-
Journal of Clinical Medicine May 2023A congenital intrathoracic kidney (ITK) is a rare anomaly that is recognized to have four causes: renal ectopia with an intact diaphragm, diaphragmatic eventration,... (Review)
Review
INTRODUCTION
A congenital intrathoracic kidney (ITK) is a rare anomaly that is recognized to have four causes: renal ectopia with an intact diaphragm, diaphragmatic eventration, diaphragmatic hernia, and traumatic diaphragmatic rupture. We report a case of a prenatal-diagnosed ITK related to a congenital diaphragmatic hernia (CDH) and conducted a systematic review of all cases of the prenatal diagnosis of this association.
CASE PRESENTATION
A fetal ultrasound scan at 22 gestational weeks showed left CDH and ITK, hyperechoic left lung parenchyma, and mediastinal shift. The fetal echocardiography and karyotype were normal. Magnetic resonance imaging at 30 gestational weeks confirmed the ultrasound suspicion of left CDH in association with bowel and left kidney herniation. The fetal growth, amniotic fluid, and Doppler indices remained within the normal range over time. The woman delivered the newborn via an at-term spontaneous vaginal delivery. The newborn was stabilized and underwent non-urgent surgical correction; the postoperative course was uneventful.
CONCLUSIONS
CDH is the rarest cause of ITK; we found only eleven cases describing this association. The mean gestational age at diagnosis was 29 ± 4 weeks and 4 days. There were seven cases of right and four cases of left CDH. There were associated anomalies in only three fetuses. All women delivered live babies, the herniated kidneys showed no functional damage after their surgical correction, and the prognosis was favorable after surgical repair. The prenatal diagnosis and counseling of this condition are important in planning adequate prenatal and postnatal management in order to improve neonatal outcomes.
PubMed: 37297803
DOI: 10.3390/jcm12113608 -
Neurourology and Urodynamics Aug 2023Some authors suggest that breathing exercises should be recommended instead of or in combination with pelvic floor muscle training (PFMT) to prevent and treat urinary... (Review)
Review
INTRODUCTION
Some authors suggest that breathing exercises should be recommended instead of or in combination with pelvic floor muscle training (PFMT) to prevent and treat urinary incontinence (UI) and pelvic organ prolapse (POP).
AIMS
The primary aim of the present study was to investigate the evidence for breathing as an intervention alone or in addition to PFM contraction in treatment of UI and POP.
MATERIALS & METHODS
This systematic review included short-term experimental studies and randomize controlled trials (RCTs) indexed on PubMed, EMBASE, and PEDro database. A form was used to extract data that was analyzed qualitatively due to the heterogeneity in interventions and outcome measures of the included studies. The individual methodological quality of RCTs was analyzed using the PEDro scale.
RESULTS
A total of 18 studies were included, 374 participants from short-term experimental studies and 765 from nine RCTs. PEDro score varied from 4 to 8. Activation of the PFM during expiration was significantly less than during a PFM contraction. In general, the RCTs showed that training the PFM is significantly more effective to improve PFM variables and UI and POP than breathing exercises, and that adding breathing exercises to PFMT have no additional effect.
CONCLUSION
This systematic review indicates that the evidence for incorporating breathing exercise in clinical practice in addition to or instead of PFMT is scant or non-existing, both based on short-term experimental studies and small RCTs.
Topics: Humans; Pelvic Floor; Exercise Therapy; Urinary Incontinence; Breathing Exercises; Pelvic Organ Prolapse; Treatment Outcome
PubMed: 37260116
DOI: 10.1002/nau.25218 -
Journal of Clinical Nursing Sep 2023To describe and synthesize non-pharmacological and nonsurgical interventions for male urinary incontinence from the existing literature. (Review)
Review
AIMS
To describe and synthesize non-pharmacological and nonsurgical interventions for male urinary incontinence from the existing literature.
METHODS
A scoping review was conducted following the methodology suggested by Arksey and O'Malley: (1) identification of the research questions; (2) identification of relevant studies using a three-step search recommended by JBI: an initial search within PubMed and CINAHL, a comprehensive literature search within PubMed, CINAHL, EMBASE, PsycINFO, Cochrane Library, and literature search of references lists; (3) study selection; (4) data extraction and charting; (5) collation, summarization, and reporting of the results. The PRISMA-ScR Checklist was used to report.
