Objectives:Postmenopausal women with stress urinary incontinence(SUI)exhibit low androgen expression.This study aimed to evaluate the efficacy and safety of vaginal androgen combined with pelvic floor muscle training(...Objectives:Postmenopausal women with stress urinary incontinence(SUI)exhibit low androgen expression.This study aimed to evaluate the efficacy and safety of vaginal androgen combined with pelvic floor muscle training(PFMT)in the treatment of SUI in postmenopausal women.Methods:Postmenopausal women with SUI were recruited from Hainan West Central Hospital between January 2024 and March 2025.Participants were randomly assigned in a double-blind manner to receive either vaginal androgen cream combined with PFMT(treatment group)or a visually identical placebo cream(without androgens)combined with PFMT(control group).The vaginal cream was applied to the vaginal wall at a dose of 0.5 g per application,twice weekly for a total of 10 applications,while PFMT was conducted for 8 weeks.The clinical efficacy and safety were compared between the two groups.Results:A total of 61 patients were finally enrolled,with 31 in the treatment group and 30 in the control group.At both 3-month and 6-month follow-ups,the treatment group demonstrated significantly lower values in daily pad usage(p<0.05),24-h pad test scores(p<0.05),and ICIQ-UI SF scores(p<0.05)compared to the control group.The improvement rate of urinary incontinence was significantly higher in the treatment group(p<0.05).Compared to baseline,the treatment group showed statistically significant reductions in all three outcome measures(all p<0.05).No severe adverse events were reported in either group during the treatment period.Conclusions:Androgen therapy combined with PFMT significantly improved the urinary incontinence remission rate in postmenopausal women with SUI,with no severe adverse effects observed.These findings suggest that androgen therapy may represent a novel therapeutic approach for SUI management in postmenopausal women.展开更多
Objective:To investigate the clinical efficacy of electrophysiological therapy under different parameter modes in chronic pelvic pain syndrome(CPPS).Methods:A total of 95patients with CPPS from the Department of Urolo...Objective:To investigate the clinical efficacy of electrophysiological therapy under different parameter modes in chronic pelvic pain syndrome(CPPS).Methods:A total of 95patients with CPPS from the Department of Urology,First Affiliated Hospital of Jinan University,were selected and treated with electrophysiological therapy.They were randomly divided into three groups:the fixed-parameter AA7 treatment group,the P2+P4 treatment group,and the precision treatment group(individualized parameter treatment).Pain scores of patients in each group were compared before and after treatment,with a pain score of 0 indicating cure.The cure rate of each group was observed.Results:The average ages of the AA7 group,P2+P4 group,and precision treatment group were 34±14.17 years,35.58±12.57 years,and 35.5±11.27 years,respectively.There was no significant difference in age among the three groups(p>0.05).Before treatment,the pain scores of the AA7 group,P2+P4 group,and precision treatment group were 4.14±1.74,4.64±1.72,and 3.50±1.89,respectively,with no significant differences among the groups(p>0.05).After treatment,the pain scores were 0.71±0.99 for the AA7 group(cure rate:57%),0.49±0.79 for the P2+P4 group(cure rate:67%),and 0.50±0.77 for the precision treatment group(cure rate:64%),with no significant differences among the groups(p>0.05).The cure rates for different pain locations were as follows:83%for lower abdominal pain,74%for perineal pain,62%for dysuria,49%for testicular pain,and 75%for inguinal pain.Conclusion:The pathogenesis of CPPS is complex and diverse,with numerous treatment options and uncertain efficacy,posing significant challenges to clinical practice.This study showed that electrophysiological therapy under different parameter modes significantly reduced pain scores before and after treatment,indicating significant therapeutic effects on CPPS.All three modes demonstrated good cure rates.Individualized precision treatment and fixed-mode P2+P4 or AA7 treatment were safe and effective in CPPS treatment and are worth promoting.Fixed-mode P2+P4 and AA7,due to their easier standardization of parameters and patch modes,reduced the learning curve and had better potential for widespread application.展开更多
Objectives:PSMA PET/CT(Prostate-Specific MembraneAntigen Positron Emission Tomography/Computed Tomography)offers improved accuracy in detecting lymph node invasion(LNI)in prostate cancer(PC)patients,potentially reduci...Objectives:PSMA PET/CT(Prostate-Specific MembraneAntigen Positron Emission Tomography/Computed Tomography)offers improved accuracy in detecting lymph node invasion(LNI)in prostate cancer(PC)patients,potentially reducing the need for extended pelvic lymph node dissection(ePLND).This study aims to evaluate a patient-tailored care pathway in which ePLND is performed only in patients with unfavorable intermediate-or high-risk PC who are deemed at risk for LNI based on PSMA PET/CT findings.Methods:In this interventional cohort study,81 patients were managed according to the new care pathway.ePLND was omitted in cases of negative PSMA PET/CT findings(N0M0),while those with positive PSMA PET/CT findings(N1M0)underwent ePLND.A comparator group of 81 patients was selected from a prospectively generated database for comparison.Results:The intervention group experienced a 75% reduction in the number of ePLNDs performed compared to the comparator group(p<0.001).ePLND-related complications were significantly lower in the intervention group(p=0.008).No significant difference was observed in 3-year biochemical-recurrence free survival(BRFS)between the two groups(p=0.958).Conclusion:Omitting ePLND in patients with negative PSMA PET/CT findings(N0M0)leads to a substantial reduction in the number of ePLNDs performed,resulting in a decrease in morbidity,without compromising early oncological outcomes.展开更多
Vaginal delivery is a fascinating physiological process,but also a high-risk process.Up to 85%–90%of vaginal deliveries lead to perineal trauma,with nearly 11%of severe perineal tearing.It is a common occurrence,espe...Vaginal delivery is a fascinating physiological process,but also a high-risk process.Up to 85%–90%of vaginal deliveries lead to perineal trauma,with nearly 11%of severe perineal tearing.It is a common occurrence,especially for first-time mothers.Computational childbirth plays an essential role in the prediction and prevention of these traumas,but fast personalization of the pelvis and floor muscles is challenging due to their anatomical complexity.This study introduces a novel shape-prediction-based personalization of the pelvis and floor muscles for perineal tearing management and childbirth simulation.300 subjects were selected from public Computed Tomography(CT)databases.The pelvic bone nmjmeshes were generated using a coarse-to-fine non-rigid mesh alignment procedure.The floor muscle meshes were personalized using the bone mesh deformation information.A feature-to-pelvic structure reconstruction pipeline was proposed,incorporating various strategies.Ten-fold cross-validation helped determine the optimal reconstruction strategy,regression method,and feature sizes.The mesh-to-mesh distance metric was employed for evaluating.The statistical shape relation-based strategy,coupled with multi-output ridge regression,was the optimal approach for pelvic structure reconstruction.With a feature set ranging from 3 to 38,the mean errors were 2.672 to 1.613 mm,and 3.237 to 1.415 mm in muscle attachment regions.The best-and worst-case predictions had errors of 1.227±0.959 mm and 2.900±2.309 mm,respectively.This study provides a novel approach to achieving fast personalized childbirth modeling and simulation for perineal tearing management.展开更多
