Visceral Dysfunctions Research Articles

Effectiveness of visceral fascial therapy targeting visceral dysfunctions outcome: systematic review of randomized controlled trials

BackgroundFascial Therapy is an ancient and widespread practice throughout the world. These approaches are very common in osteopathic practice and taught in workshops for professionals from different areas of health care, including Physiotherapy. This type of treatment is quite specialized and centered on the therapist. However, there is a lack of high-quality and low-risk bias studies that justify the use of this practice. Despite this, there is little scientific evidence about the effectiveness of Fascial Therapy to treat some visceral disorders. The purpose of this study was to critically appraise the scientific literature concerning the clinical efficacy of techniques used in Fascial Therapy targeting the visceral system.MethodsThis systematic review included randomized controlled trials in any language or date of publication. All primary outcomes reported were included. The methodological quality and statistical reporting of each eligible trial were evaluated using the version 2 of the Cochrane risk-of-bias tool for randomized trials (RoB 2). This systematic review provided a synthesis of current evidence on the effects of Fascial Therapy in patients with visceral disorders and/or pain. A total of 11 studies were included, with five of them covering gastrointestinal dysfunction, two covering cardiorespiratory dysfunction, two covering musculoskeletal dysfunction, and two covering urogenital dysfunction.ResultsFascial Therapy targeting the visceral system has been shown to be effective in reducing pain over the long term in people with low back pain when combined with standard physical therapy and effective in reducing gastroesophageal reflux symptoms over the short term. Considering the overall bias, six studies were at high risk of bias, two studies had some concerns and only three studies were at low risk of bias. Of the three studies with a low risk of bias, only two showed positive results and were effective in improving the studied outcome.ConclusionThis systematic review shows that currently, there is poor evidence for the efficacy of the techniques used in Fascial Therapy targeting the visceral system, and this information can help healthcare professionals in decision-making related to the use of Fascial Therapy targeting the visceral system in patients with visceral disorders and/or pain.

Reproductive Health of Female Patients with Connective Tissue Dysplasia

Connective tissue dysplasia is congenital anomaly manifesting as different organ's and system's alterations: locomotor, skin, visceral dysfunctions. This article presents literature review covering such topical issues as female reproductive system features affected by mesenchymal pathology (undifferentiated forms of connective tissue dysplasia) and its medicamentous management (microelements, hormonal drugs, adaptogens). The analysis of original studies on this topic has revealed that connective tissue dysplasia has significant effect on female reproductive function development and can be complicated by various menstrual dysfunctions (hypomenorrhea syndrome, oligomenorrhea, opsomenorrhea, uterine bleedings, and secondary amenorrhea) as well as by endocrine changes (anti-Mullerian hormone deficiency, hypoprolactinaemia, hypoestrogenemia, etc.). Gestation and delivery features in patients with connective tissue dysplasia (preeclampsia, premature birth, and fetal abnormalities) were also revealed.

Long-term results of combined use of speech therapy and osteopathic correction in 5–6 year old children with dysarthria

Introduction. Dysarthria is a disorder of motor dynamics, which manifests itself in oral speech in the form of illegibility and indistinctness. Also motor realization is impaired, the mobility of the organs of speech (soft palate, tongue, lips) is limited, and so articulation is difficult. Correction of dysarthria only with the help of exercises with a speech therapist is not always effective enough; therefore, there is a constant search for methods that would make it possible to solve speech therapy problems more efficiently and in a shorter time. In this regard, there is great interest in osteopathic correction. The somatic dysfunctions and the results of osteopathic correction of children with dysarthria are described in sufficient detail in the available literary, but only for the end of treatment. The question of preservation of the achieved osteopathic correction results is practically not covered.Aim is to study the long-term results of osteopathic correction of somatic dysfunctions in children aged 5–6 years with dysarthria.Materials and methods. The study involved children with an established diagnosis of dysarthria at the age of 5–6 years. The study participants were divided into the control (15 people) and the main (26 people) groups. The participants in the control group received speech therapy, the participants in the main group received speech therapy and osteopathic correction. The logopaedic, osteopathic and neurological examinations were performed at the start of the study. The logopaedic examination was repeated 12 months after the completion of the correction. The osteopathic examination was repeated immediately after the completion of the correction, after 6 and 12 months. The neurological examination was repeated 6 and 12 months after the completion of the correction.Results. During the study of the long-term results of the correction performed in the both groups, there was a positive trend in several indicators characterizing the severity of speech impairment, including impaired speech pronunciation and dysarthria. In the main group, the dynamics was statistically significantly (p<0,05) more pronounced than in the control group. In the main group, there was a statistically significant (p<0,05) decrease in the severity of global and regional somatic dysfunctions, as well as a decrease in the detection frequency of local disorders of the craniosacral system and local visceral dysfunctions. Also in the main group there was a significant (p<0,05) decrease in the detection frequency of disorders of several indicators characterizing neurological status, including such indicators as convergence, facial symmetry, pharyngeal reflex, neck muscle tension, Romberg posture, local soreness, maskiness, the location of the tongue in the center, the condition of the muscles of the floor of the mouth, the tension of the muscles of the neck, fi nger-nose test.Conclusion. The study demonstrated not only the clinical efficacy of the combined use of osteopathic correction and speech therapy, but also the preservation of the achieved results according to the follow-up evaluation data. The obtained results make it possible to recommend the inclusion of osteopathic correction in the complex correction of dysarthria in preschool children.

