骶四针疗法配合盆底肌锻炼对产后压力性尿失禁患者盆底功能及性生活质量的影响

目的探讨骶四针疗法配合盆底肌锻炼对产后压力性尿失禁患者盆底功能及性生活质量的影响。方法选取2017年5月至2020年5月新疆医科大学第一附属医院收治的98例产后压力性尿失禁患者作为研究对象。采用随机数字表法分为研究组和对照组,各49例。两组均接受常规护理,对照组在常规护理的基础上给予盆底肌锻炼,研究组在对照组的基础上给予骶四针疗法,比较两组的临床疗效?1 h漏尿量?盆底肌力恢复情况及性生活情况。结果治疗后,研究组总有效率为91.84%,明显高于对照组的69.39%,差异具有统计学意义(P<0.05);与治疗前比较,治疗后两组1 h漏尿量减少,且研究组1 h漏尿量少于对照组,差异具有统计学意义(P<0.05);治疗后,两组盆底肌力分级均升高,且研究组盆底肌力分级高于对照组,差异具有统计学意义(P<0.05);治疗后,研究组性生活质量高水平比率为38.78%,高于对照组的20.41%,差异具有统计学意义(P<0.05)。结论骶四针疗法配合盆底肌锻炼用于产后压力性尿失禁患者,能改善患者的漏尿情况,提高其盆底肌力及性生活质量,临床疗效较好。     

低频电刺激联合生物反馈治疗子宫切除术后盆底功能障碍的效果观察

目的 探讨低频电刺激联合生物反馈治疗(子宫全切或子宫次切)术后盆底功能障碍的临床效果。方法 选择2017年6月～2019年2月在我院诊断治疗的子宫全切或次全切术后盆底功能障碍的患者100例为研究对象,随机分为观察组与对照组,每组50例。对照组实施盆底肌功能训练,观察组实施低频电刺激治疗及生物反馈治疗。比较两组治疗前后PFDI-20评分、最大尿流率、平均尿流率、排尿时间、残余尿、盆底电生理功能。结果(1)治疗后,两组PFDI-20评分较治疗前低,差异有统计学意义(P0.05);观察组治疗后PFDI-20评分较对照组低,差异有统计学意义(P0.05)。(2)治疗后,两组最大尿流率、平均尿流率均显著提高,与治疗前比较差异有统计学意义(P0.05);两组排尿时间短于治疗前,残余尿量少于治疗前,差异有统计学意义(P0.05)。治疗后,观察组相较于对照组,排尿时间更短,残余尿量更少,差异有统计学意义(P0.05)。(3)治疗后,两组Ⅰ类肌纤维肌力、Ⅱ类肌纤维肌力均高于治疗前,差异有统计学意义(P0.05);观察组治疗后Ⅰ类肌纤维肌力、Ⅱ类肌纤维肌力优于对照组,差异有统计学意义(P0.05)。结论 低频电刺激联合生物反馈治疗子宫切除术后盆底功能障碍可显著改善盆底电生理功能,改善排尿情况,改善症状。     

Effects of exercise interventions on the functional status of acutely hospitalised older adults: A systematic review and meta-analysis

BackgroundAcute hospitalisation can have adverse effects in older adults, notably functional decline. We aimed to summarize evidence on the effects of exercise interventions in acutely hospitalised older adults.MethodsRelevant articles were systematically searched (PubMed, Web of Science, Rehabilitation & Sports Medicine Source, and EMBASE) until 19^th March 2020. Randomized controlled trials (RCTs) of in-hospital exercise interventions versus usual care conducted in older adults (>60yrs) hospitalised for an acute medical condition were included. Methodological quality of the studies was assessed with the PEDro scale. Primary outcomes included functional independence and physical performance. Intervention effects were also assessed for other major outcomes (length of hospital stay, incidence of readmission, and mortality). A meta-analysis was conducted when ≥3 studies analysed the same outcome.ResultsFifteen studies from 12 RCTs (n = 1748) were included. Methodological quality of the studies was overall high. None of the studies reported any adverse event related to the intervention. Exercise interventions improved functional independence at discharge (standardized mean difference [SMD] = 0.64, 95% confidence interval = 0.19–1.08) and 1–3 months post-discharge (SMD = 0.29, 95%CI = 0.13–0.43), as well as physical performance (SMD = 0.57, 95%CI = 0.18–0.95). No between-group differences were found for length of hospital stay or risk of readmission or mortality (all p > 0.05).ConclusionsIn-hospital supervised exercise interventions seem overall safe and effective for improving – or attenuating the decline of – functional independence and physical performance in acutely hospitalised older adults. The clinical relevance of these findings remains to be confirmed in future research.     

