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International Urogynecology Journal Mar 2024Despite exercise being the standard approach to diastasis recti abdominis (DRA) rehabilitation, there is no consensus on the most effective exercise routine and adjunct... (Review)
Review
INTRODUCTION AND HYPOTHESIS
Despite exercise being the standard approach to diastasis recti abdominis (DRA) rehabilitation, there is no consensus on the most effective exercise routine and adjunct modalities for reducing DRA and improving functional parameters. The present study is aimed at investigating evidence for DRA rehabilitation in postpartum women, as well as knowledge gaps and areas for future research.
METHODS
For this scoping review a systematic search was conducted in MEDLINE, AMED, CINAHL, Embase, ScienceDirect, Scopus, and PEDro up to November 2022. Selection criteria included studies investigating exercise therapy interventions both with and without adjunct modalities for postpartum DRA. Sample characteristics, diagnostic criteria, program design, and outcome measures were recorded. Critical appraisal of clinical trials was performed using PEDro classification.
RESULTS
Twenty-eight studies were included: 14 clinical trials, 3 case series, and 11 observational studies. DRA exercises that focused on deep and superficial muscles, pelvic floor muscles, respiratory maneuvers, functional exercises, or alternative interventions (yoga, suspension training, hypopressive exercise) and adjunct modalities showed promising results in reducing the inter-recti distance and related dysfunction. However, there was great variability in diagnostic criteria and methods, DRA severity, time post-birth, and exercise program design.
CONCLUSIONS
Reviewed studies provide valuable insights into exercise therapy, but it is important to recognize their limitations, as variability in diagnostic criteria, sample characteristics, and exercise program design hinder the generalizability of the findings. Further high-quality research is needed to strengthen the evidence in this area and provide reliable recommendations for clinical practice.
Topics: Female; Humans; Rectus Abdominis; Postpartum Period; Exercise Therapy; Diastasis, Muscle; Pelvis
PubMed: 38340172
DOI: 10.1007/s00192-024-05727-1 -
Journal of Cachexia, Sarcopenia and... May 2024Cancer cachexia is a multifactorial metabolic syndrome characterized by systemic inflammation and ongoing skeletal muscle loss resulting in weakness, poor quality of...
BACKGROUND
Cancer cachexia is a multifactorial metabolic syndrome characterized by systemic inflammation and ongoing skeletal muscle loss resulting in weakness, poor quality of life, and decreased survival. Whereas lipid accumulation in skeletal muscle is associated with cancer cachexia as well as the prognosis of cancer patients, surprisingly little is known about the nature of the lipids that accumulate in the muscle during cachexia, and whether this is related to inflammation. We aimed to identify the types and distributions of intramyocellular lipids in patients with and without cancer cachexia.
METHODS
Rectus abdominis muscle biopsies were collected during surgery of patients with pancreatic ductal adenocarcinoma (n = 10 without cachexia, n = 20 cachectic without inflammation (CRP < 10 mg/L), n = 10 cachectic with inflammation (CRP ≥ 10 mg/L). L3-CT scans were analysed to assess body composition based on validated thresholds in Hounsfield units (HU). Muscle sections were stained with Oil-Red O and H&E to assess general lipid accumulation and atrophy. Untargeted lipidomic analyses were performed on laser-microdissected myotubes using LC-MS/MS. The spatial distribution of intramyocellular lipids with differential abundance between groups was visualized by mass-spectrometry imaging. Genes coding for inflammation markers and enzymes involved in de novo ceramide synthesis were studied by qPCR.
RESULTS
Muscle radiation attenuation was lower in cachectic patients with inflammation (median 24.3 [18.6-30.8] HU) as compared with those without inflammation (34.2 [29.3-38.7] HU, P = 0.033) or no cachexia (37.4 [33.9-42.9] HU, P = 0.012). Accordingly, intramyocellular lipid content was lower in non-cachectic patients (1.9 [1.6-2.1]%) as compared with those with cachexia with inflammation (5.5 [4.5-7.3]%, P = 0.002) or without inflammation (4.8 [2.6-6.0]%, P = 0.017). Intramyocellular lipid accumulation was associated with both local IL-6 mRNA levels (r = 0.57, P = 0.015) and systemic CRP levels (r = 0.49, P = 0.024). Compared with non-cachectic subjects, cachectic patients had a higher relative abundance of intramyocellular glycerophospholipids and a lower relative abundance of glycerolipids. Furthermore, increases in several intramyocellular lipids such as SM(d36:1), PC(34:1), and TG(48:1) were found in cachectic patients with inflammation and correlated with specific cachexia features. Altered intramyocellular lipid species such as PC(34:1), LPC(18:2), and TG(48:1) showed an uneven distribution in muscle sections of cachectic and non-cachectic patients, with areas featuring abundance of these lipids next to areas almost devoid of them.