Objective:Stress urinary incontinence(SUI)is a common condition among women that severely impairs quality of life.Pelvic floor proprioceptive training(PFPT)has attracted increasing attention for its potential to enhan...Objective:Stress urinary incontinence(SUI)is a common condition among women that severely impairs quality of life.Pelvic floor proprioceptive training(PFPT)has attracted increasing attention for its potential to enhance pelvic floor muscle function and alleviate SUI symptoms.This study aims to observe and compare the clinical efficacy of PFPT combined with electroacupuncture,electrical stimulation,and biofeedback therapy versus conventional therapy consisting of electroacupuncture,electrical stimulation,and biofeedback alone in women with SUI,and to explore the role of PFPT in improving symptom and functional outcomes.Methods:In this randomized controlled trial,72 women with mild to moderate SUI were recruited from the Department of Rehabilitation Medicine at Third Xiangya Hospital,Central South University,between December 2021 and October 2023.Participants were randomly assigned to an experimental group(n=36)or a control group(n=36).Both groups received health education.The control group underwent electroacupuncture combined with electrical stimulation and biofeedback therapy,while the experimental group additionally received PFPT 3 times per week for 4 weeks.The primary outcome was assessed using the International Consultation on Incontinence Questionnaire-Short Form(ICIQ-SF).Secondary outcomes included pelvic floor muscle strength,bladder neck mobility,and balance ability.The ICIQ-SF was reassessed at 1,3,6,and 12 months post-treatment.Results:Both groups showed statistically significant improvements in all parameters after treatment(all P<0.05).However,there were no statistically significant differences between groups in most measures(all P>0.05).The experimental group demonstrated longer singleleg stance duration with eyes closed than the control group(left leg:P=0.026;right leg:P=0.006),with a significant increase from baseline(P<0.001).At 6 months post-treatment,the cure rate in the experimental group was significantly higher than that in the control group(P=0.037).Conclusion:Conventional therapy effectively improves SUI symptoms,but adding PFPT provides notable additional benefits,including enhanced balance ability and sustained midterm cure rates.These findings suggest that PFPT is a valuable adjunct to standard SUI management strategies.展开更多
In this editorial,we comment on an article by Wang et al.Recent literature shows an increase in research on pelvic organ prolapse(POP).Although the true incidence of POP remains uncertain,its impact on quality of life...In this editorial,we comment on an article by Wang et al.Recent literature shows an increase in research on pelvic organ prolapse(POP).Although the true incidence of POP remains uncertain,its impact on quality of life is substantial.Anatomical studies report high incidence rates,surpassing those observed in symptom-based surveys.Weakness of the endopelvic fascia is a primary anatomical risk factor for POP.Additionally,gestational diabetes mellitus(GDM)has emerged as a growing concern,as poor glycemic control increases complications for both mother and fetus.GDM and POP are interconnected,with factors like maternal obesity,macrosomia,and hormonal changes exacerbating pelvic floor dysfunction.Modifiable risk factors,such as obesity and chronic hyperglycemia,along with multiparity,instrumental deliveries,and obstetric trauma,further increase susceptibility.For patients with GDM,gynecological exams,Pelvic Organ Prolapse Quantification staging,and pelvic floor ultrasonography are valuable diagnostics,with proctological exams and magnetic resonance defecography aiding in multi-compartment prolapse diagnoses.Imaging,though uncomfortable during pregnancy,is safe in the early postpartum period.This editorial emphasizes the need for further research on the pathophysiology of GDM-related POP and offers recommendations for improving diagnosis and clinical management of patients with GDM.展开更多
BACKGROUND Pelvic fractures are often associated with significant morbidity,including injuries to the urinary tract.Understanding the incidence and risk factors for urinary tract injury in these patients is crucial fo...BACKGROUND Pelvic fractures are often associated with significant morbidity,including injuries to the urinary tract.Understanding the incidence and risk factors for urinary tract injury in these patients is crucial for prompt diagnosis and management.This meta-analysis aims to synthesize existing evidence to determine the overall incidence and identify specific risk factors associated with urinary tract injuries in patients with pelvic fractures.AIM To determine the incidence and risk factors for urinary tract injuries in patients with pelvic fractures.METHODS A systematic search of PubMed,EMBASE,Scopus,and the Cochrane Library was conducted without date restrictions.Studies examining the incidence and risk factors of urinary tract injuries in patients with pelvic fractures were included.Data extracted included demographics,injury mechanism,pelvic fracture type,urinary tract injury incidence,mortality,and discharge disposition.Review Manager 5.4 was used for data analysis.RESULTS Ten studies comprising 22700 patients were included.The pooled incidence of urinary tract injury associated with pelvic fracture was 6.88%(95%CI:6.20%-7.55%).Vehicle,motorcycle,and pedestrian accidents were identified as risk factors for urinary tract injury,with relative risks(RR)of 1.08(95%CI:1.06-1.11),1.89(95%CI:1.78-2.00),and 1.53(95%CI:1.20-1.95),respectively.Pubic fracture and pelvic ring disruption were significantly associated with urinary tract injury[odds ratio(OR)1.94,95%CI:1.09-3.44 and OR 5.53,95%CI:4.67-6.54,respectively)].Patients without urinary tract injury were more likely to be discharged home(RR 0.79,95%CI:0.67-0.92).Mortality was higher in patients with urinary tract injury(OR 1.92,95%CI:1.77-2.09).CONCLUSION Urinary tract injury occurs in nearly 7%of patients with pelvic fractures.Motorcycle accidents,pubic fractures,and pelvic ring disruptions are significant risk factors.Urinary tract injury following pelvic fracture is associated with increased mortality.展开更多
Objective This is a self-controlled multicenter retrospective study based on the clinical efficacy and complications of physiological reconstruction in the treatment of moderate and severe pelvic organ prolapse.Method...Objective This is a self-controlled multicenter retrospective study based on the clinical efficacy and complications of physiological reconstruction in the treatment of moderate and severe pelvic organ prolapse.Methods From December 2014 to August 2021,517 women were included and registered for physiological reconstruction at four Chinese urogynecology institutions.We enrolled 364 women with POP-Q stage≥3.The degree of POP was quantified via a POP-Q system.The surgical purpose of physiological reconstruction is to repair the vagina,levator ani muscle,perineum,and urogenital hiatus and adopt a repair method in accordance with the axial direction of physiology.All 330 evaluable participants were followed for 2 years.The evaluation indices included the PFDI-20,PGI-I,PFIQ-7,PISQ-12,PGI-I,and PGI-S.All complications were coded according to the category-time-site system proposed by the International Urogynecological Association(IUGA)and International Continence Society(ICS).Results Compared with the preoperative POP-Q scores,statistically significant improvements were observed at the 6-month,1-year and 2-year time points(P<0.001).Statistically significant improvements in quality of life were observed across all time points.Conclusions Physiologic reconstructive surgical techniques combined with modified anterior pelvic floor mesh implantation could help restore the physiologic axis and vaginal shape,which may be the most important factors in maintaining the functional position of pelvic floor organs and is the most effective method for repairing the pelvic fascia tendon arch.This surgical method is safe,feasible,and effective in patients with severe prolapse.展开更多
BACKGROUND Pelvic organ prolapse(POP)can lead to urinary incontinence,fecal incontinence,and other symptoms,affecting the quality of life,which results in anxiety and depression and other negative emotions in many pat...BACKGROUND Pelvic organ prolapse(POP)can lead to urinary incontinence,fecal incontinence,and other symptoms,affecting the quality of life,which results in anxiety and depression and other negative emotions in many patients.Trans-vaginal sacrospinous ligament suspension(VSSLS)involves securing the apex of the prolapsed vagina to the sacrospinous ligament to maintain the physiological axis of the vagina,help in repairing pelvic floor defects,and maintain the normal function of the pelvic floor,thereby alleviating patients’anxiety and depression.AIM To explore the effect of VSSLS in the treatment of POP and its influence on anxiety and depression among patients.METHODS Sixty patients with moderate to severe POP who underwent surgical treatment between January 2023 and June 2024 in Suzhou Ninth Hospital Affiliated to Soochow University were retrospectively enrolled in the study.According to treatment methods,they were divided into the control group(n=30,treated with vaginal hysterectomy alone)and observation group(n=30,treated with VSSLS combined with vaginal hysterectomy).The two groups were compared by baseline data,perioperative indicators,and postoperative pain intensity,prolapse distance before and after surgery,sexual function,pelvic function,anxiety,and depression.RESULTS No significant differences in baseline data,preoperative POP Quantification measurement value,Pelvic Floor Dysfunction Inventory 20(PFDI-20),Pelvic Floor Impact Questionnaire 7(PFIQ-7),Self-Rating Anxiety Scale(SAS),and Self-Rating Depression Scale(SDS)scores were found between the two groups.The obser vation group had longer operation time and more intraoperative blood loss than the control group,the Visual Analog Scale score on postoperative day 1 was slightly higher in than in the control group.On the reexamination 3 months postoperatively,the POP Quantification measurement values in the observation group were lower than those in the control group(P<0.05).Evaluation 6 months after surgery,the FSFI score was higher in the observation group than in the control group,the PFDI-20,PFIQ-7,SAS and SDS score scored were lower in than in the control group(P<0.05).The PFDI-20,PFIQ-7 scores positively correlated with the SAS and SDS scores.CONCLUSION VSSLS demonstrated a significant effect on the treatment of moderate and severe POP,as it can reduce the prolapse distance and PFDI-20 and PFIQ-7 scores and improve anxiety and depression among patients.展开更多
