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American Journal of Obstetrics and... Aug 2019Structural and functional changes of the rat pelvic floor muscles during pregnancy, specifically, sarcomerogenesis, increase in extracellular matrix content, and higher...
BACKGROUND
Structural and functional changes of the rat pelvic floor muscles during pregnancy, specifically, sarcomerogenesis, increase in extracellular matrix content, and higher passive tension at larger strains protect the integral muscle components against birth injury. The mechanisms underlying these antepartum alterations are unknown. Quantitative proteomics is an unbiased method of identifying protein expression changes in differentially conditioned samples. Therefore, proteomics analysis provides an opportunity to identify molecular mechanisms underlying antepartum muscle plasticity.
OBJECTIVE
To elucidate putative mechanisms accountable for pregnancy-induced adaptations of the pelvic floor muscles, and to identify other novel antepartum alterations of the pelvic floor muscles.
MATERIALS AND METHODS
Pelvic floor muscles, comprised of coccygeus, iliocaudalis, and pubocaudalis, and nonpelvic limb muscle, tibialis anterior, were harvested from 3-month-old nonpregnant and late-pregnant Sprague-Dawley rats. After tissue homogenization, trypsin-digested peptides were analyzed by ultra-high-performance liquid chromatography coupled with tandem mass spectroscopy using nano-spray ionization. Peptide identification and label free relative quantification analysis were carried out using Peaks Studio 8.5 software (Bioinformatics Solutions Inc., Waterloo, ON, Canada). Proteomics data were visualized using the Qlucore Omics Explorer (New York, NY). Differentially expressed peptides were identified using the multi-group differential expression function, with q-value cutoff set at <0.05. Proteomic signatures of the pelvic floor muscles were compared to nonpelvic limb muscle and between nonpregnant and pregnant states.
RESULTS
Unsupervised clustering of the data showed clear separation between samples from nonpregnant and pregnant animals along principal component 1 and between pelvic and nonpelvic muscles along principal component 2. Four major gene clusters were identified segregating proteomic signatures of muscles examined in nonpregnant vs pregnant states: (1) proteins increased in the pelvic floor muscles only; (2) proteins increased in the pelvic floor muscles and tibialis anterior; (3) proteins decreased in the pelvic floor muscles and tibialis anterior; and (4) proteins decreased in the pelvic floor muscles alone. Cluster 1 included proteins involved in cell cycle progression and differentiation. Cluster 2 contained proteins that participate in mitochondrial metabolism. Cluster 3 included proteins involved in transcription, signal transduction, and phosphorylation. Cluster 4 comprised proteins involved in calcium-mediated regulation of muscle contraction via the troponin tropomyosin complex.
CONCLUSION
Pelvic floor muscles gain a distinct proteomic signature in pregnancy, which provides a mechanistic foundation for the antepartum physiological alterations acquired by these muscles. Variability in genes encoding these proteins may alter plasticity of the pelvic floor muscles and therefore the extent of the protective pregnancy-induced adaptations. Furthermore, pelvic floor muscles' proteome is divergent from that of the nonpelvic skeletal muscles.
Topics: Adaptation, Physiological; Animals; Chromatography, High Pressure Liquid; Female; Muscle, Skeletal; Pelvic Floor; Pregnancy; Proteins; Proteomics; Rats, Sprague-Dawley; Tandem Mass Spectrometry
PubMed: 31047881
DOI: 10.1016/j.ajog.2019.04.025 -
Journal of Nuclear Medicine : Official... Feb 1984Extramedullary hematopoiesis is an infrequent cause of thoracic masses. Extrathoracic locations are even less common. We have studied two patients, one with suspected...
Extramedullary hematopoiesis is an infrequent cause of thoracic masses. Extrathoracic locations are even less common. We have studied two patients, one with suspected pelvic neoplasm, with technetium-99m sulfur colloid marrow image and transmission computerized tomography. This noninvasive evaluation established the diagnosis of pelvic extramedullary hematopoiesis in both. We recommend a similar diagnostic approach in patients with chronic anemia or other predisposing disease, presenting with a pelvic or abdominal mass.
