p73 is required for vessel integrity controlling endothelial junctional dynamics through Angiomotin.

Preservation of blood vessel integrity, which is critical for normal physiology and organ function, is controlled at multiple levels, including endothelial junctions. However, the mechanism that controls the adequate assembly of endothelial cell junctions is not fully defined. Here, we uncover TAp73 transcription factor as a vascular architect that orchestrates transcriptional programs involved in cell junction establishment and developmental blood vessel morphogenesis and identify Angiomotin (AMOT) as a TAp73 direct transcriptional target. Knockdown of p73 in endothelial cells not only results in decreased Angiomotin expression and localization at intercellular junctions, but also affects its downstream function regarding Yes-associated protein (YAP) cytoplasmic sequestration upon cell-cell contact. Analysis of adherens junctional morphology after p73-knockdown in human endothelial cells revealed striking alterations, particularly a sharp increase in serrated junctions and actin bundles appearing as stress fibers, both features associated with enhanced barrier permeability. In turn, stabilization of Angiomotin levels rescued those junctional defects, confirming that TAp73 controls endothelial junction dynamics, at least in part, through the regulation of Angiomotin. The observed defects in monolayer integrity were linked to hyperpermeability and reduced transendothelial electric resistance. Moreover, p73-knockout retinas showed a defective sprout morphology coupled with hemorrhages, highlighting the physiological relevance of p73 regulation in the maintenance of vessel integrity in vivo. We propose a new model in which TAp73 acts as a vascular architect integrating transcriptional programs that will impinge with Angiomotin/YAP signaling to maintain junctional dynamics and integrity, while balancing endothelial cell rearrangements in angiogenic vessels.

Are there differences in the damage to the pelvic floor between malmstrom's and kiwi omnicup vacuums? A multicenter study.

OBJECTIVES: The objective of this study is to investigate a multicenter study to establish if differences exist in the levator ani muscle avulsion (LAM) rates between deliveries performed with Malmstrom's vacuum and the Kiwi vacuum. STUDY DESIGN: A prospective, multicenter observational study with 199 primiparous subjects was performed. All patients had undergone vaginal delivery by vacuum (Malmstrom's or Kiwi). Avulsion was defined as an abnormal insertion of LAM in the lower pubic branch in the multiplanar mode, as identified in the three central sections by transperineal 3/4D echography 6 months after delivery. The area of ​​the levator hiatus was measured in the plane of minimum dimensions at rest, during the Valsalva maneuver and during contraction. RESULTS: LAM avulsion occurred in 33.1% of cases in which Malmstrom's vacuum was used and in 29.4% of cases in which the Kiwi vacuum was used (the difference was not statistically significant), which resulted in a crude odds ratio (OR) of 0.977 (0.426, 2.241; P = .957) and an adjusted OR of 2.90 (0.691; 12.20; P = .146). Women in the Malmstrom's vacuum group had a larger LHA at rest 14.77 vs 12.64 cm2 ; P = .001) and at maximum contraction (13.41 vs 10.83 cm2 ; P < 0.001) in comparison with the Kiwi group, although the difference did not reach statistical significance under Valsalva maneuver (18.71 vs 17.21 cm2 ; P = .051).Differences between both groups were detected in the measurements of the hiatus area levator at rest (14.77 vs 12.64 cm2 ), during the Valsalva maneuver (18.71 vs 17.21 cm2 ) and during maximum contraction (13.41 vs 10.83 cm2 ). CONCLUSIONS: In the present study, Malmstrom's vacuum was not associated with a higher risk of LAM in comparison with Kiwi's Omnicup.

Influence of the disengagement of the forceps on levator ani muscle injuries in instrumental delivery: A multicenter study.

