Abdominal Pressure Research Articles

Ultrasonographic study of female perineal body and its supportive function on pelvic floor.

The study aimed to observe, measure the size and elastic value of perineal body (PB) and assess its association with levator hiatus. Datasets were acquired in 45 nulliparous, 66 POP women and 70 postpartum women using ultrasound. The PB was measured in depth, height, and Young's modulus. The datasets were compared to assess whether there are some differences in the morphology, dimension and elastography modulus of PB among women. Pearson correlation analysis was used to evaluate the association between the morphology measurements (ΔValsalva-rest[v-r]), tissue mechanical properties (ΔValsalva-rest[v-r]) of the PB and levator hiatus area (ΔValsalva-rest[v-r]) to preliminarily explore whether PB can influence levator hiatus. Four representative manifestations of PB were presented in our study. Nulliparous women had smaller diameters and bigger Young's modulus while postpartum women had bigger diameters and smaller Young's modulus. POP and postpartum women had bigger levator hiatal distensibility and PB extensibility. There was no statistical association between PB measurements and levator hiatal area. It is feasible to observe the morphology of PB and assess the dimension and elastography modulus by high-frequency ultrasound. The manifestations and measurements of PB are influenced by parity and long-term increased abdominal pressure. Our study preliminarily shows that PB has little effect on levator hiatus area.

Stomach perforation-induced general occlusion/occlusion-like syndrome and stable gastric pentadecapeptide BPC 157 therapy effect.

Using rat stomach perforation as a prototypic direct lesion applied in cytoprotection research, we focused on the first demonstration of the severe occlusion/ occlusion-like syndrome induced by stomach perforation. The revealed stomach-induced occlusion/occlusion-like syndrome corresponds to the previously described occlusion/occlusion-like syndromes in rats suffering multicausal pathology and shared severe vascular and multiorgan failure. This general point was particularly reviewed. As in all the described occlusion/occlusion-like syndromes with permanent occlusion of major vessels, peripheral and central, and other similar noxious procedures that severely affect endothelium function, the stable gastric pentadecapeptide BPC 157 was resolving therapy. To reveal the stomach perforation-induced general occlusion/occlusion-like syndrome and BPC 157 therapy effect. The procedure included deeply anesthetized rats, complete calvariectomy, laparotomy at 15 min thereafter, and stomach perforation to rapidly induce vascular and multiorgan failure occlusion/occlusion-like syndrome. At 5 min post-perforation time, rats received therapy [BPC 157 (10 µg or 10 ng/kg) or saline (5 mL/kg, 1 mL/rat) (controls)] into the perforated defect in the stomach). Sacrifice was at 15 min or 60 min post-perforation time. Assessment (gross and microscopy; volume) included: Brain swelling, peripheral vessels (azygos vein, superior mesenteric vein, portal vein, inferior caval vein) and heart, other organs lesions (i.e., stomach, defect closing or widening); superior sagittal sinus, and peripherally the portal vein, inferior caval vein, and abdominal aorta blood pressures and clots; electrocardiograms; and bleeding time from the perforation(s). BPC 157 beneficial effects accord with those noted before in the healing of the perforated defect (raised vessel presentation; less bleeding, defect contraction) and occlusion/occlusion-like syndromes counteraction. BPC 157 therapy (into the perforated defect), induced immediate shrinking and contraction of the whole stomach (unlike considerable enlargement by saline application). Accordingly, BPC 157 therapy induced direct blood delivery via the azygos vein, and attenuated/eliminated the intracranial (superior sagittal sinus), portal and caval hypertension, and aortal hypotension. Thrombosis, peripherally (inferior caval vein, portal vein, abdominal aorta) and centrally (superior sagittal sinus) BPC 157 therapy markedly reduced/annihilated. Severe lesions in the brain (swelling, hemorrhage), heart (congestion and arrhythmias), lung (hemorrhage and congestion), and marked congestion in the liver, kidney, and gastrointestinal tract were markedly reduced. We revealed stomach perforation as a severe occlusion/occlusion-like syndrome, peripherally and centrally, and rapid counteraction by BPC 157 therapy. Thereby, further BPC 157 therapy may be warranted.

