Pelvic Area Research Articles

Is there a synergistic relationship between diaphragm and pelvic floor muscles in pregnant women?

ObjectiveThe aim of this study is to examine whether there is a synergistic relationship between the diaphragm and pelvic floor muscles (PFM) in pregnant women. Material and MethodsOur study was carried out as a cross-sectional study in primigravid pregnants in the second and third trimesters. Superficial electromyography (EMG), 2D/3D ultrasonography (USG), pulmonary function test (PFT), PERFECT, maximum expiratory pressure (MEP) and inspiratory pressure (MIP) measurements were used to evaluate pelvic floor and diaphragm muscle functions during pregnancy. Mann-Whitney U test was used to show the change in the second and third trimesters, and Spearman correlation was used to determine the relationship. ResultsNo correlation was found between the EMG data of the PFM and diaphragm, or between the USG data of the PFM and diaphragm in all participants, in the second and third trimesters. In the third trimester of the study, diaphragmatic thickness and levator hiatal area (LHA) decreased and both diaphragm and PFM % MVC EMG parameters increased. In the third trimester, FVC, MIP, MEP decreased, and nonsignificant increase in FEV1, FEV1/FVC and peak ekspiratuar flow(PEF) were detected. A significant correlation was found between pelvic floor levator hiatal area USG and FEV1/FVC in both trimesters (r: 0,577p: 0,004). ConclusionThere may be a synergistic relationship between the diaphragm and PFM in pregnant women, the relationship may weaken as pregnancy progresses, and there may be no coactivation relationship between the two muscles. In order to prevent the occurrence of pelvic floor dysfunction during pregnancy and to increase the effect of rehabilitation programs, the relationship between the diaphragm and the PFM should be determined and more studies should be conducted.

Chronic Pelvic Pain, Vulvar Pain Disorders, and Proteomics Profiles: New Discoveries, New Hopes.

Chronic pelvic pain (CPP) is generally defined as non-cyclic pain perceived in the pelvic area that has persisted from three to six months or longer and is unrelated to pregnancy. The etiology of CPP is complex, multifactorial, with heterogeneous presentation, and includes several diseases such as endometriosis, adenomyosis, and interstitial cystitis/bladder pain syndrome. It may also be associated with sexual dysfunction, musculoskeletal disorders, and comorbid psychiatric symptoms. Vulvar pain disorders (VPDs) are typically categorized separately from chronic pelvic pain; among all VPDs, vulvodynia is a chronic vulvar pain of unknown etiology, lasting at least 3 months and that might be associated with other potentially linked factors. Proteomics represents a useful approach to study the proteome profiles of clinical samples. In this review, we have considered a selection of articles that have analyzed the protein abundance and novel protein species from various biological samples, including eutopic/ectopic endometrium, urine, serum, follicular, peritoneal fluid, and cervical mucus, potentially involved in the pathogenesis and progression of CPP and VPDs. These findings could represent valuable targets for paving the way for the differential diagnosis and therapeutic management of CPP and VDPs, thereby optimizing both the prevention and treatment of these conditions.

Anatomical and topographic features of fascia of the gluteal-femoral region in the common lynx

The article presents anatomical features of the superficial and deep fascia, in particular on the pelvic limb of the common lynx, which are absent in the available literature. The material for the research was a sectional material - pelvic limbs (n= 6), selected from the common lynx, without external signs of pathologies of the musculoskeletal system. Methods of fine macro- and microanatomic dissection of the lynx's left pelvic limb were used. At the same time, a functional analysis of the studied structures and skeletotopic projection of muscles, fascia and fascial nodes were carried out. Based on the conducted studies, it was found that the deep fascia is separated from the superficial fascia by an interfacial space filled with loose connective (or fatty) tissue. In the pelvic limb area, it is represented by the gluteal-femoral fascia, and on the lower leg it continues as the deep fascia of the lower leg. In the process of dissecting the deep fascia, we noted that in the gluteal region, the deep gluteal fascia is fixed on the supracosteal ligament, in the area of the root of the tail, along the tail fold and up to the sciatic tubercle. We noted that the deep gluteal fascia begins from the vertebral head of the biceps femoris muscle and, in the cranial direction, covers successively the posterior, superficial gluteal and caudal part of the middle gluteus muscle. Along the way, the perimysium of the above muscles are interwoven into it, however, in the area of the iliac wing, it fuses with the perimysium of the middle gluteal muscle and then continues into the lumbar fascia. At the same time, it forms a fascial node in the maklok area. Distally, the deep gluteal fascia continues as the deep femoral fascia. The data obtained are the reference in assessing the structural and functional state of the fascial formations of the pelvic limb in the common lynx.

