Location specific multi-scale characterization and constitutive modeling of pig aorta.

The mechanical and structural behavior of the aorta depend on physiological functions and vary from proximal to distal. Understanding the relation between regionally varying mechanical and multi-scale structural response of aorta can be helpful to assess the disease outcomes. Therefore, this study investigated the variation in mechanical and multi-scale structural properties among the major segments of aorta such as ascending aorta (AA), descending aorta (DA) and abdominal aorta (ABA), and established a relation between mechanical and multi-structural parameters. The obtained results showed significant increase in anisotropy and nonlinearity from proximal to distal aorta. The change in periphery length and radii between load and stress free configuration was also found increasing far from the heart. Opening angle was significantly large for ABA than AA and DA (AA/DA vs ABA; p = 0.001). Mean circumferential residual stretch (ratio of mean periphery length at load and stress free configurations) was found decreasing between AA and DA, and then increasing between DA to ABA and its value was significantly more for ABA (AA vs DA; p = 0.041, AA vs ABA; p = 0.001, DA vs ABA; p = 0.001). The waviness of collagen fibers, collagen fiber content, collagen fibril diameter and total protein content were found significantly increasing from proximal to distal. Pearson correlation test showed a significant linear correlation between variation in mechanical and multi-scale structural parameters over the aortic length. Residual stretch was found positively correlated with collagen fiber content (r = 0.82) whereas opening angel was found positively correlated with total protein content (TPC) (r = 0.76).

Influence of fetal gender on overall perinatal outcome: a prospective observational study.

BACKGROUND: Fetal gender is considered as one of significant predictors of pregnancy and perinatal outcome. The aim of this study is to assess impact of fetal gender on perinatal outcome. METHODS: Present observational study was conducted in Obstetrics and Gynecology department of rural tertiary center of Northern India over one year (January-December 2018) on all randomly selected antenatal women at gestation ≥28 weeks, delivering by any route (cesarean/vaginal) and fulfilling inclusion criteria were enrolled. Immediately after delivery, neonatal birth weight was measured using table top beam weighing scale. Apgar scores at 1- and 5-minutes, Neonatal Intensive Care Unit admission, neonatal complications were assessed by pediatrician. Adverse perinatal outcome including neonatal morbidities (prematurity, neonatal intensive care unit admission, neonatal complications) and perinatal mortality were compared between two genders. Statistical analysis was done using SPSS 22 version software. RESULTS: Of 3085 delivered neonates, 1450 (47%) were females, 1,633(52.9%) males and two (0.06%) had ambiguous genitalia, hence excluded. Mean values for neonatal birth weight for males was 2.77±0.540 kg and females 2.65±0.506 kg (P=0.0000). One- and 5-minute Apgar scores for male neonate were 6.81±1.565, 8.51±1.841 and for females 6.98±1.184, 8.70±1.383, respectively (P=0.001). NICU admission rate, need for oxygen and intubation, complications were significantly higher for male neonates (P<0.05) whereas females had higher incidence of intra-uterine growth restriction (P=0.000). Intra-uterine deaths were also more common with male gender (P=0.007). No significant difference was observed between two genders in relation to gestation at birth (P>0.05). CONCLUSIONS: Male neonates had higher birth weight, but adverse perinatal outcome as compared to females.

Umbilical cord arterial blood lactate dehydrogenase and pH as predictors of perinatal outcome in high-risk term pregnancies: A cohort study.

BACKGROUND: Birth asphyxia is a common cause of perinatal morbidity, mortality. OBJECTIVE: To compare the efficacy of umbilical cord arterial blood lactate dehydrogenase (LDH) and pH as predictors of neonatal outcome in high-risk term pregnancies using receiver operating characteristic (ROC) curves. MATERIAL AND METHODS: Present retrospective cohort study was conducted in the rural tertiary centre of Northern India over two years (January 2017-December 2018). Neonates delivered to 300 term (≥37 - ≤42 weeks) high-risk antenatal women were enrolled after fulfilling inclusion criteria. Immediately after delivery of a newborn by any mode, the segment of the umbilical cord (10 cm) was double clamped, cut, and arterial blood samples were taken for LDH and pH and were compared with neonatal outcome. Statistical analysis was done using SPSS 22.0 software. RESULTS: For all 300 neonates mean ± SD values of cord blood LDH and pH were 545.19 ± 391.93 U/L and 7.13 ± 0.15, respectively. High cord blood lactate and low pH values were significantly associated with adverse neonatal outcomes including neonatal resuscitation, NICU admission, complications and early neonatal deaths (p=0.000). The sensitivity, specificity and negative predictive value of cord blood LDH in the prediction of neonatal death was 100.00%, 53.17%, 100%, and pH was 93.75%, 53.17%, 99.34%, respectively. CONCLUSION: Cord blood lactate and pH help in the early prediction of neonatal outcomes, but cord blood lactate is a better predictor.

Impact of sarcopenia in locally advanced head and neck cancer treated with chemoradiation: An Indian tertiary care hospital experience.