RESULTS
A total of 4602 studies were identified, of which 87 studies were included. Approximately 78% were randomized controlled trials. More than 88% of the participants were men with prostate cancer. Exercising pelvic floor muscles 30 times per day for 12 weeks was the most frequently reported. Parameters of electrical stimulation were typically set up to 50 Hz and 300 μs for frequency and width of pulse, respectively, and lasted for 15 min. Pure pelvic floor muscle training, Pilates, Yoga, whole body vibration, diaphragm/abdominal muscle training, micturition interruption exercise, acupuncture, and auriculotherapy showed positive effects on reducing urinary incontinence.
CONCLUSION
The findings suggested implementing pelvic floor muscle training alone before or after surgery can both prompt the recovery of continence in men after prostate cancer surgery. The decision to use biofeedback or electrical stimulation to enhance the therapeutic effect of pelvic floor muscle training should be approached with caution. More rigorous designed studies are needed to validate the effectiveness of Traditional Chinese Medicine techniques and diverse novel methods.
RELEVANCE TO CLINICAL PRACTICE
Physicians and nurses need to be up to date on the latest evidence-based non-pharmacological and nonsurgical interventions in male urinary incontinence and select appropriate interventions based on available medical resources and patient preferences.
Topics: Humans; Male; Female; Pelvic Floor; Urinary Incontinence; Electric Stimulation Therapy; Exercise Therapy; Biofeedback, Psychology
PubMed: 37161602
DOI: 10.1111/jocn.16749 -
Critical Care (London, England) May 2023Several measurements have been used to predict the success of weaning from mechanical ventilation; however, their efficacy varies in different studies. In recent years,... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Several measurements have been used to predict the success of weaning from mechanical ventilation; however, their efficacy varies in different studies. In recent years, diaphragmatic ultrasound has been used for this purpose. We conducted a systematic review and meta-analysis to evaluate the effectiveness of diaphragmatic ultrasound in predicting the success of weaning from mechanical ventilation.
METHODS
Two investigators independently searched PUBMED, TRIP, EMBASE, COCHRANE, SCIENCE DIRECT, and LILACS for articles published between January 2016 and July 2022. The methodological quality of the studies was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool; additionally, the certainty of the evidence is evaluated using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) methodology. Sensitivity and specificity analysis was performed for diaphragmatic excursion and diaphragmatic thickening fraction; positive and negative likelihood ratios and diagnostic odds ratios (DOR) with their confidence intervals (95% CI) were calculated by random effects analysis, summary receiver operating characteristic curve was estimated. Sources of heterogeneity were explored by subgroup analysis and bivariate meta-regression.
RESULTS
Twenty-six studies were included, of which 19 were included in the meta-analysis (1204 patients). For diaphragmatic excursion, sensitivity was 0.80 (95% CI 0.77-0.83), specificity 0.80 (95% CI 0.75-0.84), area under the summary receiver operating characteristic curve 0.87 and DOR 17.1 (95% CI 10.2-28.6). For the thickening fraction, sensitivity was 0.85 (95% CI 0.82-0.87), specificity 0.75 (95% CI 0.69-0.80), area under the summary receiver operating characteristic curve 0.87 and DOR 17.2 (95% CI 9.16-32.3). There was heterogeneity among the included studies. When performing a subgroup analysis and excluding studies with atypical cutoff values, sensitivity and specificity increased for diaphragmatic thickening fraction; sensitivity increased and specificity decreased for diaphragmatic excursion; when comparing studies using pressure support (PS) versus T-tube, there was no significant difference in sensitivity and specificity; bivariate meta-regression analysis shows that patient position at the time of testing was a factor of heterogeneity in the included studies.
CONCLUSIONS
Measurement of diaphragmatic excursion and diaphragmatic thickening fraction predict the probability of successful weaning from mechanical ventilation with satisfactory diagnostic accuracy; however, significant heterogeneity was evident in the different included studies. Studies of high methodological quality in specific subgroups of patients in intensive care units are needed to evaluate the role of diaphragmatic ultrasound as a predictor of weaning from mechanical ventilation.
Topics: Humans; Respiration, Artificial; Ventilator Weaning; Sensitivity and Specificity; ROC Curve; Intensive Care Units; Diaphragm; Ultrasonography
PubMed: 37147688
DOI: 10.1186/s13054-023-04430-9 -
PloS One 2023Surface Electromyography (sEMG) has been used to monitor respiratory muscle function and contractility in several clinical situations, however there is the lack of...