Topics: Adult; Anemia, Sickle Cell; Bone Marrow; Female; Hematopoiesis; Humans; Mediastinal Neoplasms; Mediastinum; Middle Aged; Pelvic Neoplasms; Pelvis; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid; Thalassemia; Tomography, Emission-Computed
PubMed: 6610033
DOI: No ID Found -
Journal of Ultrasound 2016Polysplenism and accessory spleen are congenital, usually asymptomatic anomalies. A rare case of polysplenism with ectopic spleen in pelvis of a 67-year-old, Caucasian...
Polysplenism and accessory spleen are congenital, usually asymptomatic anomalies. A rare case of polysplenism with ectopic spleen in pelvis of a 67-year-old, Caucasian female is reported here. A transvaginal ultrasound found a soft well-defined homogeneous and vascularized mass in the left pelvis. Patient underwent MRI evaluation and contrast-CT abdominal scan: images with parenchymal aspect, similar to spleen were obtained. Abdominal scintigraphy with 99mTc-albumin nanocolloid was performed and pelvic region was studied with planar scans and SPECT. The results showed the presence of an uptake area of the radiopharmaceutical in the pelvis, while the spleen was normally visualized. These findings confirmed the presence of an accessory spleen with an artery originated from the aorta and a vein that joined with the superior mesenteric vein. To our knowledge, in the literature, there is just only one case of a true ectopic, locally vascularized spleen in the pelvis.
Topics: Aged; Choristoma; Female; Humans; Magnetic Resonance Imaging; Pelvis; Spleen; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed; Ultrasonography
PubMed: 27298644
DOI: 10.1007/s40477-015-0178-x -
Diagnostic and Interventional Imaging Feb 2016Pelvic extraperitoneal pelvic masses are relatively uncommon conditions and generally raise diagnostic imaging challenges. Magnetic resonance (MR) imaging plays a...
Pelvic extraperitoneal pelvic masses are relatively uncommon conditions and generally raise diagnostic imaging challenges. Magnetic resonance (MR) imaging plays a central role in the diagnosis of these masses due to its unique tissue-specific multiplanar capabilities that allow optimal pelvic mass localization and internal characterization. This article reviews the MR imaging presentation of extraperitoneal pelvic masses, gives clues that allow identifying their extraperitoneal and/or specific origin as well as suggests different steps for narrowing the differential diagnosis. These steps include systematic analysis of the clinical context, tumor location, relationships with major pelvic structures and close study of the internal components of the lesions.
Topics: Adolescent; Adult; Aged, 80 and over; Female; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Pelvic Neoplasms
PubMed: 26404000
DOI: 10.1016/j.diii.2015.07.009 -
The Journal of International Medical... Jun 2020Primitive neuroectodermal tumours (PNETs) are rare malignant small round cell tumours. Notably, despite widespread reports of PNET in multiple parts of the body, it is... (Review)
Review
Primitive neuroectodermal tumours (PNETs) are rare malignant small round cell tumours. Notably, despite widespread reports of PNET in multiple parts of the body, it is extremely rare in the pelvis. Here, a rare case of giant PNET of the pelvis, that was treated with surgical intervention comprising hemipelvectomy and amputation, is reported. A 42-year-old female patient presented with an enlarged mass on the left hip and severe pain in the left lower extremity for the previous 6 months. Preoperative imaging examinations indicated an irregular soft tissue-like signal shadow sized 19 × 15 × 12 cm at the left ilium and sacrum. After surgical intervention involving left hemipelvectomy and amputation, the tumour was diagnosed by pathology as PNET. During the courses of postoperative radiotherapy and chemotherapy, local recurrence and distant metastasis occurred, and the patient died 9 months following surgical treatment. To the best of the authors' knowledge, the current case is the largest pelvic PNET resection reported to date. Pelvic PNET is extremely malignant and has a high mortality rate regardless of surgical treatment, however, surgical resection of the lesion may relieve the symptoms, extend life, and improve quality of life to a certain extent.
