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Moser N, Skawran S, Steigmiller K, Röhrnbauer B, Winklehner T, Reiner CS, Betschart C. Quantitative 3D Analysis of Levator Ani Muscle Subdivisions in Nulliparous Women: MRI Feasibility Study. Diagnostics (Basel) 2024; 14:923. [PMID: 38732338 PMCID: PMC11083419 DOI: 10.3390/diagnostics14090923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 04/17/2024] [Accepted: 04/24/2024] [Indexed: 05/13/2024] Open
Abstract
BACKGROUND The levator ani muscle (LAM) is crucial for pelvic floor stability, yet its quantitative MRI assessment is only a recent focus. Our study aims to standardize the quantitative analysis of the LAM morphology within the 3D Pelvic Inclination Correction System (3D-PICS). METHODS We analyzed 35 static MR datasets from nulliparous women examining the pubovisceral (PVM), iliococcygeal (ICM), coccygeal (COC), and puborectal muscle (PRM). The PVM consists of three origin-insertion pairs, namely the puboanal (PAM), puboperineal (PPM) and pubovaginal muscle (PVaM). The analysis included a quantitative examination of the morphology of LAM, focusing on the median location (x/y/z) (x: anterior-posterior, y: superior-inferior, z: left-right) of the origin and insertion points (a), angles (b) and lengths (c) of LAM. Inter-rater reliability was calculated. RESULTS Interindividual variations in 3D coordinates among muscle subdivisions were shown. In all, 93% of all origin and insertion points were found within an SD of <8 mm. Angles to the xz-plane range between -15.4° (right PRM) and 40.7° (left PAM). The PRM is the largest pelvic muscle in static MRI. The ICC indicated moderate-to-good agreement between raters. CONCLUSIONS The accurate morphometry of the LAM and its subdivisions, along with reliable inter-rater agreement, was demonstrated, enhancing the understanding of normal pelvic anatomy in young nulliparous women.
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Affiliation(s)
- Nathalie Moser
- Department of Gynecology, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, 8091 Zurich, Switzerland;
| | - Stephan Skawran
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
- Department of Nuclear Medicine, University Hospital Zurich, University of Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
| | - Klaus Steigmiller
- Institute of Epidemiology, Biostatistics and Prevention, University of Zurich, Hirschengraben 84, 8001 Zurich, Switzerland
| | - Barbara Röhrnbauer
- School of Engineering, IMES Institute of Mechanical Systems, ZHAW Zurich University of Applied Sciences, Technikumstrasse 71, 8401 Winterthur, Switzerland
| | - Thomas Winklehner
- SITEM Insel-Ability, University of Berne, Freiburgstrasse 3, 3010 Berne, Switzerland
| | - Cäcilia S. Reiner
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
| | - Cornelia Betschart
- Department of Gynecology, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, 8091 Zurich, Switzerland;
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Macchi V, Porzionato A, De Caro R. The "Hand" teaching model in the pelvic floor. Asian J Surg 2023; 46:5561-5562. [PMID: 37591752 DOI: 10.1016/j.asjsur.2023.08.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 08/06/2023] [Indexed: 08/19/2023] Open
Affiliation(s)
- Veronica Macchi
- Institute of Human Anatomy, Department of Neurosciences, University of Padova, Italy; Unit of Clinical Anatomy, Department of General Surgery, University-Hospital of Padua, Italy; National Reference Center for the Conservation and Use of the Bodies of the Deceased, University of Padua, Italy
| | - Andrea Porzionato
- Institute of Human Anatomy, Department of Neurosciences, University of Padova, Italy; Unit of Clinical Anatomy, Department of General Surgery, University-Hospital of Padua, Italy; National Reference Center for the Conservation and Use of the Bodies of the Deceased, University of Padua, Italy
| | - Raffaele De Caro
- Institute of Human Anatomy, Department of Neurosciences, University of Padova, Italy; Unit of Clinical Anatomy, Department of General Surgery, University-Hospital of Padua, Italy; National Reference Center for the Conservation and Use of the Bodies of the Deceased, University of Padua, Italy.
