Chronic Venous Disease in Pregnant Women Causes an Increase in ILK in the Placental Villi Associated with a Decrease in E-Cadherin.

Chronic venous disease (CVD) is a multifactorial vascular disorder frequently manifested in lower limbs in the form of varicose veins (VVs). Women are a vulnerable population for suffering from CVD, especially during pregnancy, when a plethora of changes occur in their cardiovascular system. Previous studies have indicated a worrisome association between CVD in pregnancy with the placental structure and function. Findings include an altered cellular behavior and extracellular matrix (ECM) composition. Integrin-linked kinase (ILK) is a critical molecule involved in multiple physiological and pathological conditions, and together with cadherins, is essential to mediate cell to ECM and cell to cell interplay, respectively. Thus, the aim of this study was to evaluate the implication of ILK and a set of cadherins (e-cadherin, cadherin-6 and cadherin-17) in placentas of women with CVD in order to unravel the possible pathophysiological role of these components. Gene expression (RT-qPCR) and protein expression (immunohistochemistry) studies were performed. Our results show a significant increase in the gene and protein expression of ILK, cadherin-6 and cadherin-17 and a decrease of e-cadherin in the placenta of women with CVD. Overall, this work shows that an abnormal expression of ILK, e-cadherin, cadherin-6 and cadherin-17 may be implicated in the pathological changes occurring in the placental tissue. Further studies should be conducted to determine the possible associations of these changes with maternal and fetal well-being.

Understanding Chronic Venous Disease: A Critical Overview of Its Pathophysiology and Medical Management.

Chronic venous disease (CVD) is a multifactorial condition affecting an important percentage of the global population. It ranges from mild clinical signs, such as telangiectasias or reticular veins, to severe manifestations, such as venous ulcerations. However, varicose veins (VVs) are the most common manifestation of CVD. The explicit mechanisms of the disease are not well-understood. It seems that genetics and a plethora of environmental agents play an important role in the development and progression of CVD. The exposure to these factors leads to altered hemodynamics of the venous system, described as ambulatory venous hypertension, therefore promoting microcirculatory changes, inflammatory responses, hypoxia, venous wall remodeling, and epigenetic variations, even with important systemic implications. Thus, a proper clinical management of patients with CVD is essential to prevent potential harms of the disease, which also entails a significant loss of the quality of life in these individuals. Hence, the aim of the present review is to collect the current knowledge of CVD, including its epidemiology, etiology, and risk factors, but emphasizing the pathophysiology and medical care of these patients, including clinical manifestations, diagnosis, and treatments. Furthermore, future directions will also be covered in this work in order to provide potential fields to explore in the context of CVD.

Association Between Lower Extremity Venous Insufficiency and Intrapartum Fetal Compromise: A Nationwide Cross-Sectional Study.

Introduction: Chronic venous disorder (CVeD) has a high prevalence, being commonly diagnosed by the presence of varicose veins. In fact, the development of varicose veins in lower extremities and/or pelvic venous insufficiency (LEPVI) is frequent. However, its potential impact on fetal health has not been investigated. This study aimed to examine whether the presence of varicose veins in women's LEPVI is related to an intrapartum fetal compromise event. Materials: A cross-sectional, national study was conducted using medical administrative records (CMBD) of all vaginal births (n = 256,531) recorded in 2015 in Spain. The independent variable was defined as the presence of varicose veins in the legs, vulva, and perineum or hemorrhoids. A logistic regression model was used to assess the association of interest. Results: Among women with vaginal deliveries, those with varicose veins in their LEPVI have a significantly greater odds of intrapartum fetal compromise (OR = 1.30, 99.55%CI = 1.08-1.54) than their counterparts without varicose veins. After adjustment, this association remained significant (OR = 1.25, 99.5%CI = 1.05-1.50). Conclusions: Our findings of an association between varicose veins in women's lower extremities and/or pelvis and intrapartum fetal compromise suggest that varicose veins may be a novel and important clinical risk factor for fetal well-being and health.

Systematic Review and Meta-Analysis of Incidence and Prevalence of Endometriosis.

There is still much controversy regarding the epidemiology of endometriosis. The objective of this work is to conduct a systematic review, and if possible, proceed with a meta-analysis of studies that have analyzed the incidence and prevalence of this condition among women in the general population. The inclusion criteria were papers published after 1997 that had reported data of the incidence or prevalence of endometriosis. The PubMed search engine was used to identify papers meeting the inclusion criteria from 1997 to 2019, with an additional manual search for the identification of potentially eligible studies. The search was limited to papers published in English. The risk of bias was assessed according to the Joanna Briggs Institute Critical Appraisal Checklist. As a result, 27 papers, which included a total of 28,660,652 women, were classified according to the type of design and sources of information in five subgroups. Pooled estimates of prevalence for studies with self-reported data were 0.05 (95% CI: 0.03; 0.06), 0.01 for population-based integrated information systems (95% CI: 0.01; 0.02), and 0.04 (95% CI 0.04; 0.05) in studies using other designs. The pooled incidence rate of endometriosis was: 1.36 per 1000 person-years (PY) (95% CI: 1.09; 1.63) for studies based on hospital discharges, 3.53 per 1000 PY (95% CI: 2.06; 4.99) for cohort studies, and 1.89 per 1000 PY (95% CI: 1.42; 2.37) for population-based integrated information systems. Meta-analysis indicated high heterogeneity based on I-squared statistics. This significant variability may not only be due to methodological issues and the specific limitations of the different designs and data analyzed, including case definitions and subject selection strategies, but also to the inherent heterogeneity of endometriosis. Epidemiological studies with appropriate study designs remain necessary to provide a valid estimation of the population burden of endometriosis.

