目的:脑卒中运动功能障碍患者康复工作的开展至关重要,然而目前缺少脑卒中患者在康复病房、社区以及家庭康复管理的相关证据总结。本研究旨在汇总脑卒中运动功能障碍患者康复管理的相关证据,为临床和社区医护人员开展康复干预提供参考...目的:脑卒中运动功能障碍患者康复工作的开展至关重要,然而目前缺少脑卒中患者在康复病房、社区以及家庭康复管理的相关证据总结。本研究旨在汇总脑卒中运动功能障碍患者康复管理的相关证据,为临床和社区医护人员开展康复干预提供参考依据。方法:系统检索BMJ Best Practice、UpToDate、美国国立指南库、美国心脏协会/美国卒中协会、加拿大医学会、英国国家卫生与临床优化研究所、美国退伍军人事务部/国防部、加拿大安大略注册护士协会、JBI循证卫生保健中心数据库、The Cochrane Library、PubMed、Web of Science、Embase、CINAHL、中国知网、万方数据库、维普数据库、中国生物医学文献系统中关于脑卒中运动功能障碍患者康复管理的所有文献,包括临床决策、指南、专家共识、推荐实践、系统评价、证据总结,检索时限为建库至2023年10月。由2名研究者独立对文献进行质量评价。结果:共纳入21篇文献,包括11篇指南、2篇专家共识和8篇系统评价。通过对纳入文献的证据进行提取与整合,从康复管理模式、康复机构、康复团队、康复介入时机、康复评估、康复项目、康复时间和频率、康复强度和康复支持9个领域中汇总45条证据,涵盖了脑卒中患者早期、亚急性期和慢性期全病程的三级康复管理的相关内容。结论:本研究汇总的脑卒中运动功能障碍患者康复管理的最佳证据较为全面,证据质量较高,对临床和社区医护人员开展康复干预具有重要指导意义。建议应用证据时,综合考虑脑卒中患者当前病情、运动功能受损情况、环境因素和患者的意愿,然后选择最适合的康复方案,并根据每位患者的具体需求和喜好调整训练的种类和强度。展开更多
Objective:Pelvic floor dysfunction is common among pregnant and postpartum women and significantly impacts quality of life.This study aims to translate the German Pelvic Floor Questionnaire for Pregnant and Postpartum...Objective:Pelvic floor dysfunction is common among pregnant and postpartum women and significantly impacts quality of life.This study aims to translate the German Pelvic Floor Questionnaire for Pregnant and Postpartum Women into Chinese and to evaluate its reliability and validity in the Chinese population.Methods:The questionnaire was translated using the Brislin model.A cross-sectional study was conducted among pregnant and postpartum women to assess the content validity,construct validity,Cronbach’sαcoefficient,test-retest reliability,and split-half reliability of the Chinese version.Results:A total of 72 women were included,with 6.9% being pregnant and 93.1% postpartum;the age was(32.3±3.6)years.The Chinese version of the questionnaire contains 4 dimensions and 45 items.The content validity index of individual items ranged from 0.833 to 1.000,with a scale-level content validity index of 0.977 and intraclass correlation coefficients(ICCs)exceeding 0.90.The overall Cronbach’s α coefficient was 0.891,with subscale coefficients ranging from 0.732 to 0.884(all ICCs>0.70).The testretest reliability of the total scale was 0.833,and for the 4 dimensions,bladder,bowel,prolapse,and sexual function,the values were 0.776,0.579,0.732,and 0.645,respectively.The split-half reliability was 0.74.Conclusion:The Chinese version of the questionnaire demonstrated good reliability and validity,indicating its applicability in assessing pelvic floor dysfunction and associated risk factors during pregnancy and postpartum.展开更多