Topics: Adult; Biopsy; Female; Humans; Neoplasm Recurrence, Local; Neuroectodermal Tumors, Primitive; Pelvic Neoplasms; Pelvis; Quality of Life
PubMed: 32500784
DOI: 10.1177/0300060520906747 -
Clinical Case Reports Nov 2019Splenosis is a medical condition that seldom occurs after splenic tissue spillage via trauma or surgery. Ectopic spleen tissues can be found almost anywhere within the...
Splenosis is a medical condition that seldom occurs after splenic tissue spillage via trauma or surgery. Ectopic spleen tissues can be found almost anywhere within the body. Albeit benign, it is often misdiagnosed as a tumor. Surgery is not indicated unless symptomatic. The imaging of choice for pelvic splenosis, although conventional, is a sulfur colloid nuclear scintigraphy.
PubMed: 31788290
DOI: 10.1002/ccr3.2419 -
American Journal of Obstetrics and... Nov 2019An increase in size of the aperture of the pelvis that must be spanned by pelvic floor support structures translates to an increase in the force on these structures....
BACKGROUND
An increase in size of the aperture of the pelvis that must be spanned by pelvic floor support structures translates to an increase in the force on these structures. Prior studies have measured the bony dimensions of the pelvis, but the effect of changes in muscle bulk that may affect the size of this area are unknown.
OBJECTIVES
To develop a technique to evaluate the aperture size in the anterior pelvis at the level of the levator ani muscle attachments, and to identify age-related changes in women with and without prolapse.
MATERIALS AND METHODS
This was a technique development and pilot case-control study evaluating pelvic magnetic resonance imaging from 30 primiparous women from the Michigan Pelvic Floor Research Group MRI Data Base: 10 younger women with normal support, 10 older women with prolapse, and 10 older menopausal women without prolapse. Anterior pelvic area measurements were made in a plane that included the bilateral ischial spines and the inferior pubic point, approximating the level of the arcus tendineus fascia pelvis. Measurements of the anterior pelvic area, obturator internus muscles, and interspinous diameter were made by 5 independent raters from the Society of Gynecologic Surgeons Pelvic Anatomy Group who focused on developing pelvic imaging techniques, and evaluating interrater reliability. Demographic characteristics were compared across groups of interest using the Wilcoxon rank sum test, χ, or Fisher exact test where appropriate. Multiple linear regression models were created to identify independent predictors of anterior pelvic area.
RESULTS
Per the study design, groups differed in age and prolapse stage. There were no differences in race, height, body mass index, gravidity, or parity. Patients with prolapse had a significantly longer interspinous diameter, and more major (>50% of the muscle) levator ani defects when compared to both older and younger women without prolapse. Interrater reliability was high for all measurements (intraclass correlation coefficient = 0.96). The anterior pelvic area (cm) was significantly larger in older women with prolapse compared to older (60 ± 5.1 vs 53 ± 4.9, P = .004) and younger (60 ± 5.1 vs 52 ± 4.6, P = .001) women with normal support. The younger and older women with normal support did not differ in anterior pelvic area (52 ± 4.6 vs 53 ± 4.9, P = .99). After adjusting for race and body mass index, increased anterior pelvic area was significantly associated with the following: being an older woman with prolapse (β = 6.61 cm, P = .004), and interspinous diameter (β = 4.52 cm, P = .004).
CONCLUSION
Older women with prolapse had the largest anterior area, suggesting that the anterior pelvic area is a novel measure to consider when evaluating women with prolapse. Interspinous diameter, and being an older woman with prolapse, were associated with a larger anterior pelvic area. This suggests that reduced obturator internus muscle size with age may not be the primary factor in determining anterior pelvic area, but that pelvic dimensions such as interspinous diameter could play a role. The measurements were highly repeatable. The high intraclass correlation coefficient indicates that all raters were able to successfully learn the imaging software and to perform measurements with high reproducibility.