Comparative study of the effectiveness of standard therapy and the complex therapy with inclusion of osteopathic correction, in patients with discogenic S<sub>I</sub> radiculopathy

Introduction . Pain in the lumbosacral region is one of the most common causes of disability and seeking medical help. The most pronounced clinical manifestations and a protracted course of pain syndrome are observed in patients with discoradical conflicts. The anatomical and functional features of the segment of the lumbosacral region predispose to persistent compression of the S I root, which makes it difficult to carry out analgesic therapy, leading the patient to long-term disability or to surgical intervention. Discogenic lesion of the SI root changes the biomechanics of not only the pelvic region and lower limb, but also affects the biomechanics of the whole body. Despite the success in the development of modern approaches to the treatment of this disease, the problem of increasing the effectiveness of treatment of patients with herniated discs of the lumbosacral spine remains relevant. One of the promising directions is the inclusion of methods of osteopathic correction in the complex treatment. The goal of research — is to substantiate the inclusion of osteopathic correction in the standard therapy of patients with discogenic S I radiculopathy. Materials and methods . The study involved 30 patients with discogenic S I radiculopathy. The two groups were formed by the method of simple randomization: the control group (15 people), whose participants underwent standard conservative treatment, and the experimental group (15 people), whose participants additionally underwent osteopathic correction. At the beginning and at the end of the study, all participants underwent a clinical and neurological examination (including an assessment of the motor function of the muscles innervated by the S I spinal nerve, an assessment of sensitivity in the zone innervated by the SI spinal nerve, and an assessment of the Achilles reflex), an assessment of the intensity of pain syndrome using a visual analogue scale (VAS), anassessment of life quality by Oswestry Disability Index, and an assessment of osteopathic status. The obtained data were processed by methods of nonparametric statistics. Results . It was found that the inclusion of osteopathic correction in the standard treatment of patients with discogenic S I radiculopathy is accompanied by a more pronounced decrease in the number of regional somatic dysfunctions (SD), local SD of the musculoskeletal system and local visceral dysfunctions (the differences are statistically significant, p<0,05). The elimination of regional viscero-somatic and somato-visceral disorders of the L I-L V spinal cord segments, as well as local disorders of the ankle joint, coccyx and muscle-fascial formations of the pelvis, thigh, lower leg and foot is observed. In addition, there is a more pronounced decrease in the intensity of sensitivity disorders in patients and in the intensity of pain. Conclusion . The obtained results allows to conclude that the inclusion of osteopathic correction in the standard conservative therapy of patients with discogenic S I radiculopathy contributes to an increase of the treatment effectiveness.

Partners in Crime: NGF and BDNF in Visceral Dysfunction.

