Pelvic Tissue Research Articles

Pelvic soft tissue sarcomas

Pelvic soft tissue sarcomas (PSTS) are a rare, heterogeneous group of tumors. They have been usually analyzed with retroperitoneal sarcomas (RPS), but actually have key differences. Due to their unique anatomic location, symptomatic presentation of PSTS may be more common than RPS. Adequate imaging approach is paramount for guiding differential diagnosis, while preoperative biopsy is mandatory, especially when preoperative treatment may be considered as initial approach. The most frequent histologic subtype is leiomyosarcoma, which is different as expected in the retroperitoneum where liposarcoma is the commonest histology. Also solitary fibrous tumor is commonly diagnosed in the pelvis. Surgical approach for PSTS differs from that for RPS mainly due to anatomic relations. Similarly, in the lack of definite evidence from specific trials about neoadjuvant and adjuvant treatments, the anatomic constraints to obtain wide margins in the pelvis as well as the expected functional outcome in case of organ resections should be factored into decision for individualized treatment offer. Vascular and genitourinary involvement are frequent, as well as herniation through pelvic foramina. For these reasons a multidisciplinary surgical team should always be considered. Early referral of these patients to high-volume centers is critical and may impact on survival, given that optimal initial resection is a major predictor of curative treatment. International consensus on PSTS treatment is advocated, similarly to the recent efforts realized for RPS.

Study on circumpelvic muscle deformation and dynamic simulation of pelvic fracture reduction

For the pelvic fracture reduction, generally the fragment of the unaffected side is fixed and the affected side is moved to its correct anatomical position and orientation. During the pelvic fracture reduction, circumpelvic muscles deformation is closely related to the surgical accuracy. In this article, the biomechanical properties of musculoskeletal tissue during pelvic fracture reduction are studied. Five-parameter hyperelastic model named Mooney-Rivlin is adopted to analyze muscle’s stress–strain relationship. The finite element model of the injured pelvic musculoskeletal tissue is established, and the deformation of circumpelvic main muscles is simulated. Then, the dynamic simulation of pelvic fracture reduction is performed according to the planned spatial reduction path. The results show that when the muscles are stretched the same stretch length, the strain of the gluteus medius is the largest. It is most prone to deformation under and the muscle injury is most easily to occur. During the pelvic fracture reduction, the strain of gluteus maximus is the largest, and it is most prone to deformation and injury. The traction length is the largest, and the traction force mainly comes from the gluteus maximus. This study provides reference for the robot assisted pelvic fracture reduction.

Does parity impact obstructed defecation in women with normal anorectal anatomy?

Obstructed defecation (OD) is often associated with trauma to pelvic connective tissue and nerves sustained during pregnancy and childbirth. Although there are multiple potential etiologies of defecatory dysfunction, the pathophysiology of this symptom complex is not well understood. The purpose of this study is to determine the role of parity in the development of obstructed defecatory symptoms in women with normal anorectal anatomy in a search for evidence of a presumptive neuropathic effect of pregnancy and childbirth. This study retrospectively evaluated the records of 754 women presenting at a tertiary urogynecology unit for pelvic floor dysfunction with no anatomical abnormalities of the anorectum on imaging. They were stratified according to parity. The authors determined the prevalence of obstructed defecation symptoms in these groups. Chi-squared test was performed for statistical analysis. Median age was 51 (range 16-88) years, and median vaginal parity was 2 (0-8); 399 (53%) women reported symptoms of OD. When anatomical abnormalities of the anorectum were excluded, parity did not seem to have a major effect on the prevalence of symptoms of OD. In this cohort, parity is unlikely to be a cause of OD in women with normal anorectal anatomy.

The difference in collagen type-1 expression in women with and without pelvic organ prolapse: a systematic review and meta-analysis.