INTRODUCTION: Forceps use is the main risk factor for levator ani muscle (LAM) injuries. We believe that the disengagement of the forceps branches before delivery of the fetal head could influence LAM injuries, so we aimed to determine the influence of the disengagement of the forceps on the occurrence of LAM avulsion during forceps delivery. MATERIAL AND METHODS: A prospective, observational, multicenter study was conducted with 261 women who underwent forceps delivery. The women were classified according to whether the branches of the forceps had been disengaged before delivery of the fetal head. LAM avulsion was defined using a multislice mode (3 central slices). RESULTS: In all, 255 women completed the study (160 without disengagement and 95 with disengagement). LAM avulsions were observed in 37.9% of women in the group with disengagement and in 41.9% of women in the group without disengagement. The crude OR (without disengagement vs with disengagement) for avulsion was 0.90 (95% CI 0.49-1.67, P = 0.757) and an adjusted OR of 0.82 (95% CI 0.40-1.69, P = 0.603). CONCLUSIONS: We did not observe a statistically significant reduction in the LAM avulsion rate with disengagement of the forceps branches before delivery of the fetal head.

Behavior of perineum during delivery before fetal head expulsion.

INTRODUCTION AND HYPOTHESIS: The aim of this study was to describe perineum deformation during the final part of delivery and suggest a modification of the episiotomy cut to increase accuracy for obtaining a suitable angle (45°) for surgical wound suture. METHODS: This prospective study enrolled 45 primiparous women. The perineum at rest was marked with five lines (0°, 30°, 45°, 60°, 90°), and each line was marked with two dots (point A-B: to 2-3 cm from initial point in fourchette, respectively). Two digital pictures were taken: one with the women at rest and the second during fetal head crowning; displacements were calculated for each point and angle. RESULTS: When the perineum is distending, the initial point of every line in the posterior fourchette moves laterally in introitus (only the 0° line remains at midline). The angle and the distance to points A and B of each line drawn do not change significantly from at rest to crowning. However, comparing original line configuration with an imaginary line from the fourchette to points A and B before expulsion, the angle and the distance is increased statistically significantly. CONCLUSIONS: Perineal distension at the moment of fetal head crowning causes a linear displacement of the perineum, which causes the difference in angle between the incision and episiotomy suture. Therefore, to obtain an episiotomy suture from fourchette with an angle of 45°, theoretically, we would have several angle incision options (between 45° and 60°), with a less acute angle when the introitus cut is closer to the fourchette (45° to 6 mm and ∼60° in the fourchette) and a sharper angle with a longer episiotomy.

Identification and characterization of endometrial carcinoma with tumor markers HE4 and CA125 in serum and endometrial tissue samples

Objective: Diagnosis of endometrial cancer (EC) is made by biopsy sampling with pathological analysis, but it is extremely important to make an accurate diagnosis in order to plan the specific treatment. We hypothesized that human epididymis protein 4 (HE4) in endometrial tissue and in serum could be beneficial for a more precise diagnosis. Material and Methods: This prospective study compared patients with EC against non- EC, matched through several variables. The inclusion criteria were: females older than 18 years who accepted to participate; who had never undergone surgery for other oncological pathologies (ovarian, colon, cervical carcinoma or uterine sarcoma); none of them had received preoperative chemo- or radio-therapy; and no participant had any severe renal or liver pathology. All had pre-surgery blood sampling and then underwent hysterectomy. Histopathological assessment of endometrial samples was made by a pathologist who compared normal histopathological staining with HE4-antibody staining. Results: In total there were 34 cases and 35 controls recruited. There was poor correlation between tissue HE4 in patients with and without carcinoma. However, serum HE4 was significant for the diagnosis of endometrial carcinoma (median EC: 123.1 U, median NE: 64.67 U, p=0.002), although the carbohydrate antigen 125 level was not significant (p=0.208). Conclusion: The findings concerning the utility of HE4 contrast with earlier reports. However, the conclusions for serum measurements are positive and suggest that the tumor marker HE4 seems to be able to diagnose EC.

Post Partum Urinary Retention and Related Risk Factors.