Efek Serbuk Jahe Merah (Zingiber Officinale Var Rubrum) Terhadap Penurunan Intensitas Dismenore Pada Siswi SMAN 1 Muncang Kabupaten Lebak Banten

Introduction: Dysmenorrhea is a condition that occurs during menstruation or menstruation which can interfere with activities and requires treatment which is characterized by pain or pain in the abdominal or pelvic area "(Judha 2012)", Dysmenorrhea is pain during menstruation that interferes with women's daily activities. According to WHO (2012), there were 1,796,425 people (90%) experiencing dysmenorrhea with 10-15% experiencing severe dysmenorrhea. About 75% of women report some degree of discomfort related to menstruation, and about 15% report severe dysmenorrhea. Methods: The research method is a pre-experimental research design. In this study, the authors conducted quantitative research using the pre-experimental design method, type one group pretest-posttest (preliminary test, final test, single group). Sampling was carried out by purposive sampling and in this study the samples were partially taken from the entire object studied and considered to represent the entire population of class X, X1, and XII students at SMAN 1 Muncang in the year 2022/2023 who experienced dysmenorrhea as many as 56 people. Results: The results of the Wilcoxon test showed that the p-value of red ginger was 0,000 0,05 so there was an effect of giving red ginger. The experimental group was given capsules containing red ginger powder 4x1 for 2 days at a dose of 250 mg. The results of the independent t-test obtained a p-value of 0,000 (α 0,05). Discussion: Broadly speaking, there is an effect of red ginger powder (Zingiber officinale var. Rubrum) on reducing the intensity of dysmenorrhea pain in female students at SMAN 1 Muncang, Lebak Regency Banten before and after consuming red ginger powder (Zingiber officinale var. Rubrum) as evidenced by the results of statistical tests using One-Sample Statistics with a significance value of p 0,000.

Alveolar rhabdomyosarcoma with pre-therapy maturation

Abstract Introduction/Objective Alveolar rhabdomyosarcoma (ARMS) is the second most common type of rhabdomyosarcoma in children and adolescents. Common locations include the head and neck, trunk, extremities, and pelvic area. They are a prototypical round cell sarcoma and are treated with multimodality therapy. The purpose of this report is to describe a case of this tumor showing unusual rhabdomyoblastic differentiation which is most commonly seen in post- therapy setting but is almost unheard of pre-therapy. Methods/Case Report A three-year-old male presented with painless, right lower extremity mass. It was noticed two months prior and had been rapidly growing since then. Incisional biopsy was performed. Histologic sections showed a round cell sarcoma with an alveolar growth pattern. Variably mature single- and multinucleated rhabdomyoblasts with ample eosinophilic cytoplasm were present throughout the biopsy specimen. On immunostains, the tumor cells were positive for desmin, MyoD1, as well as myogenin (minor subset) and negative for pancytokeratin, CD45 and WT-1, strongly supporting the diagnosis of ARMS. FISH studies showed the presence of FOXO1 (FKHR) rearrangement, further confirming diagnosis.The patient received chemotherapy, radiotherapy, and surgery. On follow-up after six months, the patient was well with no significant complications. Results (if a Case Study enter NA) N/A Conclusion Post-chemotherapy rhabdomyoblast differentiation is commonly seen and documented in literature, potentially signifying increased response of tumor cells to therapy. Our case highlights that such changes can also be seen pre-treatment and must not sway the pathologist from diagnosis of ARMS.