目的:压力性尿失禁是一种非常常见的疾病,治疗方法多,但是缺乏远期疗效追踪。本研究旨在通过对女性轻中度压力性尿失禁患者盆底康复治疗后3年的随访结果进行回顾性研究,为该病的临床治疗提供更为有效的方案。方法:收集2017年1月至2019年...目的:压力性尿失禁是一种非常常见的疾病,治疗方法多,但是缺乏远期疗效追踪。本研究旨在通过对女性轻中度压力性尿失禁患者盆底康复治疗后3年的随访结果进行回顾性研究,为该病的临床治疗提供更为有效的方案。方法:收集2017年1月至2019年1月在中南大学湘雅三医院盆底康复中心诊断为压力性尿失禁的279例女性患者的临床资料。所有患者均接受健康宣教并嘱回家每天坚持Kegel运动20 min。根据接受治疗情况分为3组:A组(n=94),接受盆底生物反馈+电刺激+电针治疗;B组(n=99),接受盆底生物反馈+电刺激治疗;C组(n=86),只进行盆底功能检查,未接受盆底治疗。盆底功能检查包括盆底电生理检测、盆腔脏器脱垂定量检查(pelvic organ prolapse quantitive examination,POP-Q)和压力性尿失禁严重程度评估。对所有患者在治疗前、治疗结束时及治疗结束后1、2、3年进行回访(共5次),随访内容包括国际尿失禁咨询委员会尿失禁问卷简表(ICIQ-UI Short Form,ICI-Q-SF)和尿失禁生活质量问卷(Incontinence Quality of Life,I-QOL)。接受治疗的患者中有43人返院,其中A组返院21人(A_(返院)组),B组返院22人(B_(返院)组),对2组进行盆底电生理检测和POP-Q。结果:问卷调查结果表明:治疗结束时及治疗后1、2、3年患者的漏尿率均是A组<B组<C组(均P<0.05),其漏尿复发率在治疗后2至3年趋于稳定;A组治疗后的I-QOL评分与B组差异无统计学意义(P>0.05),但均高于C组(均P<0.05);治疗结束时及治疗后1、2、3年ICI-Q-SF评分均是A组<B组<C组(均P<0.05);产次对治疗后I-QOL和ICI-Q-SF评分及漏尿率有显著影响(P<0.05)。返院再次评估结果表明:A_(返院)组和B_(返院)组治疗结束时阴道前壁(Aa点)脱垂程度的差异无统计学意义(P>0.05),但是治疗后3年小于B_(返院)组(P<0.05);A_(返院)组和B_(返院)组治疗结束时盆底肌力差异无统计学意义(P>0.05),但是治疗后3年大于B_(返院)组(P<0.05);A_(返院)组治疗结束时和治疗后3年肌电位均高于B_(返院)组(均P<0.05)。结论:盆底生物反馈+电刺激+电针治疗相较于盆底生物反馈+电刺激治疗女性压力性尿失禁的近期疗效更显著、远期疗效更稳定,且能明显提高女性生活质量。展开更多
Objective:Pelvic floor sensory training is commonly used in clinical practice for the treatment of stress urinary incontinence(SUI);however,there is a lack of comparative studies evaluating pelvic floor sensation betw...Objective:Pelvic floor sensory training is commonly used in clinical practice for the treatment of stress urinary incontinence(SUI);however,there is a lack of comparative studies evaluating pelvic floor sensation between women with SUI and healthy controls.Additionally,normative data for two-point discrimination thresholds in the female pelvic floor region remain scarce.This study aims to compare the results of 4 sensory tests in the pelvic floor region between women with mild SUI and healthy women,in order to provide reference values for two-point discrimination thresholds in this area.Methods:From April 1 to October 30,2023,108 healthy women[(32.5±3.6)years]and 90 women with mild SUI[(32.9±3.3)years]were recruited from the Third Xiangya Hospital,Central South University.Participants underwent 4 sensory tests in the pelvic floor region:Two-dot discrimination,weight perception,shape recognition,and 9-grid localization.The results were compared between the 2 groups.Results:Compared with healthy women,those with mild SUI had lower sensitivity and higher thresholds in 2-dot discrimination tests in the pelvic floor region(all P<0.001).No significant differences were found between groups in weight perception,shape recognition,or grid localization tests(P>0.05).Conclusion:Women with mild stress urinary incontinence have impaired two-point discrimination ability in the pelvic floor region.展开更多
