Independent volumetric internal fixation reduces posterior column acetabular fracture site motion as compared to plate/screw construct: A biomechanical analysis.

Aims & objectives: To establish whether a suprapectineal pelvic reconstruction plate and posterior column screw (P&S) construct or a single 6.5-mm cannulated posterior column screw (PCS) construct demonstrates greater mechanical stability for fixation of acetabulum fractures involving the posterior column (PC). We hypothesized that the PCS construct would result in less fracture site motion. Materials & methods: Twelve fourth-generation composite hemipelvi were utilized, 6 for each construct. The P&S construct consisted of a suprapectineal pelvic reconstruction plate with two 3.5-mm posterior column screws crossing the fracture site in lag-by-technique fashion and two screws anchoring the plate to the sciatic buttress. The PCS construct consisted of a single 6.5-mm partially threaded cannulated screw placed in an antegrade fashion. Both fixation models were cyclically loaded at 0.5 cycles/second at 400N and 800N, first in a sit-to-stand position that is expected during recovery, and subsequently in a squat-to-stand position to test overload conditions. Results: Under sit-to-stand loading, the PCS construct resulted in less motion at the fracture site than the P&S construct (0.06 ± 0.02 mm vs 0.1 ± 0.02 mm at 400N, p = 0.02; 0.13 ± 0.03 mm vs 0.19 ± 0.04 mm at 800N, p = 0.03). The PCS construct also demonstrated less fracture site motion under squat-to-stand loading (0.22 ± 0.13 mm vs 1.9 ± 0.5 mm at 400N, p = < 0.001; 1.48 ± 0.44 mm vs 4.77 ± 0.3 mm at 800N, p = < 0.001). At 800 N, half of the repairs failed during squat-to-stand loading (2 PCS, 4 P&S). Conclusion: Fixation of the posterior column of the acetabulum with a 6.5-mm cannulated screw demonstrated comparable fracture motion upon loading compared to the plate and screw construct.

A pictographic guide for decision making in surgery for pelvic bone sarcoma.

Pelvic bone sarcoma surgery is challenging due to complex anatomy, proximity to major neurovascular structures, and, more importantly, the potential for complications. Decision-making is vital in offering patients the best oncological and functional outcomes after surgery. Multidisciplinary teams involved from the stage of diagnosis and treatment planning, followed by surgery by experienced teams have proven to be beneficial. Tumour-free margin clearance is essential, and surgical planning must be tailored to achieve the same. The choice of reconstruction needs to be decided based on the amount of bone resected and the available expertise and resources. Lesions isolated only to PI or PIII region may not need reconstruction. Though pedestal cups and Custom-made prosthesis are useful in reconstruction after periacetabular tumour resections, hip transposition surgery is also widely practiced by surgeons with favourable outcomes particularly after neo-adjuvant radiotherapy/proton beam therapy. Navigation has shown promise in achieving tumour-negative margins and disease-free progression particularly in chondrosarcoma. A flap-based approach can be considered for hindquarter amputations; however, patients need to be counseled regarding the complications following this surgery. This article, with proposed flowcharts, is aimed at providing practicing surgeons with a guide toward decision-making while planning pelvic bone sarcoma surgery.

Efeito do tônus do corpo perineal nas disfunçõessexuais em mulheres jovens nulíparas / Effect of perineal body tone on sexual dysfunctionsin young nulliparous women

