1
|
Shen Y, Zhou X, He K, Cai Y, Zhu Y, Chen H, Ding H. Diastasis Recti Abdominis: A Practical and Effective Width-Length Classification Based on Ultrasound Measurements and its Clinical Validation. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2024. [PMID: 38864261 DOI: 10.1002/jum.16508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 05/26/2024] [Accepted: 05/27/2024] [Indexed: 06/13/2024]
Abstract
OBJECTIVES This study aimed to establish a simple and practical classification to guide the clinical treatment of diastasis recti abdominis (DRA) based on ultrasound characteristics with different severities of DRA, and to verify its clinical utility. METHODS We retrospectively enrolled 301 DRA patients as pilot cohort and divided into Conservative Treatment Group and Surgical Group according to clinical outcomes. A new Width-Length classification was summarized based on ultrasound measurements of the width and length of midline separation. Then, 100 DRA patients were enrolled prospectively as validation cohort, and diagnostic performance was evaluated by clinical treatment. RESULTS The Width-Length classification in pilot cohort was as follows: Type 1 (n = 108), open only at M3; Type 2 (n = 63), open at M3 and either M2 or M4 (inter-rectus distance at M3 <47 mm); Type 3 (n = 44), open at M3 and either M2 or M4 (inter-rectus distance at M3 ≥47 mm); Type 4 (n = 74), open at M3, along with other two sites of M1, M2, M4, or M5; Type 5 (n = 12), open at M2, M3, and M4, along with M1 or M5, or both. DRA patients in Type 1-2 were recommended for conservative treatment, and in Type 3-5 were recommended for surgical treatment (all P < .05). In the validation cohort, the accuracy of Width-Length classification in determining treatment strategy was 86.0%. CONCLUSIONS This study proposes a Width-Length classification based on the width and length of midline separation on ultrasound, which was validated to be simple, practical and effective in guiding DRA treatment.
Collapse
Affiliation(s)
- Ye Shen
- Department of Ultrasound, Huashan Hospital, Fudan University, Shanghai, China
| | - Xiuling Zhou
- Department of Ultrasound, Huashan Hospital, Fudan University, Shanghai, China
| | - Kai He
- Department of General Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Yehua Cai
- Department of Ultrasound, Huashan Hospital, Fudan University, Shanghai, China
| | - Yulan Zhu
- Department of Rehabilitation, Huashan Hospital, Fudan University, Shanghai, China
| | - Hao Chen
- Department of General Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Hong Ding
- Department of Ultrasound, Huashan Hospital, Fudan University, Shanghai, China
| |
Collapse
|
2
|
Chen Y, Sun XY, Qian C, Zhang XX, Zhou YJ, Zhang HY, Xie ZW. Therapeutic effect of manual massage on early postpartum rectus abdominis separation and postpartum depression. World J Psychiatry 2024; 14:678-685. [PMID: 38808091 PMCID: PMC11129154 DOI: 10.5498/wjp.v14.i5.678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 04/13/2024] [Accepted: 04/19/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND Rectus abdominis separation (DRA) affects pelvic stability and body image. No studies have explored the effects of manual massage on early postpartum DRA and postpartum depression.
AIM To analyze the curative effect of massage on early postpartum DRA and its impact on postpartum depression and thus its ability promote the overall psychosomatic rehabilitation of postpartum women.
METHODS Data were retrospectively collected on 70 primiparous women with postpartum DRA who underwent rehabilitation at the Postpartum Rehabilitation Center of Huzhou Maternal and Child Health Hospital from October 2022 to September 2023. The patients were divided into the Group S (35 cases, biomimetic electrical stimulation treatment) and Group L (35 cases, biomimetic electrical stimulation combined with manual massage treatment). Baseline data, the edinburgh postpartum depression scale (EPDS) score, and the visual analog scale (VAS) scores for rectus abdominis distance, waist circumference, and lower back pain before and after treatment were compared.
RESULTS No significant differences were found in the baseline data, rectus abdominis distance, waist circumference, and VAS and EPDS scores between the two groups before treatment (P > 0.05). After treatment, the distance between rectus abdominis and waist circumference in Group L were significantly smaller than those in Group S (P < 0.05). Furthermore, lower back pain (VAS score) and the EPDS score in Group L were significantly lower than those in Group S (P < 0.05).
CONCLUSION Manual massage can significantly reduce early postpartum DRA, waist circumference, and back pain and improve the patient’s mental state and postpartum depression.