BACKGROUND
Surface Electromyography (sEMG) has been used to monitor respiratory muscle function and contractility in several clinical situations, however there is the lack of standardization for the analysis and processing of the signals.
OBJECTIVE
To summarize the respiratory muscles most assessed by sEMG in the critical care setting and the assessment procedure details employed on those muscles regarding electrode placement, signal acquisition, and data analysis.
METHODS
A systematic review of observational studies was registered on PROSPERO (number CRD42022354469). The databases included PubMed; SCOPUS; CINAHL, Web of Science and ScienceDirect. Two independent reviewers ran the quality assessment of the studies using the Newcastle-Ottawa Scale and Downs & Black checklists.
RESULTS
A total of 311 participants were involved across the 16 studies, from which 62.5% (10) assessed the diaphragm muscle and 50% (8) assessed the parasternal muscle with similar electrode placement in both of them. We did not identify common patterns for the location of the electrodes in the sternocleidomastoid and anterior scalene muscles. 12/16 reported sample rate, 10/16 reported band-pass and 9/16 reported one method of cardiac-interference filtering technique. 15/16 reported Root Mean Square (RMS) or derivatives as sEMG-obtained variables. The main applicabilities were the description of muscle activation in different settings (6/16), testing of reliability and correlation to other respiratory muscles assessment techniques (7/16), and assessment of therapy response (3/16). They found sEMG feasible and useful for prognosis purposes (2/16), treatment guidance (6/16), reliable monitoring under stable conditions (3/16), and as a surrogate measure (5/16) in mechanically ventilated patients in elective or emergency invasive procedures (5/16) or in acute health conditions (11/16).
CONCLUSIONS
The diaphragm and parasternal muscles were the main muscles studied in the critical care setting, and with similar electrodes placement. However, several different methods were observed for other muscles electrodes placement, sEMG signals acquisition and data analysis.
Topics: Humans; Electromyography; Critical Illness; Reproducibility of Results; Respiratory Muscles; Diaphragm; Electrodes; Muscle, Skeletal
PubMed: 37104255
DOI: 10.1371/journal.pone.0284911 -
Respiratory Medicine and Research Jun 2023Diaphragm dysfunction is common among people with obstructive lung disease (OLD). The effectiveness of manual therapy (MT) techniques specifically targeting this region...
BACKGROUND
Diaphragm dysfunction is common among people with obstructive lung disease (OLD). The effectiveness of manual therapy (MT) techniques specifically targeting this region remains unclear. The scope of this systematic review is to investigate the effectiveness of MT on the zone of apposition (ΖΟΑ) of the diaphragm in lung function, diaphragm excursion (DE), chest expansion, exercise capacity (EC), maximal inspiratory pressure (PImax) and dyspnea in people suffering from OLD.
METHODS
Key databases were systematically searched. Two independent reviewers screened the papers for inclusion. Methodological quality and the quality of evidence were assessed using the PEDro scale and the GRADE approach, respectively.
RESULTS
Two studies were included. One showed that diaphragmatic stretching and the manual diaphragm release technique (MDRT) improved DE and CE (p<0.001, p<0.05, respectively). The other showed that MDRT improved DE and EC (p<0.05, p<0.05, respectively).
CONCLUSION
This systematic review provides preliminary evidence on the effectiveness of MT on the ZOA of the diaphragm in people with COPD. Further research is needed in order for definitive conclusions to be drawn.
REGISTRATION NUMBER IN PROSPERO
CRD42022308595.
Topics: Humans; Diaphragm; Pulmonary Disease, Chronic Obstructive; Musculoskeletal Manipulations; Thorax; Dyspnea
PubMed: 37027895
DOI: 10.1016/j.resmer.2023.101002 -
Taiwanese Journal of Obstetrics &... Mar 2023To compare the treatment efficacies of high-intensity focused ultrasound (HIFU), HIFU combined with gonadotrophin-releasing hormone agonist (GnRH-a), and HIFU combined... (Meta-Analysis)
Meta-Analysis Review
Comparison of the treatment efficacies of HIFU, HIFU combined with GnRH-a, and HIFU combined with GnRH-a and LNG-IUS for adenomyosis: A systematic review and meta-analysis.
