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Orthopaedics & Traumatology, Surgery &... Feb 2021Spinal balance can be defined as the trade-off between outside forces acting on the spine and the muscle response of the trunk, under sensorineural regulation, to... (Review)
Review
Spinal balance can be defined as the trade-off between outside forces acting on the spine and the muscle response of the trunk, under sensorineural regulation, to maintain stable upright posture, both static and dynamic. Homo sapiens developed sagittal alignment along with bipedalism. The upright posture was an important step in human evolution, to master the environment, at the price of some instability in postural control in the trunk, and to maintain horizontal gaze. To make upright stance energetically economical and thus sustainable, reciprocal sagittal curvatures developed. Sagittal spinal organization is governed by strict rules under physiological conditions, enabling alignment between the center of mass and the lower limb joint centers. In children and adolescents, morphologic changes related to skeletal growth and postural control centers maturation alter spinal alignment and hence spinal balance, with increases in pelvic incidence, sacral slope and consequently lumbar lordosis and thoracic kyphosis. Global cervical lordosis remains stable, at the cost of an increase of the inferior cervical lordosis angle in correlation with T1 inclination or T1 slope. In pathology, spinal alignment may induce certain spinal pathologies such as growth-related spinal dystrophy or spondylolisthesis. It can also be altered by spinal deformity such as scoliosis, a regional disorder inducing adjacent compensatory mechanisms. The management of spinal pathologies is indissociable from understanding and maintaining or restoring individual sagittal alignment so as to ensure physiological distribution of stresses and limit onset of complications or decompensation in adulthood.
Topics: Adolescent; Adult; Child; Humans; Kyphosis; Lordosis; Posture; Sacrum; Scoliosis; Spine
PubMed: 33321235
DOI: 10.1016/j.otsr.2020.102769 -
Advances in Wound Care Dec 2020To determine whether multilayer silicone foam dressings can prevent pressure ulcers arising in the sacrum and coccyx of patients with persistent severe diarrhea and/or... (Randomized Controlled Trial)
Randomized Controlled Trial
To determine whether multilayer silicone foam dressings can prevent pressure ulcers arising in the sacrum and coccyx of patients with persistent severe diarrhea and/or fragile skin. This randomized, 14-day controlled trial included 600 hospitalized patients with persistent severe diarrhea and/or fragile skin who were at high risk of developing pressure ulcers. All participants were enrolled from three Japanese institutions. Participants meeting all inclusion and exclusion criteria were randomized using the Excel program to receive standard care (control; = 300) recommended by Japanese guidelines or multilayer silicone foam dressings applied to the sacrum and coccyx (intervention; = 300). Significantly more participants in the control than the intervention group developed pressure ulcers (22 vs. 5, = 0.001). The incidence of pressure ulcers remains high in hospitalized patients at high risk of developing pressure ulcers. The present findings might contribute to novel preventive strategies for patients at high risk of developing pressure ulcers. Multilayer silicone foam dressings can prevent pressure ulcers of the sacrum and coccyx in patients with persistent severe diarrhea and/or fragile skin.
Topics: Aged; Aged, 80 and over; Bandages; Critical Care; Female; Heel; Humans; Japan; Male; Middle Aged; Pressure Ulcer; Sacrum; Silicones
PubMed: 33124968
DOI: 10.1089/wound.2019.1002 -
BMC Pregnancy and Childbirth Dec 2019It is believed that giving birth in an upright position is beneficial for both mother and the infant for several physiologic reasons. An upright positioning helps the... (Meta-Analysis)
Meta-Analysis
BACKGROUND
It is believed that giving birth in an upright position is beneficial for both mother and the infant for several physiologic reasons. An upright positioning helps the uterus to contract more strongly and efficiently, the baby gets in a better position and thus can pass through the pelvis faster. Upright and lateral positions enables flexibility in the pelvis and facilitates the extension of the outlet. Before implementing a change in birthing positions in our clinics we need to review evidences available and context valid related to duration of second stage of labor and birthing positions. Therefore this review aimed to examine the effect of maternal flexible sacrum birth position on duration of second stage of labor.