Objetivo: avaliar o tônus do corpo perineal em mulheres jovens nulíparas e correlacionar com as funções sexuais e a presença de disfunção sexual. Método: foi realizado um estudo descritivo, observacional, transversal utilizando uma amostra de conveniência incluindo mulheres adultas jovens nulíparas. A avaliação das participantes consistiu na aplicação dos questionários socioclínico, Pelvic Organ Prolaps / Urinary Incontinence Sexual Questionnaire (PISQ-12), Female Sexual Function Index (FSFI) e exame físico do tônus do corpo perineal. Os dados foram analisados pelo programa Statistical Package for the Social Sciences (SPSS®), versão 23, adotando um nível de significância de 5%. Resultados: participaram 77 mulheres jovens nulíparas (21,68 ± 2,94 anos), destas 77, 92% apresentavam vida sexual ativa e 66,03% tônus normal do corpo perineal. Dentre as alterações tônicas, o aumento do tônus predominou (33,76%). Houve alta prevalência de disfunção sexual (87,01%) pelo FSFI (23,38 ± 7,21) com maior queixa de dispareunia. Mulheres com tônus aumentado apresentaram maior disfunção sexual em relação a desejo e estímulo subjetivo (p=0,04), à excitação (p=0,01), satisfação (p=0,04) e dor ou a desconforto (p=0,03). Houve correlação inversa entre a presença de aumento do tônus e os domínios FSFI desejo e estímulo subjetivo (R= - 0,56) e excitação (R= - 0,34) e correlação direta para dor ou desconforto (R= 0,30). Conclusão: o aumento do tônus do corpo perineal piora a função sexual de mulheres jovens nulíparas.

Sexual Function Index (FSFI) and physical examination of the tone of the perineal body. The data were analyzed using the Statistical Package for the Social Sciences (SPSS®), version 23, adopting a significance level of 5%. Results: 77 young nulliparous women (21.68 ± 2.94 years) participated, of which 77, 92% had an active sexual life and 66.03% had normal tone of the perineal body. Among the tonic changes, increased tone predominated (33.76%). There was a high prevalence of sexual dysfunction (87.01%) according to the FSFI (23.38 ± 7.21) with greater complaints of dyspareunia. Women with increased tone had greater sexual dysfunction in relation to desire and subjective stimulation (p=0.04), excitement (p=0.01), satisfaction (p=0.04) and pain or discomfort (p=0.03). There was an inverse correlation between the presence of increased tone and the FSFI domains desire and subjective stimulus (R= - 0.56) and excitement (R= - 0.34) and a direct correlation for pain or discomfort (R= 0.30). Conclusion: increased perineal body tone worsens sexual function in young nulliparous women.

Comparison of the MIPPO technique and the modified Stoppa approach in the treatment of unstable anterior pelvic ring injuries: a retrospective cohort study.

BACKGROUND: Anterior pelvic ring injuries have gradually become common. Using a minimally invasive technique to treat this injury may be feasible if the reduction and stability can be effectively achieved. We describe a percutaneous technique, minimally invasive percutaneous plate osteosynthesis (MIPPO), to fixate the anterior pelvis via establishing a subperiosteal tunnel between two limited incisions over the iliac crest(s) and pubic ramus in this research. METHODS: A retrospective cohort study comparing the MIPPO technique (n = 60) versus the modified Stoppa approach (n = 53) for anterior pelvic ring injuries with posterior ring instability was performed from September 2016 to January 2023. The relative surgery variables, follow-up function evaluation, and complications were compared in two groups. The reduction quality of fracture was assessed according to the Matta criterion, and the functional score was evaluated using the Majeed score. RESULTS: All patients completed follow-up, with an average interval of 39.90 ± 17.53 months (range 12-78). In the MIPPO technique group, the surgery interval and blood losses were lower compared to the modified Stoppa approach group (P<0.05). The mean procedure times and intraoperative blood losses were 69.56 ± 14.04 min/side (range 50-110) and 156.23 ± 49.75 mL/side (range 90-250) for unilateral anterior ring MIPPO fixation separately. All patients got a satisfactory reduction of the fracture. In the follow-up, earlier ambulation, shorter postoperative hospital stays, and lower complication rates were observed for patients using the MIPPO technique compared to the modified Stoppa approach (P<0.05). However, there is no statistical difference in these indicators including fracture union interval, full load time, the Majeed score, patient satisfaction level, and return to pre-injured work rate between the two groups. CONCLUSION: This clinical experience gives support for the use of the MIPPO technique to stabilize the anterior pelvis. This minimally invasive technique was an effective and safe surgery method and could obtain satisfactory function results, particularly fitting to part of patients with resistance using the modified Stoppa approach.

Pelvic osteotomy for pelvic canal stenosis after malunion pelvic fractures in cats.

