Neural and endothelial nitric oxide synthase activity in rat penile erectile tissue

NADPH-diaphorase (NADPH-D) activity and immunoreactivity for neural and endothelial nitric oxide synthase (nNOS and eNOS, respectively) were used to investigate nitric oxide (NO) regulation of penile vasculature. Both the histochemical and immunohistochemical techniques for NOS showed that all smooth muscles regions of the penis (dorsal penile artery and vein, deep penile vessels, and cavernosal muscles) were richly innervated. The endothelium of penile arteries, deep dorsal penile vein, and select veins in the crura and shaft were also stained for NADPH-D and eNOS. However, the endothelium of cavernous sinuses was unstained by both techniques. Fewer fibers were seen in the glans penis, those present being associated with small blood vessels and large nerve bundles near the trabecular walls. All penile neurons in the pelvic plexus, located by retrograde transport of a dye placed in the corpora cavernosa penis, were stained by the NADPH-D method. Essentially similar results were obtained with an antibody to nNOS. These data suggest that penile parasympathetic neurons comprise a uniform population, as all seem capable of forming nitric oxide. However, in contrast to the endothelium of penile vessels, the endothelium lining the cavernosal spaces may not be capable of nitric oxide synthesis.     

Intraoperative electron radiation therapy after salvage surgery in gynecological cancers and retroperitoneal sarcomas: outcomes and adverse effects

BackgroundSalvage surgery is considered an option for isolated recurrences of retroperitoneal and pelvic tumors, in patients who have undergone previous radiotherapy. In order to increase local control intra operative electron radiation therapy (IOERT) can be used in these patients to administer additional radiation dose. We evaluated the outcomes and adverse effects in patients with retroperitoneal sarcoma and gynecologic tumors after salvage surgery and IOERT.Materials and methodsTwenty patients were retrospectively analyzed. Twenty-three IOERT treatments were performed after surgery. Six (30%) were sarcoma and 14 (70%) were gynecological carcinoma. Administered dose depended on previous dose received with external beam radiotherapy (EBRT) and proximity to critical structures. The toxicities were scored using the Common Terminology Criteria for Adverse Events version 4.0.ResultsThe median age of the patients was 51 years (range 34–70). After a median follow-up of 32 months (range 1–68), in the sarcoma group the local control rate was 66.6%; while in the gynecological group the local control rate was 64.3%. In relation to late toxicity, one patient had a Grade 2 vesicovaginal fistula, and one patient presented Grade 4 enterocolitis and enteric intestinal fistula.ConclusionsIOERT could have a role in the treatment of retroperitoneal sarcomas in primary tumors after EBRT, as it may suggest a benefit in local control or recurrences after surgical resection in those at high risk of microscopic residual disease. The addition of IOERT to salvage resection for isolated recurrence of gynecologic cancers suggest favorable local control in cases with concern for residual microscopic disease.     

生物反馈电刺激联合Kegel训练对产后盆底功能障碍性疾病患者盆底功能电生理指标和生活质量的影响

目的:观察生物反馈电刺激联合Kegel训练对产后盆底功能障碍性疾病(PFD)患者盆底功能电生理指标和生活质量的影响。方法:研究对象为2018年3月~2020年12月我院收治的80例产后PFD患者。采用双色球随机分组法将患者分为对照组(n=40)和研究组(n=40)。对照组给予Kegel训练,研究组给予生物反馈电刺激联合Kegel训练,两组均治疗8周。对比两组治疗8周后的疗效和尿失禁、盆底器官脱垂程度的改善情况。对比两组治疗前、治疗8周后的盆底功能电生理指标、日常生活质量和性生活质量。结果:治疗8周后,研究组的临床总有效率较对照组高(P<0.05)。治疗8周后,研究组I类肌纤维疲劳度、Ⅱ类肌纤维疲劳度、快肌最大肌电值及阴道动态压力均优于对照组(P<0.05)。研究组治疗8周后尿失禁、盆底器官脱垂程度的改善情况优于对照组(P<0.05)。治疗8周后,研究组盆底功能影响问卷简表(PIFQ-7)评分、盆腔器官脱垂-尿失禁性功能问卷(PISQ-12)评分均低于对照组(P<0.05)。结论:产后PFD患者采用生物反馈电刺激联合Kegel训练治疗疗效明确,可促进尿失禁、盆底器官脱垂程度情况及盆底功能改善,提高患者日常生活质量和性生活质量。     

