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International Urogynecology Journal Oct 2018Vaginal childbirth clearly has an effect on pelvic floor anatomy, and pregnancy itself also likely plays a role. This study investigated the effects of consecutive...
INTRODUCTION AND HYPOTHESIS
Vaginal childbirth clearly has an effect on pelvic floor anatomy, and pregnancy itself also likely plays a role. This study investigated the effects of consecutive pregnancies by comparing pelvic organ support and function in urogynecological patients delivered by cesarean section (CS) only.
METHODS
This was a retrospective study using 161 archived data sets of urogynecological patients delivered exclusively by CS presenting with symptoms of pelvic floor dysfunction between 2007 and 2015. Patients had undergone an interview, clinical examination using the Pelvic Organ Prolapse Quantification (POP-Q) system, and 3D/4D translabial ultrasound (TLUS) using Voluson systems. Measures of functional pelvic floor anatomy were obtained from stored ultrasound (US) volumes at a later date, using proprietary software, and blinded against all other data.
RESULTS
One hundred and sixty-one women delivered exclusively by CS were seen in a urogynecological clinic. Volume data analysis was possible in 151 patients. Mean age was 52 (26-82) years, with a mean body mass index (BMI) of 29.5 (18.4-48.7) kg/m. Forty-three (28.5%) women had one CS, 67 (44.4%) had two, and 41 (27.1%) had three or more. On multivariate analysis, adjusting for age, BMI, history of hysterectomy, and incontinence or prolapse surgery, there were no significant differences between groups.
CONCLUSIONS
On comparing women with one, two, or three or more CS, we found no significant differences in any measured sonographic parameters of pelvic organ descent and pelvic floor muscle function. This implies that subsequent pregnancies after the first are unlikely to exert significant additional effects on pelvic floor functional anatomy.
Topics: Adult; Aged; Aged, 80 and over; Cesarean Section; Female; Humans; Middle Aged; Multivariate Analysis; Parity; Pelvic Floor; Pelvic Organ Prolapse; Pregnancy; Retrospective Studies; Ultrasonography
PubMed: 29532121
DOI: 10.1007/s00192-018-3567-9 -
Clinical Biomechanics (Bristol, Avon) Jan 2020Many researchers emphasize adaptations following pregnancy. Our purpose was to get more insight into how morphology interacts with the pelvic walking pattern - the...
BACKGROUND
Many researchers emphasize adaptations following pregnancy. Our purpose was to get more insight into how morphology interacts with the pelvic walking pattern - the segment most prone to the adaptation following altered body demands.
METHODS
Thirty women were enrolled. Three experimental sessions were arranged according to the same protocol in the first, second and third trimesters of pregnancy. First, the anthropometric measures were taken, then walking trials at a self-selected speed were registered. At the end of the experimental session the subjects were asked to fill out a questionnaire on pain.
FINDINGS
The sagittal plane pelvic range of motion (RoM) significantly increased throughout pregnancy. There were significant positive correlations between pelvic anthropometric dimensions and pelvic tilt and rotation primarily in the third trimester of pregnancy. Significant positive correlations were found between pelvic RoM and thigh circumference. Indicators associated with body mass increase were positively correlated with pelvic obliquity in the second trimester and pelvic tilt and rotation in late pregnancy. It is also worth noting that the individual differences were not related to back pain and that the reported correlations were observed in some but not in all trimesters.
INTERPRETATION
Morphological changes following the fetus growth induced increased pelvic tilt and rotation, however, pelvis movements were not associated with back pain. Overall, the results highlight correlations between morphology and pelvis kinematic patterns in some but not in all trimesters.
Topics: Adaptation, Physiological; Adult; Anthropometry; Back Pain; Biomechanical Phenomena; Female; Gait; Humans; Movement; Pain Measurement; Pelvis; Posture; Pregnancy; Range of Motion, Articular; Rotation; Walking; Young Adult
PubMed: 31743885
DOI: 10.1016/j.clinbiomech.2019.11.001 -
BMC Musculoskeletal Disorders Oct 2023To construct a novel nomogram model that can predict DVT and avoid unnecessary examination.
Development and validation of a nomogram for predicting deep venous thrombosis in patients with pelvic and acetabular fractures: a retrospective cohort study : Predictive model for pelvic/acetabular fractures.
PURPOSE
To construct a novel nomogram model that can predict DVT and avoid unnecessary examination.