BACKGROUND Retrograde pubic ramus screw placement is an effective technique but requires substantial surgical expertise and specialized equipment.The management of osteoporotic anterior pelvic ring injuries remains ch...BACKGROUND Retrograde pubic ramus screw placement is an effective technique but requires substantial surgical expertise and specialized equipment.The management of osteoporotic anterior pelvic ring injuries remains challenging due to technical difficulties and a high risk of complications.AIM To introduce a novel and simplified surgical approach that utilizes a custom-designed handheld pelvic alignment guide(HPAG)in combination with a 6.0 mm hollow screw,aiming to enhance the accuracy,efficiency,and safety of retrograde pubic ramus screw fixation in osteoporotic pelvic fragility fractures.METHODS The HPAG and 6.0 mm hollow screw were employed during surgical treatment.A 2.0-3.0 cm incision was made to expose the optimal screw entry point.Intraop-erative pelvic inlet and obturator oblique views were used to monitor fracture reduction and guide screw insertion.Clinical outcomes and fracture reduction quality were evaluated using Matta,visual analog scale,and Majeed scores during follow-ups.A representative case is presented to demonstrate the surgical procedure in detail.RESULTS No perioperative complications were observed.The mean operative time was 35.2±6.97 minutes,with a screw insertion time of 7.25±1.86 minutes,an average incision length of 2.8±0.67 cm,and mean blood loss of 43.25±15.64 mL.At one-year follow-up,seven patients achieved excellent Majeed scores and three achieved good scores.CONCLUSION No perioperative complications were observed.The mean operative time was 35.2±6.97 minutes,with a screw insertion time of 7.25±1.86 minutes,an average incision length of 2.8±0.67 cm,and mean blood loss of 43.25±15.64 mL.At one-year follow-up,seven patients achieved excellent Majeed scores and three achieved good scores.展开更多
BACKGROUND Sagittal spinopelvic alignment(SSA)is essential for preserving a stable and effective upright posture and locomotion.Although alterations in the SSA are recognised to induce compensatory modifications in th...BACKGROUND Sagittal spinopelvic alignment(SSA)is essential for preserving a stable and effective upright posture and locomotion.Although alterations in the SSA are recognised to induce compensatory modifications in the pelvis,hips,and knees,the inverse relationship concerning knee pathology undergoing total knee arthroplasty(TKA)has been examined by a limited number of studies,yielding inconclusive results.AIM To generate evidence of the effect of TKA on the SSA from existing literature.METHODS Databases like PubMed,EMBASE,and Scopus were used to identify articles related to the“knee spine syndrome”phenomenon using a combination of subject terms and keywords such as“spinopelvic parameters”,“sagittal spinal balance”,and“total knee arthroplasty”were used with appropriate Boolean operators.Studies measuring the SSA following TKA were included,and research was conducted as per preferred reporting items for systematic review and metaanalysis guidelines.RESULTS A total of 475 participants had undergone TKA,and six studies measuring SSA were analysed.Following TKA,pelvic tilt was the only parameter that showed significant changes,while lumbar lordosis(LL),pelvic incidence,and sacral slope were non-significant,as evident from the forest plots.CONCLUSION The body's sagittal alignment is a complex balance between pelvic,spine,and lower extremity parameters.TKA,while having the potential to correct the flexion contracture,can also correct it.Still,the primary SSA for spinal pathology,i.e.,LL,may not be corrected in patients with co-existent spinal degenerative disease.展开更多
Chronic prostatitis/chronic pelvic pain syndrome(CP/CPPS)is a complex disease that is often accompanied by mental health disorders.However,the potential mechanisms underlying the heterogeneous clinical presentation of...Chronic prostatitis/chronic pelvic pain syndrome(CP/CPPS)is a complex disease that is often accompanied by mental health disorders.However,the potential mechanisms underlying the heterogeneous clinical presentation of CP/CPPS remain uncertain.This study analyzed widely targeted metabolomic data of expressed prostatic secretions(EPS)and plasma to reveal the underlying pathological mechanisms of CP/CPPS.A total of 24 CP/CPPS patients from The Second Nanning People’s Hospital(Nanning,China),and 35 asymptomatic control individuals from First Affiliated Hospital of Guangxi Medical University(Nanning,China)were enrolled.The indicators related to CP/CPPS and psychiatric symptoms were recorded.Differential analysis,coexpression network analysis,and correlation analysis were performed to identify metabolites that were specifically altered in patients and associated with various phenotypes of CP/CPPS.The crucial links between EPS and plasma were further investigated.The metabolomic data of EPS from CP/CPPS patients were significantly different from those from control individuals.Pathway analysis revealed dysregulation of amino acid metabolism,lipid metabolism,and the citrate cycle in EPS.The tryptophan metabolic pathway was found to be the most significantly altered pathway associated with distinct CP/CPPS phenotypes.Moreover,the dysregulation of tryptophan and tyrosine metabolism and elevation of oxidative stress-related metabolites in plasma were found to effectively elucidate the development of depression in CP/CPPS.Overall,metabolomic alterations in the EPS and plasma of patients were primarily associated with oxidative damage,energy metabolism abnormalities,neurological impairment,and immune dysregulation.These alterations may be associated with chronic pain,voiding symptoms,reduced fertility,and depression in CP/CPPS.This study provides a local-global perspective for understanding the pathological mechanisms of CP/CPPS and offers potential diagnostic and therapeutic targets.展开更多
Objective:Pelvic floor dysfunction is common among pregnant and postpartum women and significantly impacts quality of life.This study aims to translate the German Pelvic Floor Questionnaire for Pregnant and Postpartum...Objective:Pelvic floor dysfunction is common among pregnant and postpartum women and significantly impacts quality of life.This study aims to translate the German Pelvic Floor Questionnaire for Pregnant and Postpartum Women into Chinese and to evaluate its reliability and validity in the Chinese population.Methods:The questionnaire was translated using the Brislin model.A cross-sectional study was conducted among pregnant and postpartum women to assess the content validity,construct validity,Cronbach’sαcoefficient,test-retest reliability,and split-half reliability of the Chinese version.Results:A total of 72 women were included,with 6.9% being pregnant and 93.1% postpartum;the age was(32.3±3.6)years.The Chinese version of the questionnaire contains 4 dimensions and 45 items.The content validity index of individual items ranged from 0.833 to 1.000,with a scale-level content validity index of 0.977 and intraclass correlation coefficients(ICCs)exceeding 0.90.The overall Cronbach’s α coefficient was 0.891,with subscale coefficients ranging from 0.732 to 0.884(all ICCs>0.70).The testretest reliability of the total scale was 0.833,and for the 4 dimensions,bladder,bowel,prolapse,and sexual function,the values were 0.776,0.579,0.732,and 0.645,respectively.The split-half reliability was 0.74.Conclusion:The Chinese version of the questionnaire demonstrated good reliability and validity,indicating its applicability in assessing pelvic floor dysfunction and associated risk factors during pregnancy and postpartum.展开更多
Biodegradable magnesium(Mg)materials offer significant advantages in trauma care due to their degradable nature and superior mechanical properties.This study reports the first successful use of degradable Mg clips in ...Biodegradable magnesium(Mg)materials offer significant advantages in trauma care due to their degradable nature and superior mechanical properties.This study reports the first successful use of degradable Mg clips in damage control surgery for pelvic fractures,addressing challenges associated with severe hemorrhage and high mortality rates(30-70%).A 57-year-old male patient with pelvic fractures and traumatic shock underwent open reduction and internal fixation with Mg clips.At a six-month follow-up,imaging confirmed fracture healing,clip degradation,and no signs of rebleeding or infection,highlighting their effectiveness in precise hemorrhage control.Unlike traditional titanium clips,Mg clips degrade over time,eliminating the need for removal and reducing infection risks.This innovative approach combines Mg clips with conventional gauze packing,offering a more effective and safer alternative for managing pelvic trauma.Future large-scale clinical trials are necessary to validate these findings and establish Mg clips as a global standard for pelvic fracture treatment.Their portability and functionality hold promise for advancing emergency trauma care.展开更多
