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Annals of Anatomy = Anatomischer... Jun 2024The aim of this systematic review is to study the subdiaphragmatic anatomy of the phrenic nerve. (Review)
Review
OBJECTIVE
The aim of this systematic review is to study the subdiaphragmatic anatomy of the phrenic nerve.
MATERIALS AND METHODS
A computerised systematic search of the Web of Science database was conducted. The key terms used were phrenic nerve, subdiaphragmat*, esophag*, liver, stomach, pancre*, duoden*, intestin*, bowel, gangli*, biliar*, Oddi, gallbladder, peritone*, spleen, splenic, hepat*, Glisson, falciform, coronary ligament, kidney, suprarenal, and adrenal. The 'cited-by' articles were also reviewed to ensure that all appropriate studies were included.
RESULTS
A total of one thousand three hundred and thirty articles were found, of which eighteen met the inclusion and exclusion criteria. The Quality Appraisal for Cadaveric Studies scale revealed substantial to excellent methodological quality of human studies, while a modified version of the Systematic Review Centre for Laboratory Animal Experimentation Risk of Bias Tool denoted poor methodological quality of animal studies. According to human studies, phrenic supply has been demonstrated for the gastro-esophageal junction, stomach, celiac ganglia, liver and its coronary ligament, inferior vena cava, gallbladder and adrenal glands, with half of the human samples studied presenting phrenic nerve connections with any subdiaphragmatic structure.
CONCLUSIONS
This review provides the first systematic evidence of subdiaphragmatic phrenic nerve supply and connections. This is of interest to professionals who care for people suffering from neck and shoulder pain, as well as patients with peridiaphragmatic disorders or hiccups. However, there are controversies about the autonomic or sensory nature of this supply.
Topics: Phrenic Nerve; Humans; Diaphragm; Animals
PubMed: 38692333
DOI: 10.1016/j.aanat.2024.152269 -
Obesity (Silver Spring, Md.) Aug 2023Obesity hypoventilation syndrome is associated with diaphragmatic dysfunction. This study aimed to explore the role of endoplasmic reticulum (ER) stress in mediating...
OBJECTIVE
Obesity hypoventilation syndrome is associated with diaphragmatic dysfunction. This study aimed to explore the role of endoplasmic reticulum (ER) stress in mediating obesity-induced diaphragmatic dysfunction.
METHODS
A pulmonary function test and ultrasound were applied to evaluate diaphragmatic function and magnetic resonance imaging was applied to measure diaphragmatic lipid deposition in human patients. For the mechanistic study, obese mice were introduced to a high-fat diet for 24 weeks, followed by diaphragmatic ultrasound measurement, transcriptomic sequencing, and respective biochemical analysis. Automatic force mapping was applied to measure the mechanical properties of C2C12 myotubes.
RESULTS
People with obesity showed significant diaphragm weakness and lipid accumulation, which was further confirmed in obese mice. Consistently, diaphragms from obese mice showed altered gene expression profile in lipid metabolism and activation of ER stress response, indicated by elevated protein kinase R-like ER kinase (PERK) and c-Jun NH -terminal kinase (JNK) activation. In C2C12 myotubes, inhibition of PERK or JNK signaling abrogated lipotoxicity-induced intracellular lipid deposition and insulin resistance. Inhibition of JNK signaling reversed lipotoxicity-induced impairment of elasticity in C2C12 myotubes.
CONCLUSIONS
These data suggest that ectopic lipid deposition impairs the diaphragmatic function of people with obesity. Activation of PERK/JNK signaling is involved in the pathogenesis of lipotoxicity-induced diaphragm weakness in obesity hypoventilation syndrome.
Topics: Mice; Animals; Humans; Signal Transduction; Diaphragm; Obesity Hypoventilation Syndrome; Mice, Obese; Endoplasmic Reticulum Stress; Obesity; Lipids
PubMed: 37475688
DOI: 10.1002/oby.23809 -
Nursing For Women's Health Dec 2023To explore the evidence on the impact of extended use of intrauterine devices (IUDs) use among women of reproductive age. (Review)
Review
OBJECTIVE
To explore the evidence on the impact of extended use of intrauterine devices (IUDs) use among women of reproductive age.
DATA SOURCES
Electronic resource databases used were PubMed, CINAHL, and Google Scholar. Peer-reviewed articles published during 2012 to 2022 were considered.
ARTICLE SELECTION
Ten articles met the criteria and included data for a total of 7,420 women.
DATA EXTRACTION
Data were extracted from each study using the subheadings "Author/Date," "Participants," "Methods," "Interventions," and "Outcomes." Additionally, the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were used to guide data extraction.
DATA SYNTHESIS
Common themes were identified among each of the articles that supported the purpose of this integrative review, such as adverse effects, perceived effectiveness, pregnancy prevention, and cost effectiveness of extended use of IUDs.