HUBUNGAN KOMUNIKASI INFORMASI DAN EDUKASI (KIE) TENTANG DISMENOREA DENGAN TINGKAT NYERI PADA REMAJA YANG MENGALAMI MENSTRUASI DIDESA BINJAI DUSUN V TEBING SYAHBANDAR TAHUN 2022

Adolescence in women is a period of physical and psychological preparation to become a mother in the future. Communication, Information and Education (IEC) is a process of conveying messages, information provided to the community Both Using media such as: radio, television, press, film, etc. Gynecological disorders that often occur in adolescents are disorders related to the menstrual cycle. Some of these are dysmenorrhoea and Pre Menstrual Syndrome (PMS). During menstruation, each woman has a different experience where some of them experience discomfort in the pelvis or painDysmenorrhea can be defined as a medical condition that occurs during menstruation that can interfere with activity and requires treatment characterized by pain or pain in the abdominal or pelvic area. Menstruation is the bleeding of the uterus along with the release of the endometrium that takes place periodically and cyclically. The study used a pre-experimental design with a one- group pre-post test design. Population and Sample In this study there were 20 people with a total sampling technique. Based on the results of the study, p= 0.002 or p ≤ 0.05 means that there is a relationship between ME Dysmenorrhea and the level of menstrual pain in adolescents in binjai village, hamlet V tebing syahbandar in 2022.

INTRA- AND EARLY POSTOPERATIVE RESULTS OF BIOPSY OF SIGNAL LYMPH NODE UNDER CONTROL OF ICG MAPPING IN PATIENTS WITH ENDOMETRIAL CANCER OF INITIAL STAGES

Biopsy of sentinel lymph nodes (SNL) with the use of indocyanine green (ICG) as an indicator is becoming a standard method for evaluating the lymphatic reservoir in endometrial cancer in patients in the early stages.
 The purpose of the study. To conduct a comparative assessment of іntra- and early postoperative results in patients with endometrial cancer of initial stages when performing systemic lymphadenectomy and ICG mapping for the detection of SLNs.
 Materials and methods. The study included 98 patients (2017-2022) with morphologically verified endometrial cancer with low and mediumintermediate risks of metastasis. Removal of lymph nodes was carried out in two ways: 1)systemic lymphadenectomy (group 1); 2) ICG mapping for detection of SLN in the pelvic area (group 2).
 Results. The time of the operation for 1 group is longer - (63.7 ± 14.8) min. than for the second - (36.4 ± 8.9) min. In group 1, intraoperative lesions of the obturator nerve were detected in 2 patients (4.5%), postoperative complications also were observed: lymphocysts 3 (7.5%), lymphostasis 2 (5.5%), prolonged lymphorrhea 4 (9.5%) and. There were no complications in group 2. In both groups, there were no bleedings and intraoperative injuries of the pelvic organs. In group 1, the average number of extracted LVs was 8.5±2 on each side; positive LNs were found in 3 (8%) patients, the remaining 38 (92%) were negative. Identification of the localization of LN was not carried out; since their evacuation from the abdominal cavity was carried out in a single block - 32 (80%), in 8 (20%) - fragmentary (which still does not allow identification of the position of the LN). No metastases were detected in group 2; in 40 (70 %) patients, SLN was detected on both sides, 11 (20 %) - on one side, and 6 (10 %) - not detected. In these 10% of patients, systemic lymph node dissection was performed. The most common localizations of LN are the external iliac vessels and the obturator area on both sides.
 Conclusions. SLN biopsy should be used more often in early-stage endometrial cancer. The SLN technique can be used in patients with low and intermediate risk of lymphatic metastases to reduce the frequency of complications associated with systemic lymph node dissection. This technique can be used for patients with a higher risk of metastasis (in particular, average and high-average) in the presence of concomitant comorbid pathology. Its advantages are: reducing the trauma of the procedure, surgical comorbidity (lymphorrhea, lymphocysts, vascular and nerve injury), reducing the time of surgical intervention (which reduces the risk of infectious complications), reduction of blood loss, shortening of hospitalization, faster recovery, improvement of cosmetic effect and equivalence of oncological results.

Flat Magnetic Stimulation for Urge Urinary Incontinence.

