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MedRxiv : the Preprint Server For... May 2024Central serous chorioretinopathy (CSC) is a fluid maculopathy whose etiology is not well understood. Abnormal choroidal veins in CSC patients have been shown to have...
Central serous chorioretinopathy (CSC) is a fluid maculopathy whose etiology is not well understood. Abnormal choroidal veins in CSC patients have been shown to have similarities with varicose veins. To identify potential mechanisms, we analyzed genotype data from 1,477 CSC patients and 455,449 controls in FinnGen. We identified an association for a low-frequency (AF=0.5%) missense variant (rs113791087) in the gene encoding vascular endothelial protein tyrosine phosphatase (VE-PTP) (OR=2.85, P=4.5×10). This was confirmed in a meta-analysis of 2,452 CSC patients and 865,767 controls from 4 studies (OR=3.06, P=7.4×10). Rs113791087 was associated with a 56% higher prevalence of retinal abnormalities (35.3% vs 22.6%, P=8.0×10) in 708 UK Biobank participants and, surprisingly, with varicose veins (OR=1.31, P=2.3×10) and glaucoma (OR=0.82, P=6.9×10). Predicted loss-of-function variants in VEPTP, though rare in number, were associated with CSC in All of Us (OR=17.10, P=0.018). These findings highlight the significance of VE-PTP in diverse ocular and systemic vascular diseases.
PubMed: 38766240
DOI: 10.1101/2024.05.08.24307013 -
European Journal of Cell Biology Jun 2024Varicose veins are the most common venous disorder in humans and are characterized by hemodynamic instability due to valvular insufficiency and orthostatic lifestyle...
Varicose veins are the most common venous disorder in humans and are characterized by hemodynamic instability due to valvular insufficiency and orthostatic lifestyle factors. It is unclear how changes in biomechanical signals cause aberrant remodeling of the vein wall. Our previous studies suggest that Notch signaling is implicated in varicose vein arterialization. In the arterial system, mechanoresponsive ETS1 is a transcriptional activator of the endothelial Notch, but its involvement in sensing disrupted venous flow and varicose vein formation has not been investigated. Here, we use human varicose veins and cultured human venous endothelial cells to show that disturbed venous shear stress activates ETS1-NOTCH4/DLL4 signaling. Notch components were highly expressed in the neointima, whereas ETS1 was upregulated in all histological layers of varicose veins. In vitro microfluidic flow-based studies demonstrate that even minute changes in venous flow patterns enhance ETS1-NOTCH4/DLL4 signaling. Uniform venous shear stress, albeit an inherently low-flow system, does not induce ETS1 and Notch proteins. ETS1 activation under altered flow was mediated primarily by MEK1/2 and, to a lesser extent, by MEK5 but was independent of p38 MAP kinase. Endothelial cell-specific ETS1 knockdown prevented disturbed flow-induced NOTCH4/DLL4 expression. TK216, an inhibitor of ETS-family, prevented the acquisition of arterial molecular identity and loss of endothelial integrity in cells exposed to the ensuing altered shear stress. We conclude that ETS1 senses blood flow disturbances and may promote venous remodeling by inducing endothelial dysfunction. Targeting ETS1 rather than downstream Notch proteins could be an effective and safe strategy to develop varicose vein therapies.
Topics: Humans; Signal Transduction; Proto-Oncogene Protein c-ets-1; Receptor, Notch4; Varicose Veins; Calcium-Binding Proteins; Adaptor Proteins, Signal Transducing; Endothelial Cells; Endothelium, Vascular; Male; Stress, Mechanical; Membrane Proteins; Female; Human Umbilical Vein Endothelial Cells
PubMed: 38759515
DOI: 10.1016/j.ejcb.2024.151420 -
Medicine May 2024Varicose veins and heart failure (HF) are increasingly prevalent. Although numbers of observational studies have indicated that varicose veins might contribute to the...
Varicose veins and heart failure (HF) are increasingly prevalent. Although numbers of observational studies have indicated that varicose veins might contribute to the risk of HF, the causal relationship between them remains unclear due to the uncontrolled confounding factors and reverse causation bias. Therefore, this study aimed to explore the potential causal relationship between varicose veins and HF. Based on publicly released genome-wide association studies (GWAS), gene correlation was assessed using linkage disequilibrium score (LDSC) regression, and we conducted a two-sample Mendelian randomization (TSMR) analysis to infer the causal relationship. We performed the Inverse variance weighted (IVW) method as the primary analysis, and used Weighted median, MR-Egger, weighted mode, simple mode, and MR-pleiotropy residual sum and outlier (MR-PRESSO) methods to detect and correct for horizontal pleiotropy. LDSC revealed there was a positive genetic correlation between varicose veins and HF (rg = 0.1726184, Se = 0.04511803, P = .0001). The results of the IVW method indicated that genetically predicted varicose veins were associated with an increased risk of HF (odds ratio (OR) = 1.03; 95% confidence interval (CI): 1.01-1.06; P = .009). Our findings illustrated the significant causal effect of varicose veins on HF, suggesting that people with varicose veins might have a higher risk of HF. The results provided a novel and important perspective into the development mechanism of HF.