Topics: Adolescent; Adult; Aging; Case-Control Studies; Female; Humans; Imaging, Three-Dimensional; Magnetic Resonance Imaging; Middle Aged; Pelvic Floor; Pelvic Organ Prolapse; Pilot Projects; Young Adult
PubMed: 31401263
DOI: 10.1016/j.ajog.2019.08.001 -
Medicine May 2016The present study explored the benefit of preoperative chemoradiotherapy (PCRT) for sphincter preservation in locally advanced low-lying rectal cancer patients who... (Observational Study)
Observational Study
The present study explored the benefit of preoperative chemoradiotherapy (PCRT) for sphincter preservation in locally advanced low-lying rectal cancer patients who underwent stapled anastomosis, especially in those with deep and narrow pelvises determined by magnetic resonance imaging.Patients with locally advanced low-lying rectal cancer (≤5 cm from the anal verge) who underwent stapled anastomosis were included. Patients were categorized into two groups (PCRT+ vs. PCRT-) according to PCRT application. Patients in the PCRT+ group were matched to those in the PCRT- group according to potential confounding factors (age, gender, clinical stage, and body mass index) for sphincter preservation. Sphincter preservation, permanent stoma, and anastomosis-related complications were compared between the groups. Pelvic magnetic resonance imaging was used to measure 12 dimensions representing pelvic cavity depth and width with which deep and narrow pelvis was defined. The impact of PCRT on sphincter preservation and permanent stoma in pelvic dimensions defined as deep and narrow pelvis was evaluated, and factors associated with sphincter preservation and permanent stoma were analyzed.One hundred sixty-six patients were one-to-one matched between the PCRT+ and PCRT- groups. Overall, sphincter-saving surgery was performed in 66.3% and the rates were not different between the 2 groups. Anastomotic complications and permanent stoma occurred nonsignificantly more frequently in the PCRT+ group. PCRT was not associated with higher rate of sphincter preservation in all pelvic dimensions defined as deep and narrow pelvis, while PCRT was related to higher rate of permanent stoma in shorter transverse diameter and interspinous distance. On logistic regression analysis, PCRT was not shown to influence both sphincter preservation and permanent stoma, while longer transverse diameter and interspinous distance were associated with lower rate of permanent stoma.PCRT had no beneficial effect on sphincter preservation in patients with locally advanced low-lying rectal cancer who had undergone stapled anastomosis. In patients with deep and narrow pelvis, PCRT had no impact on sphincter preservation but was associated with higher rate of permanent stoma.
Topics: Anal Canal; Anastomosis, Surgical; Chemoradiotherapy; Female; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Neoadjuvant Therapy; Neoplasm Staging; Organ Sparing Treatments; Outcome and Process Assessment, Health Care; Pelvis; Preoperative Period; Rectal Neoplasms; Republic of Korea
PubMed: 27149445
DOI: 10.1097/MD.0000000000003463 -
BMC Musculoskeletal Disorders Sep 2020Empirical evidence that demonstrates the relationship between pelvic asymmetry and non-specific chronic low back pain (NCLBP) is currently lacking.
BACKGROUND
Empirical evidence that demonstrates the relationship between pelvic asymmetry and non-specific chronic low back pain (NCLBP) is currently lacking.
OBJECTIVE
To establish the reliability of the Global Postural System (GPS) in assessing pelvic asymmetry and identify the association between pelvic asymmetry parameters and the occurrence of NCLBP in young adults.
DESIGN
A cross-sectional, regression study.