Background and Objectives: Strategies for overactive bladder syndrome (OAB) management involve, among others, strengthening the bladder outlet to suppress urgency and neuromodulating the sacral roots. Magnetic stimulation (MS) is a technology that involves an extracorporeal device that is able to provide an electromagnetic field specifically designed to interact with pelvic floor neuromuscular tissue. The resulting tissue electrical activity induces contraction of the pelvic muscle and neuromodulation of the S2-S4 sacral roots. Flat Magnetic Stimulation (FMS) is a relevant advancement involving homogeneous electromagnetic fields, which are able to optimize the effect on the entire pelvic area. However, the benefits of this new technology for OAB syndrome are poorly known. Consequently, the aim of our study is to analyze the outcomes and quality of life (QoL) impact of FMS with Dr. Arnold (DEKA, Calenzano, Italy) in women suffering from OAB syndrome associated with urinary incontinence. Materials and Methods: This prospective study included patients with OAB, urge urinary incontinence, and no ongoing OAB treatments. At baseline (T0), the Incontinence Impact Questionnaire (IIQ-7), the Female Sexual Function Index (FSFI-19), and the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF) were collected. Patients underwent 8 FMS sessions of 25 min each in one month. At the termination of the therapy (T1), women repeated the ICIQ-UI SF, FSFI-19, and IIQ-7 tools. Moreover, the Patient Global Impression of Improvement (PGI-I) questionnaire was collected to evaluate the cure rate. Results: Our study enrolled a total of 57 consecutive patients. Most women had at least one second- or third-line treatment before FMS, while the remaining naive patients had contraindications to pharmacological treatments. No women reported adverse effects during the treatment. After the treatment, we observed a decrease in the IIQ-7 (p < 0.001) and ICIQ-UI SF scores (p < 0.001) and an improvement in sexual function (p < 0.001) evaluated with FSFI-19. According to PGI-I scores, 42 (73.7%) women referred to some kind of improvement, scoring ≤ 3 points. Specifically, 8.7% of patients considered themselves very much improved, 29.8% much improved, 35.1% minimally improved, and 26.3% found no changes. FMS was effective in treating OAB symptoms without any adverse effects. The mechanism is supposed to be related to suppressing the initiation of micturition. This makes FMS a promising device for treating naive and refractory urge urinary incontinence. Conclusions: The new FMS represents a promising non-pharmacological option for the treatment of naive and refractory OAB.

Prenatal Ultrasound Diagnosis of Klippel-Trenaunay Syndrome.

Klippel-Trenaunay syndrome (KTS) is a very rare vascular malformation syndrome also referred to as a capillary-lymphatic-venous malformation with unknown aetiology. The aim of our paper is to highlight interesting images, regarding a rare case of foetal Klippel-Trenaunay syndrome diagnosed prenatally in our department and confirmed postnatally with a favourable evolution during the gestation and neonatal periods. This case was diagnosed at 26 weeks gestation and characterised through ultrasound by the presence of superficial multiple cystic structures of different sizes spreading over the left leg with hemihypertrophy and reduced mobility. The cystic lesions were spreading to the left buttock and the pelvic area. The right leg and upper limbs had normal appearance with good mobility. There were no signs of hyperdynamic circulation or foetal anaemia, but mild polyhydramnios was associated. The ultrasound findings were confirmed postnatally, the left leg presented multiple cystic lesions and port wine stains, and there was hypertrophy and fixed position, with favourable evolution at 6 months of life, when the size of the lesions began to decrease and the mobility of the leg improved.

Dyspareunia: Etiology, presentation, and management.

Dyspareunia in women is a recurrent pain in the genital and/or pelvic area associated with sexual intercourse. Dyspareunia is associated with increased risk of sexual dysfunction and relationship distress, and it may impact an individual's confidence, self-image, and self-esteem. Pain resulting from dyspareunia can be superficial or deep; it can range from intermittent to continuous and dull to sharp. Regardless of presentation, many women are reluctant to report symptoms to providers, making it an underreported yet common condition. The onus lies with practitioners to form trusting and safe relationships with patients in which such discussions are possible. A knowledgeable practitioner can encourage disclosure and improve outcomes for patients with dyspareunia.

Engineering the perfect mattress: The influence of substrate mechanics on deep tissue stresses in supine

BackgroundWith increasing global interest in sleep hygiene, sleep ergonomics is an area that has been largely understudied. During sleep individuals turn over during the night to restore blood flow in occluded blood vessels, indicating that control of local tissue pressure may play a role in improving sleep comfort. This study investigates the influence of mattress stiffness on tissue compressive stresses during supine lying. MethodsA subject-specific 3D finite element (FE) model of the pelvis area has been developed to simulate supine lying on substrates of varying firmness. Constitutive parameters for the adipose-skin tissue and muscle-organ tissue were calibrated using a novel application of the inverse finite element method. FindingsThe compressive stress was consistently greatest in the muscle interfacing the sacrum at 18.5 kPa on the soft foam, and 30.9 kPa on the firm foam. From soft to firm, the compressive stress increased by 67% at the sacrum, 20% at the ischium, 42% at the lesser trochanter, and 50% at the skin. InterpretationThe non-linearity of the foam substrate had a pressure distributing effect, relieving the peak compressive stresses at the sacrum, indicating that it may be possible to design arrays of foam substrates that can provide most efficient pressure relief.