To compare the treatment efficacies of high-intensity focused ultrasound (HIFU), HIFU combined with gonadotrophin-releasing hormone agonist (GnRH-a), and HIFU combined with GnRH-a and levonorgestrel-releasing intrauterine system (LNG-IUS) for adenomyosis. We conducted a literature search in SCIENCE DIRECT, COCHRANE LIBRARY, WILLEY ONLINE LIBRARY, PUBMED, and TAYLOR FRANCIS. A total of 471 articles identified, 12 were included in a systematic review, and 11 of them deemed quantitively eligible included in the meta-analysis. The efficacies of the three treatment regimens were assessed using the dysmenorrhea and menstrual scores at 3, 6, 12, 24 months. Of the three regimens, HIFU combined with GnRH-a and LNG-IUS provides the best outcome. On dysmenorrhea score at 6 months there was significantly different higher heterogeneity with P < 0.00001 (I = 100% WMD 21.44 [6.34, 36.53]) with statistical significance P = 0.005. At 12 months there was significantly different higher heterogeneity P < 0.00001 (I = 100% WMD 23.47 [6.00, 40.94]) with statistically significant P < 0.008. At 24 months there was significantly different higher heterogeneity P < 0.0005 (I = 92% WMD 6.05 [4.81, 7.30]) with statistical significance P < 0.00001. HIFU combined with GnRH-a and LNG-IUS on menstrual score at 3 months was significantly different higher heterogeneity with P < 0.00001 (I = 100% WMD 56.23 [16.01, 96.45]) with statistical significance P = 0.006. At 6 months there was significantly different higher heterogeneity P < 0.00001 (I = 99% WMD 93.86 [64.15, 123.57]) with statistical significance P < 0.00001. At 12 months there was significantly different higher heterogeneity P < 0.00001 (I = 99% WMD 97.13 [67.81, 126.46]) with statistical significance P < 0.00001 compared to treatments with only HIFU and HIFU combined with GnRH-a. HIFU combined with GnRH-a and LNG-IUS treatment is more effective than only HIFU monotherapy and HIFU combined with GnRH-a.
Topics: Female; Humans; Adenomyosis; Dysmenorrhea; Levonorgestrel; Treatment Outcome; Gonadotropin-Releasing Hormone; Intrauterine Devices, Medicated
PubMed: 36965889
DOI: 10.1016/j.tjog.2022.11.009 -
The Malaysian Journal of Medical... Feb 2023There are controversial debates regarding the effects of contraceptive vaginal ring devices on females' sexual function. Therefore, the meta-analysis of before-after was... (Review)
Review
There are controversial debates regarding the effects of contraceptive vaginal ring devices on females' sexual function. Therefore, the meta-analysis of before-after was conducted on the intervention studies published in the past years to clarify these contradictions. The existing literature on the subject was reviewed by searching through such databases as PubMed, Scopus, ISI Web of Sciences, Embase, Cochrane Library and Google Scholar up to July 2021. Before-after intervention studies that had examined the effect of vaginal rings on females' sexual function were collected as well. In total, five studies with 369 participants were included in quantitative syntheses. Pooled results from the random-effect model showed that NuvaRing had a positive effect on females' sexual function three months after insertion (WMD: 2.48; 95% CI: 0.30, 4.67; = 0.026); however, this effect was not significant after 6 months (WMD: 4.38; 95% CI: -4.95, 13.72; = 0.357). Meta-regression analysis suggested that the effect of this device is associated with users' age and body mass index 3 months after insertion. No publication bias was found by Egger's test or funnel plots. Overall, the results of this meta-analysis support the view that vaginal ring use is associated with a positive effect on the sexual function of women 3 months after insertion, while the effect of this device on the sexual function of women was insignificant after 6 months. However, given the dearth of available data, it is not possible to reach a definite conclusion on the effect of vaginal rings on females' sexual function.
PubMed: 36875197
DOI: 10.21315/mjms2023.30.1.3 -
The Cochrane Database of Systematic... Feb 2023The copper intrauterine device (Cu-IUD) is a highly effective method of contraception that can also be used for emergency contraception (EC). It is the most effective...
BACKGROUND
The copper intrauterine device (Cu-IUD) is a highly effective method of contraception that can also be used for emergency contraception (EC). It is the most effective form of EC, and is more effective than other existing oral regimens also used for EC. The Cu-IUD provides the unique benefit of providing ongoing contraception after it is inserted for EC; however, uptake of this intervention has been limited. Progestin IUDs are a popular method of long-acting, reversible contraception. If these devices were also found to be effective for EC, they would provide a critical additional option for women. These IUDs could not only provide EC and ongoing contraception, but additional non-contraceptive benefits, including a reduction in menstrual bleeding, cancer prevention, and pain management.