METHODS
People who were aged between 18 and 30 and were diagnosed with NCLBP were recruited. Healthy individuals who were matched for age, sex, and education level were recruited as controls. Global Postural System (GPS) was employed to assess pelvic asymmetry. Prior to exploring the association, the reliability of GPS was assessed by the ICC (2, k) for interrater reliability, ICC (3, k) for intra-rater reliability, standard error and minimal detectable difference. Bivariate correlation analysis and logistic regression analysis were used to determine the relationship between pelvic asymmetry and the occurrence of NCLBP.
RESULTS
Twenty-eight healthy participants and 28 people with NCLBP were recruited. Moderate to excellent ICCs were observed for the inter-rater and intra-rater reliability of most postural parameters. The bivariate correlation analysis indicated that age, body mass index and pelvic asymmetry parameters were related to the occurrence of NCLBP. Pelvic angle asymmetry (odds ratio = 1.17), and asymmetry of the distance between the posterior superior iliac spine and the floor (odds ratio = 1.21) were associated with NCLBP.
LIMITATIONS
This study did not explore the causal relationship between pelvic asymmetry in the sagittal plane/pelvic asymmetry in the transverse plane and the occurrence of NCLBP. The interpretation of the results may not be generalized beyond the sample population.
CONCLUSIONS
The GPS is a reliable method to assess pelvic asymmetry in a clinical setting. Two pelvic parameters were associated with the presence of NLBP. Measurement of pelvic asymmetry may assist in the early identification of potential occurrence of NCLBP but further work is required.
Topics: Adolescent; Adult; Cross-Sectional Studies; Humans; Low Back Pain; Pelvis; Reproducibility of Results; Young Adult
PubMed: 32891129
DOI: 10.1186/s12891-020-03617-3 -
Journal of Ovarian Research Mar 2019To analyze the clinicopathological characteristics of subsequent pelvic masses after hysterectomy for benign diseases, and to compare the masses following hysterectomy... (Comparative Study)
Comparative Study
OBJECTIVES
To analyze the clinicopathological characteristics of subsequent pelvic masses after hysterectomy for benign diseases, and to compare the masses following hysterectomy with or without simultaneous bilateral salpingectomy.
METHODS
This study retrospectively analyzed patients undergone reoperation for pelvic mass subsequently to previous hysterectomy for benign disease from January 2012 to December 2016 in Peking Union Medical College Hospital.
RESULTS
A total of 247 patients were enrolled in this study, of which 80.16% (n = 198) received simple hysterectomy, and 5.67% (n = 14) underwent hysterectomy with bilateral salpingectomy. The clinicopathological data of patients undergone simple hysterectomy or simultaneous bilateral salpingectomy was compared. In the former group, we found that 68.18% (n = 135) of the pelvic massed were benign, and the remaining 31.82% (n = 63) were malignant. In latter group, 57.10% (n = 8) were benign (8%) and 42.90% (n = 6) were malignant. Univariate analysis showed that the age of surgery for pelvic masses in patients undergoing hysterectomy with simultaneous bilateral salpingectomy was significantly younger than that in patients without salpingectomy (median, 44.5 vs 50 years, P < 0.0001), and the time interval between hysterectomy and onset of pelvic masses was also significantly shorter (median, 2 vs 5 years, P < 0.0001). And the probability of pelvic encapsulated effusion was significantly higher for the salpingectomy group. Multivariate analysis showed that there was no significant difference of the age of resection of pelvic mass, the time interval hysterectomy and pelvic mass onset, and the probability of pelvic encapsulated effusion between the two groups.
CONCLUSIONS
The results showed that the incidence of secondary benign pelvic masses may be reduced when hysterectomy was performed with simultaneous bilateral salpingectomy. However, there was no statistical difference in the clinical characteristics and pathological types of pelvic masses between patients received hysterectomy with or without salpingectomy.
Topics: Abdominal Neoplasms; Adult; Analysis of Variance; Female; Humans; Hysterectomy; Middle Aged; Pelvis; ROC Curve; Reoperation; Retrospective Studies; Salpingectomy
PubMed: 30917839
DOI: 10.1186/s13048-019-0504-6