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PMC11276951_p46
|
PMC11276951
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sec[3]/sec[7]/sec[5]/p[0]
|
4.8.6. Determination of MDA Content in Organ
| 4.09375 |
biomedical
|
Study
|
[
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Mouse liver and kidney were taken to prepare 10% organ homogenate. The content of MDA in mouse organs was determined according to the following steps: (1) The experiment was divided into the blank, model, DXM, SINH, SINH-L, SINH-H, and SINH-L-H groups. (2) 1 mL of skin, liver, and kidney homogenate from each group was added to 3 mL of TBA working solution and placed in a water bath at 95 °C for 40 min. (3) After removal and cooling to room temperature with running water to stop the reaction, the supernatant was centrifuged at 4000 r/min for 8 min and the absorbance value was measured at 532 nm. (4) The absorbance values obtained were substituted into the MDA content standard curve to calculate the MDA content in the tissue and determine the degree of oxidation of the tissue. The MDA content in the skin, liver, and kidney were determined the same as above.
|
[
"Xue Chen",
"Yang Wu",
"Ruoyang Jia",
"Yuqing Fang",
"Keang Cao",
"Xinying Yang",
"Xiaobo Qu",
"Hongmei Xia"
] |
https://doi.org/10.3390/ijms25147676
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999998 |
PMC11276951_p47
|
PMC11276951
|
sec[3]/sec[7]/sec[6]/p[0]
|
4.8.7. Hematoxylin and Eosin Staining
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biomedical
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Study
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After removing the skin tissue from the back of the mice, the normal saline was rinsed and quickly fixed in 4% formalin buffer and embedded in paraffin 24 h later. Skin sections with a thickness of 5 μm made by the section mechanism and stained with hematoxylin-eosin (HE) were observed in the skin histopathological characteristics of mice.
|
[
"Xue Chen",
"Yang Wu",
"Ruoyang Jia",
"Yuqing Fang",
"Keang Cao",
"Xinying Yang",
"Xiaobo Qu",
"Hongmei Xia"
] |
https://doi.org/10.3390/ijms25147676
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
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PMC11276951_p48
|
PMC11276951
|
sec[3]/sec[7]/sec[7]/p[0]
|
4.8.8. Statistical Methods
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biomedical
|
Study
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All data were expressed as mean ± standard deviation (x ± s), one-way ANOVA was used, and the LSD method was used for two-way comparison between groups, and the test level was α = 0.05, and the difference was considered statistically significant at p < 0.05.
|
[
"Xue Chen",
"Yang Wu",
"Ruoyang Jia",
"Yuqing Fang",
"Keang Cao",
"Xinying Yang",
"Xiaobo Qu",
"Hongmei Xia"
] |
https://doi.org/10.3390/ijms25147676
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
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PMC11276951_p49
|
PMC11276951
|
sec[4]/p[0]
|
5. Conclusions
| 4.226563 |
biomedical
|
Study
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To sum up, SINH was encapsulated in liposomes and then evenly dispersed into the HA hydrogel matrix to form SINH-L-H, which could increase the residence time on the skin surface to improve the bioavailability of SINH to treat AD. The experimental results showed that SINH-L-H had uniform texture, good stability, and a slow release effect. SINH-L-H was a safe preparation based on its non-irritating effect on the skin. In the antioxidant test, SINH-L-H showed strong scavenging ability on hydroxyl free radicals and ABTS free radicals, and the scavenging ability of SINH was positively correlated with the concentration of SINH, indicating that SINH had a good antioxidant effect. For AD in mouse models, the use of SINH-L-H significantly alleviated the symptoms of AD and reduced the amount of MDA in the skin. SINH penetrated into the skin, depending on the liposomes-in-gel delivery. SINH-L-H has a good transdermal effect. SINH-L-H was a safe and effective new dosage form for the treatment of AD and provided a novel carrier for the clinical application of SINH.
|
[
"Xue Chen",
"Yang Wu",
"Ruoyang Jia",
"Yuqing Fang",
"Keang Cao",
"Xinying Yang",
"Xiaobo Qu",
"Hongmei Xia"
] |
https://doi.org/10.3390/ijms25147676
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999998 |
PMC11276965_p0
|
PMC11276965
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sec[0]/p[0]
|
1. Introduction
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biomedical
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Study
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Globally, diabetes is a major contributor to chronic kidney disease (CKD) . Chronic hyperglycemia brought on by diabetes causes a variety of hemodynamic and metabolic alterations that gradually deteriorate kidney function . Diabetes is a major global health concern, with the prevalence expected to increase from 2.8% in 2000 to 4.4% by 2030 across all age groups . According to the International Diabetes Federation, 578 million people will be diagnosed with diabetes worldwide by 2030 . In the context of Saudi Arabia, the country faces a high burden of diabetes, with one study reporting that the age-adjusted prevalence of diabetes was 17.7% . Overall, diabetes is extremely common in Saudi Arabia, with estimates indicating that the country has one of the highest diabetes prevalence rates in the world .
|
[
"Abdullah Almaqhawi"
] |
https://doi.org/10.3390/ijerph21070880
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999999 |
PMC11276965_p1
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PMC11276965
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sec[0]/p[1]
|
1. Introduction
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biomedical
|
Review
|
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Patients with diabetes are at a significant risk for a variety of microvascular and macrovascular complications. Nephropathy, retinopathy and neuropathy are examples of microvascular complications common among people with diabetes that greatly increase the burden of comorbidities . Chronic kidney disease (CKD) is one of the main global causes of morbidity and death , and it is usually diagnosed with kidney function tests, kidney imaging and the albumin-to-creatinine ratio . Verma et al. reported that these complications might result in irreversible harm to the structure and function of tissues, thereby elevating the risk of death and morbidity . Diabetes has been identified as a direct cause of kidney damage and a major contributing factor to the ongoing deterioration of kidney function . The reduced estimated glomerular filtration rate (eGFR) and albuminuria are common in patients with diabetes and nephropathy, which makes renin-angiotensin system blockade therapy necessary . According to studies, diabetes raises the risk of kidney disease progression, which can lead to end-stage kidney disease, a steady decline in eGFR, or even death from cardiovascular or renal causes .
|
[
"Abdullah Almaqhawi"
] |
https://doi.org/10.3390/ijerph21070880
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
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PMC11276965_p2
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PMC11276965
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1. Introduction
| 3.835938 |
biomedical
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Study
|
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The age-standardized prevalence of CKD in Saudi Arabia is estimated to be 9892 per 100,000 people, higher than the estimates for Western Europe and North America . Patients with diabetes in Saudi Arabia have high rates of CKD, ranging from 37.4% to 41.1% . This rate reflects a substantial increase over the 5.7% overall prevalence of CKD in the Saudi population . In this population, the use of insulin and oral hypoglycaemic medications is associated with CKD risk factors, along with obesity and hypertension . The Ministry of Health (MOH) in Saudi Arabia approved a “Ten-Year National Executive Plan” for the control of diabetes in response to the burgeoning prevalence of diabetes and its comorbidities in the Kingdom . The plan detailed treatment techniques, prevention strategies and control awareness programs .
|
[
"Abdullah Almaqhawi"
] |
https://doi.org/10.3390/ijerph21070880
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
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PMC11276965_p3
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PMC11276965
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sec[0]/p[3]
|
1. Introduction
| 4.039063 |
biomedical
|
Review
|
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Primary care physicians (PCPs) are essential in managing diseases, especially long-term conditions such as diabetes . PCPs diagnose and treat chronic illnesses with an emphasis on mitigating their effects on patients and lowering the risk of premature death and morbidity . Patients with chronic diseases can receive much better care when a disease management strategy is used and the PCP assumes the lead role . Concerning CKD, to prevent complications and manage the symptoms, regular monitoring and coordinated care between primary care and renal services are essential . Successful management requires a team approach involving PCPs, providers and patients, with the degree of participation and interaction adapted to the patient’s stage of CKD . Studies conducted in a variety of countries have all highlighted the importance of increasing family medicine physicians’ understanding of the diagnosis and treatment of CKD. For instance, Godswill reported that Nigerian family medicine trainees lacked sufficient knowledge in this domain, suggesting the necessity for enhanced instruction . Further, although recent evidence suggested that family physicians in Poland have a reasonable understanding of the causes, risk factors and progression of CKD, additional education and factual knowledge are still needed in this profession . Research has also shown that doctors’ understanding of the definition of CKD is even poorer in West Africa 38.5% , and only 38% of physicians from Pakistan were aware that eGFR could be used to diagnose CKD .
|
[
"Abdullah Almaqhawi"
] |
https://doi.org/10.3390/ijerph21070880
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999998 |
PMC11276965_p4
|
PMC11276965
|
sec[0]/p[4]
|
1. Introduction
| 2.253906 |
biomedical
|
Study
|
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This is the first study to assess family medicine doctors’ confidence and knowledge about treating CKD in the Eastern Province of Saudi Arabia. This endeavor could yield valuable information for formulating a plan of action to promote effective CKD management among family medicine physicians.
|
[
"Abdullah Almaqhawi"
] |
https://doi.org/10.3390/ijerph21070880
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999996 |
PMC11276965_p5
|
PMC11276965
|
sec[1]/sec[0]/p[0]
|
2.1. Study Design and Participant Population
| 3.910156 |
biomedical
|
Study
|
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This cross-sectional study was conducted among family medicine physicians employed in primary care settings in the Eastern Province of Saudi Arabia using a survey we created in Google Forms. Participants are recruited from various clusters across different Eastern Province areas to capture a diverse demographic and geographic representation. It announced an anonymous online survey on social media platforms, including official WhatsApp for each cluster, to increase response rates. Additionally, the questionnaire was disseminated via email through the various family medicine clusters’ mailing databases, targeting approximately 240 physicians. The clusters involved were al-Ahsa and Eastern Health Cluster, Dammam, Al Khobar, Dhahran, and Qatif. Out of the approximately 240 doctors contacted, 71 responded and participated in the study. While this represents a response rate of approximately 30%, it is important to consider the diversity within this sample in terms of geographic distribution and professional backgrounds. Distribution of the survey took place between 15 December 2023, to 16 April 2024. Every participant in the study provided informed consent before beginning the questionnaire. In addition, they read information about the aim of the study, and the survey terminated automatically if they disagreed. The questionnaire used to collect data was validated and adapted from a previously published peer-reviewed article .
|
[
"Abdullah Almaqhawi"
] |
https://doi.org/10.3390/ijerph21070880
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11276965_p6
|
PMC11276965
|
sec[1]/sec[0]/p[1]
|
2.1. Study Design and Participant Population
| 2.222656 |
biomedical
|
Study
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The primary outcome of this study was to evaluate family medicine physicians’ knowledge and confidence regarding managing CKD in the Eastern Province of Saudi Arabia. The recruitment began after receiving ethical approval from the ethical committee of the College of Medicine at King Faisal University.
|
[
"Abdullah Almaqhawi"
] |
https://doi.org/10.3390/ijerph21070880
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999996 |
PMC11276965_p7
|
PMC11276965
|
sec[1]/sec[1]/p[0]
|
2.2. Questionnaire Criteria
| 3.994141 |
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|
Study
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Family medicine professionals’ knowledge and competence regarding the management of CKD were assessed using a 12-item questionnaire scored on a 5-point Likert scale ranging from 1 (“not confident about this subject”) to 5 (“fully confident in this area and could teach others”). The total confidence score was calculated by summing all 12 items . Possible scores ranged from 12 to 60 points, with higher scores indicating greater confidence in managing CKD. We categorized scores into three confidence levels: <50% indicated poor confidence, 50% to 75% indicated moderate confidence, and above 75% indicated good confidence .
|
[
"Abdullah Almaqhawi"
] |
https://doi.org/10.3390/ijerph21070880
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11276965_p8
|
PMC11276965
|
sec[1]/sec[2]/p[0]
|
2.3. Statistical Analysis
| 3.890625 |
biomedical
|
Study
|
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Categorical variables were reported as frequencies and proportions (%), whereas continuous variables were computed and expressed as means and standard deviations. The association between confidence and the socio-demographic characteristics of the physicians was evaluated using the Mann–Whitney Z-test and the Kruskal–Wallis H-test. The normality test was evaluated using the Shapiro–Wilk test and the Kolmogorov–Smirnov test. Since the confidence scores followed a non-normal distribution, non-parametric tests were applied. A p -value of less than 0.05 was considered statistically significant. All statistical data were analyzed using Statistical Packages for Social Sciences version 26 (IBM Corp., Armonk, NY, USA).