CONCLUSIONS
Intramyocellular lipid accumulation in patients with cachexia is associated with both local and systemic inflammation, and characterized by changes in defined lipid species such as glycerolipids and glycerophospholipids.
PubMed: 38725139
DOI: 10.1002/jcsm.13474 -
Medicina (Kaunas, Lithuania) Dec 2023Pelvic floor muscle training (PFMT) represent the first-line approach to pelvic floor dysfunctions (PFDs). Recently, studies have shown a synergy between the pelvic...
Pelvic floor muscle training (PFMT) represent the first-line approach to pelvic floor dysfunctions (PFDs). Recently, studies have shown a synergy between the pelvic floor and abdominal muscles, hypothesizing that the anatomical and functional integrity of the abdominal wall plays a role in the prevention of pelvic floor disorders. Some studies have shown a significant correlation between diastasis recti abdominis (DRA) and stress urinary incontinence (SUI). Nevertheless, the evidence reported in the literature is controversial and based on low-quality data. The aim of the study is to clarify whether DRA-specific abdominal rehabilitation is needed in women with SUI after childbirth. All consecutive women who had at least one delivery and complained of symptoms of pure SUI that were urodynamically proven were considered for the study. The group of symptomatic patients was compared with a series of consecutive women, identified during the same study period, without any symptoms of SUI. In both groups, we measured the inter-rectal distance (IRD) with an ultrasound scanner above and below the navel. A total of 102 women eligible for the study group and 100 women who did not report any symptoms of SUI were enrolled. The inter-rectal distance above the umbilicus showed no significant difference between the two groups (2.12 ± 0.98 vs. 2.1 ± 0.77; = 0.94). In contrast, the data from the sub-umbilical measurements showed a significant difference. Surprisingly, the asymptomatic group showed significantly greater (0.98 ± 0.9 vs. 1.33 ± 0.87 -value: 0.009) IRD compared to the symptomatic group. The study shows that DRA is not a risk factor for SUI in women after childbirth. Therefore, specific abdominal wall rehabilitation after childbirth does not seem to be indicated.
Topics: Pregnancy; Humans; Female; Urinary Incontinence, Stress; Rectus Abdominis; Case-Control Studies; Pelvic Floor; Exercise Therapy
PubMed: 38138285
DOI: 10.3390/medicina59122182 -
Diseases of the Colon and Rectum Nov 2023Treatment of perineal defects after abdominoperineal resection or salvage surgery for either locally advanced rectal cancer or anal carcinoma can be challenging....
BACKGROUND
Treatment of perineal defects after abdominoperineal resection or salvage surgery for either locally advanced rectal cancer or anal carcinoma can be challenging. Myocutaneous flap reconstruction has proven to reduce perineal morbidity and abscess formation in the pelvis; however, it is associated with significant donor-site morbidity. To our knowledge, this is the first report of a laparoscopic oblique rectus abdominis myocutaneous flap harvesting for perineal reconstruction. This technical note aimed to demonstrate the feasibility of the technique.
IMPACT OF INNOVATION
Introduction of a laparoscopic technique in harvesting of this flap can potentially further reduce morbidity associated with this flap creation by minimizing abdominal wall trauma and obviating the need for laparotomy for tunneling of the flap intra-abdominally.
TECHNOLOGY, MATERIALS, AND METHODS
This report describes a technique using a 6-port laparoscopy, in which the harvesting of the myocutaneous flap was performed after a standardized abdominoperineal resection. The flap itself is passed through the rectus sheath toward the pelvis with the help of a retractor.
PRELIMINARY RESULTS
Two patients successfully underwent a laparoscopic oblique rectus abdominis flap reconstruction after abdominoperineal resection.