This study was aimed at identifying the difference in collagen type-1 expression in women with and without pelvic organ prolapse (POP). A systematic review and meta-analysis was carried out women with and without pelvic organ prolapse. This meta-analysis was conducted on research articles describing the evaluation of collagen type-1 expression between patients with and without POP. The articles were obtained from PubMed, EBSCO, and ProQuest, and were published between January 2000 and June 2021. Pooled mean difference (MD) and pooled odds ratio (OR) were calculated using fixed effect models. Review Manager (RevMan 5.4) was used to analyze the data. The main outcome measures were pooled MD and pooled OR of collagen type-1 expression in patients with and without POP. A total of seven case-control studies were included in the meta-analysis using the effect size of the MD and two case-control studies were included in the meta-analysis using the effect size of the OR. A total of 247 POP cases and 132 non-POP cases were identified from the studies. Our study indicated that patients with POP had a lower level of collagen type-1 expression than non-POP patients (MD = -6.77; 95% CI: -8.37, -5.17, p < 0.00001). Patients with low expression of collagen type-1 in pelvic support tissue are at a more than 3 times higher risk of suffering from pelvic organ prolapse (OR = 3.23, 95% CI: 1.52 to 6.87, p = 0.002). The results of this study showed that patients with pelvic organ prolapse have lower expression of collagen type-1 than nonpelvic organ prolapse patients.

Effects of Different Delivery Modes on Pelvic Floor Function in Parturients 6-8 Weeks after Delivery Using Transperineal Four-Dimensional Ultrasound.

Objective To evaluate the effects of different delivery modes on pelvic floor function in parturients 6–8 weeks after delivery using transperineal four-dimensional ultrasound. Methods Pelvic floor function 6–8 weeks after delivery in 40 vaginal delivery parturients between November 2018 and December 2020 was assessed by four-dimensional ultrasound, with 40 selective cesarean section delivery parturients as a control group. The imaging results of the two groups were compared. Results The levels of clinical indexes such as UVJ-M, Ar, Av, θ, Dr, Dv, and ARJ-VDv in the selective cesarean section group were significantly lower than those in the vaginal delivery group 6–8 weeks after delivery (P < 0.05). However, no significant difference in CV-VD was observed under Valsalva action and at rest between the two groups (P > 0.05). No significant difference in ARJ-VD was found at rest between the two groups (P > 0.05). The incidence of pelvic organ prolapse in the selective cesarean section group (40.0%) was significantly lower than that in the vaginal delivery group (62.5%) (P < 0.05). No significant difference in the parameters of pelvic diaphragm hiatus at rest was observed between the two groups (P > 0.05). The parameters of pelvic diaphragm hiatus under maximum Valsalva action in the vaginal delivery group were significantly higher than those in the selective cesarean section group (P < 0.05). Whether the patient was complicated with diabetes had no significant effect on the functional injury of pelvic floor muscle (P > 0.05). Conclusion The pelvic floor function 6–8 weeks after delivery was significantly more affected in vaginal delivery than in selective cesarean section. Selective cesarean section had certain but limited protective effect on maternal pelvic floor tissue.

The Developing Bird Pelvis Passes Through Ancestral Archosaurian and Dinosaurian Conditions

Living birds (Aves) have bodies dramatically modified from the ancestral reptilian condition. The avian pelvis in particular experienced dramatic changes during the transition from early archosaurs to living birds. This stepwise transformation is well documented by an excellent fossil record; however, the ontogenetic alterations that underly it are less well‐understood. We hypothesized that the avian pelvis evolved via terminal addition—a mechanism whereby ancestral states shift to derived states during late development, resulting in retention of ancestral character states. If this is the case, then developing bird embryos should possess the same character states as taxa along the avian stem lineage (i.e., non‐avian dinosaurs and their close relatives). We used embryological imaging techniques (modified CLARITY protocol) to examine the early morphogenesis of avian pelvic tissues (Japanese Quail, Common Parakeet, Chilean Tinamou), allowing direct comparison with the fossil record. We found that many ancestral dinosaurian features (e.g., forward‐facing pubis, short ilium, pubic ‘boot’) are transiently present in the early morphogenesis (‘pre‐cartilage’) of birds and arrive at their typical ‘avian’ form after transitioning through a prenatal developmental sequence that mirrors phylogeny. Using 3D geometric morphometrics, we quantitatively demonstrate that avian pelvic ontogeny closely parallels the dinosaur‐to‐bird transition and provide evidence for an evolutionary module within the pelvis that is conserved across Archosauria. The same pattern was observed in a paleognath, a galloanseriform, and a neoavian, strongly suggesting that this is the ancestral avian condition. These indicate that the avian pelvis evolved via terminal addition, and that the presence of ancestral states in avian embryos may stem from these conserved modular relationships. This modularity suggests a previously unrecognized mechanism for the retention of ancestral states in development, hinting that terminal addition may be common across evolutionary transitions.