METHOD
The research searched articles using bibliographical Databases: Medline/PUBMED, SCOPUS, Google scholar and Google. All study designs were considered while investigating the impact of maternal flexible sacrum birthing positioning in relation duration of second stage of labor. Studies including laboring mothers with normal labor and delivery. A total of 1985 women were included in the reviewed studies. We included both qualitative and quantitative analysis.
RESULTS
We identified 1680 potential citations, of which 8 articles assessed the effect of maternal upright birth positioning on the reduction during the duration of second stage of labor. Two studies were excluded because of incomplete reports for meta analysis. The result suggested a reduction in duration of second stage of labor among women in a flexible sacrum birthing position, with a mean duration from 3.2-34.8. The pooled weighted mean difference with random effect model was 21.118(CI: 11.839-30.396) minutes, with the same significant heterogeneity between the studies (I = 96.8%, p < 000).
CONCLUSION
The second stage duration was reduced in cases of a flexible sacrum birthing position. Even though the reduction in duration varies across studies with considerable heterogeneity, laboring women should be encouraged to choose her comfortable birth position. Researchers who aim to compare different birthing positions should consider study designs which enable women to choose birthing position. PROSPERO REGISTRATION NUMBER: [CRD42019120618].
Topics: Female; Humans; Labor Stage, Second; Parturition; Patient Positioning; Posture; Pregnancy; Sacrum; Time Factors
PubMed: 31801479
DOI: 10.1186/s12884-019-2620-0 -
HSS Journal : the Musculoskeletal... May 2023At the cornerstone of the pelvis and spine, the sacrum may be fractured in patients of all ages. Sacral fractures range from high-energy injuries, with mortality rates... (Review)
Review
At the cornerstone of the pelvis and spine, the sacrum may be fractured in patients of all ages. Sacral fractures range from high-energy injuries, with mortality rates of up to 18%, to low-energy insufficiency fractures. The intricate geometry of the sacrum, the breadth of morphotypes, and the presence of congenital anomalies all can complicate the treatment of these fractures. Agreement on the surgical indications for these injuries is limited. This narrative review aims to update orthopedic surgeons on the clinical evaluation and the non-surgical and surgical management of these fractures.
PubMed: 37065102
DOI: 10.1177/15563316221129607 -
The Pan African Medical Journal 2022
Topics: Anal Canal; Digestive System Abnormalities; Humans; Magnetic Resonance Imaging; Meningocele; Rectum; Sacrum; Syringomyelia
PubMed: 35519164
DOI: 10.11604/pamj.2022.41.143.33419 -
European Journal of Surgical Oncology :... Aug 2020Aim of the manuscript is to discuss how to improve margins in sacral chordoma. (Review)
Review
OBJECTIVE
Aim of the manuscript is to discuss how to improve margins in sacral chordoma.
BACKGROUND
Chordoma is a rare neoplasm, arising in half cases from the sacrum, with reported local failure in >50% after surgery.
METHODS
A multidisciplinary meeting of the "Chordoma Global Consensus Group" was held in Milan in 2017, focusing on challenges in defining and achieving optimal margins in chordoma with respect to surgery, definitive particle radiation therapy (RT) and medical therapies. This review aims to report on the outcome of the consensus meeting and to provide a summary of the most recent evidence in this field. Possible new ways forward, including on-going international clinical studies, are discussed.
RESULTS
En-bloc tumor-sacrum resection is the cornerstone of treatment of primary sacral chordoma, aiming to achieve negative microscopic margins. Radical definitive particle therapy seems to offer a similar outcome compared to surgery, although confirmation in comparative trials is lacking; besides there is still a certain degree of technical variability across institutions, corresponding to different fields of treatment and different tumor coverage. To address some of these questions, a prospective, randomized international study comparing surgery versus definitive high-dose RT is ongoing. Available data do not support the routine use of any medical therapy as (neo)adjuvant/cytoreductive treatment.
CONCLUSION
Given the significant influence of margins status on local control in patients with primary localized sacral chordoma, the clear definition of adequate margins and a standard local approach across institutions for both surgery and particle RT is vital for improving the management of these patients.
