Influence of mode of delivery on pelvic organ support 6 months postpartum

Aims: The aims of this study were to describe pelvic organ support six months postpartum among women delivered by cesarean section, spontaneous and instrumental vaginal delivery and to evaluate the differences between the groups. Methods: This was a cross-sectional study of 382 primigravid women who gave birth at Donostia Hospital during 2007. Pelvic organ support was explored six months postpartum using the pelvic organ prolapse quantification (POPQ) system. Joint hypermobility, height and weight were also assessed. Results: POPQ stage ≥ II was present in 7.7%, 18.1% and 29.0% of women delivered by caesarean section, spontaneous and instrumental vaginal delivery respectively. Spontaneous vaginal delivery increased the risk by more than three times (OR:3.19; 95% CI:1.07–9.49) while instrumental vaginal delivery increased it more than five-fold (OR:5.52; 95% CI:1.79–17.30) in comparison with caesarean section. Instrument-assisted delivery did not increase the risk of prolapse in women who delivered vaginally, although this result was limited by the sample size. Conclusions: Cesarean section has a protective effect on pelvic floor support. Instrument-assisted delivery is not associated with postpartum prolapse among women delivered vaginally.This study is part of a research project supported by the Spanish Department of Health, through the Health Research Fund (FIS) of the Instituto de Salud Carlos III (PI070261)

Influence of maternal weight on the new onset of stress urinary incontinence in pregnant women

Esta publicación detalla los trabajos realizados para investigar la incidencia y la gravedad de la incontinencia urinaria de esfuerzo (IUE) en mujeres primigrávidas a término y su asociación con diferentes factores de riesgo. Nuestra hipótesis de trabajo fue que el peso materno en exceso podría favorecer el desarrollo de la IUE durante el embarazo. En este estudio prospectivo incluimos 458 primigrávidas que acudieron a dar a luz al Hospital Universitario Donostia durante el año 2007. Se investigaron los síntomas urinarios teniendo en cuenta las definiciones de la International Continence Society (ICS) publicadas en el año 2002 y se realizó una exploración general y ginecológica para recoger las diferentes variables incluidas en el estudio. Se utilizó el Índice de Severidad de Incontinencia (ISI) para evaluar su gravedad. La identificación de los factores asociados a la IUE se realizó a través de un análisis multivariante. Un total de 139 (30,3%) gestantes manifestaron tener IUE. La distribución del ISI fue: 40,3% leve, 54,7% moderada, 4,3% severa y 0,7% muy severa. En el análisis multivariante observamos que las gestantes a término con un peso corporal ≥75 kg tenían duplicado el riesgo de padecer IUE. Los resultados de este trabajo apoyan la teoría mecánica como uno de los mecanismos fisiopatológicos que favorecen la IUE en las gestantes. Además, hemos identificado un factor de riesgo modificable, que podría utilizarse como punto de partida para la prevención de la IUE durante el embarazo.Fondo de Investigación Sanitaria del Instituto Carlos III, Departamento de Salud de España (PI070261) Proyecto titulado “Incontinencia de orina durante el embarazo y tras el parto. Factores de riesgo asociados a su incidencia al final del embarazo y a los 6, 12, y 24 meses del parto

Factors involved in the persistence of stress urinary incontinence from pregnancy to 2 years post partum.

Objective: our aim was to identify factors involved in the persistence of stress urinary incontinence (SUI) from pregnancy to two years postpartum. Severity of incontinence and impact of SUI on quality of life were evaluated. Method: a longitudinal cohort study was undertaken on 458 primigravid women. SUI was diagnosed using the 2002 ICS definitions. Severity was assessed with the Incontinence Severity Index (ISI) and impact on quality of life using the International Consultation on Incontinence Questionnaire (ICIQ-UI SF). The statistical analysis included comparison of means (Student´s t-test and analysis of variance) and percentages (Chi square and Fisher´s exact tests). Multiple logistic regression analysis was performed using variables that were significant or close to significance in the univariate analysis (p <0.2). Results: two years postpartum 26 (9.5%) women reported persistent SUI since pregnancy. Incontinence severity was slight or moderate in most cases and the impact on quality of life was low. Higher BMI in pregnant women at term was the only factor associated with persistent SUI from pregnancy to two years postpartum (OR: 1.19; 95%CI: 1.08-1.32). Conclusion: Higher BMI in pregnant women at term is an independent risk factor for the persistence of SUI from pregnancy to two years postpartum.Fondo de Investigación Sanitaria del Instituto Carlos III, Departamento de Salud de España (PI070261) Proyecto titulado “Incontinencia de orina durante el embarazo y tras el parto. Factores de riesgo asociados a su incidencia al final del embarazo y a los 6, 12, y 24 meses del parto