Neurotrophins (NTs), particularly Nerve Growth Factor (NGF) and Brain-Derived Neurotrophic Factor (BDNF), have attracted increasing attention in the context of visceral function for some years. Here, we examined the current literature and presented a thorough review of the subject.After initial studies linking of NGF to cystitis, it is now well-established that this neurotrophin (NT) is a key modulator of bladder pathologies, including Bladder Pain Syndrome/Interstitial Cystitis (BPS/IC) and Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CP/CPPS. NGF is upregulated in bladder tissue and its blockade results in major improvements on urodynamic parameters and pain. Further studies expanded showed that NGF is also an intervenient in other visceral dysfunctions such as endometriosis and Irritable Bowel Syndrome (IBS).More recently, BDNF was also shown to play an important role in the same visceral dysfunctions, suggesting that both NTs are determinant factors in visceral pathophysiological mechanisms. Manipulation of NGF and BDNF improves visceral function and reduce pain, suggesting that clinical modulation of these NTs may be important; however, much is still to be investigated before this step is taken.Another active area of research is centered on urinary NGF and BDNF. Several studies show that both NTs can be found in the urine of patients with visceral dysfunction in much higher concentration than in healthy individuals, suggesting that they could be used as potential biomarkers. However, there are still technical difficulties to be overcome, including the lack of a large multicentre placebo-controlled studies to prove the relevance of urinary NTs as clinical biomarkers.

Active Visceral Manipulation Associated With Conventional Physiotherapy in People With Chronic Low Back Pain and Visceral Dysfunction: A Preliminary, Randomized, Controlled, Double-Blind Clinical Trial

ObjectiveThe purpose of this study was to generate data for conduction of a power analysis to investigate short-term effects of visceral manipulation associated with conventional physical therapy on pain intensity, lumbar mobility, and functionality of people with chronic low back pain and visceral dysfunctions. MethodsThis was a double-blinded, randomized, controlled, clinical trial preliminary study. A blinded evaluation was conducted involving 20 people with chronic low back pain with visceral dysfunction. Pain perception, lumbar mobility, and functionality were assessed in 3 moments: evaluation 1 (1 week before the intervention), evaluation 2 (immediately after the last intervention), and evaluation 3 (1 week after the last intervention). The protocol consisted of 50-minute session of conventional physical therapy and visceral manipulation. The participants were randomly allocated to 2 groups: 10 for the experimental group (conventional physical therapy and visceral manipulation) and 10 for the control group (conventional physical therapy and placebo visceral manipulation). ResultsSignificant reductions were found in the experimental group for lumbar mobility and specific functionality in comparison with the control group (P < .05). There were no significant differences for pain perception and global functionality. ConclusionThe combination of visceral manipulation and conventional physical therapy program demonstrated significant between-groups differences over time for lumbar spine mobility and specific functionality. These gains occurred after 5 sessions, once a week, and were maintained 1 week after the end of the treatment. This study generated data for conduction of a power analysis to inform the design for future clinical research in this line of inquiry.

A Modified Nerve-Sparing Panhysterectomy for Benign Uterine Diseases: Techniques and Evaluation of Postoperative Pelvic Dysfunctions

Objective: To describe a modified nerve-sparing panhysterectomy and to investigate the feasibility and impact of this nerve-sparing technique in improving postoperative pelvic visceral dysfunctions of benign uterine disease patients. Methods: From January 2008 to January 2010, a total of 300 patients diagnosed with benign uterine diseases at the Second Affiliated Hospital of Nantong University were enrolled. Of those, 150 randomly selected patients underwent modified panhysterectomy (research group), while the other 150 patients underwent conventional panhysterectomy (control group). The surgery-related parameters, including operation time, intraoperative blood loss, length of hospital stay, postoperative indwelling catheter time, and first voiding and defecation time were compared between the two groups. The extent of nerve damage in both groups was examined using the nerve-specific marker S-100 via immunohistochemistry. Besides, postoperative assessments of bladder and bowel functions were conducted within 1 year after the operation. Results: The surgery-related parameters in the two groups showed no significant difference (p > 0.05). Immunohistochemistry results showed significantly reduced damage of the nerves in the research group. We also found a better bladder and bowel function in the research group (p < 0.05) and in younger patients (p < 0.05) compared with that in the control group. Recovery trends of the bladder and bowel function were found in both groups (χ² = 7.512, p = 0.006 in the research group; χ² = 7.299, p = 0.007 in the control group). Conclusion: Modified panhysterectomy for benign uterine diseases seems feasible and safe, with the main advantage of improving postoperative urocystic and rectal dysfunctions through the preservation of the pelvic autonomic nerves.