Topics: Chordoma; Humans; Margins of Excision; Proton Therapy; Radiotherapy Dosage; Sacrum
PubMed: 32402509
DOI: 10.1016/j.ejso.2020.04.028 -
Orthopaedics & Traumatology, Surgery &... Feb 2022Chordoma is a very rare, poorly known malignancy, with slow progression, mainly located in the sacrum and spine. All age groups may be affected, with a diagnostic peak... (Review)
Review
Chordoma is a very rare, poorly known malignancy, with slow progression, mainly located in the sacrum and spine. All age groups may be affected, with a diagnostic peak in the 5th decade of life. Clinical diagnosis is often late. Histologic diagnosis is necessary, based on percutaneous biopsy. Specific markers enable diagnosis and prediction of response to novel treatments. New radiation therapy techniques can stabilize the tumor for 5 years in inoperable patients, but en-bloc resection is the most effective treatment, and should be decided on after a multidisciplinary oncology team meeting in an expert reference center. The type of resection is determined by fine analysis of invasion. According to the level of resection, the patients should be informed and prepared for the expected vesico-genito-sphincteral neurologic sequelae. In tumors not extending above S3, isolated posterior resection is possible. Above S3, a double approach is needed. Anterior release of the sacrum is performed laparoscopically or by robot; resection uses a posterior approach. Posterior wall reconstruction is performed, with an associated flap. Spinopelvic stabilization is necessary in trans-S1 resection. Total or partial sacrectomy shows high rates of complications: intraoperative blood loss, infection or mechanical issues. Neurologic sequelae depend on the level of root sacrifice. No genital-sphincteral function survives S3 root sacrifice. Patient survival depends on initial resection quality and the center's experience. Immunotherapy is an ongoing line of research.
Topics: Chordoma; Humans; Pelvis; Sacrum; Spinal Neoplasms; Treatment Outcome
PubMed: 34890865
DOI: 10.1016/j.otsr.2021.103169 -
International Braz J Urol : Official... 2021
Topics: Electric Stimulation Therapy; Humans; Lumbosacral Plexus; Sacrum; Urinary Bladder, Overactive
PubMed: 33621015
DOI: 10.1590/S1677-5538.IBJU.2021.99.08 -
Annals of Translational Medicine Jan 2022Chordoma is a rare malignant bone tumor with high recurrence and metastasis rates. Little is known about the mutational process of this incurable disease. The aim of our...
BACKGROUND
Chordoma is a rare malignant bone tumor with high recurrence and metastasis rates. Little is known about the mutational process of this incurable disease. The aim of our research was to explore the potential driver genes and signal pathways in the pathogenesis of chordoma and provide a new idea for the study of molecular biological therapy of chordoma.
METHODS
We performed whole-exome-sequencing (WES) on 8 sacrum chordoma tissue samples (matched to peripheral blood samples that had been drawn from patients before surgery) to identify genetic alterations in Chinese patients. We analyzed the sequencing data from known driver genes, pathway enrichment analysis and significantly mutated genes (SMGs) after quality control of sequencing, comparison of reference genomes, analysis of mutations and identification of somatic mutations. Immunohistochemistry staining, Sanger sequencing and GeneChip were used to verify the related genes obtained from the analysis of sequencing data.
RESULTS
The driver genes Phosphatidylinositol-4,5-Bisphosphate 3-Kinase Catalytic Subunit Alpha (), Phosphoinositide-3-Kinase Regulatory Subunit 1 (), and Phosphatase And Tensin Homolog () were enriched in the Phosphatidylinositol 3-kinase (PI3K)/mammalian target of rapamycin (mTOR) signaling pathway and could be potential therapeutic targets for the treatment of sacrum chordoma. The significantly mutated gene Claudin 9 () may play a critical role in the development and progression of sacrum chordoma.
CONCLUSIONS
Collectively, our results identified the genetic signature of sacrum chordoma and could be used to develop a potential promising therapeutic strategy for the treatment of sacrum chordoma in Chinese patients.
PubMed: 35282040
DOI: 10.21037/atm-21-6617