Topics: Humans; Varicose Veins; Mendelian Randomization Analysis; Heart Failure; Genome-Wide Association Study; Polymorphism, Single Nucleotide; Linkage Disequilibrium; Genetic Predisposition to Disease
PubMed: 38758877
DOI: 10.1097/MD.0000000000038175 -
Alternative Therapies in Health and... May 2024Cirrhotic portal hypertension and associated opening of collateral circulation, improper feeding or sudden increase of abdominal pressure are the causes of esophageal...
BACKGROUND
Cirrhotic portal hypertension and associated opening of collateral circulation, improper feeding or sudden increase of abdominal pressure are the causes of esophageal and gastric variceal bleeding. Esophageal and gastric variceal bleeding is one of the most common and serious complications during decompensation of cirrhosis. Endoscopic surgery is an effective method for treating esophageal and gastric variceal hemorrhage. Still, postoperative health management is required to reduce the occurrence of rebleeding and improve the quality of life of patients with esophageal and gastric variceal hemorrhage.
OBJECTIVE
Our study aims to assess the impact of a health management program on the clinical efficacy, rebleeding rate, varicose vein disappearance, self-management ability, and quality of life of patients who have undergone endoscopic surgery for esophageal and gastric variceal hemorrhage.
DESIGN
This was a retrospective study.
SETTING
This study was performed in the Department of Gastroenterology, Taihe County People's Hospital, due that all the author came to take up positions in the hospital.
PARTICIPANTS
A total of 80 esophageal and gastric variceal hemorrhage patients who received endoscopic surgery in our hospital from January 2020 to January 2022 were selected as the research subjects and were divided into a study group and control group based on the random number table method, with 40 patients in each group. There were 59 males and 11 females, aged from 29 to 81 years old. For Child-Pugh classification of liver function, there were 27 cases in grade A, 34 cases in grade B and 19 cases in grade C.
INTERVENTIONS
Patients in both groups received endoscopic treatment. Postoperative health management procedures were implemented in the observation group, including establishing a health management team, health management including self-psychological counseling, daily diet management, rest management, medication management, and complications prevention and management and procedure implementation including pre-discharge guidance and follow up after discharge. Routine health management was implemented in the control group, including understanding the lifestyle and disease control status of patients after treatment, giving health education and guidance, including diet, daily exercise, intervention drugs, psychological state, and other aspects, and reminding patients to return to the hospital outpatient clinic once a time after discharge.
PRIMARY OUTCOME MEASURES
(1) clinical efficacy (2) rebleeding rate (3) varicose vein disappearance (4) self-management ability, and (5) quality of life.
RESULTS
The total clinical effective rate was 92.5% in the observation group and 82.5% in the control group (P < .05). The rebleeding rate and varicose vein disappearance rate were 2.5% and 70.0% in the observation group, presented better relative to those of 12.5% and 55% in the control group, respectively (P < .05). After intervention, the scores of self-management ability [(18.27±3.11) points, (17.84±3.64) points, (17.17±3.10) points and (18.34±3.32) points vs (16.08±2.86) points, (15.10±2.86) points, (15.48±2.54) points and (16.18±2.84) points] and quality of life [(78.23±8.10) points, (79.06±6.62) points, (78.12±3.10) points and (80.15±7.12) points vs (64.11±6.46) points, (65.15±2.36) points, (65.48±2.57) points and (72.16±2.97) points] in the observation group were higher than the control group (P < .05).
CONCLUSION
The implementation of a health management program in esophageal and gastric variceal hemorrhage patients after endoscopic treatment is helpful to improve the clinical effect of endoscopic treatment, reduce the rebleeding rate and varicose veins, and improve the self-management ability and quality of life of patients, which has important clinical significance.
PubMed: 38758139
DOI: No ID Found -
Journal of Vascular Surgery. Venous and... May 2024The purpose of this study was to compare the clinical outcomes of radiofrequency ablation (RFA), cyanoacrylate closure (CAC), mechanochemical ablation (MOCA), and...
OBJECTIVE
The purpose of this study was to compare the clinical outcomes of radiofrequency ablation (RFA), cyanoacrylate closure (CAC), mechanochemical ablation (MOCA), and surgical stripping (SS) for incompetent saphenous veins and to determine a suitable treatment modality for a specific clinical situation.