Computed tomography morphometric comparison of the pelvis in children with and without rectal prolapse in Niger

BackgroundRectal prolapse is a public health problem that affects all sexes at different ages. It is one of the most frequent reasons for consultation in pediatric surgery. The main causes are chronic constipation and diarrhea or both. The increase in abdominal pressure, whatever its cause, is an essential factor favoring the occurrence of rectal prolapse. The anatomical factors related to the morphology of the pelvis and sacrum are unknown. The objective of this work was to compare the morphometric variations of the pelvis in children aged from 0 to 15 years with and without rectal prolapse. MethodsThis was a case-control study of 128 children (64 males) living in Niger, children without rectal prolapse (controls) were paired to those with rectal prolapse by age for both sexes. Morphometric parameters were measured on computed tomography scans. The length, concavity and slope of the sacrum were measured. Antero-posterior, bi-ischiatic, and sub-sacro-sub-pubic diameters were measured on the pelvis. ResultsIn girls and boys with rectal prolapse, with the generalized linear model the sacral length was significantly increased with p = 0.0005 and sacral concavity decreased as compared with controls with p = 0.0007. The sacral slope has probably also an effect but impaired by large variations. There were no significant changes in other pelvic parameters. ConclusionThe morphology of the sacrum is an anatomical factor probably related to the occurrence of rectal prolapse in children.

Pogonias courbina sperm characteristcs in its first reproductive season.

Southern black drum (Pogonias courbina) is a species distributed along the western Atlantic Ocean, and it is the largest Sciaenidae observed in the coast of Rio Grande do Sul state, Brazil. However, it is listed as a vulnerable species at The IUCN Red List of Threatened Species™, and their fishing is prohibited. The objective of this study was to determine the sperm characteristics of P. courbina. Sperm samples of five young males (two-year-old fish) were collected through abdominal pressure. The sperm kinetics parameters were sperm motility (MOT) 10.7±5.6%, curvilinear velocity (VCL) 120.07±16.16 mm s±1, average path velocity (VAP) 75.64±23.78 mm s±1, straight-line velocity (VSL) 62.49±15.83 mm s±1, straightness (STR) 83.9±5.3%, wobble (WOB) 61.9±12.7%, beat cross frequency (BCF) 42.981±4.627 Hz and progression (PRG) 1,805.4±564.5 µm. The proportion of normal spermatozoa was 35.6±6.1%. About the abnormalities observed, 22.7% occurred in the tail (short tail = 0.6±0.5%, distally curled tail = 2.4±1.6%, strongly curled tail = 1.9±1.3%, broken tail = 7.9±5.1%, folded tail = 5.5±0.8%, loose tail = 4.4±1.9%); 14.2% occurred in the head (degenerate head = 4.2±1.6%, microcephaly = 1.8±2.5%, loose head = 8.2±2.1%) and 27.5% of the spermatozoa showed cytoplasmatic gouts (proximal gout = 20.0±8.4%, distal gout = 7.5±2.8%). Besides that, a correlation analysis was performed between sperm morphology and kinetics parameters, and the spermatozoa were measured for the morphometric parameters. There was a positive correlation between BCF and normal spermatozoa (r= 0.9269). A negative correlation occurred between BCF and loose head (r= -0.9047); WOB and strongly curled tail (r= -0.8911); and PROG and strongly curled tail (r= -0.9191). The morphometric measures found for the head were length of 2.50±0.21 µm and width of 2.12±0.22 µm, and for the tail it was length of 37.97±2.01 µm. It was possible to verify that the animals have sperm characteristics that indicate reproductive aptitude, but an abnormal behavior on sperm activation and high presence of the cytoplasmic gout abnormality indicates that the animals are not fully mature in their first reproductive season. This work contributes to a better understanding of the P. courbina spermatic parameters, what can be allies to recovery this species population in nature and promote its production in fish farms.