METHODS
Patients admitted to the hospital with pelvis/acetabular fractures were included between July 2014 and July 2018. The potential predictors associated with DVT were analyzed using Univariate and multivariable logistic regression analysis. The predictive nomogram was constructed and internally validated.
RESULTS
230 patients were finally enrolled. There were 149 individuals in the non-DVT group and 81 in the DVT group. Following analysis, we obtained the final nomogram model. The risk factors included age (OR, 1.037; 95% CI, 1.013-1.062; P = 0.002), body mass index (BMI) (OR, 1.253; 95% CI, 1.120-1.403; P < 0.001); instant application of anticoagulant after admission (IAA) (OR, 2.734; 95% CI, 0.847-8.829; P = 0.093), hemoglobin (HGB) (OR, 0.970; 95% CI, 0.954-0.986; P < 0.001), D-Dimer(OR, 1.154; 95% CI, 1.016-1.310; P = 0.027) and fibrinogen (FIB) (OR, 1.286; 95% CI, 1.024-1.616; P = 0.002). The apparent C-statistic was 0.811, and the adjusted C-statistic was 0.777 after internal validations, demonstrating good discrimination. Hosmer and Lemeshow's goodness of fit (GOF) test of the predictive model showed a good calibration for the probability of prediction and observation (χ = 3.285, P = 0.915; P > 0.05). The decision curve analysis (DCA) and Clinical impact plot (CIC) demonstrated superior clinical use of the nomogram.
CONCLUSIONS
An easy-to-calculate nomogram model for predicting DVT in patients with pelvic-acetabular fractures were developed. It could help clinicians to reduce DVT and avoid unnecessary examinations.
Topics: Humans; Nomograms; Retrospective Studies; Anticoagulants; Hip Fractures; Neck Injuries; Pelvis; Spinal Fractures; Venous Thrombosis
PubMed: 37784040
DOI: 10.1186/s12891-023-06879-9 -
Clinical Biomechanics (Bristol, Avon) Dec 2021Pelvic floor muscle training can cure or alleviate stress urinary incontinence. This study aimed to evaluate maximum voluntary contractions of the pelvic floor muscle in...
BACKGROUND
Pelvic floor muscle training can cure or alleviate stress urinary incontinence. This study aimed to evaluate maximum voluntary contractions of the pelvic floor muscle in sportswomen and verify the association with leg stiffness and muscle power, both maximal and submaximal.
METHODS
The sample consisted of 41 sportswomen between 18 and 42 years of age. Pelvic floor muscle strength was measured by the manometer. The sportswomen were instructed to perform 3 maximum voluntary contractions of the perineum, held for 3 seconds. Maximal and submaximal leg stiffness and muscle power were measured with a force platform, in two conditions: 1st condition was the sub-maximal, double leg hop test, which was performed allowing sportswomen to self-select their preferred frequency and 2nd condition was the maximal double leg hop test, which was performed asking athletes to maximize hop height and minimize contact time on the top of the force platform for 6 consecutive hops.
FINDINGS
Maximal and submaximal leg stiffness values increase with increasing age, weight, height, and body mass index, showing positive and significant (p <0.05) or close correlations. There are strong positive correlations between maximal and submaximal leg stiffness (r = 0.759) and between maximal and submaximal muscle power. Maximum voluntary contractions values decrease with increasing leg stiffness: the correlation is significant with maximal leg stiffness.
INTERPRETATION
Maximum voluntary contractions values decrease with increasing leg stiffness and increase with increasing muscle power values. If the training program aims to increase muscle power, it may also increase maximum voluntary contractions.
Topics: Athletes; Humans; Leg; Muscle Contraction; Pelvic Floor; Urinary Incontinence, Stress
PubMed: 34610505
DOI: 10.1016/j.clinbiomech.2021.105471 -
Ginekologia Polska 2023The aim of this study is to examine the effects of delivery type and birth weight on pelvic floor structure using muscle defects, uterus-vagina angles and landmarks in...
OBJECTIVES
The aim of this study is to examine the effects of delivery type and birth weight on pelvic floor structure using muscle defects, uterus-vagina angles and landmarks in pelvic magnetic resonance imaging (MRI).
