Remodeling of biological tissue: Mechanically induced reorientation of a transversely isotropic chain network

A new class of micromechanically motivated chain network models for soft biological tissues is presented. On the microlevel, it is based on the statistics of long chain molecules. A wormlike chain model is applied to capture the behavior of the collagen microfibrils. On the macrolevel, the network of collagen chains is represented by a transversely isotropic eight chain unit cell introducing one characteristic material axis. Biomechanically induced remodeling is captured by allowing for a continuous reorientation of the predominant unit cell axis driven by a biomechanical stimulus. To this end, we adopt the gradual alignment of the unit cell axis with the direction of maximum principal strain. The evolution of the unit cell axis' orientation is governed by a first-order rate equation. For the temporal discretization of the remodeling rate equation, we suggest an exponential update scheme of Euler-Rodrigues type. For the spatial discretization, a finite element strategy is applied which introduces the current individual cell orientation as an internal variable on the integration point level. Selected model problems are analyzed to illustrate the basic features of the new model. Finally, the presented approach is applied to the biomechanically relevant boundary value problem of an in vitro engineered functional tendon construct.Comment: LaTeX2e, 19 pages, 9 figure

Elasticity near the vulcanization transition

Signatures of the vulcanization transition--amorphous solidification induced by the random crosslinking of macromolecules--include the random localization of a fraction of the particles and the emergence of a nonzero static shear modulus. A semi-microscopic statistical-mechanical theory is presented of the latter signature that accounts for both thermal fluctuations and quenched disorder. It is found (i) that the shear modulus grows continuously from zero at the transition, and does so with the classical exponent, i.e., with the third power of the excess cross-link density and, quite surprisingly, (ii) that near the transition the external stresses do not spoil the spherical symmetry of the localization clouds of the particles.Comment: REVTEX, 5 pages. Minor change

Ethics and practice of trials within cohorts: An emerging pragmatic trial design

BACKGROUND: With increasing emphasis on pragmatic trials, new randomized clinical trial designs are being proposed to enhance the "real world" nature of the data generated. We describe one such design, appropriate for unmasked pragmatic clinical trials in which the control arm receives usual care, called "Trials within Cohorts" that is increasingly used in various countries because of its efficiency in recruitment, advantages in reducing subject burden, and ability to better mimic real-world consent processes. METHODS: Descriptive, ethical, and US regulatory analysis of the Trials within Cohorts design. RESULTS: Trials within Cohorts design involves, after recruitment into a cohort, randomization of eligible subjects, followed by an asymmetric treatment of the two arms: those selected for the experimental arm provide informed consent for the intervention trial, while the data from the control arm are used based on prior broad permission. Thus, unlike the traditional Zelen post-randomization consent design, the cohort participants are informed about future research within the cohort; however, the extent of this disclosure currently varies among studies. Thus, ethical analysis is provided for two types of situations: when the pre-randomization disclosure and consent regarding the embedded trials are fairly explicit and detailed versus when they consist of only general statements about future data use. These differing ethical situations could have implications for how ethics review committees apply US research rules regarding waivers and alterations of informed consent. CONCLUSION: Trials within Cohorts is a promising new pragmatic randomized controlled trial design that is being increasingly used in various countries. Although the asymmetric consent procedures for the experimental versus control arm subjects can initially raise ethical concerns, it is ethically superior to previous post-randomization consent designs and can have important advantages over traditional trial designs

Tube Models for Rubber-Elastic Systems

In the first part of the paper we show that the constraining potentials introduced to mimic entanglement effects in Edwards' tube model and Flory's constrained junction model are diagonal in the generalized Rouse modes of the corresponding phantom network. As a consequence, both models can formally be solved exactly for arbitrary connectivity using the recently introduced constrained mode model. In the second part, we solve a double tube model for the confinement of long paths in polymer networks which is partially due to crosslinking and partially due to entanglements. Our model describes a non-trivial crossover between the Warner-Edwards and the Heinrich-Straube tube models. We present results for the macroscopic elastic properties as well as for the microscopic deformations including structure factors.Comment: 15 pages, 8 figures, Macromolecules in pres

Observational cohort study of the safety of digoxin use in women with heart failure

Objectives: This study aims to assess whether digoxin has a different effect on mortality risk for women than it does for men in patients with heart failure (HF). Design This study uses the UK-based The Health Information Network population database in a cohort study of the impact of digoxin exposure on mortality for men and women who carry the diagnosis of HF. Digoxin exposure was assessed based on prescribing data. Multivariable Cox proportional hazards models were used to assess whether there was an interaction between sex and digoxin affecting mortality hazard. Setting The setting was primary care outpatient practices. Participants The study cohort consisted of 17 707 men and 19 227 women with the diagnosis of HF who contributed only time without digoxin exposure and 9487 men and 10 808 women with the diagnosis of HF who contributed time with digoxin exposure. Main outcome measures The main outcome measure was all-cause mortality. Results: The primary outcome of this study was the absence of a large interaction between digoxin use and sex affecting mortality. For men, digoxin use was associated with a HR for mortality of 1.00, while for women, the HR was also 1.00 (p value for interaction 0.65). The results of sensitivity analyses were consistent with those of the primary analysis. Conclusion: Observational data do not support the concern that there is a substantial increased risk of mortality due to the use of digoxin in women. This finding is consistent with previous observational studies but discordant with results from a post hoc analysis of a randomised controlled trial of digoxin versus placebo