Gossypiboma Post Cesarean Section: Patient Safety Review

Background: Operations in the pelvic area including cesarean section are often followed by unwanted events in the form of missing surgical instruments. The surgical device that is most often left behind during operations is surgical gauze and is known as a gossypiboma. Surgical gauze is often left in body cavities such as the peritoneum, pelvis, and retroperitoneal spaces. This surgical gauze can remain in the body for days, months, or even years before manifesting clinically. A granulomatous reaction around the surgical gauze may produce exudate followed by the formation of an abscess or fibrotic mass. Objective: To see the aspect of patient safety in cases of gossypiboma after cesarean section. Methods: Serial report of gossypiboma cases after cesarean section. Results and Discussion: Three cases of gossyfiboma were reported after cesarean section in Bali in 2017-2018. The diagnosis is made clinically according to complaints, and history of cesarean section and supported by supporting examinations such as BOF (Book-on-Filter), Ultra Sonography, and Computerized Tomography-Scan. Various surgical procedures were performed including sub-total colectomy laparotomy, right hemicolectomy laparotomy, and Hartman procedure laparotomy. All operations went well with good results too. Patient safety approaches and procedures must be carried out strictly to prevent a recurrence. Conclusion: Reports of three cases of gossypiboma after caesarean section are strongly related to patient safety procedures that are not performed in the operating room.

Pelvic floor dysfunction: prevalence and associated factors

BackgroundPelvic floor dysfunction in women encompasses a wide range of clinical disorders: urinary incontinence, pelvic organ prolapse, fecal incontinence, and pelvic-perineal region pain syndrome. A literature review did not identify any articles addressing the prevalence of all pelvic floor dysfunctions.ObjectiveDetermine the prevalence of the group of pelvic floor disorders and the factors associated with the development of these disorders in women.Material and methodsThis observational study was conducted with women during 2021 and 2022 in Spain. Sociodemographic and employment data, previous medical history and health status, lifestyle and habits, obstetric history, and health problems were collected through a self-developed questionnaire. The Pelvic Floor Distress Inventory (PFDI-20) was used to assess the presence and impact of pelvic floor disorders. Pearson's Chi-Square, Odds Ratio (OR) and adjusted Odds Ratio (aOR) with their respective 95% confidence intervals (CI) were calculated.ResultsOne thousand four hundred forty-six women participated. Urinary incontinence occurred in 55.8% (807) of the women, fecal incontinence in 10.4% (150), symptomatic uterine prolapse in 14.0% (203), and 18.7% (271) reported pain in the pelvic area. The following were identified as factors that increase the probability of urinary incontinence: menopausal status. For fecal incontinence: having had instrumental births. Factors for pelvic organ prolapse: number of vaginal births, one, two or more. Factors for pelvic pain: the existence of fetal macrosomia.ConclusionsThe prevalence of pelvic floor dysfunction in women is high. Various sociodemographic factors such as age, having a gastrointestinal disease, having had vaginal births, and instrumental vaginal births are associated with a greater probability of having pelvic floor dysfunction. Health personnel must take these factors into account to prevent the appearance of these dysfunctions.

FRI432 An Interesting Case Of Primary Hypogonadism In A Patient With Multiple Sclerosis