|
[
"Abdullah Almaqhawi"
] |
https://doi.org/10.3390/ijerph21070880
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999996 |
PMC11276965_p9
|
PMC11276965
|
sec[2]/p[0]
|
3. Results
| 2.349609 |
biomedical
|
Study
|
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This study enrolled 71 family medicine professionals. As seen in Table 1 , 69% were aged between 31 and 40 years, with females comprising more than half (56.3%) of the total sample. Almost all (98.6%) of the physicians were Saudi nationals, with most working in MOH (60.5%) or as consultants (56.3%). In terms of location, the largest group (42.3%) of physicians was practicing in Al Ahsa.
|
[
"Abdullah Almaqhawi"
] |
https://doi.org/10.3390/ijerph21070880
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999998 |
PMC11276965_p10
|
PMC11276965
|
sec[2]/p[1]
|
3. Results
| 4.136719 |
biomedical
|
Study
|
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When examining the confidence of the family physicians regarding the management of CKD ( supplementary material ), we examined family physicians who expressed full confidence in understanding the significance and importance and the ability to interpret the urine albumin–creatinine ratio testing in individuals living with diabetes and those who expressed the ability to interpret urine (56.3% and 46.5%, respectively). More than half (59.2%) of the physicians expressed full confidence in their knowledge of the stages of kidney disease, and just under half (47.9%) expressed full confidence in their knowledge of the criteria for the diagnosis of CKD and diabetic kidney disease. In terms of treatment, 38% of physicians indicated full confidence in their knowledge of the next steps in terms of treatment after diagnosis, but only 26.8% expressed full confidence in their understanding of how to predict CKD prognosis using albuminuria and estimated GFR categories. Just over one third (36.6%) of participants reported full confidence in their ability to recognize the possible signs and symptoms of more advanced CKD. Less than half (46.5%) of the physicians expressed full confidence in their awareness of kidney disease as a risk multiplier for CVD and other complications, and less than one third (31%) reported full confidence in their ability to select appropriate management to prevent or slow the progression of CKD. However, 57.7% of the respondents felt fully confident in their ability to understand blood pressure targets, and 54.9% were confident in their understanding of the use of treatments, including angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers. In addition, 50.7% expressed full confidence in initiating diabetes medications that have particular benefits in diabetic kidney disease. Based on the confidence items, the overall mean confidence score for the sample was 49.5 (SD 9.66), with 71.8%, 23.9% and 4.2% of the sample reporting high, average and low confidence levels, respectively.
|
[
"Abdullah Almaqhawi"
] |
https://doi.org/10.3390/ijerph21070880
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999996 |
PMC11276965_p11
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PMC11276965
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sec[2]/p[2]
|
3. Results
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biomedical
|
Study
|
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When analyzing the association between confidence scores and the socio-demographic characteristics of the family medicine physicians ( Table 2 ), our results indicated that a higher confidence score was associated with being younger (Z = 2.022; p = 0.043) and working in PHC (H = 9.465; p = 0.024). No significant differences were observed among confidence scores based on gender, professional degree, or city of practice ( p > 0.05).
|
[
"Abdullah Almaqhawi"
] |
https://doi.org/10.3390/ijerph21070880
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999996 |
PMC11276965_p12
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PMC11276965
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sec[3]/p[0]
|
4. Discussion
| 4.105469 |
biomedical
|
Study
|
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This study evaluated the knowledge and competence of PCPs in managing CKD patients. According to our results, physicians demonstrated high confidence levels. Based on the 12 knowledge and confidence items, the overall mean confidence score was 49.5 out of 60 possible points, with a majority of PCPs categorized as having a high level of confidence (71.8%), followed by average (23.9%) or low (4.2%) levels. To our knowledge, this is the first study conducted in Saudi Arabia to assess the overall confidence level of PCPs regarding CKD management. Apart from one study conducted in the United Kingdom, which generalized confidence levels of PCPs in all aspects, no prior research has been conducted using similar criteria on the same subject . However, a few studies have assessed PCPs’ knowledge of CKD with mixed results. For instance, Jazienicka-Kiełb et al. documented a reasonably high level of knowledge regarding the risk factors, causes and course of CKD, while Agaba et al. reported a lack of understanding of the CKD management guidelines among non-nephrology specialist physicians . Thus, this study is an important contribution to the literature given the difficulties in managing this disease, as gauging the competency levels of PCPs is vital for determining training needs and providing optimum care.
|
[
"Abdullah Almaqhawi"
] |
https://doi.org/10.3390/ijerph21070880
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11276965_p13
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PMC11276965
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sec[3]/p[1]
|
4. Discussion
| 4.015625 |
biomedical
|
Study
|
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Being younger was the only significant factor associated with increased confidence. A previous report published in the United States comparing the knowledge of PCP subspecialties revealed that the PCPs with a subspecialty of internal medicine had more than 3-fold higher odds of showing satisfactory knowledge levels than family practice specialists . However, a Nigerian study comparing family physicians and non-nephrology internists found no significant differences between their levels of knowledge ( p > 0.05) . In our study, we found that the gender, professional degree and practice city had no significant effect on practicing physicians’ confidence levels. Our findings corroborate those of Choukem et al. , who reported that knowledge of CKD did not significantly differ based on the physician’s gender, level of training, hospital practice, or city of practice ( p > 0.05) .
|
[
"Abdullah Almaqhawi"
] |
https://doi.org/10.3390/ijerph21070880
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999998 |
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4. Discussion
| 4.046875 |
biomedical
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Study
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0.00012803077697753906
] |
When examining the details of confidence toward CKD management, we noted the least amount of confidence in the specific criteria for treating and managing CKD patients. Most notably, the gaps were seen in the knowledge of the appropriate guidelines to predict a CKD prognosis, with 18.3% and 4.2% reporting a lack of confidence and needing more knowledge. Similarly, 22.5% and 7% demonstrated confidence, but with support and requiring more training about the next steps in post-diagnosis treatment. Our results are consistent with those of Seidu et al. , who found that PCPs’ ratings ranged from 16.5% to 21.8% when asked if they felt fully confident in CKD presentation, prognosis and staging . Contradicting these reports, Wolide et al. indicated that most care providers knew the CKD stages and their risk factors, many were interested in future CKD management training (71.8%), and most tended to refer CKD patients to a senior physician or nephrologist (78.5%) .
|
[
"Abdullah Almaqhawi"
] |
https://doi.org/10.3390/ijerph21070880
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999995 |
PMC11276965_p15
|
PMC11276965
|
sec[3]/p[3]
|
4. Discussion
| 4.125 |
biomedical
|
Study
|
[
0.9990234375,
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] |
[
0.99365234375,
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0.00017845630645751953
] |
Moreover, a study published in Brazil suggested that isolated serum creatinine was the most widely used test for early diagnosis of CKD, while health appointments and drug intervention were the prominent disease-prevention strategies . This finding is consistent with a study conducted in Pakistan , which reported that serum creatinine was the first choice for estimating kidney function (78.1%) and 24 h collection of urine the first one for clearance of creatinine (63.8%) . However, only 37.9% used mathematical formulas for the estimation of eGFR. Among internal medicine residents in the United States, the selected interventions for slowing the progression of CKD included aggressive glycaemic control, lipid control, dietary salt restriction, weight loss, the use of angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers, and smoking, with many of the residents reporting they knew about using eGFR to estimate CKD progression . In our study, most PCPs were either confident without support or fully confident about the importance of using and their ability to interpret the urine albumin–creatinine ratio. In addition, their confidence was high in their knowledge of the next steps for appropriate treatment, and they felt adept at selecting proper treatment and management to prevent the progression of CKD, including the beneficial effect of SGLT2-Is and glucagon-like peptide 1 receptor agonists.
|
[
"Abdullah Almaqhawi"
] |
https://doi.org/10.3390/ijerph21070880
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999996 |
PMC11276965_p16
|
PMC11276965
|
sec[3]/p[4]
|
4. Discussion
| 4.078125 |
biomedical
|
Study
|
[
0.99560546875,
0.00411224365234375,
0.0003859996795654297
] |
[
0.998046875,
0.0006451606750488281,
0.0011749267578125,
0.00024819374084472656
] |
PCPs reported confidence in determining the stages of CKD, the signs and symptoms, and the association between kidney disease and CVD, with 70.4% to 86% of the physicians reporting confidence without support to complete confidence. In Madinah, approximately two thirds of physicians sampled were aware of the five stages of CKD, while only 16% recognized CKD patients with Stage 4 as requiring a referral to a specialist, such as a nephrologist . In Cameroon, the majority of surveyed physicians were aware of the major risk factors of CKD, including diabetes and hypertension, and were confident in recognizing CKD complications, such as anaemia, hypertension, uraemia and hyperkalaemia . However, in the same study, only 12.7% of the physicians reported that they would use serum creatinine alone for CKD diagnosis, and only 21.9% would refer patients at a late stage. In our study, most of the PCPs (88.7%) reported that they were confident without support and/or fully confident in their knowledge of blood pressure targets. This is consistent with the literature, indicating that physicians were adept at the target goal of controlling blood pressure .
|
[
"Abdullah Almaqhawi"
] |
https://doi.org/10.3390/ijerph21070880
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11276965_p17
|
PMC11276965
|
sec[3]/p[5]
|
4. Discussion
| 3.970703 |
biomedical
|
Study
|
[
0.99951171875,
0.0003540515899658203,
0.0003254413604736328
] |
[
0.99853515625,
0.00022101402282714844,
0.0009479522705078125,
0.000059604644775390625
] |
Concerning barriers to CKD management, Al-Zaman et al. stated that although most physicians reported encountering few barriers to CKD management, general practitioners working in PHCs reported experiencing substantial barriers, and female physicians reported significantly more barriers than male physicians . Sperati et al. cited that barriers to managing CKD primary care varied based on patients’ awareness of CKD, poor adherence to treatment recommendations, providers staying with current CKD guidelines, and healthcare systems’ inflexible electronic medical records and limited time and resources . In our study, we did not explore barriers to managing CKD; however, barriers should be considered in future research. The sample size and response rate limitations are acknowledged in our manuscript. Nevertheless, we also emphasize the measures implemented to guarantee that the sample, in spite of its size, is representative of the larger physician population in the targeted areas. In our study, we did not explore barriers to managing CKD. Also, longer recruitment times and additional engagement techniques should be implemented in order to boost response rates and strengthen the sample’s resilience.
|
[
"Abdullah Almaqhawi"
] |
https://doi.org/10.3390/ijerph21070880
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999996 |
PMC11276965_p18
|
PMC11276965
|
sec[4]/p[0]
|
5. Conclusions
| 3.919922 |
biomedical
|
Study
|
[
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] |
[
0.9892578125,
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0.0008473396301269531
] |
PCPs in our study demonstrated a high confidence in managing patients with CKD. Higher reported levels of confidence were seen more frequently among younger physicians practicing in primary healthcare. Although the overall confidence of PCPs was good, some PCPs expressed a lack of confidence, particularly regarding knowledge in predicting CKD prognosis, the recognition of the possible signs and symptoms of more advanced CKD and the subsequent process of the treatment procedures after diagnosis. Hence, PCPs should update their CKD knowledge to provide a thorough and efficient method of managing CKD patients in primary care. The implementation of educational programs based on the presented research findings can enhance the practical value of the manuscript.
|
[
"Abdullah Almaqhawi"
] |
https://doi.org/10.3390/ijerph21070880
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11276977_p0
|
PMC11276977
|
sec[0]/p[0]
|
1. Introduction
| 4.519531 |
biomedical
|
Review
|
[
0.99267578125,
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[
0.04583740234375,
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As global longevity increases, the demographic shift towards an older population introduces significant challenges to healthcare systems worldwide, including managing the higher prevalence of chronic diseases, accommodating the increased demand for geriatric care, and addressing the financial strain on healthcare resources. According to the United Nations’ Department of Economic and Social Affairs, Population Division , the proportion of the global population aged 65 and above is projected to rise from 10% in 2022 to 16%, reaching 1.5 billion, by 2050. Simultaneously, the number of adults aged 80 or older is expected to triple between 2020 and 2050. However, extended lifespans do not necessarily equate to extended healthy life years, often being accompanied by disability, an increased risk of chronic diseases, and diminished quality of life . These issues pose a heavy economic and psychosocial burden on patients and significantly strain healthcare system budgets . Among the chronic conditions impacting older adults, sarcopenia and pelvic floor disorders (PFDs) are notable for their profound effects on daily functioning and overall well-being . Sarcopenia, characterized by the progressive loss of skeletal muscle mass and function, significantly impacts physical health and mobility, thereby increasing the risk of falls, frailty, and a cascade of related health complications . Concurrently, PFDs, broadly defined as conditions that affect the function and integrity of the pelvic floor muscles, nerves, and connective tissue, encompass a spectrum of issues, including urinary and fecal incontinence (FI) and pelvic organ prolapse (POP) . These disorders significantly contribute to morbidity and disability among the elderly, particularly among women, due to factors such as childbirth, hormonal changes during menopause, and anatomical differences . Beyond their physical impacts, these disorders profoundly affect psychological well-being and social engagement, diminishing overall quality of life . Furthermore, emerging evidence suggests that the interplay between sarcopenia and PFDs can exacerbate the severity of both conditions, indicating a complex, bidirectional relationship that amplifies their individual impacts .