Collapse
Affiliation(s)
- Yun Chen
- Department of Gynecology, Women’s Hospital School of Medicine Zhejiang University, Hangzhou 310006, Zhejiang Province, China
- Department of Obstetrics and Gynecology, Huzhou Maternity and Child Health Care Hospital, Huzhou 313000, Zhejiang Province, China
| | - Xiao-Yan Sun
- Department of Gynecology, Women’s Hospital School of Medicine Zhejiang University, Hangzhou 310006, Zhejiang Province, China
| | - Cheng Qian
- Department of Surgery, Huzhou Maternity and Child Health Care Hospital, Huzhou 313000, Zhejiang Province, China
| | - Xiao-Xing Zhang
- Department of Obstetrics, Huzhou Maternity and Child Health Care Hospital, Huzhou 313000, Zhejiang Province, China
| | - Yin-Jian Zhou
- Department of Obstetrics and Gynecology, Huzhou Maternity and Child Health Care Hospital, Huzhou 313000, Zhejiang Province, China
| | - Hong-Yun Zhang
- Department of Ultrasound, Women’s Hospital School of Medicine Zhejiang University, Hangzhou 310006, Zhejiang Province, China
| | - Zhen-Wei Xie
- Department of Gynecology, Women’s Hospital School of Medicine Zhejiang University, Hangzhou 310006, Zhejiang Province, China
| |
Collapse
|
3
|
Li J, Lu Y, Yang D, Ren M, Yin Y, Zhao Y, He S. Differentially expressed genes of esophageal tissue in male acute and chronic sleep deprivation mice. GENES, BRAIN, AND BEHAVIOR 2024; 23:e12896. [PMID: 38662955 PMCID: PMC11045192 DOI: 10.1111/gbb.12896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 03/21/2024] [Accepted: 04/06/2024] [Indexed: 04/29/2024]
Abstract
Gastroesophageal reflux disease (GERD) is associated with sleep disturbances. However, mechanisms underlying these interactions remain unclear. Male acute and chronic sleep deprivation (SD) mice were used for this study. Mice in the chronic SD group exhibited anxiety- and depression-like behaviors. We further performed high-throughput genome sequencing and bioinformatics analysis to screen for featured differentially expressed genes (DEGs) in the esophageal tissue. The acute SD group, comprised 25 DEGs including 14 downregulated and 11 upregulated genes. Compared with the acute SD group, more DEGs were present in the chronic SD group, with a total of 169 DEGs, including 88 downregulated and 81 upregulated genes. Some DEGs that were closely related to GERD and associated esophageal diseases were significantly different in the chronic SD group. Quantitative real-time polymerase chain reaction verified the downregulation of Krt4, Krt13, Krt15 and Calml3 and upregulation of Baxl1 and Per3. Notably, these DEGs are involved in biological processes, which might be the pathways of the neuroregulatory mechanisms of DEGs expression.
Collapse
Affiliation(s)
- Jing Li
- Department of GastroenterologyFirst Affiliated Hospital of Xi'an Jiaotong UniversityXi'anChina
- Shannxi Clinical Research Center of Digestive Disease (Cancer Devision)Xi'anChina
| | - Yifan Lu
- Department of NeurobiologySchool of Basic Medicine, Fourth Military Medical UniversityXi'anChina
| | - Dingding Yang
- Department of NeurobiologySchool of Basic Medicine, Fourth Military Medical UniversityXi'anChina
| | - Mudan Ren
- Department of GastroenterologyFirst Affiliated Hospital of Xi'an Jiaotong UniversityXi'anChina
- Shannxi Clinical Research Center of Digestive Disease (Cancer Devision)Xi'anChina
| | - Yan Yin
- Department of GastroenterologyFirst Affiliated Hospital of Xi'an Jiaotong UniversityXi'anChina
- Shannxi Clinical Research Center of Digestive Disease (Cancer Devision)Xi'anChina
| | - Yan Zhao
- Department of GastroenterologyFirst Affiliated Hospital of Xi'an Jiaotong UniversityXi'anChina
- Shannxi Clinical Research Center of Digestive Disease (Cancer Devision)Xi'anChina
| | - Shuixiang He
- Department of GastroenterologyFirst Affiliated Hospital of Xi'an Jiaotong UniversityXi'anChina
- Shannxi Clinical Research Center of Digestive Disease (Cancer Devision)Xi'anChina
| |
Collapse
|
4
|
Zhu Y, Jiang L, Ye T, Liu Y, Sun L, Xiao L, Chen J, Wang T, Ren Y, Xu H, Zhao H, Mao X, Shen T. Risk Factors and Patient-Reported Outcomes in Chinese Women with Postpartum Diastasis Recti Abdominis: An Observational Study. Int J Womens Health 2024; 16:179-192. [PMID: 38313599 PMCID: PMC10838504 DOI: 10.2147/ijwh.s437088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 01/22/2024] [Indexed: 02/06/2024] Open
Abstract
Purpose Diastasis recti abdominis (DRA) is a condition in which the linea alba is stretched and widened, and the abdominal muscles are separated from each other. DRA typically occurs in pregnant and postpartum women. We aimed to determine the risk factors and patient-reported outcomes (PROs) of DRA in Chinese postpartum women. Methods This observational study was conducted in Hangzhou Hospital of Traditional Chinese Medicine, and involved 534 women who filled out the following risk-factor and PRO questionnaires: SF-MPQ-2, SF-ICIQ, LDQ, EPDS, MBIS, HerQles, and SF-36 (all Chinese versions). The inter-recti distance was measured by palpation. Statistical analyses were performed using SPSS v25.0 software and the Mann-Whitney U-test, chi-square test, binary logistic regression analysis (for risk factors of DRA), and the Kendall and Spearman tests (for correlation analysis). Results After childbirth, 78.1% (417/534) of the enrolled women had DRA. Abdominal surgery (P = 0.002), number of pregnancies (P = 0.035), parity (P = 0.012), number of births (P = 0.02), fetal birth weight (P = 0.014), and waist-to-hip ratio in the supine position (P = 0.045) significantly differed between the DRA and non-DRA groups. Caesarean delivery was an independent risk factor for DRA. The PROs were significantly worse in the DRA group than in the non-DRA group. Conclusion Caesarean delivery was an independent risk factor for DRA. Women with DRA are more likely to have limited physical activity or function after childbirth, lower self-confidence, and a decreased quality of life.