OBJECTIVES: The aim of this study was to assess the efficacy of pelvic osteotomy and ventral fixation of the ischium using cortical screws and polymethylmethacrylate (PMMA) for feline pelvic canal stenosis (PCS) associated with malunion after conservative management of pelvic fractures. METHODS: Surgical pelvic enlargement was performed for PCS in six cats. The medical records, including information on the patients, surgical procedures, defecation and complications, were reviewed. The sacral index (SI) and colonic:lumbar:vertebral ratio (CLVR) were evaluated based on pre- and postoperative radiographs. RESULTS: This study included five castrated male cats and one spayed female cat. Postoperative improvements in constipation and defecatory difficulty were noted in all cases. The postoperative SI was significantly higher (mean 0.93, range 0.72-1.13) than the preoperative SI (mean 0.59, range 0.45-0.74) (P <0.001). However, no statistically significant change was found in the CLVR preoperatively and up to 3 months postoperatively. A successful union of the ilium was observed, without implant failures. One case developed necrosis of the pubic surgical wound. CONCLUSIONS AND RELEVANCE: This study indicated the potential benefits of pelvic osteotomy and ventral fixation of the pelvic floor using screws and PMMA for achieving pelvic cavity enlargement in treating feline PCS associated with defecatory problems.

Do low-density screws influence pelvic incidence in adolescent idiopathic scoliosis correction?

Background: Low-density screw constructs yield significant radiographic and clinical improvements with reduced risk of neurological complications. This study aimed to investigate the relationship between coronal Cobb angle and pelvic incidence (PI) in the correction of adolescent idiopathic scoliosis (AIS) using a low-density construct, as well as the association between PI and functional outcomes. Patients and Methods: This prospective cohort study involved 60 posteriorly instrumented AIS patients, aged 10-16 years, with Cobb angles ranging from 45° to 90° of various Lenke types. Radiological assessments were conducted pre- and postsurgery at 1, 3, 6, 12, and 24 months. Functional evaluation utilized the Scoliosis Research Society score form (SRS-30). Results: A positive correlation was observed between screw density and operation time, blood loss, and degree of correction with SRS change (P = 0.004). No correlation was found between screw density and hospital stay, loss of correction, correction rate, SRS change, change in PI, or Cobb angle. Conclusions: Correction of AIS through a posterior approach using a low-density construct can lead to satisfactory curve correction, impacting spinopelvic parameters. However, PI alone does not directly influence patient functional outcomes assessed by SRS-30. Low-density implant constructs reduce operative time, blood loss, costs, and complication risks.

Radiation Proctitis: A Review of Pathophysiology and Treatment Strategies.

Radiotherapy (RT) has become an integral part of cancer treatment worldwide; it aims to arrest the uncontrolled growth of tumor cells by using high-energy rays. Radiation proctitis is a known clinical manifestation after the RT regime for pelvic malignancies. Radiation proctitis can have a variable presentation, and there are a lot of patient-related factors that can affect the eventual outcome. In most instances, it is self-limiting; however, it can become chronic in some cases and can affect the quality of life. Many treatment options are recommended, but there has been no consensus on the treatment protocols for managing this known clinical condition. We have tried to briefly describe its pathogenesis, important factors affecting the outcome, and available treatment strategies.

Hamstring and lower back muscles flexibility as predictor of saddle pressures in young off-road cyclists.

Introduction: While pedaling, cyclists rest their pelvis on the saddle, generating pressures on it. The pressures generated on the saddle are influenced by several factors. This study aimed to evaluate whether the flexibility of hamstring and lower back muscles could be considered a predictor of pressures in the anterior region (PAR) on the saddle. Methods: For this study, 15 young off-road Italian cyclists (11m, 4f) aged 13-16 (Italian Federation categories: ES1, ES2, AL1, AL2) were recruited. Each participant was administered the V sit-and-reach (VSR) to measure the hamstring and lower back muscles flexibility. Subsequently, after performing a bike fitting, the saddle pressures during pedaling at three different intensities (100, 140, 180 W), with participants on their own bike installed on specific bike roller, were recorded. The parameters considered for statistical analysis were front pressure (%) and back pressure (%). Results: The hamstring and lower back muscles flexibility, as result of the VSR test, was a predictor of saddle PAR at 100 W (R2 = 0.362, p = 0.018), at 140 W (R2 = 0.291, p = 0.038), and at 180 W (R2 = 0.349, p = 0.020) of pedaling intensity. Conclusion: Higher values of the VSR could predict lower values of the pressures exerted in the front region of the saddle. The hamstring and lower back muscles flexibility may be considered a predictor of PAR on the saddle.