CONCLUSION AND FUTURE DIRECTIONS
This report describes our initial experience with laparoscopic harvesting of an oblique rectus abdominis flap for perineal reconstruction after abdominoperineal resection. We believe the technique is easy and reproducible for laparoscopic surgeons and can reduce donor-site morbidity. However, further studies will be needed to confirm this observation.
PubMed: 37540020
DOI: 10.1097/DCR.0000000000002981 -
Zhongguo Zhen Jiu = Chinese Acupuncture... Feb 2024To observe the therapeutic efficacy of acupuncture and its effects on abdominal circumference, separation distance of rectus abdominis and quality of life in patients... (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVES
To observe the therapeutic efficacy of acupuncture and its effects on abdominal circumference, separation distance of rectus abdominis and quality of life in patients with postpartum diastasis recti abdominis on the basis of diastasis recti abdominis exercise.
METHODS
A total of 87 postpartum women with diastasis recti abdominis were randomly divided into an observation group (44 cases) and a control group (43 cases) . The control group was treated with conventional diastasis recti abdominis rehabilitation exercise, including abdominal breathing training and supine leg lifting training, 3 times a day for 2 weeks. On the basis of the treatment in the control group, the observation group was treated with acupuncture at Zhongwan(CV 12), Qihai(CV 6)and bilateral Shenshu(BL 23), Daimai(GB 26), Daheng(SP 15), Zusanli (ST 36), etc., 30 min each time, once a day for 2 weeks. Before and after treatment, the separation distance of rectus abdominis, low back pain visual analogue scale (VAS) score, abdominal circumference and 36-item short form health survey questionnaire (SF-36) score in the two groups were compared, and the clinical effect was evaluated.
RESULTS
After treatment, the separation distance of rectus abdominis, low back pain VAS scores, abdominal circumference of the two groups were lower than those before treatment(<0.05), and the physiological function, physiological role, pain, mental health, emotional role, social function, energy, general health scores and total scores of SF-36 were higher than those before treatment(<0.05); the separation distance of rectus abdominis, low back pain VAS score, abdominal circumference of the observation group were lower than those in the control group(<0.05), the sub-item scores and total score of SF-36 of the observation group were higher than those in the control group(<0.05).The effective rate of the observation group was 95.5% (42/44), which was higher than 79.1% (34/43) in the control group(<0.05).
CONCLUSIONS
Acupuncture combined with diastasis recti abdominis exercise can effectively relieve the low back pain of postpartum diastasis recti abdominis patients, promote the recovery of recti abdominis function, and improve the quality of life. The clinical effect is superior to diastasis recti abdominis exercise alone.
Topics: Female; Humans; Rectus Abdominis; Low Back Pain; Quality of Life; Postpartum Period; Diastasis, Muscle; Acupuncture Therapy
PubMed: 38373757
DOI: 10.13703/j.0255-2930.20230626-k0004 -
Anatomy & Cell Biology May 2024Transversus abdominis release (TAR) is a myofascial release technique which helps in surgical repair of large ventral abdominal wall defects. In this procedure, the...
Transversus abdominis release (TAR) is a myofascial release technique which helps in surgical repair of large ventral abdominal wall defects. In this procedure, the medial margin of muscular part of transversus abdominis (TA) is of great importance. Hence, the authors sought to describe the extent of medial margin of TA muscle. The surgical steps of TAR were performed in 10 formalin-fixed cadavers and distance between medial margin of TA muscle, lateral margin of rectus abdominis, to linea alba at five anatomical levels were documented respectively. The distance between the inferior epigastric vessels and the medial border of TA muscle was also noted. The TA muscle was within the posterior rectus sheath in all cadavers, at the xiphisternum (R, 61.6 mm; L, 58.9 mm), and at midway between xiphisternum and umbilicus (R, 25.4 mm; L, 27.1 mm). The TA muscle exited the posterior rectus sheath between this point and the umbilicus. The mean incongruity at the next three levels were -24.6 mm, -24.9 mm, and -22.9 mm respectively on the right and -21.4 mm, -19.9 mm, and -18.9 mm respectively on the left. The mean distance between the medial border of TA and inferior epigastric vessels was 18.9 mm on the right and 17.2 mm on the left. The muscular part of TA was incorporated within the posterior rectus sheath above the umbilicus, and it completely exited the rectus sheath at the umbilicus. This is contrary to the traditional understanding of posterior rectus sheath formation.