Objective:Pelvic organ prolapse(POP)is a common condition in postmenopausal women,with an increasing prevalence due to aging.Some women experience POP recurrence after surgical treatment,significantly affecting their ...Objective:Pelvic organ prolapse(POP)is a common condition in postmenopausal women,with an increasing prevalence due to aging.Some women experience POP recurrence after surgical treatment,significantly affecting their physical and mental health.The uterosacral ligament is a critical pelvic support structure.This study aims to investigate the molecular pathological changes in the uterosacral ligament of postmenopausal women with recurrent POP using transcriptomic analysis.Methods:Transcriptomic data of uterosacral ligament tissues were obtained from the public dataset GSE28660,which includes samples from 4 postmenopausal women with recurrent POP,4 with primary POP,and 4 without POP.Differentially expressed genes(DEGs)were identified between recurrent POP and both primary and non-POP groups.Further analysis included intersection analysis of DEGs,gene ontology enrichment,protein protein interaction(PPI)network construction,gene set enrichment analysis(GSEA),single-sample GSEA,and xCell immune cell infiltration analysis to explore molecular pathological changes in recurrent POP.Additionally,histological and molecular differences in the uterosacral ligament were compared between simulated vaginal delivery(SVD)rat models with and without ovariectomy.Results:Compared with primary POP and non-POP groups,recurrent POP exhibited activation of adipogenesis and inflammation-related pathways,while pathways related to muscle proliferation and contraction were downregulated in the uterosacral ligament.Nine key DEGs(ADIPOQ,FABP4,IL-6,LIPE,LPL,PCK1,PLIN1,PPARG,and CD36)were identified,with most enriched in the peroxisome proliferator-activated receptor(PPAR)signaling pathway.These genes were significantly correlated with lipid accumulation,monocyte infiltration,and neutrophil infiltration in the uterosacral ligament.Urodynamic testing revealed that the bladder leak point pressure was significantly higher in ovariectomized SVD rats,both of which had higher values than the sham group.Masson staining showed pronounced adipogenesis in the uterosacral ligament of ovariectomized SVD rats,along with reduced collagen and muscle fibers compared to the sham and non ovariectomized SVD groups.Furthermore,real-time RT-PCR confirmed significantly elevated expression of key DEGs,including ADIPOQ,IL-6,PCK1,and PLIN1,in the uterosacral ligaments of ovariectomized SVD rats.Conclusion:Adipogenesis and inflammation in the uterosacral ligament may contribute to its reduced supportive function,potentially leading to recurrence POP in postmenopausal women.展开更多