Differential inhibition of cough by GABAA and GABAB receptor antagonists in the nucleus of the solitary tract in cats

Bicuculline and saclofen were microinjected into the rostral (rNTS) and caudal nucleus of the solitary tract (cNTS) in 17 anesthetized cats. Electromyograms (EMGs) of the diaphragm (DIA) and abdominal muscles (ABD), esophageal pressures (EP), and blood pressure were recorded and analyzed. Bilateral microinjections of 1 mM bicuculline in the rNTS significantly reduced the number of coughs (CN), amplitudes of DIA and ABD EMG, inspiratory and expiratory EP, and prolonged the duration of the cough expiratory phase (CTE) as well as the total cough cycle duration (CTtot). Bilateral microinjections of 2 mM saclofen reduced only cough expiratory efforts. Bilateral microinjection of bicuculline in the cNTS significantly reduced CN and amplitudes of ABD EMG and elongated CTE and CTtot. Bilateral microinjections of saclofen in cNTS had no significant effect on analyzed cough parameters. Our results confirm a different GABAergic inhibitory system in the rNTS and cNTS acting on mechanically induced cough in cats.

The Effect of a Myomectomy on Myoma-related Symptoms and Quality of Life: A Retrospective Cohort Study

Although it is assumed that myomectomy improves uterine myoma-related symptoms such as pelvic pain and heavy menstrual bleeding (HMB), validated measures are rarely reported. This study aimed to verify the effect of myomectomy on myoma-related symptoms. A retrospective cohort study. A university-affiliated hospital. Our study included 241 patients with a myoma diagnosis and received a myomectomy between 2004 and 2018. Data were collected from the patient medical file and patients responded in 1 questionnaire. Transcervical resection of myoma (TCRM) and laparoscopic or abdominal myomectomy (LAM). One year after TCRM, a significant number of women experienced symptom improvement for pelvic pain (79% [19/24, p=.01]) and HMB (89% [46/52, p <.001]). For other myoma-related symptoms, abdominal pressure (43%, 10/23), sexual complaints (67%, 2/3), infertility (56%, 10/18), and other complaints (83%, 5/6), improvements were not statistically significant. One year after LAM, a significant number of women experienced symptom improvement for pelvic pain (80%, 74/93), HMB (83%, 94/113), abdominal pressure (85%, 79/93), sexual complaints (77%, 36/47), and other complaints (91%, 40/44). One year after myomectomy, 47% (30/64) (TCRM) and 44% of women (78/177) (LAM) described no myoma-related symptoms. Most women (82% [172/217]) were satisfied with the postoperative result after 1 year and 53% (114/217) would have liked to receive the myomectomy earlier in life. Average quality of life (measured on a 10-point Likert scale) increased from 6.3 at baseline to 8.0 at 1 year after TCRM and from 6.2 to 8.0 1 year after LAM, resulting in a difference of 1.7 points (p <.001; 95% confidence interval, 1.1-2.3) and 1.9 points (p <.001; 95% confidence interval, 1.4-2.3), respectively. One year after myomectomy, most women have benefited from myomectomy, concluded by a significant number of women who experienced myoma-related symptom improvement, positive patient satisfaction, and a significant improvement in reported quality of life. Validation of results after conventional treatment such as myomectomy is essential in counseling patients for surgical treatment in today's evidence based practice. In addition, it is necessary to make an adequate comparison with new treatment options for myomas. To provide this, further research should preferably be conducted prospectively or by randomization.

Menopause and stress urinary incontinence: The risk factors of stress urinary incontinence in perimenopausal and postmenopausal women.

The prevalence of stress urinary incontinence (SUI) increases around menopause. The quality of life of perimenopausal and postmenopausal women with SUI is significantly affected. This study aimed to investigate the prevalence of SUI and the associated risk factors in a population of Chinese perimenopausal and postmenopausal women. A total of 273 perimenopausal and postmenopausal women were enrolled, and a cross-sectional study was conducted. SUI was defined as an involuntary loss of urine with increases in abdominal pressure. Data including personal characteristics, menopause information, estrogen levels, and pelvic floor muscle strength levels were statistically analyzed. The study enrolled 158 (57.9%) perimenopausal and 115 (42.1%) postmenopausal women. Sixty-six (41.8%) perimenopausal women and 56 (48.7%) postmenopausal women complained of SUI. The mean age was 49.42 ± 5.58 years. Body mass index over 24 kg/m2 (odds ratio [OR] 2.02, 95% confidence interval [CI] 1.07-3.81), vaginal delivery (OR 2.47, 95% CI 1.33-4.58), and diabetes (OR 4.65, 95% CI 1.23-17.62) were high-risk factors for SUI. Climacteric symptoms (evaluated by Kupperman index scores) were statistically related to SUI, and among the 13 symptoms, insomnia, nervousness, weakness and fatigue, arthralgia and myalgia, headache, palpitation, and sexual complaints were all correlated with SUI in perimenopausal and postmenopausal women. Several factors are associated with SUI in Chinese perimenopausal and postmenopausal women. Obesity, vaginal delivery, climacteric symptoms, and diabetes were identified as the most notable risk factors. The management strategy could focus on the prevention and management of risk factors.