METHODS
We retrospectively reviewed the data of patients with varicose veins who underwent RFA, CAC, MOCA, or SS from January 2012 to June 2023. The clinical outcomes, including postoperative complications and the Aberdeen Varicose Vein Questionnaire score, were assessed.
RESULTS
During the study period, 2866 patients with varicose veins were treated. Among them, 1670 patients (57.9%) were women. The mean age was 55.3 ± 12.9 years. RFA, CAC, MOCA, and SS were performed in 1984 (68.7%), 732 (25.4%), 78 (2.7%), and 88 (3.0%) patients, respectively. The complete target vein closure rate after RFA, CAC, and MOCA was 94.5%, 98%, and 98%, respectively. The absence of a target vein after SS was 98%. Deep vein thrombosis developed in four patients: one in the RFA group and three in CAC group. Surgical or endovenous procedure-induced thrombosis occurred in 2.3%, 4.8%, 6.4%, and 2.3% of the patients after RFA, CAC, MOCA, and SS, respectively. Phlebitis along the target vein occurred in 0.2% and 3.8% of patients after RFA and MOCA, respectively. A hypersensitivity reaction occurred in 3.7% of patients after CAC. Readmission was required for two patients who had undergone SS. Transient nerve symptoms developed in five (0.3%), zero, one (1.3%), and two (2.3%) patients after RFA, CAC, MOCA, and SS, respectively. After treatment, the Aberdeen Varicose Vein Questionnaire score improved significantly in all groups.
CONCLUSIONS
The clinical outcomes with improvement in quality of life were comparable among the different treatment modalities. The proximity of the nerve or skin to the target vein is the most important factor in selecting a suitable treatment modality.
PubMed: 38754778
DOI: 10.1016/j.jvsv.2024.101902 -
Journal of Wound Care May 2024A single centre, non-comparative evaluation was undertaken to observe the clinical results achieved when following best practice for the application of Debrichem. The...
A single centre, non-comparative evaluation was undertaken to observe the clinical results achieved when following best practice for the application of Debrichem. The treatment protocol involved use of this debridement product plus standard of care. The sample comprised 21 patients with complex, non-healing wounds of various aetiologies. One patient dropped out of the evaluation for unknown reasons. Wound types were either venous leg ulcers (n=16) or post-traumatic wounds (n=25). The mean wound duration was 22 months (range: 2 weeks-17 years). Over the 4-week follow-up period, there was a decline in the mean percentage of devitalised tissue present on the wounds, reducing from 69% at baseline to 49% at week 4. Most of the devitalised tissue was slough, for which the mean baseline percentage was 63% compared with an endpoint of 49%. Conversely, the mean percentage of granulation tissue increased from 31% at baseline to 51% at week 4. The mean visual analogue pain score reported during application was 4/10, where 0 represents no pain. However, general wound-related pain scores improved during the follow-up period, with no scores above 2 at week 2, compared with five at baseline. The results indicate that Debrichem is a safe and effective method of debridement that requires minimal training and is single use.
Topics: Humans; Male; Female; Wound Healing; Middle Aged; Aged; Debridement; Adult; Aged, 80 and over; Treatment Outcome; Administration, Topical; Varicose Ulcer; Wounds and Injuries; Wound Infection
PubMed: 38752846
DOI: 10.12968/jowc.2024.33.Sup5b.S12 -
Bioscience Reports May 2024Varicose vein disease (VVD) is a common health problem worldwide. Microfibril-associated protein 5 (MFAP5) is one of the potential key players in its pathogenesis. Our...
Varicose vein disease (VVD) is a common health problem worldwide. Microfibril-associated protein 5 (MFAP5) is one of the potential key players in its pathogenesis. Our previous microarray analysis revealed the cg06256735 and cg15815843 loci in the regulatory regions of the MFAP5 gene as hypomethylated in varicose veins which correlated with its up-regulation. The aim of this work was to validate preliminary microarray data, estimate the level of 5-hydroxymethylcytosine (5hmC) at these loci, and determine the methylation status of one of them in different layers of the venous wall. For this, methyl- and hydroxymethyl-sensitive restriction techniques were used followed by real-time PCR and droplet digital PCR, correspondingly, as well as bisulfite pyrosequencing of +/- oxidized DNA. Our microarray data on hypomethylation at the cg06256735 and cg15815843 loci in whole varicose vein segments were confirmed and it was also demonstrated that the level of 5hmC at these loci is increased in VVD. Specifically, among other layers of the venous wall, tunica (t.) intima is the main contributor to hypomethylation at the cg06256735 locus in varicose veins. Thus, it was shown that hypomethylation at the cg06256735 and cg15815843 loci takes place in VVD, with evidence to suggest that it happens through their active demethylation leading to up-regulation of the MFAP5 gene, and t. intima is most involved in this biochemical process.
