出生体重、1 min Apgar评分比较,差异均有统计学意义(均P<0.05)。自然分娩组AOP为(123.67±10.34)°,HPD为(4.20±0.71)cm;手术产组AOP为(109.78±9.40)°,HPD为(4.85±0.38)cm。自然分娩组AOP明显高于手术产组,HPD明显低于手术产组,差异均有统计学意义(均P<0.05)。AOP预测阴道分娩的ROC曲线下面积为0.853,灵敏度为83.33%,特异度为75.97%,最佳截断值为117°(P<0.05)。HPD预测阴道分娩的ROC曲线下面积为0.740,灵敏度为83.33%,特异度为60.47%,最佳截断值为4.54 cm(P<0.05)。AOP≥120°组与AOP<120°组自然分娩率比较,差异有统计学意义(P<0.05)。HPD≤4.50 cm组与HPD>4.50 cm组自然分娩率比较,差异有统计学意义(P<0.05)。结论第二产程中使用超声测量AOP与HPD对分娩方式有较高的预测价值。展开更多
文摘We reported a case of a 30-year-old man who reportedly sustained electrical burns and fell from a high voltage electric pole about 50 meter high onto a metal that caused impalement injury.In addition,he sustained full-thickness burns of the right upper limb(7%),the right hemithorax,the perineum(sparing the penis),the anterior abdominal wall and the lateral aspect of both thighs.There was 43%burned surface area in total.Radiographic examination revealed a slender curved object extending from his perineum into the pelvis.The management of this case was a challenging one which was described in this article.
文摘Background: Tactile imaging provides biomechanical mapping of soft tissues. Objective biomechanical and anatomical assessment of critical structures within the vagina and pelvis may allow development and validation of a clinical tool that could assist with clinical decisions regarding obstetrical procedures and mode of delivery. Objective: To assess intraobserver reproducibility of measurements of perineal elasticity and pubic bone-perineal critical distance with a novel tactile probe in pregnant women. Methods: An Antepartum Tactile Imager (ATI) was designed with a vaginal probe resembling a fetal skull. The probe comprises 128 tactile sensors on a double curved surface and measures 46 mm in width and 72 mm in length. The probe has a motion tracking sensor that allows acquisition of 3D tactile images. There were two arms of the study. In the first arm, biomechanical mapping of the perineum and pelvic bone location was performed in 10 non-pregnant women for purposes of demonstrating safety and feasibility. In the second arm, biomechanical mapping was performed in 10 pregnant women to explore intraobserver reproducibility. Each subject had two standardized examinations over 3 - 5 minutes by the same observer. Examination comfort and pain levels were assessed by post-procedure survey. Reproducibility was analyzed by intraclass correlation coefficients (ICC) with 95% confidence intervals and Bland-Altman plots. Bias and the 95% limits of agreement were also calculated. Results: The safety and feasibility arm of the study demonstrated high degree of safety and tolerability and reliable acquisition of tactile signals. In the reproducibility arm, 10 pregnant women were recruited at mean gestational age of 34.2 ± 6.5 weeks. The mean perineum elasticity (Young’s modulus, E) was 9.8 ± 5.9 kPa, and the mean pubic bone-perineal critical distance (D) at 20 kPa load was 34.6 ± 6.2 mm. The ICC was 0.97 [95% confidence interval (CI) 0.91, 0.99] and 0.82 [CI 0.44, 0.95] for E and D respectively, consistent with excellent intrarater agreement. The bias and the 95% limits of agreement of E were -6.3% and -29.4% to +16.7%, respectively. The bias and the 95% limits of agreement of D were -2.6% and -25.3% to +20.2%, respectively. Conclusions: The tactile imaging data obtained in the study reproducibly characterized perineal elasticity and pubic bone-perineal critical distance. Further evaluation of this tool in clinical settings is warranted.
文摘目的探讨在第二产程中使用产时超声测量产程进展角(AOP)和胎头-会阴距离(HPD)对分娩方式的预测价值。方法选取2022年9月—2024年6月在山东第一医科大学附属省立医院分娩的145例足月单胎初产妇,其中自然分娩129例(自然分娩组),器械助产和剖宫产16例(手术产组)。产妇在产程中均接受药物分娩镇痛,且在宫口开全进入第二产程时采用经会阴超声确定胎方位为枕前位,并于宫缩间期测量AOP和HPD。比较自然分娩组与手术产组AOP和HPD。绘制受试者工作特征(ROC)曲线,分析AOP和HPD对分娩方式的预测效能。结果自然分娩组年龄(29.22±3.42)岁,体质指数(27.11±3.20)kg/m^(2),第一产程时间(9.31±3.23)h,分娩孕周(39.87±0.82)周,出生体重(3329.61±322.98)g,1 min Apgar评分(9.78±0.49)分,5 min Apgar评分(9.98±0.20)分;手术产组年龄(30.56±3.35)岁,体质指数(28.55±2.18)kg/m^(2),第一产程时间(9.63±2.99)h,分娩孕周(40.21±0.82)周,出生体重(3746.25±408.47)g,1 min Apgar评分(9.50±0.52)分,5 min Apgar评分(9.94±0.25)分。自然分娩组与手术产组的年龄、体质指数、第一产程时间、分娩孕周及5 min Apgar评分比较差异均无统计学意义(均P>0.05)。自然分娩组与手术产组的出生体重、1 min Apgar评分比较,差异均有统计学意义(均P<0.05)。自然分娩组AOP为(123.67±10.34)°,HPD为(4.20±0.71)cm;手术产组AOP为(109.78±9.40)°,HPD为(4.85±0.38)cm。自然分娩组AOP明显高于手术产组,HPD明显低于手术产组,差异均有统计学意义(均P<0.05)。AOP预测阴道分娩的ROC曲线下面积为0.853,灵敏度为83.33%,特异度为75.97%,最佳截断值为117°(P<0.05)。HPD预测阴道分娩的ROC曲线下面积为0.740,灵敏度为83.33%,特异度为60.47%,最佳截断值为4.54 cm(P<0.05)。AOP≥120°组与AOP<120°组自然分娩率比较,差异有统计学意义(P<0.05)。HPD≤4.50 cm组与HPD>4.50 cm组自然分娩率比较,差异有统计学意义(P<0.05)。结论第二产程中使用超声测量AOP与HPD对分娩方式有较高的预测价值。