Acute post sleeve surgery bleeding as rare cause of acute renal failure: a case report

BackgroundBariatric surgeries have been considered as one of the most important treatment procedures in recent years. Being aware of the side effects of this surgery will lead to better results after the surgery.Case presentationA 37-year-old Iranian male patient presented one day after sleeve surgery with symptoms of weakness, lethargy, and shortness of breath, which hospitalization and workup to were done to rule out pulmonary embolism. Because of the high creatinine and anuria, we couldn’t perform computed tomography angiography. A bedside ultrasound was done for the patient and showed a mild to moderate amount of fluid around the spleen and some blood clots. Due to the progressive clinical findings and suspected internal bleeding, the patient was a candidate for laparoscopic revision procedure. Gradually, after performing the surgery, removing the blood clot and reducing the compressive effect of that on the inferior verna cava which was the main reason of renal failure, the patient was able to urinate afterwards and was discharged in good general condition.ConclusionSurgeons should be aware of the management of rare surgical complications after bariatric surgeries. To be best of our knowledge, this was the first case report of a patient with acute renal failure after bariatric surgery and the rare cause of clot compression on inferior vena cava and raised abdominal compartment pressure.

Design of an Extremely Lightweight Soft Actuator on a Pneumatic Corset for Support Lumbar Burden

In the case of the treatment of low back pain, the lumbar corset which is the orthotic therapy is mainly used. However, there is a problem that the trunk muscle group is not used continuously by wearing the conventional lumbar corset for a long time, and muscle decline may occur. In this research, we propose an intelligent pneumatic corset that detects the forward bending posture with a sensor and automatically drives the soft actuator according to the attitude angle. It detects a forward-leaning posture in which the burden on the lumbar region increases, and automatically pressurizes the soft actuator. And, in the corset developed so far, the effect of supporting the muscle of the lumbar region was expected by compressing the abdomen and increasing abdominal pressure. In this paper, the operation support method by the restorative force when the soft actuator is deformed and the design of the intelligent pneumatic corset with built-in them are described.

Robotic vNOTES Techniques for Hysterectomy in a Patient with a 16-week Sized Uterus and a Body Mass Index of 70

To demonstrate the surgical techniques for robotic vNOTES hysterectomy with bilateral salpingo-oophorectomy (BSO) in a World Health Organization class 3 obesity patient (body mass index=70) as well as large fibroid uterus (16 weeks sized). Stepwise demonstration with narrated video footage. An academic tertiary care hospital. Our patient is a 50-year-old G0 with postmenopausal vaginal bleeding with an enlarged uterus; her endometrial biopsy showed complex endometrial hyperplasia with atypia. The surgical exposure for extremely obese patients with a concomitantly large uterus can be very challenging transabdominally due to the patient being unable to tolerate the Trendelenburg position and abdominal gas pressure [1-5]. Therefore, transvaginal NOTES can be an alternative option for these types of challenging patients. However, although there are clear benefits of vNOTES surgery in obese patients, we still need to be thoughtful and deliberate in handling this kind of surgery [6]. Several key success factors that aid in the completion of the surgery include 1. Appropriate patient positioning (Trenguard Position) as tolerated. 2. Initial vaginal section of hysterectomy. 3. Successful port placement. 4. Trendelenburg, as far as tolerated. 5. Harnessing the robotic camera for anterior colpotomy. 6. Utilizing alternative surgical exposure techniques: air seal for maintaining gas pressure for optimizing exposure, lap pad for thermal isolation, and maintaining the uterus for safe exposure during BSO. 7. After identification of the bilateral ureters, the broad, round, and uterine ovarian ligaments were transected with vessel sealer (less thermal spread), and the cystectomy was completed. (Supplemental Video 1) 8. BSO was completed. 9. In-bag uterine tissue extraction. 10. Vaginal cuff closure with V-Loc barbed suture. Robotic-assisted NOTES hysterectomy with BSO is feasible and safe in extremely obese patients with large uterus. The combination of all these strategies could aid in the feasibility and safety of patients with these challenging pathology and morbidity.