CONCLUSION
The available evidence supports the notion that extending IUD use beyond the original time frame approved by the U.S. Food and Drug Administration is safe and effective with minimal side effects. However, there remains a paucity of evidence examining this topic.
Topics: United States; Pregnancy; Female; Humans; Intrauterine Devices; Peer Review
PubMed: 37863119
DOI: 10.1016/j.nwh.2023.06.005 -
American Journal of Obstetrics and... Aug 2023The intrauterine device is one of the most effective forms of contraception. Use of the intrauterine device has increased in the United States over the last 2 decades.... (Review)
Review
The intrauterine device is one of the most effective forms of contraception. Use of the intrauterine device has increased in the United States over the last 2 decades. Two formulations are commercially available in the United States: the levonorgestrel-releasing intrauterine device and the copper intrauterine device. The levonorgestrel intrauterine device releases progestin, causing endometrial suppression and cervical mucus thickening, whereas the primary mechanism of action of the copper intrauterine device is to create a local inflammatory response to prevent fertilization. Whereas the protective effects of combined hormonal contraception against ovarian and endometrial cancer, and of tubal sterilization against ovarian cancer are generally accepted, less is known about the effects of modern intrauterine devices on the development of gynecologic malignancies. The best evidence for a protective effect of intrauterine device use against cancer incidence pertains to levonorgestrel intrauterine devices and endometrial cancer, although studies suggest that both copper intrauterine devices and levonorgestrel intrauterine devices reduce endometrial cancer risk. This is supported by the proposed dual mechanisms of action including both endometrial suppression and a local inflammatory response. Studies on the relationship between intrauterine device use and ovarian cancer risk show conflicting results, although most data suggest reduced risk of ovarian cancer in intrauterine device users. The proposed biological mechanisms of ovarian cancer reduction (foreign-body inflammatory response, increased pH, antiestrogenic effect, ovulation suppression) vary by type of intrauterine device. Whereas it has been well established that use of copper intrauterine devices confers a lower risk of cervical intraepithelial neoplasms, the effect of levonorgestrel intrauterine device use on cervical cancer remains unclear. Older studies have linked its use to a higher incidence of cervical dysplasia, but more recent literature has found a decrease in cervical cancer with intrauterine device use. Various mechanisms of protection are postulated, including device-related inflammatory response in the endocervical canal and prostaglandin-mediated immunosurveillance. Overall, the available evidence suggests that both levonorgestrel intrauterine devices and copper intrauterine devices reduce gynecologic cancer risk. Whereas there is support for the reduction of endometrial cancer risk with hormonal and copper intrauterine device use, and reduction of cervical cancer risk with copper intrauterine device use, evidence in support of risk reduction with levonorgestrel intrauterine device use for cervical and ovarian cancers is less consistent.
Topics: Female; Humans; Cervix Uteri; Contraceptive Agents, Female; Endometrial Neoplasms; Intrauterine Devices, Copper; Intrauterine Devices, Medicated; Levonorgestrel; Ovarian Neoplasms; Uterine Cervical Neoplasms
PubMed: 37001577
DOI: 10.1016/j.ajog.2023.03.039 -
Diagnostics (Basel, Switzerland) Oct 2023Chronic obstructive pulmonary disease (COPD) typically causes airflow blockage and breathing difficulties, which may result in the abnormal morphology and motion of the...
Chronic obstructive pulmonary disease (COPD) typically causes airflow blockage and breathing difficulties, which may result in the abnormal morphology and motion of the lungs or diaphragm. This study aims to quantitatively evaluate respiratory diaphragm motion using a thoracic sagittal magnetic resonance imaging (MRI) series, including motion asynchronization and limitations. First, the diaphragm profile is extracted using a deep-learning-based field segmentation approach. Next, by measuring the motion waveforms of each position in the extracted diaphragm profile, obvious differences in the independent respiration cycles, such as the period and peak amplitude, are verified. Finally, focusing on multiple breathing cycles, the similarity and amplitude of the motion waveforms are evaluated using the normalized correlation coefficient (NCC) and absolute amplitude. Compared with normal subjects, patients with severe COPD tend to have lower NCC and absolute amplitude values, suggesting motion asynchronization and limitation of their diaphragms. Our proposed diaphragmatic motion evaluation method may assist in the diagnosis and therapeutic planning of COPD.
PubMed: 37892082
DOI: 10.3390/diagnostics13203261 -
International Urogynecology Journal Dec 2023Postpartum lumbopelvic pain (PLPP) is common among women. Abdominal, diaphragm, and pelvic floor muscles (PFMs) modulate intraabdominal pressure as a part of the force...
Ultrasound assessment of the abdominal, diaphragm, and pelvic floor muscles during the respiratory and postural tasks in women with and without postpartum lumbopelvic pain: a case-control study.