Frailty fractures of the pelvis,particularly isolated pubic ramus fractures,are often perceived as benign,especially in elderly patients.However,this perception can obscure the risk of delayed hemorrhage from occult v...Frailty fractures of the pelvis,particularly isolated pubic ramus fractures,are often perceived as benign,especially in elderly patients.However,this perception can obscure the risk of delayed hemorrhage from occult vascular injuries.Clinical deterioration is frequently subtle,with signs like fatigue or confusion mis-attributed to baseline status.In frail patients,these injuries may rapidly evolve into life-threatening scenarios.Conservative management,while standard,may be insufficient when vascular frailty or anticoagulation are present.Early clinical suspicion,serial hemoglobin checks,and multidisciplinary involvement are crucial.A dynamic assessment model that incorporates frailty,comorbidities,and physiological reserve alongside radiographic findings can better guide inter-vention and monitoring.Clinicians must lower the threshold for advanced imaging,such as computed tomography angiography,and consider early vascular consultation even in seemingly stable cases.Adopting a holistic,risk-based approach can mitigate complications and improve outcomes for this vulnerable population.展开更多
In this editorial,we proceed to comment on the article by Chua et al,addressing the management of metastatic lateral pelvic lymph nodes(mLLN)in stage II/III rectal cancer patients below the peritoneal reflection.The t...In this editorial,we proceed to comment on the article by Chua et al,addressing the management of metastatic lateral pelvic lymph nodes(mLLN)in stage II/III rectal cancer patients below the peritoneal reflection.The treatment of this nodal area sparks significant controversy due to the strategic differences followed by Eastern and Western physicians,albeit with a higher degree of convergence in recent years.The dissection of lateral pelvic lymph nodes without neoadjuvant therapy is a standard practice in Eastern countries.In contrast,in the West,preference leans towards opting for neoadjuvant therapy with chemoradiotherapy or radiotherapy,that would cover the treatment of this area without the need to add the dissection of these nodes to the total mesorectal excision.In the presence of high-risk nodal characteristics for mLLN related to radiological imaging and lack of response to neoadjuvant therapy,the risk of lateral local recurrence increases,suggesting the appropriate selection of strategies to reduce the risk of recurrence in each patient profile.Despite the heterogeneous and retrospective nature of studies addressing this area,an international consensus is necessary to approach this clinical scenario uniformly.展开更多
Pelvic fractures are rare but severe injuries that severely affect patients’quality of life.Treatment of these fractures often involves invasive approaches with high risk of injuries to nervous structures,particularl...Pelvic fractures are rare but severe injuries that severely affect patients’quality of life.Treatment of these fractures often involves invasive approaches with high risk of injuries to nervous structures,particularly lumbosacral plexus.The introduction of minimally invasive surgical approaches,such as the lateral rectus approach,not only contributes to preserving lumbar plexus integrity in operated patients but also positively impacts their psychological well-being.Patients treated by surgical reduction of pelvic fractures with lumbosacral plexus injury often experience states of anxiety and depression.The lateral rectus approach is associated with lower levels of anxiety and depression compared to more invasive surgical techniques used for similar fractures.展开更多
Introduction:Radical cystectomy with pelvic node dissection remains the standard of care for muscle-invasive bladder carcinoma(MIBC);however,there is a growing interest in bladder preservation alternatives among the e...Introduction:Radical cystectomy with pelvic node dissection remains the standard of care for muscle-invasive bladder carcinoma(MIBC);however,there is a growing interest in bladder preservation alternatives among the elderly population.Guidelines indicate that partial cystectomy(PC)combined with pelvic node dissection(LND)can be considered as an alternative in carefully selected individuals.Using the National Cancer Database,we analyzed the overall survival(OS)between PC with and without LND among octogenarians.Methods:We identified octogenarians with localized muscle-invasive bladder carcinoma(cT2-3N0M0)and urothelial histology who underwent PC with or without LND between 2004 and 2018.Based on the number of lymph nodes removed(LNR),the LND group was further subdivided into<10 and>=10 lymph node groups.A propensity-matched Kaplan-Meier survival analysis was performed to compare OS between these groups.Results:Among 2573 patients who underwent PC,492 octogenarians met our selection criteria.208(42.2%)had LND,while 284(57.8%)had no LND.Within the LND group,53(25.5%)had<10 LNR,and 155(74.5%)had>=10 LNR.The median OS for the matched LND and non-LND groups was 36.9 and 33.4 months(p=0.96),respectively.Similarly,<10 LNR and>=10 LNR had 36.9 and 43.5 months(p=0.42),respectively.Multivariate Cox regression analysis revealed no difference in the risk of mortality.Conclusion:Among octogenarians who underwent PC,there was no significant difference in OS between those with or without LND,and between<10 or>=10 LNR groups.Therefore,the role and extent of LND after PC need further exploration in this subset of the population.展开更多
Objective:To determine possible factors that may increase the complexity of reconstruction of pelvic fracture urethral injury.Prediction of complex repair helps in adequate patient counseling and preparation,and possi...Objective:To determine possible factors that may increase the complexity of reconstruction of pelvic fracture urethral injury.Prediction of complex repair helps in adequate patient counseling and preparation,and possible referral to high-volume reconstructive surgeons.Methods:A series of 30 adult male patients with pelvic fracture urethral injury underwent delayed posterior urethroplasty between January 2021 and December 2023 at the Assiut University Hospital and data were collected from medical records.Retrograde urethrography with voiding cystourethrogram was done 3 months after trauma.Defect length was measured and bladder neck position was verified.Urethroplasty was done using an elaborate perineal approach with inferior wedge pubectomy done in select cases.Results:Patients’ages ranged from 19 years to 53 years(median 34 years).The overall success rate of urethroplasty was 80%.Displacement of the bladder neck from the midline was significantly associated with prolonged operative time(p=0.004)and increased blood loss(p=0.002).There were strong positive correlations between preoperative defect length and operative time(r_(s)=0.84)as well as blood loss(r_(s)=0.78),which were statistically significant(p=0.001).Conclusion:Lateral bladder neck displacement and longer defect length in preoperative retrograde urethrogram were significantly associated with difficult urethroplasty for pelvic fracture urethral injury.展开更多
Pelvic floor dysfunction(PFD),including conditions such as stress urinary incontinence,pelvic organ prolapse,and fecal incontinence,significantly affects women's quality of life and their physical and mental healt...Pelvic floor dysfunction(PFD),including conditions such as stress urinary incontinence,pelvic organ prolapse,and fecal incontinence,significantly affects women's quality of life and their physical and mental health.With advancement of digital medicine,the systematic collection of data and the high-quality development of database platforms have increasingly become central pillars of PFD research and management.We systematically review the developmental stages of PFDrelated databases.We then conduct a comparative analysis of representative international and domestic platforms,examining key aspects including organizational structures and construction models,data sources and integration strategies,core functionalities,data quality control and standardization,data security and access management,and research applications.Finally,based on the current status of PFD database development both globally and in China,we offer recommendations to strengthen data infrastructure and guide future directions.The findings may serve as a valuable reference for the optimization of PFD databases worldwide.展开更多
基金supported by Joint Program on Health Science&Technology Innovation of Hainan Province(WSJK2024QN093)Discipline Leader Development Program for Outstanding Talents of Hainan West Central Hospital.