Immunotherapy in the treatment of rectal invasion by prostate cancer with focal neuroendocrine differentiation: a case report and literature review.

Background: Incidences of rectal infiltration by prostate cancer (PCa) are reported to affect up to 12% of patients studied. PCa invading the rectum is prone to cause difficulty in defecation, bloody stool and pain, leading to a decline in patients' quality of life. Unfortunately, the prognosis for these patients is poor and the survival period is short. Total pelvic exenteration (TPE) has been demonstrated to mitigate pain and improve symptoms such as defecation difficulty, dysuria, and hematuria. However, most patients still harbor residual tumor and fail to exhibit any improvement in long-term survival. Case Description: Here, we present a case of PCa invading the rectum with focal neuroendocrine differentiation, characterized by clinical presentations of defecation difficulties and rectal bleeding. A TPE procedure was performed, with a whole exome sequencing (WES) assay indicating that the patient exhibited a high tumor mutation burden (TMB) and high microsatellite instability (MSI-H). Subsequently, the patient received androgen deprivation therapy (ADT) combined with adjuvant immunotherapy following the procedure. At the subsequent six-year follow-up, no local or systemic recurrence was observed, and the prostate-specific antigen (PSA) level remained undetectable. Conclusions: This disease entity remains relatively rare in the literature. Accurate differential diagnosis is important. TPE combined with immunotherapy may improve the prognosis. It is of utmost importance to achieve an accurate differential diagnosis, which necessitates the collaboration of multiple disciplines and the performance of requisite tests, including immunohistochemistry and genetic testing.

Protective effect of astaxanthin on chronic prostatitis/chronic pelvic pain syndrome in rat through modulating NF-κB signaling pathway.

Background: Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a common male urological disease characterized by chronic pelvic pain and various discomforts. Astaxanthin (AST) has multiple functions, including anti-inflammatory property, but it is unclear whether AST plays a key role in CP/CPPS and how it works. This study aimed to investigate the protective effect of AST on CP/CPPS in rats and the underlying mechanism. Methods: A CP/CPPS rat model was induced by intraprostatic injection of carrageenan and the blood specimens and prostates were harvested for further research after oral administration of AST for 4 weeks. Results: Tactile allodynia test showed that AST ameliorated chronic pelvic pain in a dose-depended manner. In addition, histological evaluation indicated that AST alleviated CP/CPPS rat prostate histological inflammation. Meanwhile, AST suppressed the expression of proinflammatory cytokines, including interleukin-1ß (IL-1ß), IL-6, IL-8, and tumor necrosis factor-α (TNF-α). Besides, AST inhibited the activities of prostaglandin E2 (PGE2) and cyclooxygenase 2 (COX2). Furthermore, AST decreased the activation of the nuclear factor-κB (NF-κB) signaling pathway. Conclusions: Our study has shown that AST exerts an anti-inflammatory and protective effect against CP/CPPS and the function is mediated at least through the suppression of NF-κB signaling pathway. These results provide evidence of AST as the potential agents for the treatment of CP/CPPS.

A Single Pelvic Fibrous Tumor Associated With Doege-Potter Syndrome: A Case Study.

Doege-Potter syndrome (DPS) is a very rare paraneoplastic condition that is marked by hypoglycemia brought on by a solitary fibrous tumor rather than an islet cell tumor. Soft tissue neoplasms termed as solitary fibrous tumors (SFTs) are rare and these tumors vary in the site of origin, from the pleural cavity, mediastinum, pericardium, retroperitoneal spaces, liver, thyroid, orbit, bladder, intestines, and soft tissues, while pelvic-derived fibrous tumors are incredibly unusual. There are currently extremely few documented cases and literature reviews both domestically and internationally. In this case study, we present an 82-year-old woman who developed DPS as a result of malignant pelvic SFTs. Her hypoglycemia was clinically healed after she underwent laparoscopic retroperitoneal tumor resection in our institution, and thereafter, her quality of life improved.