INTRODUCTION AND HYPOTHESIS
Postpartum lumbopelvic pain (PLPP) is common among women. Abdominal, diaphragm, and pelvic floor muscles (PFMs) modulate intraabdominal pressure as a part of the force closure mechanism. These muscles are exposed to changes during pregnancy that compromise the force closure mechanism. It was hypothesized that abdominal and PFMs activity, the direction of bladder base displacement, diaphragm thickness, and excursion might differ between women with and without PLPP during respiratory and postural tasks.
METHODS
Thirty women with and 30 women without PLPP participated in this case-control study. Ultrasound imaging was used to assess the abdominal, diaphragm, and PFMs during rest, active straight leg raising (ASLR) with and without a pelvic belt, and deep respiration.
RESULTS
The bladder base descent was significantly greater in the PLPP group than in the controls during deep respiration and ASLR without a belt (p = 0.026; Chi-squared = 6.40). No significant differences were observed between the groups in the abdominal muscles activity and diaphragm muscle thickness. There was a significant interaction effect of the group and the task for diaphragm excursion (F (2, 116) = 6.08; p = 0.00) and PFM activity (F (2, 116) = 5.22; p = 0.00). In the PLPP group, wearing a belt compromised altered PFM activation and direction of bladder base displacement.
CONCLUSION
The PFM activity, direction of bladder base displacement, and diaphragm excursion differed between groups during postural and respiratory tasks. Therefore, it is recommended to involve retraining of the PFMs and diaphragm muscle in the rehabilitation of women with PLPP.
Topics: Humans; Female; Diaphragm; Pelvic Floor; Case-Control Studies; Abdominal Muscles; Ultrasonography; Postpartum Period; Pain; Muscle Contraction
PubMed: 37561174
DOI: 10.1007/s00192-023-05621-2 -
Critical Care (London, England) Mar 2024Several bedside assessments are used to evaluate respiratory muscle function and to predict weaning from mechanical ventilation in patients on the intensive care unit.... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Several bedside assessments are used to evaluate respiratory muscle function and to predict weaning from mechanical ventilation in patients on the intensive care unit. It remains unclear which assessments perform best in predicting weaning success. The primary aim of this systematic review and meta-analysis was to summarize and compare the accuracy of the following assessments to predict weaning success: maximal inspiratory (PImax) and expiratory pressures, diaphragm thickening fraction and excursion (DTF and DE), end-expiratory (Tdi) and end-inspiratory (Tdi) diaphragm thickness, airway occlusion pressure (P0.1), electrical activity of respiratory muscles, and volitional and non-volitional assessments of transdiaphragmatic and airway opening pressures.
METHODS
Medline (via Pubmed), EMBASE, Web of Science, Cochrane Library and CINAHL were comprehensively searched from inception to 04/05/2023. Studies including adult mechanically ventilated patients reporting data on predictive accuracy were included. Hierarchical summary receiver operating characteristic (HSROC) models were used to estimate the SROC curves of each assessment method. Meta-regression was used to compare SROC curves. Sensitivity analyses were conducted by excluding studies with high risk of bias, as assessed with QUADAS-2. Direct comparisons were performed using studies comparing each pair of assessments within the same sample of patients.
RESULTS
Ninety-four studies were identified of which 88 studies (n = 6296) reporting on either PImax, DTF, DE, Tdi, Tdi and P0.1 were included in the meta-analyses. The sensitivity to predict weaning success was 63% (95% CI 47-77%) for PImax, 75% (95% CI 67-82%) for DE, 77% (95% CI 61-87%) for DTF, 74% (95% CI 40-93%) for P0.1, 69% (95% CI 13-97%) for Tdi, 37% (95% CI 13-70%) for Tdi, at fixed 80% specificity. Accuracy of DE and DTF to predict weaning success was significantly higher when compared to PImax (p = 0.04 and p < 0.01, respectively). Sensitivity and direct comparisons analyses showed that the accuracy of DTF to predict weaning success was significantly higher when compared to DE (p < 0.01).
CONCLUSIONS
DTF and DE are superior to PImax and DTF seems to have the highest accuracy among all included respiratory muscle assessments for predicting weaning success. Further studies aiming at identifying the optimal threshold of DTF to predict weaning success are warranted.
TRIAL REGISTRATION
PROSPERO CRD42020209295, October 15, 2020.
Topics: Adult; Humans; Ventilator Weaning; Respiration, Artificial; Respiratory Muscles; Diaphragm; ROC Curve
PubMed: 38454487
DOI: 10.1186/s13054-024-04823-4 -
Muscle & Nerve Sep 2023The leading clinical feature of 5q-associated spinal muscular atrophy (SMA) is symmetric, proximal muscle weakness. Muscles involved in ventilation exhibit a specific...