MATERIAL AND METHODS
This is a retrospective study. Pelvic MR images of 38 vaginal deliveries and 62 cesarean section patients who met the study criteria were analyzed. Pubococcygeal line, H line, M line were marked on MR images, uterus cervix, cervix upper vagina, upper and middle vagina, middle and lower vagina angles, urogenital hiatus width, levator hiatus width, obturator internus muscle area, levator ani defect was measured. The urinary incontinence and pelvic organ prolapse examination findings were recorded. The patients' age, body mass index (BMI), parity, delivery type, maximum birth weight questions were asked. The data of both groups were compared.
RESULTS
Uterocervical angle and levator ani muscle defect was significantly higher in the vaginal delivery group (p < 0.001). In the vaginal delivery group, a significant positive correlation was found between the parity and the levator ani muscle defect (r = 0.552), (p = 0.000). A significant negative correlation was found between the parity and the uterocervical angle (r = -0.337), (p = 0.039). A significant negative correlation was found between maximum birth weight and cervix upper vagina angle (r = -0.365) (p = 0.024). In the vaginal delivery group, a negative significant correlation was found between birth weight and obturator internus muscle area (r = -0.378), (p = 0.019).
CONCLUSIONS
These results show that cesarean section exposes the pelvic floor to less trauma and suggest that cesarean section may protect the pelvic floor.
Topics: Pregnancy; Humans; Female; Cesarean Section; Retrospective Studies; Pelvic Floor; Birth Weight; Magnetic Resonance Imaging
PubMed: 36477780
DOI: 10.5603/GP.a2022.0140 -
Journal of Sport Rehabilitation May 2020Golf requires effective movement patterns to produce an effective swing and performance.
CONTEXT
Golf requires effective movement patterns to produce an effective swing and performance.
OBJECTIVE
To determine the relationship between the Titleist Performance Institute golf-specific functional movement screening (GSFMS) composite and individual element scores and golf performance by assessing a player's handicap, clubhead speed, side accuracy, ball speed, peak pelvis rotation speed, swing sequence, and common swing faults.
DESIGN
Cohort study, clinical measurement.
SETTING
English golf club.
PARTICIPANTS
A total of 11 amateur golfers: 5 males (age: 37.2 [18.7] y, height: 184.4 [9.6] cm, body mass: 89.5 [13.4] kg, and handicap: 9 [6.6]) and 6 females (age: 53.7 [15.0] y, height: 166.8 [5.5] cm, body mass: 67.9 [16.6] kg, and handicap: 13 [6.1]).
MAIN OUTCOME MEASURES
GSFMS composite and individual element scores and golf performance variables.
RESULTS
Significant relationships existed between GSFMS composite scores and handicap (r = -.779, P = .01); clubhead speed (r = .701, P = .02); ball speed (r = .674, P = .02); and peak pelvis rotation speed (r = .687, P = .02). Significant relationships existed between 90°/90° golf position and clubhead speed (r = .716, P = .01); ball speed (r = .777, P = .01); seated trunk rotation and peak pelvis rotation speed (r = .606, P = .048); single-leg balance and handicap (r = -.722, P = .01); torso rotation and handicap (r = -.637,P = .04); and torso rotation and peak pelvis rotation speed (r = .741, P = .01). Single-leg balance, overhead deep squat, and pelvic tilt were the GSFMS tests which participants had most difficulty in performing. The most common swing faults identified included loss of posture, slide, chicken winging, and early hip extension.
CONCLUSIONS
The GSFMS may be used to identify movement limitations that relate to golfing performance. These findings may potentially allow intervention to correct movement patterns and potentially improve golf performance.
Topics: Adult; Athletic Performance; Biomechanical Phenomena; Female; Golf; Humans; Male; Middle Aged; Motor Skills; Movement; Pelvis; Rotation; Sports Equipment; Time and Motion Studies
PubMed: 30860428
DOI: 10.1123/jsr.2018-0441 -
Annals of Biomedical Engineering Nov 2021Previous studies involving whole-body post-mortem human surrogates (PHMS) have generated biomechanical response specifications for physically simulated accelerative...