OBJECTIVES
To examine the safety and effectiveness of progestin-containing IUDs for emergency contraception, compared with copper-containing IUDs, or compared with dedicated oral hormonal methods.
SEARCH METHODS
We considered all randomized controlled trials and non-randomized studies of interventions that compared outcomes for individuals seeking a levonorgestrel IUD (LNG-IUD) for EC to a Cu-IUD or dedicated oral EC method. We considered full-text studies, conference abstracts, and unpublished data. We considered studies irrespective of their publication status and language of publication.
SELECTION CRITERIA
We included studies comparing progestin IUDs with copper-containing IUDs, or oral EC methods for emergency contraception.
DATA COLLECTION AND ANALYSIS
We systematically searched nine medical databases, two trials registries, and one gray literature site. We downloaded all titles and abstracts retrieved by electronic searching to a reference management database, and removed duplicates. Three review authors independently screened titles, abstracts, and full-text reports to determine studies eligible for inclusion. We followed standard Cochrane methodology to assess risk of bias, and analyze and interpret the data. We used GRADE methodology to assess the certainty of the evidence.
MAIN RESULTS
We included only one relevant study (711 women); a randomized, controlled, non-inferiority trial comparing LNG-IUDs to Cu-IUDs for EC, with a one-month follow-up. With one study, the evidence was very uncertain for the difference in pregnancy rates, failed insertion rates, expulsion rates, removal rates and the difference in the acceptability of the IUDs. There was also uncertain evidence suggesting the Cu-IUD may slightly increase rates of cramping and the LNG-IUD may slightly increase bleeding and spotting days. AUTHORS' CONCLUSIONS: This review is limited in its ability to provide definitive evidence regarding the LNG-IUD's equivalence, superiority, or inferiority to the Cu-IUD for EC. Only one study was identified in the review, which had possible risks of bias related to randomization and rare outcomes. Additional studies are needed to provide definitive evidence related to the effectiveness of the LNG-IUD for EC.
Topics: Female; Humans; Pregnancy; Contraception, Postcoital; Copper; Intrauterine Devices; Intrauterine Devices, Copper; Progestins; Randomized Controlled Trials as Topic; Steroids
PubMed: 36847591
DOI: 10.1002/14651858.CD013744.pub2 -
ANZ Journal of Surgery Mar 2023Neck dissection is a commonly performed procedure for oncologic control of head and neck malignancy. With contemporary modified radical and selective neck dissections,... (Review)
Review
BACKGROUND
Neck dissection is a commonly performed procedure for oncologic control of head and neck malignancy. With contemporary modified radical and selective neck dissections, haematoma, wound infection, tissue necrosis, chyle leak and injury involving the marginal mandibular, hypoglossal, vagus or accessory nerves are commonly described complications. Although the phrenic nerve courses within the surgical planes explored during a neck dissection and has a vital function in innervating the diaphragm, few studies have been performed to investigate the exact incidence of post-operative phrenic nerve paresis. This study aims to review the literature as to the rate of phrenic nerve injury following neck dissection.
METHODS
A systematic literature review was conducted from 2000 to 2022 including studies reporting on phrenic nerve paresis following neck dissection.
RESULTS
In total, 11 studies were included. The reported rate of immediate post-operative phrenic nerve paresis ranged from 0% to 5.3%, with an average rate of 0.613% (12/1959). The reported rate of phrenic nerve paresis at follow-up (1 month-127 months) ranged from 0% to 4.7%, with an average rate of 1.035% (5/483). There were no cases of bilateral phrenic nerve paresis reported in this period.
CONCLUSIONS
Phrenic nerve paresis is an uncommon complication following neck dissection, often asymptomatic and potentially underreported. Bilateral phrenic nerve paresis is exceedingly rare. Injury can be avoided by staying superficial to the prevertebral fascia when dissecting around the anterior scalene muscle. Routine phrenic nerve integrity monitoring is not commonly utilized but may aid intra-operative phrenic nerve identification or confirmation of function.
Topics: Humans; Phrenic Nerve; Neck Dissection; Head and Neck Neoplasms; Paresis
PubMed: 36792555
DOI: 10.1111/ans.18322