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Alexander S, Oelfke U, McNair H, Tree A. GI factors, potential to predict prostate motion during radiotherapy; a scoping review. Clin Transl Radiat Oncol 2023; 40:100604. [PMID: 36936470 PMCID: PMC10020110 DOI: 10.1016/j.ctro.2023.100604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 02/16/2023] [Accepted: 02/19/2023] [Indexed: 02/27/2023] Open
Abstract
Purpose A scoping literature review was conducted to identify gastrointestinal (GI) factors most likely to influence prostate motion during radiotherapy. We proffer that patient specific measurement of these GI factors could predict motion uncertainty during radiotherapy, facilitating personalised care by optimising treatment technique e.g., daily adaption or via bespoke patient pre-habilitation and preparation. Methods The scoping review was undertaken as per JBI guidelines. Searches were conducted across four databases: Ovid Medline®, EMBASE, CINAHL and EBSCO discovery. Articles written in English from 2010-present were included. Those pertaining to paediatrics, biological women exclusively, infectious and post-treatment GI morbidity and diet were excluded.Common GI factors impacting men were identified and related symptoms, incidence and measurement tools examined. Prevalence among persons with prostate cancer was explored and suitable assessment tools discussed. Results A preliminary search identified four prominent GI-factors: mental health, co-morbidity and medication, physical activity, and pelvic floor disorder. The scoping search found 3644 articles; 1646 were removed as duplicates. A further 1249 were excluded after title and abstract screening, 162 remained subsequent to full text review: 42 mental health, 53 co-morbidity and medication, 39 physical activity and 28 pelvic floor disorder.Six GI factors prevalent in the prostate cancer population and estimated most likely to influence prostate motion were identified: depression, anxiety, diabetes, obesity, low physical activity, and pelvic floor disorder. Reliable, quick, and easy to use tools are available to quantify these factors. Conclusion A comprehensive GI factor assessment package suitable to implement into the radiotherapy clinic has been created. Unveiling these GI factors upfront will guide improved personalisation of radiotherapy.
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Affiliation(s)
- S.E. Alexander
- The Royal Marsden NHS Foundation Trust, United Kingdom and The Institute of Cancer Research, United Kingdom
| | - U. Oelfke
- The Joint Department of Physics, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, United Kingdom
| | - H.A. McNair
- The Royal Marsden NHS Foundation Trust, United Kingdom and The Institute of Cancer Research, United Kingdom
| | - A.C. Tree
- The Royal Marsden NHS Foundation Trust, United Kingdom and The Institute of Cancer Research, United Kingdom
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Albaladejo-Belmonte M, Tarazona-Motes M, Nohales-Alfonso FJ, De-Arriba M, Alberola-Rubio J, Garcia-Casado J. Characterization of Pelvic Floor Activity in Healthy Subjects and with Chronic Pelvic Pain: Diagnostic Potential of Surface Electromyography. SENSORS 2021; 21:s21062225. [PMID: 33806717 PMCID: PMC8004809 DOI: 10.3390/s21062225] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 03/13/2021] [Accepted: 03/15/2021] [Indexed: 12/16/2022]
Abstract
Chronic pelvic pain (CPP) is a highly disabling disorder in women usually associated with hypertonic dysfunction of the pelvic floor musculature (PFM). The literature on the subject is not conclusive about the diagnostic potential of surface electromyography (sEMG), which could be due to poor signal characterization. In this study, we characterized the PFM activity of three groups of 24 subjects each: CPP patients with deep dyspareunia associated with a myofascial syndrome (CPP group), healthy women over 35 and/or parous (>35/P group, i.e., CPP counterparts) and under 35 and nulliparous (<35&NP). sEMG signals of the right and left PFM were recorded during contractions and relaxations. The signals were characterized by their root mean square (RMS), median frequency (MDF), Dimitrov index (DI), sample entropy (SampEn), and cross-correlation (CC). The PFM activity showed a higher power (>RMS), a predominance of low-frequency components (<MDF, >DI), greater complexity (>SampEn) and lower synchronization on the same side (<CC) in CPP patients, with more significant differences in the >35/P group. The same trend in differences was found between healthy women (<35&NP vs. >35/P) associated with aging and parity. These results show that sEMG can reveal alterations in PFM electrophysiology and provide clinicians with objective information for CPP diagnosis.