Abstract Disclosure: S. Ahsun: None. P. Lekprasert: None. K.K. Win: None. Introduction: As per the recent data there is an association between low levels of testosterone in men and the risk for multiple sclerosis (MS). Most recent practice involves checking testosterone levels for male patients with newly developed MS and treating with testosterone supplementation if levels are low. CASE PRESENTATION: A 65-year-old male with medical history of multiple sclerosis, prediabetes, hypogonadism, squamous cell carcinoma of left ear, thyroid cancer (unknown type) status post total thyroidectomy and radioiodine therapy; presented to our endocrine office for an initial visit. Patient had been following with Endocrinologist at different state in the past and did not have much of his prior records since that practice closed. He has been on 150 mcg of levothyroxine and his TSH was stable at 1.2 (0.4-4.5 mIU/L). He also had a history of hypogonadism and had been on testosterone supplementation since the age around 50. Patient did not know the underlying cause for his hypogonadism. He has 3 biological children and the youngest one is 26 years old. He had been off of testosterone therapy for 3 months prior to our initial visit. We did some workup which showed total testosterone level of &amp;lt;20 (250-1100 ng/dL). Free testosterone 2.2 (46-224 pg/mL). FSH and LH levels were elevated at 27.1 (1.6-8 mIU/mL) and 17.3 (1.6-15.2 mIU/mL). Prolactin level was 5.1 (5.2-26.5) ng/mL. These labs were consistent with Primary hypogonadism. Repeat testing was done and the patient had redemonstration of very low testosterone levels. Further checking of the karyotype analysis revealed normal male karyotype testing. His physical exam showed normal sized testicles at 20 cc and no gynecomastia. Body hair distribution was normal but there was decreased shaving frequency with decreased muscle strength. Patient never had any chemotherapy or the radiation therapy to the pelvic area. No known history of chronic infection or trauma. Currently, he is on Ocrelizumab for Multiple Sclerosis. His testosterone level is now in the normal range with the testosterone therapy after the work up. CONCLUSION: As per the above case, our patient has an interesting presentation of primary hypogonadism with multiple sclerosis. He has no known reason for his primary testicular failure. We know that testosterone deficiency has been linked to development of MS and MS can lead to secondary hypogonadism. But Primary hypogonadism has not yet been seen with MS although autoimmunity can be postulated to lead to primary testicular failure in these patients, but more studies and investigation will need to be done to establish this cause and effect relationship. REFERENCE: Chitnis T. The role of testosterone in MS risk and course. Mult Scler. 2018 Jan;24(1):36-41. doi: 10.1177/1352458517737395. PMID: 29307293 Presentation: Friday, June 16, 2023

Prevalence of Symphysis Pubis Dysfunction in Pregnant Women

Pregnancy is a period when a woman’s body leads to various musculoskeletal issues including Symphysis Pubis Dysfunction (SPD). The term symphysis pubis dysfunction refers to a collection of distressing symptoms that occur in the pelvic area and cause limitation while performing activities of daily living. Objective: To find the Prevalence of symphysis pubis dysfunction in pregnant women. Methods: From June 2022 to January 2023, following a duration of 6 months, a descriptive cross-sectional study was conducted on 267 pregnant women aged 20-35 years. Those with pelvic pain during any trimester were enrolled from gynecology department of Riphah International Hospital and Al-Khidmat Razi Hospital, Rawalpindi. Participants meeting inclusion criteria were evaluated for symphysis pubic pain based on specific criteria, including (signs and symptoms, palpation, and diagnostic tests like the Positive Patrick Faber and Trendelenburg tests). Pain severity was assessed using visual analogue scale. Results: Out of 267 participants, 32% participants were diagnosed with symphysis pubis dysfunction while 68% participants did not have SPD. The most prevalent symptoms are turning over in the bed (79 %), bending down (75%), and standing on one leg (71%) which is mostly reported by the majority of women in the third trimester with moderate pain perception. Conclusions: Study concluded the notable prevalence of SPD with the most prevalent symptoms turning over in the bed, bending down, and standing on one leg. These symptoms were predominantly noted among women in the third trimester, accompanied by a moderate level of pain.

Postoperative Radiotherapy to Abdominal and Pelvic Lymphatic Drainage Area for Stage III Epithelial Ovarian Cancer: A Sharp Tool to Prolong Disease-Free Survival Time