Uterine procidentia in a virgin woman: A rare case.

Uterine prolapse in virgin females is extremely rare. In this case study, we present a 65-year-old virgin female patient who experienced voiding difficulties and uterine prolapse. She did not have any preexisting medical conditions, and all laboratory tests came back normal. We will discuss the surgical procedure performed, the patient's follow-up course and provide a brief review of the existing literature.

Effectiveness of gluteal control training in chronic low back pain patients with functional leg length inequality.

Chronic low back pain (LBP) is a common musculoskeletal disorder and is often accompanied by functional leg length inequality (FLLI). However, little was known about the effects of gluteal muscle control training in patients with LBP and FLLI. This study was designed to investigate the effects of gluteal control training in patients with LBP and FLLI. This is a double-blinded, randomized controlled study design. Forty-eight LBP patients with FLLI were randomized to the gluteal control training (GT) (47.58 ± 9.42 years) or the regular training (RT) (47.38 ± 11.31 years) group and received allocated training for six weeks. The outcome measures were pelvic inclination (PI), ilium anterior tilt difference (IATD), FLLI, visual analogue scale (VAS), patient specific-functional scale (PSFS), Oswestry disability index (ODI), hip control ability, global rating of change scale (GRoC), and lower extremity strength and flexibility. The intervention effects were compared using two-way repeated measures analysis of variance and chi-square tests with α = 0.05. The results indicated that the GT group showed greater improvement (P < 0.01) in PI (1.03 ± 0.38∘ vs. 1.57 ± 0.51∘), IATD (0.68 ± 0.66∘ vs. 2.31 ± 0.66∘), FLLI (0.3 ± 0.22 vs. 0.59 ± 0.13 cm), VAS (1.41 ± 1.32 vs. 3.38 ± 1.51), hip control ability (2.20 ± 0.45 vs. 0.89 ± 0.74), GRoC at 3rd and 6th week as compared to the RT group. Hip strength and flexibility also improved more in the GT group (P < 0.05). In conclusion, gluteal control training was more effective in improving low back pain and dysfunctions, and should be integrated in the management plan in patients with LBP and FLLI.

Progress of fluorescence imaging in lymph node dissection surgery for prostate and bladder cancer.

Fluorescence imaging is a relatively new imaging method used to visualize different tissue structures to help guide intraoperative operations, which has potential advantages with high sensitivity and contrast compared to conventional imaging. In this work, we review fluorescent contrast agents and devices used for lymphatic system imaging. Indocyanine green is the most widely utilized due to its high sensitivity, specificity, low background fluorescence, and safety profile. In prostate and bladder cancer lymph node dissection, the complex lymphatic drainage can result in missed metastatic nodes and extensive dissection increases the risk of complications like lymphocele, presenting a significant challenge for urologists. Fluorescence-guided sentinel lymph node dissection facilitates precise tumor staging. The combination of fluorescence and radiographic imaging improves the accuracy of lymph node staging. Multimodal imaging presents new potential for precisely identifying metastatic pelvic lymph nodes.

Factors associated with pelvic organ prolapse: case-control study in two hospitals of Bon-Berger and Saint Georges of the city of Kananga in the Democratic Republic of the Congo.

Introduction: pelvic organ prolapse is a disease or disorder of the pelvic floor that can both worsen or regress, especially in the postpartum period. It carries a high risk of recurrence after surgical treatment. The objective of this study is to identify the factors associated with pelvic organ prolapse in the two hospitals of Bon-Berger and Saint-Georges in the town of Kananga in the Democratic Republic of Congo. Methods: this is a case-control study that is carried out on the medical records of 134 patients admitted to the gynecology departments of the Bon-Berger Hospitals of Tshikaji and Saint Georges of Katoka, from January 1st to July 31st, 2023 and based on non-probability convenience sampling for case selection. The ANOVA test, Chi-test and logistic regression with adjustment are used in the statistical analyses. Results: the factors associated with the occurrence of pelvic organs prolapse are heavy physical work (aOR: 4.031, 95% CI: 2.760-9.212; p: 0.004), malnutrition in the form of BMI less than 18.5 (aOR: 2.550, 95% CI: 1.360-5.840; p: 0.023), multiparity (aOR: 1.520, 95% CI: 1.234-4.320; p: 0.015), vaginal delivery (aOR: 3.020, 95% CI: 0.063-14.470; 0.002), fetal macrosomia (aOR: 4.290, 95% CI: 3.320-5.550; p: 0.032), pelvic tears (aOR: 2.910, 95% CI: 2.090-5.930, p: 0.006) and menopause (aOR: 3.110, 95% CI: 1.040-9.250, p: 0.001). Conclusion: these results can serve as a basis for screening women at high risk of suffering from pelvic organ prolapse during gynecological and obstetrical consultations and for in-depth studies seeking the matrix metalloproteinases associated with pelvic organ prolapse to improve its treatment in hospitals of our town of Kananga.