Choice of surgical procedure and management of postoperative incision for anal fistula / 中华胃肠外科杂志

Anal fistula is a common disease in general surgery. It is difficult to heal without intervention and surgical treatment is the major treatment. Method of surgical treatment and management of postoperative incision are based on features and classifications of anal fistula. Choosing the appropriate approach in accordance with specific conditions of patients can obtain effective healing and proper protection against anal sphincter, along with the improvement of life quality. Comprehensive evaluation on methods of surgical treatment and managements of postoperative incision for anal fistula is presented in this paper.

Features of anorectal manometry in patients with rectocele / 中华消化杂志

Objective To assess the anal and pelvic floor function in patients with rectocele (RC),and to afford the evidence for the treatments of RC.Methods Patients with functional constipation (FC) and healthy controls were consecutively enrolled,and all the subjects underwent defecography and anorectal manometry.According to defecography,the subjects were divided into four groups as no RC,mild RC,moderate RC and severe RC.The t-test,analysis of variance,rank sum test and Chi-square test were performed to compare the results of anorectal manometry between different RC groups in FC patients,and the results of anorectal manometry between moderate RC group in FC patients and control group with moderate RC were also compared.Results A total of 54 FC patients and 17 healthy controls were enrolled.No RC was found in all of male subjects.Of 48 female patients with FC,nine cases (18.8％) had no RC,seven (14.6％) had mild RC,18(37.5％) had moderate RC,and 14(29.2％) had severe RC.Three of the 12 female controls had no RC,one had mild RC,and eight had severe RC.Among all female patients with FC,the defecation rectal pressure in severe RC group ((34.4 ± 14.2) mmHg,1 mmHg=0.133 kPa) was significantly higher than of no RC group ((20.8 ± 13.1) mmHg,t=3.663,P=0.001),mild RC group ((19.1± 15.1) mmHg,t=3.719,P＜0.01) and moderateRC group ((25.6±16.3) mmHg,t=2.525,P=0.010).The left rectal pressure after defecation in mild RC group ((55.1 ± 19.7) mmHg) was significantly higher than that of moderate RC group ((43.3±17.6) mmHg,t=2.507,P=0.019) and severe RC group ((40.0±20.9) mmHg,t=2.619,P=0.006).The anal relax ratio in mild RC group (3.0％,0.5％ to 25.5％) was significantly lower than that of moderate RC group (19.5％,10.0％ to 29.0％,Z=-2.583,P=0.010) and severe RC group (22.0％,7.3％ to 54.5％,Z=-2.830,P=0.005).There were no significant differences in rectal and anal resting pressure,anal squeezing pressure,rectal sensory threshold and constituent ratio of manometry among four groups (all P＞0.05).The left rectal pressure after defecation in FC patients with moderate RC ((43.3 ± 17.6) mmHg) was significantly higher than that of controls with moderate RC ((26.3±20.8) mmHg,t=2.997,P＜0.01),and anal relax ratio was significantly lower than that of controls with moderateRC ((23.4±20.2)％ vs (55.2±16.3)％,t=-5.266,P=0.008).Conclusions RC is found in female and also found in individuals with normal defecation.FC patients with mild RC lack enough anal relax during defecation.However,defecation is relatively coordinate in FC patients with severe RC,which indicates that severe RC may be part of manifestation of pelvic floor relaxation.

Correlation analysis of acute pancreatitis with hyperlipemia and C reactive protein / 中国基层医药

Objective To analyze the correlation of acute pancreatitis with hyperlipemia and C reactive pro-tein. Methods 42 patients with acute pancreatitis with hyperlipemia were divided into two groups of SAP group and MAP group under the diagnostic code. The blood fat and CRP were compared between the two groups, also the scores of APACHE Ⅱ , Ranson and CT were measured. Results The CRP and TG in group SAP compared with those in group MAP had significant difference(P<0.01),but the CHOL has no-difference;the scores of APACHEⅡ , Ranson and CT after control lipid in 42 patients were significantly' different( P < 0.05). Conclusion Hyperlipe-mia is one risk factors of the AP;combined with the CRP, it can be one evaluating index of the severity.

Effect of partial internal sphincterotomy on the pain after cutting seton treatment / 中国微创外科杂志

Objective To study the influence of partial internal sphincterotomy on the postoperative pain after cutting seton treatment in patients with perianal infection. Methods A controlled study was carried out on 40 cases of cutting seton insertion with (Group A) or without (Group B) partial internal sphincterotomy. The subjects reported their postoperative pain at defecation and at rest respectively using a visual analogue scale (VAS). The intensity of pain between the two groups was compared. Results All the 40 patients were cured, without recurrence or fecal incontinence. During the period of cutting seton treatment, the pain scores at defecation and at rest were lower in the Group A than in the Group B ( P 0.05). Conclusions Internal sphincterotomy can significantly relieve anal pain after cutting seton treatment, being an effective method.