PubMed: 38797746
DOI: 10.5115/acb.23.305 -
Current Oncology (Toronto, Ont.) Jan 2024The aim of this study was to explore the outcomes of pelvic reconstruction with a rectus abdominis myocutaneous (RAM) or rectus abdominis myoperitoneal (RAMP) flap...
The aim of this study was to explore the outcomes of pelvic reconstruction with a rectus abdominis myocutaneous (RAM) or rectus abdominis myoperitoneal (RAMP) flap following radical surgery for gynecologic malignancy. This is a retrospective case series of all pelvic reconstructions with RAM or RAMP flap performed in a gynecologic oncology service between 1998 and 2023. Reconstructions with other flaps were excluded. A total of 28 patients were included. Most patients had vulvar cancer ( = 15, 53.6%) and the majority had disease recurrence ( = 20, 71.4%). Exenteration was the most common procedure, being carried out in 20 (71.4%) patients. Pelvic reconstruction was carried out with a RAM flap in 24 (85.7%) cases and a RAMP flap in 4 (14.3%) cases. Flap-specific complications included cellulitis (14.3%), partial breakdown (17.9%), and necrosis (17.9%). Donor site complications included surgical site infection and necrosis occurring in seven (25.0%) and three (10.7%) patients, respectively. Neovaginal reconstruction was performed in 14 patients. Out of those, two (14.3%) had neovaginal stenosis and three (21.4%) had rectovaginal fistula. In total, 50% of patients were disease-free at the time of the last follow up. In conclusion, pelvic reconstruction with RAM/RAMP flaps, at the time of radical surgery for gynecologic cancer, is an uncommon procedure. In our case series, we had a significant complication rate with the most common being infection and necrosis. The development of a team approach, with input from services including Gynecologic Oncology and Plastic Surgery should be developed to decrease post-operative complications and improve patient outcomes.
Topics: Humans; Female; Genital Neoplasms, Female; Surgery, Plastic; Retrospective Studies; Cellulitis; Necrosis
PubMed: 38248111
DOI: 10.3390/curroncol31010026 -
Journal of Bodywork and Movement... Oct 2023The study was carried out in the athletes with and without Low Back Pain (LBP) to determine the surface electromyography activity of core stabilizing muscles while...
BACKGROUND
The study was carried out in the athletes with and without Low Back Pain (LBP) to determine the surface electromyography activity of core stabilizing muscles while performing isometric shoulder and trunk contractions.
STUDY DESIGN
Cross-sectional study.
METHODS
This study enlisted the participation of 40 athletes. Group A included 20 athletes (18 males and 2 females) without LBP, and Group B included 20 athletes (12 males and 8 females) with LBP. Athletes with LBP were assessed using the Modified Oswestry Disability Questionnaire (MODQ) and Visual Analog Scale (VAS) to determine their level of disability and pain severity, respectively. EMG activity of the rectus abdominis, external oblique, longissimus, and multifidus was recorded in both groups as they performed bilateral isometric shoulder and trunk contractions.
RESULTS
In the LBP group, EMG activity of the rectus abdominis and external oblique muscles was significantly lower (P < 0.05). The LBP group had significantly more multifidus activity (P = 0.03) than the NLBP group. Among all the exercises, bilateral isometric shoulder extension contraction activated the rectus abdominis, right external oblique, and longissimus group of muscles significantly more (P < 0.05) in both groups. In both groups, bilateral isometric shoulder flexion contraction resulted in significantly higher multifidus muscle activation (P = 0.002).
CONCLUSION
The activation of core stabilizing muscles was altered in athletes with LBP. When athletes are unable to contract and activate trunk muscles owing to pain, upper extremity exercises can be used to activate these muscles.
Topics: Male; Female; Humans; Low Back Pain; Electromyography; Shoulder; Cross-Sectional Studies; Muscle, Skeletal; Isometric Contraction; Rectus Abdominis; Upper Extremity; Abdominal Muscles; Back Muscles
PubMed: 37949585
DOI: 10.1016/j.jbmt.2023.04.019 -
PeerJ 2023The purpose of this study is to examine the impact of trunk kinematic characteristics and trunk muscle electromyography (EMG) activity on propulsion speeds in wheelchair...
BACKGROUND
The purpose of this study is to examine the impact of trunk kinematic characteristics and trunk muscle electromyography (EMG) activity on propulsion speeds in wheelchair racing T54 athletes.