OBJETIVE: To investigate the prevalence and potential risk factors for postpartum voiding dysfunction (PPVD). METHODS: A retrospective observational study was performed in a university hospital center between January 2018 and April 2019. Women with PPVD criteria postpartum were diagnosed and treated. Gestational, delivery, and puerperium characteristics were compared between women with and without PPVD. RESULTS: A total of 1894 out of 2308 deliveries (81%) were vaginal, 73 (9.85%) had PPVD and 13.7% were severe. Epidural analgesia (odds ratio [OR] 7.72, 95% confidence interval [CI],1.02-58.37), operative vaginal delivery (OR 2.23, 95% CI,1.01-4.93), birthweight >4000g (OR 3.7, 95%CI,1.4-9.73), and previous cesarean delivery (OR 6.54, 95% CI, 2.2-19.2) were independent risk factors for PPVD. CONCLUSION: PPVD is a relatively common finding that complicates around 10% of vaginal deliveries. Epidural analgesia, birthweight, operative vaginal birth, and having a previous cesarean delivery are independent risk factors for PPVD. In order to prevent PPVD, more research on PPVD risk factors is needed.

Incidence of obstetric anal sphincter injuries after implementing the Triepi-45 tool to improve episiotomy angle in instrumental deliveries.

OBJECTIVE: To assess the impact of Triepi-45-a tool that enables an episiotomy angle of 45° to be marked on the perineum at rest-on the incidence of obstetric anal sphincter injuries (OASIS) during operative vaginal delivery (OVD). METHOD: A retrospective-prospective cohort study was performed among successive women who underwent OVD at Complejo Asistencial Universitario de de León, Spain, between 2011 and 2013 (preintervention cohort, n=986) and between 2014 and 2016 (intervention cohort, n=986) after implementation of an interventional programme in 2013 to improve the episiotomy angle, including use of Triepi-45, in OVD. RESULTS: The intervention cohort had a lower incidence of OASIS than the preintervention cohort (70/986 [7.1%] vs 93/986 [9.4%]), but the difference was not significant, owing to the low use of Triepi-45 in the intervention cohort (n=375). However, the OASIS incidence was significantly lower in the Triepi-45 cohort than in the preintervention cohort (18/375 [4.8%] vs 93/986 [9.4%]; odds ratio, 0.47; 95% confidence interval, 0.26-0.86). CONCLUSION: Use of Triepi-45 had a positive impact on reducing OASIS in OVD. It remains essential to raise obstetricians' awareness of the importance of the episiotomy angle and to implement the systematic use of tools to reduce the incidence of OASIS.

Which characteristics of the episiotomy and perineum are associated with a lower risk of obstetric anal sphincter injury in instrumental deliveries.

OBJETIVE: Operative vaginal delivery (OVD) is the most important risk fact for obstetric anal sphincter injury (OASI). Knowledge of possible risk factors for their occurrence may therefore reduce the likelihood of faecal incontinence. The aim is to analyse the effect of mediolateral episitomy and perineum characteristics on the occurrence of OASI in OVD. STUDY DESIGN: Case-control study, which included 958 OVD that were reviewed in Pelvic Floor and Puerperium Clinic. The episiotomy and perineum characteristics of those women who experienced OASIs (n = 150) were compared with those who had no evidence of anal sphincter injury (n = 788). RESULTS: In multivariate logistic regression analysis the factors which were independently associated were nulliparity, persistent occipitoposterior position, birthweight >3500 g, an angle of episiotomy <30°, a distance episiotomy-fourchette <5 mm and a distance of perineal body <30 mm. The analysis of subgroups show that only the multiparous women does not benefit from any feature of the episiotomy, and an angle greater than 30° and a distance episiotomy-fourchette >5 mm are associated with a risk reduction of OASI in nulliparous, perineal bodies ≤30 mm and occipitoanterior position. CONCLUSIONS: Two modifiable risk factors at the time of performing the episiotomy, the angle and distance episiotomy-fourchette, have been identified as the risk modification of OASI. It is necessary to achieve an adequate angle to reduce the probability of OASIs in OVD, and in nulliparous women with an anterior position and a distance of perineal body ≤30 mm could benefit from increasing the episiotomy-fourchette distance.