Aesthetic results were more satisfactory after oncoplastic surgery than after total breast reconstruction according to patients and surgeons.

INTRODUCTION: Patient satisfaction after breast cancer surgery has an impact on body image, sexual function, self-esteem, and quality of life and may differ from the perception of the attending physician. This study aimed to compare the aesthetic outcomes and satisfaction with conservative oncoplastic surgeries, mastectomies, and total breast reconstruction. METHODS: We included 760 women diagnosed with invasive breast carcinoma or phyllodes tumors who returned at least 6 months after surgery or radiotherapy at two public hospitals and a private clinic between 2014 and 2022. Data was collected prospectively from patients and retrospectively from their medical records using a specific form after obtaining their informed consent. Aesthetic outcomes and quality of life were assessed using the BREAST-Q©, Harris Scale, and BCCT.core software. Data were evaluated using the SPSS statistical software. Statistical significance was set at p < 0.05. This study was approved by the hospital ethics committees. RESULTS: A total of 405 (53.29%) partial and 355 (46.71%) total reconstructions were included. Patients who underwent partial reconstruction were older and had higher body mass index. Patients who underwent total reconstruction had larger tumors with advanced clinical and pathological stages. Clinical and surgical complications occurred more frequently in the total reconstruction group. A greater number of reparative surgeries and lipofilling procedures were required for total reconstruction. According to the BREAST-Q, the partial reconstruction group showed significantly higher levels of women's satisfaction with their breasts, the surgical outcomes, psychosocial and sexual well-being, provision of information, and the reconstructive surgeon. Only physical well-being was slightly higher in the total reconstruction group. In most cases, the results were rated good or excellent. Physicians considered partial reconstructions to have better results than total reconstructions, although this difference was not perceived by the BCCT.core software. CONCLUSION: Women who underwent partial breast reconstruction had higher levels of satisfaction in several domains, lower frequency of complications, and required fewer surgeries to complete their reconstruction than women who underwent total reconstruction. Physicians were also more satisfied with the results of partial reconstructions.

Exercise regimens other than pelvic floor muscle training cannot increase pelvic muscle strength-a systematic review.

BACKGROUND: Although pelvic floor muscle training is widely recommendedin the literature as the gold standard for the treatment of pelvic floor dysfunctions, such as urinary incontinence, interest in other exercise regimens is increasing. However, it is unknown whether other exercise regimens increase pelvic floor muscle strength. METHODS: This was a systematic review of randomized clinical trials found in PEDro, tridatabase, Cochrane and PubMed on the efficacy of nonspecific exercises, such as Pilates, the Paula method, and hypopressive exercises, in strengthening pelvic floor muscles in adults without underlying neurological disorders and with or without pelvic floor dysfunction. RESULTS: Seven studies were analyzed, and the results demonstrated that Pilates, the Paula method, and hypopressive exercises are ineffective in increasing pelvic muscle strength unless they are performed in conjunction with pelvic floor muscle training. The protocol was registered in the PROSPERO database (www.crd.york.ac.uk/prospero/) under the number CRD42019123396. CONCLUSION: Considering the available studies, we have concluded that Pilates, the Paula method and hypopressive exercises performed alone do not increase pelvic floor muscle strength. Pelvic floor muscle training continues to be the gold standard for increasing pelvic muscle strength.

Effectiveness of transcutaneous tibial nerve stimulation at two different thresholds for overactive bladder symptoms in older women: a randomized controlled clinical trial.

OBJECTIVES: To compare the effectiveness of transcutaneous tibial nerve stimulation (TTNS) at two different current amplitude thresholds (sensory and motor) in terms of urinary habit, symptoms and the degree of discomfort of overactive bladder (OAB) in older women. STUDY DESIGN: This is a randomized, controlled, 3-arm blinded trial. One hundred and one patients attending secondary care with OAB were randomized into one of three groups: group 1, TTNS sensitivity threshold (n = 39); group 2, TTNS motor threshold (n = 33); and control group 3 (n = 29). MAIN OUTCOME MEASURES: Participants allocated to groups 1 and 2 had 8 sessions of TTNS for 30 min, twice a week. Group 3 received no intervention. The results measured were the symptoms of overactive bladder (ICIQ-OAB, overall score), bother scales (to indicate the impact of individual symptoms for the patient) and urinary habit (3-day bladder diary). A blind assessor measured outcomes at baseline and 5 weeks after randomization. RESULTS: After five weeks, a statistically significant difference between group 3 (control) and group 1 (TTNS sensitivity threshold) and group 2 (TTNS motor threshold) was observed in the intergroup analysis, but no difference in the outcomes analyzed was detected between the two groups receiving intervention (groups 1 and 2). CONCLUSION: TTNS is effective in the treatment of OAB in older women, with no difference between the sensitivity and motor thresholds. CLINICAL TRIAL REGISTRATION NUMBER: Registro Brasileiros de Ensaios Clínicos (RBR-39DZ5V).

Do moderate aerobic exercise and strength training influence electromyographic biofeedback of the pelvic floor muscles in female non-athletes?

[Purpose] To assess the influence of moderate physical exercise on pelvic floor muscle electromyographic (EMG) biofeedback signal in female non-athletes. [Subjects and Methods] A prospective, non-randomized study of 90 adult females (age ≥18 years) divided into three groups: Intervention (I), which began physical exercise upon study enrollment; Moderate Exercise (ME), comprising those who already engaged in physical activity; and Sedentary (S), comprising those who had a sedentary lifestyle. All participants underwent EMG biofeedback of the pelvic floor muscles upon study enrollment (T1) and at the end of the third subsequent month (T2). [Results] Mean age was 35.7 (SD: 7.5) years, with no significant difference between groups. T1 values in groups I and S were significantly lower than in group ME. There was no statistically significant difference between groups S and I. On comparison between groups at T2, values were highest in group I (18.5 µV vs. 15.3 µV in group S, vs. 16.1 µV in group ME). There was no significant difference between groups S and ME. On age-adjusted analysis, group I exhibited the greatest change between T1 and T2 (I, 4.7 µV; ME, 2.1 µV; S, 1.5 µV). [Conclusion] Females who exercise exhibit better pelvic floor muscle function than those who do not engage in physical activity.

Alcohol acute intoxication before sepsis impairs the wound healing of intestinal anastomosis: rat model of the abdominal trauma patient.

INTRODUCTION: Most trauma patients are drunk at the time of injury. Up to 2% of traumatized patients develop sepsis, which considerably increases their mortality. Inadequate wound healing of the colonic repair can lead to postoperative complications such as leakage and sepsis. OBJECTIVE: To assess the effects of acute alcohol intoxication on colonic anastomosis wound healing in septic rats. METHODS: Thirty six Wistar rats were allocated into two groups: S (induction of sepsis) and AS (alcohol intake before sepsis induction). A colonic anastomosis was performed in all groups. After 1, 3 or 7 days the animals were killed. Weight variations, mortality rate, histopathology and tensile breaking strength of the colonic anastomosis were evaluated. RESULTS: There was an overall mortality of 4 animals (11.1%), three in the group AS (16.6%) and one in the S group (5.5%). Weight loss occurred in all groups. The colon anastomosis of the AS group didn't gain strength from the first to the seventh postoperative day. On the histopathological analysis there were no differences in the deposition of collagen or fibroblasts between the groups AS and S. CONCLUSION: Alcohol intake increased the mortality rate three times in septic animals. Acute alcohol intoxication delays the acquisition of tensile strength of colonic anastomosis in septic rats. Therefore, acute alcohol intoxication before sepsis leads to worse prognosis in animal models of the abdominal trauma patients.