目的:单一的盆底电刺激或磁刺激治疗盆底功能障碍性疾病疗效有限,本研究拟探讨磁刺激联合射频治疗对轻中度盆腔器官脱垂(pelvic organ prolapse,POP)的疗效。方法:筛选中南大学湘雅三医院诊断为POP并完成治疗的患者,依据治疗方案不同分...目的:单一的盆底电刺激或磁刺激治疗盆底功能障碍性疾病疗效有限,本研究拟探讨磁刺激联合射频治疗对轻中度盆腔器官脱垂(pelvic organ prolapse,POP)的疗效。方法:筛选中南大学湘雅三医院诊断为POP并完成治疗的患者,依据治疗方案不同分为2组:磁刺激治疗组(n=28)为完成磁刺激治疗的患者,联合治疗组(n=21)为完成磁刺激联合射频治疗的患者。比较2组治疗前后的盆腔器官脱垂定量分期法(pelvic organ prolapse quantitation,POPQ)结果、盆底肌肌力和盆底超声结果,治疗结束后3个月,采用POP-Q评价治疗方式的维持效果。结果:2组治疗后Aa、Ap、C点的POP-Q结果均优于治疗前,差异均有统计学意义(均P<0.05);治疗后联合治疗组Aa点POP-Q结果优于磁刺激治疗组,差异有统计学意义(P<0.05);联合治疗组在valsalva动作下盆底超声评估膀胱颈的位置高于磁刺激治疗组,差异有统计学意义(P<0.05);治疗结束后3个月,联合治疗组疗效持续性好于磁刺激治疗组,差异有统计学意义(P<0.01)。结论:磁刺激联合射频治疗的疗效优于单一的磁刺激治疗,且疗效更持久。展开更多
文摘目的:脑卒中运动功能障碍患者康复工作的开展至关重要,然而目前缺少脑卒中患者在康复病房、社区以及家庭康复管理的相关证据总结。本研究旨在汇总脑卒中运动功能障碍患者康复管理的相关证据,为临床和社区医护人员开展康复干预提供参考依据。方法:系统检索BMJ Best Practice、UpToDate、美国国立指南库、美国心脏协会/美国卒中协会、加拿大医学会、英国国家卫生与临床优化研究所、美国退伍军人事务部/国防部、加拿大安大略注册护士协会、JBI循证卫生保健中心数据库、The Cochrane Library、PubMed、Web of Science、Embase、CINAHL、中国知网、万方数据库、维普数据库、中国生物医学文献系统中关于脑卒中运动功能障碍患者康复管理的所有文献,包括临床决策、指南、专家共识、推荐实践、系统评价、证据总结,检索时限为建库至2023年10月。由2名研究者独立对文献进行质量评价。结果:共纳入21篇文献,包括11篇指南、2篇专家共识和8篇系统评价。通过对纳入文献的证据进行提取与整合,从康复管理模式、康复机构、康复团队、康复介入时机、康复评估、康复项目、康复时间和频率、康复强度和康复支持9个领域中汇总45条证据,涵盖了脑卒中患者早期、亚急性期和慢性期全病程的三级康复管理的相关内容。结论:本研究汇总的脑卒中运动功能障碍患者康复管理的最佳证据较为全面,证据质量较高,对临床和社区医护人员开展康复干预具有重要指导意义。建议应用证据时,综合考虑脑卒中患者当前病情、运动功能受损情况、环境因素和患者的意愿,然后选择最适合的康复方案,并根据每位患者的具体需求和喜好调整训练的种类和强度。
基金supported by the Natural Science Foundation of Hunan Province(2024JJ6626)the Hunan Provincial Key Laboratory of Regional Hereditary Birth Defects Prevention and Control(HPKL202320),China.
文摘Objective:Pelvic floor dysfunction is common among pregnant and postpartum women and significantly impacts quality of life.This study aims to translate the German Pelvic Floor Questionnaire for Pregnant and Postpartum Women into Chinese and to evaluate its reliability and validity in the Chinese population.Methods:The questionnaire was translated using the Brislin model.A cross-sectional study was conducted among pregnant and postpartum women to assess the content validity,construct validity,Cronbach’sαcoefficient,test-retest reliability,and split-half reliability of the Chinese version.Results:A total of 72 women were included,with 6.9% being pregnant and 93.1% postpartum;the age was(32.3±3.6)years.The Chinese version of the questionnaire contains 4 dimensions and 45 items.The content validity index of individual items ranged from 0.833 to 1.000,with a scale-level content validity index of 0.977 and intraclass correlation coefficients(ICCs)exceeding 0.90.The overall Cronbach’s α coefficient was 0.891,with subscale coefficients ranging from 0.732 to 0.884(all ICCs>0.70).The testretest reliability of the total scale was 0.833,and for the 4 dimensions,bladder,bowel,prolapse,and sexual function,the values were 0.776,0.579,0.732,and 0.645,respectively.The split-half reliability was 0.74.Conclusion:The Chinese version of the questionnaire demonstrated good reliability and validity,indicating its applicability in assessing pelvic floor dysfunction and associated risk factors during pregnancy and postpartum.