Stress urinary incontinence six months after first vaginal delivery

Esta publicación recoge la prevalencia, severidad e impacto en la calidad de vida de la IUE seis meses después del primer parto vaginal, así como el estudio de los factores de riesgo implicados. Se trata de un estudio prospectivo que incluyo 396 primigrávidas que dieron a luz por vía vaginal en el año 2007 en el Hospital Universitario Donostia. Se investigaron los síntomas urinarios teniendo en cuenta las definiciones de la International Continence Society (ICS) publicadas en el año 2002 y se realizó una exploración general y ginecológica para recoger las diferentes variables incluidas en el estudio. Se utilizó el Índice de Severidad de Incontinencia (ISI) para evaluar su gravedad. Las mujeres con IUE completaron la versión española del cuestionario “International Consultation of Incontinence Short Form” (ICIQ-UI-SF) que evalúa la severidad de la incontinencia de orina, así como su impacto en la vida cotidiana. Para evaluar el tipo de parto vaginal se establecieron tres grupos: parto eutócico, parto asistido con fórceps o espátulas y parto asistido con ventosa. La identificación de los factores asociados a la IUE se realizó a través de un análisis multivariante. Seis meses después del primer parto 50 (15,1%) mujeres manifestaron tener IUE. De estas, 20 (8,8%) indicaron que sus síntomas habían empezado tras el parto. La distribución del ISI fue: 40 % leve, 56 % moderada y 4% severa. Ninguna manifestó incontinencia muy severa. La puntuación media del cuestionario ICIQ UI-SF fue de 8,19 (rango 3-16). En el análisis multivariante observamos que el haber desarrollado IUE durante el embarazo fue el único factor de riesgo para padecer este síntoma seis meses después del parto (OR, 3,71; 95% CI: 1,95-7,06). Demostramos esta asociación independiente teniendo en cuenta un gran número de variables constituciones, del embarazo y del parto. El tipo de parto vaginal no influyó en la presencia de IUE a los seis meses del parto, ni siquiera en el subgrupo de mujeres que habían sido continentes durante el embarazo.Fondo de Investigación Sanitaria del Instituto Carlos III, Departamento de Salud de España (PI070261) Proyecto titulado “Incontinencia de orina durante el embarazo y tras el parto. Factores de riesgo asociados a su incidencia al final del embarazo y a los 6, 12, y 24 meses del parto

Postpartum impairment of pelvic floor muscle function: factors involved and association with prolapse

Esta publicación refleja el estudio realizado para identificar los factores implicados en el deterioro de la musculatura del suelo pélvico (MSP) tras el parto vaginal. También se evalúa la asociación de dicho deterioro con el prolapso de los órganos pélvicos (POP). Nuestra hipótesis principal del trabajo fue que el parto instrumental podría asociarse a un empeoramiento de la función de la MSP tras el parto. Se trata de un estudio prospectivo que incluyo 319 primigrávidas que dieron a luz por vía vaginal en el año 2007 en el Hospital Universitario Donostia. La capacidad contráctil de la MSP se valoró en las gestantes a término y seis meses después del parto mediante la palpación y perineometria a través de la vagina. El prolapso se evaluó utilizando el sistema “Pelvic Organ Prolapse Quantification” (POPQ) validado por la International Continence Society (ICS). La identificación de los factores asociados al deterioro de la función de la MSP se realizó a través de un análisis multivariante. El parto vaginal fue espontaneo en 220 (69,0%) mujeres, asistido por fórceps en 84 (26,3%) y con ventosa en 15 (4,7%). El parto instrumental, el perímetro cefálico del recién nacido ≥36 cm y la edad ≥30 fueron factores de riesgo independientes para el deterioro de la función de la MSP después del parto. Estas asociaciones se establecieron considerando otros factores obstétricos como la duración del segundo periodo del parto, la utilización de oxitocina o anestesia epidural, la episiotomía y los desgarros de 3º y 4º grado. La evaluación del POP a los seis meses del parto indicó que 69 (21,6%) mujeres tenían un grado de POP-Q ≥ II. Este grupo de mujeres tuvieron una disminución significativa de la capacidad contráctil de la MSP después del parto en comparación con los valores del embarazo. También presentaron menor capacidad contráctil al compararlas con el grupo de mujeres sin POP. Con estos resultados confirmamos nuestra hipótesis de que el parto instrumental se asocia a un empeoramiento de la función de la MSP. También identificamos el perímetro cefálico ≥36 cm como otro factor asociado al deterioro, que comparte con el parto instrumental una mayor distención de la MSP durante el parto. El perímetro cefálico no es modificable y el parto instrumental puede ser imprescindible en determinados casos, por lo que la prevención primaria está limitada. Sin embargo, como se ha visto en publicaciones posteriores sobre la materia, una rehabilitación precoz de las mujeres que han sufrido un mayor daño de la MSP puede ser útil para la recuperación de su funcionalidad. Por tanto, el haber identificado pacientes con mayor posibilidad de lesión, puede ayudar a implementar medidas precoces para su recuperación.Fondo de Investigación Sanitaria del Instituto Carlos III, Departamento de Salud de España (PI070261