文摘Objectives:Postmenopausal women with stress urinary incontinence(SUI)exhibit low androgen expression.This study aimed to evaluate the efficacy and safety of vaginal androgen combined with pelvic floor muscle training(PFMT)in the treatment of SUI in postmenopausal women.Methods:Postmenopausal women with SUI were recruited from Hainan West Central Hospital between January 2024 and March 2025.Participants were randomly assigned in a double-blind manner to receive either vaginal androgen cream combined with PFMT(treatment group)or a visually identical placebo cream(without androgens)combined with PFMT(control group).The vaginal cream was applied to the vaginal wall at a dose of 0.5 g per application,twice weekly for a total of 10 applications,while PFMT was conducted for 8 weeks.The clinical efficacy and safety were compared between the two groups.Results:A total of 61 patients were finally enrolled,with 31 in the treatment group and 30 in the control group.At both 3-month and 6-month follow-ups,the treatment group demonstrated significantly lower values in daily pad usage(p<0.05),24-h pad test scores(p<0.05),and ICIQ-UI SF scores(p<0.05)compared to the control group.The improvement rate of urinary incontinence was significantly higher in the treatment group(p<0.05).Compared to baseline,the treatment group showed statistically significant reductions in all three outcome measures(all p<0.05).No severe adverse events were reported in either group during the treatment period.Conclusions:Androgen therapy combined with PFMT significantly improved the urinary incontinence remission rate in postmenopausal women with SUI,with no severe adverse effects observed.These findings suggest that androgen therapy may represent a novel therapeutic approach for SUI management in postmenopausal women.
文摘Objective:To investigate the clinical efficacy of electrophysiological therapy under different parameter modes in chronic pelvic pain syndrome(CPPS).Methods:A total of 95patients with CPPS from the Department of Urology,First Affiliated Hospital of Jinan University,were selected and treated with electrophysiological therapy.They were randomly divided into three groups:the fixed-parameter AA7 treatment group,the P2+P4 treatment group,and the precision treatment group(individualized parameter treatment).Pain scores of patients in each group were compared before and after treatment,with a pain score of 0 indicating cure.The cure rate of each group was observed.Results:The average ages of the AA7 group,P2+P4 group,and precision treatment group were 34±14.17 years,35.58±12.57 years,and 35.5±11.27 years,respectively.There was no significant difference in age among the three groups(p>0.05).Before treatment,the pain scores of the AA7 group,P2+P4 group,and precision treatment group were 4.14±1.74,4.64±1.72,and 3.50±1.89,respectively,with no significant differences among the groups(p>0.05).After treatment,the pain scores were 0.71±0.99 for the AA7 group(cure rate:57%),0.49±0.79 for the P2+P4 group(cure rate:67%),and 0.50±0.77 for the precision treatment group(cure rate:64%),with no significant differences among the groups(p>0.05).The cure rates for different pain locations were as follows:83%for lower abdominal pain,74%for perineal pain,62%for dysuria,49%for testicular pain,and 75%for inguinal pain.Conclusion:The pathogenesis of CPPS is complex and diverse,with numerous treatment options and uncertain efficacy,posing significant challenges to clinical practice.This study showed that electrophysiological therapy under different parameter modes significantly reduced pain scores before and after treatment,indicating significant therapeutic effects on CPPS.All three modes demonstrated good cure rates.Individualized precision treatment and fixed-mode P2+P4 or AA7 treatment were safe and effective in CPPS treatment and are worth promoting.Fixed-mode P2+P4 and AA7,due to their easier standardization of parameters and patch modes,reduced the learning curve and had better potential for widespread application.
基金supported by a grant from Kom op tegen Kanker(Stand Up to Cancer,Belgium).
文摘Objectives:PSMA PET/CT(Prostate-Specific MembraneAntigen Positron Emission Tomography/Computed Tomography)offers improved accuracy in detecting lymph node invasion(LNI)in prostate cancer(PC)patients,potentially reducing the need for extended pelvic lymph node dissection(ePLND).This study aims to evaluate a patient-tailored care pathway in which ePLND is performed only in patients with unfavorable intermediate-or high-risk PC who are deemed at risk for LNI based on PSMA PET/CT findings.Methods:In this interventional cohort study,81 patients were managed according to the new care pathway.ePLND was omitted in cases of negative PSMA PET/CT findings(N0M0),while those with positive PSMA PET/CT findings(N1M0)underwent ePLND.A comparator group of 81 patients was selected from a prospectively generated database for comparison.Results:The intervention group experienced a 75% reduction in the number of ePLNDs performed compared to the comparator group(p<0.001).ePLND-related complications were significantly lower in the intervention group(p=0.008).No significant difference was observed in 3-year biochemical-recurrence free survival(BRFS)between the two groups(p=0.958).Conclusion:Omitting ePLND in patients with negative PSMA PET/CT findings(N0M0)leads to a substantial reduction in the number of ePLNDs performed,resulting in a decrease in morbidity,without compromising early oncological outcomes.
基金funded by Vietnam National University Ho Chi Minh City(VNU-HCM)under grant number DS.C2025-28-06.
文摘Vaginal delivery is a fascinating physiological process,but also a high-risk process.Up to 85%–90%of vaginal deliveries lead to perineal trauma,with nearly 11%of severe perineal tearing.It is a common occurrence,especially for first-time mothers.Computational childbirth plays an essential role in the prediction and prevention of these traumas,but fast personalization of the pelvis and floor muscles is challenging due to their anatomical complexity.This study introduces a novel shape-prediction-based personalization of the pelvis and floor muscles for perineal tearing management and childbirth simulation.300 subjects were selected from public Computed Tomography(CT)databases.The pelvic bone nmjmeshes were generated using a coarse-to-fine non-rigid mesh alignment procedure.The floor muscle meshes were personalized using the bone mesh deformation information.A feature-to-pelvic structure reconstruction pipeline was proposed,incorporating various strategies.Ten-fold cross-validation helped determine the optimal reconstruction strategy,regression method,and feature sizes.The mesh-to-mesh distance metric was employed for evaluating.The statistical shape relation-based strategy,coupled with multi-output ridge regression,was the optimal approach for pelvic structure reconstruction.With a feature set ranging from 3 to 38,the mean errors were 2.672 to 1.613 mm,and 3.237 to 1.415 mm in muscle attachment regions.The best-and worst-case predictions had errors of 1.227±0.959 mm and 2.900±2.309 mm,respectively.This study provides a novel approach to achieving fast personalized childbirth modeling and simulation for perineal tearing management.
基金supported by the Natural Science Foundation of Hunan Province(2024JJ8121,2024JJ6626)the Hunan Provincial Key Research and Development Program(2023SK2038),China.