INTRODUCTION/AIMS
The leading clinical feature of 5q-associated spinal muscular atrophy (SMA) is symmetric, proximal muscle weakness. Muscles involved in ventilation exhibit a specific pattern of denervation: intercostal muscles are severely atrophic, whereas the diaphragm muscle is less affected. The aim of this study was to investigate the involvement of diaphragmatic function by ultrasound imaging in adult patients with SMA and to quantify dynamics of diaphragmatic function during nusinersen treatment.
METHODS
Diaphragmatic thickness, thickening, and excursion during quiet breathing were assessed in 24 adult patients with SMA type 2 and 3 by diaphragm ultrasound imaging before and during nusinersen treatment and were correlated with spirometric parameters.
RESULTS
Diaphragm thickness was not reduced, but increased in a remarkable proportion of patients, whereas diaphragm thickening and excursion were reduced in about 20% to 30% of nusinersen-naive, adult patients with SMA types 2 and 3. During 26 months of nusinersen treatment, diaphragm thickening fraction and excursion improved.
DISCUSSION
Diaphragm ultrasound imaging can provide disease- and treatment-relevant information that is not identified during routine clinical assessments and may therefore be a valuable complementary outcome measure.
Topics: Humans; Adult; Diaphragm; Muscular Atrophy, Spinal; Oligonucleotides; Spinal Muscular Atrophies of Childhood
PubMed: 37466180
DOI: 10.1002/mus.27938 -
Journal of Ultrasound in Medicine :... Feb 2024Weaning failure is common in mechanically ventilated patients, and whether ultrasound (US) can predict weaning outcome remains controversial. This review aims to... (Review)
Review
INTRODUCTION
Weaning failure is common in mechanically ventilated patients, and whether ultrasound (US) can predict weaning outcome remains controversial. This review aims to evaluate the diaphragmatic function measured by US as a predictor of weaning outcome.
METHODS
PubMed was searched to identify original articles about the use of diaphragmatic US in ICU patients. A total of 61 citations were retrieved initially; available data of 26 studies were included in this review.
RESULTS
To assess diaphragmatic dysfunction in adults, six studies evaluated excursion, five evaluated thickening fraction, and both in nine. Despite heterogeneity in the diagnostic accuracy of diaphragm US among the studies, the sonographic indices showed good diagnostic performance for predicting weaning outcome.
CONCLUSIONS
Diaphragmatic US can be a useful and accurate tool to detect diaphragmatic dysfunction in critically ill patients and predict weaning outcome.
Topics: Adult; Humans; Ventilator Weaning; Respiration, Artificial; Diaphragm; Prospective Studies; Critical Care; Ultrasonography
PubMed: 37915259
DOI: 10.1002/jum.16363 -
American Journal of Obstetrics and... Mar 2024Obstetrical hemorrhage is a relatively frequent obstetrical complication and a common cause of maternal morbidity and mortality worldwide. The majority of maternal... (Review)
Review
Obstetrical hemorrhage is a relatively frequent obstetrical complication and a common cause of maternal morbidity and mortality worldwide. The majority of maternal deaths attributable to hemorrhage are preventable, thus, developing rapid and effective means of treating postpartum hemorrhage is of critical public health importance. Intrauterine devices are one option for managing refractory hemorrhage, with rapid expansion of available devices in recent years. Intrauterine packing was historically used for this purpose, with historical cohorts documenting high rates of success. Modern packing materials, including chitosan-covered gauze, have recently been explored with success rates comparable to uterine balloon tamponade in small trials. There are a variety of balloon tamponade devices, both commercial and improvised, available for use. Efficacy of 85.9% was cited in a recent meta-analysis in resolution of hemorrhage with the use of uterine balloon devices, with greatest success in the setting of atony. However, recent randomized trials have demonstrated potential harm associated with improvised balloon tamponade use In low resource settings and the World Health Organization recommends use be restricted to settings where monitoring is available and care escalation is possible. Recently, intrauterine vacuum devices have been introduced, which offer a new mechanism for achieving hemorrhage control by mechanically restoring uterine tone via vacuum suction. The Jada device, which is is FDA-cleared and commercially available in the US, found successful bleeding control in 94% of cases in an initial single-arm trial, with recent post marketing registry study described treatment success following hemorrhage in 95.8% of vaginal and 88.2% of cesarean births. Successful use of improvised vacuum devices has been described in several studies, including suction tube uterine tamponade via Levin tubing, and use of a modified Bakri balloon. Further research is needed with head-to-head comparisons of efficacy of devices and assessment of cost within the context of both device pricing and overall healthcare resource utilization.
Topics: Female; Humans; Pregnancy; Cesarean Section; Intrauterine Devices; Postpartum Hemorrhage; Treatment Outcome; Uterine Balloon Tamponade; Uterus; Clinical Trials as Topic
PubMed: 37690862
DOI: 10.1016/j.ajog.2023.08.015