|
[
"Yacov Grosman",
"Leonid Kalichman"
] |
https://doi.org/10.3390/ijerph21070879
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999999 |
PMC11276977_p1
|
PMC11276977
|
sec[0]/p[1]
|
1. Introduction
| 4.027344 |
biomedical
|
Review
|
[
0.99267578125,
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0.0028324127197265625
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[
0.01922607421875,
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0.95068359375,
0.0008602142333984375
] |
Despite their significant impacts on the elderly, leading to diminished quality of life and increased healthcare utilization, the intersection of sarcopenia and PFDs remains largely underexplored. This oversight is particularly concerning given that these conditions are often managed within the narrow confines of geriatrics, urogynecology, physical therapy, and potentially other relevant fields, such as nutrition and psychology, leading to compartmentalized care that fails to address the interconnectedness of sarcopenia and PFDs. Such compartmentalization overlooks the potential for these conditions to exacerbate each other and reveals a significant gap in geriatric healthcare, highlighting the urgent need to shift from isolated treatment modalities to a more comprehensive, interdisciplinary approach. Such a shift would not only bridge the existing divide in healthcare practices but also enhance patient outcomes by addressing the bidirectional relationship between muscle strength, pelvic floor integrity, and overall health.
|
[
"Yacov Grosman",
"Leonid Kalichman"
] |
https://doi.org/10.3390/ijerph21070879
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999996 |
PMC11276977_p2
|
PMC11276977
|
sec[0]/p[2]
|
1. Introduction
| 3.884766 |
biomedical
|
Review
|
[
0.98779296875,
0.0063018798828125,
0.006023406982421875
] |
[
0.0026397705078125,
0.00345611572265625,
0.9931640625,
0.0005846023559570312
] |
Currently, there is a lack of comprehensive literature examining the bidirectional relationship between sarcopenia and PFDs. This review addresses this gap by synthesizing existing studies and highlighting the need for integrated research and clinical approaches.
|
[
"Yacov Grosman",
"Leonid Kalichman"
] |
https://doi.org/10.3390/ijerph21070879
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11276977_p3
|
PMC11276977
|
sec[0]/p[3]
|
1. Introduction
| 3.935547 |
biomedical
|
Review
|
[
0.98583984375,
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] |
[
0.002315521240234375,
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0.99169921875,
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] |
This review aims to explore the interplay between sarcopenia and PFDs, focusing on how these conditions interact and affect each other, emphasizing the implications for patient care and treatment strategies.
|
[
"Yacov Grosman",
"Leonid Kalichman"
] |
https://doi.org/10.3390/ijerph21070879
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999998 |
PMC11276977_p4
|
PMC11276977
|
sec[1]/p[0]
|
2. Methods
| 4.09375 |
biomedical
|
Study
|
[
0.9990234375,
0.0005512237548828125,
0.00054931640625
] |
[
0.65478515625,
0.0022106170654296875,
0.342529296875,
0.0004642009735107422
] |
Literature Search Strategy : A comprehensive literature search was performed across PubMed, Scopus, EBSCO, and Google Scholar to identify articles relevant to sarcopenia and PFDs in the context of aging, particularly in older adult women. The search strategy combined keywords and Medical Subject Headings (MeSH) terms, including “sarcopenia”, “pelvic floor disorders”, “urinary incontinence”, “pelvic organ prolapse”, “aging”, “fecal incontinence”, and “women’s health”. Boolean operators and wildcard characters were employed to refine the search further. The following specific research phrases were used: “sarcopenia AND urinary incontinence”, “sarcopenia AND fecal incontinence”, “sarcopenia AND pelvic organ prolapse”, “aging AND sarcopenia”, “aging AND pelvic floor disorders”, “women’s health AND sarcopenia”, and “women’s health AND pelvic floor disorders”. Searches were conducted iteratively, refining the terms based on the initial findings to ensure the inclusion of relevant studies. The search was restricted to articles published in English from inception until January 2024. This time frame was chosen to capture the complete historical development and the most recent advancements in the field, ensuring a comprehensive review. The language restriction to English was applied to ensure the accurate interpretation and analysis of the studies.
|
[
"Yacov Grosman",
"Leonid Kalichman"
] |
https://doi.org/10.3390/ijerph21070879
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999996 |
PMC11276977_p5
|
PMC11276977
|
sec[1]/p[1]
|
2. Methods
| 3.939453 |
biomedical
|
Study
|
[
0.9990234375,
0.0006275177001953125,
0.0002980232238769531
] |
[
0.943359375,
0.0018644332885742188,
0.054473876953125,
0.0002875328063964844
] |
Selection Criteria : Articles were selected that discussed the epidemiology, pathophysiology, diagnosis, treatment, or management of sarcopenia and PFDs, or their interrelationships, specifically within the aging female population. This encompassed both observational (cross-sectional, cohort, case–control) and interventional (randomized controlled trials, clinical trials) studies. Review articles, meta-analyses, systematic reviews, and guidelines were also included to ensure a broad overview. Studies involving broader demographics were included if they provided relevant insights applicable to older adult women. The exclusion criteria excluded studies that did not provide specific data or insights into the aging female population.
|
[
"Yacov Grosman",
"Leonid Kalichman"
] |
https://doi.org/10.3390/ijerph21070879
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11276977_p6
|
PMC11276977
|
sec[1]/p[2]
|
2. Methods
| 3.970703 |
biomedical
|
Study
|
[
0.9990234375,
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] |
[
0.99755859375,
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0.00008106231689453125
] |
Data Extraction : Titles and abstracts were initially screened by two independent reviewers for relevance. The full texts of the selected articles were then reviewed to confirm their inclusion, with any disagreements resolved through consensus. A standardized data extraction form was used to collect information on the study design, participant demographics, interventions or exposures, outcomes measured, and key findings. The extraction form ensured consistent data collection across studies, capturing all relevant information for a comprehensive analysis.
|
[
"Yacov Grosman",
"Leonid Kalichman"
] |
https://doi.org/10.3390/ijerph21070879
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11276977_p7
|
PMC11276977
|
sec[1]/p[3]
|
2. Methods
| 4 |
biomedical
|
Review
|
[
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] |
[
0.07000732421875,
0.00244140625,
0.9267578125,
0.0005512237548828125
] |
Data Synthesis : Data synthesis was conducted narratively, organizing the findings according to the review’s objectives. This included identifying and integrating key themes from the literature to build a comprehensive narrative around the relationship between sarcopenia and PFDs in aging women, their impacts on health and functionality, and their implications for treatment strategies. The narrative synthesis was structured to highlight epidemiological associations, interaction mechanisms, and clinical implications. Criteria such as the study design’s appropriateness, sample size considerations, and methodological clarity in the statistical analysis were rigorously applied to ensure the robustness of the included studies for this narrative review.
|
[
"Yacov Grosman",
"Leonid Kalichman"
] |
https://doi.org/10.3390/ijerph21070879
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999996 |
PMC11276977_p8
|
PMC11276977
|
sec[2]/sec[0]/p[0]
|
3.1. Sarcopenia
| 4.015625 |
biomedical
|
Review
|
[
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] |
[
0.01415252685546875,
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] |
The term sarcopenia, introduced by Irwin Rosenberg in the late 1980s, translates from Greek to ‘loss of flesh’, underscoring the essence of the condition—age-related muscle deterioration . Its recognition as a distinct disease entity was marked by the allocation of an ICD-10-CM code (M62.84) in 2016 . Sarcopenia has been defined as a progressive and generalized skeletal muscle disease that results in a significant reduction in muscle strength, muscle quantity, or quality. Severe cases are further distinguished by additional deficits in physical performance .
|
[
"Yacov Grosman",
"Leonid Kalichman"
] |
https://doi.org/10.3390/ijerph21070879
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11276977_p9
|
PMC11276977
|
sec[2]/sec[0]/p[1]
|
3.1. Sarcopenia
| 4.101563 |
biomedical
|
Study
|
[
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[
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] |
Even in the realm of “healthy aging”, there is a consistent decline in skeletal muscle quality, marked by changes in structure, mechanics, and function . Research indicates that adults lose approximately 25% of their peak muscle mass between the ages of 40 and 70, with this decline accelerating beyond the age of 70 with a gradual decline of about 2% each year . Moreover, the rate of muscle strength loss (dynapenia) progresses 2–5 times faster than the reduction in muscle mass, suggesting a decline in muscle quality . Notably, individuals over 75 experience a dramatic decline, losing around 60% of their peak muscle strength and 30% of their physical function .
|
[
"Yacov Grosman",
"Leonid Kalichman"
] |
https://doi.org/10.3390/ijerph21070879
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999999 |
PMC11276977_p10
|
PMC11276977
|
sec[2]/sec[0]/p[2]
|
3.1. Sarcopenia
| 3.101563 |
biomedical
|
Other
|
[
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] |
[
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] |
However, while the natural aging process can lead to some loss of muscle function, sarcopenia represents a more severe and clinically significant deterioration.
|
[
"Yacov Grosman",
"Leonid Kalichman"
] |
https://doi.org/10.3390/ijerph21070879
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999994 |
PMC11276977_p11
|
PMC11276977
|
sec[2]/sec[0]/p[3]
|
3.1. Sarcopenia
| 4.382813 |
biomedical
|
Study
|
[
0.9990234375,
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0.0004057884216308594
] |
[
0.572265625,
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0.4228515625,
0.0007519721984863281
] |
The underlying pathophysiological mechanisms of sarcopenia are multifaceted and complex. With aging, the crucial balance between muscle protein synthesis and breakdown is disrupted, mainly due to a decline in anabolic hormones like testosterone, growth hormone, and insulin-like growth factor 1, which are essential in maintaining muscle mass . This hormonal decline is compounded by changes in the metabolic and cellular environments within muscle tissue, such as altered insulin signaling and mitochondrial dysfunction, alongside chronic low-grade inflammation and oxidative stress, all of which impede muscle cell repair and regeneration . Additionally, the number of muscle satellite cells, vital for muscle repair, diminishes with age, limiting muscle growth and recovery capabilities and thus compromising overall muscle function .
|
[
"Yacov Grosman",
"Leonid Kalichman"
] |
https://doi.org/10.3390/ijerph21070879
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999998 |
PMC11276977_p12
|
PMC11276977
|
sec[2]/sec[0]/p[4]
|
3.1. Sarcopenia
| 4.308594 |
biomedical
|
Study
|
[
0.99951171875,
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0.00014030933380126953
] |
[
0.93603515625,
0.006549835205078125,
0.056854248046875,
0.0006051063537597656
] |
Neuromuscular degeneration significantly contributes to sarcopenia’s progression. The loss of motoneurons reduces the muscle fiber number and size, while insufficient reinnervation by the remaining neurons diminishes muscle function . Compounded by age-related deterioration at the neuromuscular junction, these changes result in decreased muscle activation and force production . Additionally, sarcopenic muscle exhibits a reduced size and number of myofibers, especially type II fibers, leading to fewer motor units and increased intramuscular fat .
|
[
"Yacov Grosman",
"Leonid Kalichman"
] |
https://doi.org/10.3390/ijerph21070879
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11276977_p13
|
PMC11276977
|
sec[2]/sec[0]/p[5]
|
3.1. Sarcopenia
| 3.970703 |
biomedical
|
Review
|
[
0.9990234375,
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[
0.211181640625,
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0.0006070137023925781
] |
Moreover, lifestyle factors such as poor nutrition and reduced physical activity not only contribute to the development of sarcopenia but also significantly exacerbate its progression. These factors highlight the role of environmental influences in both triggering and accelerating the decline in muscle mass and strength. Specifically, inactivity exacerbates aging’s effects on muscle, highlighting disuse as a primary factor in the age-related loss of muscle mass and strength .