Comprehensive treatment of primary pelvic synovial sarcoma: A 28-month follow-up case report and review of the literature.

Background: Primary synovial sarcoma originating in the pelvis is an extremely rare malignancy, and only a few cases have been reported. Usually, the tumor is detected at an advanced stage, making treatment more difficult. Lacking high-quality research, there are no consensus guidelines for the systemic treatment of the disease. Case presentation: We admitted a 32-year-old male patient with an MRI suggestive of an 8.2 × 7.7 x 8.9 cm mass in the pelvis with bleeding. After a comprehensive evaluation, the patient underwent surgery, and postoperative pathology suggested biphasic synovial sarcoma. Once the diagnosis was clear, the patient was treated with chemotherapy, radiotherapy, and targeted therapy. Unfortunately, the patient died due to a recurrence of pelvic synovial sarcoma with multiple metastases throughout the body, with a survival period of 28 months. Conclusion: Synovial sarcoma, a highly malignant soft tissue tumor, and primary intrapelvic synovial sarcoma are even rarer, with a poor prognosis. Ultrasound, Computed Tomography, and MRI can help doctors detect the tumor at an early stage and treat it aggressively, especially with surgical treatment, which can effectively improve the survival rate. Combined with the course of diagnosis and treatment of this case, it is possible to deepen the understanding of primary pelvic synovial sarcoma and discuss appropriate treatment strategies for this rare disease.

An uncommon case of anorectal malignant melanoma (ARMM): Clinical presentation and surgical outcome.

INTRODUCTION AND IMPORTANCE: Anorectal mucosal melanoma (ARMM) is a rare disease with a poor prognosis. However, surgery is often difficult, due to the lentiginous growth pattern of such melanoma. CASE PRESENTATION: A 61 years old lady presented with anal pain for 1 year, associated with painless fresh per rectal bleeding post defecation and altered bowel habit. Physical examination showed hyperpigmentation at the anal verge, extending to the dentate line. CT, MRI and PET imaging showed localised disease. She underwent pelvic exanteration and radical lymph node dissection with gracilis flap coverage. Post operatively, she recovers well, and was discharged well on day 8. HPE came back as malignant melanoma, with 1 out 12 lymph nodes involved. She was subsequently referred to oncology, started on pembrolizumab immunotherapy. CLINICAL DISCUSSION: Anorectal melanoma is an aggressive disease, often present with delayed diagnosis. Multiple imaging has been proposed, however none is standardized to diagnose ARMM. Immunohistochemical stains such as S-100 protein, MelanA and tyrosinase and with HMB-45 help in diagnosis and are sensitive for melanocytic differentiation. Surgery excision remains the most common and superior initial treatment for ARMM. One retrospective study done to compare different treatment modalities has shown that patients with surgical excision and radiation therapy had the highest median survival at 32.3 months but surgical excision remains the single best modality for ARMM. CONCLUSION: Suspicious hyperpigmentation at the anal region should raise clinical awareness. Surgical excision with optimal margin is indicated to achieve favourable symptom control, reduce local recurrence and improve survival rate.

Predictive value of transabdominal pelvic ultrasonography for the diagnosis of central precocious puberty: A single-center observational retrospective study.