MP32-14 IN VITRO TESTING OF UNTETHERED THERMAL-ACTUATED MICROGRIPPERS AS A NOVEL DIAGNOSTIC TOOL FOR UROTHELIAL TISSUE

You have accessJournal of UrologyCME1 May 2022MP32-14 IN VITRO TESTING OF UNTETHERED THERMAL-ACTUATED MICROGRIPPERS AS A NOVEL DIAGNOSTIC TOOL FOR UROTHELIAL TISSUE Ridwan Alam, Wangqu Liu, Ezra Baraban, Brian Matlaga, Andres Matoso, David Gracias, and Jared Winoker Ridwan AlamRidwan Alam More articles by this author , Wangqu LiuWangqu Liu More articles by this author , Ezra BarabanEzra Baraban More articles by this author , Brian MatlagaBrian Matlaga More articles by this author , Andres MatosoAndres Matoso More articles by this author , David GraciasDavid Gracias More articles by this author , and Jared WinokerJared Winoker More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002581.14AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The gold standard for diagnosis of a suspicious upper tract mass is ureteroscopic biopsy. However, due to the microscopic caliber of the ureter, the development of tools to obtain an adequate tissue sample for analysis has proven challenging. All tools to date have required tethering to the ureteroscope, which severely restrict the size of the biopsy instrument and range of motion. As a result, up to 65% of upper tract malignancies are inaccurately staged. Therefore, we propose the development of untethered submillimeter tools called microgrippers to obtain tissue samples from the upper urinary tract using an in vitro model of porcine urothelium. METHODS: Microgrippers are microsurgical tools measuring 1 mm in the open configuration (Figure 1A). These devices are fabricated using materials safe for use within the human body. A thermosensitive layer keeps the microgrippers in the open configuration at 4°C but softens at 37°C, allowing the microgrippers to close (Figure 1B). The closing motion allows the device to capture contents within its phalanges. Experiments were conducted by placing microgrippers on a sample of porcine urothelial tissue. The microgrippers were retrieved using a magnet and centrifuged to separate the microgrippers from tissue. Tissue samples were analyzed using standard histopathological techniques. RESULTS: Urothelial tissue was successfully obtained when tested on 10 separate samples of porcine ureteral and renal pelvic tissue. Histological analysis confirmed the presence of urothelial tissue without excessive damage or artifact. CONCLUSIONS: Untethered thermal-actuated microgrippers demonstrate the ability to adequately sample urothelial tissue in vitro for analysis by pathologists. There is potential for this revolutionary technology to establish a new standard for biopsy of the upper urinary tract. Ongoing studies are focused on ex vivo and in vivo experimentation for biopsy and drug delivery mechanisms. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e537 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ridwan Alam More articles by this author Wangqu Liu More articles by this author Ezra Baraban More articles by this author Brian Matlaga More articles by this author Andres Matoso More articles by this author David Gracias More articles by this author Jared Winoker More articles by this author Expand All Advertisement PDF DownloadLoading ...