|
[
"Yacov Grosman",
"Leonid Kalichman"
] |
https://doi.org/10.3390/ijerph21070879
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999998 |
PMC11276977_p14
|
PMC11276977
|
sec[2]/sec[0]/p[6]
|
3.1. Sarcopenia
| 4.335938 |
biomedical
|
Review
|
[
0.994140625,
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] |
[
0.0279998779296875,
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0.0007395744323730469
] |
The diagnostic criteria for sarcopenia are generally divided into three primary categories: (a) muscle strength, commonly evaluated using the hand grip strength; (b) muscle mass, typically quantified as the appendicular skeletal muscle mass adjusted for height or body mass index (BMI); and (c) physical performance, frequently assessed using the gait speed . Recognizing the established diagnostic cutoffs is crucial in accurately differentiating normal aging from sarcopenia. Among the various frameworks for diagnosis, the European Working Group on Sarcopenia in Older People (EWGSOP2) provides widely recognized criteria . According to the EWGSOP2, sarcopenia is probable when low muscle strength is detected, explicitly defined as hand grip strength of less than 27 kg for men and less than 16 kg for women. For muscle mass, low levels are indicated by an appendicular skeletal muscle mass divided by height squared (ASM/h 2 ) of less than 7.0 kg/m 2 for men and less than 5.5 kg/m 2 for women. Additionally, a gait speed of less than 0.8 m per second over a short distance may suggest severe sarcopenia . These specific thresholds from the EWGSOP2 illustrate the practical application of the diagnostic criteria and help in the clinical identification and management of sarcopenia.
|
[
"Yacov Grosman",
"Leonid Kalichman"
] |
https://doi.org/10.3390/ijerph21070879
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999998 |
PMC11276977_p15
|
PMC11276977
|
sec[2]/sec[0]/p[7]
|
3.1. Sarcopenia
| 3.048828 |
biomedical
|
Other
|
[
0.99658203125,
0.0021495819091796875,
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[
0.0145111083984375,
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0.002727508544921875
] |
Sarcopenia is associated with a broad spectrum of adverse health outcomes. This condition not only leads to an increased risk of falls and fractures but also has significant implications for functional limitations, making daily activities more challenging and often leading to disability in performing activities of daily living independently .
|
[
"Yacov Grosman",
"Leonid Kalichman"
] |
https://doi.org/10.3390/ijerph21070879
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11276977_p16
|
PMC11276977
|
sec[2]/sec[0]/p[8]
|
3.1. Sarcopenia
| 3.773438 |
biomedical
|
Review
|
[
0.99755859375,
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] |
[
0.061492919921875,
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0.84912109375,
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] |
Hospitalization and institutionalization become more likely outcomes for individuals suffering from sarcopenia, as their increased care needs and functional limitations may necessitate admission into both short-term and long-term care facilities . Furthermore, sarcopenia is an independent predictor of increased mortality risk, highlighting its critical impact on longevity and the urgent need for intervention .
|
[
"Yacov Grosman",
"Leonid Kalichman"
] |
https://doi.org/10.3390/ijerph21070879
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11276977_p17
|
PMC11276977
|
sec[2]/sec[0]/p[9]
|
3.1. Sarcopenia
| 3.789063 |
biomedical
|
Review
|
[
0.9970703125,
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0.0012140274047851562
] |
[
0.0190582275390625,
0.16796875,
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0.0014400482177734375
] |
Sarcopenia’s influence extends to impaired metabolic health, with a noted association with type 2 diabetes mellitus , osteoporosis , and cardiometabolic diseases , indicating a complex interplay between muscle mass reduction and metabolic dysregulation. This relationship emphasizes the necessity of addressing sarcopenia within the broader context of chronic disease management.
|
[
"Yacov Grosman",
"Leonid Kalichman"
] |
https://doi.org/10.3390/ijerph21070879
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11276977_p18
|
PMC11276977
|
sec[2]/sec[0]/p[10]
|
3.1. Sarcopenia
| 3.123047 |
biomedical
|
Review
|
[
0.99755859375,
0.0009131431579589844,
0.0015592575073242188
] |
[
0.033111572265625,
0.1602783203125,
0.80517578125,
0.0013990402221679688
] |
In addition, sarcopenia is strongly associated with various long-term conditions, including musculoskeletal, endocrine, neurological, psychiatric, eye, and cardiovascular conditions . Moreover, sarcopenia is associated with cognitive impairment and depression , suggesting a link between physical and mental health that warrants further exploration.
|
[
"Yacov Grosman",
"Leonid Kalichman"
] |
https://doi.org/10.3390/ijerph21070879
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999994 |
PMC11276977_p19
|
PMC11276977
|
sec[2]/sec[0]/p[11]
|
3.1. Sarcopenia
| 2.314453 |
biomedical
|
Other
|
[
0.99462890625,
0.001758575439453125,
0.003643035888671875
] |
[
0.0270538330078125,
0.83642578125,
0.1343994140625,
0.0019989013671875
] |
This wide range of associations underscores the pervasive impact of sarcopenia on the health and well-being of older adults.
|
[
"Yacov Grosman",
"Leonid Kalichman"
] |
https://doi.org/10.3390/ijerph21070879
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999998 |
PMC11276977_p20
|
PMC11276977
|
sec[2]/sec[1]/p[0]
|
3.2. Pelvic Floor Disorders
| 3.587891 |
biomedical
|
Other
|
[
0.99755859375,
0.0017986297607421875,
0.0007109642028808594
] |
[
0.016448974609375,
0.9228515625,
0.0587158203125,
0.0020580291748046875
] |
PFDs refer to a spectrum of clinical conditions resulting from pelvic floor muscle (PFM) and connective tissue dysfunction. These disorders predominantly affect the structural support and function of the pelvic organs, leading to urinary incontinence (UI), anal incontinence (AI), and POP .
|
[
"Yacov Grosman",
"Leonid Kalichman"
] |
https://doi.org/10.3390/ijerph21070879
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999996 |
PMC11276977_p21
|
PMC11276977
|
sec[2]/sec[1]/p[1]
|
3.2. Pelvic Floor Disorders
| 3.927734 |
biomedical
|
Study
|
[
0.9990234375,
0.00031304359436035156,
0.0006847381591796875
] |
[
0.8984375,
0.001247406005859375,
0.09991455078125,
0.00020754337310791016
] |
PFDs represent a significant health concern among adult women, with research indicating their substantial prevalence across various populations. A recent study conducted in Spain involving 1446 women found that approximately 40% of women presented with a single problem, around 17% had two disorders, approximately 6% experienced three problems, and about 2% had four PFDs. UI emerged as the most frequent issue, followed by pelvic pain, symptoms of POP, and FI . In the United States, a study conducted by Wu et al. revealed that approximately one quarter of women encounter at least one form of PFD, with this prevalence notably escalating with age. The rate more than doubles among women aged over 80 years.
|
[
"Yacov Grosman",
"Leonid Kalichman"
] |
https://doi.org/10.3390/ijerph21070879
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999995 |
PMC11276977_p22
|
PMC11276977
|
sec[2]/sec[1]/p[2]
|
3.2. Pelvic Floor Disorders
| 3.998047 |
biomedical
|
Study
|
[
0.9990234375,
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0.0009813308715820312
] |
[
0.9912109375,
0.0010328292846679688,
0.00745391845703125,
0.00007164478302001953
] |
The anticipated trends in the prevalence of PFDs among women in the United States highlight a critical public health concern, reflective of the shifting demographics towards an older female population. Utilizing data from the 2005 National Health and Nutrition Examination Survey and population projections from the U.S. Census Bureau spanning 2010 to 2050, Wu et al. project a substantial rise in the occurrence of PFDs. By 2050, the number of women experiencing at least one PFDs is expected to escalate from 28.1 million in 2010 to 43.8 million. This projection delineates significant increases across specific disorders, with UI predicted to surge by 55%, FI by 59%, and POP by 46%. Such projections are instrumental in underscoring the evolving landscape of women’s health needs directly tied to an aging demographic.
|
[
"Yacov Grosman",
"Leonid Kalichman"
] |
https://doi.org/10.3390/ijerph21070879
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11276977_p23
|
PMC11276977
|
sec[2]/sec[1]/p[3]
|
3.2. Pelvic Floor Disorders
| 3.761719 |
biomedical
|
Other
|
[
0.9921875,
0.00499725341796875,
0.0029888153076171875
] |
[
0.009735107421875,
0.61572265625,
0.3720703125,
0.0021610260009765625
] |
Urinary incontinence: UI is defined as “the complaint of any involuntary loss of urine” . This encompasses a range of conditions where the leakage of urine occurs at times that may not be socially or hygienically acceptable and is a significant enough problem to warrant attention. Furthermore, this acknowledges the broad spectrum of experiences among individuals, including those with rare or incidental episodes of UI, highlighting the condition’s varied impact on quality of life and personal distress. UI manifests in several subtypes, each defined by distinct triggers and symptoms.
|
[
"Yacov Grosman",
"Leonid Kalichman"
] |
https://doi.org/10.3390/ijerph21070879
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999998 |
PMC11276977_p24
|
PMC11276977
|
sec[2]/sec[1]/p[4]
|
3.2. Pelvic Floor Disorders
| 4.214844 |
biomedical
|
Review
|
[
0.9990234375,
0.0005903244018554688,
0.00031185150146484375
] |
[
0.491455078125,
0.01019287109375,
0.497314453125,
0.0011425018310546875
] |
Stress UI (SUI) occurs when physical activities with abdominal pressure, such as coughing, sneezing, exercising, lifting, or laughing, lead to involuntary urine leakage . SUI is attributed to a combination of factors, including weakened PFM, sphincter dysfunction, urethral support loss, and age-related changes in urethral function . However, the two primary pathophysiological mechanisms identified in SUI are urethral hypermobility and intrinsic sphincter deficiency, representing a spectrum rather than distinct entities. Urethral hypermobility is characterized by insufficient pelvic floor support, leading to unequal pressure transmission during intra-abdominal pressure rises. Intrinsic sphincter deficiency involves a failure in the urethral sphincter mechanics, resulting in leakage even with minimal pressure increases .
|
[
"Yacov Grosman",
"Leonid Kalichman"
] |
https://doi.org/10.3390/ijerph21070879
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999994 |
PMC11276977_p25
|
PMC11276977
|
sec[2]/sec[1]/p[5]
|
3.2. Pelvic Floor Disorders
| 4.113281 |
biomedical
|
Study
|
[
0.99853515625,
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0.00037384033203125
] |
[
0.4140625,
0.25439453125,
0.32861328125,
0.002986907958984375
] |
Contrary to SUI, urge UI (UUI) arises from physiological disturbances within bladder function. This condition is marked by a sudden, overpowering urge to urinate that leads to involuntary leakage. UUI is often attributed to detrusor muscle overactivity or neurological factors compromising normal bladder control . Poor detrusor compliance leads to reduced bladder capacity and increased filling pressures, while bladder hypersensitivity, mediated by abnormal sensory signal processing from the bladder, enhances the sensation of urgency .
|
[
"Yacov Grosman",
"Leonid Kalichman"
] |
https://doi.org/10.3390/ijerph21070879
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11276977_p26
|
PMC11276977
|
sec[2]/sec[1]/p[6]
|
3.2. Pelvic Floor Disorders
| 3.318359 |
biomedical
|
Other
|
[
0.99755859375,
0.001384735107421875,
0.0010328292846679688
] |
[
0.0301055908203125,
0.86572265625,
0.10260009765625,
0.001750946044921875
] |
Mixed UI combines SUI and UUI symptoms, presenting a dual challenge of incontinence with an overlap in their pathophysiological mechanisms . Most women do not have pure stress or urge incontinence, and studies show that mixed incontinence is the most common type of urine loss in women .
|
[
"Yacov Grosman",
"Leonid Kalichman"
] |
https://doi.org/10.3390/ijerph21070879
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999999 |
PMC11276977_p27
|
PMC11276977
|
sec[2]/sec[1]/p[7]
|
3.2. Pelvic Floor Disorders
| 2.617188 |
biomedical
|
Other
|
[
0.98974609375,
0.00682830810546875,
0.003459930419921875
] |
[
0.0027313232421875,
0.98779296875,
0.00798797607421875,
0.001392364501953125
] |
Anal incontinence: AI and FI are related but distinct conditions with significant implications for diagnosis and management. FI involves the involuntary loss of fecal material , while AI encompasses fecal and gas leakage, impacting social interactions and psychological well-being .
|
[
"Yacov Grosman",
"Leonid Kalichman"
] |
https://doi.org/10.3390/ijerph21070879
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999998 |
PMC11276977_p28
|
PMC11276977
|
sec[2]/sec[1]/p[8]
|
3.2. Pelvic Floor Disorders
| 4.234375 |
biomedical
|
Review
|
[
0.99755859375,
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0.0006103515625
] |
[
0.294677734375,
0.313232421875,
0.38720703125,
0.00482177734375
] |
The process of defecation is initiated by rectal distension, which leads to rectal contraction, an urgency sensation, and the reflex relaxation of the internal anal sphincter. Socially convenient circumstances allow for PFM relaxation and subsequent defecation, whereas, in other cases, the voluntary contraction of the external sphincter and puborectalis muscles can defer defecation . Within this mechanism, anal continence is maintained through a coordinated effort between the anal sphincters, PFM, rectal and colonic motility, and central and peripheral nervous systems. FI emerges when there are disruptions to this process, which can result from a range of factors, such as disturbances in bowel habits, altered bowel motility, damage or weakening of the anal sphincter muscles, conditions that lead to poor rectal compliance like rectal inflammation, abnormalities in rectal sensation, or dysfunction in the PFM .