探讨女性盆底功能障碍性疾病的相关因素及盆底超声测定压力性尿失禁SUI的临床意义

目的:探讨女性盆底功能障碍性疾病的相关因素及盆底超声测定压力性尿失禁SUI的临床意义。方法:选取我院2019年-2020年共收治的63例盆底功能障碍性疾病患者作为研究对象,将其分为研究组,另取同期来我院进行体检的63例健康女性作为对照组,对所有女性应用盆底超声检测,对比两组女性静息状态下和Valsalva状态下的盆底超声检查指标,对通过问卷调查方式,调查两组女性的一般临床治疗,对于女性盆底功能障碍性疾病的相关因素进行单因素分析与多因素分析,最终得出盆底肌功能障碍性疾病的相关因素。结果:在静息状态下通过盆底超声发现,研究组与对照组膀胱尿道后角、肛提肌裂孔面积、尿道倾斜度对比差异显著(P<0.05),两组女性膀胱颈位置、膀胱位置对比无明显差异(P>0.05);在Valsalva状态下通过盆底超声发现,研究组与对照组膀胱尿道后角、肛提肌裂孔面积、尿道倾斜度、膀胱颈位置、膀胱位置对比差异显著(P<0.05);两组女性年龄、BMI、孕次、产次、绝经情况以及白带清洁度是否≥Ⅲ度情况对比差异显著(P<0.05),两组女性子宫肌瘤史情况对比无显著差异(P>0.05);logistic回归分析结果显示,年龄、绝经情况、子宫肌瘤史和白带清洁度≥Ⅲ度不是盆底功能障碍性疾病的独立危险因素(P>0.05),BMI、孕次、产次为盆底功能障碍性疾病的独立危险因素(P<0.05)。结论:盆底肌超声在对盆底功能障碍性疾病患者压力性尿失禁的诊断中具有重要价值,在静息状态下和Valsalva状态下发现患者的膀胱经移动情况与尿道倾斜情况。年龄、BMI、孕次、产次、绝经情况以及白带清洁度是否≥Ⅲ度可能与盆底功能障碍性疾病具有一定关系,BMI、孕次、产次为盆底功能障碍性疾病的独立危险因素。     

电针阴部神经刺激疗法联合Kegel盆底康复训练对产后压力性尿失禁患者盆底肌力、尿流动力学和生活质量的影响

摘要 目的：探讨电针阴部神经刺激疗法联合Kegel盆底康复训练对产后压力性尿失禁（SUI）患者盆底肌力、尿流动力学和生活质量的影响。方法：选取2019年6月~2021年11月期间于我院就诊的产后SUI患者109例,按照入院就诊奇偶顺序分为两组,其中对照组54例,接受Kegel盆底康复训练,研究组55例,接受电针阴部神经刺激疗法联合Kegel盆底康复训练。对比两组疗效、漏尿量、尿失禁程度、盆底肌力、尿流动力学和生活质量。结果：研究组的临床总有效率高于对照组（P<0.05）。两组治疗后盆底肌肌力各指标（手测肌力和Ⅰ类肌纤维最大值、Ⅱ类肌纤维平均值）均升高,且研究组高于对照组（P<0.05）。两组治疗后漏尿量、尿失禁程度评分均下降,且研究组低于对照组（P<0.05）。两组治疗后尿流动力学相关指标[腹压漏尿点压（AL-PP）、最大尿流率（Qmax）和最大尿道闭合压力（MUCP）]均升高,且研究组高于对照组（P<0.05）。两组治疗后尿失禁生活质量量表（I-QOL）各维度（限制性行为、心理影响、社交活动受限）评分及总分均升高,且研究组高于对照组（P<0.05）。结论：电针阴部神经刺激疗法联合Kegel盆底康复训练可有效改善产后SUI患者的盆底肌肌力和尿失禁情况,减少漏尿量,同时可促进尿流动力学恢复,进而提高患者的生活质量。     

