Cross-modality and in-vivo validation of 4D flow MRI evaluation of uterine artery blood flow in human pregnancy.

OBJECTIVES: Clinical assessment of uterine artery (UtA) hemodynamics is currently limited to Doppler ultrasound (US) velocimetry. We have demonstrated previously the feasibility of applying four-dimensional (4D) flow magnetic resonance imaging (MRI) to evaluate UtA hemodynamics during pregnancy, allowing flow quantification of the entire course of the vessel. In this study, we sought to further validate the physiological relevance of 4D flow MRI measurement of UtA blood flow by exploring its association with pregnancy outcome relative to US-based metrics. METHODS: Recruited into this prospective, cross-sectional study were 87 women with a singleton pregnancy who underwent 4D flow MRI between May 2016 and April 2019 to measure the UtA pulsatility index (MRI-PI) and blood flow rate (MRI-flow, in mL/min). UtA-PI was also measured using US (US-PI). The primary outcome was a composite (COMP) of pre-eclampsia (PE) and/or small-for-gestational-age (SGA) neonate, and secondary outcomes were PE and SGA neonate individually. We assessed the ability of MRI-flow, MRI-PI and US-PI to distinguish between outcomes, and evaluated whether MRI-flow changed as gestation progressed. RESULTS: Following 4D flow postprocessing and exclusions from the analysis, 74 women had 4D flow MRI data analyzed for both UtAs. Of these, 18 developed a COMP outcome: three developed PE only, 11 had a SGA neonate only and four had both. A comparison of the COMP group vs the no-COMP group found no differences in maternal age, body mass index, nulliparity, gravidity or race. For 66 of the 74 subjects, US data were also available. In these subjects, both median MRI-PI (0.95 vs 0.70; P < 0.01) and median US-PI (0.95 vs 0.73; P < 0.01) were significantly increased in subjects in the COMP group compared with those in the no-COMP group. The UtA blood-flow rate, as measured by MRI, did not increase significantly from the second to the third trimester (median flow (interquartile range (IQR)), 543 (419-698) vs 575 (440-746) mL/min; P = 0.77), but it was significantly lower overall in the COMP compared with the no-COMP group (median flow (IQR), 486 (366-598) vs 624 (457-749) mL/min; P = 0.04). The areas under the receiver-operating-characteristics curves for MRI-flow, MRI-PI and US-PI in predicting COMP were not significantly different (0.694, 0.737 and 0.731, respectively; P = 0.87). CONCLUSIONS: 4D flow MRI can yield physiological measures of UtA blood-flow rate and PI that are associated with adverse pregnancy outcome. This may open up new avenues in the future to expand the potential of this technique as a robust tool with which to evaluate UtA hemodynamics in pregnancy. © 2020 International Society of Ultrasound in Obstetrics and Gynecology.

Modelación y simulación de la arteria aorta a partir de datos clínicos utilizando un modelo fraccional viscoelástico y el método del elemento finito / Modeling and simulation of the aorta from clinical data using a fractional viscoelastic model and finite element method

Los modelos y simulaciones de los efectos biomecánicos presentes en la arteria aorta, le proporcionan al especialista de la salud una herramienta computacional, que puede ser empleada en la prevención y el tratamiento de las enfermedades cardiovasculares. Es por esto que en la presente investigación se desarrolla un modelo matemático con la finalidad de implementarlo en simulaciones tridimensionales digitales que permitan analizar el comportamiento mecánico de arterias. Primero se describe la metodología utilizada en la construcción de la geometría de la arteria basada en imágenes provenientes de una tomografía axial computarizada, los ensayos experimentales necesarios para la obtención de los parámetros mecánicos requeridos por el modelo y por último su orden fraccional. Con lo que se obtiene una simulación mediante elementos finitos donde se identifican las zonas de mayor concentración de esfuerzos y el campo de desplazamientos. Para poder obtener estos resultados se empleó una formulación novedosa basada en modelos viscoelásticos de orden fraccional donde además se obtuvieron, a través del módulo complejo, los valores requeridos para la simulación.

The modeling and simulation of the biomechanical effects present in the aorta, give the health specialist a computational tool that can be used in the prevention and treatment of cardiovascular diseases. For that reason on this research a mathematical model was developed in order to implement digital dimensional simulations to analyze the mechanical behavior of arteries. First, its described the methodology used in the construction of the geometry of the artery based on images from a CT scan, next the necessary experimental tests to obtain mechanical parameters required by the model and finally his fractional order. Obtaining a finite element simulation where the areas of greatest stress concentration and the displacement field are identified. To obtain these results a novel formulation based on fractional order viscoelastic models was used and the values required for simulation were obtained through the complex modulus.

[Premature mortality by selected causes, Cuba 1981]. / Mortalidad prematura por algunas causas de defuncion seleccionadas, Cuba 1981.

PIP: The authors estimate premature mortality due to selected causes of death for different age groups, particularly at early ages, using an indicator of potential years of life lost by a population. Premature mortality in Cuba in 1981 is calculated by sex for 10 selected causes of death and for all causes. (SUMMARY IN ENG AND FRE)^ieng

[Infant mortality in the province of Granma, 1977-1984]. / La mortalidad infantil en la provincia Granma. Anos 1977-1984.

PIP: Trends in infant mortality in the Cuban province of Granma between 1977 and 1984 are analyzed. Consideration is given to causes of death, geographic factors, and timing of occurrence of death (SUMMARY IN ENG AND FRE)^ieng