|
[
"Yacov Grosman",
"Leonid Kalichman"
] |
https://doi.org/10.3390/ijerph21070879
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11276977_p29
|
PMC11276977
|
sec[2]/sec[1]/p[9]
|
3.2. Pelvic Floor Disorders
| 4.257813 |
biomedical
|
Study
|
[
0.9990234375,
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] |
[
0.728515625,
0.004657745361328125,
0.265869140625,
0.0006566047668457031
] |
Aging significantly influences FI through various physiological and structural changes in the anorectal region. The internal and external anal sphincters undergo changes such as fibrosis, thinning, and decreased muscle strength, leading to a reduced resting tone and maximum squeeze pressures . This sphincter deterioration is a key contributor to FI’s increased occurrence in the elderly. Additionally, the aging process compromises PFM support, introducing laxity that alters the anorectal angle and disrupts the continence mechanism. Age-related declines in rectal sensation and compliance further exacerbate the FI risk by impairing the rectum’s reservoir function. Decreased sensation extends the time to recognize rectal filling, and diminished compliance restricts stool accommodation, heightening the likelihood of incontinence episodes .
|
[
"Yacov Grosman",
"Leonid Kalichman"
] |
https://doi.org/10.3390/ijerph21070879
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11276977_p30
|
PMC11276977
|
sec[2]/sec[1]/p[10]
|
3.2. Pelvic Floor Disorders
| 3.939453 |
biomedical
|
Other
|
[
0.99267578125,
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0.0010156631469726562
] |
[
0.0260162353515625,
0.88134765625,
0.08953857421875,
0.00307464599609375
] |
Pelvic organ prolapse: POP is defined by the International Continence Society and the International Urogynecological Association as the descent of one or more of the anterior vaginal wall, posterior vaginal wall, the uterus (cervix), or the apex of the vagina (vaginal vault or cuff scar post-hysterectomy). According to this definition, it is essential to correlate the presence of any such anatomical changes with relevant symptoms experienced by the woman, which may include alterations in normal sensation, structure, or functional capabilities in relation to the position of her pelvic organs .
|
[
"Yacov Grosman",
"Leonid Kalichman"
] |
https://doi.org/10.3390/ijerph21070879
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999996 |
PMC11276977_p31
|
PMC11276977
|
sec[2]/sec[1]/p[11]
|
3.2. Pelvic Floor Disorders
| 4.164063 |
biomedical
|
Review
|
[
0.998046875,
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0.0008401870727539062
] |
[
0.113525390625,
0.0033283233642578125,
0.88232421875,
0.0006265640258789062
] |
The most frequently reported symptoms include sensations of a vaginal lump or bulge and a ‘dragging’ sensation within the pelvis, which can profoundly affect a woman’s quality of life . Symptomatic individuals may describe a sensation akin to sitting on a ball or an egg and may observe tissue protruding through the vagina, complicating routine activities such as voiding or passing stool . The symptom complex of POP extends beyond bulge symptoms to include pelvic pressure, groin pain, low back pain, painful intercourse, difficult bowel movements, UI or FI, and sexual dysfunction, encompassing difficulties in achieving orgasm and diminished vaginal sensation . Notably, research indicates that a significant proportion of women with POP exhibit signs of central sensitization, reflecting an enhanced response of the central nervous system to stimulation, which may exacerbate pain perception .
|
[
"Yacov Grosman",
"Leonid Kalichman"
] |
https://doi.org/10.3390/ijerph21070879
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11276977_p32
|
PMC11276977
|
sec[2]/sec[1]/p[12]
|
3.2. Pelvic Floor Disorders
| 4.554688 |
biomedical
|
Study
|
[
0.9990234375,
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] |
[
0.724609375,
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0.2705078125,
0.0010099411010742188
] |
The pathophysiology of POP is characterized by biomechanical and structural alterations within the pelvic floor and its supporting tissue. The weakening or damage to the PFM, endopelvic fascia, and pelvic ligaments undermines their capacity to sustain the pelvic organs, which leads to their downward displacement into the vaginal canal . This condition is marked by changes in the composition and structure of collagen and elastin in the pelvic tissue, leading to diminished elasticity and structural integrity . Furthermore, the normal distribution of intra-abdominal pressure is disrupted due to compromised support, exacerbating the organ prolapse . Consequently, this disruption results in the mechanical displacement of the organs and potentially impairs their functionality, manifesting as urinary, bowel, and sexual dysfunction . Aging plays a pivotal role, contributing to tissue denervation, devascularization, anatomical changes, and increased collagen degradation, alongside hormonal variations, all of which may reduce mechanical strength and predispose individuals to POP .
|
[
"Yacov Grosman",
"Leonid Kalichman"
] |
https://doi.org/10.3390/ijerph21070879
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999998 |
PMC11276977_p33
|
PMC11276977
|
sec[2]/sec[2]/p[0]
|
3.3. Bidirectional Relationships between Sarcopenia and PFDs
| 3.511719 |
biomedical
|
Review
|
[
0.99853515625,
0.0004696846008300781,
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] |
[
0.1600341796875,
0.1737060546875,
0.6650390625,
0.0012617111206054688
] |
Current research suggests a bidirectional relationship between sarcopenia and PFDs in the aging population, revealing not just a coincidental co-occurrence but a potential causative interplay that may exacerbate the severity and implications of each disorder.
|
[
"Yacov Grosman",
"Leonid Kalichman"
] |
https://doi.org/10.3390/ijerph21070879
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999995 |
PMC11276977_p34
|
PMC11276977
|
sec[2]/sec[2]/p[1]
|
3.3. Bidirectional Relationships between Sarcopenia and PFDs
| 4.433594 |
biomedical
|
Review
|
[
0.998046875,
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] |
[
0.338134765625,
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] |
Sarcopenia’s Impact on PFDs: Several studies have demonstrated how sarcopenia can influence the development and severity of PFDs. Specifically, a longitudinal study found that variations in body composition and muscle strength are closely linked to the risk of SUI and UUI. It revealed that a decline in grip strength of 5% or more significantly increases the likelihood of these disorders, whereas an improvement in appendicular lean mass reduces their occurrence . Further reinforcing this connection, cross-sectional studies have directly linked UI to diminished muscle mass and strength, emphasizing the crucial role of sarcopenia in the development of UI . Additional research has indicated that severe forms of POP often coexist with sarcopenia, suggesting that muscle deterioration might exacerbate the severity of POP . This is complemented by findings that deteriorated muscle quality, especially in the psoas muscle, is significantly associated with the increased severity of POP . The relationship between sarcopenia and FI, particularly in patients with dysphagia, has also been investigated, revealing a significant increase in the risk of FI associated with sarcopenia . Furthermore, rehabilitation outcomes for patients suffering from sarcopenia also show that sarcopenia adversely affects the recovery of independence in basic pelvic functions, such as urination and defecation . These findings collectively demonstrate a significant association between sarcopenia and the lifecycle of PFDs. Sarcopenia may contribute to the initiation of these conditions, potentially exacerbate their severity, and complicate recovery efforts through mechanisms such as decreased muscle strength and the reduced force-generating capacity of the PFM. The muscle deterioration associated with sarcopenia, including a decrease in the cross-sectional area of type II muscle fibers and an increase in fibrosis, is associated with an increased risk of incontinence and POP . Detailed mechanisms are discussed in the ‘Mechanisms of Interaction’ section.
|
[
"Yacov Grosman",
"Leonid Kalichman"
] |
https://doi.org/10.3390/ijerph21070879
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999998 |
PMC11276977_p35
|
PMC11276977
|
sec[2]/sec[2]/p[2]
|
3.3. Bidirectional Relationships between Sarcopenia and PFDs
| 2.177734 |
biomedical
|
Other
|
[
0.9951171875,
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] |
[
0.10797119140625,
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] |
PFDs’ Impact on Sarcopenia: Despite the paucity of research exploring the reverse relationship, evidence suggests that PFDs may also lead to sarcopenia.
|
[
"Yacov Grosman",
"Leonid Kalichman"
] |
https://doi.org/10.3390/ijerph21070879
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999998 |
PMC11276977_p36
|
PMC11276977
|
sec[2]/sec[2]/p[3]
|
3.3. Bidirectional Relationships between Sarcopenia and PFDs
| 4.085938 |
biomedical
|
Study
|
[
0.99951171875,
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[
0.95556640625,
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] |
Given that significant functional impairments are key indicators in the diagnosis of sarcopenia, research examining the relationship between new-onset urinary incontinence and physical performance measures like gait speed and timed chair stand tests has found that urinary incontinence could serve as an early indicator of this muscle-wasting condition . This link is supported by findings that older adults with fecal incontinence symptoms experienced significant declines in physical performance over time, suggesting a direct connection between PFDs and the development or worsening of sarcopenia . Additionally, a recent survey found that 46% of women with symptomatic pelvic floor disorders ceased participating in specific physical activities, particularly high-impact sports and gym-based strength training, which are crucial in maintaining muscle mass and strength. These behavior changes highlight the impact of PFDs on physical activity levels, potentially initiating or exacerbating sarcopenia.
|
[
"Yacov Grosman",
"Leonid Kalichman"
] |
https://doi.org/10.3390/ijerph21070879
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999996 |
PMC11276977_p37
|
PMC11276977
|
sec[2]/sec[2]/p[4]
|
3.3. Bidirectional Relationships between Sarcopenia and PFDs
| 3.798828 |
biomedical
|
Review
|
[
0.9990234375,
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[
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0.0005216598510742188
] |
Evidence suggests that pelvic floor disorders may influence the progression of sarcopenia, particularly by limiting physical activity and impairing routine daily functions. While studies indicate that the symptoms of PFDs, such as incontinence, could lead to decreased overall physical performance and potentially accelerate sarcopenia, the precise nature of this relationship warrants further detailed investigation to develop effective integrated treatment strategies.
|
[
"Yacov Grosman",
"Leonid Kalichman"
] |
https://doi.org/10.3390/ijerph21070879
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999998 |
PMC11276977_p38
|
PMC11276977
|
sec[2]/sec[3]/p[0]
|
3.4. Mechanisms of Interaction
| 3.853516 |
biomedical
|
Review
|
[
0.9990234375,
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[
0.338623046875,
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] |
Epidemiological data reveal an overlap in the prevalence of sarcopenia and PFDs among older adults, suggesting shared risk factors and possibly common pathological pathways. Despite this observed co-occurrence, the underlying mechanisms that intertwine these conditions remain underexplored . Recognizing this gap, it is important to examine the shared pathophysiological processes underlying sarcopenia and PFDs, highlighting the potential commonalities in their development.
|
[
"Yacov Grosman",
"Leonid Kalichman"
] |
https://doi.org/10.3390/ijerph21070879
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999994 |
PMC11276977_p39
|
PMC11276977
|
sec[2]/sec[3]/p[1]
|
3.4. Mechanisms of Interaction
| 4.703125 |
biomedical
|
Review
|
[
0.9951171875,
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[
0.2032470703125,
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The pelvic floor is a complex anatomical entity comprising muscles, ligaments, and fascial components, intricately woven to support the pelvic organs. This structure primarily includes the levator ani muscle group, consisting of the puborectalis, pubococcygeus, and iliococcygeus muscles, alongside the urogenital diaphragm. Equally important are the sphincter muscles, including the urethral and anal sphincters, which are essential in maintaining control of urination and defecation . Through proper coordination with the nervous system, these elements collectively play a pivotal role in ensuring continence, supporting organ suspension, and facilitating functions such as voiding, defecation, and sexual activities. In responding to increases in intra-abdominal pressure, such as during coughing, the PFM contract involuntarily to uphold the pelvic organ support, closing the urethra, anus, and vagina to maintain continence while also enabling voluntary control for urination, defecation, and sexual functions through sphincter management and organ positioning . The PFM are critical in maintaining pelvic girdle stability, illustrating a finely tuned balance between structural support and functional capability.
|
[
"Yacov Grosman",
"Leonid Kalichman"
] |
https://doi.org/10.3390/ijerph21070879
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999996 |
PMC11276977_p40
|
PMC11276977
|
sec[2]/sec[3]/p[2]
|
3.4. Mechanisms of Interaction
| 4.074219 |
biomedical
|
Other
|
[
0.99755859375,
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[
0.1539306640625,
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Beyond its local significance, the pelvic floor is not an isolated entity. However, it is integrated with distant body structures through myofascial connections, establishing a network that interacts with the abdominal muscles and diaphragm, extending its influence to the feet and neck . Integrating the pelvic floor with the abdominal and surrounding musculature forms a functional unit essential in stabilizing the body posture, contributing to respiratory processes, and participating in locomotion, emphasizing the necessity of considering these interrelations when addressing the pelvic floor’s pathophysiology .