文摘Objective:Stress urinary incontinence(SUI)is a common condition among women that severely impairs quality of life.Pelvic floor proprioceptive training(PFPT)has attracted increasing attention for its potential to enhance pelvic floor muscle function and alleviate SUI symptoms.This study aims to observe and compare the clinical efficacy of PFPT combined with electroacupuncture,electrical stimulation,and biofeedback therapy versus conventional therapy consisting of electroacupuncture,electrical stimulation,and biofeedback alone in women with SUI,and to explore the role of PFPT in improving symptom and functional outcomes.Methods:In this randomized controlled trial,72 women with mild to moderate SUI were recruited from the Department of Rehabilitation Medicine at Third Xiangya Hospital,Central South University,between December 2021 and October 2023.Participants were randomly assigned to an experimental group(n=36)or a control group(n=36).Both groups received health education.The control group underwent electroacupuncture combined with electrical stimulation and biofeedback therapy,while the experimental group additionally received PFPT 3 times per week for 4 weeks.The primary outcome was assessed using the International Consultation on Incontinence Questionnaire-Short Form(ICIQ-SF).Secondary outcomes included pelvic floor muscle strength,bladder neck mobility,and balance ability.The ICIQ-SF was reassessed at 1,3,6,and 12 months post-treatment.Results:Both groups showed statistically significant improvements in all parameters after treatment(all P<0.05).However,there were no statistically significant differences between groups in most measures(all P>0.05).The experimental group demonstrated longer singleleg stance duration with eyes closed than the control group(left leg:P=0.026;right leg:P=0.006),with a significant increase from baseline(P<0.001).At 6 months post-treatment,the cure rate in the experimental group was significantly higher than that in the control group(P=0.037).Conclusion:Conventional therapy effectively improves SUI symptoms,but adding PFPT provides notable additional benefits,including enhanced balance ability and sustained midterm cure rates.These findings suggest that PFPT is a valuable adjunct to standard SUI management strategies.
文摘In this editorial,we comment on an article by Wang et al.Recent literature shows an increase in research on pelvic organ prolapse(POP).Although the true incidence of POP remains uncertain,its impact on quality of life is substantial.Anatomical studies report high incidence rates,surpassing those observed in symptom-based surveys.Weakness of the endopelvic fascia is a primary anatomical risk factor for POP.Additionally,gestational diabetes mellitus(GDM)has emerged as a growing concern,as poor glycemic control increases complications for both mother and fetus.GDM and POP are interconnected,with factors like maternal obesity,macrosomia,and hormonal changes exacerbating pelvic floor dysfunction.Modifiable risk factors,such as obesity and chronic hyperglycemia,along with multiparity,instrumental deliveries,and obstetric trauma,further increase susceptibility.For patients with GDM,gynecological exams,Pelvic Organ Prolapse Quantification staging,and pelvic floor ultrasonography are valuable diagnostics,with proctological exams and magnetic resonance defecography aiding in multi-compartment prolapse diagnoses.Imaging,though uncomfortable during pregnancy,is safe in the early postpartum period.This editorial emphasizes the need for further research on the pathophysiology of GDM-related POP and offers recommendations for improving diagnosis and clinical management of patients with GDM.
文摘BACKGROUND Pelvic fractures are often associated with significant morbidity,including injuries to the urinary tract.Understanding the incidence and risk factors for urinary tract injury in these patients is crucial for prompt diagnosis and management.This meta-analysis aims to synthesize existing evidence to determine the overall incidence and identify specific risk factors associated with urinary tract injuries in patients with pelvic fractures.AIM To determine the incidence and risk factors for urinary tract injuries in patients with pelvic fractures.METHODS A systematic search of PubMed,EMBASE,Scopus,and the Cochrane Library was conducted without date restrictions.Studies examining the incidence and risk factors of urinary tract injuries in patients with pelvic fractures were included.Data extracted included demographics,injury mechanism,pelvic fracture type,urinary tract injury incidence,mortality,and discharge disposition.Review Manager 5.4 was used for data analysis.RESULTS Ten studies comprising 22700 patients were included.The pooled incidence of urinary tract injury associated with pelvic fracture was 6.88%(95%CI:6.20%-7.55%).Vehicle,motorcycle,and pedestrian accidents were identified as risk factors for urinary tract injury,with relative risks(RR)of 1.08(95%CI:1.06-1.11),1.89(95%CI:1.78-2.00),and 1.53(95%CI:1.20-1.95),respectively.Pubic fracture and pelvic ring disruption were significantly associated with urinary tract injury[odds ratio(OR)1.94,95%CI:1.09-3.44 and OR 5.53,95%CI:4.67-6.54,respectively)].Patients without urinary tract injury were more likely to be discharged home(RR 0.79,95%CI:0.67-0.92).Mortality was higher in patients with urinary tract injury(OR 1.92,95%CI:1.77-2.09).CONCLUSION Urinary tract injury occurs in nearly 7%of patients with pelvic fractures.Motorcycle accidents,pubic fractures,and pelvic ring disruptions are significant risk factors.Urinary tract injury following pelvic fracture is associated with increased mortality.
基金supported by the National Natural Science Foundation of China(No.82260297)Yunnan Province Clinical Research Center for Chronic Kidney Disease(No.202102AA100060).
文摘Objective This is a self-controlled multicenter retrospective study based on the clinical efficacy and complications of physiological reconstruction in the treatment of moderate and severe pelvic organ prolapse.Methods From December 2014 to August 2021,517 women were included and registered for physiological reconstruction at four Chinese urogynecology institutions.We enrolled 364 women with POP-Q stage≥3.The degree of POP was quantified via a POP-Q system.The surgical purpose of physiological reconstruction is to repair the vagina,levator ani muscle,perineum,and urogenital hiatus and adopt a repair method in accordance with the axial direction of physiology.All 330 evaluable participants were followed for 2 years.The evaluation indices included the PFDI-20,PGI-I,PFIQ-7,PISQ-12,PGI-I,and PGI-S.All complications were coded according to the category-time-site system proposed by the International Urogynecological Association(IUGA)and International Continence Society(ICS).Results Compared with the preoperative POP-Q scores,statistically significant improvements were observed at the 6-month,1-year and 2-year time points(P<0.001).Statistically significant improvements in quality of life were observed across all time points.Conclusions Physiologic reconstructive surgical techniques combined with modified anterior pelvic floor mesh implantation could help restore the physiologic axis and vaginal shape,which may be the most important factors in maintaining the functional position of pelvic floor organs and is the most effective method for repairing the pelvic fascia tendon arch.This surgical method is safe,feasible,and effective in patients with severe prolapse.
基金Supported by 2023 Academy Level Research Start-up Fund,No.YK2023332024 Academy Level Research Start-up Fund,No.YK202430+1 种基金Wujiang District,Suzhou City,“Promoting Health through Science and Education”Project,No.WWK202201Xuzhou Medical University Affiliated Hospital Development Fund Support Project,No.XYFY202423.