Two-dimensional biomechanical finite element modeling of the pelvic floor and prolapse.

We developed the pelvic floor model in physiological and pathological states to understand the changes of biomechanical axis and support that may occur from the normal physiological state to the prolapse pathological state of the pelvic floor. Based on the physiological state model of the pelvic floor, we model the uterus to the pathological state position by balancing intra-abdominal pressure (IAP) and uterine pathological position load. Under combined impairments, we compared the patterns of changes in pelvic floor biomechanics that may be induced by different uterine morphological characteristic positions under different IAP. The orientation of the uterine orifice gradually changes from the sacrococcygeal direction to the vertical downward of vaginal orifice, and a large downward prolapse displacement occurs, and the posterior vaginal wall shows "kneeling" profile with posterior wall bulging prolapse. When the abdominal pressure value was 148.1cmH2O, the descent displacement of the cervix in the normal and pathological pelvic floor system was 11.94, 20, 21.83 and 19.06mm in the healthy state, and 13.63, 21.67, 22.94 and 19.38mm in the combined impairment, respectively. The above suggests a maximum cervical descent displacement of the uterus in the anomalous 90° position, with possible cervical-uterine prolapse as well as prolapse of the posterior vaginal wall. The combined forces of the pelvic floor point in the direction of vertical downward prolapse of the vaginal orifice, and the biomechanical support of the bladder and sacrococcygeal bone gradually diminishes, which may exacerbate the soft tissue impairments and biomechanical imbalances of the pelvic floor to occur of POP disease.

Does Manual Abdominal Pressure During Colonoscopy Put Endoscopy Staff and Patients at Risk?: Experiences of Endoscopy Nurses and Technicians.

Endoscopy staff suffer work-related musculoskeletal disorders at a rate greater than or comparable to nurses and technicians in other subspecialities, which may be attributable to the widespread use of manual pressure and repositioning during colonoscopy. In addition to negatively impacting staff health and job performance, colonoscopy-related musculoskeletal disorder injuries may also signal potential risks to patient safety. To assess the prevalence of staff injury and perceived patient harm relating to the use of manual pressure and repositioning techniques during colonoscopy, 185 attendees of a recent national meeting of the Society of Gastroenterology Nurses and Associates were asked to recall experiencing injuries to themselves or observing injuries to other staff or patients during colonoscopy. A majority of respondents (84.9%, n = 157) reported either experiencing or observing staff injury, whereas 25.9% (n = 48) reported observing patient complications. Among respondents who perform manual repositioning and apply manual pressure during colonoscopy (57.3%, n = 106), 85.8% (n = 91) reported experiencing musculoskeletal disorders from performing these tasks; 81.1% (n = 150) reported no awareness of colonoscopy-specific ergonomics policies at their facility. Results highlight the relationship between the physical job requirements of endoscopy nurses and technicians, staff musculoskeletal disorders, and patient complications, and suggest that implementation of staff safety protocols may benefit patients as well as endoscopy staff.

Prevalence and Risk Factors of Pelvic Floor Disorders After Delivery in Japanese Women Using the Pelvic Floor Distress Inventory: A Retrospective Cohort Study.