Effect of aspirin on the diagnostic accuracy of the faecal immunochemical test for colorectal advanced neoplasia

Background: Aspirin (ASA) is a drug that can cause gastrointestinal lesions and symptoms. Colorectal cancer (CRC) is the most prevalent type of cancer in Western countries. We assessed the effect of aspirin on the diagnostic accuracy of the faecal immunochemical test (FIT) for CRC and/or advanced neoplasia (AN) in patients undergoing colonoscopy for gastrointestinal symptoms. Methods: We conducted a prospective multicentre observational study of diagnostic tests that included patients with gastrointestinal symptoms undergoing colonoscopy between March 2012 and 2014 (the COLONPREDICT study). Symptoms were assessed and a FIT and blood tests assessing haemoglobin and carcinoembryonic antigen (CEA) levels were performed. Results: The study included 3052 patients: A total of 2567 did not take aspirin (non-user group) and 485 (16%) took aspirin (user group). Continuous treatment with ASA did not change the AUC (0.88, 0.82; p = 0.06), sensitivity (92%, 88%; p = 0.5) or specificity (71%, 67%; p = 0.2) of the FIT for CRC detection. Similarly, we found no differences in the AUC (0.81, 0.79; p = 0.6), sensitivity (74%, 75.5%; p = 0.3) or specificity (76%, 73.6%; p = 0.3) for AN detection. Patients with an aspirin use of = 300 mg/day had a lower prevalence of AN and the sensitivity, specificity and AUC for AN for these patients were 54%, 68% and 0.66, significantly lower than for the non-user group (p = 0.03). Conclusions: Aspirin does not modify the diagnostic accuracy of FIT for CRC and/or AN in patients with gastrointestinal symptoms. Aspirin use of = 300 mg/day decreases the accuracy of the test

Pilates based core stability training in ambulant individuals with multiple sclerosis: protocol for a multi-centre randomised controlled trial

<p>Abstract</p> <p>Background</p> <p>People with Multiple Sclerosis (MS) frequently experience balance and mobility impairments, including reduced trunk stability. Pilates-based core stability training, which is aimed at improving control of the body's stabilising muscles, is popular as a form of exercise with people with MS and therapists. A replicated single case series study facilitated by the Therapists in MS Group in the United Kingdom (UK) provides preliminary evidence that this approach can improve balance and mobility in ambulant people with MS; further evidence is needed to substantiate these findings to ensure that limited time, energy, finances and resources are used to best effect.</p> <p>This study builds upon the pilot work undertaken in the case series study by implementing a powered randomised controlled study, with the aims of:</p> <p>1 Establishing the effectiveness of core stability training</p> <p>2 Comparing core stability training with standardised physiotherapy exercise</p> <p>3 Exploring underlying mechanisms of change associated with this intervention</p> <p>Methods</p> <p>This is a multi-centre, double blind, block randomised, controlled trial. Eligible participants will be recruited from 4 UK centres. Participants will be randomly allocated to one of three groups: Pilates based core stability training, standardised physiotherapy exercise or contract-relax relaxation sessions (placebo control). All will receive face to face training sessions over a 12 week period; together with a 15 minute daily home programme. All will be assessed by a blinded assessor before training, at the end of the 12 week programme and at 4 week follow-up. The primary outcome measure is the 10 metre timed walk. Secondary outcome measures are the MS walking Scale (MSWS-12), the Functional Reach (forwards and lateral), a 10 point Numerical Rating Scale to determine "Difficulty in carrying a drink when walking", and the Activities-specific Balance Confidence (ABC) Scale. In addition, ultrasound imaging of the abdominal muscles will be performed before and after intervention to assess changes in abdominal musculature at one of the four centres (Plymouth).</p> <p>Discussion</p> <p>This pragmatic trial will assess the effect of these exercise programmes on ambulatory people with MS. It may not be possible to extrapolate the conclusions to those who are non-ambulatory.</p> <p>Trial registration</p> <p>ClinicalTrials.gov: <a href="http://www.clinicaltrials.gov/ct2/show/NCT01414725">NCT01414725</a></p

Are Reduced Levels of Coagulation Proteins Upon Admission Linked to COVID-19 Severity and Mortality?