文摘BACKGROUND Pelvic organ prolapse(POP)can lead to urinary incontinence,fecal incontinence,and other symptoms,affecting the quality of life,which results in anxiety and depression and other negative emotions in many patients.Trans-vaginal sacrospinous ligament suspension(VSSLS)involves securing the apex of the prolapsed vagina to the sacrospinous ligament to maintain the physiological axis of the vagina,help in repairing pelvic floor defects,and maintain the normal function of the pelvic floor,thereby alleviating patients’anxiety and depression.AIM To explore the effect of VSSLS in the treatment of POP and its influence on anxiety and depression among patients.METHODS Sixty patients with moderate to severe POP who underwent surgical treatment between January 2023 and June 2024 in Suzhou Ninth Hospital Affiliated to Soochow University were retrospectively enrolled in the study.According to treatment methods,they were divided into the control group(n=30,treated with vaginal hysterectomy alone)and observation group(n=30,treated with VSSLS combined with vaginal hysterectomy).The two groups were compared by baseline data,perioperative indicators,and postoperative pain intensity,prolapse distance before and after surgery,sexual function,pelvic function,anxiety,and depression.RESULTS No significant differences in baseline data,preoperative POP Quantification measurement value,Pelvic Floor Dysfunction Inventory 20(PFDI-20),Pelvic Floor Impact Questionnaire 7(PFIQ-7),Self-Rating Anxiety Scale(SAS),and Self-Rating Depression Scale(SDS)scores were found between the two groups.The obser vation group had longer operation time and more intraoperative blood loss than the control group,the Visual Analog Scale score on postoperative day 1 was slightly higher in than in the control group.On the reexamination 3 months postoperatively,the POP Quantification measurement values in the observation group were lower than those in the control group(P<0.05).Evaluation 6 months after surgery,the FSFI score was higher in the observation group than in the control group,the PFDI-20,PFIQ-7,SAS and SDS score scored were lower in than in the control group(P<0.05).The PFDI-20,PFIQ-7 scores positively correlated with the SAS and SDS scores.CONCLUSION VSSLS demonstrated a significant effect on the treatment of moderate and severe POP,as it can reduce the prolapse distance and PFDI-20 and PFIQ-7 scores and improve anxiety and depression among patients.
基金Supported by Shanghai Tongren Hospital,Shanghai Jiaotong University School of Medicine,No.TRYJ2024 LC16the National Natural Science Foundation of China,No.82102577the Laboratory Open Fund of Key Technology and Materials in Minimally Invasive Spine Surgery,No.2024JZWC-YBA05.
文摘BACKGROUND Retrograde pubic ramus screw placement is an effective technique but requires substantial surgical expertise and specialized equipment.The management of osteoporotic anterior pelvic ring injuries remains challenging due to technical difficulties and a high risk of complications.AIM To introduce a novel and simplified surgical approach that utilizes a custom-designed handheld pelvic alignment guide(HPAG)in combination with a 6.0 mm hollow screw,aiming to enhance the accuracy,efficiency,and safety of retrograde pubic ramus screw fixation in osteoporotic pelvic fragility fractures.METHODS The HPAG and 6.0 mm hollow screw were employed during surgical treatment.A 2.0-3.0 cm incision was made to expose the optimal screw entry point.Intraop-erative pelvic inlet and obturator oblique views were used to monitor fracture reduction and guide screw insertion.Clinical outcomes and fracture reduction quality were evaluated using Matta,visual analog scale,and Majeed scores during follow-ups.A representative case is presented to demonstrate the surgical procedure in detail.RESULTS No perioperative complications were observed.The mean operative time was 35.2±6.97 minutes,with a screw insertion time of 7.25±1.86 minutes,an average incision length of 2.8±0.67 cm,and mean blood loss of 43.25±15.64 mL.At one-year follow-up,seven patients achieved excellent Majeed scores and three achieved good scores.CONCLUSION No perioperative complications were observed.The mean operative time was 35.2±6.97 minutes,with a screw insertion time of 7.25±1.86 minutes,an average incision length of 2.8±0.67 cm,and mean blood loss of 43.25±15.64 mL.At one-year follow-up,seven patients achieved excellent Majeed scores and three achieved good scores.
文摘BACKGROUND Sagittal spinopelvic alignment(SSA)is essential for preserving a stable and effective upright posture and locomotion.Although alterations in the SSA are recognised to induce compensatory modifications in the pelvis,hips,and knees,the inverse relationship concerning knee pathology undergoing total knee arthroplasty(TKA)has been examined by a limited number of studies,yielding inconclusive results.AIM To generate evidence of the effect of TKA on the SSA from existing literature.METHODS Databases like PubMed,EMBASE,and Scopus were used to identify articles related to the“knee spine syndrome”phenomenon using a combination of subject terms and keywords such as“spinopelvic parameters”,“sagittal spinal balance”,and“total knee arthroplasty”were used with appropriate Boolean operators.Studies measuring the SSA following TKA were included,and research was conducted as per preferred reporting items for systematic review and metaanalysis guidelines.RESULTS A total of 475 participants had undergone TKA,and six studies measuring SSA were analysed.Following TKA,pelvic tilt was the only parameter that showed significant changes,while lumbar lordosis(LL),pelvic incidence,and sacral slope were non-significant,as evident from the forest plots.CONCLUSION The body's sagittal alignment is a complex balance between pelvic,spine,and lower extremity parameters.TKA,while having the potential to correct the flexion contracture,can also correct it.Still,the primary SSA for spinal pathology,i.e.,LL,may not be corrected in patients with co-existent spinal degenerative disease.
基金supported by the National Natural Science Foundation of China(No.81770759 and No.82270806)Innovation Project of Guangxi Graduate Education(No.YCBZ2022094).
文摘Chronic prostatitis/chronic pelvic pain syndrome(CP/CPPS)is a complex disease that is often accompanied by mental health disorders.However,the potential mechanisms underlying the heterogeneous clinical presentation of CP/CPPS remain uncertain.This study analyzed widely targeted metabolomic data of expressed prostatic secretions(EPS)and plasma to reveal the underlying pathological mechanisms of CP/CPPS.A total of 24 CP/CPPS patients from The Second Nanning People’s Hospital(Nanning,China),and 35 asymptomatic control individuals from First Affiliated Hospital of Guangxi Medical University(Nanning,China)were enrolled.The indicators related to CP/CPPS and psychiatric symptoms were recorded.Differential analysis,coexpression network analysis,and correlation analysis were performed to identify metabolites that were specifically altered in patients and associated with various phenotypes of CP/CPPS.The crucial links between EPS and plasma were further investigated.The metabolomic data of EPS from CP/CPPS patients were significantly different from those from control individuals.Pathway analysis revealed dysregulation of amino acid metabolism,lipid metabolism,and the citrate cycle in EPS.The tryptophan metabolic pathway was found to be the most significantly altered pathway associated with distinct CP/CPPS phenotypes.Moreover,the dysregulation of tryptophan and tyrosine metabolism and elevation of oxidative stress-related metabolites in plasma were found to effectively elucidate the development of depression in CP/CPPS.Overall,metabolomic alterations in the EPS and plasma of patients were primarily associated with oxidative damage,energy metabolism abnormalities,neurological impairment,and immune dysregulation.These alterations may be associated with chronic pain,voiding symptoms,reduced fertility,and depression in CP/CPPS.This study provides a local-global perspective for understanding the pathological mechanisms of CP/CPPS and offers potential diagnostic and therapeutic targets.
基金supported by the Natural Science Foundation of Hunan Province(2024JJ6626)the Hunan Provincial Key Laboratory of Regional Hereditary Birth Defects Prevention and Control(HPKL202320),China.
文摘Objective:Pelvic floor dysfunction is common among pregnant and postpartum women and significantly impacts quality of life.This study aims to translate the German Pelvic Floor Questionnaire for Pregnant and Postpartum Women into Chinese and to evaluate its reliability and validity in the Chinese population.Methods:The questionnaire was translated using the Brislin model.A cross-sectional study was conducted among pregnant and postpartum women to assess the content validity,construct validity,Cronbach’sαcoefficient,test-retest reliability,and split-half reliability of the Chinese version.Results:A total of 72 women were included,with 6.9% being pregnant and 93.1% postpartum;the age was(32.3±3.6)years.The Chinese version of the questionnaire contains 4 dimensions and 45 items.The content validity index of individual items ranged from 0.833 to 1.000,with a scale-level content validity index of 0.977 and intraclass correlation coefficients(ICCs)exceeding 0.90.The overall Cronbach’s α coefficient was 0.891,with subscale coefficients ranging from 0.732 to 0.884(all ICCs>0.70).The testretest reliability of the total scale was 0.833,and for the 4 dimensions,bladder,bowel,prolapse,and sexual function,the values were 0.776,0.579,0.732,and 0.645,respectively.The split-half reliability was 0.74.Conclusion:The Chinese version of the questionnaire demonstrated good reliability and validity,indicating its applicability in assessing pelvic floor dysfunction and associated risk factors during pregnancy and postpartum.