Introduction Female pelvic floor disorders (PFDs) include clinical conditions such as urinary and fecal incontinence and pelvic organ prolapse. Disease-specific questionnaires like the Pelvic Floor Distress Inventory-20 (PFDI-20) have facilitated pelvic floor disorder assessment. We aimed to investigate the prevalence of pelvic floor disorders in Japanese women after different modes of delivery and the association of pelvic floor disorders with epidural anesthesia. Material and methods We included 212 women who gave birth at our institution. The PFDI-20 questionnaire (validated in Japanese) was used to evaluate the symptoms of pelvic floor disorders 6-15 months postpartum. Results Out of the 212 postpartum women who participated in this study, 156 (73.6%) had symptoms of pelvic floor disorder; the most prevalent symptom was urinary distress inventory in 114 (53.8%) women [79 (37.3%) of them experienced urine leakage related to increased abdominal pressure]. A comparison of the epidural and non-epidural groups to determine the association between pelvic floor disorder and delivery mode revealed a higher disease burden score of 8.67 points in the epidural group. Conclusion The prevalence of pelvic floor disorder symptoms is relatively high, affecting 156 (73.6%) of 212 women. Accurate diagnosis of women and appropriate and regular follow-up until improvement of their symptoms are crucial. Furthermore, healthcare workers should advise pregnant women on whether to choose vaginal delivery with or without anesthesia. To the best of our knowledge, our study is the first to investigate postpartum pelvic floor disorder in Japan.

Development and Validation of a Dynamic Abdominal Pressure Twin Sensor Finite Element Model

&lt;div&gt;Some anthropomorphic test devices (ATDs) currently being developed are equipped with abdominal pressure twin sensors (APTS) for the assessment of abdominal injuries and as an indicator of the occurrence of the submarining of an occupant during a crash event. The APTS is comprised of a fluid-filled polyurethane elastomeric bladder which is sealed by an aluminum cap with an implanted pressure transducer. It is integrated into ATD abdomens, and fluid pressure is increased due to the abdomen/bladder compression due to interactions with the seatbelt or other structures. In this article, a nonlinear dynamic finite element (FE) model is constructed of an APTS using LS-PrePost and converted to the LS-Dyna solver input format. The polyurethane bladder and the internal fluid are represented with viscoelastic and isotropic hypoelastic material models, respectively. The aluminum cap was considered a rigid part since it is significantly stiffer than the bladder and the fluid. To characterize the APTS, dynamic compression tests were conducted on a servo-hydraulic load frame under displacement control and held at the peak compression to allow for stress relaxation prior to slowly releasing the compression amount. The initial peak pressures and loads were 15–17% above the level observed at a 10-second hold period with 50% of the decay occurring within 300 ms. The material properties are identified using an inverse method that minimizes the difference between measured and predicted load and pressure time histories. Further, the bio-fidelity static specifications of the APTS manufacturer are used as a basis to identify the quasi-static material parameters. This approach resulted in a reasonable match between physical test data and model-simulated data for dynamic compressions of 10 mm and 15 mm (~50% compression). Additional compression tests are conducted at two compression levels (5 and 10 mm) and at four load offset configurations for use in the model validation. The FE model was used to predict peak pressure responses within approximately 10% error at full-load capacity and achieved CORA ratings &amp;gt;0.99 for the pressure time history. The proposed inverse method is expected to be generally applicable to the component characterization of other models and sizes of APT sensors.&lt;/div&gt;

Intermittent abdominal pressure ventilation management in neuromuscular diseases: a Delphi panel Consensus

ABSTRACT Background Intermittent abdominal pressure ventilator (IAPV) use started in the 1930s for ventilatory assistance with muscular dystrophy patients. Later, the device was perfected and expanded for other neuromuscular disorders (NMD). In recent years, the morbidity and mortality tracheotomies and trach tubes related renewed the interest around IAPV. However, there are no guidelines for its use. This study aimed to establish a consensus among physicians involved in its practice to provide IAPV suggestions for the treatment of patients with NMD. Method A 3-step modified Delphi method was used to establish consensus. Fourteen respiratory physicians and one psychiatrist with strong experience in IAPV use and/or who published manuscripts on the topic participated in the panel. A systematic review of the literature was carried out according to the PRISMA to identify existing evidence on IAPV for patients with neuromuscular disorders. Results In the first round, 34 statements were circulated. Panel members marked ‘agree’ or ‘disagree’ for each statement and provided comments. The agreement was reached after the second voting session for all 34 statements. Conclusions Panel members agreed and IAPV indications, parameter settings (including procedure protocol), potential limitations, contraindications, complications, monitoring, and follow-up are described. This is the first expert consensus on IAPV

SAT-540 - Symptoms from refractory ascites: contributions from both abdominal pressure and the patient

SAT-540 - Symptoms from refractory ascites: contributions from both abdominal pressure and the patient

Nabiximols oromucosal spray in patients with multiple sclerosis-related bladder dysfunction: A prospective study.