Background: The link between coagulation system disorders and COVID-19 has not yet been fully elucidated. Aim: Evaluating the association of non-previously reported coagulation proteins with COVID-19 severity and mortality. Design: Cross-sectional study of 134 COVID-19 patients recruited at admission and classified according to the highest COVID-19 severity reached (asymptomatic/mild, moderate, or severe) and 16 healthy control individuals. Methods: Coagulation proteins levels (antithrombin, prothrombin, factor_XI, factor_XII, and factor_XIII) and CRP were measured in plasma by the ProcartaPlex Panel (Invitrogen) multiplex immunoassay upon diagnosis. Results: We found higher levels of antithrombin, prothrombin, factor XI, factor XII, and factor XIII in asymptomatic/mild and moderate COVID-19 patients compared to healthy individuals. Interestingly, decreased levels of antithrombin and factors XI, XII, and XIII were observed in those patients who eventually developed severe illness. Additionally, survival models showed us that patients with lower levels of these coagulation proteins had an increased risk of death. Conclusion: COVID-19 provokes early increments of some specific coagulation proteins in most patients. However, lower levels of these proteins at diagnosis might "paradoxically" imply a higher risk of progression to severe disease and COVID-19-related mortality.This study was supported by grants from Instituto de Salud Carlos III [ISCIII; Grant Number COV20/1144 (MPY224/20) to AF-R/MJ-S]. AF-R, MJ-S, and MR are Miguel Servet researchers supported and funded by ISCIII (Grant Numbers: CP14CIII/00010 to AF-R, CP17CIII/00007 to MJ-S, and CP19CIII/00002 to MR).S

CEA, EpCAM, alpha v beta 6 and uPAR expression in rectal cancer patients with a pathological complete response after neoadjuvant therapy

Rectal cancer patients with a complete response after neoadjuvant therapy can be monitored with a watch-and-wait strategy. However, regrowth rates indicate that identification of patients with a pathological complete response (pCR) remains challenging. Targeted near-infrared fluorescence endoscopy is a potential tool to improve response evaluation. Promising tumor targets include carcinoembryonic antigen (CEA), epithelial cell adhesion molecule (EpCAM), integrin alpha v beta 6, and urokinase-type plasminogen activator receptor (uPAR). To investigate the applicability of these targets, we analyzed protein expression by immunohistochemistry and quantified these by a total immunostaining score (TIS) in tissue of rectal cancer patients with a pCR. CEA, EpCAM, alpha v beta 6, and uPAR expression in the diagnostic biopsy was high (TIS > 6) in, respectively, 100%, 100%, 33%, and 46% of cases. CEA and EpCAM expressions were significantly higher in the diagnostic biopsy compared with the corresponding tumor bed (p < 0.01). CEA, EpCAM, alpha v beta 6, and uPAR expressions were low (TIS < 6) in the tumor bed in, respectively, 93%, 95%, 85%, and 62.5% of cases. Immunohistochemical evaluation shows that CEA and EpCAM could be suitable targets for response evaluation after neoadjuvant treatment, since expression of these targets in the primary tumor bed is low compared with the diagnostic biopsy and adjacent pre-existent rectal mucosa in more than 90% of patients with a pCR.Surgical oncolog

Growth arrest-specific transcript 5 associated snoRNA levels are related to p53 expression and DNA damage in colorectal cancer

BACKGROUND The growth arrest-specific transcript 5 gene (GAS5) encodes a long noncoding RNA (lncRNA) and hosts a number of small nucleolar RNAs (snoRNAs) that have recently been implicated in multiple cellular processes and cancer. Here, we investigate the relationship between DNA damage, p53, and the GAS5 snoRNAs to gain further insight into the potential role of this locus in cell survival and oncogenesis both in vivo and in vitro. METHODS We used quantitative techniques to analyse the effect of DNA damage on GAS5 snoRNA expression and to assess the relationship between p53 and the GAS5 snoRNAs in cancer cell lines and in normal, pre-malignant, and malignant human colorectal tissue and used biological techniques to suggest potential roles for these snoRNAs in the DNA damage response. RESULTS GAS5-derived snoRNA expression was induced by DNA damage in a p53-dependent manner in colorectal cancer cell lines and their levels were not affected by DICER. Furthermore, p53 levels strongly correlated with GAS5-derived snoRNA expression in colorectal tissue. CONCLUSIONS In aggregate, these data suggest that the GAS5-derived snoRNAs are under control of p53 and that they have an important role in mediating the p53 response to DNA damage, which may not relate to their function in the ribosome. We suggest that these snoRNAs are not processed by DICER to form smaller snoRNA-derived RNAs with microRNA (miRNA)-like functions, but their precise role requires further evaluation. Furthermore, since GAS5 host snoRNAs are often used as endogenous controls in qPCR quantifications we show that their use as housekeeping genes in DNA damage experiments can lead to inaccurate results