Previous studies involving whole-body post-mortem human surrogates (PHMS) have generated biomechanical response specifications for physically simulated accelerative loading intended to reproduce seat and floor velocity histories occurring in under-body blast (UBB) events (e.g.,. References 10, 11, 21 These previous studies employed loading conditions that only rarely produced injuries to the foot/ankle and pelvis, which are body regions of interest for injury assessment in staged UBB testing using anthropomorphic test devices. To investigate more injurious whole-body conditions, three series of tests were conducted with PMHS that were equipped with military personal protective equipment and seated in an upright posture. These tests used higher velocity and shorter duration floor and seat inputs than were previously used with the goal of producing pelvis and foot/ankle fractures. A total of nine PMHS that were approximately midsize in stature and mass were equally allocated across three loading conditions, including a 15.5 m/s, 2.5 ms time-to-peak (TTP) floor velocity pulse with a 10 m/s, 7.5 ms TTP seat pulse; a 13 m/s, 2.5 ms TTP floor pulse with a 9.0 m/s, 5 ms TTP seat pulse; and a 10 m/s, 2.5 ms TTP floor pulse with a 6.5 m/s, 7.5 ms TTP seat pulse. In the first two conditions, the seat was padded with a ~ 120-mm-thick foam cushion to elongate the pulse experienced by the PMHS. Of the nine PMHS tests, five resulted in pelvic ring fractures, five resulted in a total of eight foot/ankle fractures (i.e., two unilateral and three bilateral fractures), and one produced a femur fracture. Test results were used to develop corridors describing the variability in kinematics and in forces applied to the feet, forces applied to the pelvis and buttocks in rigid seat tests, and in forces applied to the seat foam in padded seat tests. These corridors and the body-region specific injury/no-injury response data can be used to assess the performance and predictive capability of anthropomorphic test devices and computational models used as human surrogates in simulated UBB testing.
Topics: Acceleration; Adult; Aged; Biomechanical Phenomena; Blast Injuries; Cadaver; Explosions; Foot Injuries; Fractures, Bone; Humans; Male; Middle Aged; Military Personnel; Models, Biological; Pelvis; Stress, Mechanical; Young Adult
PubMed: 34142277
DOI: 10.1007/s10439-021-02803-1 -
Clinical Biomechanics (Bristol, Avon) Jan 2019To explore the movement patterns utilized by persons post stroke from the simultaneous perspective of pelvic and limb loading with the path of centre of mass during the...
BACKGROUND
To explore the movement patterns utilized by persons post stroke from the simultaneous perspective of pelvic and limb loading with the path of centre of mass during the movement transitions sit to stand and stand to sit.
METHODS
A descriptive pilot study where kinetic and kinematic data were collected and compared between the contribution made by the less affected versus more affected lower limb and trunk during sit to stand and stand to sit following stroke. Movement analysis was undertaken using force-plates and a 3D VICON motion capture system.
FINDINGS
Data were successfully collected on nine subjects of whom four presented with left side more affected and eight were male. Two patterns were demonstrated for pelvic loading, four patterns for limb loading and five patterns for deviation of centre of mass. There were no consistent patterns of movement demonstrated dependent upon the more or less affected side. There was no consistent relationship between pelvic and limb loading and deviation of centre of mass throughout the movement phases.
INTERPRETATION
In contrast to assumptions often made with respect to limb loading, we found large variability in movement patterns utilized by person's with a hemiparetic presentation during sit to stand and stand to sit. The findings suggest that movement problems encountered by persons post-stroke are complex and identifies limitations with respect to current measurement techniques.
Topics: Adult; Aged; Biomechanical Phenomena; Extremities; Female; Humans; Imaging, Three-Dimensional; Lower Extremity; Male; Middle Aged; Movement; Pelvis; Pilot Projects; Sitting Position; Standing Position; Stress, Mechanical; Stroke; Stroke Rehabilitation; Torso
PubMed: 30458329
DOI: 10.1016/j.clinbiomech.2018.11.004 -
Medical Physics Jun 2021Current prostate brachytherapy uses transrectal ultrasound images for implant guidance, where contours of the prostate and organs-at-risk are necessary for treatment...
PURPOSE
Current prostate brachytherapy uses transrectal ultrasound images for implant guidance, where contours of the prostate and organs-at-risk are necessary for treatment planning and dose evaluation. This work aims to develop a deep learning-based method for male pelvic multi-organ segmentation on transrectal ultrasound images.