Spasticity and urinary disturbances can profoundly impact the daily lives of persons with multiple sclerosis (pwMS). Cannabis has been associated with improvement in sphincteric disturbances. To our knowledge, few studies have evaluated the effect of nabiximols oromucosal spray (Sativex®) on urinary disturbances by instrumental methods. This longitudinal study was conducted to assess the effect of nabiximols oromucosal spray on urinary disturbances by clinical and urodynamic evaluation in pwMS. Neurological, spasticity, and quality of life (QoL) assessments were performed before (T0), and at one (T1) and six (T6) months after the start of nabiximols treatment. At these same time points, patients were assessed for urinary disturbances by the International Prostatic Symptoms Score (IPSS) and a urodynamic test evaluating maximum detrusor pressure (Pdet), bladder filling capacity (CCmax), uninhibited detrusor contractions (UDC), bladder volume at first desire (BVFD), post-void residual volume (PVR) and voluntary abdominal pressure (PA). Of 31 pwMS enrolled in the study, 25 reached T1 and 18 reached T6. Mean IPSS total score, its subscores, and IPSS QoL decreased significantly from T0 to T6 (p=0.000), with no differences according to sex, age, MS type, disease duration and disability at baseline. Pdet improved significantly from T0 to T6 (p=0.0171), and CCmax changed only marginally (p=0.0494); results were similar in patient subgroups naïve to or previously exposed to urological treatment. All patients with overactive bladder showed improvement in their urodynamic assessment based on significant reduction of Pdet (p=0.0138). In patients with mainly hypotonic bladder, mean Pdet decreased from T0 to T6 without reaching statistical significance; most urodynamic parameters showed a trend to improve. Mean numerical scale scores for MS spasticity, and for spasms, pain and tremors, decreased significantly from T0 to T6. The mean 'physical health composite' score of the MS Quality of Life-54 questionnaire increased significantly from T0 to T6 (p=0.0126). Our data suggest that nabiximols has an appreciable effect on ameliorating subjective perception of urinary disturbances and appears to have a positive effect on objective urodynamic parameters, particularly in patients with hyperactive bladder.

Re-discussion on the comprehensive treatment strategy of complex ventral hernia from the perspective of intraperitoneal pressure

Complex ventral hernia refers to a large hernia that is complicated by a series of concurrent conditions. Change in intra-abdominal pressure is one of the main pathways through which various factors exert an impact on perioperative risk and postoperative recurrence. Taking abdominal pressure reconstruction as the core, the treatment strategy for complex abdominal hernia can be formulated from three aspects: improving patients' tolerance, expanding abdominal cavity volume, and reducing the volume of abdominal contents. Improving patients' tolerance includes abdominal wall compliance training and progressive preoperative pneumoperitoneum. To expand the volume of the abdominal cavity, implanting hernia repair materials, component separation technique, autologous tissue transplantation, component expend technique, and chemical component separation can be used. Initiative content reduction surgery and temporary abdominal closure may be performed to reduce the volume of abdominal contents. For different cases of complex ventral hernia, personalized treatment measures can be safely and feasibly adopted depending on the condition of the patients and the intra-abdominal pressure situation.