盆底肌功能训练联合阴茎夹对前列腺增生术后患者尿失禁的临床应用分析

目的:分析盆底肌功能训练联合阴茎夹对前列腺增生术后患者尿失禁的临床应用效果。方法:选取我院2017年4月～2019年4月收治的72例前列腺增生术后尿失禁患者,随机分为对照组和观察组各36例,两组均予盆底肌功能训练,观察组加用阴茎夹控制排尿。对比两组术后尿失禁改善情况、排尿改善情况、国际尿失禁咨询委员会尿失禁问卷表简表(ICI-Q-SF)评分变化、压力性尿失禁分度评价及经济费用情况。结果:两组干预后20 d、干预后30 d、干预后90 d尿失禁发生率均较干预后10 d下降,观察组干预后10 d、干预后20 d、干预后30 d、干预后90 d尿失禁发生率均低于对照组,差异均有统计学意义(P0.05)。两组干预后90 d每日总尿量较干预前升高,每日总排尿次数、每日总漏尿次数均较干预前下降;观察组干预后90 d每日总尿量高于对照组,每日总排尿次数、每日总漏尿次数均低于对照组,差异均有统计学意义(P0.05)。两组干预后90d ICI-Q-SF评分均较干预前下降,且观察组干预后90d ICI-Q-SF评分低于对照组,差异均有统计学意义(P0.05)。观察组患者干预后压力性尿失禁临床治愈率高于对照组,差异有统计学意义(P0.05)。两组患者压力性尿失禁分度情况比较差异无统计学意义(P0.05)。观察组阴茎夹使用费用为(70.26±8.51)元,低于对照组的(388.71±26.44)元,差异有统计学意义(P0.05)。结论:在盆底肌功能训练的基础上联合阴茎夹能够有效改善前列腺增生术后患者尿失禁症状及生活质量,且有助于降低患者经济负担,值得临床推广应用。     

Validation of density–elasticity relationships for finite element modeling of human pelvic bone by modal analysis

In total hip arthroplasty and particularly in revision surgery, computer assisted pre-operative prediction of the best possible anchorage strategy for implant fixation would be a great help to the surgeon. Computer simulation relies on validated numerical models. In the current study, three density–elasticity relationships (No. 1–3) from the literature for inhomogeneous material parameter assignment from CT data in automated finite element (FE) modeling of long bones were evaluated for their suitability for FE modeling of human pelvic bone. Numerical modal analysis was conducted on 10 FE models of hemipelvic bone specimens and compared to the gold standard provided by experimental modal analysis results from a previous in-vitro study on the same specimens. Overall, calculated resonance frequencies came out lower than measured values. Magnitude of mean relative deviation of numerical resonance frequencies with regard to measured values is lowest for the density–elasticity relationship No. 3 (−15.9%) and considerably higher for both density–elasticity relationships No. 1 (−41.1%) and No. 2 (−45.0%). Mean MAC values over all specimens amount to 77.8% (No. 1), 78.5% (No. 2), and 83.0% (No. 3). MAC results show, that mode shapes are only slightly influenced by material distribution. Calculated resonance frequencies are generally lower than measured values, which indicates, that numerical models lack stiffness. Even when using the best suited (No. 3) out of three investigated density–elasticity relationships, in FE modeling of pelvic bone a considerable underestimation of model stiffness has to be taken into account.     