文摘目的:压力性尿失禁是一种非常常见的疾病,治疗方法多,但是缺乏远期疗效追踪。本研究旨在通过对女性轻中度压力性尿失禁患者盆底康复治疗后3年的随访结果进行回顾性研究,为该病的临床治疗提供更为有效的方案。方法:收集2017年1月至2019年1月在中南大学湘雅三医院盆底康复中心诊断为压力性尿失禁的279例女性患者的临床资料。所有患者均接受健康宣教并嘱回家每天坚持Kegel运动20 min。根据接受治疗情况分为3组:A组(n=94),接受盆底生物反馈+电刺激+电针治疗;B组(n=99),接受盆底生物反馈+电刺激治疗;C组(n=86),只进行盆底功能检查,未接受盆底治疗。盆底功能检查包括盆底电生理检测、盆腔脏器脱垂定量检查(pelvic organ prolapse quantitive examination,POP-Q)和压力性尿失禁严重程度评估。对所有患者在治疗前、治疗结束时及治疗结束后1、2、3年进行回访(共5次),随访内容包括国际尿失禁咨询委员会尿失禁问卷简表(ICIQ-UI Short Form,ICI-Q-SF)和尿失禁生活质量问卷(Incontinence Quality of Life,I-QOL)。接受治疗的患者中有43人返院,其中A组返院21人(A_(返院)组),B组返院22人(B_(返院)组),对2组进行盆底电生理检测和POP-Q。结果:问卷调查结果表明:治疗结束时及治疗后1、2、3年患者的漏尿率均是A组<B组<C组(均P<0.05),其漏尿复发率在治疗后2至3年趋于稳定;A组治疗后的I-QOL评分与B组差异无统计学意义(P>0.05),但均高于C组(均P<0.05);治疗结束时及治疗后1、2、3年ICI-Q-SF评分均是A组<B组<C组(均P<0.05);产次对治疗后I-QOL和ICI-Q-SF评分及漏尿率有显著影响(P<0.05)。返院再次评估结果表明:A_(返院)组和B_(返院)组治疗结束时阴道前壁(Aa点)脱垂程度的差异无统计学意义(P>0.05),但是治疗后3年小于B_(返院)组(P<0.05);A_(返院)组和B_(返院)组治疗结束时盆底肌力差异无统计学意义(P>0.05),但是治疗后3年大于B_(返院)组(P<0.05);A_(返院)组治疗结束时和治疗后3年肌电位均高于B_(返院)组(均P<0.05)。结论:盆底生物反馈+电刺激+电针治疗相较于盆底生物反馈+电刺激治疗女性压力性尿失禁的近期疗效更显著、远期疗效更稳定,且能明显提高女性生活质量。
基金supported by the Key Research and Development Program of Hunan Province,China(2023SK2038).
文摘Objective:Pelvic floor sensory training is commonly used in clinical practice for the treatment of stress urinary incontinence(SUI);however,there is a lack of comparative studies evaluating pelvic floor sensation between women with SUI and healthy controls.Additionally,normative data for two-point discrimination thresholds in the female pelvic floor region remain scarce.This study aims to compare the results of 4 sensory tests in the pelvic floor region between women with mild SUI and healthy women,in order to provide reference values for two-point discrimination thresholds in this area.Methods:From April 1 to October 30,2023,108 healthy women[(32.5±3.6)years]and 90 women with mild SUI[(32.9±3.3)years]were recruited from the Third Xiangya Hospital,Central South University.Participants underwent 4 sensory tests in the pelvic floor region:Two-dot discrimination,weight perception,shape recognition,and 9-grid localization.The results were compared between the 2 groups.Results:Compared with healthy women,those with mild SUI had lower sensitivity and higher thresholds in 2-dot discrimination tests in the pelvic floor region(all P<0.001).No significant differences were found between groups in weight perception,shape recognition,or grid localization tests(P>0.05).Conclusion:Women with mild stress urinary incontinence have impaired two-point discrimination ability in the pelvic floor region.