Effect of naturalistic seating postures and seatbelt routing on booster-seated Q6 ATD kinematics and kinetics in frontal impacts

Research questions / objectiveTest protocols evaluate restraint performance with pediatric ATDs placed in an ideal seating posture. However, real-world evidence suggests that ideal test conditions do not always reflect actual occupant positions. Prior studies have also shown that booster seat designs affect the position of the seatbelt around the child. Occupants in naturalistic seating postures, coupled with potentially unfavorable seatbelt positions, could result in adverse kinematics and kinetics in a crash. Therefore, the aim of this study was to quantify the effect of different naturalistic seating postures on the response of the Q6 ATD restrained on boosters with varying initial static belt fit in a frontal impact. Methods/data sourcesThe Q6 ATD was positioned on two booster seats of similar design but varying static belt fit metrics in three seating postures: reference, leaning forward, and leaning inboard. These booster seats were chosen from extensive belt fit studies on human volunteers and ATDs, and were defined as follows:•Booster A: more inboard shoulder belt position, more inferior lap belt position, larger gap size.•Booster B: more outboard shoulder belt position, more superior lap belt position, smaller gap size.The booster-seated ATD was restrained on the simulated Consumer Reports test buck (2010 Ford Flex 2nd row seat) with a front blocker plate using a 3-point lap-shoulder belt with a retractor and pretensioner. The sled environment was subjected to the FMVSS 213 frontal impact pulse, and each booster and seating posture was evaluated twice (n = 12 sled tests). Kinematic and kinetic measures were recorded. A linear regression analysis was conducted across postures on each booster. Further, a paired t-test analysis was conducted across booster seats for each seating posture. ResultsAcross seating postures, the reference posture exhibited similar or higher kinematic and kinetic metric values compared to the leaning forward and leaning inboard postures on both boosters. However, both leaning forward (Booster A = 279.5 ± 21.6 mm; Booster B = 298.8 ± 1.5 mm) and leaning inboard (Booster A = 308.7 ± 1.1 mm; Booster B = 331.4 ± 8.5 mm) postures generally resulted in greater head excursion than the reference posture (Booster A = 285.0 ± 16.9 mm; Booster B = 288.1 ± 1.5 mm), indicating greater potential for head contact.Between boosters, Booster A resulted in significantly lower head 3 ms clip acceleration (p = 0.0026), HIC15 (p = 0.0008), upper neck tensile force (Fz)(p = 0.0057), chest 3 ms clip acceleration (p = 0.0013), and right abdominal pressure (p = 0.0163), and significantly higher left ASIS force (Fx)(p = 0.0150) and left (p = 0.0489) and right (p = 0.0088) ASIS moment (My) than Booster B. Upper neck tensile forces on Booster B crossed the 20% and 50% thresholds for AIS3 + injury. Lower abdominal pressure and higher ASIS forces and moments on Booster A suggest that the lap belt loaded the ASIS appropriately, and hence, relatively better kinematics than Booster B. Significance of resultsThis study shows that booster design affects static belt fit which can have an effect on dynamic crash performance and assessment criteria. By connecting static belt fit to dynamic performance, these effects may have the potential to help guide booster seat design.

Reduction of Pain After Laparoscopic Bariatric Surgery by Personalized Checkpoint Acupuncture—Data of a STRICTA Conform Pilot Study

BackgroundItremains challenging in clinical practice to perform optimal pain management following bariatric surgeries. Acupuncture (AC) is an effective method of postoperative pain management, but its clinical efficacy depends on the rationale used to select AC points.MethodsWe developed a method to identify individual patterns of pain and a corresponding set of acupoints (corrAC) based on the relative pressure sensitivity of six abdominal visceral pressure points, i.e., the gastrointestinal (GI) checkpoints (G1–G6). Patients with moderate to severe pain were included and received a single AC treatment following surgery. The visual analog scale (VAS) score, pain threshold, and skin temperature were assessed before AC and at 5 min, 1 h, and 24 h following AC. AC was performed with 1-mm-deep permanent needles.ResultsFrom April 2021 to March 2022, 72 patients were included in the analysis. Fifty-nine patients received corrAC, whereas 13 received a noncorresponding AC (nonAC) as an internal control. Patients receiving corrAC showed a significant reduction (74%) in pain at 5 min after treatment (p < 0.0001) and a significant increase (37%) in the pain threshold (p < 0.0001). In this group, a significant increase in skin temperature above G1, G3, G4, and G5 was observed. Patients receiving nonAC showed neither significant pain reduction nor significant changes in pain threshold. The skin above G3 and G4 did not reveal temperature changes.ConclusionCheckpoint AC may be an effective tool in postoperative pain therapy after bariatric surgery. Vegetative functional involvement might be associated with pain relief.Graphical