A Treatment Algorithm for High-Tone Pelvic Floor Dysfunction.

OBJECTIVE: To develop evidence- and consensus-based clinical practice guidelines for management of high-tone pelvic floor dysfunction (HTPFD). High-tone pelvic floor dysfunction is a neuromuscular disorder of the pelvic floor characterized by non-relaxing pelvic floor muscles, resulting in lower urinary tract and defecatory symptoms, sexual dysfunction, and pelvic pain. Despite affecting 80% of women with chronic pelvic pain, there are no uniformly accepted guidelines to direct the management of these patients. METHODS: A Delphi method of consensus development was used, comprising three survey rounds administered anonymously via web-based platform (Qualtrics XM) to national experts in the field of HTPFD recruited through targeted invitation between September and December 2021. Eleven experts participated with backgrounds in urology, urogynecology, minimally invasive gynecology, and pelvic floor physical therapy (PFPT) participated. Panelists were asked to rate their agreement with rated evidence-based statements regarding HTPFD treatment. Statements reaching consensus were used to generate a consensus treatment algorithm. RESULTS: A total of 31 statements were reviewed by group members at the first Delphi round with 10 statements reaching consensus. 28 statements were reposed in the second round with 17 reaching consensus. The putative algorithm met clinical consensus in the third round. There was universal agreement for PFPT as first-line treatment for HTPFD. If satisfactory symptom improvement is reached with PFPT, the patient can be discharged with a home exercise program. If no improvement after PFPT, second-line options include trigger or tender point injections, vaginal muscle relaxants, and cognitive behavioral therapy, all of which can also be used in conjunction with PFPT. Onabotulinumtoxin A injections should be used as third line with symptom assessment after 2-4 weeks. There was universal agreement that sacral neuromodulation is fourth-line intervention. The largest identified barrier to care for these patients is access to PFPT. For patients who cannot access PFPT, experts recommend at-home, guided pelvic floor relaxation, self-massage with vaginal wands, and virtual PFPT visits. CONCLUSION: A stepwise approach to the treatment of HTPFD is recommended, with patients often necessitating multiple lines of treatment either sequentially or in conjunction. However, PFPT should be offered first line.

Selenite Adsorption and Reduction via Iron(II) Impregnated Activated Carbon Produced from the Phosphoric Acid Activation of Construction Waste Wood.

Chemical activation of waste materials, to form activated carbon, (AC) is complicated by the large amounts of chemical activating agents required and wastewater produced. To address these problems, we have developed an optimized process for producing AC, by phosphoric acid activation of construction waste. Waste wood from construction sites was ground and treated with an optimized phosphoric acid digestion and activation that resulted in high surface areas (> 2000 m2/g) and a greater recovery of phosphoric acid. Subsequently the phosphoric acid activated carbon (PAC), was functionalized with iron salts and evaluated for its efficacy on the adsorption of selenite and selenate. Total phosphoric acid recovery was 96.7% for waste wood activated with 25% phosphoric acid at a 1:1 ratio, which is a substantially higher phosphoric acid recovery, than previous literature findings. Post activation impregnation of iron salts resulted in iron(II) species adsorbed to the PAC surface. The iron(II) chloride impregnated AC removed up to 11.41 ± 0.502 mg selenium per g Iron-PAC. Competitive ions such as sulfate and nitrate had little effect on selenium adsorption, however, phosphate concentration did negatively impact the selenium uptake at high phosphate levels. At 250 ppm, approximately 75% of adsorption capacity of both the selenate and the selenite solutions was lost, although selenium was still preferentially adsorbed. Peak adsorption occurred between a pH of 4 and 11, with a complete loss of adsorption at a pH of 13.