经会阴二维超声对自然分娩女性产后盆底三腔室运动和早期盆底功能的评估价值

目的:探讨经会阴二维超声对自然分娩女性产后盆底三腔室运动和早期盆底功能的评估价值。方法:选取2019年2月～2019年7月于我院进行自然分娩的产妇284例作为研究组,另选取同期于我院接受诊治的未育女性200例作为对照组。两组均进行经会阴二维超声检查,比较两组静息期、张力期、缩肛期的肛管直肠连接部(ARJ)、宫颈外口(CV)、尿道膀胱连接部(UVJ)的位置及运动变化情况,对比两组静息状态下以及最大Valsaval动作下盆底超声参数。结果:研究组静息期、张力期、缩肛期的CV距离水平参照线的垂直长度(CV-VD)、UVJ距离水平参照线的垂直长度(UVJ-VD)均低于对照组(均P0.05)。研究组张力期对应静息期垂直长度△r-s CV-VD、△r-s UVJ-VD均高于对照组,而缩肛期对应静息期垂直长度△r-s CV-VD、△r-s UVJ-VD均低于对照组(均P0.05)。研究组静息状态下膀胱颈位置(BNP)低于对照组,而膀胱尿道后角(PUA)高于对照组(均P0.05);研究组最大Valsaval动作下膀胱颈移动度(BND)、PUA、尿道旋转角(URA)均高于对照组(均P0.05)。结论:经会阴二维超声可对自然分娩女性产后盆底三腔室运动和早期盆底功能进行有效观察,有助于评估女性盆底结构、功能变化,具有一定的临床推广应用价值。     

Lower limb kinematics in individuals with chronic low back pain during walking

Several investigators have suggested the presence of a link between Chronic Low Back Pain (CLBP) and lower limbs kinematics that can contribute to functional limitations and disability. Moreover, CLBP has been connected to postural and structural asymmetry. Understanding the movement pattern of lower extremities and its asymmetry during walking can provide a basis for examination and rehabilitation in people with CLBP. The present study focuses on lower limbs kinematics in individuals with CLBP during walking. Three-dimensional movements of the pelvic, hip, knee and ankle joints were tracked using a seven-camera Qualysis motion capture system. Functional dada analysis (FDA) was applied for the statistical analysis of pelvic and lower limbs motion patterns in 40 participants (20 CLBP and 20 controls). The CLBP group showed significantly different hip motion pattern in the transvers plane, altered knee and ankle motion pattern in the sagittal plane on the dominant side and different hip motion pattern in the transvers and frontal planes on the non-dominant side in comparison with the control group over the stance phase. In terms of symmetry, in the CLBP group, hip and knee moved through a significantly different motion patterns in the transvers plane on the dominant side in comparison with the non-dominant side. In the control group, knee moved through a significantly different motion pattern in the transvers plane on the dominant side in comparison with the non-dominant side. In conclusion, low back pain lead to altered movement patterns of the main joints of lower limbs especially on the dominant side during stance phase. Therefore, care should be taken to examine dominant lower limb movement pattern in CLBP to make a better clinical decision.     

彩色多普勒超声对盆腔瘀血综合征的诊断价值及与临床因素的相关性研究

目的:探讨盆腔瘀血综合征患者彩色多普勒超声的影像学特征及与临床因素的相关性。方法:对112例盆腔瘀血综合征患者行彩色多普勒超声检查,按超声诊断分级Ⅰ级、Ⅱ级、Ⅲ级分为62例、27例、23例,观察彩色多普勒超声的影像学特征,分析静脉内径与病程的相关性,并分析超声诊断分级与临床症状积分、体质量指数(BMI)、妊娠次数、既往工作站立时间的相关性。结果:不同超声诊断分级患者的静脉内径、静脉丛范围和静脉流速差异具有统计学意义(P<0.05)。静脉内径与病程呈正相关(P<0.05),超声诊断分级与临床症状积分、妊娠次数、既往工作站立时间呈显著正相关(P<0.05),与BMI呈负相关(P<0.05)。结论:彩色多普勒超声对盆腔瘀血综合征具有特异性的诊断价值,超声诊断分级、静脉内径与临床因素存在一定的的关联性。