MiR-26a-5p as a useful therapeutic target for upper tract urothelial carcinoma by regulating WNT5A/\u03b2-catenin signaling

The role of miRNAs in cancer and their possible function as therapeutic agents are interesting and needed further investigation. The miR-26a-5p had been demonstrated as a tumor suppressor in various cancers. However, the importance of miR-26a-5p regulation in upper tract urothelial carcinoma (UTUC) remains unclear. Here, we aimed to explore the miR-26a-5p expression in UTUC tissues and to identify its regulatory targets and signal network involved in UTUC tumorigenesis. The miR-26a-5p expression was validated by quantitative real-time polymerase chain reaction (qPCR) using renal pelvis tissue samples from 22 patients who were diagnosed with UTUC and 64 cases of renal pelvis tissue microarray using in situ hybridization staining. BFTC-909 UTUC cells were used to examine the effects of miR-26a-5p genetic delivery on proliferation, migration and expression of epithelial-to-mesenchymal transition (EMT) markers. MiR-26a-5p was significantly down-regulated in UTUC tumors compared to adjacent normal tissue and was decreased with histological grades. Moreover, restoration of miR-26a-5p showed inhibition effects on proliferation and migration of BFTC-909 cells. In addition, miR-26a-5p delivery regulated the EMT marker expression and inhibited WNT5A/β-catenin signaling and expression of downstream molecules including NF-κB and MMP-9 in BFTC-909 cells. This study demonstrated that miR-26a-5p restoration may reverse EMT process and regulate WNT5A/β-catenin signaling in UTUC cells. Further studies warranted to explore the potential roles in biomarkers for diagnostics and prognosis, as well as novel therapeutics targets for UTUC treatment.

Extra-Nodal Follicular Dendritic Cell Sarcoma with Unusual Morphological Features and PDL1 Expression

AbstractFollicular dendritic cell (FDC) sarcoma, a rare tumor of FDCs, poses a diagnostic challenge due to its myriad morphologic and architectural patterns. We present a unique case of extra-nodal FDC sarcoma occurring in a 28-year-old gentleman who presented with multiple pelvic, peritoneal and retroperitoneal soft tissue, and axial skeletal lesions. The tumor was composed of islands and trabeculae of epithelioid cells with interspersed lymphocytes against a background of abundant myxoid matrix. On immunohistochemistry, in addition to the CD21, the tumor was positive for GATA3, inhibin, and programmed death-ligand 1 (PDL1), which have been rarely reported previously in FDC sarcoma. The patient underwent surgical excision of the tumor and was later offered immunotherapy. He has been disease-free for 2 years following immunotherapy. Our case highlights the potential role of immune checkpoint inhibitors in treating FDC sarcoma, which show immuno-expression of PDL1.

Compression devices for temporary hemostasis in injuries of the abdomen and adjacent ileo‑inguinal areas (literature review)

The review analyzes the available literature on the experimental justification and experience of practical application of existing promising devices for stopping intra‑abdominal and external bleeding in the ilio‑inguinal regions by creating an external local compression. Objective : to analyze the order of application, effectiveness and parameters of safe use of “abdominal tourniquet” for local compression of the abdomen and ilio‑inguinal areas with continued bleeding into the peritoneal cavity and pelvic tissue, damage to the vessels of the ilio‑femoral segment, as well as with high hip detachments, when it is impossible to fix the classic tourniquet. Materials and methods. The analysis of modern domestic and foreign literature, the sacred relevance of the pathology under consideration, the constructive features of the main models of devices for creating external compression in the abdomen and adjacent areas of the body, the experience and results of their application in laboratory and real conditions is carried out. Results. The obtained data allow us to assert that today the following four models belong to the main products of the above‑described purpose: AAJT (Abdominal Aortic and Junctional Tourniquet), CRoC (Combat Ready Clamp), JETT (Junctional Emergency Treatment Tool), SJT (SAM Junctional Tourniquet). The considered devices for creating local compression provide temporary hemostasis in intra‑abdominal bleeding, injury of large vessels of the ilio‑inguinal regions and high separation of the thighs, but their use has a number of features that affect the effectiveness of stopping blood flow. Conclusion. The considered compression devices have design features and limitations, so when creating a domestic analog, additional data on the algorithm of use is needed, depending on the area of the wound and the intended source of bleeding, the timing of fixation, as well as the possible combination of this method of temporary hemostasis with other promising methods of stopping bleeding at the pre‑hospital stage.

