Collagen concentration and biomechanical properties of samples from the lower uterine cervix in relation to age and parity in non-pregnant women

<p>Abstract</p> <p>Background</p> <p>During normal pregnancy the cervix has a load bearing function. The cervical tissue consists mainly of an extracellular matrix (ECM) rich in collagen; important for the biomechanical properties. The aim of the present study was to evaluate how the biomechanical strength of samples from the distal cervix is associated with collagen content in relation to age and parity. This study demonstrates a method to investigate cervical tissue from women who still have their uterus in situ.</p> <p>Methods</p> <p>Cervical punch biopsies (2 × 15 mm) were obtained from 57 healthy women (median age: 39 years, range: 29-49 years). Biomechanical tensile testing was performed, and collagen concentration (as % of dry defatted weight (DDW)) and content (mg of collagen per mm of specimen length) was determined. Histomorphometry was used to determine the volume densities of extracellular matrix and smooth muscle cells. Smooth muscle cells were identified by immunohistochemistry. Finally, orientation of collagen fibers was estimated. Data are given as mean +/- SD.</p> <p>Results</p> <p>The mean collagen concentration (62.2 +/- 6.6%) increased with age (0.5% per year, r = 0.45, p = 0.003) and decreased with parity (1.7% per birth, r = -0.45, p = 0.033). Maximum load was positively correlated with collagen content (mg of collagen per mm of specimen length) (r = 0.76, p < 0.001). Normalized maximum stiffness was increased with age (r = 0.32, p = 0.017), whereas no correlation was found with regard to parity. In tissue samples with a length of approximately one cm, volume density of smooth muscle cells increased gradually from 8.9% in the distal part near the epithelium, to 15.5% in the proximal part (p < 0.001).</p> <p>Conclusions</p> <p>The present study shows that cervical collagen concentration increases with age and decreases with parity in non-pregnant women. In addition, collagen stiffness increased with age, whereas no change in collagen tensile strength with respect to age and parity was found. These results show that collagen contributes to cervical tissue tensile strength and age and parity should be considered confounding factors.</p

Baseline hospital performance and the impact of medical emergency teams: Modelling vs. conventional subgroup analysis

<p>Abstract</p> <p>Background</p> <p>To compare two approaches to the statistical analysis of the relationship between the baseline incidence of adverse events and the effect of medical emergency teams (METs).</p> <p>Methods</p> <p>Using data from a cluster randomized controlled trial (the MERIT study), we analysed the relationship between the baseline incidence of adverse events and its change from baseline to the MET activation phase using quadratic modelling techniques. We compared the findings with those obtained with conventional subgroup analysis.</p> <p>Results</p> <p>Using linear and quadratic modelling techniques, we found that each unit increase in the baseline incidence of adverse events in MET hospitals was associated with a 0.59 unit subsequent reduction in adverse events (95%CI: 0.33 to 0.86) after MET implementation and activation. This applied to cardiac arrests (0.74; 95%CI: 0.52 to 0.95), unplanned ICU admissions (0.56; 95%CI: 0.26 to 0.85) and unexpected deaths (0.68; 95%CI: 0.45 to 0.90). Control hospitals showed a similar reduction only for cardiac arrests (0.95; 95%CI: 0.56 to 1.32). Comparison using conventional subgroup analysis, on the other hand, detected no significant difference between MET and control hospitals.</p> <p>Conclusions</p> <p>Our study showed that, in the MERIT study, when there was dependence of treatment effect on baseline performance, an approach based on regression modelling helped illustrate the nature and magnitude of such dependence while sub-group analysis did not. The ability to assess the nature and magnitude of such dependence may have policy implications. Regression technique may thus prove useful in analysing data when there is a conditional treatment effect.</p

Evolution of localized blobs of swirling or buoyant fluid with and without an ambient magnetic field

We investigate the evolution of localized blobs of swirling or buoyant fluid in an infinite, inviscid, electrically conducting fluid. We consider the three cases of a strong imposed magnetic field, a weak imposed magnetic field, and no magnetic field. For a swirling blob in the absence of a magnetic field, we find, in line with others, that the blob bursts radially outward under the action of the centrifugal force, forming a thin annular vortex sheet. A simple model of this process predicts that the vortex sheet thins exponentially fast and that it moves radially outward with constant velocity. These predictions are verified by high-resolution numerical simulations. When an intense magnetic field is applied, this phenomenon is suppressed, with the energy and angular momentum of the blob now diffusing axially along the magnetic field lines, converting the blob into a columnar structure. For modest or weak magnetic fields, there are elements of both types of behavior, with the radial bursting dominating over axial diffusion for weak fields. However, even when the magnetic field is very weak, the flow structure is quite distinct to that of the nonmagnetic case. In particular, a small but finite magnetic field places a lower bound on the thickness of the annular vortex sheet and produces an annulus of counter-rotating fluid that surrounds the vortex core. The behavior of the buoyant blob is similar. In the absence of a magnetic field, it rapidly develops the mushroomlike shape of a thermal, with a thin vortex sheet at the top and sides of the mushroom. Again, a simple model of this process predicts that the vortex sheet at the top of the thermal thins exponentially fast and rises with constant velocity. These predictions are consistent with earlier numerical simulations. Curiously, however, it is shown that the net vertical momentum associated with the blob increases linearly in time, despite the fact that the vertical velocity at the front of the thermal is constant. As with the swirling blob, an imposed magnetic field inhibits the formation of a vortex sheet. A strong magnetic field completely suppresses the phenomenon, replacing it with an axial diffusion of momentum, while a weak magnetic field allows the sheet to form, but places a lower bound on its thickness. The magnetic field does not, however, change the net vertical momentum of the blob, which always increases linearly with time