基金supported by grants from the Integrated Traditional Chinese and Western Medicine Guidance Project for General Hospitals of Shanghai Municipal Health Commission(ZXXT-202311)the National Key R&D Program of China(No.2023YFC2416800)+1 种基金the National Natural Science Foundation of China(No.52201300)the Fundamental Research Funds for the Central Universities(No.2232024D-34).
文摘Biodegradable magnesium(Mg)materials offer significant advantages in trauma care due to their degradable nature and superior mechanical properties.This study reports the first successful use of degradable Mg clips in damage control surgery for pelvic fractures,addressing challenges associated with severe hemorrhage and high mortality rates(30-70%).A 57-year-old male patient with pelvic fractures and traumatic shock underwent open reduction and internal fixation with Mg clips.At a six-month follow-up,imaging confirmed fracture healing,clip degradation,and no signs of rebleeding or infection,highlighting their effectiveness in precise hemorrhage control.Unlike traditional titanium clips,Mg clips degrade over time,eliminating the need for removal and reducing infection risks.This innovative approach combines Mg clips with conventional gauze packing,offering a more effective and safer alternative for managing pelvic trauma.Future large-scale clinical trials are necessary to validate these findings and establish Mg clips as a global standard for pelvic fracture treatment.Their portability and functionality hold promise for advancing emergency trauma care.
文摘Frailty fractures of the pelvis,particularly isolated pubic ramus fractures,are often perceived as benign,especially in elderly patients.However,this perception can obscure the risk of delayed hemorrhage from occult vascular injuries.Clinical deterioration is frequently subtle,with signs like fatigue or confusion mis-attributed to baseline status.In frail patients,these injuries may rapidly evolve into life-threatening scenarios.Conservative management,while standard,may be insufficient when vascular frailty or anticoagulation are present.Early clinical suspicion,serial hemoglobin checks,and multidisciplinary involvement are crucial.A dynamic assessment model that incorporates frailty,comorbidities,and physiological reserve alongside radiographic findings can better guide inter-vention and monitoring.Clinicians must lower the threshold for advanced imaging,such as computed tomography angiography,and consider early vascular consultation even in seemingly stable cases.Adopting a holistic,risk-based approach can mitigate complications and improve outcomes for this vulnerable population.
文摘In this editorial,we proceed to comment on the article by Chua et al,addressing the management of metastatic lateral pelvic lymph nodes(mLLN)in stage II/III rectal cancer patients below the peritoneal reflection.The treatment of this nodal area sparks significant controversy due to the strategic differences followed by Eastern and Western physicians,albeit with a higher degree of convergence in recent years.The dissection of lateral pelvic lymph nodes without neoadjuvant therapy is a standard practice in Eastern countries.In contrast,in the West,preference leans towards opting for neoadjuvant therapy with chemoradiotherapy or radiotherapy,that would cover the treatment of this area without the need to add the dissection of these nodes to the total mesorectal excision.In the presence of high-risk nodal characteristics for mLLN related to radiological imaging and lack of response to neoadjuvant therapy,the risk of lateral local recurrence increases,suggesting the appropriate selection of strategies to reduce the risk of recurrence in each patient profile.Despite the heterogeneous and retrospective nature of studies addressing this area,an international consensus is necessary to approach this clinical scenario uniformly.
文摘Pelvic fractures are rare but severe injuries that severely affect patients’quality of life.Treatment of these fractures often involves invasive approaches with high risk of injuries to nervous structures,particularly lumbosacral plexus.The introduction of minimally invasive surgical approaches,such as the lateral rectus approach,not only contributes to preserving lumbar plexus integrity in operated patients but also positively impacts their psychological well-being.Patients treated by surgical reduction of pelvic fractures with lumbosacral plexus injury often experience states of anxiety and depression.The lateral rectus approach is associated with lower levels of anxiety and depression compared to more invasive surgical techniques used for similar fractures.
文摘Introduction:Radical cystectomy with pelvic node dissection remains the standard of care for muscle-invasive bladder carcinoma(MIBC);however,there is a growing interest in bladder preservation alternatives among the elderly population.Guidelines indicate that partial cystectomy(PC)combined with pelvic node dissection(LND)can be considered as an alternative in carefully selected individuals.Using the National Cancer Database,we analyzed the overall survival(OS)between PC with and without LND among octogenarians.Methods:We identified octogenarians with localized muscle-invasive bladder carcinoma(cT2-3N0M0)and urothelial histology who underwent PC with or without LND between 2004 and 2018.Based on the number of lymph nodes removed(LNR),the LND group was further subdivided into<10 and>=10 lymph node groups.A propensity-matched Kaplan-Meier survival analysis was performed to compare OS between these groups.Results:Among 2573 patients who underwent PC,492 octogenarians met our selection criteria.208(42.2%)had LND,while 284(57.8%)had no LND.Within the LND group,53(25.5%)had<10 LNR,and 155(74.5%)had>=10 LNR.The median OS for the matched LND and non-LND groups was 36.9 and 33.4 months(p=0.96),respectively.Similarly,<10 LNR and>=10 LNR had 36.9 and 43.5 months(p=0.42),respectively.Multivariate Cox regression analysis revealed no difference in the risk of mortality.Conclusion:Among octogenarians who underwent PC,there was no significant difference in OS between those with or without LND,and between<10 or>=10 LNR groups.Therefore,the role and extent of LND after PC need further exploration in this subset of the population.
文摘Objective:To determine possible factors that may increase the complexity of reconstruction of pelvic fracture urethral injury.Prediction of complex repair helps in adequate patient counseling and preparation,and possible referral to high-volume reconstructive surgeons.Methods:A series of 30 adult male patients with pelvic fracture urethral injury underwent delayed posterior urethroplasty between January 2021 and December 2023 at the Assiut University Hospital and data were collected from medical records.Retrograde urethrography with voiding cystourethrogram was done 3 months after trauma.Defect length was measured and bladder neck position was verified.Urethroplasty was done using an elaborate perineal approach with inferior wedge pubectomy done in select cases.Results:Patients’ages ranged from 19 years to 53 years(median 34 years).The overall success rate of urethroplasty was 80%.Displacement of the bladder neck from the midline was significantly associated with prolonged operative time(p=0.004)and increased blood loss(p=0.002).There were strong positive correlations between preoperative defect length and operative time(r_(s)=0.84)as well as blood loss(r_(s)=0.78),which were statistically significant(p=0.001).Conclusion:Lateral bladder neck displacement and longer defect length in preoperative retrograde urethrogram were significantly associated with difficult urethroplasty for pelvic fracture urethral injury.
文摘Pelvic floor dysfunction(PFD),including conditions such as stress urinary incontinence,pelvic organ prolapse,and fecal incontinence,significantly affects women's quality of life and their physical and mental health.With advancement of digital medicine,the systematic collection of data and the high-quality development of database platforms have increasingly become central pillars of PFD research and management.We systematically review the developmental stages of PFDrelated databases.We then conduct a comparative analysis of representative international and domestic platforms,examining key aspects including organizational structures and construction models,data sources and integration strategies,core functionalities,data quality control and standardization,data security and access management,and research applications.Finally,based on the current status of PFD database development both globally and in China,we offer recommendations to strengthen data infrastructure and guide future directions.The findings may serve as a valuable reference for the optimization of PFD databases worldwide.