|
[
"Yacov Grosman",
"Leonid Kalichman"
] |
https://doi.org/10.3390/ijerph21070879
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999998 |
PMC11276977_p41
|
PMC11276977
|
sec[2]/sec[3]/p[3]
|
3.4. Mechanisms of Interaction
| 4.507813 |
biomedical
|
Review
|
[
0.99755859375,
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[
0.408447265625,
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] |
Research has shown that the PFM undergo progressive age-related muscle deterioration, similar to sarcopenia’s effects on other skeletal muscles. Specifically, a decrease in the cross-sectional area of PFM, associated with aging, correlates with an increased risk of UI . Furthermore, studies on the obturator internus muscle, a key component of the pelvic floor, reveal age-related reductions in its force-generating capacity and an increase in fibrosis, particularly in individuals over 60 years . Additionally, the study by Alperin et al. identifies that aging significantly reduces the physiological cross-sectional area and increases fibrosis in the PFM, suggesting a notable decline in the force-generating capacity of these muscles. Further supporting the link between age-related sarcopenia and PFDs, a study by Yaşar et al. utilized static MRI to demonstrate that the physiological cross-sectional area of the PFM, specifically the puborectalis part of the levator ani, significantly decreases with age in women with stress and mixed UI. Furthermore, the study by Neshatian et al. highlights that the severity of POP is associated with an increasing psoas muscle fat fraction, a biomarker indicative of sarcopenic changes, suggesting that sarcopenia could significantly influence the exacerbation of POP. Additionally, drawing from the anatomical insights provided by the literature, it was postulated that the weakening of the iliococcygeus muscle may precipitate POP, whereas a diminishment in the strength of the puborectalis muscle is implicated in the onset of UI . These insights draw a direct parallel between the aging impact on the PFM and the broader phenomenon of muscle deterioration seen in sarcopenia, emphasizing the importance of addressing age-related musculoskeletal changes in the context of PFDs.
|
[
"Yacov Grosman",
"Leonid Kalichman"
] |
https://doi.org/10.3390/ijerph21070879
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11276977_p42
|
PMC11276977
|
sec[2]/sec[3]/p[4]
|
3.4. Mechanisms of Interaction
| 4.332031 |
biomedical
|
Study
|
[
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[
0.9931640625,
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Similar to sarcopenia, characterized by a reduction in muscle fiber size and number, especially in type II (fast-twitch) fibers, which are known for their reliance on anaerobic metabolism and their pivotal role in short bursts of high-intensity activity , studies on the PFM also reveal analogous alterations . These fast-twitch fibers within the PFM are essential in maintaining continence in the rapid, forceful contractions that increase the pressure in the urethral and anal sphincters during activities that raise the intra-abdominal pressure, such as coughing, laughing, or physical exertion, thereby preventing urine and fecal leakage . The decline in type II fiber functionality underscores a mutual pathway influencing UI and FI, reflecting the systemic nature of the muscle deterioration observed in sarcopenia and its implications for pelvic floor health.
|
[
"Yacov Grosman",
"Leonid Kalichman"
] |
https://doi.org/10.3390/ijerph21070879
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999996 |
PMC11276977_p43
|
PMC11276977
|
sec[2]/sec[3]/p[5]
|
3.4. Mechanisms of Interaction
| 4.191406 |
biomedical
|
Study
|
[
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] |
[
0.9970703125,
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0.00008589029312133789
] |
Building on the understanding of sarcopenia’s impact on the muscle fiber size and number, including the significant role of type II fibers, the study by Dias et al. extends this narrative to the neural control properties of the PFM in the context of aging. Their research elucidates that aging is associated with a notable decrease in motor unit firing rates and an increase in motor unit action potential amplitudes within the external anal sphincter, highlighting an age-related decline in neural excitation and muscular responsiveness. These findings mirror the neural and muscular deterioration seen in sarcopenia, suggesting a comprehensive age-related decline across both the skeletal and PFM that contributes to the increased prevalence of FI among the elderly .
|
[
"Yacov Grosman",
"Leonid Kalichman"
] |
https://doi.org/10.3390/ijerph21070879
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999995 |
PMC11276977_p44
|
PMC11276977
|
sec[2]/sec[4]/p[0]
|
3.5. Shared Risk Factors
| 3.201172 |
biomedical
|
Other
|
[
0.99853515625,
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] |
[
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] |
In addition to the physiological changes and neural alterations observed in aging populations, it is crucial to consider the shared risk factors contributing to the development of sarcopenia and PFDs.
|
[
"Yacov Grosman",
"Leonid Kalichman"
] |
https://doi.org/10.3390/ijerph21070879
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999994 |
PMC11276977_p45
|
PMC11276977
|
sec[2]/sec[4]/p[1]
|
3.5. Shared Risk Factors
| 4.449219 |
biomedical
|
Study
|
[
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[
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] |
Physical inactivity is a recognized precursor to the onset and progression of sarcopenia, influenced by conditions such as disease-related immobility or disability, as well as lifestyle choices that favor minimal physical engagement. Such inactivity is linked to a cascade of adverse effects, including muscle weakness, which further discourages physical activity and decreases muscle quality and strength . Furthermore, UI is recognized as a significant deterrent to physical activity, establishing a complex interrelationship between physical inactivity, sarcopenia, and PFDs . The interplay between these conditions suggests a vicious cycle where the muscle weakening associated with sarcopenia adversely affects the pelvic floor’s structural and functional integrity, increasing the susceptibility to PFDs. Meanwhile, the challenges posed by PFDs can lead to a reluctance to engage in physical activities, exacerbating the muscle loss and weakness characteristic of sarcopenia. Evidence from a study on older adults residing in nursing homes underscores the significant interplay between sarcopenia and PFDs, highlighting sedentary behavior as a significant exacerbating factor for both conditions. The findings demonstrate how physical inactivity not only accelerates the decline in muscle mass and strength associated with sarcopenia but also contributes to the weakening of the PFM, leading to an increased risk of PFDs such as UI. Furthermore, the study illustrates that individuals with PFDs may experience discomfort, pain, or a fear of incontinence during physical activities, prompting a reduction in their engagement, creating a vicious cycle that amplifies the severity of sarcopenia and further impairs the pelvic floor functionality . Complementing the evidence on PFDs as a deterrent to physical activity, in a large cohort study involving 2914 older adults, 8% reported symptoms of FI, which was associated with significant declines in physical performance over four years. This research further highlights the significant impact of PFDs on physical performance among older adults. It was found that individuals with FI symptoms exhibited notable declines in physical performance over time, underlining the complex relationship where FI is not only potentially influenced by factors such as physical inactivity and muscle weakness but also contributes to the cycle of decreased physical engagement due to the accompanying social and psychological burdens .
|
[
"Yacov Grosman",
"Leonid Kalichman"
] |
https://doi.org/10.3390/ijerph21070879
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11276977_p46
|
PMC11276977
|
sec[2]/sec[4]/p[2]
|
3.5. Shared Risk Factors
| 4.128906 |
biomedical
|
Study
|
[
0.99951171875,
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] |
[
0.99267578125,
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0.00012493133544921875
] |
Another study focusing on the prevalence of sarcopenia in older women with PFDs highlighted the significant presence of sarcopenia among those with POP, indicating that muscle weakening associated with sarcopenia could exacerbate the severity of POP. This aligns with the understanding that physical inactivity can lead to sarcopenia, further impairing the pelvic floor’s integrity and functionality, thereby heightening the vulnerability to PFDs such as POP . However, groundbreaking research from the UK Biobank presents a counterintuitive perspective, showing that more time spent in light-intensity physical activity was associated with an increased risk of developing POP among middle-aged and elderly women. This prospective cohort study revealed that every additional hour per day spent in light-intensity physical activity elevated the risk of POP by 18%, while an increase in sedentary time was inversely associated with the POP risk . These findings challenge the conventional approach that all forms of physical activity uniformly confer protective effects against PFDs and suggest a more complex relationship that may vary with the intensity of the activity.
|
[
"Yacov Grosman",
"Leonid Kalichman"
] |
https://doi.org/10.3390/ijerph21070879
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11276977_p47
|
PMC11276977
|
sec[2]/sec[4]/p[3]
|
3.5. Shared Risk Factors
| 4.4375 |
biomedical
|
Review
|
[
0.99853515625,
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0.000629425048828125
] |
[
0.298095703125,
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0.697265625,
0.000896453857421875
] |
Metabolic syndrome emerges as a significant risk factor for both sarcopenia and PFDs, revealing complex interconnections that underscore the systemic nature of these conditions. In sarcopenia, metabolic syndrome contributes to muscle degradation through insulin resistance, reducing muscle protein synthesis and increasing muscle breakdown. This is compounded by the inflammatory state associated with metabolic syndrome, which can further accelerate muscle loss . Concurrently, metabolic syndrome influences the development of PFDs by exacerbating obesity-related pressures on the pelvic floor, altering adipokine profiles, and fostering systemic inflammation that can weaken the PFM and connective tissue . Therefore, the shared pathways of insulin resistance and chronic inflammation establish metabolic syndrome as a pivotal common risk factor that intricately links the pathogenesis of sarcopenia and PFDs.
|
[
"Yacov Grosman",
"Leonid Kalichman"
] |
https://doi.org/10.3390/ijerph21070879
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999996 |
PMC11276977_p48
|
PMC11276977
|
sec[2]/sec[4]/p[4]
|
3.5. Shared Risk Factors
| 4.308594 |
biomedical
|
Study
|
[
0.9990234375,
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] |
[
0.81298828125,
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] |
Nutritional deficiencies, particularly in protein, vitamin D, and minerals, directly affect both skeletal muscle health and the integrity of the pelvic floor, contributing to sarcopenia and PFDs . These deficiencies reduce muscle mass and function, setting the stage for sarcopenia . Additionally, evidence shows that these nutritional deficiencies also weaken the PFM, thereby increasing the risk of PFDs . Moreover, constipation represents a critical intersecting point in this relationship, arising from sarcopenia due to the reduced functionality of the abdominal and pelvic muscles and directly from poor nutritional habits . The mechanism by which constipation exacerbates PFDs involves increased intra-abdominal pressure during straining efforts to evacuate, which places additional strain on the PFM. Over time, this repetitive stress can further weaken these muscles and supporting structures, leading to or worsening existing PFDs .
|
[
"Yacov Grosman",
"Leonid Kalichman"
] |
https://doi.org/10.3390/ijerph21070879
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999996 |
PMC11276977_p49
|
PMC11276977
|
sec[2]/sec[4]/p[5]
|
3.5. Shared Risk Factors
| 4.257813 |
biomedical
|
Review
|
[
0.998046875,
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] |
[
0.11822509765625,
0.0027103424072265625,
0.87841796875,
0.0004897117614746094
] |
Menopausal hormonal influences: Menopause, which involves a significant decline in estrogen levels, is associated with various changes in musculoskeletal health, potentially influencing both sarcopenia and PFDs. Research shows that estrogen influences muscle protein synthesis and degradation, essential mechanisms for muscle health . It is also suggested that estrogen inhibits disuse-induced muscle atrophy and stimulates regeneration . Estrogen modulates mitochondrial function in the skeletal muscle, impacting energy production and the oxidative capacity, which is important for muscle endurance. It also regulates genes involved in mitochondrial biogenesis and influences satellite cell activity, which is necessary for muscle repair and regeneration . Evidence also indicates that estrogen protects the skeletal muscle from apoptosis, helping to defend against muscle mass loss .
|
[
"Yacov Grosman",
"Leonid Kalichman"
] |
https://doi.org/10.3390/ijerph21070879
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11276977_p50
|
PMC11276977
|
sec[2]/sec[4]/p[6]
|
3.5. Shared Risk Factors
| 4.246094 |
biomedical
|
Study
|
[
0.99951171875,
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] |
[
0.87060546875,
0.0015630722045898438,
0.1275634765625,
0.00032210350036621094
] |
Studies also suggest that estrogen plays a role in modulating the inflammatory responses that affect muscle health. A decrease in estrogen levels is associated with an increase in pro-inflammatory cytokines such as IL-6 and TNF-α . These cytokines can contribute to muscle catabolism, potentially exacerbating muscle mass loss and strength decline in postmenopausal women. Estrogen is observed to mitigate these inflammatory processes, suggesting a role in protecting against inflammation-induced muscle degradation . Furthermore, it influences the ubiquitin–proteasome system involved in protein degradation. Changes in this system during menopause may lead to increased muscle protein breakdown, contributing to the higher prevalence of muscle wasting among postmenopausal women .