METHOD
The Vicon infrared high-speed 3D motion capture system was utilized to acquire kinematic data of the shoulders, elbows, wrists, and trunk from twelve T54 athletes at four different speeds (5.55 m/s, 6.94 m/s, 8.33 m/s, and personal maximum speed). Additionally, the Trigno Wireless EMG system was employed to collect synchronous surface electromyography (EMG) data from the rectus abdominis and erector spinae muscles. The kinematics and EMG data of the trunk were compared across various wheelchair propulsion speeds while also examining the correlation coefficient between wheelchair propulsion speeds and: (1) the range of motion of upper limb joints as well as the trunk; (2) the maximum angular velocities of the upper limbs joints as well as the trunk; and (3) rectus abdominis and erector spinae EMG activity. Two multiple linear stepwise regression models were utilized to examine the impact of variables that had been identified as significant through correlation coefficient tests (1) and (2) on propulsion speed, respectively.
RESULTS
There were significant differences in the range of motion (<0.01) and angular velocity (<0.01) of the athlete's trunk between different propulsion speeds. The range of motion (<0.01, = 0.725) and angular speed (<0.01, = 0.882) of the trunk showed a stronger correlation with propulsion speed than did upper limb joint movements. The multiple linear stepwise regression model revealed that the standardized values of trunk motion range and angular velocity in athletes were greater than those of other independent variables in both models. In terms of the EMG variables, four of six variables from the rectus abdominis showed differences at different speeds (<0.01), one of six variables from the erector spinae showed differences at different speeds (<0.01). All six variables derived from the rectus abdominis exhibited a significant correlation with propulsion speed (<0.05, >0.3), while one variable derived from the erector spinae was found to be significantly correlated with propulsion speed (<0.01, = 0.551).
CONCLUSION
The movement of the trunk plays a pivotal role in determining the propulsion speed of wheelchair racing T54 athletes. Athletes are advised to utilize trunk movements to enhance their wheelchair's propulsion speed while also being mindful of the potential negative impact on sports performance resulting from excessive trunk elevation. The findings of this study indicate that it would be beneficial for wheelchair racing T54 athletes to incorporate trunk strength training into their overall strength training regimen, with a specific emphasis on enhancing the flexion and extension muscles of the trunk.
Topics: Humans; Electromyography; Biomechanical Phenomena; Muscle, Skeletal; Athletes; Wheelchairs
PubMed: 37581118
DOI: 10.7717/peerj.15792 -
Irish Journal of Medical Science Mar 2024Perianal wound healing and/or complications are common following abdominoperineal resection (APR). Although primary closure is commonly undertaken, myocutaneous flap... (Review)
Review
Primary closure versus vertical rectus abdominis myocutaneous (VRAM) flap closure of perineal wound following abdominoperineal resection-a systematic review and meta-analysis.
PURPOSE/AIM
Perianal wound healing and/or complications are common following abdominoperineal resection (APR). Although primary closure is commonly undertaken, myocutaneous flap closure such as vertical rectus abdominis myocutaneous flap (VRAM) is thought to improve wound healing process and outcome. A comprehensive meta-analysis was performed to compare outcomes of primary closure versus VRAM flap closure of perineal wound following APR.
METHODS
PubMed, MEDLINE, EMBASE, and Cochrane Central Registry of Controlled Trials were comprehensively searched until the 8th of August 2023. Included studies underwent meta-analysis to compare outcomes of primary closure versus VRAM flap closure of perineal wound following APR. The primary outcome of interest was perineal wound complications, and the secondary outcomes were abdominal wound complications, dehiscence, wound healing time, length of hospital stay, and mortality.
RESULTS
Ten studies with 1141 patients were included. Overall, 853 patients underwent primary closure (74.8%) and 288 patients underwent VRAM (25.2%). Eight studies reported on perineal wound complications after APR: 38.2% (n = 263/688) in the primary closure group versus 32.8% (n = 80/244) in the VRAM group. Perineal complication rates were statistically significantly lower in the VRAM group versus primary closure ((M-H OR, 1.61; 95% CI 1.04-2.49;
CONCLUSION
We highlight the advantage of VRAM flap closure over primary closure for perineal wounds following APR. However, tailoring operative strategy based on patient and disease factors remains important in optimising outcomes.
PubMed: 38532236
DOI: 10.1007/s11845-024-03651-3