For patients with stage III epithelial ovarian cancer, there are limited studies on the effects of postoperative adjuvant radiotherapy (RT) after standard cytoreductive surgery (CRS) and full treatment of first-line adjuvant chemotherapy (CT). The aims of our study were to assess the therapeutic efficacy and toxicity of our special postoperative radiotherapy to abdominal and pelvic lymphatic drainage area for stage III epithelial ovarian cancer patients. We retrospectively collected patients with stage III epithelial ovarian cancer after CRS and full-course adjuvant chemotherapy. The CT+RT group patients were treated with intensity modulated radiotherapy (IMRT) to abdominal and pelvic lymphatic drainage area (which has been shown to be an alternative to whole abdominal radiotherapy (WART) both on the basis of clinical result and dosimetric verification from our prior study). The CT group data was obtained from the PUMCH's electronic medical record analytical database between 2010 and 2020. A propensity score matching analysis was performed 1:2 between CT+RT group and CT group. A total of 132 patients with median follow-up of 73.9 months (9.1-137.7 months) were included (44 and 88 for the CT+RT and CT groups, retrospectively). The baseline characteristics of age, histology, level of CA12-5, surgical staging, residual tumor, courses of adjuvant CT, and courses to reduce CA12-5 to normal were all balanced. The median disease-free survival (DFS) time, 5-year overall survival (OS), and local recurrence free survival (LRFS) of CT+RT group and CT group were 100.0 months versus 25.9 months (p = 0.020), 69.2% versus 49.9% (p = 0.002), 85.9% versus 50.5% (p = 0.020), respectively. Distant metastasis was still the primary reason (57.6%), and local failure rate was 42.3%, the local recurrence rate was significantly lower in CT+RT group, compared with CT group (13.6% versus 45.5%, p = 0.016). In terms of toxicity, CT+RT group mainly presented with acute hematological toxicities, with no statistically significant difference with CT group when compared with grade III intestinal adverse effects (3/44 versus 6/88, p = 0.480). This report demonstrates that long-term disease-free survival could be achieved in stage III epithelial ovarian cancer patients treated with IMRT preventive radiation to abdominal and pelvic lymphatic area. Compared with CT group, DFS and OS were significantly prolonged and adverse effects were acceptable.

Adaptive Ultra-Hypofractionated Whole-Pelvic Radiotherapy in High-Risk and Very High-Risk Prostate Cancer on 1.5-1.5 MR Linac: The Estimated Delivered Dose and Early Toxicity Results

To study the feasibility and safety for patients with high-risk (HR) and very high-risk (VHR) prostate cancer treated with adaptive ultra-hypofractionated whole-pelvic radiotherapy (UHF-WPRT) on 1.5 magnetic resonance (MR)-Linac. Sevenpatients with clinical stage T3a-4N0-1M0-1c consecutively treated with UHF-WPRT on a 1.5-T MR-Linac were recruited prospectively in a phase II trial (NCT05183074, ChiCTR2000033382). A 36.25 Gy dose in five fractions was delivered every other day with a boost of 40 Gy to the whole prostate, as well as 25 Gy to whole pelvic nodal area with a concomitant boost of 35 Gy to metastatic regional nodes. To estimate the delivered dose, we collected data by 3D-MR for the following stages: pre-MR, position verification-MR (PV-MR) in the Adapt-To-Shape (ATS) workflow, and 3D-MR during the beam-on phase (Bn-MR) and at the end of RT (post-MR). The target and organ-at-risk contours in the PV-MR, Bn-MR, and post-MR stages were projected from the pre-MR data by deformable image registration and manually adapted by the physician, followed by dose recalculation for the ATS plan. The cumulative acute genitourinary (GU) and gastrointestinal (GI) toxicities were evaluated as per NCI-CTCAE 5.0 criteria. The primary endpoints were acute ≥grade 3 genitourinary (GU) and gastrointestinal (GI) toxicities during the first 3 months. Overall, 133 MR scans were collected (35 pre-MR, 35 PV-MR, 31 Bn-MR and 32 post-MR scans). With a median on-couch time of 61 minutes, the mean prostate and pelvic planning target volume (PTV)-V95% of all scans was 96.98 ± 3.06% and 96.44 ± 2.85%, respectively. The corresponding mean prostate clinical target volume (CTV)-V100% was 99.89 ± 0.32%, 98.71 ± 1.90%, 97.77 ± 2.89%, and 98.56 ± 1.72%, and the mean pelvic CTV-V100% was 97.57% ± 3.70%, 96.54 ± 3.80%, 95.43 ± 4.31%, and 94.39 ± 4.47% on pre-MR, PV-MR, Bn-MR and post-MR scans, respectively. For the 4 patients with positive nodes, the mean V100% of metastatic regional nodes was 99.89 ± 0.81%. The median V29 Gy change in the rectal wall was -1% (-18%-20%). The V29 Gy of the rectal wall increased by >15% was observed in one scan. A slight increase in the high dose of bladder wall was noted due to gradual bladder growth during the workflow. With median follow-up time of 7.3 (4.6-12.2) months, all patients were followed-up for more than 3 months. No patient was observed with acute CTCAE grade 2 or more severe GU or GI toxicities (0%). UHF-RT to prostate and pelvic with ATS workflow is well tolerated by patients with HR and VHR prostate cancer, with only mild GU and GI toxicities. The 3D-MR-based dosimetry analysis demonstrated clinically acceptable estimated dose coverage of target volumes during the beam-on period.