This single-center, observational, retrospective study aimed to evaluate the diagnostic accuracy of pelvic ultrasonographic parameters for detecting central precocious puberty (CPP) in a cohort of female pediatric patients undergoing gonadotropin stimulation tests. The study population consisted of 47 female patients with a suspicion of CPP. Thirty four out of 47 patients (72.34%) were subsequently diagnosed with CPP based on the current laboratory diagnostic criteria (LH peak > 5 IU/L). The ultrasonography results of 39 out of 47 patients (82.97%) were categorized as pubertal, while 31 out of 34 participants (91.17%) in the CPP group exhibited pubertal ultrasonography features. In 13 out of 47 girls (27.65%), a CPP diagnosis was ruled out; however, among these 13 patients, eight exhibited pubertal ultrasonography features suspicious of CPP. We observed a robust concordance between the GnRH test results indicative of pubertal activation and the presence of pubertal pelvic ultrasonographic features in 31 out of 34 children (91.17%). A significant correlation was found between ovarian volume and basal LH and LH/ FSH ratio, and also for basal LH, LH peak, LH/FSH ratio and peak LH/FSH ratio (p = 0.026, p = 0.011, p = 0.031, p = 0.004, respectively). Pelvic ultrasonography had a sensitivity of 91.17% and a specificity of 38.46% in differentiating CPP from premature thelarche.

A dynamic approach for MR T2-weighted pelvic imaging.

OBJECTIVE: T2-weighted 2D fast spin echo sequence serves as the standard sequence in clinical pelvic MR imaging protocols. However, motion artifacts and blurring caused by peristalsis present significant challenges. Patient preparation such as administering antiperistaltic agents is often required before examination to reduce artifacts, which discomfort the patients. This work introduce a novel dynamic approach for T2 weighted pelvic imaging to address peristalsis-induced motion issue without any patient preparation. Approach: A rapid dynamic data acquisition strategy with complementary sampling trajectory is designed to enable highly undersampled motion-resistant data sampling, and an unrolling method based on deep equilibrium model is leveraged to reconstruct images from the dynamic sampled k-space data. Moreover, the fix-point convergence of the equilibrium model ensures the stability of the reconstruction. The high acceleration factor in each temporal phase, which is much higher than that in traditional static imaging, has the potential to effectively freeze pelvic motion, thereby transforming the imaging problem from conventional motion prevention or removal to motion reconstruction. Main results: Experiments on both retrospective and prospective data have demonstrated the superior performance of the proposed dynamic approach in reducing motion artifacts and accurately depicting structural details compared to standard static imaging. Significance: The proposed dynamic approach effectively captures motion states through dynamic data acquisition and deep learning-based reconstruction, addressing motion-related challenges in pelvic imaging.

Patient-Reported Outcome Measures for Pelvic Organ Prolapse: A Systematic Review Using the COnsensus-Based Standards for the Selection of Health Measurement Instruments (COSMIN) Checklist.

BACKGROUND: Patient-reported outcome measures (PROMs) are recommended to measure the impact of a health condition or intervention effectiveness as they aim to capture what is most meaningful to patients. Several PROMs are used to evaluate pelvic organ prolapse (POP)-related domains, yet the measurement properties of these instruments have not been fully explored with a rigorous analysis of the methodological quality and quality of evidence. OBJECTIVE: To conduct a systematic review reporting on the measurement properties of PROMs used for the assessment of POP-related domains in accordance with the COSMIN guidelines. SEARCH STRATEGY: Five databases were searched from inception to December 2023. SELECTION CRITERIA: Studies were eligible if they involved (1) at least one group of female adults diagnosed with or presenting with symptoms of POP; (2) a self-reported outcome measure (PROMs, questionnaires) to evaluate POP-related domains; and (3) at least one measurement property. DATA COLLECTION AND ANALYSIS: Methodological quality and measurement quality were assessed using the COSMIN risk of bias (ROB) checklist and the COSMIN criteria for good measurement properties. MAIN RESULTS: A total of 13 PROMs were included. The BIPOP had the lowest ROB for Content Validity. The POP-SS was the only PROM with sufficient evidence of adequate construct validity and responsiveness to be used in both surgical and conservative management settings. CONCLUSION: This original work identified a gap in evidence regarding the measurement qualities of identified PROMs used in the POP population.