|
[
"Yacov Grosman",
"Leonid Kalichman"
] |
https://doi.org/10.3390/ijerph21070879
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11276977_p51
|
PMC11276977
|
sec[2]/sec[4]/p[7]
|
3.5. Shared Risk Factors
| 3.736328 |
biomedical
|
Review
|
[
0.99853515625,
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] |
[
0.11676025390625,
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] |
While the research on estrogen’s role in musculoskeletal health is insightful, it is predominantly derived from in vitro studies. This highlights a significant gap in its clinical translation to human models, particularly in longitudinal studies with postmenopausal women. Thus, further research involving human subjects is essential to fully understand and verify these mechanistic findings and their implications for menopausal healthcare.
|
[
"Yacov Grosman",
"Leonid Kalichman"
] |
https://doi.org/10.3390/ijerph21070879
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999996 |
PMC11276977_p52
|
PMC11276977
|
sec[2]/sec[4]/p[8]
|
3.5. Shared Risk Factors
| 4.046875 |
biomedical
|
Study
|
[
0.99951171875,
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] |
[
0.8671875,
0.0028533935546875,
0.1298828125,
0.00031876564025878906
] |
Specifically regarding PFDs, the presence of abundant estrogen receptors in the pelvic floor indicates that estrogen depletion could significantly impact these structures . However, whether these effects are comparable to those observed in the broader musculoskeletal system is uncertain, underscoring the need for cautious interpretation. The hormonal depletion is linked to increased vulnerability to PFDs, such as UI and POP . Estrogen deficiency affects collagen production, tissue elasticity, and neurovascular support, weakening the pelvic tissue and increasing the susceptibility to prolapse and incontinence .
|
[
"Yacov Grosman",
"Leonid Kalichman"
] |
https://doi.org/10.3390/ijerph21070879
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11276977_p53
|
PMC11276977
|
sec[2]/sec[4]/p[9]
|
3.5. Shared Risk Factors
| 3.796875 |
biomedical
|
Review
|
[
0.99853515625,
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] |
[
0.10968017578125,
0.00583648681640625,
0.8837890625,
0.0004925727844238281
] |
Although some research has explored estrogen’s role in skeletal muscle health, studies on its effects on the pelvic floor during menopause are still scarce. Findings suggest a potential relationship between estrogen deficiency and the onset of PFD symptoms, including both structural failures like prolapse and functional disturbances such as incontinence. However, the specific mechanisms remain under-researched and poorly understood, highlighting the need for further investigation .
|
[
"Yacov Grosman",
"Leonid Kalichman"
] |
https://doi.org/10.3390/ijerph21070879
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11276977_p54
|
PMC11276977
|
sec[2]/sec[4]/p[10]
|
3.5. Shared Risk Factors
| 3.857422 |
biomedical
|
Review
|
[
0.99755859375,
0.001293182373046875,
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] |
[
0.0307769775390625,
0.00189971923828125,
0.966796875,
0.0003237724304199219
] |
Considering the possible roles that sex hormones play in both sarcopenia and PFDs, hormone therapy (HT) emerges as a potential intervention. However, the application of estrogen in managing these conditions is nuanced. Several studies have evaluated the effect of estrogen replacement therapy on sarcopenia parameters in postmenopausal women and have reported a positive effect on muscle strength and function . Despite these findings, for sarcopenia in postmenopausal women, estrogen is not a recommended treatment due to its unconfirmed efficacy and the potential for severe adverse effects .
|
[
"Yacov Grosman",
"Leonid Kalichman"
] |
https://doi.org/10.3390/ijerph21070879
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999998 |
PMC11276977_p55
|
PMC11276977
|
sec[2]/sec[4]/p[11]
|
3.5. Shared Risk Factors
| 3.873047 |
biomedical
|
Review
|
[
0.9970703125,
0.0013132095336914062,
0.001476287841796875
] |
[
0.03680419921875,
0.001880645751953125,
0.9609375,
0.0002923011779785156
] |
Similarly, the application of estrogen therapy in treating PFDs in postmenopausal women presents both potential benefits and challenges. Local estrogen treatments have demonstrated effectiveness in alleviating symptoms of UI by enhancing tissue quality and function , but not for FI and POP . Evidence for the effectiveness of systemic hormone therapy in these conditions is inconclusive and sometimes contradictory. Systemic hormone therapy has been associated with an increased risk of developing or worsening urinary incontinence and does not show consistent benefits in terms of preventing or treating PFDs .
|
[
"Yacov Grosman",
"Leonid Kalichman"
] |
https://doi.org/10.3390/ijerph21070879
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999996 |
PMC11276977_p56
|
PMC11276977
|
sec[2]/sec[4]/p[12]
|
3.5. Shared Risk Factors
| 3.292969 |
biomedical
|
Other
|
[
0.99658203125,
0.0018901824951171875,
0.0016355514526367188
] |
[
0.0379638671875,
0.6865234375,
0.27392578125,
0.0015468597412109375
] |
Given these mixed outcomes, the use of hormone therapy for PFDs requires the careful consideration of individual patient factors and potential side effects, emphasizing the need for tailored therapeutic approaches based on the most recent research findings.
|
[
"Yacov Grosman",
"Leonid Kalichman"
] |
https://doi.org/10.3390/ijerph21070879
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999998 |
PMC11276977_p57
|
PMC11276977
|
sec[2]/sec[4]/p[13]
|
3.5. Shared Risk Factors
| 3.818359 |
biomedical
|
Review
|
[
0.99755859375,
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] |
[
0.0404052734375,
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] |
Exploring shared risk factors underscores the complex interplay between lifestyle, metabolic health, and nutrition in the pathogenesis of sarcopenia and pelvic floor PFDs. These insights lay the groundwork for holistically advanced patient care strategies that address these multifaceted concerns, highlighting the importance of integrated approaches in managing these age-related conditions.
|
[
"Yacov Grosman",
"Leonid Kalichman"
] |
https://doi.org/10.3390/ijerph21070879
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11276977_p58
|
PMC11276977
|
sec[2]/sec[4]/p[14]
|
3.5. Shared Risk Factors
| 3.126953 |
biomedical
|
Study
|
[
0.99853515625,
0.0003228187561035156,
0.0009813308715820312
] |
[
0.73193359375,
0.04541015625,
0.2216796875,
0.0008130073547363281
] |
To encapsulate the critical points discussed in this section, we present Table 1 below, which outlines the main findings regarding the bidirectional relationships, mechanisms of interaction, and shared risk factors between sarcopenia and PFDs.
|
[
"Yacov Grosman",
"Leonid Kalichman"
] |
https://doi.org/10.3390/ijerph21070879
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999998 |
PMC11276977_p59
|
PMC11276977
|
sec[2]/sec[5]/p[0]
|
3.6. Implications for Patient Care
| 3.998047 |
biomedical
|
Review
|
[
0.98876953125,
0.00687408447265625,
0.00457000732421875
] |
[
0.0030193328857421875,
0.0025691986083984375,
0.99365234375,
0.0005517005920410156
] |
Integrated Screening Approach: This review underscores the significance of combined screening for sarcopenia and PFDs as they have well-documented physiological and functional interconnectedness. Specifically, it promotes an insightful assessment recognizing the complex link between the two phenomena. This approach does not suggest creating novel screening tools but utilizing the existing validated instruments for each pathology in collaboration. The innovative aspect lies in the systematic integration of assessments for both conditions within routine clinical evaluations, thus enabling early identification and management.
|
[
"Yacov Grosman",
"Leonid Kalichman"
] |
https://doi.org/10.3390/ijerph21070879
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999998 |
PMC11276977_p60
|
PMC11276977
|
sec[2]/sec[5]/p[1]
|
3.6. Implications for Patient Care
| 3.859375 |
biomedical
|
Study
|
[
0.99853515625,
0.0010480880737304688,
0.0005059242248535156
] |
[
0.6240234375,
0.2186279296875,
0.156005859375,
0.0012760162353515625
] |
Extend Screening to Underlying Conditions: A critical outcome of this analysis underlines the need to extend the screening scope to include underlying conditions that contribute to both sarcopenia and PFDs. These conditions, such as metabolic imbalances and nutritional deficiencies, are known to play a critical role in their development . We believe that a holistic screening approach that includes evaluating these contributory factors is essential to improve the quality of care for both conditions.
|
[
"Yacov Grosman",
"Leonid Kalichman"
] |
https://doi.org/10.3390/ijerph21070879
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11276977_p61
|
PMC11276977
|
sec[2]/sec[5]/p[2]
|
3.6. Implications for Patient Care
| 4 |
biomedical
|
Review
|
[
0.98828125,
0.006229400634765625,
0.00556182861328125
] |
[
0.0030078887939453125,
0.0026950836181640625,
0.99365234375,
0.0004832744598388672
] |
Addressing Cyclical Contributing Factors: Our review highlights the importance of recognizing and addressing the cyclical contributing factors, where one condition may trigger the other—for instance, the way in which sarcopenia can lead to an increased risk of PFDs through mechanisms like constipation or reduced mobility, and, in contrast, how PFDs may contribute to sarcopenia by limiting physical activity. Identifying these cycles offers a substantial opportunity for preventative care, allowing for interventions that treat the existing conditions and disrupt the pathological feedback loops.
|
[
"Yacov Grosman",
"Leonid Kalichman"
] |
https://doi.org/10.3390/ijerph21070879
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999995 |
PMC11276977_p62
|
PMC11276977
|
sec[2]/sec[5]/p[3]
|
3.6. Implications for Patient Care
| 3.978516 |
biomedical
|
Review
|
[
0.9990234375,
0.0004608631134033203,
0.0005469322204589844
] |
[
0.285400390625,
0.006954193115234375,
0.70703125,
0.0005311965942382812
] |
Adapting Resistance Exercise for Patients with PFDs: Resistance exercises are a primary intervention for the prevention and treatment of sarcopenia, allowing one to preserve or regain physical capabilities . The dose–response relationship between PA and sarcopenia has been well established, demonstrating that regular PA, particularly resistance training in a progressive manner, is crucial in preserving or increasing muscle mass and strength, thereby mitigating the effects of sarcopenia . This makes physical activity the most significant modifiable driver of sarcopenia . However, the relationship between PA and PFDs is less clear. While PA generally benefits overall health and can improve PFM function through indirect mechanisms, such as weight management and enhanced general fitness, the specific dose–response relationship between PA and PFDs is not established .
|
[
"Yacov Grosman",
"Leonid Kalichman"
] |
https://doi.org/10.3390/ijerph21070879
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999996 |
PMC11276977_p63
|
PMC11276977
|
sec[2]/sec[5]/p[4]
|
3.6. Implications for Patient Care
| 4.117188 |
biomedical
|
Review
|
[
0.9970703125,
0.0014638900756835938,
0.0014905929565429688
] |
[
0.131591796875,
0.0009446144104003906,
0.8671875,
0.0004031658172607422
] |
Current evidence suggests that mild to moderate PA may decrease the risk of UI and other PFDs, but the impact of high-intensity or light-intensity PA remains controversial and varies depending on the type, intensity, and duration of the exercise, as well as individual patient factors . One possible reason for the lack of a well-defined dose–response relationship between PA and PFDs is the complexity and variability of PFDs themselves. PFDs encompass a range of conditions, each with different pathophysiological mechanisms and risk factors . While these conditions may present separately, they can also influence one another; for instance, POP can lead to UI . Additionally, the impact of PA on the pelvic floor can vary significantly based on individual patient characteristics such as age, parity, hormonal status, baseline pelvic floor muscle strength, and previous physical activity habits . Furthermore, methodological differences in studies, including how PA and PFDs are measured and reported, contribute to their inconsistent findings. The heterogeneity of the study populations and the lack of standardized protocols for the assessment of PA and PFD outcomes further complicate the establishment of a clear dose–response relationship .
|
[
"Yacov Grosman",
"Leonid Kalichman"
] |
https://doi.org/10.3390/ijerph21070879
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999994 |
PMC11276977_p64
|
PMC11276977
|
sec[2]/sec[5]/p[5]
|
3.6. Implications for Patient Care
| 3.945313 |
biomedical
|
Study
|
[
0.9990234375,
0.0005526542663574219,
0.0003941059112548828
] |
[
0.7021484375,
0.003108978271484375,
0.29443359375,
0.0004444122314453125
] |
Despite these challenges, evidence suggests a relationship between exercise intensity and PFM strength. For example, the maximum PFM voluntary contraction (MVC) is notably lower in women who engage in strenuous or high-impact exercise compared to those who participate in mild or moderate activities . This finding underscores the importance of tailoring exercise regimens to enhance the pelvic floor muscle functionality, particularly advocating for moderate-intensity exercises that support rather than strain these muscles . Moreover, women engaging in moderate exercise exhibit better control and strength in the pelvic floor, leading to favorable outcomes in managing PFD symptoms. For instance, to minimize stress on the pelvic floor, focusing on supine moderate-intensity exercises may be advisable, while avoiding prolonged periods of light-intensity physical activity .