BACKGROUND: Sarcopenia is emerging as a poor prognostic factor in terms of treatment outcome as well as complications in cancer patients. This study aims to determine the prevalence of sarcopenia and its impact on outcome and toxicity in head and neck squamous cell carcinoma (HNSCC) patients treated with definitive chemo radiotherapy. MATERIAL AND METHODS: Three hundred patients of locally advanced HNSCC were included. All patients were treated with radical radiotherapy dose of 70 Gy/35# over 7 weeks along with concurrent chemotherapy. Sarcopenia was assessed from radiation planning computed tomography (CT) scans using skeletal muscle mass at level C3. The impact of sarcopenia on treatment outcome, Disease Free Survival (DFS) and toxicity was evaluated. Association between patient factors and outcome was calculated in univariate and multivariate analyses. RESULTS: Sarcopenic patients were more likely to be elderly, female gender and hypopharyngeal primary. The average SMI of the entire patient cohort was 31.9 cm2/m2 and for males and females were 32.78 cm2/m2 and 26.19 cm2/m2 respectively. As per cut of criteria used nearly 91% of the patient cohort were sarcopenic. Sarcopenic patients had a worse treatment outcome namely poorer disease free survival, more toxicities and more treatment gaps. As per ROC curve patients with SMI of >32 cm2/m2 fared better than those with SMI < 32 cm2/m2. CONCLUSION: Sarcopenia in HNSCC patients receiving definitive chemo radiotherapy is an independent prognostic factor and is associated with a worse treatment outcome and more toxicities.

Perinatal Outcome in Women with Hypertensive Disorders of Pregnancy in Rural Tertiary Center of Northern India: A Retrospective Cohort Study".

BACKGROUND: Hypertensive disorder of pregnancy is associated with adverse maternal, perinatal outcome. OBJECTIVE: To know the perinatal outcome in women with hypertensive disorders of pregnancy. METHODS: Present retrospective cohort study was conducted in the Obstetrics and Gynecology department of the rural tertiary center of Northern India over one year (January-December 2018) on 205 antenatal women with hypertensive disorders of pregnancy at gestation ≥28 weeks. All the participants on the basis of diagnosis were divided into four groups: Group 1 Gestational hypertension; Group 2 Pre-eclampsia; Group 3 Eclampsia and Group 4 with Chronic Hypertension. Demographic features, gestational age, the onset of labor, mode of delivery and perinatal outcome including birthweight, Apgar scores, morbidity and mortality were recorded and compared between four groups. Statistical analysis was done using software SPSS 22.0. version. RESULTS: Of 205 participants, 93 had Gestational Hypertension, 68 Pre-eclampsia; 36 Eclampsia, 06 Chronic Hypertension. The mean age of presentation was 24.96±3.535 years. Average gestation at birth for group 1 was 37.91±2.38 weeks, group 2: 36.50±3.312 weeks, group 3: 34.44±4.062 weeks and group 4: 37.97±1.524 weeks. The majority of participants had induced labor especially in preeclampsia and eclampsia groups with a spontaneous vaginal delivery as the most common mode. 1 and 5-minute Apgar scores, birth weight were lower in eclampsia and pre-eclampsia women. Severe disease was associated with the adverse perinatal outcome with maximum neonatal morbidity and mortality in eclampsia and pre-eclampsia group. CONCLUSION: Hence, hypertensive disorder of pregnancy was associated with adverse perinatal outcome, especially in women with severe disease (Eclampsia and Pre-eclampsia).

Study of microvascular non-Newtonian blood flow modulated by electroosmosis.

An analytical study of microvascular non-Newtonian blood flow is conducted incorporating the electro-osmosis phenomenon. Blood is considered as a Bingham rheological aqueous ionic solution. An externally applied static axial electrical field is imposed on the system. The Poisson-Boltzmann equation for electrical potential distribution is implemented to accommodate the electrical double layer in the microvascular regime. With long wavelength, lubrication and Debye-Hückel approximations, the boundary value problem is rendered non-dimensional. Analytical solutions are derived for the axial velocity, volumetric flow rate, pressure gradient, volumetric flow rate, averaged volumetric flow rate along one time period, pressure rise along one wavelength and stream function. A plug swidth is featured in the solutions. Via symbolic software (Mathematica), graphical plots are generated for the influence of Bingham plug flow width parameter, electrical Debye length and Helmholtz-Smoluchowski velocity (maximum electro-osmotic velocity) on the key hydrodynamic variables. This study reveals that blood flow rate accelerates with decreasing the plug width (i.e. viscoplastic nature of fluids) and also with increasing the Debye length parameter.

Electro-kinetically driven peristaltic transport of viscoelastic physiological fluids through a finite length capillary: Mathematical modeling.

Analytical solutions are developed for the electro-kinetic flow of a viscoelastic biological liquid in a finite length cylindrical capillary geometry under peristaltic waves. The Jefferys' non-Newtonian constitutive model is employed to characterize rheological properties of the fluid. The unsteady conservation equations for mass and momentum with electro-kinetic and Darcian porous medium drag force terms are reduced to a system of steady linearized conservation equations in an axisymmetric coordinate system. The long wavelength, creeping (low Reynolds number) and Debye-Hückel linearization approximations are utilized. The resulting boundary value problem is shown to be controlled by a number of parameters including the electro-osmotic parameter, Helmholtz-Smoluchowski velocity (maximum electro-osmotic velocity), and Jefferys' first parameter (ratio of relaxation and retardation time), wave amplitude. The influence of these parameters and also time on axial velocity, pressure difference, maximum volumetric flow rate and streamline distributions (for elucidating trapping phenomena) is visualized graphically and interpreted in detail. Pressure difference magnitudes are enhanced consistently with both increasing electro-osmotic parameter and Helmholtz-Smoluchowski velocity, whereas they are only elevated with increasing Jefferys' first parameter for positive volumetric flow rates. Maximum time averaged flow rate is enhanced with increasing electro-osmotic parameter, Helmholtz-Smoluchowski velocity and Jefferys' first parameter. Axial flow is accelerated in the core (plug) region of the conduit with greater values of electro-osmotic parameter and Helmholtz-Smoluchowski velocity whereas it is significantly decelerated with increasing Jefferys' first parameter. The simulations find applications in electro-osmotic (EO) transport processes in capillary physiology and also bio-inspired EO pump devices in chemical and aerospace engineering.