A pilot study of stereotactic body radiotherapy combined with pelvic radiotherapy and GTVp boost based on multiparameter magnetic resonance image in patients with high-risk prostate cancer.

This pilot study aimed to explore the preliminary effects and safety of stereotactic body radiotherapy (SBRT) combined with preventive pelvic radiotherapy and primary gross tumor volumes (GTVp) boost in patients with high-risk prostate cancer based on multiparameter magnetic resonance image (mpMRI). Tumors were contoured as GTVp based on mpMRI. The prostate and proximal seminal vesicles were considered as the clinical target volume1. The pelvic lymphatic drainage area constituted clinical target volume 2. Radiation doses were 40Gy or 45Gy/5fractions to planning target volume of primary tumor, 37.5Gy/5f to prostate, seminal vesicle, and positive pelvic lymph nodes, and 25Gy/5f to pelvic synchronously. The treatment was delivered 3 times per week. Volumetric modulated arc radiotherapy and intensity-modulated radiotherapy were used to complete SBRT. The genitourinary (GU) and gastrointestinal (GI) toxicities were evaluated. Quality of life data was also captured. A total of 15 patients were enrolled in this study with a median age of 78 (56-87) from 2017 to 2020. All patients received SBRT. At 3 months after radiotherapy, the proportion of PSA < 0.006 ng/mL was 66.7% (10/15). The 2-year biochemical relapse-free survival was 93.3%. The incidence of grade 1 acute GU side effects was 80% (12/15); the incidence of acute grade 1 GI toxicity was 66.7% (10/15); and no grade 2 or higher acute GU and GI side effects was observed. Two patients presented with temporary late grade 2 GI toxicity. International Prostatic System Score increased rapidly after a transient increase at 1 week (P = .001). There were no significant differences in EORTC quality of life scores in all domains except global health status. In this pilot study, it was revealed that SBRT combined with preventive pelvic radiotherapy and GTVp boost based on mpMRI image was effective and well tolerated for patients with high-risk prostate cancer.

The Effect of Effleurage Massage on Reducing the Degree of Dysmenorrhea in Adolescent Girls in Sukarama Village, Cianjur Regency, Indonesia

Effleurage massage can provide a sense of relaxation and calm that can help reduce stress. By increasing blood flow to the pelvic area, effleurage techniques can help improve the supply of nutrients and oxygen to the tissues, potentially speeding recovery and reducing pain. This study aimed to determine the effect of effleurage massage on reducing the degree of dysmenorrhea in adolescent girls in Sukarama Village, Cianjur Regency, Indonesia. This study is a quasi-experimental research with a pre-post-test approach and uses primary data obtained from direct observation of respondents. A total of 30 research subjects took part in this study. This study shows that the intervention of providing effleurage massage is effective in reducing pain intensity in dysmenorrhea sufferers. There was a decrease in pain intensity after giving effleurage massage and it was stated to be statistically different, p&lt;0.05. In conclusion, there is an effect of effleurage massage on reducing the degree of dysmenorrhea in adolescent girls in Sukarama Village, Cianjur Regency, Indonesia.

Cutaneous mycobacteriosis in a dog

Mycobacteriosis is a skin disease caused by a bacterium of the genus Mycobacterium. Although prevalent, the infection has a difficult diagnosis, and its occurrence is underestimated in veterinary medicine. The disease presents firm, painless and non-pruritic nodules, mainly in the extremities of the body. The diagnosis can be confirmed by performing the histopathological exam in Ziehl-Nielsen stain to observe the bacilli. The purpose of this report was to describe a case of canine cutaneous mycobacteriosis in a mixed-breed dog, approximately 10 years old, with clinical signs of alopecia and hyperkeratosis in the lumbar region and pelvic area, and later developing nodules in the muzzle, ears, lips and scrotum, confirmed by histopathological examination. Antemortem diagnosis is laborious because it has a nonspecific clinical presentation, in addition to little knowledge about the pathogen. Based on the histopathology associated with the presence of acid-alcohol resistant bacilli in the macrophage cytoplasm, the diagnosis of cutaneous mycobacteriosis was established.