OBJECTIVES:To elucidate the urethral closure mechanism during abdominal pressure in men, we investigated changes in pelvic anatomy during abdominal pressure using dynamic Magnetic Resonance Imaging (MRI). METHODS:This study retrospectively analyzed data from 145 patients scheduled for robot-assisted radical prostatectomy at Kanazawa University Hospital from 2016 to 2022. Preoperative dynamic MRI was used to take measurements at several anatomical points to assess changes in pelvic anatomy during abdominal pressure. RESULTS:Dynamic MRI measurements during abdominal pressure revealed that the prostate apex rotates anteriorly at an average of 5.6°, and the internal urethral orifice shifts dorsally. Additionally, the prostate apex moves 1.2 mm toward the pubic bone. Conversely, the distal end of the membranous urethra shifts 0.9 mm dorsally during abdominal pressure. Consequently, a misalignment between the prostate apex and the membranous urethra is observed, resulting in the closure of the anterior-posterior direction of the proximal membranous urethra that may contribute to urethral closure during abdominal pressure. CONCLUSION:These results may suggest that prostate rotation during abdominal pressure creates a step-like displacement at the proximal membranous urethra, which could contribute to urethral closure in men with an intact prostate. Dynamic MRI provides anatomical evidence supporting a complementary role of prostate motion in this mechanism. CLINICAL TRIAL REGISTRATION:Not applicable. This study was conducted prospectively with written informed consent and institutional ethical approval; however, it was not designed as a clinical trial because it was a non-interventional observational study in which a specialized MRI protocol was added to standard clinical imaging without any therapeutic intervention or treatment allocation.
Introduction Quantifying the mobilization dose in the intensive care unit (ICU) remains a major challenge. Although the Mobilization Quantification Score (MQS) is a validated and widely used index, its calculation requires separate quantification of the time spent at multiple mobilization levels, making it complex and less feasible for routine clinical use. To address this limitation, we developed the Rehabilitation Activity Time score (RATs), which is a simple, time-based bedside tool designed to efficiently quantify the rehabilitation dose. This pilot study primarily aimed to evaluate the feasibility and convergent validity of RATs in mechanically ventilated ICU patients, and secondarily to explore their association with clinical outcomes. Methods This prospective single-center observational pilot study included adult ICU patients expected to require invasive mechanical ventilation for ≥48 hours and to receive rehabilitation as part of usual care. Daily RATs and MQS were recorded by physical therapists, and physical activity was continuously measured using a wrist-worn triaxial accelerometer (ActiGraph wGT3X-BT; Ametis, Pensacola, Florida). Feasibility outcomes included data completion rates, valid accelerometer wear days, and adverse events. Convergent validity among RATs, MQS, and accelerometer-derived activity metrics was assessed using Spearman's rank correlation. Exploratory analyses examined associations between activity measures and clinical outcomes. Results Twelve patients were screened, and 10 were enrolled (median age 68, IQR 61-81). Across 59 ICU patient-days, the RATs and MQS were recorded on 56 (95%) and 53 (90%) days, respectively, whereas accelerometry provided 55 valid days (83%). No device-related adverse events were observed. RATs was strongly correlated with the MQS (r=0.94) and accelerometer activity counts (r=0.76). Exploratory analyses indicated that higher mean RATs were associated with a higher discharge Barthel Index (r=0.56) and earlier ventilator liberation (median four vs. six days; Cliff delta =0.47). Conclusion The RATs demonstrated high feasibility and strong validity, reflecting objective activity levels while requiring minimal bedside effort. As a simple and reliable measure, the RATs may enable the standardized quantification of rehabilitation doses in the ICU and inform future dose-response research.
BACKGROUND:Thoracic epidural analgesia (TEA) is widely used for postoperative pain control in abdominal surgery, but its role in minimally invasive procedures remains unclear. This pragmatic multicentre open-label randomized non-inferiority trial evaluated whether scheduled intravenous acetaminophen combined with local wound infiltration provides non-inferior analgesia to TEA following minimally invasive gastrectomy. METHODS:Adults with gastric adenocarcinoma categorized as clinical stage I-III (according to the Japanese classification of gastric carcinoma) who were undergoing laparoscopic or robot-assisted gastrectomy were randomized 1 : 1 to TEA or scheduled intravenous acetaminophen (1 g every 6 hours (h) for 72 h). All patients received wound infiltration with ropivacaine. Participants and clinicians were not blinded to the randomization; statisticians were masked. The primary endpoint in the study was the proportion of patients with a numerical rating scale (NRS) pain score ≥ 4 at rest 24 h after surgery, with a prespecified non-inferiority margin of 20 percentage points. Analyses used the modified intention-to-treat population. RESULTS:Between June 2020 and May 2024, 140 patients were randomized and 135 were analysed (TEA 68, acetaminophen 67). At 24 h after surgery, 27.9% of patients in the TEA group and 23.9% in the acetaminophen group had an NRS score ≥ 4 at rest (risk difference -4.1%; 95% confidence interval -24.3 to 16.6), confirming non-inferiority. Pain trajectories, rescue analgesic use, patient satisfaction, and recovery were comparable between the two groups. No patient required rescue opioids, and there were no serious catheter- or acetaminophen-related adverse events. CONCLUSION:Scheduled intravenous acetaminophen with wound infiltration was non-inferior to TEA for postoperative pain after minimally invasive gastrectomy and provided safe, effective, and opioid-sparing analgesia consistent with enhanced recovery principles. Registration number: UMIN000039505 (https://www.umin.ac.jp/english/).
BACKGROUND:This study aimed to evaluate skeletal muscle metabolism during walking in symptomatic and asymptomatic patients with knee osteoarthritis using positron emission tomography-computed tomography with 18F-fluorodeoxyglucose. We hypothesized that quadriceps muscle metabolism during walking would vary between the groups. METHODS:Twenty-two participants (11 males and 11 females) with knee osteoarthritis (Kellgren-Lawrence grade 2) were divided into symptomatic and asymptomatic groups. The participants performed two 10-min walks on a treadmill, received an intravenous injection of 18F-fluorodeoxyglucose between sets, and underwent positron emission tomography-computed tomography. Regions of interest were manually segmented into 35 skeletal muscles from the pelvis to the foot. The standardized uptake value was calculated to quantitatively examine 18F-fluorodeoxyglucose uptake by muscle tissue. RESULTS:The mean standardized uptake values of the hip abductor and external rotator muscles were lower in the symptomatic group than in the asymptomatic group and displayed a medium effect size (gluteus medius, P = 0.281; d = 0.482; gluteus minimus, P = 0.079; d = 0.793; piriformis, P = 0.184; d = 0.622). Although the vastus medialis demonstrated a medium effect size (P = 0.191; d = 0.597), the rectus femoris (P = 0.454; d = 0.299), vastus lateralis (P = 0.303; d = 0.392), and vastus intermedius (P = 0.300; d = 0.434) demonstrated no significant differences and only small effect sizes. Therefore, no overall difference in quadriceps muscle metabolism was observed between the groups. CONCLUSION:A trend towards lower hip abductor and external rotator muscle metabolism was observed in patients with symptomatic knee osteoarthritis, suggesting that muscle metabolism may be associated with knee symptoms.