|
[
"Yacov Grosman",
"Leonid Kalichman"
] |
https://doi.org/10.3390/ijerph21070879
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999996 |
PMC11276977_p65
|
PMC11276977
|
sec[2]/sec[5]/p[6]
|
3.6. Implications for Patient Care
| 3.992188 |
biomedical
|
Review
|
[
0.99609375,
0.002445220947265625,
0.0014972686767578125
] |
[
0.018798828125,
0.001850128173828125,
0.97900390625,
0.0003788471221923828
] |
Given the conflicting literature on the impact of the exercise intensity on PFDs, exercise regimens for sarcopenic patients must be carefully tailored to ensure that they do not exacerbate PF symptoms. Additionally, a systematic review emphasizes that exercises lacking targeted PFM contraction are not effective treatment regimens for PFDs such as urinary incontinence . To effectively address this, it is essential to incorporate specific PFM exercises into the recommended approach to improve the morphology and muscle function of the pelvic floor. Thus, given the special considerations for sarcopenia patients, integrating PFM exercises with resistance training is essential. Research indicates that voluntary PFM contractions during exercise can help to prevent negative impacts on the pelvic floor, such as bladder neck descent and hiatal area enlargement, which are risks associated with high-impact or strenuous activities .
|
[
"Yacov Grosman",
"Leonid Kalichman"
] |
https://doi.org/10.3390/ijerph21070879
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999998 |
PMC11276977_p66
|
PMC11276977
|
sec[2]/sec[5]/p[7]
|
3.6. Implications for Patient Care
| 3.990234 |
biomedical
|
Review
|
[
0.9951171875,
0.003204345703125,
0.00152587890625
] |
[
0.01715087890625,
0.0167999267578125,
0.96533203125,
0.0006990432739257812
] |
For optimal outcomes, incorporating low-impact strength-training modalities like Pilates, along with targeted pelvic floor exercises, ensures the active engagement of these muscles, enhancing both pelvic floor function and overall muscle strength . Research highlights that supervised and intensive pelvic floor muscle exercises are significantly more effective than unsupervised exercises. Such structured and closely monitored regimens not only improve the symptoms of SUI and POP but are also associated with no known adverse effects, making them a safe and essential component of pelvic health management . This balanced approach not only addresses the muscle deterioration common in sarcopenia but also supports pelvic health, preventing complications like the exacerbation of PFDs.
|
[
"Yacov Grosman",
"Leonid Kalichman"
] |
https://doi.org/10.3390/ijerph21070879
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999996 |
PMC11276977_p67
|
PMC11276977
|
sec[2]/sec[5]/p[8]
|
3.6. Implications for Patient Care
| 3.847656 |
biomedical
|
Review
|
[
0.98388671875,
0.0118408203125,
0.00426483154296875
] |
[
0.0020427703857421875,
0.0124359130859375,
0.984375,
0.001148223876953125
] |
Multidisciplinary Approach: Our review underlines the necessity of a multidisciplinary strategy in managing sarcopenia and PFDs, integrating the expertise of geriatricians, urogynecologists, physical therapists, dietitians, and mental health professionals. This team approach could provide comprehensive care for both conditions and their bidirectional effects, resulting in improved patient outcomes.
|
[
"Yacov Grosman",
"Leonid Kalichman"
] |
https://doi.org/10.3390/ijerph21070879
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11276977_p68
|
PMC11276977
|
sec[2]/sec[5]/p[9]
|
3.6. Implications for Patient Care
| 1.399414 |
other
|
Other
|
[
0.380126953125,
0.0037441253662109375,
0.6162109375
] |
[
0.25830078125,
0.72607421875,
0.01280975341796875,
0.0028972625732421875
] |
To further illustrate these key practical implications, we summarize them in Table 2 below.
|
[
"Yacov Grosman",
"Leonid Kalichman"
] |
https://doi.org/10.3390/ijerph21070879
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11276977_p69
|
PMC11276977
|
sec[2]/sec[6]/p[0]
|
3.7. Implications for Research
| 3.744141 |
biomedical
|
Study
|
[
0.99853515625,
0.0005521774291992188,
0.0007462501525878906
] |
[
0.3994140625,
0.218994140625,
0.38037109375,
0.00106048583984375
] |
Exploration of Integrated Physical Therapy Methods: Despite the recognized benefits of resistance exercise for sarcopenia , the application of targeted physical therapy techniques such as biofeedback, electrostimulation, and the use of vaginal cones remains unexplored in patients with concurrent PFDs. Future research should evaluate the effectiveness and safety of incorporating these techniques in patients with sarcopenia and PFD, without worsening their PF symptoms.
|
[
"Yacov Grosman",
"Leonid Kalichman"
] |
https://doi.org/10.3390/ijerph21070879
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999998 |
PMC11276977_p70
|
PMC11276977
|
sec[2]/sec[6]/p[1]
|
3.7. Implications for Research
| 3.357422 |
biomedical
|
Other
|
[
0.99853515625,
0.0004413127899169922,
0.0009675025939941406
] |
[
0.2196044921875,
0.71337890625,
0.06610107421875,
0.0009765625
] |
Longitudinal Studies on the Bidirectional Relationship: There is a significant gap in longitudinal studies on the progression of sarcopenia and PFDs over time in the same cohort. Examining how these conditions influence each other over the long term could provide invaluable insights into their interplay and guide the development of proactive, preventive strategies.
|
[
"Yacov Grosman",
"Leonid Kalichman"
] |
https://doi.org/10.3390/ijerph21070879
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999996 |
PMC11276977_p71
|
PMC11276977
|
sec[2]/sec[6]/p[2]
|
3.7. Implications for Research
| 3.730469 |
biomedical
|
Review
|
[
0.984375,
0.00787353515625,
0.007740020751953125
] |
[
0.0021038055419921875,
0.004302978515625,
0.9931640625,
0.00046062469482421875
] |
Evaluate the Efficacy of Multidisciplinary Care Models: This review suggests a shift towards comprehensive, interdisciplinary care approaches. Future studies should evaluate the efficacy of such models in managing sarcopenia and PFDs, particularly looking at outcomes related to patient satisfaction, quality of life, and healthcare utilization.
|
[
"Yacov Grosman",
"Leonid Kalichman"
] |
https://doi.org/10.3390/ijerph21070879
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999999 |
PMC11276977_p72
|
PMC11276977
|
sec[3]/p[0]
|
4. Conclusions
| 4.066406 |
biomedical
|
Review
|
[
0.99609375,
0.0027484893798828125,
0.0013818740844726562
] |
[
0.0288543701171875,
0.002964019775390625,
0.9677734375,
0.0005469322204589844
] |
The bidirectional relationship between sarcopenia and PFDs gives more insight into the complex interconnection between these two clinical conditions. Current evidence suggests that sarcopenia and PFDs not only coexist but may also exacerbate each other’s severity and progression. Therefore, an integrated screening and management approach is essential. Furthermore, similar risk factors, particularly physical inactivity, metabolic syndrome, or nutritional deficiencies, result in the development and exacerbation of both conditions. Considering the bidirectional relationship and shared risk factors, healthcare professionals may need to adopt a more integrated approach to increase the quality of care. Moreover, longitudinal research is required to study the natural course of the development of sarcopenia and PFDs and examine the applicability of multidisciplinary models during their management. Finally, the further integration of physical therapy interventions, including tailor-made exercise plans, may be required to prevent the exacerbation of the symptoms.
|
[
"Yacov Grosman",
"Leonid Kalichman"
] |
https://doi.org/10.3390/ijerph21070879
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999995 |
PMC11276977_p73
|
PMC11276977
|
sec[3]/p[1]
|
4. Conclusions
| 3.480469 |
biomedical
|
Other
|
[
0.994140625,
0.003467559814453125,
0.0023555755615234375
] |
[
0.01050567626953125,
0.6767578125,
0.310791015625,
0.0017175674438476562
] |
In conclusion, the evidence above illustrates the need for a paradigm shift towards an integrative approach and preventive care model that prioritizes patient-oriented and interdisciplinary work. By addressing the nature of sarcopenia and PFDs, healthcare professionals can significantly improve the management of these conditions, enhancing the quality of life of the aging population.
|
[
"Yacov Grosman",
"Leonid Kalichman"
] |
https://doi.org/10.3390/ijerph21070879
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 1 |
PMC11276977_p74
|
PMC11276977
|
sec[4]/p[0]
|
5. Limitations
| 4.011719 |
biomedical
|
Review
|
[
0.98828125,
0.006977081298828125,
0.004978179931640625
] |
[
0.0036983489990234375,
0.0015573501586914062,
0.994140625,
0.0005197525024414062
] |
This review is based on existing studies and literature with inherent methodological biases or limitations. The synthesis of these studies may not capture all aspects of the bidirectional relationship between sarcopenia and PFDs. Additionally, the heterogeneity of the study populations and differing diagnostic criteria for sarcopenia and PFDs across studies may limit the generalizability of the findings. As a narrative review, this study does not employ a systematic literature search and selection approach, potentially introducing selection bias. Further research is needed to confirm these findings and explore the mechanisms underlying the relationship between sarcopenia and PFDs in diverse populations.
|
[
"Yacov Grosman",
"Leonid Kalichman"
] |
https://doi.org/10.3390/ijerph21070879
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999998 |
PMC11276989_p0
|
PMC11276989
|
sec[0]/p[0]
|
1. Introduction
| 4.144531 |
biomedical
|
Study
|
[
0.994140625,
0.0002853870391845703,
0.005512237548828125
] |
[
0.8759765625,
0.0099334716796875,
0.11376953125,
0.0002617835998535156
] |
Melon ( Cucumis melo L.) is a vital economic vegetable crop worldwide , with a global production of 27.3 million metric tons. For commercial cultivation, the cultivars Jiashi (JSG) and Huang mengcui (HMC) melon are the most important . Selenium nanoparticles, melatonin, and other bio-stimulants have no negative effects on endophytic bacteria; therefore, they may be conducive to promoting plant health . Plant primary metabolites are directly involved in growth, development, and reproduction . Plant secondary metabolites are not only useful natural products, but they also play important roles in plant defense systems against pathogenic attacks and environmental stresses . Plant secondary metabolites provide defense functions and regulate defense-signaling pathways that protect plants in response to herbivore invasion . Plants produce three main types of secondary metabolites, phenols, terpenes, and nitrogen/sulfur compounds. The shikimic acid pathway leads to the formation of phenolic products involved in plant defenses. Terpenes, based on 5-C isoterpenoids, are toxins and deter herbivores, and nitrogen and sulfur compounds are synthesized mainly from amino acids .
|
[
"Lu Kang",
"Yujiao Jia",
"Yangliu Wu",
"Hejiang Liu",
"Duoyong Zhao",
"Yanjun Ju",
"Canping Pan",
"Jiefei Mao"
] |
https://doi.org/10.3390/ijms25147830
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11276989_p1
|
PMC11276989
|
sec[0]/p[1]
|
1. Introduction
| 4.28125 |
biomedical
|
Study
|
[
0.9990234375,
0.00028228759765625,
0.0007038116455078125
] |
[
0.96484375,
0.0007510185241699219,
0.0340576171875,
0.0001430511474609375
] |
Selenium nanoparticles are less toxic and more biocompatible than sodium selenate or sodium selenite . Selenium nanoparticles increase the carboxylase activity of ribulose diphosphate and the chlorophyll content, especially through the activation of some key genes and proteins involved in the photosynthetic system. Treatments of 25–50 μmol·L −1 selenium nanoparticles reduce the large amount of reactive oxygen species (ROS) produced by nicotinamide adenine dinucleotide phosphate oxidase and enhance glutathione peroxidase (GSH-Px), thereby reducing protein carbonylation in rice seedlings . Foliar applications of 25 mg·L −1 selenium nanoparticles increase cucumber height and leaf area . The activities of antioxidant enzymes in plants are key factors in alleviating the effects of external stress . The exogenous application of selenium nanoparticles improves the photosynthetic pigments of rape by increasing the activities of antioxidant enzymes, such as catalase (CAT), ascorbate peroxidase (APX), and superoxide dismutase (SOD). Additionally, the expression of stress-response genes enhances the drought and heat tolerances of rape .
|
[
"Lu Kang",
"Yujiao Jia",
"Yangliu Wu",
"Hejiang Liu",
"Duoyong Zhao",
"Yanjun Ju",
"Canping Pan",
"Jiefei Mao"
] |
https://doi.org/10.3390/ijms25147830
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999998 |
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