基于移动医疗的妊娠期盆底肌训练对产后尿失禁发生的影响：一项基于随机对照试验设计的探索性研究

背景 孕产妇尿失禁（UI）发病率高，严重影响了女性生活质量。研究表明，盆底肌训练是UI有效的防治手段，本研究前期进行了一项随机对照试验（RCT），结果发现相比于常规宣教，基于移动医疗APP的盆底肌训练并未显现出预防优势，其原因需要进一步深入探讨。 目的 本研究拟对一项基于APP的妊娠期盆底肌训练的干预研究的阴性结果进行探索性分析，旨在探讨产后UI预防效果的影响因素以及获益的亚组人群。 方法 本研究数据来源于前期开展的一项RCT，采用方便抽样法，于2020年6—10月在南方医科大学深圳医院产科门诊招募了126例研究对象，采用随机数字表法分为干预组与对照组，每组各63例。对照组采用常规护理，干预组在此基础上使用"有爱屋"APP进行尿失禁自我管理，干预周期为2个月。产后42 d随访时收集两组产后相关资料，包括产后42 d UI发生情况。以产后是否发生UI为结局指标，将研究对象分为病例组和对照组，采用Logistic回归分析探讨混杂因素及其与干预方式之间的交互作用对产后UI发生的影响。针对Logistic回归分析的结果进行分层分析，探讨是否存在能从APP干预中获益的亚组人群。 结果 病例组和对照组阴道分娩史、入组时存在UI、Broome盆底肌自我效能量表（BPMSES）得分比较，差异均有统计学意义（P<0.05）。Logistic回归分析结果显示，入组时存在UI是产后发生UI的危险因素〔OR=15.897，95%CI（4.724，53.495），P<0.001〕；BPMSES得分与干预方式的交互作用可影响产后UI的发生〔OR=1.034，95%CI（1.017，1.051），P<0.001〕。分层分析结果显示，入组时存在UI症状的孕妇，干预组产后UI发生率低于对照组（χ2=4.18，P=0.041）；入组时不存在UI症状的孕妇，两组产后UI发生率比较，差异无统计学意义（χ2=1.89，P=0.284）。 结论 推荐有UI症状的孕妇使用"有爱屋"APP或许可预防产后UI的发生。而对于妊娠期没有UI症状的人群使用"有爱屋"APP预防产后UI发生的证据尚不充分。另外，不管有无UI症状，盆底肌训练自我效能高的孕妇有望从APP干预中获益。     

The magnitude and progress of lean body mass,fat-free mass,and skeletal muscle mass loss following bariatric surgery: A systematic review and meta-analysis

Postbariatric loss of muscle tissue could negatively affect long-term health due to its role in various bodily processes, such as metabolism and functional capacity. This meta-analysis aimed to unravel time-dependent changes in the magnitude and progress of lean body mass (LBM), fat-free mass (FFM), and skeletal muscle mass (SMM) loss following bariatric surgery. A systematic literature search was conducted in Pubmed, Embase, and Web of Science. Fifty-nine studies assessed LBM (n = 37), FFM (n = 20), or SMM (n = 3) preoperatively and ≥1 time points postsurgery. Random-effects meta-analyses were performed to determine pooled loss per outcome parameter and follow-up time point. At 12-month postsurgery, pooled LBM loss was ?8.13 kg [95%CI ?9.01; ?7.26]. FFM loss and SMM loss were ?8.23 kg [95%CI ?10.74; ?5.73] and ?3.18 kg [95%CI ?5.64; ?0.71], respectively. About 55% of 12-month LBM loss occurred within 3-month postsurgery, followed by a more gradual decrease up to 12 months. Similar patterns were seen for FFM and SMM. In conclusion, >8 kg of LBM and FFM loss was observed within 1-year postsurgery. LBM, FFM, and SMM were predominantly lost within 3-month postsurgery, highlighting that interventions to mitigate such losses should be implemented perioperatively.     

Contribution of different somatosensory afferent input to subcortical somatosensory evoked potentials in humans

ObjectivesTo investigate the subcortical somatosensory evoked potentials (SEPs) to electrical stimulation of either muscle or cutaneous afferents.MethodsSEPs were recorded in 6 patients suffering from Parkinson’s disease (PD) who underwent electrode implantation in the pedunculopontine (PPTg) nucleus area. We compared SEPs recorded from the scalp and from the intracranial electrode contacts to electrical stimuli applied to: 1) median nerve at the wrist, 2) abductor pollicis brevis motor point, and 3) distal phalanx of the thumb. Also the high-frequency oscillations (HFOs) were analysed.ResultsAfter median nerve and pure cutaneous (distant phalanx of the thumb) stimulation, a P1-N1 complex was recorded by the intracranial lead, while the scalp electrodes recorded the short-latency far-field responses (P14 and N18). On the contrary, motor point stimulation did not evoke any low-frequency component in the PPTg traces, nor the N18 potential on the scalp. HFOs were recorded to stimulation of all modalities by the PPTg electrode contacts.ConclusionsStimulus processing within the cuneate nucleus depends on modality, since only the cutaneous input activates the complex intranuclear network possibly generating the scalp N18 potential.SignificanceOur results shed light on the subcortical processing of the somatosensory input of different modalities.     

Uncommon causes of nerve compression in the distal forearm

IntroductionNerve compression by anomalous masses located at the wrist and distal forearm is an infrequent condition. They may compress underlying structures in the carpal tunnel region, causing pain and paresthesias, which leads to the wrong diagnosis of carpal tunnel syndrome.Clinical casesWe present three cases of patients with symptomatology and clinical tests compatible with compression of the median nerve in the carpal tunnel but whose physical examination showed a soft mass in the distal region of the forearm which was compressing the median nerve, as demonstrated by ultrasound evaluation.DiscussionThe reported cases of accessory muscles or lipomas described in the literature as causes of median nerve compression clinic are mainly described only after the surgical decompression of the carpal tunnel, due to the maintenance of residual symptoms.ConclusionCareful examination with an ultrasound evaluation prior to surgery may help to identify these cases and help planning surgical treatment.