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Affiliation(s)
- Monica Albaladejo-Belmonte
- Centro de Investigación e Innovación en Bioingeniería, Universitat Politècnica de València, 46022 Valencia, Spain; (M.A.-B.); (J.G.-C.)
| | - Marta Tarazona-Motes
- Servicio de Ginecología y Obstetricia, Hospital Politècnic i Universitari La Fe, 46026 Valencia, Spain; (M.T.-M.); (F.J.N.-A.); (M.D.-A.)
| | - Francisco J. Nohales-Alfonso
- Servicio de Ginecología y Obstetricia, Hospital Politècnic i Universitari La Fe, 46026 Valencia, Spain; (M.T.-M.); (F.J.N.-A.); (M.D.-A.)
| | - Maria De-Arriba
- Servicio de Ginecología y Obstetricia, Hospital Politècnic i Universitari La Fe, 46026 Valencia, Spain; (M.T.-M.); (F.J.N.-A.); (M.D.-A.)
| | - Jose Alberola-Rubio
- Unidad de Bioelectrónica, Procesamiento de señales y Algoritmia, Instituto de Investigación Sanitaria La Fe, 46026 Valencia, Spain
- Correspondence:
| | - Javier Garcia-Casado
- Centro de Investigación e Innovación en Bioingeniería, Universitat Politècnica de València, 46022 Valencia, Spain; (M.A.-B.); (J.G.-C.)
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Williams AM, Eginyan G, Deegan E, Chow M, Carpenter MG, Lam T. Residual Innervation of the Pelvic Floor Muscles in People with Motor-Complete Spinal Cord Injury. J Neurotrauma 2020; 37:2320-2331. [DOI: 10.1089/neu.2019.6908] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Alison M.M. Williams
- School of Kinesiology, University of British Columbia, Vancouver, British Columbia, Canada
- International Collaboration On Repair Discoveries (ICORD), Vancouver Costal Health Research Institute, Vancouver, British Columbia, Canada
| | - Gevorg Eginyan
- School of Kinesiology, University of British Columbia, Vancouver, British Columbia, Canada
- International Collaboration On Repair Discoveries (ICORD), Vancouver Costal Health Research Institute, Vancouver, British Columbia, Canada
| | - Emily Deegan
- School of Kinesiology, University of British Columbia, Vancouver, British Columbia, Canada
- International Collaboration On Repair Discoveries (ICORD), Vancouver Costal Health Research Institute, Vancouver, British Columbia, Canada
| | - Mason Chow
- International Collaboration On Repair Discoveries (ICORD), Vancouver Costal Health Research Institute, Vancouver, British Columbia, Canada
| | - Mark G. Carpenter
- School of Kinesiology, University of British Columbia, Vancouver, British Columbia, Canada
- International Collaboration On Repair Discoveries (ICORD), Vancouver Costal Health Research Institute, Vancouver, British Columbia, Canada
| | - Tania Lam
- School of Kinesiology, University of British Columbia, Vancouver, British Columbia, Canada
- International Collaboration On Repair Discoveries (ICORD), Vancouver Costal Health Research Institute, Vancouver, British Columbia, Canada
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Bao J, He C, Chen B, Zhao J. Application of gabapentin after stapled hemorrhoidopexy may prevent age-related complication. Asian J Surg 2020; 43:636-637. [PMID: 31964582 DOI: 10.1016/j.asjsur.2019.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Accepted: 12/25/2019] [Indexed: 11/18/2022] Open
Affiliation(s)
- Juhang Bao
- Department of Colorectal Surgery, Zhejiang Hospital, Hangzhou, Zhejiang, China.
| | - Chao He
- Department of Colorectal Surgery, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, Zhejiang, China
| | - Bangfei Chen
- Department of Colorectal Surgery, Zhejiang Hospital, Hangzhou, Zhejiang, China
| | - Jiayi Zhao
- Department of Anesthesiology, Zhejiang Hospital, Hangzhou, Zhejiang, China
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