Evaluation of pelvic visceral functions after modified nerve-sparing radical hysterectomy

Background Nerve-sparing radical hysterectomy (NSRH) was developed in an attempt to minimize complications after radical hysterectomy. Since 2008, a modified NSRH-nerve plane-sparing radical hysterectomy (NPSRH) has been developed at the Cancer Hospital, Chinese Academy of Medical Sciences. The aim of this study was to investigate the role of NPSRH in improving postoperative pelvic visceral dysfunctions. Methods Eighty-three patients with International Federation of Gynecology and Obstetrics (FIGO) stage IB1-IIA2 cervical cancer received NPSRH (the study group) from January 2008 to October 2012. One hundred and sixty-six patients who underwent conventional radical hysterectomy (CRH) were randomly selected as the control group. Age, pathological type and stage were matched between the two groups. The safety of surgery was assessed by duration of operation and blood transfusion rate. Postoperative short-term bladder function was analyzed by duration of catheterization. Long-term bladder, anorectal and sexual function were evaluated with questionnaires. Results Seventy-eight patients (94.0%) in the NPSRH group and one hundred and sixty patients (96.4%) in the CRH group completed the study. Median follow-up time was 31.9 months and 31.0 months respectively (P=0.708). There was no significant difference between the two groups in terms of age, body mass index, FIGO stage, pathologic type, preoperative and postoperative therapy (P &gt;0.05). The blood transfusion rate shared no difference between two groups (P=0.364). The operation time in the NPSRH group was significantly longer than CRH group (P &lt;0.01). But the duration of catheterization and hospitalization in the NPSRH group was significantly reduced compared with CRH group (P &lt;0.01). In addition, the incidence of long-term urinary frequency, urinary incontinence, urinary retention, straining to void, constipation and diarrhea was significantly lower in the NPSRH group (P &lt;0.05). However, there was no significant difference regarding sexual function (P &gt;0.05). Conclusions The current evidence indicated that NPSRH improved long-term bladder function compared to CRH. Moreover, it may improve long-term anorectal function as well.

Identification of thymus and activation-regulated chemokine (TARC/CCL17) as a potential marker for early indication of disease and prediction of disease activity in drug-induced hypersensitivity syndrome (DIHS)/drug rash with eosinophilia and systemic symptoms (DRESS)

Drug-induced hypersensitivity syndrome (DIHS)/drug rash with eosinophilia and systemic symptoms (DRESS) is a serious acute drug reaction with fever, cutaneous eruption, lymphadenopathy, and several visceral dysfunctions. Eosinophilia is a common hematological abnormality in DIHS/DRESS suggesting that the Th2-type immune response is involved. Thymus and activation-regulated chemokine (TARC/CCL17) is a family of CC chemokines known to play an important role in Th2-mediated immune-inflammatory processes. We investigated the pathogenic role of TARC in patients with DIHS. Sera were obtained from 8 patients with DIHS, 7 patients with Stevens-Johnson syndrome/Toxic epidermal necrolysis (SJS/TEN), and 14 patients with drug-induced maculopapular exanthema (MPE). Serum TARC levels were measured by ELISA. TARC levels were then compared with clinical symptoms and various hematological parameters. In addition, a biopsy was taken from the lesional skin of patients with DIHS and stained with anti-TARC Ab and anti-CD11c Ab. Serum TARC levels in patients with DIHS were significantly higher than those in patients with SJS/TEN and MPE during the acute phase. Serum TARC levels in DIHS patients correlated with skin eruptions, serum sIL-2R levels, eosinophil counts, and serum IL-5 levels. Immunohistochemical staining revealed that TARC was mainly expressed on CD11c+ dermal dendritic cells in patients with DIHS. Serum TARC levels may be associated with the initial presentation of DIHS as well as disease activity during the course. Thus, they could be useful as an indicator for early diagnosis and assessment of disease activity in DIHS. CD11c+ dendritic cells may be the main source of TARC in patients with DIHS.

Sympathovagal imbalance in type 2 diabetic (T2D) Goto‐Kakizaki (GK) rats associates with abnormal hypothalamic and brainstem gene expressions relevant to food intake