METHODS
We developed an anchor-free mask convolutional neural network (CNN) that consists of three subnetworks, that is, a backbone, a fully convolutional one-state object detector (FCOS), and a mask head. The backbone extracts multi-level and multi-scale features from an ultrasound (US) image. The FOCS utilizes these features to detect and label (classify) the volume-of-interests (VOIs) of organs. In contrast to the design of a previously investigated mask regional CNN (Mask R-CNN), the FCOS is anchor-free, which can capture the spatial correlation of multiple organs. The mask head performs segmentation on each detected VOI, where a spatial attention strategy is integrated into the mask head to focus on informative feature elements and suppress noise. For evaluation, we retrospectively investigated 83 prostate cancer patients by fivefold cross-validation and a hold-out test. The prostate, bladder, rectum, and urethra were segmented and compared with manual contours using the Dice similarity coefficient (DSC), 95% Hausdorff distance (HD ), mean surface distance (MSD), center of mass distance (CMD), and volume difference (VD).
RESULTS
The proposed method visually outperforms two competing methods, showing better agreement with manual contours and fewer misidentified speckles. In the cross-validation study, the respective DSC and HD results were as follows for each organ: bladder 0.75 ± 0.12, 2.58 ± 0.7 mm; prostate 0.93 ± 0.03, 2.28 ± 0.64 mm; rectum 0.90 ± 0.07, 1.65 ± 0.52 mm; and urethra 0.86 ± 0.07, 1.85 ± 1.71 mm. For the hold-out tests, the DSC and HD results were as follows: bladder 0.76 ± 0.13, 2.93 ± 1.29 mm; prostate 0.94 ± 0.03, 2.27 ± 0.79 mm; rectum 0.92 ± 0.03, 1.90 ± 0.28 mm; and urethra 0.85 ± 0.06, 1.81 ± 0.72 mm. Segmentation was performed in under 5 seconds.
CONCLUSION
The proposed method demonstrated fast and accurate multi-organ segmentation performance. It can expedite the contouring step of prostate brachytherapy and potentially enable auto-planning and auto-evaluation.
Topics: Humans; Image Processing, Computer-Assisted; Male; Neural Networks, Computer; Pelvis; Prostate; Retrospective Studies; Ultrasonography
PubMed: 33894057
DOI: 10.1002/mp.14895 -
American Journal of Physical... Dec 2021In humans, the pelvis is the most sexually dimorphic skeletal element and is often utilized in aging and sexing remains. The pelvis has become greatly relied upon in...
OBJECTIVES
In humans, the pelvis is the most sexually dimorphic skeletal element and is often utilized in aging and sexing remains. The pelvis has become greatly relied upon in anthropological research (e.g., forensics, demographics, obstetrics, evolutionary history); however, pelvis morphology is highly variable, and very little is known about the nature, sources, patterning, and interpretation of this variation. This study aims to quantify pelvis shape variation, document sexual shape variation, and estimate the plasticity of morphology. This will ultimately give greater ability to interpret modern, archaeological, and evolutionary patterns to gain deeper insight into processes which shape human anatomy.
MATERIALS AND METHODS
Using a sample of 129 Medieval Danish skeletons, shape variation is documented in the greater sciatic notch (GSN), iliac crest (IC), arcuate line (AL), and sub-pubic angle (SPA) using 3D geometric morphometrics. The landmarking method applied here has the advantage of being applicable to fragmentary remains, rather than requiring whole bones. This allows it to be easily applied to archaeological samples and for the interpretation of separate bone features. Differences in shape were statistically analyzed by principle component analysis, linear discriminate analysis, and morphological disparity. Relationships between maximum femur length, body mass, and shape centroid size were also test by allometric regression.
RESULTS
Results quantify the sexual dimorphism and shape variation present in these features. The GSN shape is the most variable, while the AL is the least. Similarly, the IC is the only feature which shows almost no dimorphism in shape, and instead best reflects lifestyle/activity patterns. Evidence of dimorphism in the IC is likely a result of cultural labor patterns rather than genetic and hormonal influence. Finally, the shapes of the GSN, AL, and SPA are more related to body mass than to femur length, such that individuals with increased mass exhibit more classically "male" shapes and those with less mass have more "female" shapes.
DISCUSSION
The results have important implications for the evolution of pelvic anatomy, and sexual dimorphism, but also highlight the plasticity inherent in pelvic morphology. Analyzing pelvis features separately in a clearly defined, relatively genetically homogenous population gives insight into the determinants of bone morphology, which are not readily observable by other means. The relationship between body mass and shape suggests dimorphism in body size and composition may affect bone shape.
Topics: Adult; Animals; Female; Hominidae; Humans; Pelvic Bones; Pelvis; Pregnancy; Pubic Bone; Sex Characteristics
PubMed: 34528241
DOI: 10.1002/ajpa.24399