Biomechanically Compliant Gynecologic Training Simulator.

Pap smear training is commonly conducted using simulators before practicing with humans. Unfortunately, existing simulators do not well simulate the biomechanical properties of pelvic tissues, and this may negatively impact the training outcome. In this study, we used finite element analysis (FEA) to identify a material that most accurately simulates pelvic tissues in terms of biomechanical properties for fabricating gynecologic training simulators. The selected material was then used to fabricate a vagina and cervix model using a hybrid technique of fused deposition modeling and molding to qualitatively confirm the structural integrity of the simulator. The vagina and cervix were reconstructed in a 3-dimensional feature according to geometrical parameters reported in the literature. The biomechanical compliance of the simulators was investigated by comparing 5 materials-RTV615, Dragon Skin 10, Dragon Skin 30, Dragon Skin FX-Pro, and Ecoflex 00-30-and a pelvic tissue model (control) using 2 FEA modules. The structural mechanics module simulated the insertion and opening of a vaginal speculum, and the (1) horizontal opening of the vagina and peak von Mises stress at the anterior and (2) posterior walls of the vagina were obtained. The explicit dynamics module estimated (1) the fracture stress during punch biopsies and (2) maximum perpendicular deformation of the cervix before break. The most biomechanically compliant material was subsequently used to fabricate the simulator using the hybrid technique. From the FEA, the horizontal opening of the vagina, peak von Mises stress at the anterior wall of the vagina, peak von Mises stress at the posterior wall of the vagina fracture stress, and maximum perpendicular deformation of the cervix before break were obtained; the results of Dragon Skin 10 and the control were most similar. Therefore, the simulator was fabricated using the material. A qualitative evaluation of the simulator by the naked eye verified its structural integrity. Of the materials studied, the FEA results showed that Dragon Skin 10 was the most accurate material for simulating pelvic tissues in terms of the biomechanical properties in a gynecologic training simulator. The simulator was also successfully fabricated using the hybrid technique. Further studies may also involve experimental testing to support the simulation results.

Development and in vitro investigation of a biodegradable mesh for the treatment of stress urinary incontinence

Introduction and hypothesisThe use of polypropylene (PP) mesh for stress urinary incontinence (SUI) surgery has declined because of safety concerns. The aim of this study is to evaluate a biodegradable polycaprolactone (PCL) mesh and a PCL composite mesh tissue engineered with human uterine fibroblasts (HUFs) for SUI surgery by comparing mechanical properties and in vitro biocompatibility to commercially available PP and porcine dermis (PD).MethodsThe mechanical properties of four scaffold materials were evaluated: PCL, PCL-collagen-hyaluronic acid composite, acellular porcine dermal collagen (PD) (Pelvicol™) and polypropylene (Gynecare TVT™ Exact®). HUFs were seeded on separate scaffolds. After 7 and 14 days scaffolds were assessed for metabolic activity and cell proliferation using Alamar Blue, Live/Dead and PicoGreen assays. Soluble collagen production was evaluated using a Sircol assay.ResultsPCL and the composite scaffold reached ultimate tensile strength (UTS) values closest to healthy pelvic floor tissue (PCL = 1.19 MPa; composite = 1.13 MPa; pelvic floor = 0.79 MPa; Lei et al. Int Urogynecol J Pelvic Floor Dysfunct. 18(6):603-7, 2007). Cells on PCL showed significantly greater cell viability than PP at day 7 (p < 0.0001). At D14 the composite scaffold showed significantly greater cell viability than PP (p = 0.0006). PCL was the best performing scaffold for soluble collagen production at day 14 (106.1 μg versus 13.04 μg for PP, p = 0.0173).ConclusionsWe have designed a biodegradable PCL mesh and a composite mesh which demonstrate better biocompatibility than PP and mechanical properties closer to that of healthy pelvic floor tissue. This in vitro study provides promising evidence that these two implants should be evaluated in animal and human trials.