BackgroundBrainstem thyrotropin‐releasing hormone (TRH) resides in nerve fibers innervating sympathetic and vagal motor neurons and regulates food intake through vagal stimulation of ghrelin release (Endocrinology, 2006). TRH induced sympathetic activation is potentiated and vagal activation is impaired in GK rats, resulting in profound visceral dysfunctions (Endocrinology, 2005, Neuroscience, 2010, Hypertension Res 2011), including reduced food intake (Endo meeting 2010).MethodHypothalamic and brainstem gene expression relevant to food intake was measured by qPCR in Wistar and GK rats normally fed, fasted for 48 h and fasted for 48 h + refed 2 h.ResultsFasting increases TRH/TRH receptor mRNA in brainstem and ghrelin in serum in Wistar rats but not in GK rats. Fasting also increased hypothalamic gene expression of NPY, AgRP, ghrelin receptor, and leptin receptor, and decreased that of POMC in Wistar rats. These changes were not found in GK rats. Differences in gene expression of brainstem NPY, POMC, leptin receptor, MC4R, and 5‐HT receptor3a, and hypothalamic TRH, Y2 receptor and MC4R were found between fasted or refed Wistar and GK rats.Conclusionsympathovagal imbalance resulting from brainstem TRH dysfunction associates with disabled hypothalamic and brainstem responses to energy demand in T2D GK rats. Supported by VA Merit Ward (Yang).

Quality of Life and Sexual, Bladder, and Intestinal Dysfunctions After Class III Nerve-Sparing and Class II Radical Hysterectomies

To compare quality of life and bladder, intestinal, and sexual dysfunctions in 2 groups of patients undergoing different types of radical hysterectomies (RHs). Patients with cervical cancer who underwent RH have been enrolled in a questionnaire-based study. Quality of life (QoL) and bladder, intestinal, and sexual dysfunctions were evaluated with the Functional Assessment of Cancer Therapy-Cervix (FACT-Cx). Patients were grouped according to the type of RH: group 1, class II RH and group 2, class III nerve-sparing RH (NSRH). Of 157 women included in the study, 127 filled out the questionnaire. Overall, QoL score assessed with the FACT questionnaire did not differ significantly between the 2 groups. The FACT subscales assessing physical, functional, emotional, and social well-being did not differ significantly between the 2 groups, whereas the FACT-Cx subscales assessing disease-related symptoms in group 2 patients showed a significantly worse score (72 vs 66; P = 0.03). Evaluating singularly the 15 items of the Cx subscales assessing disease-related symptoms, we did not find any significant difference between the 2 groups, but only Cx1 ("I am bothered by discharge or bleeding from my vagina") was significantly worse in group 2 patients. At univariate analysis, we found that NSRH and adjuvant radiotherapy (RT) impact negatively on the FACT-Cx subscales regarding pelvic visceral function. However, at multivariate analysis, only adjuvant RT impact negatively. Patients submitted to class III NSRH did not present worse QoL and pelvic visceral dysfunctions when compared with class II RH. The RT seems to be a factor impacting negatively on bladder and sexual function.

Pontine regulation of pelvic viscera: pharmacological target for pelvic visceral dysfunctions.

The pathophysiology and pharmacological targets of disorders of the bladder and colon have focused predominantly on the periphery. However, these viscera are regulated by the CNS, which, in turn, must integrate their functions with compatible behaviours. This review focuses on the role of the pontine micturition centre, Barrington's nucleus, as a key to this integration. Through its efferent network this pontine centre links parasympathetic preganglionic neurones with forebrain-projecting nuclei, providing an anatomical substrate for coregulation of pelvic visceral and forebrain activity. Disorders characterized by multiple pelvic visceral symptoms and comorbidity with psychiatric disorders (for example functional bowel disorders) might have their roots in dysfunctions of this circuit, which could provide a novel target for pharmacological treatment.

タキキニン情報伝達と創薬の可能性

The mammalian nervous system contains 3 main tachykinins, substance P (SP), neurokinin A (NKA), and neurokinin B (NKB), and 3 subtypes of tachykinin receptors, NK1, NK2 and NK3. There is persuasive evidence that SP and NKA act as neurotransmitters in mammalian central and peripheral nervous systems. The possibility of development of new drugs related to tachykininergic signalling will be discussed, comparing with the opioid peptide-mediated signalling. Concerning the opioid peptides, a large field of narcotic analgesics had been developed since long time ago, which was one of the hints leading to the recent discovery of opioid peptides and receptors. In contrast, tachykinins and their receptors were found recently, and attempts for the drug development are just starting. The amounts of tachykinins in mammalian CNS are comparable to those of opioid peptides, and 3 subtypes of receptors are known for both tachykinin and opioid systems, which suggests that the tachykininergic signalling in mammalian nervous system may be as important as the opiopid-mediated signalling. Therefore, we may expect that many useful drugs related to tachykinins may develop for therapeutics of pain, inflammation, central and visceral dysfunctions.