Effects of pelvic floor myofascial manipulation intervention on primiparas and neonates during the second stage of vaginal delivery.

A prolonged second stage of vaginal delivery increases the risk of shoulder dystocia, unnecessary episiotomies and cesarean sections. However, no standardized method has been proposed to tackle this issue. The effects of pelvic floor myofascial manipulation intervention during the second stage of labor in primiparas and its prognostic value in neonatal postpartum outcomes remain unknown. In the present study, a total of 60 primiparas who were expecting a vaginal delivery in the Second Affiliated Hospital of Hainan Medical College (Haikou, China) between October 2021 and January 2022 were selected. These women were randomly assigned to a control group (standard intrapartum care) or an experimental group (pelvic floor myofascial manipulation for 15-20 min during the second stage of labor along with standard intrapartum care) using a random number table, with 28 patients in each group. There was no significant difference in age, gestational time or body mass index between the two groups before delivery, indicating that the baseline data were comparable. The second stage of labor duration, forced breath-holding time and postpartum hemorrhage volume in the experimental group were significantly lower than those in the control group. The pain visual analog scale scores, fatigue scores and neonatal Apgar scores in the experimental group were also significantly lower than those in the control group. The rate of episiotomy in the experimental group was lower than that in the control group, but the difference was not statistically significant. In conclusion, pelvic floor myofascial manipulation intervention during the second stage of labor for primiparas with vaginal delivery can reduce the duration of the second stage of labor, the amount of bleeding during labor and the pain during labor. Meanwhile, it has the potential to improve neonatal outcomes.

Caffeic acid attenuates tissue damage and inflammatory response in Klebsiella pneumonia by modulating AhR-Src-STAT3-IL-10 signaling pathway.

CA is a plant derivative with antibacterial and antiviral pharmacological effects, however, the therapeutic effect of CA on Klebsiella pneumonia and its mechanism study is still unclear. A rat KP model was established in vitro, a pneumonia cell model was established in vivo, the histopathological changes in the lungs were observed by HE staining after CA treatment, the expression of relevant inflammatory factors was detected by ELISA, the changes in the expression of proteins related to the AhR-Src-STAT3-IL-10 signaling pathway were detected by Western blot and immunofluorescence in the lungs, and the interactions between the proteins were verified by COIP relationship. The results showed that CA was able to attenuate the injury and inflammatory response of lung tissues, and molecular docking showed that there were binding sites between CA and AhR, and COIP demonstrated that AhR interacted with both STAT3 and Ser. In addition, CA was able to up-regulate the expression levels of pathway-related proteins of AhR, IL-10, p-Src, and p-STAT3, and AhR knockdown was able to reduce LPS-induced inflammatory responses and up-regulate pathway-related proteins, whereas CA treatment of AhR-knockdown-treated A549 cells did not show any statistically significant difference compared with the AhR knockdown group, demonstrating that CA exerts its pharmacological effects. These findings elucidated the mechanism of CA in the treatment of KP and demonstrated that CA is a potential therapeutic agent for KP.

Pelvic floor myofascial manipulation combined with Kegel exercise and mecobalamin in the treatment of atypical diabetic neurogenic bladder: a case report.

Background: Diabetic neurogenic bladder (DNB) is one of the autonomic neuropathies of diabetes mellitus (DM), with an incidence rate reaching 40-60%. This study combined bladder function rehabilitation training and mecobalamin to treat a patient with DNB to provide reference for clinical work. Case Description: A 67-year-old woman was admitted to our hospital on 5 December 2018, with a 3-year history of dysuria that had progressively worsened for 15 days. The patient was treated with pelvic floor myofascial manipulation combined with Kegel training and mecobalamin for 6 months. Pelvic organ prolapse (POP), pelvic floor surface electromyography (EMG), psychological status, and quality of life were evaluated before, during, and after treatment, and the changes in urodynamics were observed. After comprehensive rehabilitation treatment, the patient's POP, pelvic floor muscle strength, mental state, and quality of life were significantly improved. The results of the urodynamic examination showed that the patient's safe bladder capacity reached 500 mL after treatment, in contrast to the first safe bladder capacity measurement of 90 mL. The symptoms of ureteral reflux disappeared, the detrusor compliance increased from 2 to 20 mL/cmH2O, which roughly indicated a return to healthy function. However, there was no detrusor contraction in the bladder during urination. Conclusions: This patient achieved good curative effect after the treatment of comprehensive pelvic floor rehabilitation combined with mecobalamin. However, the safe capacity of the patient reported in this case showed a small bladder safe capacity, and the patient's detrusor muscle did not contract during urination. Thus, urination in this patient may be accomplished by increasing abdominal pressure. When treating patients with atypical neurogenic bladder, the adverse effects caused by excessive abdominal pressure and abdominal wall relaxation need to be considered.