Phenotyping Sexual Pain in Endometriosis Using the Central Sensitization Inventory

IntroductionDeep dyspareunia, a common symptom in endometriosis, has previously been associated with bladder and/or pelvic floor tenderness (BPFT), which suggests a role for central nervous system sensitization. The Central Sensitization Inventory (CSI, 0–100) is a validated self-reported scale for patients with central sensitization.AimThe objective of this study was to phenotype deep dyspareunia using BPFT and the CSI.MethodsThe methods included cross-sectional analysis from a prospective registry from January 2018 to June 2018 at a tertiary center for endometriosis (ClinicalTrials.gov #NCT02911090). Included were women aged 18–50 years with endometriosis (previously surgically diagnosed, current visualized endometrioma on ultrasound, or current palpable or visualized nodule on ultrasound), who were newly or re-referred to the center. Severity of deep dyspareunia was self-reported using an 11-point numeric rating scale (0 = no pain; 10 = worst pain imaginable), categorized as no or low deep dyspareunia (0–4) and high deep dyspareunia (5–10). We identified the subgroup with high deep dyspareunia and presence of BPFT, where we hypothesized a central component of the sexual pain. This subgroup was compared with 2 other subgroups: no or low deep dyspareunia and high deep dyspareunia but no BPFT. The CSI was compared between the groups using analysis of variance, followed by post hoc testing (P < .05).Main Outcome MeasureThe main outcome measure was the CSI score ranging from 0 to 100.ResultsData from 163 women with endometriosis were analyzed. The mean age of this cohort was 36.4 ± 6.8 years, and the mean CSI score was 41.0 ± 18.6. 37 percent (61/163) had high deep dyspareunia and BPFT; 29% (47/163) had high deep dyspareunia and no BPFT; and 34% (55/163) had no or low deep dyspareunia. The CSI significantly differed between the 3 groups (analysis of variance: F = 22.4, P < .001). In post hoc testing, the CSI was higher in women with high deep dyspareunia and BPFT (51.3 ± 16.9), compared with women with no or low deep dyspareunia (30.9 ± 15.4, P < .001) and compared with women with high deep dyspareunia but no BPFT (39.4 ± 17.2, P = .001).Clinical ImplicationsThe CSI could be used to classify and phenotype patients with endometriosis-associated sexual pain.Strength & LimitationsStrengths include a prospective registry with integrated pain scores, validated questionnaires, and physical examination findings. Limitations include the lack of quantitative sensory testing for central sensitization.ConclusionsIn women with endometriosis, the subgroup with high deep dyspareunia and bladder and/or pelvic floor tenderness had a significantly higher score on the CSI than other subgroups, suggesting that this group may have a central component to their sexual pain.Orr NL, Wahl KJ,Noga H, et al. Phenotyping Sexual Pain in Endometriosis Using the Central Sensitization Inventory. J Sex Med 2020;17:761–770.     

Outcomes of Acetabular Reconstructions for the Management of Chronic Pelvic Discontinuity: A Systematic Review

BackgroundA number of articles have been published reporting on the clinical outcomes of various acetabular reconstructions for the management of chronic pelvic discontinuity (PD). However, no systematic review of the literature has been published to date comparing the outcome and complications of different approaches to reconstruction.MethodsThe US National Library of Medicine (PubMed/MEDLINE) and EMBASE were queried for publications from January 1980 to January 2019 using keywords pertinent to total hip arthroplasty, PD, acetabular dissociation, clinical or functional outcomes, and revision total hip arthroplasty or postoperative complications.ResultsOverall, 18 articles were included in this analysis (569 cases with chronic PD). The overall survival rate of the acetabular components used for the treatment of chronic PD was 84.7% (482 of 569 cases) at mid-term follow-up, whereas the most common reasons for revision were aseptic loosening (54 of 569 hips; 9.5%), dislocations (45 of 569 hips; 7.9%), periprosthetic joint infection (30 of 569 hips; 5.3%), and periprosthetic fractures (11 of 569 hips; 1.9%). Both pelvic distraction technique (combined with highly porous shells) and custom triflanges resulted in less than 5% failure rates (96.2% and 95.8%, respectively) at final follow-up. Also, highly effective in the treatment of PD were cup-cages and highly porous shells with and/or without augments with 92% survivorship free of revision for aseptic loosening for both reconstruction methods. Inferior outcomes were reported for conventional cementless shells combined with acetabular plates (72.7%) as well as ilioischial cages and reconstruction rings (66.7% and 60.6% survivorship, respectively).ConclusionThe current literature contains moderate quality evidence in support of the use of custom triflange implants and pelvic distraction techniques for the treatment of chronic PD, with a less than 5% all-cause revision rate and low complication rates at mean mid-term follow-up. Cup-cages and highly porous shells with or without augments could also be considered for the treatment of PD because both resulted in greater than 90% survival rates. Finally, there is still no consensus regarding the impact of different types of acetabular reconstruction methods on optimizing the healing potential of PD, and further studies are required in this area to better understand the influence of PD healing on construct survivorship and functional outcomes with each reconstruction method.