基金supported by the Key Research and Development Program of Hunan Province(2023SK2038)the Natural Science Foundation of Hunan Province(2024JJ8121),China。
文摘Objective:Pelvic organ prolapse(POP)is a common condition in postmenopausal women,with an increasing prevalence due to aging.Some women experience POP recurrence after surgical treatment,significantly affecting their physical and mental health.The uterosacral ligament is a critical pelvic support structure.This study aims to investigate the molecular pathological changes in the uterosacral ligament of postmenopausal women with recurrent POP using transcriptomic analysis.Methods:Transcriptomic data of uterosacral ligament tissues were obtained from the public dataset GSE28660,which includes samples from 4 postmenopausal women with recurrent POP,4 with primary POP,and 4 without POP.Differentially expressed genes(DEGs)were identified between recurrent POP and both primary and non-POP groups.Further analysis included intersection analysis of DEGs,gene ontology enrichment,protein protein interaction(PPI)network construction,gene set enrichment analysis(GSEA),single-sample GSEA,and xCell immune cell infiltration analysis to explore molecular pathological changes in recurrent POP.Additionally,histological and molecular differences in the uterosacral ligament were compared between simulated vaginal delivery(SVD)rat models with and without ovariectomy.Results:Compared with primary POP and non-POP groups,recurrent POP exhibited activation of adipogenesis and inflammation-related pathways,while pathways related to muscle proliferation and contraction were downregulated in the uterosacral ligament.Nine key DEGs(ADIPOQ,FABP4,IL-6,LIPE,LPL,PCK1,PLIN1,PPARG,and CD36)were identified,with most enriched in the peroxisome proliferator-activated receptor(PPAR)signaling pathway.These genes were significantly correlated with lipid accumulation,monocyte infiltration,and neutrophil infiltration in the uterosacral ligament.Urodynamic testing revealed that the bladder leak point pressure was significantly higher in ovariectomized SVD rats,both of which had higher values than the sham group.Masson staining showed pronounced adipogenesis in the uterosacral ligament of ovariectomized SVD rats,along with reduced collagen and muscle fibers compared to the sham and non ovariectomized SVD groups.Furthermore,real-time RT-PCR confirmed significantly elevated expression of key DEGs,including ADIPOQ,IL-6,PCK1,and PLIN1,in the uterosacral ligaments of ovariectomized SVD rats.Conclusion:Adipogenesis and inflammation in the uterosacral ligament may contribute to its reduced supportive function,potentially leading to recurrence POP in postmenopausal women.
基金supported by the Hunan Provincial Clinical Medical Technology Innovation Guidance Project(2020SK53612)the Natural Science Foundation of Hunan Province(2021JJ30998),China。
文摘目的:单一的盆底电刺激或磁刺激治疗盆底功能障碍性疾病疗效有限,本研究拟探讨磁刺激联合射频治疗对轻中度盆腔器官脱垂(pelvic organ prolapse,POP)的疗效。方法:筛选中南大学湘雅三医院诊断为POP并完成治疗的患者,依据治疗方案不同分为2组:磁刺激治疗组(n=28)为完成磁刺激治疗的患者,联合治疗组(n=21)为完成磁刺激联合射频治疗的患者。比较2组治疗前后的盆腔器官脱垂定量分期法(pelvic organ prolapse quantitation,POPQ)结果、盆底肌肌力和盆底超声结果,治疗结束后3个月,采用POP-Q评价治疗方式的维持效果。结果:2组治疗后Aa、Ap、C点的POP-Q结果均优于治疗前,差异均有统计学意义(均P<0.05);治疗后联合治疗组Aa点POP-Q结果优于磁刺激治疗组,差异有统计学意义(P<0.05);联合治疗组在valsalva动作下盆底超声评估膀胱颈的位置高于磁刺激治疗组,差异有统计学意义(P<0.05);治疗结束后3个月,联合治疗组疗效持续性好于磁刺激治疗组,差异有统计学意义(P<0.01)。结论:磁刺激联合射频治疗的疗效优于单一的磁刺激治疗,且疗效更持久。