A rare case of ovarian Actinomycosis in an 8-year-old girl. A case reports

Anaerobic, nonsporulating, Gram-positive bacteria groups called actinomyces organisms are responsible for the so called actinomycosis. This chronic disease is rare in children and has tendency to mimic many other diseases. It also has wide variety of manifestations and non-specific symptoms. As a result, it is difficult to diagnose before the biopsy and microscopic examination. Although infection may involve any organ in the body, the significant sites of actinomyces infection include cervicofacial, abdominal, pelvic and pulmonary tissues. Case report: Here, we describe one case of unusual presentation; an 8-year-old girl with an ovarian mass which was finally diagnosed actinomycosis based on the pathological findings. Conclusions: Actinomycosis may rarely present with ovarian mass in young girls. Keywords: Actinomyces, Ovarian actinomycosis, Child, Microscopic Examination.

A new method of intraoperative pelvic neuromonitoring: a preclinical feasibility study in a porcine model

Low anterior resections (LAR) are frequently associated with complications such as urinary and fecal incontinence as well as sexual disorders. Typical risk factors are rectal cancer with low tumor location, preoperative radiotherapy, and surgery-related damage of pelvic autonomic nerves. As preserving the pelvic autonomic nerves without any technical assistance is challenging, the objective of this preclinical study was to investigate the technical feasibility of a new method for intraoperative pelvic neuromonitoring. Twelve female pigs undergoing low anterior resections were involved in a prospective preclinical study. Intraoperative pelvic neuromonitoring included direct pelvic nerve stimulation and tissue impedance measurement on the urinary bladder and the rectum for the identification of efferent pelvic nerves in the surgical area. Immunohistochemistry was used to verify the results. Smooth muscle contraction of the urinary bladder and/or the rectum in response to direct stimulation of the innervating nerves was detectable with impedance measurement. The macroscopic contraction of both the urinary bladder and the rectum correlated with a change in tissue impedance compared to the status before contraction. Thus, it was possible to identify pelvic nerves in the surgical area, which allows the nerves to be preserved. The results indicate a reliable identification of pelvic autonomic nerves, which allows nerve damage to be prevented in the future.

Lynch Syndrome-Associated Endometrial Cancer With Combined EPCAM-MSH2 Deletion: A Case Report.

BackgroundLynch syndrome (LS), an autosomal dominant disorder, is characterized by germline pathogenic variants in DNA mismatch repair (MMR) genes like MSH2. EPCAM deletions cause a minority (3%) of LS cases. However, there are only a few reports of LS-associated endometrial cancer (LS-EC) induced by the inactivation of the MSH2 gene due to EPCAM deletions.Case PresentationWe present the case of a 45-years old woman diagnosed with endometrial cancer (EC). Definitive surgery revealed meso-differentiated endometrioid adenocarcinoma, stage IA without lymph-vascular space invasion. Four months later, she received radiation therapy (125I radioactive seeds implantation), and platinum-containing regimen combined chemotherapy because of vaginal stump metastasis of EC. After five years, we performed immunohistochemistry (IHC) on pelvic mass because of presacral metastatic lymph node. IHC showed the absence of MSH2 and MSH6 protein expression in the pelvic mass tissue. Peripheral blood was used for genetic testing based on her cancer diagnosis and family history of cancer in close relatives. Genetic testing revealed deletions of exon 8 and 9 in EPCAM and deletions of exon 1 and 8 in MSH2; thus, we diagnosed the presence of LS. The patient underwent interstitial brachytherapy (BT) of the presacral metastatic lymph node.ConclusionThis case highlights that patients with LS-EC who are carriers of combined EPCAM-MSH2 deletion might experience better oncologic outcomes even with early recurrence.