Collapse
Affiliation(s)
- Ying Zhu
- School of Basic Medical Sciences, Zhejiang Chinese Medical University, Hangzhou, 310053, People’s Republic of China
| | - Liyuan Jiang
- Department of Acupuncture and Rehabilitation, Hangzhou Hospital of Traditional Chinese Medicine, Hangzhou, 310005, People’s Republic of China
| | - Tiantian Ye
- The 1st Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, 310053, People’s Republic of China
| | - Yan Liu
- The 2nd Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, 310053, People’s Republic of China
| | - Li Sun
- Department of Acupuncture and Rehabilitation, Hangzhou Hospital of Traditional Chinese Medicine, Hangzhou, 310005, People’s Republic of China
| | - Lijuan Xiao
- Department of Rehabilitation, Chun’an County Hospital of Traditional Chinese Medicine, Chun’an, 311799, People’s Republic of China
| | - Jiayu Chen
- Department of Rehabilitation, Huzhou Central Hospital, Huzhou, 313099, People’s Republic of China
| | - Ting Wang
- The 3rd Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, 310053, People’s Republic of China
| | - Yinghua Ren
- Department of Acupuncture and Tuina, Community Health Service Center of Zhuantang Street, Hangzhou, 310024, People’s Republic of China
| | - Hongjun Xu
- Department of Acupuncture and Tuina, Community Health Service Center of Zhuantang Street, Hangzhou, 310024, People’s Republic of China
| | - Huihui Zhao
- Department of Acupuncture and Tuina, Community Health Service Center of Zhuantang Street, Hangzhou, 310024, People’s Republic of China
| | - Xiaozhen Mao
- Department of Acupuncture and Tuina, Community Health Service Center of Zhuantang Street, Hangzhou, 310024, People’s Republic of China
| | - Tiantian Shen
- Department of Acupuncture and Rehabilitation, Shengzhou Municipal Hospital of Traditional Chinese Medicine, Hangzhou, 312499, People’s Republic of China
| |
Collapse
|
5
|
Chen B, Zhao X, Hu Y. Rehabilitations for maternal diastasis recti abdominis: An update on therapeutic directions. Heliyon 2023; 9:e20956. [PMID: 37867827 PMCID: PMC10589864 DOI: 10.1016/j.heliyon.2023.e20956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 10/06/2023] [Accepted: 10/11/2023] [Indexed: 10/24/2023] Open
Abstract
Diastasis recti abdominis (DRA) affects a significant number of postpartum women, while its treatments are still under debate. This study aimed to systematically evaluate the effectiveness of rehabilitation training programs for postpartum DRA treatment. Four databases were systematically searched to identify eligible studies published up to February 1, 2023. We followed the PRISMA for scoping reviews guideline in this study. The characteristics and the main findings of the included studies were extracted. Sixteen studies enrolling 1129 women during the ante- and/or postnatal period were included. The common rehabilitation training for DRA included physical exercise, non-exercise physical therapy, acupuncture, and electrotherapy. The presence of DRA could be diagnosed by ultrasound, caliper, or palpation, of which ultrasound had the best reliability. Besides, these assessments could also be used for evaluating the therapeutic efficacy after the rehabilitation training programs. Several studies concluded that patients with DRA could be effectively improved by specific interventions. But a few included studies revealed rehabilitation training might be not more effective than no interventions when treating DRA. For example, some investigators did not recommend physical exercise for DRA patients due to this intervention during pregnancy kept the linea alba less stressed by maintaining abdominal tone, strength, and control, and therefore might aggravate DRA. However, it should be noted that this evidence was derived from limited studies (16/60, 27 % papers) with small samples. To some extent, women with postpartum DRA can benefit from the specific rehabilitation regimen by alleviating postpartum inter-rectus distance. Further research is still warranted to propose strategies for improving postpartum DRA.
Collapse
Affiliation(s)
- Beibei Chen
- Hangzhou Women's Hospital (Hangzhou Maternity and Child Health Care Hospital), Hangzhou 310008, Zhejiang, China
| | - Xiumin Zhao
- Hangzhou Women's Hospital (Hangzhou Maternity and Child Health Care Hospital), Hangzhou 310008, Zhejiang, China
| | - Yan Hu
- Department of Obstetrics and Gynecology, Taizhou Central Hospital (Taizhou University Hospital), Taizhou 318000, Zhejiang, China
| |
Collapse
|