Topics: Varicose Veins; Humans; DNA Methylation; Male; Female; Middle Aged; 5-Methylcytosine; Adult; Aged; Regulatory Sequences, Nucleic Acid; Genetic Loci
PubMed: 38743016
DOI: 10.1042/BSR20231938 -
Cureus Apr 2024An 82-year-old man with left leg edema was referred to our department after an ultrasound examination by his previous physician, which revealed deep vein thrombosis...
An 82-year-old man with left leg edema was referred to our department after an ultrasound examination by his previous physician, which revealed deep vein thrombosis (DVT) in the left superficial femoral vein and a left common femoral artery aneurysm (CFAA). The DVT was caused by the CFAA. The patient was adjudged to be at high risk of peripheral embolization due to the irregular shape of the varicose vein and a large amount of mural thrombus. Surgery was performed to replace the artificial blood vessel. The patient displayed firm adhesion to the surrounding area, marked lymph node swelling, and a large amount of mural thrombus in the mass. The superficial femoral artery (SFA) demonstrated severe intimal thickening and partial dissection. The postoperative course was good, and the patient was undergoing rehabilitation to be discharged home; however, B-cell lymphoma was suspected based on the pathology results of the mass wall submitted intraoperatively. The patient had a history of rheumatoid arthritis and was treated with methotrexate (MTX). During the course of his illness, a subcutaneous mass was found on his right forearm, and a skin biopsy revealed MTX-associated lymphoproliferative disease (MTX-LPD), which had resolved with MTX withdrawal. The histopathological results of the skin biopsy matched those of the CFAA mural thrombus, and Epstein-Barr virus-positive cells were also observed, leading to the diagnosis of MTX-LPD, which was considered to be the cause of CFAA. No MTX-LPD was identified in the vessel walls or intramural thrombus. We herein report a case of CFAA with an extremely rare etiology and clinical presentation.
PubMed: 38738091
DOI: 10.7759/cureus.57933 -
The Journal of Medical Investigation :... 2024Vitiligo is an acquired chronic depigmenting disorder of the skin and is characterized by the destruction of melanocytes. One of the clinical features of vitiligo is...
Vitiligo is an acquired chronic depigmenting disorder of the skin and is characterized by the destruction of melanocytes. One of the clinical features of vitiligo is that damage to normal skin frequently results in the formation of depigmented macules, which is known as Köebner's phenomenon (KP). Here, we presented a case of vitiligo, in which depigmented macules followed the course of a dilated varicose vein. Dilatation of blood vessels was considered to contribute to the development of the vitiliginous lesions as a trigger for KP. Any kind of skin injury can trigger KP, but this is only the second case in which a dilated blood vessel caused KP in vitiligo. J. Med. Invest. 71 : 177-178, February, 2024.
Topics: Humans; Vitiligo; Varicose Veins; Leg; Male; Female; Adult
PubMed: 38735717
DOI: 10.2152/jmi.71.177 -
Journal of Clinical Medicine Apr 2024Venous disorders encompass a diverse range of manifestations and diseases, impacting a significant portion of the population. While life-threatening conditions are... (Review)
Review
Venous disorders encompass a diverse range of manifestations and diseases, impacting a significant portion of the population. While life-threatening conditions are uncommon in non-thrombotic disorders, like telangiectasias or uncomplicated varicose veins (VVs), these conditions still have a substantial impact on affected individuals. Ensuring that patients are well informed about their venous disorder is a crucial step in their treatment journey. Providing them with valuable information regarding the disease's natural progression and available therapeutic options plays a pivotal role in optimizing their care. When patients are diagnosed with venous disorders, they often have numerous questions and concerns they want to discuss with their healthcare providers. Addressing these inquiries not only improves patients' knowledge and understanding but also influences their treatment compliance and overall outcomes. Therefore, it is of utmost importance to provide comprehensive explanations that address any doubts, uncertainties, and areas of confusion that patients may have. This report aims to present a concise, practical, and informative guide to venous disorders, focusing specifically on the common questions frequently raised by patients in everyday clinical practice. By serving as a valuable resource for healthcare professionals working in the field of venous diseases, this guide equips them with the necessary tools to effectively address patients' concerns and provide optimal care. By bridging the gap between patients' inquiries and medical expertise, this guide strives to enhance therapeutic outcomes and improve the overall management of venous disorders, ultimately empowering patients in their treatment journey.
PubMed: 38731068
DOI: 10.3390/jcm13092539