Biomechanical integrity score of the female pelvic floor

Introduction and HypothesisThe aim of this study is to develop and validate a new integral parameter, the Biomechanical Integrity score (BI-score), for the characterization of the female pelvic floor.MethodsA total of 253 subjects with normal and pelvic organ prolapse (POP) conditions were included in the multi-site observational, case-control study; 125 subjects had normal pelvic floor conditions, and 128 subjects had POP stage II or higher. A Vaginal Tactile Imager (VTI) was used to acquire and automatically calculate 52 biomechanical parameters for eight VTI test procedures (probe insertion, elevation, rotation, Valsalva maneuver, voluntary muscle contractions in two planes, relaxation, and reflex contraction). Statistical methods were applied (t-test, correlation) to identify the VTI parameters sensitive to the pelvic conditions.ResultsTwenty-six parameters were identified as statistically sensitive to POP development. They were subdivided into five groups to characterize (1) tissue elasticity, (2) pelvic support, (3) pelvic muscle contraction, (4) involuntary muscle relaxation, and (5) pelvic muscle mobility. Every parameter was transformed to its standard deviation units against the patient age similar to T-score for bone density. Linear combinations with specified weights led to the composition of five component parameters for groups (1)–(5) and the BI-score in standard deviation units. The p-value for the BI-score has p = 4.3 × 10−31 for POP versus normal conditions. A reference BI-score curve against age for normal pelvic floor conditions was defined.ConclusionsQuantitative transformations of the pelvic tissues, support structures, and functions under diseased conditions may be studied with the BI-score in future research and practical applications.

Oncologic outcomes of Complex Primary Pelvic Soft Tissue Sarcoma, tumor biology, or surgical constraints of the true pelvis.

Background: Pelvic soft tissue sarcomas are a rare group of tumours whose management is distinctively complex and less reported upon. Surgical resection is the main curative option. However, this can be challenging due to anatomical constraints of the true pelvis, with the proximity to various confined vital structures, along with the ability of tumour for trans-compartmental spread through various anatomical hiatus into thigh, buttock and perineum.

On the management of maternal pushing during the second stage of labor: a biomechanical study considering passive tissue fatigue damage accumulation

During the second stage of labor, the maternal pelvic floor muscles undergo repetitive stretch loading as uterine contractions and strenuous maternal pushes combined to expel the fetus, and it is not uncommon that these muscles sustain a partial or complete rupture. It has recently been demonstrated that soft tissues, including the anterior cruciate ligament and connective tissue in sheep pelvic floor muscle, can accumulate damage under repetitive physiological (submaximal) loads. It is well known to material scientists that this damage accumulation can not only decrease tissue resistance to stretch but also result in a partial or complete structural failure. Thus, we wondered whether certain maternal pushing patterns (in terms of frequency and duration of each push) could increase the risk of excessive damage accumulation in the pelvic floor tissue, thereby inadvertently contributing to the development of pelvic floor muscle injury. This study aimed to determine which labor management practices (spontaneous vs directed pushing) are less prone to accumulate damage in the pelvic floor muscles during the second stage of labor and find the optimum approach in terms of minimizing the risk of pelvic floor muscle injury. We developed a biomechanical model for the expulsive phase of the second stage of labor that includes the ability to measure the damage accumulation because of repetitive physiological submaximal loads. We performed 4 simulations of the second stage of labor, reflecting a directed pushing technique and 3 alternatives for spontaneous pushing. The finite element model predicted that the origin of the pubovisceral muscle accumulates the most damage and so it is the most likely place for a tear to develop. This result was independent of the pushing pattern. Performing 3 maternal pushes per contraction, with each push lasting 5 seconds, caused less damage and seemed the best approach. The directed pushing technique (3 pushes per contraction, with each push lasting 10 seconds) did not reduce the duration of the second stage of labor and caused higher damage accumulation. The frequency and duration of the maternal pushes influenced the damage accumulation in the passive tissues of the pelvic floor muscles, indicating that it can influence the prevalence of pelvic floor muscle injuries. Our results suggested that the maternal pushes should not last longer than 5 seconds and that the duration of active pushing is a better measurement than the total duration of the second stage of labor. Hopefully, this research will help to shed new light on the best practices needed to improve the experience of labor for women.

Diagnostic accuracy of [18F]PSMA-1007 PET/CT in biochemical recurrence of prostate cancer

AimDespite increasing use for the detection of biochemically recurrent prostate cancer (rPC), the diagnostic accuracy of positron emission tomography/computed tomography (PET/CT) with [18F]PSMA-1007 remains only partially investigated. The aim of this study was to determine the sensitivity (SE), specificity (SP), positive predictive value (PPV), and negative predictive value (NPV) for PC-local recurrence and metastases on a per region basis.Materials and methodsOne hundred seventy-seven consecutive patients undergoing [18F]PSMA-1007 PET/CT for rPC were retrospectively analysed. Six body regions were defined: prostate fossa, pelvic lymph nodes (LN), retroperitoneal LN, supradiaphragmatic LN, bones, and soft tissue. A region was counted positive if at least one PSMA-positive lesion suspicious for PC was observed. Confirmation of a true-positive PSMA-avid lesion was defined as positive by histopathology, fall in serum prostate-specific antigen (PSA) (> 50%) after targeted therapy or confirmatory further CT, MRI, PET/CT, or bone scan imaging. Regions where additional imaging was able to confirm the absence of suspicious PC lesions or regions outside exclusively targeted RT with serum PSA decline (> 50%) were counted as true-negative regions. SE, SP, PPV, and NPV were calculated for all six regions.ResultsThe overall PET-positivity rate was 91%. Conclusive follow-up for affirmation or refutation of a PSMA-positive lesion was available for 81/152 patients on a per region basis. In this subgroup, overall sensitivity, specificity, PPV, and NPV were 95% (CI: 0.90–0.98), 89% (CI: 0.83–0.93), 86% (0.80–0.90), and 96% (CI: 0.92–0.98), respectively. On a per region basis, PPV was 97% (CI: 0.83–0.99) for local recurrence, 93% (CI: 0.78–0.98) for pelvic LN, 87% (CI: 0.62–0.96) for retroperitoneal LN, 82% (CI: 0.52–0.95) for supradiaphragmatic LN, and 79% (0.65–0.89) for bone lesions. The number of solid organ metastases (n = 6) was too small for an accurate statistical analysis.ConclusionThe known high PET-positivity rate of [18F]PSMA-1007 PET/CT in rPC was confirmed, with corresponding high (> 90%) sensitivity and NPV on a per region basis. However, overall PPV was limited (86%), particularly for bone lesions (79%), which are a potential diagnostic weaknesses when using this tracer.

Path-related pain after implantation of anterior transvaginal mesh: perspective from anatomical study.

Pelvic organ prolapse (POP) is a common gynecological disease caused by defects in pelvic support tissue that manifests as the descent of the pelvic organs, significantly impacting patient quality of life. Transvaginal mesh (TVM) is an effective treatment (Grade A). However, postoperative pain in the groin and medial thigh is very common. Although the use of mesh for transvaginal POP repair has been prohibited or the indications for such use have been extensively limited in many places, it is still an alternative in some countries. Therefore, the safety of the use of mesh still needs to be discussed. The current research on postoperative pain has mainly focused on management. The pathophysiology is unclear. In this study, anterior TVM surgery was performed on ten frozen cadavers. The obturator area was carefully dissected. We explored the relative position of the polypropylene mesh to the internal segment of the obturator nerve in the obturator canal. Four out of 20 obturator explorations were insufficient to allow conclusions to be drawn. We observed a small branch of the obturator nerve, which is a new anatomical finding that we named the obturator externus muscle branch. This structure terminated in the external obturator muscle in 6 out of the 16 successfully dissected obturator areas. The mean distance between the superficial mesh arm and this nerve branch was 7.5 mm. The mean distance between the deep mesh arm and the closest nerve branch was 5.5 mm. The path of the obturator externus muscle branch of the obturator nerve ran close to the mesh arm. It may provide a clinical anatomical basis explaining the observed postoperative pain.